Authoritative Knowledge and Single Women's Unintentional Pregnancies, Abortion and Single Motherhood

American Anthropological Association
Wiley
Authoritative Knowledge and Single Women's Unintentional Pregnancies, Abortions, Adoption,

and Single Motherhood: Social Stigma and Structural Violence
Author(s): Marcia A. Ellison
Source: Medical Anthropology Quarterly, Vol. 17, No. 3 (Sep., 2003), pp. 322-347
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MARCIAA. ELLISON
MassachusettsGeneralHospital
HarvardMedical School
Authoritative Knowledge and Single Women's

UnintentionalPregnancies,Abortions,Adoption,
and Single Motherhood: Social Stigma and
Structural Violence
This article explores the sources of authoritativeknowledgethat shaped

single, white,middle-classwomen'sunintentionalpregnanciesand child-
bearing decisions throughoutfivereproductiveeras. Womenwho termi-
nateda pregnancywere most influencedby theirownpersonal needs and
circumstances.birth mothers'decisions were based on externalsources
of knowledge,such as theirmothers,social workers,and social pressures.
In contrast,single mothersbased their decision on instinctsand their re-
ligious or moral beliefs. Reproductivepolicies further constrainedand
significantlyshaped women's experiences.The social stigma associated
with theseforms of stratifiedmaternitysuggests that categorizingpreg-
nant women by their marital status, or births as out-of-wedlock,repro-
duces the structuralviolence implicitto normativemodelsoffemale sexu-
ality and maternity.This mixed-methodstudy includedfocus groups to
determine the kinds of knowledge women considered authoritative,a
mailed surveyto quantifythese identifiedsources, and one-on-one inter-
views to explore outcomes in depth. [authoritativeknowledge, social
stigma,abortion,birthmothers,single mothers,unintentionalpregnancies]
We need to anthropologizethe West: show how exotic its constitutionof realityhas

been; emphasizethose domainsmost takenfor grantedas universal... makethem
seem as historicallypeculiaras possible; show how theirclaims to trutharelinkedto
social practicesandhave hence become effective forces in the social world.
-Paul Rabinow[1986]
t least 48 percentof women living in the United States will experiencean

unintentionalpregnancyby midlife.1The lack of public awarenessof the
high rate of unplannedpregnancies, which are neither limited to early
childbearingnor to single women,indicatesthe culturalcensorshipof an experience
Quarterly17(3):322-347.Copyright? 2003,AmericanAnthropological
MedicalAnthropology Association.
322
WOMEN'S
SINGLE UNINTENTIONAL
PREGNANCIES 323
sharedby manywomen andtheirpartners.This censorshipreflectsthe tensionsof a

dominantpronatalistideology within a culturethat increasinglyprizes self-deter-
mination (Blake 1974; Solinger 2001). Planned pregnancies are socially pre-
scribed,andwomen expect to be able to time theirpregnanciesto fit theirlife goals
and family needs at a socially accepted age and maritalstatus. Marriedwomen
avoid social stigmaregardingtheirunplannedfertilitythroughtheirlegal relation-
ship to a man, which allows them to "pass"(Goffman 1963). In contrast,single
women2are particularlyvulnerableto the social stigma surroundingunintentional
pregnancies.3
In the United States,when marriageis not an option,single women who unin-
tentionallyconceive face threealternatives:to terminatetheirpregnancy,to adopt
away their child, or to become a single mother.This study suggests that each of
these alternativespermanentlyandprofoundlyaltersa woman's life courseandher
reproductivehistory or "procreativestory"(Ginsburg1987). The meaning of the
term history as a story or tale is derived from the Greekhistoria, for inquiry,and
from istor, knowing, what is learned.4This study furthersuggests that women's
storiesandthe knowledgethatsingle women glean fromtheirpregnancyandchild-
bearingoutcomeshave been culturallycensored.Moreover,this censorshipsignals
the implicit structuralviolence5(Kleinman2000) thatunderliesnormativemodels
of female sexuality and fertility and the rhetoricof what it means to be a "good"
andworthywoman,mother,andwife.6Becausereproductivepolicies in the United
Stateshave been ethnicallybifurcated(Collins 1995; Davis 1981; Litt2000; Solin-
ger 1992), this studyis limitedto the sourcesof authoritativeknowledgethatshape
single, white, middle-class women's unintentionalpregnancies and their sub-
sequentchildbearingdecisions.7
Pregnancy, Knowledge, and Power

The label "authoritative" is intendedto drawattentionto [the statusof a body of
knowledge] withina particularsocial groupandto the workit does in maintainingthe
group's definitionof moralityandrationality.The powerof authoritativeknowledge
is not thatit is correctbutthatit counts.
-Brigitte Jordan[1997]
Since Jordan'sgroundbreakingwork in the mid-1970s, studies of authorita-

tive knowledge (AK), have clarified how social differences in power, authority,
prestige, and access to resourcesshape birthingpractices.These differencesper-
petuateformsof stratifiedreproduction"thatsupportsandrewardsthe maternityof
some women, while despising or outlawing the mother-workof others" (Rapp
2001:469). For example, the biomedical hierarchiesof hospitals, medical clinics,
andepidemiologytendto reproduceandprivilegea birthingecology dominatedby
technologicalinterventionsand professionaland medical expertise,while occlud-
ing ethnomedicalknowledge and women's embodied knowledge (Jordan1997;
Kitzinger1997). In contrast,birthingpracticesthatminimizesocial hierarchiesbe-
tween birthattendantsandparturientwomantendto incorporatepluralisticsources
of knowledge,such as maternalembodiedknowledge,touch,instincts,ethnomedi-
cal knowledge,andculturalpracticesthatprivilegesocial affiliations(Davis-Floyd
andDavis 1997; Kitzinger1997; Sosa et al. 1980).
324 MEDICAL
ANTHROPOLOGY
QUARTERLY
Studies of authoritativeknowledge in childbirthhave illuminatedthe muta-

ble, context-dependentquality of the birthing knowledge that counts in non-
biomedical settings. For example, among the San, primiparasare not expected to
have the requisiteknowledge to meet the culturalideal of a silent and unassisted
birth;their first birth is often assisted (Biesele 1997). Similarly, in ruralMayan
communities,a midwife may yield to the knowledgeof a multiparain labor,butas-
serther own authorityover an inexperiencedprimipara(Jordan1978; Sargentand
Bascope 1997). Thus, differencesin power and authorityarenot simply indices of
hegemonic versus pluralistic knowledge systems, but may be determined by
women's reproductivehistories.
Women may also resist, negotiate,and reproducethe hegemony of biomedi-
cal birthing.For instance, Betty-Anne Daviss (1997) describes how the secular
logic of an epidemiology-basedprogramto reducematernal-childmortalityrates
inadvertentlyincreasedthe personaltraumato laboringInuitwomen. The practice
of airliftingparturientInuit women to a distanthospitalinvalidatedethnomedical
models and severed women from birth"as a community,social and spiritualact"
(1997:441). Similarly,women of color and working-classwomen, who may face
the triple jeopardy of ethnicity, class, and hegemonic medical models, may be
more likely thanwhite middle-classwomen to resist dominantbiomedicalmodels
and instead draw on parallel systems of knowledge (Litt 2000; Martin 1987). In
contrast,women may inadvertentlyreproducethe hegemonyof medicalmodels, as
they ambivalentlyaccept medical advice regardlessof its actualbenefits, in an at-
tempt to hedge their bets as reflective consumers and responsible mothers
(BrownerandPress 1997).
The dense interplayof agency and social forces revealedin these studies un-
derscoresthatwomen are,ineluctably,neitherfree agentsnorpassive victims. This
study explores one of the historicallymost contestedforms of conception-single
women's unintentionalpregnancies-and underscoresthe intractabletensions be-
tween individualagency and social forces, which arefurthershapedby shiftingre-
productivepolicies.
Five reproductiveeras have profoundlyshapedwomen's fertility-regulating
options in the United States:the mid-19thcenturystatutesthatcriminalizedabor-
tion and the distributionof contraceptives;the cult of motherhoodas a civic duty;
the subsequentcult of scientific motherhood;8the post-World War II adoption
mandate;and the interplayof the FDA approvalof birthcontrolpills in 1960 and
the 1973 passageof Roe v. Wade.Eachof these erasreified shiftingformsof medi-
cal and scientificknowledge.In this study,I explorethe sourcesof knowledgethat
count, and theirmoral and rationalconcomitants,for single women who discover
they have unintentionallyconceived.
CriminalizingAbortionand Contraceptives
Until the mid-19th century,the quickening,when a woman first senses fetal
movement,confirmedpregnancy(Duden 1993). Abortion,which was viewed as a
means to remove "obstructed"menses, was not socially sanctioned;yet abortifa-
cients were widely available to both single and marriedwomen. With the estab-
lishmentof the AmericanMedical Association in 1848, physiciansused the medi-
cal managementof childbirthto separatethemselves from competing models of
SINGLEWOMEN'SUNINTENTIONAL
PREGNANCIES 325
medical knowledge (Mohr 1978). Their purportedbiomedical authorityencom-

