In the Old Testament, Abraham’s wife, Sarah, foremother of a people, was initially unable to conceive a child. Despite harmonious marital relations, she bled every month and her belly failed to swell. Longing for a son, she did what any resourceful wife of her day would have done: she dispatched her husband to her maidservant, Hagar. The plan worked, but Hagar, having succeeded where Sarah had failed, lost respect for her barren mistress. Sarah, in turn, began to treat her harshly, making her fetch extra water and denying her seconds of stew. It was an unpleasant situation for everyone–with the possible exception of Abraham.

Hagar bore a son, Ishmael, on Sarah’s behalf. Fourteen years later, though, God stepped in. He blessed Sarah–by then wizened and post-postmenopausal–with a child by blood, Isaac. “Who would have said to Abraham that Sarah would suckle children!” marveled the triumphal nonagenarian. “Yet I have borne a son in his old age.” Eventually she instructed Abraham to cast Hagar and Ishmael out into the desert.

Had Sarah lived in the twenty-first century, she would have had a menu of options to consider before resorting to concubine recruitment. She could have tried fertility drugs, a few rounds of in vitro fertilization (IVF) or a trick called intracytoplasmic sperm injection to escort Abraham’s seed to its destination. If all that failed, she could have had eggs extracted from Hagar or taken her pick among strangers with higher SAT scores. There likely would have been no need to wait until her 90s to bear a child–although if she were to give birth at that age, she would have had no shortage of company in the never-ending tabloid contest for World’s Oldest Mother.

Couples throughout history have sought to control reproduction, with varying degrees of success. To avert pregnancy, there were always crude contraceptive techniques–withdrawal, proto-condoms–or cold baths. But if your problem was a fertility deficit, there wasn’t much you could do besides adopt, enlist a third party or pray. For the most part family planning was the domain of God or nature until, in the twentieth century, technology and feminism joined forces to make childbearing preventable for many women. While lagging in effectiveness, remedies for infertility evolved too. By the late 1930s, hormonal treatments and tubal surgeries had become available, and the 1970s brought the spectacular breakthrough of IVF.

Today, infertility groups consider this array of treatments an extension of “reproductive choice,” while flummoxed prochoice groups fear that their terminology has been hijacked. Despite the discord–and the very real differences–the two camps are intimately linked. Both are trying to sort through our increased reliance on technology to shape our lives and solve our problems–problems often created by other technologies. Indeed, in a significant minority of cases the demand for assisted reproductive technology (ART) results more or less directly from old-school reproductive rights: happily, women can take advantage of birth control and abortion to postpone motherhood–but some find that when they’re finally ready and willing to get pregnant, they’re no longer able to.

Some feminists are suspicious of ART because it allows women to fulfill a traditional role rather than emancipating them from one. Others, feminist or not, squirm at the commercialism: ordering a child, for a considerable price, and in some cases shopping for gametes or leasing a uterus. The availability of these items as consumer products elicits a jumble of reactions: why must we turn to the market to meet all our needs? Isn’t there something character-building about accepting limitations and life circumstances? That said, why should only the poor have to accept such limits? Oh and, um, incidentally, what’s the going rate for the sperm of a Harvard alum with low blood pressure and silky hair?

Likewise, we may instinctively recoil from the unnaturalness of ART. But this response warrants further scrutiny. “Unnatural” is a smear that can be leveraged against anything from birth control to vaccines. Manipulations of nature can be liberating or oppressive: medical science can be used to prevent pregnancy, to induce it and to provide a cosmetic “mommy job” to erase the residual signs of it. And while we all have opinions about these various technological applications, our judgments are bound to be colored by self-interest. A college sophomore who swears she’ll never have kids is going to look at ART very differently from a 40-year-old in her third year of pregnancy attempts. The former could someday become the latter, struck by baby lust she had never anticipated, and distaste for ART could turn to gratitude. In this area, moral disapprobation is a slippery luxury.

…

Since Louise Brown, the first “test-tube baby,” was born in 1978, more than 3 million children have been conceived by IVF worldwide. But the technology has advanced faster than the ethical and political consensus. This gap is especially conspicuous in the United States. Due to our peculiar abortion politics and free-market fetishism, the fertility industry–widely known among doctors and bioethicists as the Wild West of medicine–operates with virtually no government oversight.

Among the roughly 15 percent of Americans who have struggled with infertility is first-time author Beth Kohl. As a married woman in her late 20s, she was diagnosed with Polycystic Ovarian Disorder, which prevented her from conceiving the low-tech way. Embryo Culture is a memoir of her quest for pregnancy via IVF. (She lives in Illinois, where, unusually for the United States, a state mandate requires insurers to cover four rounds of that treatment.)

Unfortunately, Kohl’s book is often marred by clunky prose–modifiers such as “spoony-looking” and “nonquiet”–as well as a scattered narrative. But it offers a serviceable introduction to the infertility scene. She covers an IVF cycle in detail: countless hours in the waiting room of the fertility clinic; daily self-administered injections of hormones; bloated discomfort and teary mood swings. Her husband, Gary, “worried about me, about us. He wanted to be of help, but I was becoming too much for him to handle. I was becoming too much for Freud or FEMA to handle.” The ordeal is punctuated by moments of encouragement. When an ultrasonographer monitors the drug-induced follicles in her uterus, she thinks, with a touching desire for normality, “I was getting ultrasounds, just like any old pregnant woman.”

Kohl’s aim is not only autobiography; she wants to explore the ethical territory of ART. While she gamely acknowledges the standard concerns, however, her probing is perfunctory. When Gary suggests considering adoption, she replies, “Trust me…. I just know that this is the right thing for me. For us.” This assertion of intuition is always the gist of her answer. In her foray into religious questions, she wonders “if I should put my faith in an all-knowing yet benevolent God who shall, at an unspecified miraculous point in the future, deliver a son or daughter unto me, patient member of His flock.” She then confides her uneasiness at the prospect of spending more money to create a child than most parents spend to raise one. Her response to these worries: “But a force, an inner drive, is pushing me toward IVF.” Ultimately, she fails to do the work of grappling with her reservations and spelling out why they are insufficient to override her decision.

Perhaps Kohl embodies a common attitude–the deep irrational drive to reproduce, in the face of which qualms are defenseless. But she is more a symptom of this tendency than a diagnostician. Two other recent books on the subject do a better job of analyzing the intense hunger for parenthood, as well as the fertility industry’s manipulations of it. In Waiting for Daisy, Peggy Orenstein describes the incremental steps she took down a path of treatments she’d sworn she’d never try, such as egg donation, because, “What if this worked? What if it was the only way I could have a baby?” As Debora Spar argues in The Baby Business, this logic could lead to cloning: not out of an egomaniacal desire for self-replication but as a last recourse for patients who have tried everything else. It’s not that infertility patients lack a moral compass, Spar suggests, but that they are vulnerable–which is an argument for policies setting certain legal limits.

Kohl was relatively lucky: although her first IVF cycle failed, she subsequently had two successful rounds. In the end, her story is quite conventional. The sole obstacle to a traditional family was her medical condition. She always expected to have kids, and when a problem arose, the remedy was available. Thanks to insurance coverage, she was spared the commercial excesses that are common in the United States. Hand-wringing notwithstanding, Kohl’s essential feeling toward infertility treatment is gratitude. Her true worries center not on the ethics of assisted reproduction as a method but on its effects: whether IVF poses risks for the babies it brings to life. According to her research, it might. One study found an appreciably higher incidence of birth defects, especially heart problems and urinary- and genital-tract problems, in IVF children.

The apparent health of Kohl’s three daughters, two of whom are twins, appears to reassure her on this point. Her agonizing then shifts to another question: what to do with the seven excess frozen embryos? Knowing and loving what the embryos could become, she is reluctant to discard them like so many leftovers. As the book ends, the embryos are still in the limbo of the freezer.

