MARCIA A. ELLISON
Massachusetts General Hospital
Harvard Medical School
Authoritative Knowledge and Single Women's
Unintentional Pregnancies, Abortions, Adoption,
and Single Motherhood: Social Stigma and
This article explores the sources of authoritative knowledge that shaped
single, white, middle-class women's unintentional pregnancies and child-
bearing decisions throughout five reproductive eras. Women who termi-
nated a pregnancy were most influenced by their own personal needs and
circumstances, birth mothers' decisions were based on external sources
of knowledge, such as their mothers, social workers, and social pressures.
In contrast, single mothers based their decision on instincts and their re-
ligious or moral beliefs. Reproductive policies further constrained and
significantly shaped women's experiences. The social stigma associated
with these forms of stratified maternity suggests that categorizing preg-
nant women by their marital status, or births as out-of-wedlock, repro-
duces the structural violence implicit to normative models of female sexu-
ality and maternity. This mixed-method study included focus groups to
determine the kinds of knowledge women considered authoritative, a
mailed survey to quantify these identified sources, and one-on-one inter-
views to explore outcomes in depth, [authoritative knowledge, social
stigma, abortion, birth mothers, single mothers, unintentional pregnancies]
We need to anthropologize the West: show how exotic its constitution of reality has
been; emphasize those domains most taken for granted as universal... make them
seem as historically peculiar as possible; show how their claims to truth are linked to
social practices and have hence become effective forces in the social world.
childbearing nor to single women, indicates the cultural censorship of an experience
—Paul Rabinow 
t least 48 percent of women living in the United States will experience an
unintentional pregnancy by midlife.1 The lack of public awareness of the
high rate of unplanned pregnancies, which are neither limited to early
Medical Anthropology Quarterly 17(3):322-347. Copyright © 2003, American Anthropological Association.
SINGLE WOMEN'S UNINTENTIONAL PREGNANCIES 323
shared by many women and their partners. This censorship reflects the tensions of a
dominant pronatalist ideology within a culture that increasingly prizes self-deter-
mination (Blake 1974; Solinger 2001). Planned pregnancies are socially pre-
scribed, and women expect to be able to time their pregnancies to fit their life goals
and family needs at a socially accepted age and marital status. Married women
avoid social stigma regarding their unplanned fertility through their legal relation-
ship to a man, which allows them to "pass" (Goffman 1963). In contrast, single
women2 are particularly vulnerable to the social stigma surrounding unintentional
In the United States, when marriage is not an option, single women who unin-
tentionally conceive face three alternatives: to terminate their pregnancy, to adopt
away their child, or to become a single mother. This study suggests that each of
these alternatives permanently and profoundly alters a woman's life course and her
reproductive history or "procreative story" (Ginsburg 1987). The meaning of the
term history as a story or tale is derived from the Greek historia, for inquiry, and
from istor, knowing, what is learned.4 This study further suggests that women's
stories and the knowledge that single women glean from their pregnancy and child-
bearing outcomes have been culturally censored. Moreover, this censorship signals
the implicit structural violence5 (Kleinman 2000) that underlies normative models
of female sexuality and fertility and the rhetoric of what it means to be a "good"
and worthy woman, mother, and wife.6 Because reproductive policies in the United
States have been ethnically bifurcated (Collins 1995;Davis 1981; Litt 2000; Solin-
ger 1992), this study is limited to the sources of authoritative knowledge that shape
single, white, middle-class women's unintentional pregnancies and their sub-
sequent childbearing decisions.7
Pregnancy, Knowledge, and Power
The label "authoritative" is intended to draw attention to [the status of a body of
knowledge] within a particular social group and to the work it does in maintaining the
group's definition of morality and rationality. The power of authoritative knowledge
is not that it is correct but that it counts.
—Brigitte Jordan 
Since Jordan's groundbreaking work in the mid-1970s, studies of authorita-
tive knowledge (AK), have clarified how social differences in power, authority,
prestige, and access to resources shape birthing practices. These differences per-
petuate forms of stratified reproduction "that supports and rewards the maternity of
some women, while despising or outlawing the mother-work of others" (Rapp
2001:469). For example, the biomedical hierarchies of hospitals, medical clinics,
and epidemiology tend to reproduce and privilege a birthing ecology dominated by
technological interventions and professional and medical expertise, while occlud-
ing ethnomedical knowledge and women's embodied knowledge (Jordan 1997;
Kitzinger 1997). In contrast, birthing practices that minimize social hierarchies be-
tween birth attendants and parturient woman tend to incorporate pluralistic sources
of knowledge, such as maternal embodied knowledge, touch, instincts, ethnomedi-
cal knowledge, and cultural practices that privilege social affiliations (Davis-Floyd
and Davis 1997; Kitzinger 1997; Sosaet al. 1980).
324 MEDICAL ANTHROPOLOGY QUARTERLY
Studies of authoritative knowledge in childbirth have illuminated the muta-
ble, context-dependent quality of the birthing knowledge that counts in non-
biomedical settings. For example, among the San, primiparas are not expected to
have the requisite knowledge to meet the cultural ideal of a silent and unassisted
birth; their first birth is often assisted (Biesele 1997). Similarly, in rural Mayan
communities, a midwife may yield to the knowledge of a multipara in labor, but as-
sert her own authority over an inexperienced primipara (Jordan 1978; Sargent and
Bascope 1997). Thus, differences in power and authority are not simply indices of
hegemonic versus pluralistic knowledge systems, but may be determined by
women's reproductive histories.
Women may also resist, negotiate, and reproduce the hegemony of biomedi-
cal birthing. For instance, Betty-Anne Daviss (1997) describes how the secular
logic of an epidemiology-based program to reduce maternal-child mortality rates
inadvertently increased the personal trauma to laboring Inuit women. The practice
of airlifting parturient Inuit women to a distant hospital invalidated ethnomedical
models and severed women from birth "as a community, social and spiritual act"
(1997:441). Similarly, women of color and working-class women, who may face
the triple jeopardy of ethnicity, class, and hegemonic medical models, may be
more likely than white middle-class women to resist dominant biomedical models
and instead draw on parallel systems of knowledge (Litt 2000; Martin 1987). In
contrast, women may inadvertently reproduce the hegemony of medical models, as
they ambivalently accept medical advice regardless of its actual benefits, in an at-
tempt to hedge their bets as reflective consumers and responsible mothers
(Browner and Press 1997).
The dense interplay of agency and social forces revealed in these studies un-
derscores that women are, ineluctably, neither free agents nor passive victims. This
study explores one of the historically most contested forms of conception—single
women's unintentional pregnancies—and underscores the intractable tensions be-
tween individual agency and social forces, which are further shaped by shifting re-
Five reproductive eras have profoundly shaped women's fertility-regulating
options in the United States: the mid-19th century statutes that criminalized abor-
tion and the distribution of contraceptives; the cult of motherhood as a civic duty;
the subsequent cult of scientific motherhood;8 the post-World War II adoption
mandate; and the interplay of the FDA approval of birth control pills in 1960 and
the 1973 passage ofRoe v. Wade. Each of these eras reified shifting forms of medi-
cal and scientific knowledge. In this study, I explore the sources of knowledge that
count, and their moral and rational concomitants, for single women who discover
they have unintentionally conceived.
Criminalizing Abortion and Contraceptives
Until the mid-19th century, the quickening, when a woman first senses fetal
movement, confirmed pregnancy (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 married women. With the estab-
lishment of the American Medical Association in 1848, physicians used the medi-
cal management of childbirth to separate themselves from competing models of
SINGLE WOMEN'S UNINTENTIONAL PREGNANCIES 325
medical knowledge (Mohr 1978). Their purported biomedical authority encom-
passed all aspects of maternity, including female sexuality, morality, and the scien-
tific determination of pregnancy and fetal personhood. By 1872, this consolidation
of medical authority, paralleled by social reform movements, culminated in the
Comstock Act, which prohibited the advertisement and mailed distribution of con-
traceptives and abortifacients. Although a lively black market for contraceptive de-
vices and abortifacients continued to thrive (Tone 2001), by the Turn of the Cen-
tury abortion had become illegal in the United States and women's fertility was
more firmly under legal and medical authority.