passedall aspectsof maternity,includingfemale sexuality,morality,andthe scien-
tific determinationof pregnancyandfetal personhood.By 1872, this consolidation
of medical authority,paralleledby social reform movements, culminatedin the
ComstockAct, which prohibitedthe advertisementandmaileddistributionof con-
traceptivesandabortifacients.Althougha lively black marketfor contraceptivede-
vices and abortifacientscontinuedto thrive (Tone 2001), by the Turnof the Cen-
tury abortionhad become illegal in the United States and women's fertility was
morefirmlyunderlegal andmedicalauthority.
The Cult of Maternityas Civic Duty
The social puritymovementsof the early 1900s, increasedbirthrates among

recentnon-Protestantimmigrants,paralleledby declining birthratesamong white
Anglo-Saxon Protestants,resulted in fears of "race suicide" (Berebitsky 2001;
May 1995). PresidentTheodoreRoosevelt called on white middle-classandupper-
class Protestantwomen to fulfill their civic duty and procreate.His pronatalist
campaignreified maternity,typified by nurturanceand self-sacrifice,as women's
highest calling andcivic duty (Berebitsky2001; May 1995; Solinger 1992). As ur-
banizationandindustrializationincreasedthe genderstratificationof labor,gender
ideals were furtherredefined (Apple 1987; Nathanson 1991). In contrastto the
18th-centurycolonial era, where the practiceof bundlingcontributedto a 33 per-
cent rateof premaritalconceptionsandbirths(LawsonandRhode 1993; Smithand
Hindus 1975),9duringthe Progressiveera feminine purityand premaritalchastity
became the cornerstonesof maternalmoral superiority(Brodie 1994; Nathanson
1991). This reificationof white, middle-classmaternityas a civic need resultedin
the establishmentof evangelical maternityhomes and widows' pensions. Thus, it
was socially expected that single, pregnant,middle-class white women and wid-
ows would keep andraisetheirown children(Berebitsky2000; Kunzel 1993).10
The Cult of ScientificMotherhood
By the 1920s, the advent of the first-wave feminist movement, the newly
formedChildren'sBureau,andrisingmaternal-childmortalityratesculminatedin
the 1921 Sheppard-TownnerAct. This legislation allocated federal funds to pro-
mote hospitalbirthsandincreasewomen's access to obstetricspecialists.Hospitals
offered the "twilightsleep,"x-rays, transfusions,and sterilizedequipment.Scien-
tific expertsprofferedadvice to motherson the managementof householdgerms,
infantfeeding, andchildcare(Apple 1987;WertzandWertz 1977).
As the new science of eugenics garneredculturalauthority,the etiology of
single women's unintentionalpregnanciesshifted from a redeemablemoral fail-
ing, to feeblemindedness,a form of heritable intellectual inferiority.Thus, the
managementof maternityhomes shifted from evangelical charityworkers,to so-
cial workerswith the scientific trainingnecessaryto deal with heritabledisorders
(Kunzel 1993; Solinger 1992). This new scientific approachdictatedthat a single
motherand her child remaintogetherin the maternityhome until the child, at six
monthsof age, could undergoan intelligencetest. Withinthis model, social workers
326 MEDICAL
ANTHROPOLOGY
QUARTERLY
were then able to scientificallymatchthe tested child with adoptiveparents(Bere-

bitsky 2000).
The Post-World WarII AdoptionMandate
From 1960-70,27 percentof all birthsto marriedwomen betweenthe ages of

15 and 29 were conceived premaritally.Yet the etiology of single, white, middle-
class women's conceptionshad shifted again and were now perceivedas a symp-
tom of female neurosis(Solinger 1992; Vincent 1961). In keeping with this medi-
cal model, a single pregnantwoman could obtain a therapeuticabortionif she
could find a physicianwilling to diagnoseheras psychologicallyunsound,or if her
pregnancy could be diagnosed as life threatening.However, the approval of a
boardof hospitalphysicianswas necessaryto obtaina therapeuticabortionand 53
percentof teaching hospitals and 40 percentof all U.S. hospitals, and, thus, their
boards,requiredthat women accept simultaneoussterilizationto preventa future
unplannedpregnancy(Solinger 1998:24).
Given these constraints,the majority(85-95 percent)of single, white middle-
class women, who either could not or would not procurean illegal or therapeutic
abortion,were encouraged,and at times coerced, to adopt away their child (Ed-
wards 1998; McAdoo 1992; Pannoret al. 1978; Solinger 1992, 1993).11Maternity
homes became total institutions where neurotic pregnanciescould be cured by
separatingsingle mothersfrom their children(Solinger 1992). By the 1950s, at-
tachmenttheory dictatedthatthis separationoccur as soon afterbirthas possible,
to promotean infant'sabilityto bond with its marriedadoptiveparents(Berebitsky
2000).12Afterrelinquishingtheirchild, birthmotherscould secretlyreentersociety
as marriageablewomen andbearfuturelegitimatechildren.13
The Oral ContraceptivePill and Roe v. Wade
The civil rights movement, the second-wave women's movement, and the
gay rightsmovementfitfully reconfiguredthe kinds of knowledge thatcountedre-
garding female sexuality, fertility, and maternity.Rising divorce rates, the in-
creased numberof women obtainingsecondaryeducationand in the work force,
and women's delayed childbearing shifted normative models of the family
(Petchesky1984). In 1960, Enovid,the firstFDA approvedoralcontraceptive,was
availableby medical prescription(Marks2001), and by 1965, the SupremeCourt
ruling of Griswoldv. Connecticutguaranteedmarriedcouples the rightto privacy
regardingcontraception.Seven years later, Eisenstadt v. Baird extended these
rights to single women and men, repealingthe last of the century-longComstock
statutes.
As a result of women's access to the pill and the dual 1973 SupremeCourt
rulings-Roe v. WadeandDoe v. Bolton14-that legalized abortion,the numberof
white middle-class women adoptingaway their childrenplummetedfrom 85-95
percent to 3 percent. This rate has not increased since, despite the 1976 Hyde
Amendmentthat prohibitedthe use of Medicaid funds for abortionswhile main-
taining full federal funding for sterilizationor birth expenses, thus limiting poor
andyoungwomen'saccessto abortion(McFarlaneandMeier2001; Solinger1993).
PREGNANCIES
SINGLEWOMEN'SUNINTENTIONAL 327
By 1988, religious fundamentalistantiabortiongroupshad reframedprocrea-

