The New Civil War: The Psychology, Culture and Politics of Abortion
Linda J. Beckman and S. Marie Harvey (Eds.)
Washington, DC: American Psychological Association, 1998.

Review by Joan C. Chrisler, reprinted from the Psychology of Women Quarterly [2000], 24, 200-201.

As I began to read The New Civil War, I was reminded of the feminist slogan from the 1970's: "Women's health care is political." If you have any doubt that women's heath care is still political, if you think that the government's Women's Health Initiative is the solution to the neglect of women's health needs, if you are too young to have lived through the full cycle of the gains and losses of the pro-choice movement or are curious about why psychologists would concern themselves with a controversial medical procedure, this book is for you. If you know the answers to these questions but are looking for ideas for your next research project, want some advice about assisting women clients with making reproductive decisions and coping with their ramifications, or want to read and engaging, comprehensive, and persuasive example of how and why to do psychology in the public interest, this book is for you, too.

Beckman and Harvey have assembled an interdisciplinary set of contributors in order to place abortion in its historical, cultural, and sociopolitical context. The authors are health care practitioners, academics, consultants, and policy advocates. Most are psychologists; some come from related fields with important perspectives to offer (e.g., anthropology, law, medicine, public health). The focus of the book is clearly psychological. The authors are explicit in their goals to set a research agenda, to improve counseling and psychotherapy services for women who are making reproductive health choices, and to urge a return to the activist roots of feminist psychology. In their concluding chapter, the editors insist that psychologists have a responsibility to share their knowledge with legislators, policymakers, and the media so that accurate information about the psychology of women and the diversity of women's health care needs will be included in the ongoing abortion debate.

The book consists of a foreword, introduction, conclusion, and 15 substantive chapters, which are divided into four sections. The chapters are primarily literature reviews, but some contain information that cannot be found elsewhere: data previously unreported, clinical experience, and accounts of activism. All chapters contribute to the editors' goals, and the diversity of the authors' points of view make for interesting reading.

Part I, entitled "The Sociopolitical Context of Abortion," contains a history of U.S. federal abortion policy, an examination of the reasons why abortion is a controversial issue, a discussion of the many barriers to abortion access even when it is legal, and a consideration of the impact of antiabortion activities on women who seek services. I found the last chapter to be particularly interesting and thought provoking. Antiabortion activities have clearly had an impact on the delivery of services: many clinic workers have been harassed, threatened, even physically harmed. News reports of clinic bombings and murders of physicians have led to difficulty in finding trained personnel to staff clinics and a major barrier to access is the lack of service providers. Yet, we know little of the impact that antiabortion picketers and "sidewalk counselors" have on women who use the clinics' services. Stress and coping theories suggest that anything that increases a patient's stress level prior to medical procedures could influence outcome, yet little has been done to examine the stress of encountering angry activists at the clinic's door. Nor do we know whether pro-choice activists acting as "escorts" can moderate the effects of the stress. In their chapter, Cozzarelli and Major outline the applicable theories, make predictions, review the little work that exists, share some of their own data, and suggest research directions that one hopes readers will follow up.

Part II, entitled "The Cultural Context of Abortion," contains chapters on abortion attitudes of and use of services by African Americans, Latinas, Asian Americans, and Pacific Islanders. The authors discuss the ways in which ethnic minority women's attitudes are similar to and different from those reported in mainstream population surveys. Particularly interesting were the discussions of the effects of religion, acculturation (and the legality of abortion in the home country of immigrant women), and the history of denial of reproductive rights to Black women on current attitudes and how discrepancies between attitude and behavior are resolved when women decide to have an abortion even though they would say that in general they are against it. I wish this section had contained a few more chapters. I would have liked for example, to read about Native American women, particularly because the federal government has refused to allow abortion in hospitals run by the Indian Health services, and about Jewish women particularly because so many Jews have provided leadership in pro-choice movement and as an illustration of how another major religion affects its followers' attitudes.

Part III, entitled "Intrapersonal and Interpersonal Contexts of Abortion," contains chapters on adolescents and abortion, men's attitudes toward abortion, women's attitudes toward medical versus surgical abortion, the relationship of violence against women to unwanted pregnancies, and the testing of a model of psychological sequelae of abortion. The chapter on men's attitudes concerns an understudied population, and I found Marsiglio and Diekow's discussion of the political philosophies of various segments of the men's movement to be enlightening. The chapter on violence by Russo and Denious was among the strongest chapters in the book. Although we know that violence is widespread and related to a lot of women's issues, the authors do an excellent job of showing how this particular relationship should inform clinic procedures and public policies.

Part IV, entitled "Abortion in the Context of Practice," consists of chapters about counseling abortion patients, clinical approaches to abortion issues in psychotherapy, and what we can learn from other countries to improve medical service delivery. I was surprised and pleased to see the international chapter. Rarely do Americans consider what we can learn from colleagues in Kenya, Bangladesh, or Nicaragua, yet there are many suggestions for policy and training that could be very helpful in removing some of the barriers to access in the United States.

This is a book that will appeal to psychologies, lobbyists, policymakers, clinic personnel, and students of psychology, medicine, women's studies, and political science. Most of the chapters are accessible to students, and I encourage faculty to consider adding to their syllabi some chapters from The New Civil War.