The Cult of Maternity as Civic Duty .
The social purity movements of the early 1900s, increased birth rates among
recent non-Protestant immigrants, paralleled by declining birth rates among white
Anglo-Saxon Protestants, resulted in fears of "race suicide" (Berebitsky 2001;
May 1995). President Theodore Roosevelt called on white middle-class and upper-
class Protestant women to fulfill their civic duty and procreate. His pronatalist
campaign reified maternity, typified by nurturance and self-sacrifice, as women's
highest calling and civic duty (Berebitsky 2001; May 1995; Solinger 1992). As ur-
banization and industrialization increased the gender stratification of labor, gender
ideals were further redefined (Apple 1987; Nathanson 1991). In contrast to the
18th-century colonial era, where the practice of bundling contributed to a 33 per-
cent rate of premarital conceptions and births (Lawson and Rhode 1993; Smith and
Hindus 1975),9 during the Progressive era feminine purity and premarital chastity
became the cornerstones of maternal moral superiority (Brodie 1994; Nathanson
1991). This reification of white, middle-class maternity as a civic need resulted in
the establishment of evangelical maternity homes and widows' pensions. Thus, it
was socially expected that single, pregnant, middle-class white women and wid-
ows would keep and raise their own children (Berebitsky 2000; Kunzel 1993).10
The Cult of Scientific Motherhood
By the 1920s, the advent of the first-wave feminist movement, the newly
formed Children's Bureau, and rising maternal-child mortality rates culminated in
the 1921 Sheppard-Townner Act. This legislation allocated federal funds to pro-
mote hospital births and increase women's access to obstetric specialists. Hospitals
offered the "twilight sleep," x-rays, transfusions, and sterilized equipment. Scien-
tific experts proffered advice to mothers on the management of household germs,
infant feeding, and childcare (Apple 1987; Wertz and Wertz 1977).
As the new science of eugenics garnered cultural authority, the etiology of
single women's unintentional pregnancies shifted from a redeemable moral fail-
ing, to feeblemindedness, a form of heritable intellectual inferiority. Thus, the
management of maternity homes shifted from evangelical charity workers, to so-
cial workers with the scientific training necessary to deal with heritable disorders
(Kunzel 1993; Solinger 1992). This new scientific approach dictated that a single
mother and her child remain together in the maternity home until the child, at six
months of age, could undergo an intelligence test Within this model, social workers
326 MEDICAL ANTHROPOLOGY QUARTERLY
were then able to scientifically match the tested child with adoptive parents (Berc-
The Post-World War II Adoption Mandate
From 1960-70,27 percent of all births to married women between the ages of
15 and 29 were conceived premaritally. Yet the etiology of single, white, middle-
class women's conceptions had shifted again and were now perceived as a symp-
tom of female neurosis (Solinger 1992; Vincent 1961). In keeping with this medi-
cal model, a single pregnant woman could obtain a therapeutic abortion if she
could find a physician willing to diagnose her as psychologically unsound, or if her
pregnancy could be diagnosed as life threatening. However, the approval of a
board of hospital physicians was necessary to obtain a therapeutic abortion and 53
percent of teaching hospitals and 40 percent of all U.S. hospitals, and, thus, their
boards, required that women accept simultaneous sterilization to prevent a future
unplanned pregnancy (Solinger 1998:24).
Given these constraints, the majority (85-95 percent) of single, white middle-
class women, who either could not or would not procure an illegal or therapeutic
abortion, were encouraged, and at times coerced, to adopt away their child (Ed-
wards 1998;McAdoo 1992; Pannoretal. 1978; Solinger 1992,1993).11 Maternity
homes became total institutions where neurotic pregnancies could be cured by
separating single mothers from their children (Solinger 1992). By the 1950s, at-
tachment theory dictated that this separation occur as soon after birth as possible,
to promote an infant's ability to bond with its married adoptive parents (Berebitsky
2000).12 After relinquishing their child, birth mothers could secretly reenter society
as marriageable women and bear future legitimate children.13
The Oral Contraceptive Pill and Roe v. Wade
The civil rights movement, the second-wave women's movement, and the
gay rights movement fitfully reconfigured the kinds of knowledge that counted re-
garding female sexuality, fertility, and maternity. Rising divorce rates, the in-
creased number of women obtaining secondary education and in the work force,
and women's delayed childbearing shifted normative models of the family
(Petchesky 1984). In 1960, Enovid, the first FDA approved oral contraceptive, was
available by medical prescription (Marks 2001), and by 1965, the Supreme Court
ruling of Griswold v. Connecticut guaranteed married couples the right to privacy
regarding contraception. Seven years later, Eisenstadt v. Baird extended these
rights to single women and men, repealing the last of the century-long Comstock
As a result of women's access to the pill and the dual 1973 Supreme Court
rulings—Roe v. Wade and Doe v. Bolton14—that legalized abortion, the number of
white middle-class women adopting away their children plummeted from 85-95
percent to 3 percent. This rate has not increased since, despite the 1976 Hyde
Amendment that prohibited the use of Medicaid funds for abortions while main-
taining full federal funding for sterilization or birth expense's, thus limiting poor
and young women's access to abortion (McFarlane and Meier 2001; Solinger 1993).
SINGLE WOMEN'S UNINTENTIONAL PREGNANCIES 327
By 1988, religious fundamentalist antiabortion groups had refrained procrea-
tion as a religious and moral obligation to female nature while promoting the pro-
life position that life begins at conception (Ginsburg 1989; Luker 1984). From
1989-1992, over 700 antiabortion rights statutes were brought before state legisla-
tors, and by 1992, only 26 percent of U.S. counties had physicians willing to pro-
vide abortion (Solinger 1993). By 1995, members of religious fundamentalist pro-
life groups had murdered two employees at a women's health clinic and one
physician who provided abortions. Given this cultural climate, and the shift away
from the model of unintentional pregnancy as a neurotic symptom to be treated by
separating single women from their children, it is not surprising that single mother-
hood has become single women's most frequent childbearing decision, despite re-
cent restrictions on public support for single mothers (U.S. Department of Health
and Human Services 1995).
Each reproductive era comprised shifts in the sources of knowledge that de-
fined single women's unintentional pregnancies. In contrast to previous struc-
tural-functional analyses of single pregnancies as a form of "deviant" social be-
havior (Rains 1971; Vincent 1961), this study examines how white middle-class
women negotiate, resist, and reproduce the scientific and biomedical authority that
informs normative models of sexuality, fertility, and maternity.