tion as a religious and moralobligationto female naturewhile promotingthe pro-
life position that life begins at conception (Ginsburg 1989; Luker 1984). From
1989-1992, over 700 antiabortionrightsstatuteswere broughtbefore statelegisla-
tors, and by 1992, only 26 percentof U.S. counties had physicianswilling to pro-
vide abortion(Solinger 1993). By 1995, membersof religiousfundamentalistpro-
life groups had murderedtwo employees at a women's health clinic and one
physician who providedabortions.Given this culturalclimate, and the shift away
from the model of unintentionalpregnancyas a neuroticsymptomto be treatedby
separatingsingle women fromtheirchildren,it is not surprisingthatsingle mother-
hood has become single women's most frequentchildbearingdecision, despitere-
cent restrictionson public supportfor single mothers(U.S. Departmentof Health
andHumanServices 1995).
Each reproductiveera comprisedshifts in the sources of knowledge that de-
fined single women's unintentionalpregnancies. In contrastto previous struc-
tural-functionalanalyses of single pregnanciesas a form of "deviant"social be-
havior (Rains 1971; Vincent 1961), this study examines how white middle-class
women negotiate,resist, andreproducethe scientific andbiomedicalauthoritythat
informsnormativemodels of sexuality,fertility,andmaternity.
Methods
This sequential,mixed-methodsstudy (n = 62) evolved from an earlierpilot
study that comparedwomen's long-termoutcomes of abortionversus adoption.15
In the currentstudy,focus groups(n = 24) exploredwomen's perspectivesof unin-
tentionalpregnanciesand childbearingdecisions. These data informedthe devel-
opmentof a mailed, self-administeredquestionnaire(n = 58). Finally,to providea
context for the survey and focus group findings, a subsampleof survey respon-
dents participatedin one-on-one interviews (n = 10). The triangulationof data
across these data caches enhancedthe reliabilityand validity of the study's find-
ings and reducedresearchbias (DeMunck and Sobo 1998; Miles and Huberman
1994).
To explore the impactof shifting reproductivepolicies, the study's age eligi-
bility criteriawas broad,from 22-72. To controlfor the impactof ethnicityon ra-
cially bifurcatedreproductivepolicies, all participantswere of EuroAmericande-
scent. The sample was also limited to women currently residing in southern
California,with the assumptionthatthis highly transientpopulationwould include
women whose pregnancyoccurredin variousregions of the United States.To pro-
vide ample time for long-term evaluations of their decision, participantswere
screenedto ensurethat their pregnancyhad occurredat least seven years priorto
theirparticipationin the study.16
Focus Groups
In a pilot test group (n = 5) and six small focus groups (n = 19), I explored
single women's procreationstoriesandkey issues, such as the kinds of knowledge
thatthey privilegedduringtheirpregnancyandin makingchildbearingdecisions.l7
To control for idiosyncraticgroup responses, I conductedtwo groups for each of
328 MEDICALANTHROPOLOGY
QUARTERLY
the threechildbearingdecisions. Groupswere kept small (n = 3-6). This protected

participants'privacy,increasedthe homogeneityof the groups,and createda safe
place for participantsto discuss sensitive life experiences(Krueger1994; Madriz
2000).18
I moderatedand audiotapedeach of the two-hoursessions. I transcribedthe
tapes verbatim and analyzed them following standardqualitativedata analysis
techniques:open coding to identify core themes, axial coding to determinethe
rangeand dimensionsof each theme, and selective coding to "findthe story in the
data"(StraussandCorbin1995).19
The topics relevantto AK were:(1) How do single women feel when they dis-
cover they unintentionallyconceived? (2) Who do single women turnto for help
and advice in dealing with their pregnancies? and (3) What most influences
women's childbearingdecisions duringan unintentionalpregnancy?The sources
of authoritativeknowledge identifiedin the groupdiscussionsinformedthe devel-
opmentof the surveyitems describedbelow.
Surveys
I reviewed existing surveys and scales, none of which fit the study's focus.
Therefore,I used the focus groupdatato generaterelevantsurveyitems. I pretested
the surveyin a focus groupsetting,which consistedof the most vocal formerfocus
group participants.This sample enhancedthe likelihood that participantswould
thoroughlyandopenly critiquethe surveyinstrument.
The revised mailed self-administeredsurvey included two items measuring
authoritativeknowledge: (1) At the time of your first unplannedpregnancy,who
had the most influence on you in reachingyour decision? (2) How importantwere
each of the following in making your decision about your pregnancy?20Likert
scales measuredthe level of influence/importanceof each item (i.e., from "1" [not
at all] to "7"[verymuch]).21
I analyzedcontinuousdatausing the Kruskal-Wallistest.22Categoricalvari-
ables were analyzedusing the chi-squaretest (ao= .05, two-sided).The surveypar-
ticipants (n = 58) were identified through a random sample (n = 24), snowball
sample (n = 6), respondentsto the focus groupadvertisements(n = 23), purposive
samplingthroughan adoption-affectedsupportgroup(n = 4), anda newspaperad-
vertisementfor birthmothersandsingle mothers(n = 1).23
Interviews
A small sample of survey respondents(n = 10) participatedin a two-hour,
one-on-one, face-to-face interview with me.24The participantswere purposively
sampledby theirpositive or negative outcomes.25I interviewedfour women who
had had an abortion(two positive and two negative outcomes) and four women
who had adoptedaway their child (two positive and two negative outcomes). Be-
cause the small sampleof single mothersresultedin overwhelminglypositive out-
comes, I only interviewedtwo single mothers.I transcribedthe audiotapedinter-
views verbatim and analyzed them using the same qualitative data analysis
proceduresdescribed above for the focus group data. Given my previous pilot
study, and the data caches described above, only a small numberof interviews
PREGNANCIES 329
were necessary to reach theoretical saturation(Sandelowski 1995; Strauss and

Corbin 1995). The interviewsincludedtopics such as what it meantto the women
to discover they had unintentionallyconceived, how their pregnancyand child-
bearingexperiencesimpactedtheirsense of self and social status,andhow they ne-
gotiateddisclosureabouttheirpregnancyandchildbearingdecisions.
Findings: Survey Demographics

The survey respondents(n = 58) included 26 women who terminatedtheir
pregnancy,21 birthmothers,and 11 single mothers.26 The currentage of the survey
respondentsrangedfrom 27-72, with a medianage of 45. Theirages at the time of
their pregnancyranged from 15-37, with a median age of 19.5.27Although this
study's sample was not representative,this median age is similarto nationaldata
(Henshaw 1998). Althoughwomen's age at the time of theirpregnancywas not as-
sociated with a particularchildbearingdecision, women living with their parents
were more likely than others to adopt away their child.28The remainingdemo-
graphic characteristicsof the survey sample are presented in Appendix A. Al-
thoughwomen from working-classor poor families were more likely to carrytheir
child to term, and upper-middle-classwomen were more likely to terminatetheir
pregnancy,there were no significantassociationsbetween class and childbearing
decisions. Similar to national data, religion was not associated with a particular
childbearingdecision. Nor were there significant associationsbetween women's
childbearingdecisions and a history of social vulnerability(e.g., the loss of a par-
ent, child abuse,or rape).29Althoughthe majority(61 percent)of the respondents'
pregnanciesoccurredin California,theirdecision was not determinedby theirac-
cess to childbearingoptions (e.g., living in an urban,suburban,or ruralarea).
The only predictive variablewas the reproductiveera of their pregnancy.30
Women who unintentionallyconceived duringthe adoptionmandate,before Roe
v. Wadelegalized abortion,were more likely to adoptaway theirchild. This under-
scores the significanceof reproductivepolicies and the social force of the shifting
formsof knowledgethatshapewomen's childbearingdecisions (see Figure 1).
Results
Whenyou'resingleandhaveanunplanned youfeelisolated.Youfeel like
pregnancy
you'vehadunprotected
sex,oryou'vehadsexandyourcontraceptionfailed,and
nowwhatdoyoudo?Youhaveto choosethedecisionyouwantto makeanddecide
howto makeit.
-Ellen [abortion1983]
Isolationand fear were dominantthemes in single-women's procreationsto-

ries. Althoughthereis nothinginherentlytraumaticaboutbecomingpregnant,sin-
gle women described their unintentionalconception as a traumaticevent: "the
world stopped,""everythingwas in slow motion,""I went cold," "I cried uncon-
trollably,"or "it was as if the earthhad swallowed me."31The traumawomen de-
scribed illuminatesthe common core of authoritativeknowledge that influenced
their pregnancyand childbearingdecision, a code of honor regardingwomen's
sexuality, fertility, and maternity(Ellison 2000). That is, regardlessof era of the
330 MEDICAL
ANTHROPOLOGY
QUARTERLY
25
20
E
o 15 -
10
z
5
Adoption Abortion Single mother

