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  From abortion to contraception: A resource to public policies and reproductive behavior in Central and Eastern Europe from 1917 to the present.
Henry David
Westport, CT: Greenwood Press, 1999.
(hardcover, 382 pp.)

Review by S. Marie Harvey

This impressive volume provides a comprehensive, archival, and historical record of public policy, reproductive behavior and women's rights in Central and Eastern Europe (CEE). The book encompasses more than seven decades of socialist rule and nearly a decade of postsocialist transition in 28 CEE countries. The 15 contributors examine the interaction between public policy and private reproductive behavior and review each country's unique experience within a broader historical, psychosocial and public health context. A unique feature of the volume is its women-centered approach and the placement of contraception and abortion firmly within the context of women's rights and status.

The book is comprised of two parts: Part I, the Introduction, consists of three chapters and Part II includes nine Central and Eastern European country reports presented in alphabetical order. The first chapter, an Overview of the book by Henry David, introduces the organizational structure of the book, discusses the content of Chapters 2 and 3, and outlines and summarizes the major themes addressed in the nine country chapters. In Chapter 2, 'Understanding the 'Abortion Culture' in Central and Eastern Europe,' Libor Stloukal provides insight into the reasons for the reliance on abortion within Central and Eastern Europe. From 1960 to 1990 legal abortion rates in CEE were the highest in the developed world. Explanations for the high abortion levels during these decades included liberal abortion laws; lingering pronatalist views; limited and erratic availability of modern contraceptives; the use of ineffective or no methods for avoiding unintended pregnancy; and the slow acceptance of feminism and personal responsibility. Abortion rates have declined and continue to decline nearly everywhere in CEE. While the trend today is toward contraception and responsibility for individual behavior, Stloukal concludes that 'the transition from abortion to contraception remains an incomplete process in the CEE countries.'

In Chapter 3 Henry David and Joanna Skilogianis review the historical development of socialist views on what they refer to as the 'woman question.' This phrase was introduced by a the German Social Democratic Party theoretician, August Bebel, in the nineteenth century and was subsequently used by others. All nine country reports include a section devoted to a review of the country-specific trends and the impact of political change on women's rights and status. Chapter 3 provides an overview of the historical development of the socialist view on the woman question before and after the October 1917 Revolution in the former Soviet Union. The authors summarize the effects that the political and economic transitions from socialism to more democratic political systems are having on such issues as women's rights, reproductive health, and feminism. For many of the CEE countries, the transition process resulted in a decline in women's rights and gender equality. The change from centrally planned to market economies negatively affected women in many ways including increased unemployment, poverty, a decrease in political representation, a lower level of health care, and poorer living conditions. The transition marked a return to traditional patriarchal values and to the multiple burdens for many women as worker, mother and wife. David and Skilogianis conclude that the women question remains unresolved in the CEE countries.

This book has many strengths and much to recommend it. First, the volume is comprehensive and inclusive in its content, approach and geographic scope. The editor acknowledges that traditional demographic studies of reproductive behavior are too broad-based. He incorporates a microlevel approach to facilitate a better understanding of the multifaceted determinants of sexual and reproductive behavior. Thus, the analysis of the determinants of fertility behavior moves beyond the pure demographic and public policy approach to include the reproductive health perspective. 'Private reproductive behavior involves a series of individual decisions reflecting historical, political, economic, social, cultural and other values and traditions.' Within this broad interdisciplinary approach, each country report considers a range of factors affecting sexual and reproductive behavior including 'society values and traditions, Marxist theory, socialist and patriarchal perceptions of gender roles, the status of women as producers of labor and reproducers of families, changes in legislation facilitating or constraining access to modern contraceptives, pronatalist incentive influences on demographic trends, attitudes of health service providers, views on sexuality education, adolescent sexual behavior, and emerging roles of public services and nongovernmental organizations.'

The geographic scope of book is equally impressive covering 28 formerly socialist countries of Central and Eastern Europe and the USSR successor states from 1917 to the present. Although each of the country chapters is similarly organized to address common topics, the determinants of fertility behavior varied greatly between and within countries. Thus, the authors review each country's unique experience within a broader context. Historical and current information specific to each country is presented and, when available, statistical data (e.g., birth rates, total fertility rates, legal abortion rate, legal abortion ratios, maternal mortality rates and ratios) displayed in easy to read tables and figures are also presented. It is noteworthy, that this volume has compiled extensive data and information about reproductive health issues in countries where such information has been previously unavailable or extremely difficult to come by.

The book is also distinguished in terms of quality and coherence. All chapters are well written, thoroughly researched and meticulously documented. The nearly 1300 references are combined into a single chapter with listings by author in alphabetical order. Although this is an edited volume with 15 contributors and is ambitious in scope, the individual chapters refer to and are informed by one another. Because the country chapters are organized to address common topics and because of the skillful editing by David, the book forms a coherent whole. Each country chapter begins with an introduction by David in which he discusses the historical context and outlines the topics to be addressed. A commentary on "Future Perspectives" concludes each chapter.

Perhaps what I find most profound and valuable about From Abortion to Contraception, is its focus on the 'woman question.' A unique feature of the volume is the examination of the interrelationships among public policies, private reproductive behavior and women's roles and status. Through his women-centered approach and the placement of contraception and abortion firmly within the contexts of women's rights and status, David affirms the 1994 Program of Action of the International Conference on Population and Development (ICPD) held in Cairo. Women's control over their own reproductive health and fertility has been and continues to be an enduring goal of feminism. If women are to achieve full social, political and economic equality, they must have easy access to a continuum of pregnancy prevention and termination options. Moreover, the most effective way to prevent unintended pregnancy, change reproductive behavior and improve women's health is to elevate the status of women by providing the means for social and economic self-determination. David concludes, however, that the extent to which access to modern contraceptives and safe abortion is available to all women is, to a large degree, dependent upon whether 'public policy concurs or conflicts with private values.'

In summary, I commend David and his colleagues for their efforts to place contraception and abortion in the context of gender equality and women's status. Given its breadth and depth of information and its quality and coherence, this book is an invaluable resource not only for demographers but also for historians, policy-makers, social scientists, public health and women studies scholars, and health and human rights advocates.

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