In 2016 researchers at Advancing New Standards in Reproductive Health, a public health project focused on reproductive well-being, made headlines with their “Turnaway Study.” The groundbreaking longitudinal study was comprised of nearly 8,000 interviews with 1,000 women who had either been “turned away” from abortion because they were past a clinic’s gestational limits or had successfully received abortions. Through interviews conducted every six months over a period of five years, the study compared the life circumstances of study participants following these two reproductive outcomes. The study, the first of its kind, sought to quantify the effects of being denied a wanted abortion.

Contrary to anti-abortion claims about the supposed psychological harm of ending a pregnancy, researchers found that obtaining an abortion did not increase women’s risk of developing PTSD, depression, or anxiety. Those denied abortions, on the other hand, did not fare as well. They were almost four times more likely to have a household income below the federal poverty level, more than three times more likely to be unemployed, and far more likely to need public safely net programs to be able to pay for basic necessities such as food. The study systematically tallied the costs of being denied an abortion, debunking the longstanding anti-abortion slogan, “Abortion harms women.”

If adequate resources are not available to create an abundance of choice, then choice itself is meaningless, reserved only for the most privileged and resourced.

When I first read the results of the “Turnaway Study,” I thought of scholar and activist Angela Davis’s essay “Racism, Birth Control and Reproductive Rights,” one of the chapters in her groundbreaking 1981 book Women, Race & Class. The publication is considered a classic text, theorizing Black women’s changing position within U.S. history and illuminating the consequences of feminist movements weakened by white myopia and class elitism. “Racism, Birth Control and Reproductive Rights” was written in the wake of the 1977 Hyde Amendment, which barred the use of federal funds to pay for an abortion (except to save the life of the mother), effectively making the medical procedure available only to those who could pay for it outright. At the same time, Medicaid continued to cover the far costlier procedure of sterilization. Davis recognized this as coercive and linked it to the historic abuse of poor women of color, which she felt must be addressed in any successful movement for reproductive rights.

Already Davis could see the direction that legal attacks on abortion would take, going after the rights of the most vulnerable, least powerful women first. Davis wrote in part to alert the “almost lily-white” abortion rights movement that its analysis was deeply flawed. Abortion rights activists had failed to understand how legal abortion—like other forms of birth control—could undermine the reproductive autonomy of “Black, Puerto Rican, Chicana and Native American women, together with their impoverished white sisters” if racism and class exploitation went unchallenged.

The abortion rights movement was repeating past harms of early twentieth-century birth control advocates when it willingly prescribed abortion to poor women and motherhood to those who could afford it.

Davis accused the movement of treating abortion as a panacea for gender oppression, acting as though “legal abortions provided a viable alternative to the myriad problems posed by poverty.” The availability of legal abortion would do little to improve circumstances that kept poor women from keeping wanted pregnancies. In the higher rates of abortion amongst poor Black and Latina women living in New York City both before and immediately following Roe v. Wade, for example, Davis saw a story “not so much about their desire to be free of their pregnancy, but rather about the miserable social conditions which dissuade them from bringing new lives into the world.” Such misery could cause women to “relinquish the right to reproduction itself.” The abortion rights movement was repeating past harms of early twentieth-century birth control advocates when it willingly prescribed abortion to poor women and motherhood to those who could afford it.

Davis’s essay remains a timely, vital lesson about how racism and elitism within feminist movements make their claims of universal justice ring hollow (recent reporting on the racism and other hostile working conditions within major abortion rights organizations reveals that many still have yet to grasp the urgency of Davis’s cautionary tale). Her indictment helps us to understand how racism and exploitation produce everyday forms of coercion that cause people to end pregnancies they might otherwise want to keep. While the reproductive justice movement has been steadily working since the 1990s to bring such insights to the center of conversations about reproductive rights, the idea that having children and the means to raise them should be meaningful rights is far from commonplace. Instead, most people treat parenthood as something reserved for those who can provide on their own.

Perhaps this absence from popular debate is not all that surprising. Under Davis’s treatment, we are forced to ask a question that, at least for many who support abortion rights, is uncomfortable: Should we interpret the abortions successfully obtained by the women in the “Turnaway Study” as evidence of freedom of choice, or of being out of options? And is the fact that access to abortion kept women’s financial health from worsening a story of feminist success or one of a feminist failing in a much grander sense? In other words, the results of the “Turnaway Study” offer not just an indictment of anti-abortion legislators, judges, and activists, but also of a society that lets families go without food and housing.

Racism and exploitation produce everyday forms of coercion that cause people to end pregnancies they might otherwise want to keep.

There is no question that we must seek to close the vast distance that now stands between the precarious legal right guaranteed by Roe v. Wade and the ability, practically speaking, to actually end a pregnancy. But we must also ask how much choice the families Davis was most concerned with have had since Roe v. Wade, and contemplate the ways that vast inequalities have piled up to make reproductive choice more myth than reality for an ever growing number of people.