Childbearing decision
*Pre-1973 E 1973 on
Figure 1
Women's childbearing decisions pre- and post-Roe v. Wade.
participants' pregnancy, an ideal of female sexual purity and honor was the most
pervasive and enduring form of implicit cultural knowledge. While participants
were keenly aware of the sexual double standard of their situation, each feared be-
ing stigmatized as an "easy" or "loose" woman.
My mom looked down upon girls thatgot pregnantvery young, so I was afraidof dis-
appointingher.It would have really hurtmy dad. I would have been labeledas loose
or easy. I had an abortionbecause I thoughthaving a baby would ruinmy life. I
wasn't readyto have a baby.
-Julia [abortion1989]
I wantedto make sureI wasn't portrayednegatively or discountedat work,thatmy

boss wouldn'tthinkI was less able to be successful.A mancan walk away andno one
knows. But as a single pregnantwoman,you're wearinga scarletA.
-Susan [single mother1988]
Moreover, the social stigma of their pregnancy also threatened their family's
social standing and, depending on the era of their pregnancies, their child. These
are classic examples of what Erving Goffman (1963) described as a "courtesy"
stigma, which may afflict associates of stigmatized individuals.
Theremustbe societies thatdon't make single women feel this way aboutbeing preg-
nant,strippingthem of motherhood.I don't thinkit's aboutreligion;it was aboutbe-
ing single. Nobody shouldbe surprisedthatmost birthmothersarewhite, from
middle-classhomes becausethose were the people thatcaredwhatthe neighbors
thought.That's whatit all comes down to, shame,shamingyour family.
-Bonnie [birthmother1965]
PREGNANCIES 331
My motherwas livid. It was an affrontto her. She told me I was ruiningherlife. My

fathercalled me a whore;I don't know whathe could have said to hurtme more. It's
unbelievablethatthis still persists,but sexually active single women areconsidered
whores.For men it's positive, but women lose respect.
-Nancy [abortion1987]
The women negotiatedthese symbols of social stigma by drawingon cultur-

ally implicit "rulesfor breakingrules"(Edgerton1967, 1985). Thatis, to preserve
theirpersonaland theirfamily's honor,women used the culturallyimplicit gender
work of secrecy, to navigatenormativeexpectationsof maternity,female sexual-
ity, andfertility.This secrecy isolatedwomen, intensifiedtheirtrauma,andlimited
their access to information.Further,because of the culturalcensorshipof stigma-
tized single pregnancies,the wealth of stories and knowledge of other women,
even that of their own mothersor sisters, was often inaccessible. Thus, women's
options and social supportwere circumscribed.Within these constraints,which
were furtherconstrictedby the reproductiveera of a single woman's pregnancy,
women madetheirchildbearingdecisions.
Abortion
Women who terminatedtheir pregnancy reported making their decision
based on self-knowledge, their own needs, and circumstances.They were not
readyto have a child;theirpartnerwas not the rightmanto have a child with;it was
not the righttime in theirrelationshipto have a child. Comparedto single mothers,
they rated meeting their own needs and their personalgoals as significant influ-
ences in their childbearingdecision.32Their decision was also significantlymore
influencedby meetingtheirown needs thanit was for birthmothers.33
TheplacewhereI gotmypregnancy testwasverypro-lifeandtriedto talkmeinto
keepingthechild.I didn'tevenhaveajob.I didn'tknowif I wasgoingto getajob.
Therewasa lotof uncertaintyin mylife.I wasmovingoutto California.I didn'tthink
thatwastherighttimeinmylife to havea child.
-Joni [abortion1986]
I wasverymucha feministin the 1970sandbelievedabortionwasmyright.Butit

wasa muchmoredifficultdecisionthanI thoughtit wouldbe.I didn'twantto marry
themanI wasseeingandI didn'twantto havea childwithsomeoneI didn'twantto
marry.Inmygut,myfeelingwasthatthisis nottherightperson;thiswasnottheright
time.I didn'twantto raisea childalone.
-Meredith [abortion1988]
The reproductiveerain which women's pregnanciesoccurredalso influenced

theirdecisions. Pre-Roe v. Wade,women ratedmeetingtheirown needs, not being
readyto raise a child, and theirpersonalgoals highly; they also ratedsocial expec-
tations, avoiding family shame, and avoiding social stigma highly. In contrastto
single mothersfrom the same era, women's decisions to terminatetheirpregnancy
were significantlyinfluencedby their desire to avoid social stigma, to meet their
personal goals, and because they did not feel they were ready to raise a child.34
332 MEDICAL
ANTHROPOLOGY
QUARTERLY
However, post-Roe v. Wade, again, in contrast to single mothers from the same
era, fear and avoiding family shame significantly influenced their decision to ter-
minate their pregnancy.35
In the focus groupsandone-on-oneinterviews,all of the women who hadter-
minated a pregnancyreportedenduring social stigma. For example, both of the
women quotedbelow were middle-aged,Jewish-identifiedbut not religiously ob-
servant,middle-class professionalswith a college education.Emily is divorced;
Donna is married.They are pro-choice, liberal Democrats whose parents most
likely share their political beliefs. Yet they have never disclosed to their parents
thatthey had an abortion.Donna has also kept her abortiona secretfrom her ado-
lescent daughter.
Yearsagoa groupof prominent womentookoutanadin theNewYorkTimesstating
thattheyhadhadanabortion. I remember GloriaSteinemwasonthatlist.Therewere
lotsandlotsof women,tryingto destigmatize butI don'twantmyparentsto
abortion,
know.
-Emily [abortion
1980s]
I don'twantmymother'snegativejudgmentaboutme.I don'tknowwhatmymother
wouldthinkof me,thatherdaughter hadanabortion. Andbackthenyoujustdidn't
tellyourparentsif youdidn'thaveto, if youcouldhandleit onyourown,whichI did.
I havenevertoldmydaughter, andeventhoughmyhusbandthoughtshecouldknow
thatwe hadanabortion beforewe weremarried andhadher,I madesurethatshe
wouldnotbe homeduringthisinterview.
-Donna [abortion
1977]
This sense of shame and secrecy was not uncommon;mothersof the studypartici-
pantshad often kept theirown unintentionalpregnanciessecret from theirdaugh-
ters, sometimes until years after their daughter had secretly endured an
unintentionalsingle pregnancyof her own.
Adopting Away
Women who adopted away their child reportedbeing influenced by their
mothers,social workers,social expectations,and multiplethreatsof social stigma
for themselves, their family, and their child. Birth mothers,in comparisonto the
othertwo childbearinggroups,were significantlymore influencedby social work-
ers.36They also reportedbeing more highly influenced by their mothers than
women who terminateda pregnancy.37 In contrastto single mothers,theirdecision
was significantlymore influenced by a desire to protecttheir child from shame,
which reflectsthe eraof theirpregnancy.38
The majorityof birthmothers (76 percent)adoptedaway their child before
1973, during the adoption mandate.Women in this cohort reportedbeing more
highly influencedby social workersthanthe otherchildbearinggroups.39In inter-
views and duringparticipantobservation,birthmothersoften repeatedthe advice
they had received from social workers,thatit would be selfish to keep theirchild.
In contrastto the single mothersof that era, birthmothersalso reportedthat they
WOMEN'S
PREGNANCIES 333
were more influenced by financial instability, avoiding family shame, avoiding so-
cial stigma, and social expectations.40
After we hit our seventhmonthwe weren'tallowed to leave the maternityhome. In
the hospitalthey let me hold him and see him. When the caseworkershowed up with
the papersfor me to sign, I sat with my armsdefiantlycrossedin frontof me, saying,
"I'mnot signing. I'm not. I can't. No." It was my only defiantmoment.The social
workerleanedinto me andsaid, "You'rethe most selfish personI've ever met."I
said, "Ilove him."And she said, "No you don't. You couldn'tpossibly love this
child."I signed.
I thinkyou honoryour parents'choice; it reallydoesn't matterwhatyou feel. My par-