This sequential, mixed-methods study (n = 62) evolved from an earlier pilot
study that compared women's long-term outcomes of abortion versus adoption.15
In the current study, focus groups (n = 24) explored women's perspectives of unin-
tentional pregnancies and childbearing decisions. These data informed the devel-
opment of a mailed, self-administered questionnaire (n = 58). Finally, to provide a
context for the survey and focus group findings, a subsample of survey respon-
dents participated in one-on-one interviews (n = 10). The triangulation of data
across these data caches enhanced the reliability and validity of the study's find-
ings and reduced research bias (DeMunck and Sobo 1998; Miles and Huberman
To explore the impact of shifting reproductive policies, the study's age eligi-
bility criteria was broad, from 22-72. To control for the impact of ethnicity on ra-
cially bifurcated reproductive policies, all participants were of Euro American de-
scent. The sample was also limited to women currently residing in southern
California, with the assumption that this highly transient population would include
women whose pregnancy occurred in various regions of the United States. To pro-
vide ample time for long-term evaluations of their decision, participants were
screened to ensure that their pregnancy had occurred at least seven years prior to
their participation in the study.16
In a pilot test group (n = 5) and six small focus groups (n = 19), I explored
single women's procreation stories and key issues, such as the kinds of knowledge
that they privileged during their pregnancy and in making childbearing decisions.17
To control for idiosyncratic group responses, I conducted two groups for each of
328 MEDICAL ANTHROPOLOGY QUARTERLY
the three childbearing decisions. Groups were kept small (n = 3-6). This protected
participants' privacy, increased the homogeneity of the groups, and created a safe
place for participants to discuss sensitive life experiences (Krueger 1994; Madriz
I moderated and audiotaped each of the two-hour sessions. I transcribed the
tapes verbatim and analyzed them following standard qualitative data analysis
techniques: open coding to identify core themes, axial coding to determine the
range and dimensions of each theme, and selective coding to "find the story in the
data" (Strauss and Corbin 1995).19
The topics relevant to AK were: (1) How do single women feel when they dis-
cover they unintentionally conceived? (2) Who do single women turn to for help
and advice in dealing with their pregnancies? and (3) What most influences
women's childbearing decisions during an unintentional pregnancy? The sources
of authoritative knowledge identified in the group discussions informed the devel-
opment of the survey items described below.
I reviewed existing surveys and scales, none of which fit the study's focus.
Therefore, I used the focus group data to generate relevant survey items. I pretested
the survey in a focus group setting, which consisted of the most vocal former focus
group participants. This sample enhanced the likelihood that participants would
thoroughly and openly critique the survey instrument.
The revised mailed self-administered survey included two items measuring
authoritative knowledge: (1) At the time of your first unplanned pregnancy, who
had the most influence on you in reaching your decision? (2) How important were
each of the following in making your decision about your pregnancy?20 Likert
scales measured the level of influence/importance of each item (i.e., from "1" [not
at all] to "7" [very much]).21
I analyzed continuous data using the Kruskal-Wallis test.22 Categorical vari-
ables were analyzed using the chi-square test (a = .05, two-sided). The survey par-
ticipants (n = 58) were identified through a random sample (n = 24), snowball
sample (n = 6), respondents to the focus group advertisements (n = 23), purposive
sampling through an adoption-affected support group in = 4), and a newspaper ad-
vertisement for birth mothers and single mothers (n = I).23
A small sample of survey respondents (n = 10) participated in a two-hour,
one-on-one, face-to-face interview with me.24 The participants were purposively
sampled by their positive or negative outcomes.251 interviewed four women who
had had an abortion (two positive and two negative outcomes) and four women
who had adopted away their child (two positive and two negative outcomes). Be-
cause the small sample of single mothers resulted in overwhelmingly positive out-
comes, I only interviewed two single mothers. I transcribed the audiotaped inter-
views verbatim and analyzed them using the same qualitative data analysis
procedures described above for the focus group data. Given my previous pilot
study, and the data caches described above, only a small number of interviews
SINGLE WOMEN'S UNINTENTIONAL PREGNANCIES 329
were necessary to reach theoretical saturation (Sandelowski 1995; Strauss and
Corbin 1995). The interviews included topics such as what it meant to the women
to discover they had unintentionally conceived, how their pregnancy and child-
bearing experiences impacted their sense of self and social status, and how they ne-
gotiated disclosure about their pregnancy and childbearing decisions.
Findings: Survey Demographics
The survey respondents (n = 58) included 26 women who terminated their
pregnancy, 21 birth mothers, and 11 single mothers.26 The current age of the survey
respondents ranged from 27-72, with a median age of 45. Their ages at the time of
their pregnancy ranged from 15-37, with»a median age of 19.5.27 Although this
study's sample was not representative, this median age is similar to national data
(Henshaw 1998). Although women's age at the time of their pregnancy was not as-
sociated with a particular childbearing decision, women living with their parents
were more likely than others to adopt away their child.28 The remaining demo-
graphic characteristics of the survey sample are presented in Appendix A. Al-
though women from working-class or poor families were more likely to carry their
child to term, and upper-middle-class women were more likely to terminate their
pregnancy, there were no significant associations between class and childbearing
decisions. Similar to national data, religion was not associated with a particular
childbearing decision. Nor were there significant associations between women's
childbearing decisions and a history of social vulnerability (e.g., the loss of a par-
ent, child abuse, or rape).29 Although the majority (61 percent) of the respondents'
pregnancies occurred in California, their decision was not determined by their ac-
cess to childbearing options (e.g., living in an urban, suburban, or rural area).
The only predictive variable was the reproductive era of their pregnancy.30
Women who unintentionally conceived during the adoption mandate, before Roe
v. Wade legalized abortion, were more likely to adopt away their child. This under-
scores the significance of reproductive policies and the social force of the shifting
forms of knowledge that shape women's childbearing decisions (see Figure 1).
When you're single and have an unplanned pregnancy you feel isolated. You feel like
you've had unprotected sex, or you've had sex and your contraception failed, and
now what do you do? You have to choose the decision you want to make and decide
how to make it.
—Ellen [abortion 1983]
Isolation and fear were dominant themes in single-women's procreation sto-
ries. Although there is nothing inherently traumatic about becoming pregnant, sin-
gle women described their unintentional conception as a traumatic event: "the
world stopped," "everything was in slow motion," "I went cold," "I cried uncon-
trollably," or "it was as if the earth had swallowed me."31 The trauma women de-
scribed illuminates the common core of authoritative knowledge that influenced
their pregnancy and childbearing decision, a code of honor regarding women's
sexuality, fertility, and maternity (Ellison 2000). That is, regardless of era of the
M E D I C A L ANTHKOHOI <KA Q L A K I I KLY
• Pr. 1973 • 1973 on
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 that got pregnant \ en young, so ] » as afraid oi dis-
appointing her. It would have really hurt my dad. I would ha\e been labeled as loose
or easy. I had an abortion because I thought having a baby would ruin m> life. I
wasn't ready to have a baby.
—Julia [abortion 1989]
I wanted to make sure I wasn't portrayed negatively or discounted at work, that m\
boss wouldn't think I was less able to be successful. A man can walk aw a\ and no one
knows. But as a single pregnant woman, you re wearing a scarlet A
—Susan [single mother 1988]
Moreover, the social stigma ot their pregnanc\ also threatened their famih s
social standing and, depending on the era of their pregnancies, their child. These
are classic examples ot what Erving Goffman (1963) described as a courtes)
stigma, which may afflict associates of stigmatized individuals
There must be societies that don't make single women feel this waj about being preg-
nant, stripping them of motherhood. I don't think its about religion, it was about be-
ing single. Nobody should be surprised that most birth mothers are white, from
middle-class homes because those w ere the people that cared w hat the neighbors
thought That's what it all comes down to. shame, shaming \our familj
Bonnie [birth mother 1965]
SINGLE WOMEN'S UNINTENTIONAL PREGNANCIES 331
My mother was livid. It was an affront to her. She told me I was ruining her life. My
father called me a whore; I don't know what he could have said to hurt me more. It's
unbelievable that this still persists, but sexually active single women are considered
whores. For men it's positive, but women lose respect.
—Nancy [abortion 1987]
The women negotiated these symbols of social stigma by drawing on cultur-
ally implicit "rules for breaking rules" (Edgerton 1967,1985). That is, to preserve
their personal and their family's honor, women used the culturally implicit gender
work of secrecy, to navigate normative expectations of maternity, female sexual-
ity, and fertility. This secrecy isolated women, intensified their trauma, and limited
their access to information. Further, because of the cultural censorship of stigma-
tized single pregnancies, the wealth of stories and knowledge of other women,
even that of their own mothers or sisters, was often inaccessible. Thus, women's
options and social support were circumscribed. Within these constraints, which
were further constricted by the reproductive era of a single woman's pregnancy,
women made their childbearing decisions.
