A couple of weeks ago, the Collective Behavior and Social Movements section of the American Sociological Association held an Author Meets Critics session on the two most recent winners of the Charles Tilly Best Book Award, my book, Doctors and Demonstrators and Kathleen Blee's Democracy in the Making. My critics were Myra Marx Ferree and Annulla Linder. Myra's comments, below, echoed her earlier review in the American Journal of Sociology:
Doctors and Demonstrators: How Political Institutions Shape Abortion Law in the United States, Britain and Canada, by Drew Halfmann
Myra Marx Ferree, American Journal of Sociology, Vol. 118, No. 4 (January 2013), pp. 1112-1114
Everyone knows that abortion is a highly polarizing, violently contested, ideologically central issue in U.S. politics. Understanding why this is so, and why it was not always this way, has spawned a huge literature, both scholarly and journalistic, scrutinizing the role of public opinion, social movement mobilizations, state and federal political competition, and the balance of judicial and legislative power. There is also a smaller but still substantial literature drawing comparisons between the highly contentious politics of abortion in the United States and more measured debates in other countries. Drew Halfmann’s own earlier work expanded this explanation by bringing in a consideration of the role of the medical profession and the financing of health care, and drawing a useful comparison between the way the United States organizes health systems and pays for medical procedures and how this is done in two other countries, Britain and Canada, that share our largely liberal view of government.
In Doctors and Demonstrators, Halfmann has greatly expanded his argument about the role of the medical establishment by placing its activities in a wider comparative institutionalist framework—one that now gives even more weight to the political institutions of each of these three countries. The title may still hark back to his original focus on how health care is managed, but along with more attention to social movements and their mobilizations, the new book actually gives more attention to the nature of political institutions in general. The apparent similarities of the United States, Britain, and Canada in terms of language, political culture, and religious mix of Protestant and Catholic, turn out to be dwarfed by vast differences in how parties and movements relate, how governments can or cannot control legislative agendas, how judicial decisions are framed, and again, centrally how health care is institutionalized, funded, and politically understood in these three countries.
The crux of Halfmann’s argument now is that political institutions— including the degree to which social movements can gain access to being part of a political party’s core constituency, the extent to which health care was institutionalized as a central government responsibility, and the ability of elected officials to control the political agenda—have had a huge effect in defining what kind of issue abortion is thought to be in the public mind, moving political parties toward or away from embracing it as an opportunity for electoral gain, and giving other institutional actors a stake in resolving it or keeping it as a burning issue. Health care is still central to his story. While the move to liberalize access to abortion in the “long 1960s” was a global phenomenon, the specific nature of the reforms implemented had much to do with doctors’ concerns about protecting their autonomy in different health-care systems and with the courts’ willingness to define health- care provision as a right of citizens. But Halfmann adds an emphasis on the specific ways that political parties are organized, candidates selected, and campaigns funded, and on how bills are introduced, debated, amended, and either allowed to die or not. In sum, Halfmann’s attention to the interplay between politics and political institutions is now expanded beyond the politics around health care, and the book is thus a much more generalizable and significant contribution.
As Halfmann shows convincingly, abortion is not necessarily defined as a critical issue of conscience and religion, even the Roman Catholic Church is less mobilized around it in the United Kingdom and Canada, nor is “taxpayer funding” always framed as a matter of deep religious significance. He offers carefully documented accounts of how U.S. religious actors were particularly motivated to engage the issue at a critical moment of party realignment as “amnesty, abortion, and acid” became, with race, the issues Nixon’s “Southern strategy” exploited and got the power they did from the opportunities that realignment offered. Halfmann also gives a clear and comprehensive account of how abortion moved in the United States from being an issue that divided the parties and from which politicians fled, which it remained in Canada and Britain, to one that small groups of highly committed actors on both sides could use to select, fund, and ultimately discipline candidates until parties fell into line. In short, the abortion issue offers Halfmann the opportunity to account for many of the ills that the U.S. system is manifesting across many other issues, and thus provides not only a comprehensive political history of the path the abortion issue followed but good indications of the sources of the havoc wreaked on U.S. decisions on other issues from climate change to tax policy.
Overall, the book offer a refreshingly unpolemic counter both to the tendency to see all political collapse as a matter of the global spread of neoliberalism and all abortion politics as a struggle between the forces of good and evil in the world. Halfmann uses his impressive command of the literature to offer a detailed and nuanced story of constrained change, where the institutional opportunities that vary across countries matter a great deal, but choices and strategies of individual actors—from Harry Blackmun to Nixon strategist Kevin Phillips to Tony Blair—give a sometimes decisive push in particular directions. The writing is clear and uncluttered, and advanced undergraduates should have no difficulty following the argument.
There are, of course, some omissions, the institutional structure of the media itself is ignored and racial impacts of both political campaigns and policy outcomes are slighted, and some flaws, the U.S. Affordable Care Act is treated as if it were actually being implemented rather than held up in the courts; the variation in actual abortion access in Canada is not conveyed, but on the whole this is a convincing account both of why U.S. women have lost much of the right to reproductive control that they thought they had won, and why British and Canadian women have gained more access and affordability over time and are now in a much better position relative to the United States than anyone would have imagined in the 1970s.