Leslie J Reagan, When Abortion was a Crime: Women, medicine, and law in the United States, 1867-1973, Berkeley, Ca., University of California Press, 1997. Pp. xiv + 397. $29.95. ISBN 0-520-8848-4.

This book, locating abortion in the USA in its broader historical context, is an illuminating study of a subject which has generated much controversy in recent decades. Using a wide variety of sources subtly and sensitively interpreted, this book elucidates the complex interplay between law, medicine, folk practice, and women's lives during a century of major social changes. A detailed case-study of Chicago is presented in the context of national data and trends. The picture painted is perhaps necessarily urban, as it would probably be difficult, if not impossible, to produce a similar study of rural areas. A major strength of Reagan's study is her demonstration of definite periodization of debate and activities around abortion. She picks up, more or less, where Janet Farrell Brodie's excellent Contraception and Abortion in Nineteenth Century America (1995) leaves off, at the point where a largely free market situation for medical care was being subjected to greater regulation, the orthodox medical profession was increasingly asserting its right to police medical practice, and an aggressive form of moral policing, embodied in the notorious Comstock laws, was on the rise. Physicians were laying claims to the definition of pregnancy and derogating traditional female concepts such as 'quickening'. While emphasizing the significance of abortion to physicians' desire to define and police the boundaries of medical practice, and the strongly anti-feminist core persisting through the various waves of attempts to restrict or eliminate abortion, Reagan reveals that there were many doctors during the entire period she discusses who were sympathetic to women's desires to terminate their pregnancies in particular circumstances, and flexible and sensitive in defining 'therapeutic' abortion, 'patient-centred' rather than authoritarian in their medical practice. She also reveals that changing locations of medical practice, internal political shifts within the profession, and the evolving relationship between doctors and state power at local and national levels could alter the position of such doctors from one of toleration, if not legitimacy, to harassment, prosecution and imprisonment. Doctors deployed abortion as a major tool in their campaign against the midwife, identified with obscurantist folk practice among immigrant communities. The stigmatization of abortion, however, had ambiguous repercussions. The space the medical profession claimed for the exercise of clinical judgement on the therapeutic legitimacy of abortion was contested. Reagan argues that, by the 1950s, individual self-policing by medics under fears of accusation as well as institutional and legal constraints during the paranoid years of McCarthyism led to nearly two decades during which abortion was less accessible, and more dangerous, than it had been prior to the Second World War. She draws an interesting contrast between the situation in the USA and that in the UK, as depicted by Barbara Brookes in Abortion in Britain, 1900-1967 (1988), suggesting that the USA lacked the feminist/socialist campaign to legalize abortion during the 1930s which by generating extensive public debate in both lay and medical circles enabled the prosecution of Aleck Bourne to become a test-case and to redefine the parameters of the law. Lacking this climate of concern comparable US cases failed to raise consideration of the wider issues. Besides producing convincing arguments against regarding the medical profession as monolithic and demonizing all doctors, she has also uncovered evidence which indicates that at certain times and in particular locations women had far more agency and choice in seeking abortions than might be imagined, haggling with medical providers over what was the fair price for the operation in their particular circumstances, with the post-1945 period, again, being one in which women had less choice and control than in earlier decades of the century. Another perhaps unexpected facet is the involvement of men as accessories in obtaining abortions; the rigour of the law in condemning men who assisted their unmarried women friends in finding the means of terminating pregnancies is also emphasized in Angus McLaren's recent The Trials of Masculinity (1997). While much of the concern around abortion has been expressed around a persistent motif of middle class, white, women evading their maternal and nation-building responsibilities, the active policing of abortion has always affected working-class, less privileged women to a much greater extent: Reagan points out that the efforts of the 'pro-life' movement over the last two decades have disproportionately eroded the facilities available to the most vulnerable groups in contemporary US society. This is an important contribution to women's history and the history of medicine, which does not shy away from exploring the complexities and ambiguities thrown up by the rich empirical evidence on which it is based.

Lesley A. Hall

Wellcome Institute for the History of Medicine