…

Even prochoice patients tend to think of their frozen embryos as, in Liza Mundy’s words, “souls on ice.” In Everything Conceivable, Mundy reports that some 400,000 frozen embryos are in storage in the United States. They belong mostly to American parents but also to foreigners who come here for the “reproductive tourism” they enjoy under the United States’ relaxed laws. These parents haven’t yet made the “disposition decision”: whether to discard the embryos, give them to a different couple, try for another pregnancy themselves or donate them to science (a daunting prospect, thanks to religious-right activism against embryo research). In Louisiana, such embryos have been designated “juridical persons” entitled to some legal rights–a source of alarm for Roe v. Wade supporters. And like other outgrowths of the fertility industry, this one has spawned its own lucrative niche: companies devoted to managing the ever-growing embryo inventories of clinics. The staffs of such companies sometimes find themselves offering impromptu counseling to patients, who typically receive little guidance from any other source.

Mundy, a staff writer for The Washington Post Magazine, thoroughly explores this and other aspects of ART in America, bringing to bear impressive reporting skills and a sharp analytical mind. With empathy and wit, she illuminates the ironies and absurdities, the tragedies and dilemmas, but also the joys, of assisted reproduction. As she observes, “Parenting has been divided up; it has been compartmentalized; it has been outsourced. At the same time it has been made deliciously possible.”

Mundy writes accessibly about science, but the human dimension is at least as prominent in her work. Her accounts vividly dramatize the resolve of aspiring parents and the improvisatory pluck ART calls for. She also looks at the new types of relationships formed–between egg donors and intended mothers, sperm donors and their genetic children, gay parents and surrogates. Among her sources these relationships tend to be warm, as opposed to, say, the conflict between Sarah and Hagar or the infamous case of Baby M, whose biological mother, hired as a surrogate, fought a legal battle to keep her. Like Kohl, Mundy has a rosy view of the fundamental premise of ART; she scarcely addresses philosophical objections. But she is by no means blind to its practical problems. Her book identifies serious flaws in its implementation and makes persuasive policy recommendations for ameliorating them.

Mundy ventures beyond the confines of Kohl’s first-person narrative, finding several patterns that diverge from that conventional scenario. We encounter women who deferred parenthood–due to career pressures, nonexistent or reluctant partners, or their own ambivalence. When they have at last prepared to start a family, some find that their fertility has diminished with age. (An increasing number of this group purchase eggs from younger donors for anywhere from about $5,000 to $50,000 a batch.) We also meet would-be moms who refuse to wait for Mr. Right–or, rather, seek him on the website of their local sperm bank instead of on Match.com. There are lesbians who employ the same method, while gay dad wannabes go to even greater lengths. Consider the case of Eric Ethington and Doug Okun. In an increasingly typical instance of “collaborative reproduction,” this San Francisco couple hired a surrogate to carry twins, using the eggs of a second woman. The twins, while gestating in the same womb, were half-siblings; each egg had been deliberately fertilized by one of the men.

The beautiful twins and their devoted dads make a happy ending (except, of course, for those offended by the notion of plural fathers in a single family). But the surrogate who carried them, Ann Nelson, hemorrhaged dangerously from the delivery, necessitating a hysterectomy. Nelson, an environmental activist and counselor of pregnant teens, considers surrogacy part of “a grassroots thing. I thought, ‘I could help these poor people.'” Married to a firefighter paramedic, she had given birth, via C-section, to four of her own children and one for a different gay couple. This time, although her doctor had cleared her to bear twins or triplets, she suffered from placenta accrete, a condition more likely after a previous C-section, in which the placenta is not fully expelled upon delivery. Nelson’s generosity strains belief–she calls surrogacy her “passion” and claims she accepted payment only for her family’s benefit–but others object to what they call the exploitation of women like her, who are paid about $20,000. As Mundy notes, such arrangements manage to elicit disapproval from both the left and the right. She quotes feminist bioethicist Barbara Katz Rothman: “Any man with a checkbook can buy a baby…. The pieces are all for sale.”

The commercialization of ART is not just unseemly; it carries real risks. Clinics competing for clients want to boast high rates of successful pregnancies, leading them to transfer greater numbers of embryos to increase the chance that at least one will bloom into a baby. This tendency has contributed to an “epidemic” of multiple births in the United States. (There are other factors at play, too: fertility drugs alone tend to produce the quintuplets and sextuplets that make the evening news.) The twinning rate, Mundy reports, has risen by 300 percent in three decades, while the rate of births involving higher-order multiples has increased by about 1,000 percent. “If Nature thought it was appropriate for homo sapiens to have litters, Nature would not have selected against it,” one doctor tells her. Multiple births have a much greater incidence of prematurity, low birth weight and other risks. Mundy describes the calamitous pregnancy of Tammy LaMantia, who, having told her IVF doctor she wanted no more than twins, conceived triplets, all of whom died at or before birth.

A significant chunk of Everything Conceivable is devoted to the phenomenon of multiples. When they survive, they are more likely to suffer from long-term disadvantages. One couple, unable to afford IVF, used fertility drugs and conceived quadruplets. Born at twenty-five weeks, three of the babies survived and stayed in the hospital for months; at age 3, one was preparing to learn Braille and walk with a cane. Even in the absence of such problems, parents are often utterly overwhelmed. “The theme of uncontrollable crying,” Mundy notes dryly, “entered into many conversations I had with mothers raising high-order multiples.”

Whether or not there is a veritable “epidemic,” more responsible medical practice and better regulations would result in fewer multiple pregnancies and lower health risks for mothers and children. Doctors tend to leave the choice of how many embryos to implant to the patients, who are desperate to conceive and typically given little time and information to make the decision. LaMantia’s pregnancy probably would have gone smoothly if her doctors had transferred two embryos instead of three. (She later gave birth to twins.) Mundy convincingly argues that the number of embryos transferred should be limited by law to two, as is already the case in much of Europe.

Another culprit here is the lack of federal funding for embryo research, thanks to antiabortion activism. We’re more familiar with the impact of the funding ban on stem-cell research, the promising area of medicine that holds the potential to cure diseases such as Parkinson’s and maybe even to regrow limbs. But the same funding ban has seriously hampered reproductive medicine too, with the result that all experimentation happens inside wombs. Meanwhile, infertility groups support embryo research but oppose government regulation of the fertility industry, on the grounds of reproductive freedom. The two campaigns have contributed to more multiple pregnancies, miscarriages, selective reduction and infant mortality. In effect, these disparate ideologies have colluded to undermine the interests of their respective constituencies–“preborn children” and infertility patients.

Mundy emphasizes that while bioethicists and the media fret about “designer babies,” the more pressing issue is closer to the opposite. ART is creating children with disadvantages–those from multiple births but also, as Kohl touches on, IVF singletons. This affects not only the children and parents but also society at large, in terms of staggering healthcare costs and special educational needs.

Yet these dangers seem unlikely to captivate the popular imagination the way designer babies have: low birth weight, miscarriages and overwhelmed parents are mundane, compared with choosing Tyler’s eye color or trying to engineer Chloe’s IQ. The prospect of manufacturing a dream baby plays on desires and fears, harking back to our uncertainty about the ethics of usurping God or nature. Our doubts derive not only from the hazards of the process or the inequities that would ensue; the awesome possibilities are themselves threatening. In the same vein, one wonders if the right-wing resistance to stem-cell science is about more than the embryo. Perhaps, especially to people of conservative temperament, there’s something hubristic, even blasphemous, about the radical curative potential. Even those of us who support stem-cell research can probably relate to the uneasiness about revolutionary advances and miracles of human provenance.

Such uneasiness regarding these and other innovations is a reaction to what bioethicists call a “yuck factor.” These cringes are worth our attention, especially in the realm of personal decisions. But a big part of the yuck factor is novelty. In 1985 Leon Kass, the conservative bioethicist and future chair of the President’s Council on Bioethics (2002-05), thundered that IVF would inevitably lead to “self-degradation and dehumanization.” Now he endorses the treatment for married couples. Kass famously relies on the “wisdom of repugnance” in assessing biotechnology, but apparently repugnance has a half-life.

The yuck factor is alive today, but its power is eroding as we become ever more blasé about novelty and as our connections with nature become ever more mediated. That’s why, in the end, ART isn’t really very shocking. On the contrary, it fits right into our world. Although some ART parents hesitate to tell their children about their origins, the kids in Mundy’s book don’t seem particularly nonplussed. “I’m a miracle!” exults one little girl. A teenage boy says, charmingly, “I’m very thankful for all the technology and all the money put into, um, me.”

