18615424.pdf

(54 KB) Pobierz
Medicalization and Demedicalization of Abortion in the
United States and Britain, 1861-Present
Drew Halfmann
UC-Davis
The paper analyzes the medicalization and demedicalization of abortion in the United
States and Britain during six episodes over the last 140 years. These include the
criminalization of abortion in both countries in the late 19
th
and early 20
th
century, the
establishment of a therapeutic exception to the criminalization of abortion, the feminist
challenge to medical provision of abortion in the United States during the 1960s, the
reform of abortion laws in both countries in the late 1960s and early 1970s, legalization
of the so-called abortion pill (mifepristone) in 1991 in Britain and 2000 in the US, and
the widespread use of emergency contraception (progestin) in the 1990s in each
country. The paper examines medicalization and demedicalization processes at
conceptual, organizational and interactional levels and shows that the two processes
often occur simultaneously, but at different levels. It also suggests that medicalization
has had both positive and negative effects on women’s access to abortion.
A paper prepared for the Annual Meeting of the American Sociological
Association, Philadelphia, 2005.
The concept of medicalization has a long history in the sociology of health and
illness. Most uses of the term are pejorative--suggesting increasing social control of
society and the lifeworld by (often male) technical elites (Zola 1972). Others suggest
that medicalization may also have benefits--such as the legitimation of claims to illness,
and the reduction of stigma for conditions and practices that were once considered
crimes or sins (Conrad and Schneider 1992). Numerous scholars have noted that
medicalization and demedicalization processes are prominent in the area of
reproduction in general and abortion in particular (Joffe, Weitz, and Stacey 2004;
Morgan 1998; Reissman 1998). However, it is often difficult to determine whether
particular developments in abortion policy and practice constitute medicalization,
demedicalization or both. In this paper, I utilize Conrad and Schneider’s (1980) concept
of “levels of medicalization” in an attempt to shed some light on this question for
abortion in the United States and Britain. This, in turn, aids the identification of
similarities and differences between the abortion experience of the two countries.
Conrad and Schneider’s three levels of medicalization (Conrad 1992; Conrad
and Schneider 1980) include the conceptual, the institutional (which they also call the
organizational) and the interactional. At the conceptual level, “a medical vocabulary (or
model)” is used to “order or define the problem at hand”, but medical professionals and
treatments may or may not be involved. This may occur in terms of “discoveries”
published in medical journals, through the adoption of medical definitions and
explanations by non-medical groups or “through government or court-mandated
definitions of human problems and who is to control them(Conrad and Schneider 1980,
p. 75). At the institutional level, organizations such as Alcoholics Anonymous “adopt a
medical definition and approach to a problem”, but medical professionals may or may
not be involved. At the level of doctor-patient interaction, “a physician defines a
problem as medical” or “treats a ‘social problem’ with a medical form of treatment”.
Conrad notes that medicalization should be thought of as a continuum rather
than a dichotomy. There are degrees of medicalization. And presumably there are also
degrees of medicalization at each of the three levels. Medicalization also refers to a
process rather than a state. So when I refer to medicalization or demedicalization, I
mean that the amount of medicalization has increased or decreased--not that abortion
has become wholly medicalized or de-medicalized or that abortion is in a state of
medicalization or demedicalization—usually both medical and non-medical actors and
definitions are involved at any one time. The goal here is to identify changes in the
balance between medical and non-medical actors and definitions over time. Conrad
and Schneider have tended to privilege the conceptual level as the key site of
medicalization, but I treat each of the three levels equally.
This paper examines six major episodes in the history of abortion policy in the
United States and Britain with respect to each of the three levels of medicalization (see
Table 1). The six episodes are: the criminalization of abortion in both countries in the
late 19
th
and early 20
th
century, the establishment of a therapeutic exception to abortion
criminalization, the feminist challenge to medical provision of abortion in the United
States during the 1960s, the reform of abortion laws in both countries in the late 1960s
and early 1970s, legalization of the so-called abortion pill (mifepristone) in 1991 in
Britain and 2000 in the US, and the widespread use of emergency contraception
(progestin) in the 1990s in each country.
CRIMINALIZATION AND THE THERAPEUTIC EXCEPTION
The first two episodes are the criminalization of abortion and the establishment of
a therapeutic exception for physicians. In the late 19
th
century, abortion was
criminalized in the US and England, but not in Scotland. At the same time, in the US, a
therapeutic exception for physicians, usually for the preservation of the pregnant
woman’s life, was established in most American states. In Britain, a therapeutic
exception for physicians was established in 1929.
In early British common law, abortion before quickening was legal, while abortion
after quickening was a misdemeanor. In 1803, abortion after quickening became a
criminal offense. In 1861, Parliament strengthened restrictions on abortion at the
behest of physicians seeking to destroy the trade of “irregular” practitioners. The
Offences Against the Person Act of 1861
made abortion illegal at any stage of the
pregnancy. Anyone procuring an abortion, including a pregnant woman was subject to
imprisonment for 3 years to life. The Act did not apply to Scotland. The Infant Life
Preservation Act of 1929 permitted abortions to preserve the life of the pregnant
woman(Greenwood and Young 1976; Hindell and Simms 1971). And the 1938 case,
R. v. Bourne,
gave doctors a legal defense for performing therapeutic abortions that
preserved a woman’s life, or physical or mental health(Greenwood and Young 1976;
Hindell and Simms 1971; Hordern 1971).
Early American abortion law followed the British common law. Abortion was
legal before quickening and a misdemeanor afterwards. But beginning in the late
1850s, the American Medical Association (AMA) waged a successful state-level
campaign to restrict and regulate abortion. As in Britain, this campaign was part of a
professionalization project. It was aimed at establishing medical licensing and driving
out “irregular” practitioners. By the turn of the century, every American state had
passed antiabortion legislation. All but six of these state statutes included a therapeutic
exemption allowing doctors to perform abortions when they felt it was necessary to
preserve the life of the pregnant woman.
Demedicalization at all three levels
Criminalization moved abortion from a procedure that was modestly medicalized
to one that was a crime. It was an instance of demedicalization at all three levels. At
the conceptual level, a previously common and uncontroversial procedure that was in
part associated with doctors of various kinds was now a deviant and illegal act. At the
organizational level, abortions could no longer be performed in medical, or any other,
institutions. At the interactional level, abortions had previously been provided by a
variety of providers, regulars and irregular doctors and midwives. Now, they could not
be provided legally by anyone. However, large numbers of illegal abortions would be
provided largely by non-doctors.
Medicalization at all three levels
The creation of a therapeutic exemption increased medicalization at all three
levels. At the conceptual level, the only legitimate abortion was now a therapeutic
abortion--an abortion that was diagnosed as medically necessary by a physician.
Abortion was now a treatment for a disease or condition. Because the therapeutic
exemption was limited to doctors, it gave them a legal monopoly over the procedure. At
the organizational level, most legal abortions would now be performed in a medical
institution, the hospital. At the interactional level, the medicalization was modest,

Plik z chomika:

Inne pliki z tego folderu:

Inne foldery tego chomika:

Zgłoś jeśli naruszono regulamin