ents paid for the maternityhome. I didn'treallyhave an option.I did this for thembe-
cause I had madea mistake.Why shouldmy parentshave to pay for the rest of their
lives with commentsor sneers?
-Kathleen [birthmother1971]
After 1973, the birth mothers in this study had not been institutionalized dur-
ing their pregnancy.41 However, they still reported making decisions that were in-
fluenced by their parents and by social expectations. In contrast to women who had
an abortion, birth mothers were significantly more influenced by doing what
seemed best for their child and by their fathers.42In comparison with single moth-
ers, birth mothers were significantly more influenced by social workers, a desire to
protect their child from shame, their mothers, and social stigma.43 Birth mothers
were the only group to rate what they thought was best for their child more highly
than their own needs.
When my fatherfound out I was pregnant,he said, "Theonly optionyou have is to
give up this child for adoption."
-Jan [birthmother1975]
I'm pro-choicebut when I went for my abortionI found out I was six monthspreg-
nant.My mom is a pro-lifecounselorandwhen she found out, she took over andsaid,
"We'regoing to get you set up for an adoption."I just went along with it becauseI
knew thatwould be my ultimaterole, my decision.
-Mona [birthmother1978]
Birth mothers bear the twin stigmata of being single and pregnant and giving
birth as a single woman. However, these stigmata are further compounded by
adopting away their child in a strongly pronatalist society. For example, both of the
birth mothers quoted below are single, middle-aged, middle-class women who
have never carried another pregnancy to term. Both are professionals with ad-
vanced degrees. Neither is religious; Bonnie was raised as a Presbyterian, and
Carol was raised in a nonreligious Jewish extended family. Carol's adult birth
daughter searched for her and found her. Although they live in different countries,
they have an ongoing relationship. In contrast, ten years ago Bonnie searched for
334 MEDICAL
ANTHROPOLOGY
QUARTERLY
and found her adult birth son. He did not want to meet her; she has respected his de-
cision.
My God, it was the 60s! Everyonewas sleeping with everyone. But still therewas this
feeling of turninginto a Jezebel,thatI was differentfromotherwomen who were no
longer virgins.They could sleep with anyonethey wanted.But if you hadrelin-
quisheda child you reallycould, becauseyou were in a differentcategory.Therewas
a blacknessaroundit.
-Carol [birthmother1964]
I'd like people to understandthe loss involved;it's a trueloss. I'd like people to take
this issue a little more seriously.I don't thinkthingshave reallychangedthatmuch.
Women arestill relinquishingbecauseof shame.
Single Mothers
Single mothers ranked internal sources of knowledge most highly; these in-
cluded instinct, religious and moral beliefs, their own needs, and doing what they
felt was best for their child. Compared to the other groups, their decision to bear
and raise their child was significantly less influenced by their marital status or their
lack of financial security, social expectations, avoiding social stigma, or family
shame.44In contrast to women who terminated their pregnancy, single mothers re-
ported being significantly more influenced by what they thought was best for their
child and by their religious beliefs.45
Once I knew thatabortionwasn't an option,I knew thatI was going to keep the child.
Therewas somethingdeep inside me thatsaid I was going to makethis choice. We
thinkexpertsknow betterandwe don't even listen to thatvoice. Especiallyfor
women, people always tell us whatwe shoulddo. My hearttold me to do it, to bear
andraise my child. I've wonderedif it's innate,hard-wired.
-Sherry [single mother1961]
I was nineteenandI thoughtI would be the best motherto my child. My child would
never wonder,why didn't my mom keep me? I thinkthe most importantthing is love.
You have to be kind of winging it on instinct.
-Amelia [single mother1978]
I thinkthe decision has to come from the personthemselves.My decision was based
on me, not on what everybody else was saying, not on what I saw or heard, not on
social expectations.A woman knows herself. I had to standup and do what I needed
to do.
-Zoe [single mother1989]
Before 1973, the single mothers in this study made their decision based on
their own needs and what they felt was best for their child. Single mothers from 1973
on still ranked these influences highly. However, in interviews they emphasized
PREGNANCIES 335
the importance of their family's support in their decision making, as well as the im-
portance of their religious beliefs, and their feelings for their partner.
I thoughtthatwith the supportof my family I could be fine. My friendswantedto kill
me for not having an abortion.I knew rightaway whatI hadto do. But I remember
thatI did prayto have a miscarriage,"God,please remove this burdenfrom me."I re-
memberthinkingthis is crazy,I'm so committedto doing this, but wantedto have a
miscarriage.
-June [single mother1988]
I was crazyin love with this guy. He didn'twanta child. We went to an abortionclinic
twice butI had alreadygrown attachedandmy heartwas with the baby. I wantedto
keep it. Subconsciously,I thinkyears of being in religiondid affect me; I felt it was
wrong to end the pregnancy.I didn'tgive it muchthoughtat the time;I was morecon-
cernedwith the way I felt, but I do thinkreligionaffectedmy decision.
-Sabrina [single mother1990]
Although a subsequent marriage may allow single mothers to pass ("I eventu-
ally did marry; people didn't have to know that I'd been a single mother"), they
still reported enduring social stigma. Doreen, at 40, was divorced, middle class, a
politically liberal nonreligious Quaker with an advanced degree and a professional
career. At 31, Susan, who never married, was an upper-middle-class professional,
in a field dominated by males. A pro-life Republican, she also regularly attended a
Catholic church with her daughter.
I used to say I was an unwed mother,but now I nevertell anybodyunless I know them
very, very well. They may thinkless of me because I nevergot married.
-Doreen [single mother1978]
It's difficultwith the oldermen I work with. I'm very professional,but when I talk
aboutmy daughterI still thinkthatbecause I was unmarriedandpregnantthey must
be thinking,she's sleeping around.No one has ever said thatto me but it's in the back
of my head.
-Susan [single mother1988]
Discussion
When single women discover they have unintentionallyconceived, their
agency is circumscribedby "rulesfor breakingrules"(Edgerton1985). For unin-
tentionalpregnancies,the implicit rule is secrecy; that silences individualas well
as collective bodies (Ellison 2000; Scheper-HughesandLock 1986; Sheriff2000).
This secrecy reflects the genderwork of veiled virtuethatwomen assumedas they
navigated the symbols of social stigma, of being "loose" or "easy" women (Edger-
ton 1967; Goffman 1963), while they secured the aid of others that was necessary
to finalize theirdecision.
Deeply ingrainedculturalassumptionsabout the categories of women who
can legitimatelylay claim to theirsexuality,fertility,and maternityrepresentwhat
was most at stake in single women's procreation stories. The cultural ideal of being
QUARTERLY
a "good"womanpromotesa formof structuralviolence (Kleinman2000) thatcon-