With Davis’s Women, Race, and Class now more than forty years old, and as we find ourselves bracing for two likely scenarios—the overturning of Roe v. Wade and the failure of Democrats to deliver even a hollowed-out version of Biden’s Build Back Better Act—it is crucial we foreground Davis’s insight about the harmful effects of exploitative systems on intimate life. Davis was clear that “the progressive potential of birth control remains indisputable,” but such potential has yet to be fully achieved.

The limitations baked directly into Roe v. Wade are partially responsible for abortion’s unrealized potential. If “Roe is the floor, not the ceiling”—as the slogan increasingly visible on Twitter and protest signs would have it—then it is worth noting that we have long been standing on flimsy ground. Judith Levine recently argued that, even without the Hyde Amendment and the incremental hollowing out of Roe v. Wade, the 1973 decision—which secured abortion through the negative right to privacy and physician authority—was a far cry from casting reproductive autonomy as a public good.

However, just as important to limiting Roe v. Wade’s “progressive potential”—its ability to transform pregnancy into a choice for, rather than a precondition of, parenthood—were the broader conditions in which it arrived. The decision delivered choice just as elected officials were making key decisions about whether, and to what degree, the state should support family-making in the face of the changing economic conditions that foreshadowed our current levels of inequality. The period saw longstanding racial and gender employment discrimination exacerbated by declining wages and the proliferation of low-wage, precarious service jobs. At the same time, the dual-earner household rapidly became a financial necessity for most, which worsened the stress already felt by women who were providing the unwaged labor of childrearing and homemaking. Families for whom the breadwinner and caretaker were one in the same turned to welfare to try to square competing labor demands, but encountered rampant racial and gender discrimination, inadequate payments, and burdensome work requirements. President Richard Nixon’s veto of the Comprehensive Child Development Act in 1971 is just one example of the federal government’s refusal to meet the demands of different feminist movements, including those of the National Welfare Rights Organization, which had attempted to wrest from the state a guaranteed income that would have helped accommodate family-making. By the end of the 1970s, working Americans wound up poorer than when the decade began, and by 1977 the “feminization of poverty” was firmly in place, with nearly half of all poor families headed by a single mother.

As we now know all too well, such trends were part of a political shift that would position government intervention as the cause of, rather than the solution to, racial, gender, and economic inequalities (Nixon, at the urging of conservative political strategist Pat Buchanan, derided federally funded childcare as “family-weakening” a decade before Reagan declared government to be “the problem” outright). “Family values,” or the politics of sanctifying the heteropatriarchal home, became the ground upon which political power was concentrated on the right before Third Way Democrats unveiled their own version in the early 1990s. These ostensibly “cultural” politics consistently carried policy riders: fiscal austerity measures that decimated social supports. This political framework cast those reliant on government support (rather than their own economically well-functioning nuclear families) into bad actors who got what they deserved—very little to nothing at all.

Vast inequalities have piled up to make reproductive choice more myth than reality for an ever growing number of people.

In this neoliberal context of individual and family responsibility alongside legal abortion, childbearing was reframed as reproductive choice, one women knowingly and actively made, just as the circumstances shaping women’s lives became their sole responsibility to overcome. Having children became a choice at the precise moment that more and more families were struggling and also expected to meet the costs of family-making on their own. Davis’s essay is evidence that some movements persisted in indicting the ideas and systems that produced such tortured calculations. But the arrival of reproductive choice helped cast families’ as responsible for their own misery.

The reader may now be thinking about the fact that the United States is one of just a few industrialized nations that denies its citizens a social safety net, even as it deems “essential” the underpaid labor of care workers—essential, but not worth a living wage or meaningful labor protections. This reality is a crucial plot point in the story of family-making since the 1970s, as all families face the condition of being made to perform two jobs while receiving only the recognition and compensation (often just barely) of one.

But what we euphemistically describe as the “work-life balance” problem is not the sole or even greatest threat to family-making, and it alone does not capture the conditions that, by 1981, caused Davis to claim that class exploitation and white supremacy could make legal abortion into a tool of coercion rather than one of liberation. Rather, we must add to the narrative the HIV/AIDS epidemic; increased criminalization and mass incarceration; medical and legal gatekeeping of who can be legally recognized as “a family”; a racist, for-profit system of health care; and an unprecedented reliance on charitable, faith-based organizations to deliver social welfare services. In each of these cases, we can find evidence of how state neglect imperiled family-making. Since the 1970s, what the state has not done to support families has been just as devastating to the goal of reproductive freedom as its more explicit attacks on reproductive rights. That is because state neglect and meaningful choice are fundamentally at odds. Systematic neglect does not produce an abundance of choice, but a contraction of it.

State neglect of family-making is a precondition for the popular belief that having children is a privilege rather than a public good.

State neglect also forms one of the primary engines of the devaluation of reproductive labor. As Davis argued in another essay from Women, Race & Class, “The Approaching Obsolescence of Housework,” the refusal of the state to take “the burden of housework and child care” from the shoulders of “Black women . . . and . . . their working-class sisters” ensured that women “working for a living and servicing husbands and children” would be exploited twice over. State neglect of family-making is a precondition for the popular belief that having children is a privilege rather than a public good. The state’s lack of investment in this realm of life ensures family is seen as a private burden and that those who fail to meet the demands of this endeavor have only themselves to blame when, inevitably, such demands exceed their available labor reserves and resources.