Women who terminated their pregnancy reported making their decision
based on self-knowledge, their own needs, and circumstances. They were not
ready to have a child; their partner was not the right man to have a child with; it was
not the right time in their relationship to have a child. Compared to single mothers,
they rated meeting their own needs and their personal goals as significant influ-
ences in their childbearing decision.32 Their decision was also significantly more
influenced by meeting their own needs than it was for birth mothers.33
The place where I got my pregnancy test was very pro-life and tried to talk me into
keeping the child. I didn't even have a job. I didn't know if I was going to get a job.
There was a lot of uncertainty in my life. I was moving out to California. I didn't think
that was the right time in my life to have a child.
—Joni [abortion 1986]
I was very much a feminist in the 1970s and believed abortion was my right. But it
was a much more difficult decision than I thought it would be. I didn't want to marry
the man I was seeing and I didn't want to have a child with someone I didn't want to
marry. In my gut, my feeling was that this is not the right person; this was not the right
time. I didn't want to raise a child alone.
—Meredith [abortion 1988]
The reproductive era in which women's pregnancies occurred also influenced
their decisions. Pre-Roe v. Wade, women rated meeting their own needs, not being
ready to raise a child, and their personal goals highly; they also rated social expec-
tations, avoiding family shame, and avoiding social stigma highly. In contrast to
single mothers from the same era, women's decisions to terminate their pregnancy
were significantly influenced by 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.33
In the focus groups and one-on-one interviews, all of the women who had ter-
minated a pregnancy reported enduring social stigma. For example, both of the
women quoted below were middle-aged, Jewish-identified but not religiously ob-
servant, middle-class professionals with 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
that they had an abortion. Donna has also kept her abortion a secret from her ado-
Years ago a group of prominent women took out an ad in the New York Times stating
that they had had an abortion. I remember Gloria Steinem was on that list. There were
lots and lots of women, trying to destigmatize abortion, but I don't want my parents to
—Emily [abortion 1980s]
I don't want my mother's negative judgment about me. I don't know what my mother
would think of me, that her daughter had an abortion. And back then you just didn't
tell your parents if you didn't have to, if you could handle it on your own, which I did.
I have never told my daughter, and even though my husband thought she could know
that we had an abortion before we were married and had her, I made sure that she
would not be home during this interview.
—Donna [abortion 1977]
This sense of shame and secrecy was not uncommon; mothers of the study partici-
pants had often kept their own unintentional pregnancies secret from their daugh-
ters, sometimes until years after their daughter had secretly endured an
unintentional single pregnancy of her own.
Women who adopted away their child reported being influenced by their
mothers, social workers, social expectations, and multiple threats of social stigma
for themselves, their family, and their child. Birth mothers, in comparison to the
other two childbearing groups, were significantly more influenced by social work-
ers.36 They also reported being more highly influenced by their mothers than
women who terminated a pregnancy.37 In contrast to single mothers, their decision
was significantly more influenced by a desire to protect their child from shame,
which reflects the era of their pregnancy.38
The majority of birth mothers (76 percent) adopted away their child before
1973, during the adoption mandate. Women in this cohort reported being more
highly influenced by social workers than the other childbearing groups.39 In inter-
views and during participant observation, birth mothers often repeated the advice
they had received from social workers, that it would be selfish to keep their child.
In contrast to the single mothers of that era, birth mothers also reported that they
SINGLE WOMEN'S UNINTENTIONAL PREGNANCIES 333
were more influenced by financial instability, avoiding family shame, avoiding so-
cial stigma, and social expectations.40
After we hit our seventh month we weren't allowed to leave the maternity home. In
the hospital they let me hold him and see him. When the caseworker showed up with
the papers for me to sign, I sat with my arms defiantly crossed in front of me, saying,
"I'm not signing. I'm not. I can't. No." It was my only defiant moment. The social
worker leaned into me and said, "You're the most selfish person I've ever met." I
said, "I love him." And she said, "No you don't. You couldn't possibly love this
child." I signed.
—Bonnie [birth mother 1965]
I think you honor your parents' choice; it really doesn't matter what you feel. My par-
ents paid for the maternity home. I didn't really have an option. I did this for them be-
cause I had made a mistake. Why should my parents have to pay for the rest of their
lives with comments or sneers?
—Kathleen [birth mother 1971]
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.42 In 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 father found out I was pregnant, he said, "The only option you have is to
give up this child for adoption."
—Jan [birth mother 1975]
I'm pro-choice but when I went for my abortion I found out I was six months preg-
nant. My mom is a pro-life counselor and when she found out, she took over and said,
"We're going to get you set up for an adoption." I just went along with it because I
knew that would be my ultimate role, my decision.
—Mona [birth mother 1978]
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-
My God, it was the 60s! Everyone was sleeping with everyone. But still there was this
feeling of turning into a Jezebel, that I was different from other women who were no
longer virgins. They could sleep with anyone they wanted. But if you had relin-
quished a child you really could, because you were in a different category. There was
a blackness around it.
—Carol [birth mother 1964]
I'd like people to understand the loss involved; it's a true loss. I'd like people to take
this issue a little more seriously. I don't think things have really changed that much.
Women are still relinquishing because of shame.
—Bonnie [birth mother 1965]
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.44 In 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 that abortion wasn't an option, I knew that I was going to keep the child.
There was something deep inside me that said I was going to make this choice. We
think experts know better and we don't even listen to that voice. Especially for
women, people always tell us what we should do. My heart told me to do it, to bear
and raise my child. I've wondered if it's innate, hard-wired.
—Sherry [single mother 1961]
I was nineteen and I thought I would be the best mother to my child. My child would
never wonder, why didn't my mom keep me? I think the most important thing is love.
You have to be kind of winging it on instinct.
—Amelia [single mother 1978]
I think the decision has to come from the person themselves. 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 stand up and do what I needed
—ZoS [single mother 1989]
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
SINGLE WOMEN'S UNINTENTIONAL 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 thought that with the support of my family I could be fine. My friends wanted to kill
me for not having an abortion. I knew right away what I had to do. But I remember
that I did pray to have a miscarriage, "God, please remove this burden from me." I re-
member thinking this is crazy, I'm so committed to doing this, but wanted to have a
—June [single mother 1988]
I was crazy in love with this guy. He didn't want a child. We went to an abortion clinic
twice but I had already grown attached and m v heart was with the baby. I wanted to
keep it. Subconsciously, I think years of being in religion did affect me; I felt it was
wrong to end the pregnancy. I didn't give it much thought at the time; I was more con-
cerned with the way I felt, but I do think religion affected my decision.
—Sabrina [single mother 1990]
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 never tell anybody unless I know them
very, very well. They may think less of me because I never got married.
—Doreen [single mother 1978]
It's difficult with the older men I work with. I'm very professional, but when I talk
about my daughter I still think that because I was unmarried and pregnant they must
be thinking, she's sleeping around. No one has ever said that to me but it's in the back
of my head.
—Susan [single mother 1988]
When single women discover they have unintentionally conceived, their
agency is circumscribed by "rules for breaking rules" (Edgerton 1985). For unin-
tentional pregnancies, the implicit rule is secrecy; that silences individual as well
as collective bodies (Ellison 2000; Scheper-Hughes and Lock 1986; Sheriff 2000).
This secrecy reflects the gender work of veiled virtue that women assumed as 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 their decision.
Deeply ingrained cultural assumptions about the categories of women who
can legitimately lay claim to their sexuality, fertility, and maternity represent what
was most at stake in single women's procreation stories. The cultural ideal of being
336 MEDICAL ANTHROPOLOGY QUARTERLY
a "good" woman promotes a form of structural violence (Kleinman 2000) that con-
stricts single women's sexuality, fertility, and maternity. Thus, women's preg-
nancy experiences and their subsequent childbearing decisions were strongly in-
fluenced by their attempts to avoid social stigma for themselves and their families.