After all, to kids who grow up in a culture thoroughly dominated by technology and commercialism, what could seem more natural? Indeed, given the extreme measures some take to produce children, the debt and the hormone injections and the devastating failures, what seems amazing is that other people accomplish the same feat with a method that’s free and easy and that they’d presumably be more than happy to do anyway. Now that is a miracle.

On January 17, 1916, the eve of her scheduled obscenity trial, Margaret Sanger addressed a gathering of supporters. A political radical and former nurse who would go on to found Planned Parenthood, Sanger had been indicted for the distribution of her fiery paper “The Woman Rebel,” which advocated contraception. More than a hundred guests attended a dinner to listen to the comely wife and mother who had caused such a stir. The prepared text of her speech proclaimed–with typographical fervor presumably matched in her delivery–“THERE is nothing new, nothing radical in birth control. Aristotle advocated it; Plato advocated it; all our great and modern thinkers have advocated it!”

It was true that contraception–Sanger and her comrades coined the term “birth control” in 1914–had been practiced, or attempted, for millennia; ancient Egyptians had blocked sperm with a paste made of crocodile dung. But in the United States at the time, birth control was legally restricted and widely inaccessible, especially for the poor. In the previous century, a thriving market in prophylactics had provoked a conservative crackdown. The federal Comstock Act, passed in 1873, made it illegal to send “obscene” materials, including contraceptive devices and information, through the mail. Although the manufacture and sale of the devices were generally allowed, various state laws prohibited advertisements, doctors’ prescriptions and use. These legal constraints, combined with the expense and taboo, meant, for many couples, coitus interruptus or pregnancy–or, frequently, both.

Birth control’s enemies worried that it would encourage fornication and subvert traditional gender roles. (Their fears were, of course, not unfounded.) According to the Catholic Church, sex, even in marriage, was for procreation alone, and contraception would debase conjugal relations. Some called it “child murder.” Essentially, all of the objections to birth control anticipated those more familiar today in reference to abortion.

On behalf of fertility control, several distinct cases were beginning to emerge in Europe and the United States. In economies that no longer relied on farm labor, ordinary couples sought to limit their families for financial reasons. Emma Goldman, the American feminist and anarchist, perceived birth control’s promise for sexual freedom. Neo-Malthusians warned of explosive population growth, while eugenicists aspired to halt the reproduction of the “unfit.” In her speech that winter night, Sanger, for her part, focused on the wretched conditions of the poor, forced by lack of contraception to multiply their hungry offspring. But she never met a rationale for birth control she didn’t like, and over the course of her career she invoked them all.

The mother of the birth control movement took an unorthodox approach to activism. Rather than seeking solutions to a given problem, she found a solution–she called birth control her religion–and continually identified ills she thought it could remedy. In part this was sheer political calculation. At the time, eugenics, for instance, was considered progressive, and she hoped it would lend credibility to her suspect cause. But if Sanger was pragmatic to a fault, she wasn’t a cynic; she seems to have truly believed in birth control’s eclectic applications.

Today, of course, the most controversial of these is the disgraced philosophy of eugenics, which attempted to apply the principles of horse and dog breeding to human reproduction in order to improve the human race. By the 1920s, eugenics courses were taught at American universities, and fairs sponsored “fitter families” contests. Sanger was never a bona fide eugenicist: She always disdained a key component of the eugenics program–encouraging the “fit” to breed prolifically–and eugenicists for the most part shunned her. But she accepted their premises regarding the “unfit,” and she borrowed their metaphors. In 1924 she compared ideal childbearing to the careful strategizing of the gardener: “How are we to breed a race of human thoroughbreds unless we follow the same plan? We must make this country into a garden of children instead of a disorderly back lot overrun with human weeds.”

Remarks like these are a gift to today’s reactionaries, whose websites feature Sanger’s more embarrassing quotes, as well as misattributed and fabricated ones. Reading certain extremist “prolife” literature, you would think Sanger was a genocidal racist and a proponent of infanticide. More responsible antiabortion sources, such as the National Right to Life Coalition and Margaret Sanger’s Eugenic Legacy, a 2005 book by Catholic scholar Angela Franks, make an effort to be factually accurate and attack her for her problematic beliefs, such as her advocacy of sterilization of the “unfit.” Still, their opposition to reproductive rights opens them to charges of historical selectivity, since Sanger’s positions were mainstream at the time. Harder to dismiss are the critiques of black feminists like Angela Davis, who points out that minority women’s longstanding alienation from mainstream white feminism has roots in Sanger’s association with eugenics. What is more, some of Sanger’s contemporary defenders, notably those at Planned Parenthood, have themselves quoted her out of context, downplaying her offensive views. Between the sanitizing and the smearing, it’s difficult to discern who Margaret Sanger really was.

Against this polarized backdrop, The Selected Papers of Margaret Sanger is a refreshing antidote. (The first volume, The Woman Rebel, 1900-1928, was released in 2003; the second, Birth Control Comes of Age, 1928-1939 has just been published. Two more volumes are planned, to cover the last third of Sanger’s life and her international work.) The editors have burrowed through an archive of more than 120,000 documents to select speeches, diary entries and, mostly, letters. The papers they’ve chosen reflect the commendable as well as the unsavory in Sanger’s political views and personal life. This fidelity extends to scrupulously transcribed misspellings and heroically comprehensive footnotes. Altogether, the two completed volumes offer a singular record of her life and times. (Ellen Chesler’s 1992 biography, which likewise avoids the common biases, makes an excellent companion.)

…

Born Margaret Louise Higgins in 1879, in Corning, New York, Sanger was the sixth of eleven children of two Irish-Americans. Her father, Michael, had socialist, anticlerical politics that, along with his alcohol-fueled boisterousness, antagonized the community and hastened the failure of his stonecutting business. Margaret, her father’s favorite, inherited his freethinking convictions. Her mother, Anne, a forbearing Catholic, had less obvious influence on her, but Anne’s life of perpetual pregnancy was Margaret’s first exposure to the burdens of motherhood. Her mother gave her another inadvertent bequest as well: At 50 she died of tuberculosis, leaving Margaret, who tended to her on her deathbed, with recurring bouts of the illness, although she seems scarcely to have complained of this and comes across as the very reverse of a fragile consumptive.

Caring for her dying mother confirmed Margaret’s interest in medicine, and at 20 she entered nursing school in White Plains, New York. But before graduating she met William Sanger, a handsome young Jewish draftsman and painter, at a dance, and he lobbied hard to win her hand. As she wrote to her sister Nan, “That man of mine simply carried me off–he made me marry him ‘now or never’ he said I had only two hours off duty–and we drove around the Park arguing on the subject until four oclock–then he turned in and made me get out–and we were married at ten minutes past–and I was due here at four thirty.” Her husband was one of the first of a long series of men who would love her with such urgency.

Sanger’s beauty and magnetism served her cause as well as her love life. The press frequently marveled at the ostensible disjunction between the militant message and the feminine messenger. Photographs capture her delicate features–widely spaced, liquid hazel eyes, a luminous, freckled complexion–but not her charm or sensuality. Nor are these qualities particularly apparent in her writing, even, for the most part, in her personal correspondence. More reflective of her charisma than the letters she sent are the letters she received. “I want you. I need you. Already our friendship has been the greatest thing that has ever come into my life,” wrote one paramour, sounding indistinguishable from numerous others. As for her marriage, her allure probably expedited both the wedding and the eventual divorce.

In the beginning, the Sangers’ union was happy. They had three children–Grant, Stuart and Peggy–and moved from the suburbs to the city. In Manhattan, they were active in the Socialist Party and mingled with the likes of Mabel Dodge and Emma Goldman. Sanger went to work as a visiting nurse in the tenements on the Lower East Side, where many of her patients suffered from repeated unwanted pregnancies. (State law allowed physicians to prescribe prophylactics to prevent venereal disease but not conception.) Later, in speeches, Sanger would tell the story of Sadie Sachs, probably a composite, a poor, ill Jewish immigrant who begged her doctor to help her avoid another pregnancy. His advice, according to Sanger: “Tell Jake to sleep on the roof.” The tale of woe ended with Sadie Sachs’s death from a self-induced abortion. Sanger became convinced that there had to be a better way than “continence,” a more realistic solution that honored married love. She began to investigate the options–at the time the most sophisticated method was a pessary (diaphragm) with spermicide–and promote their use.

