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Sara Matthiesen’s Reproduction Reconceived offers a dark but crucial perspective on the idea of privacy at the heart of Roe, a liberty from government interference that the Supreme Court resolutely insisted did not carry any entitlement to support for family-making. Matthiesen reconceptualizes Roe’s central concept—a privacy right to make the decision to terminate a pregnancy—as a willingness to sign off on government neglect of those at the margins. Reproduction Reconceived offers a fascinating glimpse of the real-world costs of negative rights and explores how grassroots movements seeking support for families navigate a legal system that often rejects the idea of any entitlement to government support.

Matthiesen traces the obstacles facing lesbians and incarcerated people seeking parental rights, who confronted a combination of incomprehension and neglect. Reproduction Reconceived also documents the dangers of family-making for those to whom the state was indifferent, particularly pregnant people with AIDS or Black people confronting spiraling rates of infant mortality. The obstacles facing many of those making the choice to have a family, Matthiesen argues, helped propel one of the most successful initiatives of the antiabortion movement—the creation of crisis pregnancy centers (CPCs). Far from being unwitting dupes convinced that they were visiting abortion clinics, as some pro-choice leaders suggested, the people who turned to CPCs saw them as “the last line of defense against poverty, homelessness, and food insecurity.” (P. 21.)

Matthiesen’s study of family-making at the margins begins with lesbian couples using artificial insemination by donor (AID) and seeking parental rights. Matthiesen chronicles lesbians’ quest for “woman-controlled conception” (P. 56), exploring how lesbians turned to friends and feminist sperm banks to achieve self-insemination. But as Matthiesen notes, a backlash to lesbian family-making encouraged couples to turn to lawyers for help. By the 1990s, reliance on legal change had produced a compromise: same-sex couples could gain formal recognition, but only if they complied with certain legal requirements governing insemination at sperm banks or through private physicians. Those who best took advantage of these rules tended to be white and middle-class, Matthiesen writes, while low-income, nonwhite LGBTIQ families’ journey to parenthood remains fraught with uncertainty.

Reproduction Reconceived next turns to the obstacles facing women trying to parent in prison. Matthiesen explores the legal rules and unspoken assumptions that led women in prison to see their children almost automatically placed in foster care and probes the failure of state and national experiments to end parent-child separation. A mix of governmental indifference and hostility in the era of tough-on-crime mandates ensured that programs to help incarcerated mothers made nothing but empty promises.

The centrality of neglect in Matthiesen’s story carries through in her analysis of Black infant mortality. She studies social movement campaigns in Philadelphia and Oakland to improve outcomes for Black newborns. While the government expanded Medicaid for pregnant people, legal changes did not address the pre-pregnancy period so essential to infant survival, ensuring that issues with infant mortality would remain.

Neglect—and assumptions about women’s reproductive capacity—similarly helped to explain the exclusion of women with AIDS from drug trials. Having painted a compelling picture of the challenges and constraints on family-making for those at the margins, Matthiesen returns to the abortion debate and pivotal role played by crisis pregnancy centers. Reproduction Reconceived shows how CPCs thrived during the Reagan era and into the presidential administration of George W. Bush because they fulfilled conservatives’ vision of a slimmed down government handing over responsibility to a network of volunteers. Pro-choice leaders long argued that these centers misled women who believed that they were at abortion clinics. Matthiesen shows instead that women facing racism, incarceration, unemployment, underemployment, and lack of access to health care knowingly turned to CPCs as a last resort to meet their basic needs.

Reproduction Reconceived historicizes the medical, legal, and political shifts that made it hard for low-income families (and especially families of color) to take advantage of the choice to form families promised by Roe and its progeny. Matthiesen spotlights the importance of the law and policy of government inaction—conscious and consequential—in a variety of legal areas not often central to discussions of reproductive rights. In turn, she documents how government neglect led to the expansion and success of part of the antiabortion movement.

Reproduction Reconceived is also a powerful study of social movement strategy. This timely history offers a sense of the challenges facing a post-Roe movement for reproductive justice, challenges that reach beyond overtly antiabortion mandates to government indifference and a tendency to blame families for their own struggles. Often, as Matthiesen shows, those seeking support from the government struggled to make themselves visible—to identify themselves as deserving parents and to gather data to show the responsibility of policy for the outcomes they suffered. Reproduction Reconceived illuminates the importance of these strategies for movements seeking legal change. Identifying something as a problem—and convincing the government that it has some responsibility for it—emerges as a crucial organizing step in Matthiesen’s account.

For those seeking reproductive justice, there are no easy solutions in Reproduction Reconceived, but as Matthiesen documents, the history of inaction, misunderstanding, and hostility that characterizes governmental attitudes toward poor families is a core issue for those seeking to understand what reproductive choice really means. The problems that Matthiesen identifies will likely become much worse in a post-Roe America, especially since the states with the most sweeping laws against abortion have the worse outcomes for children. But Reproduction Reconceived ably demonstrates that seeing the depth of a problem and knowing how it began is a necessary step for social change. In this original and important book, Matthiesen accomplishes just that.

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Cite as: Mary Ziegler, Family-Making in an Age of Scarcity, JOTWELL (January 20, 2022) (reviewing Sara Matthiesen, Reproduction Reconceived: Family Making and the Limits of Choice after Roe v. Wade (2021)),