The trauma they described resulted from their fear of failing to meet culturally en-
trenched ideals of female sexual honor and socially accepted forms of maternity.46
The data from this study suggest that similar to women who have struggled with a
life-threatening illness or infertility, single unintentional pregnancies were not epi-
sodic events. Single women's unintentional pregnancies and childbearing out-
comes were deeply embodied experiences that irrevocably altered women's lives
(Becker 2000; Lock and Kaufert 1988). This article demonstrates that these experi-
ences, choreographed by a culture of honor, result in a stigmatized form of sexual-
ity, fertility, and maternity, stratified by women's marital status.
Women who had an abortion reported that their decision was influenced by
internal forms of authoritative knowledge, such as their circumstances, their assess-
ments of their partner, and their life goals. The majority of 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 potential child, and their family of origin. Al-
though most women obtained an abortion without telling their parents, this was
less a reflection of their religious beliefs than the social stigma of abortion.
In contrast to Brenda Major and Richard H. Gramzow (1998), this study
found that all women who had an abortion feared social judgment about their deci-
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 tensions that Faye Ginsburg (1989) and Kristin Luker (1984) identified
in their studies of abortion activists. These authors found that the pro-life ideology
of naturalized ascribed maternity clashed with the pro-choice ideology of mater-
nity as a self-determined role that women may achieve or reject. The pro-life ideol-
ogy of ascribed maternity that hinges on the belief that life begins at conception
provides another motif to the 19th-century cults of female domesticity and mother-
hood as women's duty. The authoritative knowledge of selfless maternity persists,
in another authoritative guise, influencing women regardless of their position on
Birth mothers reported being strongly influenced by external sources of
knowledge, such as their mothers and social workers. This finding supports pre-
vious studies of adoption (Bachrach et al. 1992; Edwards 1999; Solinger 1992). It
is important to note that birth mothers' ages at the time of their unintentional preg-
nancy were not different than those of women who terminated their pregnancies. It
was the reproductive era of their pregnancy that most impacted their childbearing
decision. The majority of birth mothers conceived during the post-World War II
adoption mandate, while abortion was illegal. The sharp decline in the number of
SINGLE WOMEN'S UNINTENTIONAL PREGNANCIES 337
women adopting away their child after Roe v. Wade (Cooksey 1990; McAdoo
1992) suggests that birth mothers were not psychologically different from other
women. Their decisions were congruent with the reproductive policies of the adop-
tion mandate and its control of illegitimacy, women's sexuality, and fertility
(Nathanson 1991; Solinger 1995; Vincent 1965).
Forty-three percent of the birth mothers in this study were sequestered in total
institutions during the visible stages of their pregnancy. Faced with limited child-
bearing options, women adopted away their child to preserve their own and their
families' honor, and to do what the adoption mandate dictated as being in the best
interest of their child. Similar to women who terminated their pregnancy, birth
mothers reported making their decision to protect themselves, their families, and
their child from social stigma. However, birth mothers were the only group that
rated their child's needs above their own and excluded themselves in the ethics of
care that informed their decision. This reflects the ideology of selfless maternity at
the heart of the adoption mandate.
Across all three data caches, single mothers stood apart from the two other
childbearing groups in the kinds of knowledge that influenced their decision. They
interpreted their pregnancy decisions as moral or religious obligations to them-
selves and their child and drew on intuition and instincts in their decision to be-
come a single mother. They often anticipated social support from their families of
origin and they were the only group that talked about being "crazy" in love with
their child's father. The most intriguing aspect of this group was the paradox that
their religious or moral conservatism was coupled with their resistance to norma-
tive expectations. This was particularly striking, given that the social visibility of
raising children as a single mother increased their vulnerability to stigma. The in-
ternalized sources of knowledge that they drew on—"winging it on instinct,"
"knowing in my heart," "knowing what I had to do"—appear to have defrayed ex-
ternal sources of authoritative knowledge.
In the interviews, single mothers talked about the gender work of maternity as
"stepping up to the plate" and "handling their mistakes," which represent active
agency and self-determination. A dominant theme in their stories, of making an un-
selfish childbearing decision, is congruent with pronatalist sentiments and social
expectations of selfless maternity. Yet in contrast to birth mothers, single mothers
staunchly included their own needs in the ethics of care that influenced their deci-
sion (Belenky 1978; Ruddick 1993). These findings support Martha Ward (1995)
and Diana M. Pearce's (1993) assertion that referring to young single mothers as
"children having children" disempowers and infantalizes women. In addition, this
study's findings suggest that dismissing single mothers as children promotes cur-
rent dominant forms of scientific knowledge, while disparaging single mothers'
This study's findings are particularly provocative, given that, to date, neither
demographic nor psychological factors predict single women's pregnancies or
childbearing decisions (Solinger 1992; Vincent 1961).47 This research elucidates
the significance of reproductive policies and authoritative knowledge in single
women's pregnancy experiences and their subsequent childbearing decisions.
338 MEDICAL ANTHROPOLOGY QUARTERLY
A limitation of this study is that its relatively small, predominantly self-selected
sample may have introduced selection bias, which limits the generalizability of its
findings. Another limitation is that the study is retrospective. However, recent re-
search on maternal recall has documented the accuracy of retrospective accounts of
such a significant life experience (Tomeo et al. 1999). Another limitation is the
study's purposive narrow focus, which future studies can extend across ethnicity
Until there was an infectious disease model in the AIDS pandemic, male sex-
ual activity had provoked little public controversy. Communities in the United
States have neither built nor filled paternity homes with single fathers to undergo
moral or psychological cleansing before being returned to society as marriageable.
Male illegitimate fertility has not been the focus of heated political controversy,
moral recriminations, reproductive legislation, or institutionalization.
This study illustrates the extent to which single women's bodies have been
the sites of extensive and extended biopolitical contestations. At the core of these
contestations lie the definitions of morality and rationality (Jordan 1997) that give
shape to normative models of female sexuality, fertility, and maternity. Although
the authoritative knowledge forging these models has shifted across reproductive
eras, the core social category that has undergirded each of these models has been a
woman's legal relationship to a man. While female dependence on a father or a
husband is socially legitimate, single women's independent fertility and sexuality
or single mothers interdependence on her community and extended webs of social
affiliation or the state are proscribed (Pearce 1993).
The social stigma study participants experienced reflects a culture of honor
that anthropology has, for the most part, attributed to circum-Mediterranean socie-
ties and religious fundamentalists. This showcasing (Appardurai 1986) has ob-
scured the similar, deeply entrenched cultural assumptions in the West (Rabinow
1986). The everyday violence explored here, as explicated in pregnant single
women's isolation, shame, stigma, and the coercive practices circumscribing their
childbearing decisions, is not as extreme as infibulation (Johansen 2002) or honor
killings (Los Angeles Times 2000; New York Times 2002). Yet these findings sug-
gest that the biopolitics of single women's pregnancies are similarly rationalized
and given moral weight, enacted, embodied, and reproduced as authoritative facts,
rather than as social artifacts.
Moreover, the cultural censorship of an experience shared by so many women
reinforces an inflexible tension between cultural ideals and women's lived reali-
ties. Consequently, pregnant single women resort to the socially prescribed gender
work of secrecy as they struggle to maintain their social standing as good women
and mothers. Thus, women's secrecy, and the censorship of their experiences, re-
produces the social order and the cultural ideology of female sexual honor. This
limits social diversity and narrows social expectations about what constitutes a le-
gitimate family. Secrecy and cultural censorship also results in the loss of valuable
knowledge for future generations. This, in turn, perpetuates the structural violence
and social stigma surrounding single women's sexuality, fertility, and maternity.