In March 1914, Sanger launched “The Woman Rebel,” an eight-page monthly produced out of her apartment. At this stage she advocated contraception for feminist reasons but also as part of an anticapitalist agenda: Workers, in her view, were multiplying too fruitfully, thus cheapening their labor; birth control offered a weapon for the revolution. In the first issue she wrote, “Woman is enslaved by the world machine, by sex conventions, by motherhood and its present necessary child-rearing, by wage-slavery, by middle-class morality, by customs, laws and superstitions.” She was indicted after seven issues of this.

Rather than face trial, she fled to Europe, where she took notes on contraceptive devices and distribution in the comparatively open continent, and had an affair with a Spanish anarchist. She returned to the States after almost a year, and the charges were eventually dropped. Still, it was a time of turmoil for Sanger. Her marriage was deteriorating, thanks to her infidelities and ultimately her wish to separate despite her husband’s abject resistance. Tragically aggravating this hardship, the couple’s 5-year-old daughter, Peggy, died suddenly of pneumonia. Margaret’s guilt over her absence for a significant fraction of the child’s life would haunt her in dreams.

Her grief, though, couldn’t keep her away from work for long. In October 1916 Sanger opened a clinic in Brownsville, Brooklyn, again testing the law. Hundreds of women, mostly Jewish and Italian immigrants, flocked there to receive birth control information and instruction. In a newspaper interview, Sanger boasted, “You can hear them calling from house to house in the congested district, ‘Oh, Mrs. Rosenbaum, you ought to see this; this is something fine!'” But after ten days, the police shut the clinic down and arrested Sanger and her colleagues. Sanger spent several weeks in prison, but the sacrifice paid off: The case resulted in a court decision that contraception could be prescribed by doctors in New York State for general health reasons, not just for the prevention of venereal disease.

This court decision, and the tremendous national attention generated through Sanger’s sensational tactics, were major victories. Sanger’s radicalism advanced her cause at this stage, although as she shifted to a more moderate approach, she tried to distance herself from these roots. (She denied any association with Emma Goldman–“Emma Goldman hated me,” she sniffed disingenuously in one letter–even though the anarchist’s vision of free love aided by birth control had in fact inspired her.) Social progress often results from the dovetailing efforts of radicals, who draw attention to a cause, and reformists, who make a more measured case and benefit from comparisons with their extremist counterparts. The primary occupant of both of these roles in the birth control movement was Sanger.

In 1922, the year after William Sanger finally granted Margaret a divorce, she married J. Noah Slee, a rich, rather dull South African-born businessman almost twenty years her senior. It was, the editors note, a marriage of convenience. From that time on, his wealth largely bankrolled the movement as well as her increasingly luxurious lifestyle, although the couple spent amazingly little time together over the years, as Sanger traveled, worked and carried on discreet affairs.

…

As she turned to more conventional advocacy, Sanger founded the American Birth Control League, eventually renamed Planned Parenthood, and the Birth Control Review, which she edited. In 1923 she established and ran the Clinical Research Bureau, which conducted studies and offered contraceptive services–legally, thanks to the court decision her Brownsville clinic had won. (At Sanger’s clinic, the health provision was interpreted liberally to include “child spacing.”) The birth control movement, however, was rife with infighting, as others resented her dominance and her unsystematic administrative style. In 1929 Sanger resigned from both the league and the journal she had founded. (The movement was “more like a group of Billingsgate fishwives than intelligent, responsible women championing a great cause,” she complained in a letter.) But she would move on unflappably to found, that same year, the National Committee on Federal Legislation for Birth Control, devoted to lobbying Congress.

Sanger made her case for birth control with compelling logic. She had a gift for confronting her opponents on their own terms, the better to expose their inconsistencies. In 1915, she wrote, “Tolstoy was opposed to the use of preventives because they liberate men from the cares and sorrows of having children, which he thought must be regarded as the penance to be paid for sensual love. One might naturally ask why the children should be made to suffer; and if sensual love is a degraded love, why not prevent children being born in it?” But of course, Sanger disagreed with that take on sexuality, and–boldly for a woman then–she promoted erotic harmony as key to a healthy marriage. Her arguments against her nemesis, the Catholic Church, were particularly piercing. In a 1932 piece for this magazine, she asked of Jesus, “Did He ever say anything that by any twist of argument can be interpreted to mean that He disapproved of contraception? If He did, why does not the Pope cite chapter and verse?”

Although Sanger’s arguments centered on the rights of women to be emancipated from conscripted motherhood, broader social ideologies were always present as well. Initially anticapitalist, she later adopted eugenic reasoning; later still, during the Depression, she insisted that birth control for the poor would solve the economy’s problems. The common thread was that fewer children were better than more–a reasonable opinion with problematic implications.

Her primary exposure was to the masses of women who desperately wanted to control their family size. She received a constant stream of letters thanking her and soliciting advice, and answered many of them personally and with care. “You must not look upon this relationship as if you were a bad girl,” she wrote to one young woman distraught over the premarital loss of her virginity. But presumably Sanger never received letters from the “unfit” reporting the tragedies that resulted from eugenic policies of forced sterilization. Her own views on the “dysgenic” are chilling. In a speech called “My Way to Peace” (she considered birth control the antidote to war, to boot), she advocated “a stern and rigid policy of sterilization” in order to control the reproduction of “morons, mental defectives, epileptics.”

She did not regard the poor as inherently “unfit”–after all, she herself came from a poor family. She believed access to birth control would enable the working classes to provide for and nurture their children; lower quantity would mean higher quality. And in a milieu where racism was common, she frowned on prejudice in her clients and won the admiration of W.E.B. Du Bois for her work with the black community. But she believed that certain traits, such as epilepsy, mental retardation and physical disabilities, should disqualify people from reproducing. In 1934, in response to a questionnaire for the Yale News, she wrote of the new Nazi sterilization laws for the “unfit” (which were based on the proposals of American eugenicists): “If by ‘unfit’ is meant the physical or mental defects of a human being, that is an admirable gesture but if ‘unfit’ refers to races or religions, then that is another matter which I frankly deplore.” (Sanger later helped a number of Jews escape from Europe by promising them work in the States.)

Sanger’s concept of worthwhile life, then, was ruthlessly narrow, and she readily disregarded the rights of certain people. Also, she naïvely failed to see that oppression easily leaks beyond porous barriers. In Nazi Germany, the sterilization laws she admired–explicitly directed at the mentally retarded, schizophrenic and comparable classes–were, of course, soon turned against the Jews and other ethnic groups.

In the United States, involuntary sterilization was also scandalously widespread. In 1927 the practice received the blessing of the Supreme Court in Buck v. Bell, which upheld the compulsory sterilization of a poor young mother, Carrie Buck, who was deemed “feeble-minded.” The laws technically applied to the “feeble-minded” and other pseudo-scientifically designated “dysgenic” sorts. But in practice, the victims of involuntary sterilization–and there were tens of thousands of them, over the course of decades–were simply poor women and girls, disproportionately black, Puerto Rican and Native American.

…

What lessons can be taken from Sanger today? In the thorny domain of reproductive politics, widely divergent ideologies can coincide in some of the same conclusions. Sanger’s heirs can be sure to disentangle true reproductive freedom from related doctrines and policies that actually jeopardize it. A given tool is not an intrinsic good. Abortion, for example, is a tremendous relief for one woman; for another, it’s a heartbreaking choice made out of economic necessity; for a third, it’s the result of coercive population policies in a country like China. Sanger’s tendency to advocate her tool as a panacea is understandable, especially when the fight for access is uphill. But the real good is more abstract and complex: the ability of all women to make their own reproductive decisions.