stricts single women's sexuality, fertility, and maternity.Thus, women's preg-
nancy experiences and their subsequentchildbearingdecisions were strongly in-
fluenced by theirattemptsto avoid social stigmafor themselvesand theirfamilies.
The traumathey describedresultedfrom theirfear of failing to meet culturallyen-
trenchedideals of female sexual honorand socially acceptedforms of maternity.46
The datafrom this study suggest that similarto women who have struggledwith a
life-threateningillness or infertility,single unintentionalpregnancieswere not epi-
sodic events. Single women's unintentionalpregnancies and childbearingout-
comes were deeply embodiedexperiencesthat irrevocablyalteredwomen's lives
(Becker2000; Lock andKaufert1988). This articledemonstratesthatthese experi-
ences, choreographedby a cultureof honor,resultin a stigmatizedform of sexual-
ity, fertility,andmaternity,stratifiedby women's maritalstatus.
Abortion
Women who had an abortionreportedthat their decision was influenced by
internalformsof authoritativeknowledge,such as theircircumstances,theirassess-
ments of theirpartner,and theirlife goals. The majorityof women who made this
decision did so when they had legal access to an abortion.Their decision was
guided by an ethics of care (Gilligan and Belenky 1980; Ruddick 1993) that in-
cluded themselves, as well as their potentialchild, and their family of origin. Al-
though most women obtained an abortionwithout telling their parents,this was
less a reflectionof theirreligiousbeliefs thanthe social stigmaof abortion.
In contrastto Brenda Major and Richard H. Gramzow (1998), this study
found thatall women who had an abortionfearedsocialjudgmentabouttheirdeci-
sion. In particular,and similar to other studies of abortion,women feared being
judged as having made a "selfish"decision (Belenky 1978). This echoes the same
ideological tensionsthatFaye Ginsburg(1989) and KristinLuker(1984) identified
in theirstudiesof abortionactivists.These authorsfound thatthe pro-lifeideology
of naturalizedascribedmaternityclashed with the pro-choice ideology of mater-
nity as a self-determinedrole thatwomen may achieve or reject.The pro-lifeideol-
ogy of ascribedmaternitythat hinges on the belief that life begins at conception
providesanothermotif to the 19th-centurycults of female domesticityandmother-
hood as women's duty. The authoritativeknowledge of selfless maternitypersists,
in anotherauthoritativeguise, influencing women regardlessof their position on
abortion.
BirthMothers
Birth mothers reported being strongly influenced by external sources of
knowledge, such as their mothersand social workers.This finding supportspre-
vious studies of adoption(Bachrachet al. 1992; Edwards1999; Solinger 1992). It
is importantto note thatbirthmothers'ages at the time of theirunintentionalpreg-
nancy were not differentthanthose of women who terminatedtheirpregnancies.It
was the reproductiveera of theirpregnancythatmost impactedtheirchildbearing
decision. The majorityof birthmothersconceived duringthe post-World War II
adoptionmandate,while abortionwas illegal. The sharpdecline in the numberof
PREGNANCIES 337
women adopting away their child after Roe v. Wade (Cooksey 1990; McAdoo
1992) suggests that birth mothers were not psychologically differentfrom other
women. Theirdecisions were congruentwith the reproductivepolicies of the adop-
tion mandate and its control of illegitimacy, women's sexuality, and fertility
(Nathanson1991; Solinger 1995; Vincent 1965).
Forty-threepercentof the birthmothersin this studywere sequesteredin total
institutionsduringthe visible stages of theirpregnancy.Faced with limited child-
bearingoptions, women adoptedaway their child to preservetheir own and their
families' honor,and to do whatthe adoptionmandatedictatedas being in the best
interest of their child. Similar to women who terminatedtheir pregnancy,birth
mothersreportedmaking their decision to protectthemselves, their families, and
their child from social stigma. However, birth motherswere the only group that
ratedtheirchild's needs above theirown and excluded themselves in the ethics of
care thatinformedtheirdecision. This reflects the ideology of selfless maternityat
the heartof the adoptionmandate.
Single Mothers
Across all three data caches, single mothersstood apartfrom the two other
childbearinggroupsin the kindsof knowledge thatinfluencedtheirdecision. They
interpretedtheir pregnancydecisions as moral or religious obligations to them-
selves and their child and drew on intuitionand instincts in their decision to be-
come a single mother.They often anticipatedsocial supportfrom theirfamilies of
origin and they were the only group that talked about being "crazy"in love with
their child's father.The most intriguingaspect of this group was the paradoxthat
their religious or moralconservatismwas coupled with theirresistanceto norma-
tive expectations.This was particularlystriking,given that the social visibility of
raising childrenas a single motherincreasedtheir vulnerabilityto stigma. The in-
ternalized sources of knowledge that they drew on-"winging it on instinct,"
"knowingin my heart,""knowingwhat I had to do"-appear to have defrayedex-
ternalsourcesof authoritativeknowledge.
In the interviews,single motherstalkedaboutthe genderworkof maternityas
"steppingup to the plate" and "handlingtheir mistakes,"which representactive
agency and self-determination.A dominantthemein theirstories,of makingan un-
selfish childbearingdecision, is congruentwith pronatalistsentimentsand social
expectationsof selfless maternity.Yet in contrastto birthmothers,single mothers
staunchlyincludedtheirown needs in the ethics of care that influencedtheirdeci-
sion (Belenky 1978; Ruddick 1993). These findings supportMarthaWard(1995)
and Diana M. Pearce's (1993) assertionthatreferringto young single mothersas
"childrenhaving children"disempowersand infantalizeswomen. In addition,this
study's findings suggest thatdismissing single mothersas childrenpromotescur-
rent dominantforms of scientific knowledge, while disparagingsingle mothers'
embodiedknowledge.
This study's findings are particularlyprovocative,given that,to date, neither
demographicnor psychological factors predict single women's pregnancies or
childbearingdecisions (Solinger 1992; Vincent 1961).47This researchelucidates
the significance of reproductivepolicies and authoritativeknowledge in single
women's pregnancy experiences and their subsequent childbearing decisions.
QUARTERLY
A limitationof this study is that its relatively small, predominantlyself-selected

samplemay have introducedselection bias, which limits the generalizabilityof its
findings. Anotherlimitationis thatthe study is retrospective.However, recentre-
searchon maternalrecallhas documentedthe accuracyof retrospectiveaccountsof
such a significant life experience (Tomeo et al. 1999). Another limitationis the
study's purposivenarrowfocus, which futurestudies can extend across ethnicity
and gender.
Conclusion
Until therewas an infectiousdisease model in the AIDS pandemic,male sex-

ual activity had provoked little public controversy.Communitiesin the United
States have neitherbuilt nor filled paternityhomes with single fathersto undergo
moralor psychologicalcleansingbeforebeing returnedto society as marriageable.
Male illegitimate fertility has not been the focus of heated political controversy,
moralrecriminations,reproductivelegislation,or institutionalization.
This study illustratesthe extent to which single women's bodies have been
the sites of extensive and extendedbiopoliticalcontestations.At the core of these
contestationslie the definitionsof moralityandrationality(Jordan1997) thatgive
shape to normativemodels of female sexuality, fertility, and maternity.Although
the authoritativeknowledge forging these models has shifted across reproductive
eras, the core social categorythathas undergirdedeach of these models has been a
woman's legal relationshipto a man. While female dependenceon a father or a
husbandis socially legitimate,single women's independentfertilityand sexuality
or single mothersinterdependenceon her communityand extendedwebs of social
affiliationor the stateareproscribed(Pearce1993).
The social stigma study participantsexperiencedreflects a cultureof honor
thatanthropologyhas, for the most part,attributedto circum-Mediterranean socie-
ties and religious fundamentalists.This showcasing (Appardurai1986) has ob-
scuredthe similar,deeply entrenchedculturalassumptionsin the West (Rabinow
1986). The everyday violence explored here, as explicated in pregnant single
women's isolation, shame,stigma, and the coercive practicescircumscribingtheir
childbearingdecisions, is not as extremeas infibulation(Johansen2002) or honor
killings (LosAngeles Times2000; New YorkTimes2002). Yet these findings sug-
gest that the biopolitics of single women's pregnanciesare similarlyrationalized
and given moralweight, enacted,embodied,and reproducedas authoritativefacts,
ratherthanas social artifacts.
Moreover,the culturalcensorshipof an experiencesharedby so manywomen
reinforcesan inflexible tension between culturalideals and women's lived reali-
ties. Consequently,pregnantsingle women resortto the socially prescribedgender
work of secrecy as they struggleto maintaintheir social standingas good women
and mothers.Thus, women's secrecy, and the censorshipof theirexperiences,re-
producesthe social order and the culturalideology of female sexual honor. This
limits social diversityand narrowssocial expectationsaboutwhat constitutesa le-
gitimatefamily. Secrecy andculturalcensorshipalso resultsin the loss of valuable
knowledge for futuregenerations.This, in turn,perpetuatesthe structuralviolence
and social stigmasurroundingsingle women's sexuality,fertility,andmaternity.
SINGLE WOMEN'S UNINTENTIONAL PREGNANCIES 339
Notes
Acknowledgments. I thankRobertB. EdgertonandM. BelindaTuckerfor theircom-