SINGLE WOMEN'S UNINTENTIONAL PREGNANCIES 339
ments and suggestions on earlier drafts of this work. I thank Gery Ryan for his valuable re-
search design suggestions. Carole E. Browner offered welcome suggestions during early
phases of this research. I also thank the anonymous reviewers for their helpful comments,
and Carole Bernard for her well-honed editing of this manuscript. In addition, I thank Janet
E. Hall for the opportunity to conduct my current research on another aspect of nonnorma-
tive fertility and iatrogenic multiple births. This study was funded in part by the Social and
Community Psychiatry Department at the University of California, Los Angeles.
1. For a discussion of how these rates were estimated, see U.S. Department of Health
and Human Services 1999; see also Henshaw 1998.
2. Throughout this article, I have used the«terms single woman rather than unmarried
woman, and single pregnancy instead of out-of-wedlock pregnancy to avoid defining
women by their legal relationships to men.
3. Two other categories of women vulnerable to the social stigma of nonnormative fer-
tility are infertile women or women whose partners are infertile (Becker 2000; May 1995)
and lesbians (Lewin 1995).
4. Merriam-Webster's Collegiate Dictionary, 10th ed. Springfield, MA: Merriam-
Webster, Inc., 1993.
5. See Kleinman 2000, for analyses of the ways in which the collective and individual
suffering wrought by social forces often remains socially invisible, especially when it has
been normalized or routinized by historically specific social practices that codify moral and
ethical norms and, hence, social hierarchies and power relations.
6. By normative fertility, I mean socially legitimated intercourse between a husband
7. Future research is needed to explore the biopolitics of unintentional pregnancies
8. Whereas Solinger (1992, 2001) suggests the adoption mandate took place
post-World War n, Kunzel (1993) and Berebitsky (2001) demonstrate that this race- and
class-specific reproductive mandate began to gain force by the late 19th century; Solinger il-
lustrates the impact of this mandate at its zenith, post-World War II.
9. Single males and females shared the same bed but, ostensibly, remained clothed.
10. See Garfinkel and McLanahan (1986) and Solinger (1992,2001) for these ethnic
and class-specific policies.
11. Children were redistributed from women of a socially proscribed category to
women deemed legitimate mothers. For example, in Ireland single women suspected of be-
ing sexually active or who became pregnant were forcibly incarcerated in the Magdalene
Laundries run by the Catholic church; their children were adopted away, many to couples in
the United States. Children were also forcibly separated from indigenous women and fami-
lies in Australia and the United States. These programs of forced assimilation, "child res-
cue," and adoption were based on religious beliefs, eugenics, and social science.
12. The post-World War II practice of closed stranger adoption was given authority
by social scientists, including psychologists Henry Harlow and John Bowlby, sociologist
Clark Vincent, and anthropologists Margaret Mead and Ashley Montagu.
13. The term birth mother refers to women who conceive and carry a child to term and
then adopt away their child. Unlike surrogate mothers, who intentionally conceive and are
paid for their services, birth mothers, until the recent shift toward a transnational adoption
market, did not receive financial remuneration.
14. For a history of abortion legislation, see Solinger 1993 and McFarlane and Meier
15. I conducted sequential, open-ended, face-to-face life history interviews with four
women who had adopted away a child as a single woman and had terminated a subsequent
I thank Robert B. Edgerton and M. Belinda Tucker for their com-
340 MEDICAL ANTHROPOLOGY QUARTERLY
pregnancy. These interviews were augmented by two years of participant observation in
adoption-affected peer support groups, in three U.S. metropolitan areas.
16. Although studies suggest that the trauma of abortion is transient for most women,
the trauma of adopting away appears to be most severe during the early years of women's
separation from their child, hence the time-based criteria of seven years. Many birth mothers
insist that the trauma is lifelong; some suffer from psychological reactions similar to post-
traumatic stress disorder. This trauma may be acutely revisited during adoptee-birthparent
searches and reunions.
17. The focus groups comprised women living in San Diego County. Local pregnancy
counseling centers, hospitals, women's health centers, adoption agencies, and peer support
groups were contacted and informed about the study. A church-based adoption agency and
an adoption support group distributed a flyer for it. Advertisements were placed in ten local
newspapers, with distribution across broad demographic strata.
18. Similar to peer support groups, group interviews provide participants an opportu-
nity to share their experiences with others who share similar experiences, thus decreasing
judgment. Participants tend to treat one another with interest and a sensitivity leavened by an
insiders' dark humor. This study's participants often commented that they enjoyed the op-
portunity to participate in research on a topic that they feel is socially taboo and misunder-
stood. At the close of each session, some participants spontaneously shared identifying
information. This suggests that just as researchers strive to protect the confidentiality of re-
search participants, it is also important to avoid making paternalistic decisions about which
research methods we deem appropriate to research sensitive topics.
19. A computerized data analysis program, QSR NUD*IST Vivo, was used to manage
the study's narrative data and facilitate coding. SPSS was used to manage and analyze the
20. Abbreviated responses for Item I included: self, partner, friends, mother, father,
social worker, doctor, God, laity, other. Item 2: social expectations, marital status, meeting
own needs, fear, financial instability, best for child, social stigma, religious beliefs, feelings
for partner, protecting family from shame, personal goals, not ready to raise a child, partner
not willing to marry.
21. Cronbach's alpha for the first items was low (.53) but acceptable for an exploratory
study; the internal consistency of the second scale was good (Cronbach's alpha = .72).
22. Because the data were not normally distributed and the sample sizes were small,
the Kruskal Wallis Test was used in place of ANOVA. To compare the direction of differ-
ences between groups, the Mann-Whitney U test was used, followed by the Dunn Multiple
Comparisons Procedure, with an alpha corrected to .0166 to control for Type I errors (Pett
23. Due to the difficulty of identifying and recruiting participants about such sensitive
topics, the initial random sample study design was integrated with snowball and conven-
ience sampling. One-third of the survey respondents had participated in a focus group; there
were no statistically significant differences in AK between the two groups. Approximately
one-third of the survey respondents for each childbearing decision had participated in the
survey (31 percent abortion, 33 percent single mothers, 36 percent birth mothers).
24. Only two women preferred not to be interviewed in their home; one requested that
I meet her at a church-affiliated office, another asked that we conduct the interview in my
home. I am indebted to each of these women for their trust and their willingness to discuss
such deeply personal aspects of their lives with a stranger.
25. A paper that explores women's evaluations of their childbearing decision is in
preparation (see also Ellison 2000).
26. Their median age was 34, with a range from 27 to 56. At the time of their first unin-
tentional pregnancy their median age was 19, ranging from 15 to 37. One-third had never
married; 70 percent had completed some college; one-third were Presbyterian; and one-third
SINGLE WOMEN'S UNINTENTIONAL PREGNANCIES 341
were Catholic. Their current combined annual household incomes ranged from $15,000 to
over $50,000 per year.
27. Just as social stigma contributes to women underreporting the number of abortions
they have had, their use of fertility treatment, and the use of donor gametes, it also appears to
contribute to women underreporting the number of unintentional pregnancies they have had.
28. (p = .057).
29. The survey included items about verbal, physical, and sexual abuse; neglect; and
the presence of alcohol or drug abuse in their household of origin. Almost half of the women
in each childbearing decision reported one of these abuses as a child (abortion, 46 percent;
adopting away, 62 percent; and single mothers, 64 percent) and 10 percent reported that they
had experienced sexual abuse as a child. One-third reported involuntary sexual intercourse
at some point in their lives (25 percent date rape, 8 percent stranger rape); 9 percent of the re-
spondents' first unintentional pregnancies were flie result of date rape (14 percent adoption,
18 percent single mothers).