The women’s movement has already come a long way in learning these lessons. In recent decades, many feminists, especially minorities familiar with sterilization abuse or coerced contraception, have expanded the concept of reproductive rights to include the right to have children as well as the right not to. This contingent also takes issue with the notion of birth control as a solution to poverty. From this perspective, in a society of true reproductive justice, support would be available to help women bear and raise healthy children. Today, the dangers of coercive reproductive politics have not entirely vanished, but the voices of marginalized women ignored in Sanger’s time are now more audible within the American movement.

The conflation of eugenics and reproductive rights has resurfaced, however, in a different context. New genetic technologies herald the arrival of a “new eugenics,” allowing the creation of “designer babies.” The original eugenics was a misguided utopian scheme gone disastrously awry, all too typical of its time; the sequel, appropriately for ours, is about consumer choice. In both cases, threats lurk among the apparent promises: This time, unfettered use of enhancement technologies could lead to starkly deepened inequalities and disconcerting control over human evolution. Whatever Sanger would have made of this new eugenics, she likely would have been surprised to see its cheerleaders appropriate the language of “reproductive choice.” John Robertson, for example, a law professor and bioethicist at the University of Texas, advocates access to some of these technologies on the grounds of “procreative liberty.” Reproductive rights advocates today are rightly wary of this association.

But Sanger’s most important legacy is her advocacy on behalf of women’s rights and health. Her movement revolutionized mainstream society’s ideas of contraception, bringing the subject “out of the gutter” and reframing it as essential to women’s health and well-being. The push for abortion rights by feminists later in the century was an extension of that logic. (Although Sanger endorsed abortion in her early years, for most of her life she publicly disavowed it for political reasons.)

In 1929 Sanger began lobbying Congress and testifying about birth control; talk of such matters was unprecedented in those solemn halls. As she wrote to a colleague, “Their faces were scarlet! Poor darlings they wanted to escape but they had to sit & listen to what women endure.” Although this legislative effort bore no direct fruit, Sanger got her victory, once again, from the courts, in the 1936 U.S. v. One Package of Japanese Pessaries case. Her clinic’s staff doctor, Hannah Stone, was the recipient of this package, which was confiscated on a tip from Sanger, who wanted the chance to argue the point before the court. The ensuing case resulted in a decision in the US Circuit Court of Appeals ruling that contraceptives could no longer be classified as obscene. Shortly before her death, Sanger witnessed another triumph: the 1965 Supreme Court decision in Griswold v. Connecticut, which overturned Connecticut’s law against contraception for married couples. The decision articulated the right to privacy and paved the way for Roe v. Wade eight years later.

Sanger’s lobbying coincided with Prohibition and the Depression, and most lawmakers didn’t want to touch her issue. As she wrote ruefully in a letter, “One Senator told me that prohibition was a greater peril than any harm that could be done by lack of knowledge of birth control. This was quite logical from his point of view. He never had to bear a child and for him to do without a drink is a great hardship.” The judicial branch, in her lifetime and afterward, has been a more reliable friend to reproductive rights.

But that has begun to change. Since Roe, several cases have chipped away at the constitutional right it guaranteed. And the erosion is accelerating. The Supreme Court’s decision in April upholding the Partial-Birth Abortion Ban Act, ruling against Planned Parenthood and Dr. LeRoy Carhart, is, as Justice Ruth Bader Ginsburg wrote in her dissent, “alarming.” For the first time since Roe, the Court upheld a law that lacks an exception for the woman’s health, overriding the testimony of physicians that the procedure–known medically as intact dilation and evacuation–is sometimes the safest option. The five Justices in the majority betrayed the same attitude as Sanger’s solipsistic senator. Justice Anthony Kennedy’s poorly argued opinion appears to be based far more on antiabortion propaganda than on precedent.

This ruling is only one example of the resurgence of Sanger’s opponents. Today, fundamentalist pharmacists refuse to fill prescriptions for birth control pills; some health plans cover Viagra but not contraception; Fox News recently rejected a Trojan ad because “advertising must stress health-related uses rather than the prevention of pregnancy.” Sanger must be rolling over in her grave, while Comstock laughs somewhere. Still, against much greater odds, Sanger never lost faith that the last laugh would go to the side of reason.

Over the last century, the link between sex and reproduction has weakened. Feminist activism, aided by technological advances, has given middle-class women in the United States widespread access to effective contraception and safe, legal abortion. Although far too many exceptions persist, for large numbers of women, sex today has no necessary relationship to childbearing. Meanwhile, a burgeoning fertility industry has, for thousands, taken baby-making from the bedroom to the laboratory.

In vitro fertilization (IVF) does not merely help the infertile to procreate; increasingly, it allows parents to determine the genetic makeup of their offspring. Initially, preimplantation genetic diagnosis (PGD) targeted severe childhood diseases, such as Tay-Sachs and sickle cell anemia. Now, more parents use it to screen out genes for late-onset, treatable diseases, such as colon cancer; sex selection is also popular. According to a 2006 survey conducted by the Genetics and Public Policy Center at Johns Hopkins University, 42 percent of 137 IVF-PGD clinics allowed parents to select for gender. Scientists predict that parents will be able to choose such characteristics as blue eyes or curly hair. Less certain, but plausible, is that scientists will be able to identify genes for more complex traits, such as intelligence and homosexuality. Genetic engineering, which will enable not merely the selection but the insertion of desired genes, is on the horizon. In the United States, this rapidly advancing technology is unchecked by any regulatory mechanism.

It will emerge as an important political issue, complicated by competing values, such as individual liberty and social equality. Nowhere will this tension be more conspicuous than in the reproductive rights movement. There is a lot of messy overlap between reproductive rights and what could emerge as a neo-eugenics: both benefit from the separation of sex and reproduction and both entail increased “choice.” Pro-choice advocates already find themselves associated with advocates of this “reprogenetic” technology, who often appropriate pro-choice language. “It’s about Reproductive Rights, Stupid,” reads the title of an article on the Web site betterhumans.com, which promotes the use of biotechnologies to improve the human species.

Even without the borrowed buzzwords, the pro-choice movement would be uneasily close to the issue. Historically, pro-choice arguments have focused on the right to privacy and freedom from government interference. Legally, those are the terms that define reproductive rights. The landmark Supreme Court cases Connecticut v. Griswold (1965) and Roe v. Wade (1973) recognized the right of individuals to control their reproductive destinies. Legal scholars predict that when the question of selecting the traits of offspring inevitably arrives in court, it will be considered in this framework.

Like it or not, pro-choice groups, then, will be compelled to take a stand. They will have to distinguish their concept of reproductive rights from that advanced by neo-eugenicists and to decide whether and how to endorse regulation of reproductive technologies without jeopardizing already tenuous rights. But along with these challenges come opportunities. By incorporating concerns about the abuse of reproductive technologies into a pro-choice platform, the movement can shift away from an individual-liberties paradigm toward a social justice orientation; move away from a single-issue focus on abortion toward a more comprehensive agenda; and form coalitions with other segments of the left.

The link between reproductive rights and eugenics is not new; in fact, it has dogged the movement since its early days. Margaret Sanger, the tireless pioneer of birth control in the United States, started out in the early twentieth century as a radical socialist and feminist. A nurse with working-class origins, she saw firsthand the travails of poor women drained physically and financially by endless births. Sanger believed that birth control—legally restricted at the time—was all but a panacea for society’s ills. She launched a crusade, even subordinating other values to the cause: during World War I, for example, she kept quiet about her pacifist beliefs out of fear that her unpopular opinion would undermine support for birth control.

By 1919, Sanger’s far-left political background was a liability in a climate hostile to radicalism. At the same time, the eugenics movement was seen as socially responsible and forward-thinking by the public and many intellectuals. Eugenicists argued that society would benefit if families with “good genes” reproduced prolifically, while the “unfit” refrained from procreating.

To advance the latter goal, some eugenicists advocated sterilization, by force, if necessary. This option was presented as a humane alternative: the “dysgenic” would not have to be permanently institutionalized or even remain celibate to avoid propagating their undesirable genes. Forced sterilization received Supreme Court approval in Buck v. Bell (1927). Justice Oliver Wendell Holmes, Jr., famously wrote, “It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind . . . . Three generations of imbeciles are enough.” Numerous state laws were enacted to authorize forced sterilization.