ments and suggestionson earlierdraftsof this work. I thankGery Ryan for his valuablere-
search design suggestions. Carole E. Browner offered welcome suggestions duringearly
phases of this research.I also thankthe anonymousreviewers for their helpful comments,
andCaroleBernardfor her well-honedediting of this manuscript.In addition,I thankJanet
E. Hall for the opportunityto conductmy currentresearchon anotheraspect of nonnorma-
tive fertilityand iatrogenicmultiplebirths.This study was fundedin partby the Social and
CommunityPsychiatryDepartmentat the Universityof California,Los Angeles.
1. For a discussion of how these rates were estimated,see U.S. Departmentof Health
andHumanServices 1999; see also Henshaw 1998.
2. Throughoutthis article,I have used the termssingle womanratherthan unmarried
woman, and single pregnancy instead of out-of-wedlock pregnancy to avoid defining
women by theirlegal relationshipsto men.
3. Two othercategoriesof women vulnerableto the social stigmaof nonnormativefer-
tility are infertilewomen or women whose partnersare infertile(Becker 2000; May 1995)
andlesbians (Lewin 1995).
4. Merriam-Webster'sCollegiate Dictionary, 10th ed. Springfield, MA: Merriam-
Webster,Inc., 1993.
5. See Kleinman2000, for analysesof the ways in which the collective and individual
suffering wroughtby social forces often remainssocially invisible, especially when it has
been normalizedor routinizedby historicallyspecific social practicesthatcodify moraland
ethicalnormsand,hence, social hierarchiesandpowerrelations.
6. By normativefertility, I mean socially legitimatedintercoursebetween a husband
andwife.
7. Futureresearchis needed to explore the biopolitics of unintentionalpregnancies
acrossethnicity.
8. Whereas Solinger (1992, 2001) suggests the adoption mandate took place
post-World War II, Kunzel (1993) and Berebitsky(2001) demonstratethat this race- and
class-specificreproductivemandatebeganto gain force by the late 19thcentury;Solingeril-
lustratesthe impactof this mandateat its zenith,post-WorldWarII.
9. Single males andfemales sharedthe same bed but,ostensibly,remainedclothed.
10. See Garfinkeland McLanahan(1986) and Solinger (1992, 2001) for these ethnic
andclass-specific policies.
11. Children were redistributedfrom women of a socially proscribedcategory to
women deemed legitimatemothers.For example, in Irelandsingle women suspectedof be-
ing sexually active or who became pregnantwere forcibly incarceratedin the Magdalene
Laundriesrunby the Catholicchurch;theirchildrenwere adoptedaway, manyto couples in
the United States.Childrenwere also forcibly separatedfrom indigenouswomen andfami-
lies in Australiaand the United States. These programsof forced assimilation,"childres-
cue,"and adoptionwere based on religiousbeliefs, eugenics, and social science.
12. The post-World War II practiceof closed strangeradoptionwas given authority
by social scientists, including psychologists Henry Harlow and John Bowlby, sociologist
ClarkVincent, andanthropologistsMargaretMead andAshley Montagu.
13. The termbirthmotherrefersto women who conceive andcarrya child to termand
then adopt away theirchild. Unlike surrogatemothers,who intentionallyconceive and are
paid for their services, birthmothers,until the recent shift towarda transnationaladoption
market,did not receive financialremuneration.
14. For a historyof abortionlegislation, see Solinger 1993 and McFarlaneand Meier
2001.
15. I conductedsequential,open-ended,face-to-face life historyinterviewswith four
women who had adoptedaway a child as a single woman and had terminateda subsequent
340 ANTHROPOLOGY
MEDICAL QUARTERLY
pregnancy.These interviews were augmentedby two years of participantobservationin

adoption-affectedpeer supportgroups,in threeU.S. metropolitanareas.
16. Althoughstudies suggest thatthe traumaof abortionis transientfor most women,
the traumaof adoptingaway appearsto be most severe duringthe early years of women's
separationfromtheirchild, hence the time-basedcriteriaof seven years.Manybirthmothers
insist that the traumais lifelong; some suffer from psychological reactionssimilarto post-
traumaticstress disorder.This traumamay be acutely revisitedduringadoptee-birthparent
searchesandreunions.
17. The focus groupscomprisedwomen living in San Diego County.Local pregnancy
counseling centers,hospitals,women's healthcenters,adoptionagencies, and peer support
groupswere contactedand informedaboutthe study. A church-basedadoptionagency and
an adoptionsupportgroupdistributeda flyer for it. Advertisementswere placed in ten local
newspapers,with distributionacrossbroaddemographicstrata.
18. Similarto peer supportgroups,groupinterviewsprovideparticipantsan opportu-
nity to share their experiences with others who share similarexperiences, thus decreasing
judgment.Participantstendto treatone anotherwith interestanda sensitivityleavenedby an
insiders' darkhumor.This study's participantsoften commentedthat they enjoyed the op-
portunityto participatein researchon a topic thatthey feel is socially taboo and misunder-
stood. At the close of each session, some participantsspontaneouslyshared identifying
information.This suggests thatjust as researchersstrive to protectthe confidentialityof re-
searchparticipants,it is also importantto avoid makingpaternalisticdecisions aboutwhich
researchmethodswe deem appropriateto researchsensitive topics.
19. A computerizeddataanalysisprogram,QSR NUD*IST Vivo, was used to manage
the study's narrativedata and facilitatecoding. SPSS was used to manage and analyze the
quantitativedata.
20. Abbreviatedresponses for Item I included:self, partner,friends, mother,father,
social worker,doctor,God, laity, other.Item 2: social expectations,maritalstatus,meeting
own needs, fear,financialinstability,best for child, social stigma,religiousbeliefs, feelings
for partner,protectingfamily from shame,personalgoals, not readyto raise a child, partner
not willing to marry.
21. Cronbach'salphafor the firstitems was low (.53) butacceptablefor anexploratory
study;the internalconsistencyof the second scale was good (Cronbach'salpha= .72).
22. Because the data were not normallydistributedand the sample sizes were small,
the KruskalWallis Test was used in place of ANOVA. To comparethe directionof differ-
ences between groups,the Mann-WhitneyU test was used, followed by the Dunn Multiple
ComparisonsProcedure,with an alphacorrectedto .0166 to controlfor Type I errors(Pett
1997).
23. Due to the difficultyof identifyingandrecruitingparticipantsaboutsuch sensitive
topics, the initial random sample study design was integratedwith snowball and conven-
ience sampling.One-thirdof the surveyrespondentshadparticipatedin a focus group;there
were no statisticallysignificantdifferencesin AK between the two groups.Approximately
one-thirdof the survey respondentsfor each childbearingdecision had participatedin the
survey(31 percentabortion,33 percentsingle mothers,36 percentbirthmothers).
24. Only two women preferrednot to be interviewedin theirhome;one requestedthat
I meet her at a church-affiliatedoffice, anotherasked that we conduct the interviewin my
home. I am indebtedto each of these women for theirtrustand theirwillingness to discuss
such deeply personalaspectsof theirlives with a stranger.
25. A paper that explores women's evaluations of their childbearingdecision is in
preparation(see also Ellison 2000).
26. Theirmedianage was 34, with a rangefrom27 to 56. At the time of theirfirstunin-
tentionalpregnancytheir median age was 19, rangingfrom 15 to 37. One-thirdhad never
married;70 percenthadcompletedsome college; one-thirdwere Presbyterian;andone-third
PREGNANCIES 341
were Catholic.Theircurrentcombinedannualhousehold incomes rangedfrom $15,000 to

