Vol. 7 No. 1 (January 1997) pp. 41-44.

NO NEUTRAL GROUND? ABORTION POLITICS IN AN AGE OF ABSOLUTES by Karen O'Connor (Boulder, Colorado: Westview Press, 1996). 208 pp. Paper $13.95.

Reviewed by Barbara Hinkson Craig, Department of Government, Wesleyan University.

After reading the headlines in today's paper about the clinic bombing in Atlanta, Georgia, it seems that the question mark in this title might lead otherwise than to the author's final prediction that the abortion issue at last may be reaching "neutral ground." Whether Professor O'Connor's conclusion is premature or merely wrong does not detract from the value of her interesting and thorough discussion of the abortion issue as it has played out in our political system.

The framework that the author uses (which is set out in the first chapter) to structure her analysis focuses on the stages an issues goes through as it is dealt with in our policymaking process: from (1) problem recognition and definition; to 2) agenda setting; to 3) policy formulation; to 4) policy adoption; to 5) budgeting; to 6) implementation; to 7) evaluation. Her model recognizes that policy making is a fluid process one in which several phases of the stages may be active at once and that often events (such as the intervention of the courts or the murder of clinic personnel) may cause or enable stages in the process to be bypassed entirely. Abortion, like other policy issues she notes, has gone through these stages as political actors have struggled to make decisions about abortion as a public policy issue. Unlike other issues though, the abortion issue is complicated by what the author terms "the absolutist positions" of the opposite sides in the policy struggle. Because the issue is framed as one of "rights" and because the democratically accountable branches have so much trouble dealing with an issue on which compromise is anathema to those who care most deeply about the issue (in political science parlance, those for whom the issue has the most salience and who are thus willing to expend the most time and effort on protecting their position) the least democratic branch has played the major role. It is her thesis that the Supreme Court in its WEBSTER and CASEY decisions and the cases that led up to them has "come perhaps the closest to mirroring public sentiment on the abortion issue." In these decisions, she argues, the Supreme Court may have found "a neutral ground by allowing for some restrictions on abortion while continuing to guarantee the right of an abortion to most women."

Before arriving at this conclusion, the author takes the reader through a fascinating journey covering the long history of abortion as a medical, political, legal and moral issue. The early history of abortion as a "medical" practice and a political issue up to the Supreme Court's decision in ROE v. WADE in 1973 is the subject of Chapters 2 and 3. Chapter 4 chronicles the aftermath of ROE and the rise of the anti-abortion (pro-life) forces. The remaining chapters cover the issue as it twists and turns through the various stages of policy making as set forth in her analytical framework (Chapter 5 covers the issue from 1980-88; Chapter 6 from 1988-1992; and Chapter 7 from Clinton's election and beyond). In this analysis the author does a superb job of covering this controversial issue with a balanced hand. This is especially impressive as she admits, up front, that her perspective is anything but neutral. O'Connor worked as an attorney with NARAL (the National Abortion Rights Action League) in its challenge to the Hyde Amendment (the provision attached by Rep. Henry Hyde to the Medicaid bill in the late 1970s which outlawed federal funding for abortions for poor women under the program) and later served on the board of the Feminist Women's Health Center. In addition she notes that she developed a course on the "Politics of Reproductive Rights" at Emory and continues to teach that course at American University where she now is a professor. The book is an effort of a partisan to step back and attempt to understand why this issue seem has been so impossible to resolve.

The author seems to recognize that the policy process is a never ending one in which the arrival at stage 7 merely sets in place the opportunity for the process to begin again. Yet, in the end, the author concludes: "In the final analysis, then, the abortion issue may not be all that different from other policy issues, including civil rights and the environment. All such policy issues have gone off on tangents, incurred violence, and, ultimately, moved toward neutral ground. It appears that the abortion issue is now reaching that stage of equilibrium." (p.181)

I would agree that the abortion issue, like other issues, has moved back and forth through the policy stages and that like other issues it has had periods of equilibrium. I would differ, though with the conclusion or prediction that the abortion issue as a public policy issue has finally moved toward "neutral ground." But, in saying this I do not mean to say that abortion is thus so different from most other issues in our polity. To be sure, most issues—civil rights and environmental ones included—arrive at periods of quiescence where they appear to be resolved and thus can be ignored for a time. If civil rights and the environment are cases in point for the argument that neutral ground is the ultimate inevitable end of policy making, I do not think they provide much of a basis for proof of the conclusion. Certainly the current arguments over affirmative action and the rights of groups such as lesbians and gays would not lead one to conclude that civil rights is an issue that has arrived at equilibrium in our polity. Neither would the current politics over the reauthorization of such programs as the endangered species, superfund or air and water pollution standards lead one to conclude that environmental issues have arrived at equilibrium.