30. The results of the chi-square test for k independent samples indicates a very highly
statistically significant, moderate association between the era in which the unintentional
pregnancy occurred and women's childbearing decision (X2 = 14.75, p = .001, Cramer's V
31. Only one woman did not report being traumatized. She and her partner were en-
gaged at the time of her legal abortion, eventually married, and are now raising children.
This participant stated that her pregnancy, although difficult, also gave her pleasure, as it
was proof of her fertility.
32. (p = .0003,p
33. (p = .0003).
34. (p = .024,p ,p
35. (p = .OO7,p = .O12).
36. (p = .0001, p = .0006).
37. (p = .0008).
38. (p = .0023).
39. (p = .OO5,p = .O37).
40. (p = .011,p = .020,p =
41. An exception to this is the recent proliferation of fundamentalist Christian mater-
44. (p = .0001; p = .0001, p = .0016; p = .0008, p = .0015; p = .0001; p = .0006,/
45. (p = .0139, p = .0166).
46. For two excellent analyses of Mediterranean cultures of honor, see Kertzer (1993)
and Abu-Lughod 1986. Although the ideologies and practices of a culture of honor have
been attributed to other cultures, and often male codes of honor, the social norms of female
sexual and moral behavior in the United States reflect a similar culture of honor. This article
follows Wikan's (1984) suggestion, to explicate female cultures of honor.
47. Increased parental education has been found to be associated with terminating a
pregnancy (Cooksey 1990), whereas increased maternal education has been associated with
a daughter becoming a birth mother (Bachrach et al. 1992). Thus, demographic predictors of
this decision have been contradictory.
1986 Veiled Sentiments: Honor and Poetry in a Bedouin Society. Berkeley: University
of California Press.
342 MEDICAL ANTHROPOLOGY QUARTERLY
1986 Theory in Anthropology: Center and Periphery. Comparative Studies in Society
and History 28(2):356-374.
Apple, Rima D.
1987 Mothers and Medicine. Madison: University of Wisconsin Press.
Bachrach, Christine A., Kathy Shepherd Stolley, and Kathryn A. London
1992 Relinquishment of Premarital Births: Evidence from National Survey Data. Fam-
ily Planning Perspectives 24( 1 ):27-32,48.
2000 The Elusive Embryo: How Women and Men Approach New Reproductive Tech-
nologies. Berkeley: University of California Press.
Belenky, Mary Field
1978 Conflict and Development: A Longitudinal Study of the Impact of Abortion Deci-
sions on Moral Judgments of Adolescent and Adult Women. Doctoral Thesis, Human
Development, Graduate School of Education, Harvard University.
2001 Like Our Very Own: Adoption and the Changing Culture of Motherhood,
1851-1950. Lawrence: University Press of Kansas.
1997 An Ideal of Unassisted Birth. In Childbirth and Authoritative Knowledge: Cross-
Cultural Perspectives. Robbie E. Davis-Floyd and Carolyn F. Sargent, eds. Pp.
441-472. Berkeley: University of California Press.
1974 Coercive Pronatalism and American Population Policy. In Pronatalism: The Myth
of Mom and Apple Pie. Ellen Peck and Judith Senderowitz, eds. Pp. 29-67. New York:
Thomas Y. Cromwell.
Brodie, Janet Farrel
1994 Contraception and Abortion in Nineteenth-Century America. Ithaca: Cornell Uni-
Browner, Carole H., and Nancy Press
1997 Production of Authoritative Knowledge in American Prenatal Care. In Childbirth
and Authoritative Knowledge: Cross-Cultural Perspectives. Robbie E. Davis-Floyd
and Carolyn F. Sargent, eds. Pp. 113-131. Berkeley: University of California Press.
Collins, Patricia Hill
1995 Shifting the Center: Race, Class, and Feminist Theorizing about Motherhood. In
Mothering: Ideology, Experience, and Agency. Evelyn Nakano Glenn, Grace Chang,
and Linda Rennie Forcie, eds. Pp. 45-65. New York: Routledge Press.
Cooksey, Elizabeth C.
1990 Factors in the Resolution of Adolescent Premarital Pregnancies. Demography
Davis, Angela Y.
1981 Women, Race, and Class. New York: Vintage Press.
Davis-Floyd, Robbie E., and Elizabeth Davis
1997 Intuition as Authoritative Knowledge in Midwifery and Home Birth. In Childbirth
and Authoritative Knowledge: Cross-Cultural Perspectives. Robbie E. Davis-Floyd
and Carolyn F. Sargent, eds. Pp. 315-349. Berkeley: University of California Press.
1997 Heeding Warnings from the Canary, the Whale, and the Inuit. In Childbirth and
Authoritative Knowledge: Cross-Cultural Perspectives. Robbie E. Davis-Floyd and
Carolyn F. Sargent, eds. Pp. 441-472. Berkeley: University of California Press.
SINGLE WOMEN'S UNINTENTIONAL PREGNANCIES 343
DeMunck, Victor C, and Elisa J. Sobo, eds.
1998 Using Methods in the Field: A Practical Introduction and Casebook. Walnut
Creek, CA: AltaMira.
1993 Disembodying Woman: Perspectives on Pregnancy and the Unborn. Cambridge,
MA: Harvard University Press.
Edgerton, Robert B.
1967 The Cloak of Competence: Stigma in the Lives of the Mentally Retarded.
Berkeley: University of California Press.
1985 Rules, Exceptions, and Social Order. Berkeley: University of California Press.
Edwards, Diana S.
1999 The Social Control of Illegitimacy through Adoption: Mothers Who Relinquished
a Child Offer a Cultural Critique. Human drganization 58(4):387—396.
Ellison, Marcia A.
2000 Disclosing Selves/Exposing Culture: The Gender Work of Single Women's Crisis
Pregnancies—Abortion, Birth mothers and Single Mothers. Ph.D. dissertation, Depart-
ment of Anthropology, University of California, Los Angeles.
Garfinkel, Irwin, and Sara S. McLanahan
1986 Single Mothers and Their Children: A New American Dilemma. Washington,
DC: Urban Institute Press
Gilligan, Carol, and Mary Belenky
1980 A Naturalistic Study of Abortion Decisions: Clinical Developmental Psychology.
San Francisco: Jossey-Bass.
1987 Procreation Stories: Reproduction, Nurturance and Procreation in Life Narratives
of Abortion Activists. American Ethnologist 14(4):623-636.
1989 Contested Lives: The Abortion Debate in an American Community. Berkeley:
University of California Press.
1963 Stigma: Notes on the Management of Spoiled Identity. New York: Simon and
Henshaw, Stanley K.
1998 Unintended Pregnancy in the United States. Family Planning Perspectives.
Johansen, R. Elise B.
2002 Pain as a Counterpoint to Culture: Toward an Analysis of Pain Associated with In-
fibulation among Somali Immigrants in Norway. Medical Anthropology Quarterly
1978 Birth in Four Cultures. 4th edition. Prospect Heights, IL: Waveland.
1997 Authoritative Knowledge and Its Construction. In Childbirth and Authoritative
Knowledge: Cross-Cultural Perspectives. Robbie E. Davis-Floyd and Carolyn F. Sar-
gent, eds. Pp. 55-79. Berkeley: University of California Press.
Kertzer, David I.
1993 Sacrificed for Honor: Italian Infant Abandonment and the Politics of Reproduc-
tive Control. Boston: Beacon Press.
1997 Authoritative Touch in Childbirth. In Childbirth and Authoritative Knowledge:
Cross-Cultural Perspectives. Robbie E. Davis-Floyd and Carolyn F. Sargent, eds. Pp.
209-231. Berkeley: University of California Press.