In an attempt to gain the imprimatur of science, and in a move that has since haunted her legacy, Sanger became associated with the eugenics movement. She had promoted birth control for the poor because she saw that they suffered most for the lack of it. The well-off always managed to procure means for controlling their fertility; Sanger’s poor patients begged her for the secrets of the rich. When she embraced eugenics, her rhetoric adapted easily to the values of the movement. “While I personally believe in the sterilization of the feeble-minded, the insane and the syphiletic [sic],” she wrote in 1919, “I have not been able to discover that these measures are more than superficial deterrents when applied to the constantly growing stream of the unfit. . . . Birth control, on the other hand, not only opens the way to the eugenist [sic], but it preserves his work.”

This early association, along with certain government policies, helped to taint birth control and abortion in the eyes of many minorities. Plenty of poor white people suffered under eugenic policies, but black, Hispanic, and indigenous women were targeted disproportionately. (In the rural South, sterilizations of black women—often performed without their knowledge following childbirth, abortion, or other operations—were known as the “Mississippi appendectomy,” a term coined by Fannie Lou Hamer to describe her own.) In the 1960s and 1970s, the Black Panther Party and the Nation of Islam both denounced birth control as genocidal. Other groups, such as the National Association for the Advancement of Colored People and the Student Non-violent Coordinating Committee, also harbored suspicions. When the government funded birth control rather than health care or child care in poor communities, some activists angrily pointed out that reducing the number of poor people was not the same as reducing poverty. Fears ran deep that contraception and abortion, as well as sterilization, were means of controlling, if not eliminating, these communities.

Meanwhile, the mainstream pro-choice movement was operating from a vastly different perspective. Mainstream feminists wanted the choice not to have children, to be emancipated from the constraints of the traditional female role. Rarely did white women have to fight to have children; the struggle was to avoid having them. In the 1960s and 1970s, abortion rights activists framed the debate in terms of feminism and sexual liberation. The movement triumphed with Roe v. Wade.

In the following decades, some strands of the mainstream pro-choice movement, notably NARAL (then known as the National Abortion Rights Action League), modified their approach in the face of changing political realities. In the aftermath of the Webster v. Reproductive Health Services Supreme Court decision (1989), which upheld a Missouri statute prohibiting the use of public facilities for abortions, NARAL launched its successful “Who Decides?” campaign, which toned down the women’s liberation language and focused on the right to freedom from government intervention. As Kate Michelman, until recently NARAL’s president, recalls in her 2005 book, With Liberty and Justice for All, “The issue was not whether abortion was morally right or wrong; that was a matter of individual conscience. The question was, who had the right to decide—women or the government?” On the defensive against a passionately committed (and sometimes murderous) anti-abortion movement, many feminists focused more intensively on abortion, shifting energy away from other goals, such as child care, maternity leave, and support for alternative sexual lifestyles. All of these had once been integral parts of the feminist pro-choice agenda, as Carole Joffe discussed in these pages (“It’s Not Just Abortion, Stupid,” Winter 2005).

Although arguably a political necessity at the time, focusing on abortion and adopting an individual liberties paradigm had its costs. (William Saletan has analyzed the campaign in his book Bearing Right: How Conservatives Won the Abortion War.) One was the loss of a compelling moral narrative, which left a vacuum for the anti-abortion side to fill. Another was the alienation of poor minority women. Abortion was less of a priority for women struggling with multiple reproductive challenges: environmental hazards, lack of health care and child care, the fear of coerced sterilization. Some of those who wanted abortions couldn’t afford to pay for them, so the freedom from government intervention was inadequate. The racial component of reproductive politics has been analyzed by scholars such as Dorothy Roberts in Killing the Black Body and Jennifer Nelson in Women of Color and the Reproductive Rights Movement.

Currently, the pro-choice movement is under siege to a greater degree than any time since 1973, a situation that has led it to reassess its strategy. Now, some supporters of abortion rights want to move beyond the stagnant terms of the debate. Efforts to rethink the conventional approach are evident in the work of Frances Kissling, former president of Catholics for a Free Choice; “reproductive justice” advocates, including Loretta Ross; mainstream players in the Democratic Party, such as George Lakoff, a linguist and consultant; and would-be presidential nominee Hillary Clinton; as well as many other feminists and activists. The term “choice” itself has come under scrutiny, often criticized as a problematic concept and a weak and morally flaccid competitor with “life.” Recent documents, such as Beyond Choice, a 2004 book by Alexander Sanger, grandson of Margaret and chair of the International Planned Parenthood Council, and More than a Choice, a 2006 paper by the Center for American Progress, reflect this attitude.

Choice rhetoric has seeped into other aspects of feminism as well, with mixed results. Linda Hirschman caused a stir in 2005 with an article in the American Prospect decrying “choice feminism”—the notion that staying home with the kids is as feminist as working, provided that it’s the woman’s “choice.” Her article focused on the “mommy wars” debate, but the same rationale can apply to other aspects of female life. Some women assert that anything from wearing lipstick to topless dancing can be a feminist act, because a woman is empowered by her choice to perform it. (Ariel Levy discusses this phenomenon in her book Female Chauvinist Pigs.) Hirschman argued that women, with the goal of collective advancement in mind, ought to aggressively pursue high-power, high-paying positions.

Although I don’t agree with everything Hirschman wrote—for instance, that we should eschew low-paying, socially beneficial work in favor of cutthroat corporate success—I think she was onto something. “Choice feminism” is uncomfortably close to the ethos of consumer culture. A feminism that consecrates individual choices, endorsing them all as equally valid, has lost its mission and its soul. (Indeed, “choice feminism” is Hirschman’s term, not a movement with an agenda; but some women do subscribe to the idea.)

And here is where the reprogenetic technologies fit in. What is a “designer baby” but a new consumer choice? When a vague, distorted feminism is conflated with enthusiastic consumerism, when “choice” is the catchword of both, designer babies can easily emerge as the natural, if not inevitable, next step in the evolution of our liberated, capitalist society, in which choices will continue to multiply for consumers—especially for those consumers par excellence, women.

Eugenics is a bad word, and “designer baby” is a term the media use to conjure science fiction dystopias, but is it really wrong to use new technologies to improve the human species?

There’s no easy answer. Many people instinctively react against the idea of tinkering with genetics. It evokes fears of playing God, of technological experimentation gone horribly awry, even of the end of humanity as we know it. If only, or primarily, out of pure nostalgia, a lot of us bristle at the prospect.

Approached on the level of specifics, however, the questions appear more complicated. A couple profiled in The New York Times underwent elective in vitro fertilization—even though they could likely have conceived without it—in order to choose an embryo without a gene that would predispose their child to colon cancer. There are several possible criticisms of their decision. Colon cancer is a late-onset, treatable disease. By the time the child is an adult, a cure may be found. The gene is not even certain to cause the disease. How can they justify the expenditure and the godlike control they’ve assumed? On the other hand, their family has suffered immensely from this disease, and they want to ensure that their child avoids that suffering. If the technology is available, and they choose to spend their money on it, how can we deprive them of that option?

This example leads us down the slippery slope. Where, and how, do we draw the line between acceptable and unacceptable? Many people condone health-related genetic tinkering, but not a cosmetic kind. Or, we may feel comfortable with treatment, but not enhancement. Yet, in a culture in which health and beauty are increasingly conflated, as are treatments and enhancements (as more natural variation is pathologized), these distinctions are exceedingly difficult to make. It is even more difficult to imagine how they would be regulated.

The “new eugenics” is in many ways the opposite of its predecessor. The original eugenics was largely “negative”: its goal was to curtail the population growth of the “unfit,” often through involuntary, state-sanctioned, sometimes state-funded sterilization. Today’s version is “positive”: it allows for the creation of more desirable babies. (Granted, it could be interpreted as negative because, at this stage, it involves discarding “unfit” embryos. And the original eugenics also included a “positive” element: encouraging “fit families” to breed.) The more meaningful distinction is that the original eugenics involved coercion, depriving people of their rights and liberties. Today’s variety technically does the opposite: the technologies offer more choices. Indeed, some proponents of their use accuse “bio-Luddites” of being the true descendants of eugenicists—for proposing state interference in the arena, for seeking to circumscribe the full range of available “reproductive choices.”