over $50,000 per year.
27. Justas social stigmacontributesto women underreporting the numberof abortions
they have had,theiruse of fertilitytreatment,andthe use of donorgametes,it also appearsto
contributeto women underreportingthe numberof unintentionalpregnanciesthey have had.
28. (p = .057).
29. The survey includeditems about verbal,physical, and sexual abuse;neglect; and
the presenceof alcohol or drugabusein theirhouseholdof origin.Almost half of the women
in each childbearingdecision reportedone of these abuses as a child (abortion,46 percent;
adoptingaway, 62 percent;andsingle mothers,64 percent)and 10 percentreportedthatthey
had experiencedsexual abuse as a child. One-thirdreportedinvoluntarysexual intercourse
at some point in theirlives (25 percentdaterape,8 percentstrangerrape);9 percentof the re-
spondents'first unintentionalpregnancieswere the resultof daterape(14 percentadoption,
18 percentsingle mothers).
30. The resultsof the chi-squaretest for k independentsamplesindicatesa very highly
statistically significant, moderateassociation between the era in which the unintentional
pregnancyoccurredand women's childbearingdecision (X2= 14.75, p = .001, Cramer'sV
= .504).
31. Only one woman did not reportbeing traumatized.She and her partnerwere en-
gaged at the time of her legal abortion,eventually married,and are now raising children.
This participantstatedthat her pregnancy,althoughdifficult, also gave her pleasure,as it
was proof of herfertility.
32. (p =.0003,p = .001).
33. (p = .0003).
34. (p = .024,p = .026,p = .023).
35. (p = .007, p = .012).
36. (p = .0001,p = .0006).
37. (p= .0008).
38. (p = .0023).
39. (p = .005,p =.037).
40. (p = .011, p = .020, p = .033, p = .038).
41. An exception to this is the recentproliferationof fundamentalistChristianmater-
nity homes.
42. (p = .012,p = .042).
43. (p = .013,p = .019,p = .028,p = .036).
44. (p = .0001; p = .0001, p = .0016; p = .0008, p = .0015; p = .0001; p = .0006, p=
.0005).
45. (p =.0139,p =.0166).
46. For two excellent analysesof Mediterraneanculturesof honor,see Kertzer(1993)
and Abu-Lughod 1986. Although the ideologies and practicesof a cultureof honor have
been attributedto othercultures,and often male codes of honor,the social normsof female
sexual andmoralbehaviorin the United Statesreflecta similarcultureof honor.This article
follows Wikan's (1984) suggestion,to explicatefemale culturesof honor.
47. Increasedparentaleducationhas been found to be associatedwith terminatinga
pregnancy(Cooksey 1990), whereasincreasedmaternaleducationhas been associatedwith
a daughterbecominga birthmother(Bachrachet al. 1992). Thus,demographicpredictorsof
this decision have been contradictory.
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Abu-Lughod,Lila
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Appendix A: Demographics of survey respondents.
Abortion Adoption Single Mother Total

N=26 N=21 N= 11 N=58
Class
Uppermiddle class 36% 9 14% 3 18% 2 25% 14
Middle class 48% 12 43% 9 46% 5 46% 26
Workingclass or poor 16% 4 43% 9 36% 4 30% 17
Completed education
High school/GED 8% 2 - 9% 1 5% 3
Some college 35% 9 62% 13 27% 3 43% 25
Bachelor's degree 23% 6 5% 1 36% 4 19% 11
Advanceddegree 35% 9 33% 7 27% 3 33% 19
Combined income
Over $100,000 19% 5 19% 4 27% 3 21% 12
$81,000-$100,000 4% 1 14% 3 18% 2 10% 6
$61,000-$80,000 23% 6 14% 3 18% 2 19% 11
$41,000-$60,000 27% 7 24% 5 18% 2 24% 14
$21,000-$40,000 15% 4 5% 1 18% 2 12% 7
$15,000-$20,000 4% 1 14% 3 - 7% 4
Under$15,000 8% 2 10% 2 - 7% 4
Current religion
Protestant 16% 4 14% 3 46% 5 21% 12
Catholic 20% 5 24% 5 18% 2 21% 12
Jewish 28% 7 5% 1 - 14% 8
Agnostic/atheist 16% 4 29% 6 - 18% 10
Other 20% 5 29% 6 36% 4 26% 15

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American Anthropological Association

Authoritative Knowledge and Single Women's Unintentional Pregnancies, Abortions, Adoption,

Authoritative Knowledge and Single Women's

This article explores the sources of authoritativeknowledgethat shaped

We need to anthropologizethe West: show how exotic its constitutionof realityhas

t least 48 percentof women living in the United States will experiencean

sharedby manywomen andtheirpartners.This censorshipreflectsthe tensionsof a

Pregnancy, Knowledge, and Power

Since Jordan'sgroundbreakingwork in the mid-1970s, studies of authorita-

Studies of authoritativeknowledge in childbirthhave illuminatedthe muta-

medical knowledge (Mohr 1978). Their purportedbiomedical authorityencom-

The Cult of Maternityas Civic Duty

The social puritymovementsof the early 1900s, increasedbirthrates among

The Cult of ScientificMotherhood

were then able to scientificallymatchthe tested child with adoptiveparents(Bere-

The Post-World WarII AdoptionMandate

From 1960-70,27 percentof all birthsto marriedwomen betweenthe ages of

The Oral ContraceptivePill and Roe v. Wade

By 1988, religious fundamentalistantiabortiongroupshad reframedprocrea-

the threechildbearingdecisions. Groupswere kept small (n = 3-6). This protected

were necessary to reach theoretical saturation(Sandelowski 1995; Strauss and

Findings: Survey Demographics

Isolationand fear were dominantthemes in single-women's procreationsto-

Adoption Abortion Single mother

I wantedto make sureI wasn't portrayednegatively or discountedat work,thatmy

-Susan [single mother1988]

My motherwas livid. It was an affrontto her. She told me I was ruiningherlife. My

The women negotiatedthese symbols of social stigma by drawingon cultur-

I wasverymucha feministin the 1970sandbelievedabortionwasmyright.Butit

The reproductiveerain which women's pregnanciesoccurredalso influenced

I thinkyou honoryour parents'choice; it reallydoesn't matterwhatyou feel. My par-

-Sherry [single mother1961]

a "good"womanpromotesa formof structuralviolence (Kleinman2000) thatcon-

A limitationof this study is that its relatively small, predominantlyself-selected

Until therewas an infectiousdisease model in the AIDS pandemic,male sex-

Acknowledgments. I thankRobertB. EdgertonandM. BelindaTuckerfor theircom-

pregnancy.These interviews were augmentedby two years of participantobservationin

were Catholic.Theircurrentcombinedannualhousehold incomes rangedfrom $15,000 to

DeMunck,VictorC., andElisa J. Sobo, eds.

Sosa, R., J. Kennell,M. Klaus,S. Robertson,andJ. Urrutia

Appendix A: Demographics of survey respondents.

Abortion Adoption Single Mother Total

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Authoritative Knowledge and Single Women's Unintentional Pregnancies, Abortion and Single Motherhood

Authoritative Knowledge and Single Women's Unintentional Pregnancies, Abortion and Single Motherhood