344 MEDICAL ANTHROPOLOGY QUARTERLY
2000 The Violences of Everyday Life: The Multiple Forms and Dynamics of Social
Violence. In Violence and Subjectivity. Veena Das, Arthur Kleinman, Mamphela
Ramphele, and Pamela Reynolds, eds. Pp. 226-241. Berkeley: University of California
Krueger, Richard A.
1994 Focus Groups: A Practical Guide for Research. Thousand Oaks, C A: Sage.
1993 Fallen Women, Problem Girls: Unmarried Mothers and the Professionalization of
Social Work 1890-1945. New Haven: Yale University Press.
Lawson, Annette, and Deborah L. Rhode, eds.
1993 The Politics of Pregnancy. New Haven: Yale University Press.
1995 On the Outside Looking In: The Politics of Lesbian Motherhood. In Conceiving
the New World Order: The Global Politics of Reproduction. Faye Ginsburg and Rayna
Rapp, eds. Pp. 103-121. Berkeley: University of California Press.
Litt, Jacquelyn S.
2000 Medicalized Motherhood. New Brunswick, NJ: Rutgers University Press.
Lock, Margaret, and Deborah Kaufert
1988 Biomedicine Examined. Dordrecht, The Netherlands: Kluwer Academic Publish-
Los Angeles Times
2000 In Modern Turkey, Women Continue to Pay the Price for Honor. Los Angeles
Times, September 10: A3.
1984 Abortion & the Politics of Motherhood. Berkeley: University of California Press.
2000 Focus Groups in Feminist Research. In Handbook of Qualitative Research. Nor-
man Denzin and Yvonna Lincoln, eds. Pp. 835-950. Thousand Oaks, CA: Sage.
Major, Brenda, and Richard H. Gramzow
1998 Abortion as Stigma: Cognitive and Emotional Implications of Concealment Jour-
nal of Personality and Social Psychology 77(4):735-745.
Marks, Lara V.
2001 Sexual Chemistry: History of the Contraceptive Pill. New Haven: Yale University
1987 The Woman in the Body: A Cultural Analysis of Reproduction. Boston: Beacon
May, Elaine Tyler
1995 Barren in the Promised Land: Childless Americans and the Pursuit of Happiness.
New York: Basic Books.
McAdoo, Layne Lawrence
1992 Birth mothers: The Forgotten Link in the Adoption Triangle. Ph.D. dissertation,
Department of Sociology, University of New Mexico.
McFarlane, Deborah R., and Kenneth J. Meier
2001 The Politics of Fertility Control. New York: Chatham House Publishers.
Miles, Matthew B., and A. Michael Huberman
1994 Qualitative Data Analysis: An Expanded Sourcebook. Thousand Oaks, CA: Sage.
Mohr, James C.
1978 Abortion in America: The Origins and Evolution of National Policy, 1800-1900.
New York: Oxford University Press.
SINGLE WOMEN'S UNINTENTIONAL PREGNANCIES 345
Nathanson, Constance A.
1991 Dangerous Passage: The Social Control of Sexuality in Women's Adolescence.
Philadelphia: Temple University Press.
New York Times (AP)
2002 Court Upholds Stoning for Nigerian Mother. New York Times, August 20: A10.
Pannor, Reuben, Annette Baron, and Arthur. D. Sorosky
1978 Birth Parents Who Relinquished Babies for Adoption Revisited. Family Process
Pearce, Diana M.
1993 "Children Having Children": Teenage Pregnancy and Public Policy from the
Woman's Perspective. In The Politics of Pregnancy. Annette Lawson and Deborah L.
Rhode, eds. Pp. 46-58. New Haven: Yale University Press.
Petchesky, Rosalind Pollack
1984 Abortion and Woman's Choice. Boston: Northeastern University Press.
1997 Nonparametric Statistics for Health Care Research. Thousand Oaks, CA: Sage.
1986 Representations Are Social Facts: Modernity and Post-Modernity in Anthropol-
ogy. In Writing Culture: The Poetics and Politics of Ethnography. James Clifford and
George Marcus, eds. Pp. 234-261. Berkeley: University of California Press.
Rains, Prudence Mors
1971 Becoming an Unwed Mother: A Sociological Account. Chicago: Aldine Atherton.
2001 Gender, Body, Biomedicine: How Some Feminist Concerns Dragged Reproduc-
tion to the Center of Social Theory. Medical Anthropology Quarterly 15(4):466-^77.
1993 Procreative Choice for Adolescent Women. In The Politics of Pregnancy. Annette
Lawson and Deborah L. Rhode, eds. Pp. 126-143. New Haven: Yale University Press.
1995 Sample Size in Qualitative Research. Research in Nursing and Health
Sargent, Carolyn F., and Grace Bascope
1997 Ways of Knowing about Birth in Three Cultures. In Childbirth and Authoritative
Knowledge: Cross-Cultural Perspectives. Robbie E. Davis-Floyd and Carolyn F. Sar-
gent, eds. Pp. 183-208. Berkeley: University of California Press.
Scheper-Hughes, Nancy, and Margaret Lock
1986 The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology.
Medical Anthropology Quarterly 1:6-41.
Sheriff, Robin E.
2000 Exposing Silence as Cultural Censorship: A Brazilian Case. American Anthro-
pologist 102( 1): 114-131.
Smith, Daniel Scott, and Michael S. Hindus
1975 Premarital Pregnancy in America 1640-1971: An Overview and Interpretation.
Journal of Interdisciplinary History 4:537-570.
1992 Wake Up Little Susie: Single Pregnancy and Race before Roe v. Wade. New
1993 Pregnancy and Power before Roe v. Wade, 1950-1970. In The Abortion Wars: A
Half Century of Struggle, 1950—2000. Rickie Solinger, ed. Pp. 15-32. Berkeley: Uni-
versity of California Press.
2001 Beggars and Choosers: How the Politics of Choice Shapes Adoption, Abortion,
and Welfare in the United States. New York: Hill and Wang.
346 MEDICAL ANTHROPOLOGY QUARTERLY
Sosa, R., J. Kennell, M. Klaus, S. Robertson, and J. Umitia
1980 The Effect of a Supportive Companion on Perinatal Problems, Length of Labor,
and Mother-in-Law Interactions. New England Journal of Medicine 303:597-600.
Strauss, Anselm, and Juliet Corbin
1995 Basics of Qualitative Research: Techniques and Procedures for Developing
Grounded Theory, 2nd edition. Thousand Oaks, CA: Sage.
Tomeo, Catherine A., Janet W. Rich-Edwards, Karin B. Michels, Catherine S. Berkey,
David J. Hunter, A. Lindsay Frazier, Walter C. Willett, and Stephen L. Burka
1999 Reproducibility and Validity of Maternal Recall of Pregnancy-Related Events.
2001 Devices and Desires: A History of Contraception in America. New York: Hill and
U.S. Department of Health and Human Services
1995 Report to Congress on Out-of-Wedlock Childbearing. CDC, National Center for
Health Statistics. (PHS) 95-1257:1-265.
1999 Trends in Pregnancies and Pregnancy Rates by Outcomes: Estimates for the
United States, 1976-1996. CDC, National Center for Health Statistics 21(56): 1-47.
Vincent, Clark E.
1961 Unmarried Mothers. New York: The Free Press of Glencoe.
1995 The Case of Early Childbearing: What Is the Problem and Who Owns It? In Con-
ceiving the New World Order: The Global Politics of Reproduction. Faye Ginsburg
and Rayna Rapp, eds. Pp. 140-158. Berkeley: University of California Press.
Wertz, Richard W., and Dorothy C. Wertz
1977 Lying-in: A History of Childbirth in America. New York: Free Press.
1984 Shame and Honour. A Contestable Pair. MAN 19(4):635-652.
SINGLE WOMEN'S UNINTENTIONAL PREGNANCIES 347
Appendix A: Demographics of survey respondents.
Upper middle class
Working class or poor