But individual choices can have larger social consequences. Princeton professor Lee Silver has outlined a nightmarish scenario in which an essentially new species evolves: “The GenRich class and the Natural class will become entirely separate species with no ability to crossbreed, and with as much romantic interest in each other as a current human would have for a chimpanzee.” Others, such as bioethicist George Annas, have worried that such a scenario could undermine the notion of human rights, which is based on a concept of our shared humanity. On a less existentially threatening but disturbing note, Annas and others have also predicted an “arms race” among relatively affluent parents: added to pressure to enroll kids in the most prestigious preschools will be pressure to provide them with the best genes. The result could be an increased tendency to see children as commodities and status markers; on the other hand, parents who choose to forgo these measures could be seen as negligent.

Clearly, there is great potential for good as well as harm in these technologies. They shouldn’t be left, as they currently are, entirely to the market. It’s time for a society-wide conversation about their use and abuse. The United States is lagging in this regard. Many countries, mostly in Europe, but also Canada, Australia, and Trinidad and Tobago have passed laws or regulations restricting or proscribing various kinds of genetic modifications. The United Kingdom has the Human Fertilization and Embryology Authority (HFEA), which licenses and monitors all fertility clinics.

This issue creates strange bedmates. The common political assumption is that conservatives would oppose the potentially radical change promised by reprogenetic technologies, while liberals would embrace the scientific progress they represent. And indeed, the religious right, concerned about the embryo and the blasphemy of playing God, condemns them, while some liberals are more inclined to welcome them on the grounds of “progress”—and, perhaps, in opposition to “culture of life” priorities. At the same time, economic libertarians oppose regulation of this three-billion-dollar-a-year industry, and a fringe of neo-eugenicists wants to create a super race. Qualms on the left include the potential exacerbation of inequalities, the eugenic overtones, and the environmental implications of meddling with nature.

Other progressive contingents have their worries. Disability activists are wary of technologies that essentially aim to eliminate their community. Gay and lesbian people have an especially complex relationship to assisted reproductive technology. I spoke to staff at the GLBT (Gay, Lesbian, Bisexual and Trans-gendered) Community Center in New York, who said that to the extent that it helps them have genetically related families, they welcome the technology. But if a “gay gene” is ever identified, their communities, too, could be threatened. Many feminists are troubled by sex selection, but fear that regulating any aspect of reproduction could jeopardize abortion rights.

The relevant legal infrastructure adds another complication. The court decisions that uphold rights valued by progressives could also afford protection to the right to design babies. This applies to all of the major cases affirming the right to contraception and abortion: Griswold and Roe, but also Eisenstadt v. Baird (1972), which recognized the right of unmarried people to use contraception, and even Planned Parenthood v. Casey (1992), which allowed some restrictions on abortion but reiterated the essential right of people to make decisions regarding reproduction. Further, Lawrence v. Texas (2003), hailed by the left for striking down sodomy laws, dramatically limits the ability of government to restrict personal decisions “absent injury to a person or abuse of an institution the law protects.” Although progressives welcome these freedoms, the implications for the unfettered use of reprogenetic technologies are disturbing. (Of course, the recent decision in Gonzalez v. Carhart raises questions about the durability of these liberties under the current Supreme Court.)

Legal issues aside, in the court of public opinion reproductive rights may be conflated with a libertarian view on genetic technologies. University of Texas law professor John Robertson has defended the use of reprogenetic technologies on the grounds of “procreative liberty.” His argument goes like this: people have the right to procreate; sometimes the choice whether to procreate depends on the qualities of the prospective offspring; therefore, enhancement must be permitted (although he endorses limited restrictions). British author Nicholas Agar, in his recent book Liberal Eugenics, writes, “The eugenics defended here [is] primarily concerned with the protection and extension of reproductive freedom.” Thus can the concept of reproductive choice be appropriated and abused.

The first and least controversial task for pro-choice activists, then, is to make it very clear that the rights for which they have fought are fundamentally different from the right to determine the genetic makeup of offspring. Whether the latter right is legitimate or not, it is not the same as or an extension of the former. Pro-choice activists have struggled for women’s freedom to control their own lives and bodies, not to control the lives and bodies of their children.

Drawing this distinction could lead to another step: emphasizing the morality of abortion rights. Abortion should be legal because women should have the same rights as men to shape their lives; because sometimes bringing a child into the world is the wrong thing to do; because without legal abortion, women suffer and die. Abortion-rights advocates can frame abortion as a matter of social justice, not just of freedom from government interference.

As an alternative to “choice,” women of color have created the concept of “reproductive justice.” In the literature of SisterSong Women of Color Reproductive Health Collective, the national coordinator, Loretta Ross, defines the term, coined in 1994, as “(1) the right to have a child; (2) the right not to have a child; (3) the right to parent the children we have . . . . We also fight for the necessary enabling conditions to realize these rights.” This more comprehensive notion of reproductive justice can be useful in confronting the issue of designer babies. Although not currently one of the main items on the reproductive justice agenda, a position on reprogenetic technologies can easily be added to the list of concerns, which include environmental hazards and health care. In fact, of the reproductive rights activists I’ve spoken to, Ross was the most sympathetic to the prospect of regulating these technologies.

As Joffe pointed out in the Dissent article mentioned earlier, “the logic of seeing abortion as just one part of the mosaic of reproductive and sexual rights and services is not simply that it is persuasive to others. It is also the most authentic position of the reproductive freedom movement itself.” Reproductive technologies did not factor into the original movement, because they didn’t yet exist. But now that they do, promoting sensible policies on their use should fit into a broader platform. Such a platform could appeal to other factions of the left as well as moderates, who might be turned off by the focus on abortion but who share concerns about related issues, including the abuse of reprogenetic technologies.

The concept of reproductive justice has already made inroads into the mainstream movement. The pro-choice movement eludes generalization, because different organizations have different priorities and approaches, but many parts of it have already begun to shift toward a social justice focus and a broader platform. The literature of Choice USA, a fifteen-year-old organization founded by Gloria Steinem, uses the term reproductive justice, and Planned Parenthood sponsored a conference in 2005 at Smith College titled “Reproductive Justice for All.”

Concerns about reprogenetics have also surfaced. The Planned Parenthood conference devoted a quarter of the agenda to reproductive technologies. The Center for Genetics and Society, billed as “a pro-choice organization working for sensible policies on genetic engineering technology,” aims to initiate and facilitate conversations about the subject. One effort was a retreat in October 2006 with representatives from various progressive organizations, including Planned Parenthood, Choice USA, the ACLU, the disability rights group Not Dead Yet, and the LGBT Community Center of New York.

According to Sujatha Jesudason of the Center for Genetics and Society, the groups that attended that retreat were enthusiastic about continuing the conversations within their own organizations and forming coalitions to address the issue. The pro-choice advocates in particular started a process of reflection on the tensions—between individual liberties and social justice—that are especially prominent in their movement.

In contemplating regulation, an example from the past might prove illuminating. In 1975, in New York, a multiracial coalition called the Advisory Committee on Sterilization helped implement guidelines for regulating sterilization, including a mandatory waiting period. The aim was to ensure informed consent, because so many poor minority women had been sterilized without it, in haste. Planned Parenthood and NARAL opposed the restrictions, arguing that they infringed on reproductive freedom. (White women, who frequently could not persuade doctors to sterilize them, did not want to make the process more cumbersome.) This conflict was perhaps the clearest manifestation of the discordant outlooks of different feminists.

The opposition of the mainstream groups was understandable, but it also reflected a degree of myopia. Likewise, Margaret Sanger was so single-minded in the promotion of her cause that she endorsed wrongheaded ideas that she believed would serve it. Now, we who support abortion rights may fear that regulating reproductive technologies could endanger our cause. There is no doubt that maintaining the legality of abortion—and fighting to reverse harmful restrictions of it—is paramount. But it is also important for us to sustain a larger moral vision. We have to find a way to advance that multifaceted program, including views on reproductive technologies, while protecting the right to abortion.

