Book review: Doctors of Conscience

Mathieu Deflem
www.mathieudeflem.net

This is a copy of a review Doctors of Conscience: The Struggle to Provide Abortion before and after Roe v. Wade, by Carole Joffe, published in American Journal of Sociology 103(3):808-809, 1997.

Cite as: Deflem, Mathieu. 1997. Review of ‘Doctors of Conscience: The Struggle to Provide Abortion before and after Roe v. Wade,’ by Carole Joffe. American Journal of Sociology 103(3):808-809.



Debated time and time again as one of the most divisive issues in American society, abortion in its many sociologically relevant dimensions remains poorly understood. The state of abortion research is a rather sad instance of our discipline's occasional lack of attention for issues that passionately move broad segments of society. With the book under review here, sociologist Carole Joffe has added to the sparse scholarly informed abortion literature. We should be grateful for the author's effort. But, unfortunately, there remains much to be desired about the results.

Based on interviews with 45 abortion providers, Doctors of Conscience presents an analysis of abortion services in the years before and after the Supreme Court decision of Roe v. Wade in 1973. The central argument of the book is that abortion was an inevitably risky enterprise before Roe and that it stayed an activity at the margins of mainstream medical practice in the period thereafter. The author presents various case studies as illustrations to indicate how abortion providers worked before and after 1973 and how they sought to legalize abortion in the days before Roe. Most striking is that the medical treatment of abortion after legalization of the practice did not gain much attention in professional health training and never received much support from within the medical profession. Thus, the freestanding abortion clinics represent the failure as much as the success of legalized abortion, because they are as specialized in their work as they are marginalized from mainstream health care. The author concludes that in order to secure women's rights to abortion, the medical community should be more actively involved in supporting abortion services.

This book has its merits. It supports the argument that the history of abortion in the United States is surely not alone a history of Roe v. Wade. However relevant, the Supreme Court's decision cannot be assumed to have had the impact on abortion access a legalistic outlook would naively imply. An analysis of the profession of abortion, indeed, adds to the value of the notion that rights are never secured through court activity and legislation only. The relative continuity in the medical profession's ambivalence towards abortion, furthermore, suggests how misleading the histories are that portray a one-sided picture of greedy abortion butchers before 1973 and of respected professionals thereafter.

Regrettably, the weaknesses of this book are many. Most clearly demonstrating the tremendous bias and methodological flaws of this work, the bold conclusions and predictions follow an analysis which is based on interviews with only abortion providers who were doing their work for reason of a self-proclaimed compassion with women seeking abortion. The story told is inevitably one very sympathetic to the providers. The author acknowledges the limitations of her sampling methodology (p.156) but totally fails to address the consequences. Instead, the perceptions of a select group of providers are relied upon to draw conclusions on the state of abortion services. The author so overlooks that while self-reports are perfectly acceptable for research on motivations and experiences, they are insufficient when trying to account for the conditions and implications thereof.

This book is theoretically not grounded, not in the sociology of health nor in the sociology of social movements, not in the sociology of law nor in political sociology. It for the better part presents a fragment of a history of abortion, one which, moreover, conveniently fits the author's personal agenda. Explicitly mentioning her personal beliefs, the author occasionally touches upon sociologically significant themes but fails to address these to any satisfactory degree of sophistication. Most notably, the discrepancy between legality and accessibility is often hinted at throughout this book, but never sufficiently explored. We learn, for instance, that the availability of abortion services is unevenly spread across the United States, but we do not learn of the factors that condition this state of affairs. Some of the providers interviewed are said to have played an active role in the repeal and reform movement in the 1960s, but there is almost no analysis of how the medical profession actually influenced changes in legislation. Some statements in this book remain without argument or proof, for instance when the author claims that there is "no question" on the chilling effect of violence surrounding abortion on its availability (p.5). In her conclusions, Joffe is swayed to argue that the impact of abortion's marginalization in mainstream health care can be overcome by educating and reforming the medical profession. But suggesting this empowerment through professionalization, no mention is made of the created dependencies on reproductive technologies, no mention either of the alienating effects of professionalism and medicalization.

Lacking a theoretically substantiated research agenda and a useful methodology, this book is unlikely to appeal to sociologists. However, participants in the popular abortion debate --regardless of what side they are on-- may fare much better. Those who seek to secure women's reproductive freedoms will find in this book further support for their conviction. Those who struggle for the dignity of fetal life will once again find an easy prey against which to position their viewpoint. For anyone interested in the sociology of selected aspects on abortion, Joffe's book presents one more item in an ever increasing mass of primary materials. Perhaps that was the author's intention.