The "temporary accommodation" nature of "decisions" arrived at in our governmental system is well recognized in the open systems analysis approach to understanding policy making. In open systems analysis the outputs of governing bodies (legislatures, courts, or executive agencies at all levels, national, state or local) spark reactions from the polity which provide feedback to the policymakers who then must react to that feedback modifying their past actions to address concerns, complaints, changing conditions, etc. The temporary nature of all decisions is both the strength and weakness of our constitutional federal system—that issues are never finally resolved is frustrating, but the absence of finality allows losers to have the hope of becoming winners by getting some other branch or level to reverse or modify their losses. Thus groups can fight within the system for change rather than having to overthrow the system itself to win.

Throughout her analysis, O'Connor appears to be well aware of both the strength and weakness of this temporary nature of our constitutional federal decision making process. Indeed, I was prepared for a conclusion in which the attempt of the plurality (the opinion of Justices Kennedy, O'Connor and Souter) in CASEY to find a neutral ground would be seen by the author as an effort bound to fail. Certainly neither of the activist camps is particularly satisfied with it. The fight to expand restrictions under the decision continues just as does the fight to contain its reach. So long as there remains a Democratic president who is willing to use his power to execute the law, his judicial appointment power, and veto weapon against a Republican Congress to prevent new abortion restrictions, the Supreme Court's plurality "compromise" may indeed hold. But, if the president is successful in appointing justices more sympathetic to abortion as a constitutional right, I imagine the abortion rights forces will be ready and willing to seek modification from the court in their favor. Similarly, if the balance on the court or in the executive changes the other way, abortion opponents, I imagine, will be equally ready, willing and able to seek change in their favor. Perhaps the conclusion she reaches represents nothing more than the triumph of hope over experience.

O'Connor's final conclusion does not base its "hope" of neutral ground being realized solely on the CASEY decision though. Rather, she sees this court decision coupled with the arrival on the scene of the "pill" alternative to abortion (RU-486 and the combination medications that can be used to terminate pregnancy nonsurgically) as circumstances that will provide a resolution to this long political controversy. The pill, she argues, will "move abortion out of clinics into physicians' offices, allowing abortion to become a truly private decision (although still not an easy one) for millions of women" (p.177). Thus the restrictions that CASEY might allow would be negated by the new way abortion could be accomplished. [Implicit here, of course, is the underlying acceptability of the "neutral ground" resting on the continued availability of abortion on demand--a resolution that is far more acceptable to one side than the other in this controversy. Is it neutral ground she really means?] Perhaps she will be proven right on this prediction. I would add a cautionary note here. While CASEY and the pill may augur the change she predicts, other circumstances surrounding the issue have not remained constant. Just as these "positive" developments emerge, the practice of medicine is facing dramatic change. No longer are most doctors in single or small group practices. The era of the regulated and regimented HMO approach is galloping onto the scene. As medical practice becomes more and more centralized where doctors are not free agents to make decisions about appropriate services and procedures, the opportunity for abortion opponents to put pressure on "no funding" or "no provision" for abortion services (even pills) is increased. While fighting against the decisions of hundreds of thousands of independent doctors is nearly impossible, will the fight against a few large providers who have power to make the decision about which procedures will be funded be equally impossible?

One lesson of the study of policy making in our decisions is that "made" is the wrong verb tense. Rare is the issue that is decided and done with. For me, wisdom dictates that experience triumphs over hope more often than the reverse. I imagine Professor O'Connor, and dozens of others of us who write about this policy issue, will find it around to write about for years to come. This reality is not one I find appealing, as abortion is an issue that complicates and distorts the ability of our polity to address many other critical issues like budget making, deficit reduction and health care reform to name just a few. Though I remain unpersuaded by her conclusion, for those interested in a better understanding of the complexities of this intractable issue I would recommend a careful read of O'Connor's otherwise fine book.

Copyright 1997