It appears inevitable that genetic technologies of all kinds will become one of the major issues of this century. It appears equally inevitable that the pro-choice movement will become entangled in the debate. In this new challenge, Margaret Sanger provides an instructive example—today’s reproductive-rights advocates should emulate her passionate advocacy and avoid repeating her mistakes.

Turkish writer Yashar Kemal is best known for Memed, My Hawk (1955), the first of four novels starring the title’s good-hearted brigand. They Burn the Thistles concludes this quartet. Originally published in 1969 and situated in the early twentieth century, the novel feels much older than either period. The tone is anachronistically free of self-consciousness and irony; the setting, too, is untouched by the “bourgeois class” that Kemal, perennially rumored to be a Nobel Prize candidate, finds “rotten.” Peasants plow and herd, individualism is minimal—some quotes are attributed to entire villages—and loyalty never wavers.

Not that we’ve landed in some prelapsarian idyll. When our hero first appears in Memed, My Hawk, he is a traumatized adolescent, running through fields of thistles to escape Abdi Agha, the landlord who terrorizes his tenant farmers. Later, after attempting to kill his enemy, Memed flees the village and joins a band of outlaws in the mountains. Like a more revolutionary Robin Hood, he dreams of offing cruel landowners and liberating the peasants. The people, in turn, develop an unbreakable loyalty to the legendary rebel. Unbeknownst to most of his admirers, he remains a “puny boy” who cries in his sleep. (Kemal has a refreshing, modern sense of humor about his hero.) Still, the popular awe is not misplaced. When visited by righteous anger, Memed subtly transforms, and the “needlepoint of light” in his eye dispels all doubts. Bullets seem to avoid him, while his own aim is mysteriously unerring.

As They Burn the Thistles opens, Memed is on the lam, having at last succeeded in assassinating Abdi Agha. His mission supplies the story’s adventure, but the subplots, animated by mighty passions, are more poignant and indelible. Kemal describes emotions in simple, direct language. The lovely Seyran, falling for Memed, “was aware that within her something had stirred… that she was being agitated by mixed feelings which resembled pity, love, motherliness and friendship.” Adem, a landlord’s lackey, receives orders to track down a magnificent stallion, but the creature appears to possess supernatural powers, vanishing at will. Adem longs for his wife, but, befuddled by his own tenacity, can’t give up his pursuit. “Is this horse my father, my limbs, my eyes?” he shouts.

Kemal’s characters are unable to check their emotions, which seem to assail them from external sources. These passions may lead to ecstasy or ruin, but either way there’s pathos in the characters’ vulnerability to them. Even indecision, far from a namby-pamby state, consists of comically wild swings between opposite certainties. It’s a world of excessive life, and the vitality is not limited to human fervor. Kemal also turns his sensuous attention to nature—sometimes pages go by without reference to a person, as he inventories the snakes and beetles and barberry shrubs.

Born in 1922 to a Kurdish family, Kemal has spent time in prison for his activism, and his leftist politics informs his work. To his credit, Thistles reads more like a juicy folktale than a treatise about the exploitation of labor. Finally, though, the message is unavoidable, even didactic: despite the Sisyphean frustrations of fighting injustice, “We struggle.” The richness of Kemal’s storytelling has earned him the right to preach a little—indeed, one of his strengths is his guilelessness. It’s the same reason he gets away with explicit reports of his characters’ feelings. What would come off as too bald in a lesser writer often seems here like radical honesty.

Circa 1970, one pro-choice activist explained the significance of abortion this way: “We can get all the rights in the world,” she said, but “none of them means a doggone thing if we don’t own the flesh we stand in.” Abortion mattered just as deeply to its opponents, including future Buffalo, New York, mayor Jimmy Griffin. “I suppose I’m a square,” Griffin said around the same time, “but I see these plans to liberalize abortion as another sign of the permissiveness, the decay of our society.”

In Absolute Convictions, journalist Eyal Press documents the battle born of these irreconcilable outlooks. His interest is more than that of a detached reporter: Shortly after women’s libbers and squares declared war, his father, Dr. Shalom Press, unwittingly sauntered onto the battlefield. Dr. Press emigrated from Israel to Buffalo in 1973 and soon began performing abortions in addition to delivering babies. No one told him about the passions and meanings attached to this operation in his adopted country. In the decades to come, he would brave death threats, protests outside his office, and the 1998 assassination of a colleague, Dr. Barnett Slepian. An unflappable sabra, Dr. Press resolved to continue what he saw as a necessary service. But he had started because, as he told his son decades later, “It was work.” Deftly integrating personal and social history, Press junior chronicles his father’s path to accidental heroism (or villainy, according to the graffiti on his car).

As it happened, the author’s hometown was a hotbed of pro-life activism. Abortion was legalized in New York State in 1970, despite opposition from heavily Catholic Buffalo. Press’s analysis of Buffalonian conservatism smacks of Thomas Frank: Apparently, what’s the matter with Kansas is also the matter with Buffalo. In the ’70s, following the exodus of factory jobs, resentment began to build against an immoral elite. But the anger (manipulated by conservative politicians, Press suggests) was directed not at union busters and fat cats, but at the homosexuals and “pro-aborts” who were sending the culture to hell.

Press shows that amid all the “absolute convictions,” the people who make abortion possible tend to be pragmatists, not ideologues. Many physicians, like Dr. Press, think of abortion as merely a medical procedure. Those who have come to feel strongly about reproductive rights—again like Dr. Press—were swayed by their exposure to the need. Some older physicians support legalization for different practical reasons. Theirs is the coat-hanger rationale: They’ve seen the bloody consequences of criminalization.

The other pragmatists in this story are the patients, several of whom Press interviews at his father’s clinic. Catholic “Jessica” had passed out pictures of aborted fetuses to high school classmates a few years back. Her positive pregnancy test had changed her views. She tells Press that, at age 19, “I’m just not ready to be a mom.” The two others, already mothers, can’t afford to add another kid’s worth of expenses to their debt. To these women, abortion is not a symbol.

To its most extremist foes, abortion isn’t necessarily a symbol either. That it’s murder is grounds enough for fervent opposition—and for, well, murder. Press believes the protests against doctors, especially the acts of violence, have had a “chilling effect.” Between 1992 and 2005, Press writes, six doctors and clinic workers were killed—including Buffalo’s Slepian—and hundreds of abortion providers closed shop. But the same forces have galvanized some doctors. When Shalom Press retires, abortion will be legally available in Buffalo thanks only to a few physicians who fly in from other states—a testament to the success of the scare tactics as well as the commitment to neutralize them.

A scrupulous reporter (and regular contributor to The Nation), Eyal Press is more comfortable with facts and political commentary than with feelings and storytelling. In emotional territory, he resorts to cliché—chills run down his spine, he gets knots in his stomach—and his descriptive prose often seems forced. Still, the memoir component is sufficiently well executed to provide an absorbing narrative, and his father emerges as a courageous character. Besides, the author’s aversion to navel-gazing—not to mention his fidelity to facts—is refreshing. Also refreshing is his even-handedness. While clearly pro-choice (he never says so explicitly), Press acknowledges that in the pro-life moral universe— “a world where every unborn child represents God’s creation and life begins at conception, where this is not a matter of debate but of truth as handed down in Scripture—the ethical imperative is clear.”

Ironically, if there’s a lacuna in this book, it’s that the pro-choice argument is not spelled out in its full complexity. Press doesn’t cite the most eloquent pro-choice partisans—such as his Nation colleague Katha Pollitt—to explain why abortion can be the moral option for women and for a society with limited resources. In part, that’s because his focus is on the movement whose activities have so disrupted his father’s life, while pro-choice activism plays a far smaller role in his story. Indeed, he refers to the “complacency that Roe had bred” in the pro-choice camp. But as Press makes clear at the end of his account, the momentum has shifted. Now any complacent pro-choicer is as naive about the issue as Shalom Press was when his plane landed in Buffalo.