As a result, state neglect produced a vertiginous proliferation of the types of labor required for family-making that persisted in spite of miserable conditions: think family-making from inside a prison; or after receiving a diagnosis of an illness the federal government refuses to treat; or without access to quality, humane prenatal care; or whilst hiding from laws incapable of recognizing your parenthood; or supported by pro-life/anti-abortion pregnancy services deeply compromised by medically inaccurate and stigmatizing anti-abortion propaganda. In all these cases, state neglect has been integral to the creation of new forms of reproductive labor necessary for families’ survival.

In the face of this state neglect, individuals have found extraordinary ways of making and valuing family-making: lesbians determined to get pregnant on their own terms and raise fatherless children; incarcerated women and free allies who have made it possible to “mother from behind bars”; groups that have mobilized in response to high rates of Black infant mortality and inaccessible medical care; women and AIDS activists who have insisted on family-friendly AIDS services. Often these efforts have included calling local councilmembers, state officials, judges, and federal authorities to account for their role in producing families’ conditions. And in the process, they have modeled what it looks like to treat family-making as a public good worthy of investment rather than a private burden to be resolved with individual resources.

Family-making is a public good worthy of investment rather than a private burden to be resolved with individual resources.

We can see such moral vision at work in campaigns to fight Black infant mortality in Oakland during the late 1970s. The Coalition to Fight Infant Mortality (CFIM), the Bay Area chapter of the Third World Women’s Alliance, laid the discriminatory, inadequate care delivered by the only public hospital in Alameda County at the feet of the county board of supervisors. The CFIM campaign for accessible, culturally competent prenatal care and other pregnancy support programs accused board members of “infanticide by neglect.” CFIM invoked the history of racist population control chronicled by Davis (Davis herself spoke at community hearings in support of the coalition’s demands) while zeroing in on the deathly impact that the failure to act could have. When CFIM explained to its supporters that “Racism + Sexism + Profits = High Infant Mortality,” it brought a Third World, socialist, feminist analysis to bear on the unequal distribution of basic necessities in the United States.

Similarly, the Maternity Care Coalition (MCC) in Philadelphia centered a critique of capitalism and made service provision a fundamental component of its advocacy. MCC focused on making sure women had support navigating hospital bills, obtaining welfare aid, finding post-pregnancy care, keeping the lights on, making rent, and obtaining food for themselves and their families. So prominent was this component of the MCC’s work that after five years of organizing, one founder reflected, “Ironically, the more successful direct services of this type, the more likely do they distract attention from the causes of the need.”

If adequate resources are not available to create an abundance of choice, then choice itself is meaningless, reserved only for the most privileged and resourced.

Not all efforts to address families’ needs were as concerned with the root causes of, or as stretched by state neglect. Conservative charitable networks have tended to fare better in an ecosystem of slashed government funding because they can rely on the deep pockets of conservative and religious donors. One of the more misunderstood and harmful manifestations of this has been the success of pro-life pregnancy centers, now commonly referred to as “crisis pregnancy centers” (CPCs). What began as a “service-based” response to legal abortion in the early 1970s has grown into a network of lifelines of last resort for families’ facing poverty and insecurity. As abortion rights activists have long pointed out, CPCs manipulate those who come to them for support with anti-abortion propaganda, conservative Christian values, and race-based rhetoric that stigmatizes Black women’s reproduction. But they pair such harmful tactics with much-needed—albeit limited—aid that pregnant women and families often cannot find elsewhere. The leadership of prominent CPC networks have for decades struggled with the fact that CPCs tend mainly to attract “clients” seeking pregnancy support rather than women who are in search of abortion care and then misled by the movement’s deceptive tactics. Such a reality is the logical outcome of combatting legal abortion through service provision in the United States: state neglect has driven more and more pregnant women and families to CPCs doorsteps, making them vulnerable to the movement’s deeply compromised support.

As politicians debate whether it is the government’s responsibility to ensure that people have their basic needs met, families struggle to survive the exploitative conditions that Davis drew our attention to forty years ago. Many do not succeed. Since the arrival of reproductive “choice” that Roe v. Wade is so often made to symbolize, what the state has not done for families has meant that such choice exists only for an ever-shrinking few. If adequate resources are not available to create an abundance of choice, then choice itself is meaningless, reserved only for the most privileged and resourced. For everyone else, choice remains an abstract idea far out of reach.

The myth that family-making is a private choice serves, then, simply to excuse society while laying blame for criminalization, poverty, racism, and other systemic failures at the feet of individual families. It also obscures just how much work is required to have family amidst the twin forces of state violence and neglect. One way to combat this is through a critical reappraisal of the labors and costs of reproduction that have proliferated under state neglect. Only if we have an accurate picture of the work involved in maintaining family—and then decide that such work is worthy of greater public investment—will choice become a meaningful reality.


This essay is adapted from ideas developed in Reproduction Reconceived: Family Making and the Limits of Choice after Roe v. Wade (University of California Press, 2021).