Many of the most hotly contested battles of the abortion wars in the United States have focused on the fate of Roe v. Wade, the US Supreme Court’s decision recognizing a right to choose abortion. The criminalization of abortion disproportionately interests anyone concerned about abortion. In some ways, this might be no surprise. Criminalization is an issue that would affect all women, white and Black, wealthy and poor.

There also seems to be something of a political consensus against the criminal punishment of pregnancy. The antiabortion movement has insisted that, even if Roe is reversed and states can criminalize abortion, no one will punish women. Antiabortion leaders point to the history of nineteenth-century statutes and case law that often did not treat women as perpetrators. Even those states that formally treated women as accomplices or perpetrators rarely prosecuted them. Indeed, since the 1990s, the antiabortion movement has focused on arguments that portray women as “the second victims of abortion.”

Michele Goodwin’s brilliant Policing the Womb delivers an authoritative account of how the law already punishes pregnant women. Debates about the future criminalization of abortion seemingly leave out the low-income, nonwhite women who figure centrally in Policing the Womb. By unearthing their stories, Goodwin shows that states have already taken significant steps toward criminalizing pregnancy. Policing the Womb serves as a cautionary tale for anyone who has downplayed the effects of the law on the poorest pregnant people.

As important, Goodwin urges readers to look beyond abortion. In the United States, a preoccupation with abortion is not difficult to understand. Abortion is a crucial wedge issue: abortion politics have transformed Supreme Court nominations and presidential elections. But Policing the Womb shows how much is lost when scholars and politicians look at one reproductive issue at the expense of others. Goodwin, by contrast, considers how a wide variety of laws punish behavior during pregnancy, from criminal laws governing drug use to international family planning policy and state policy on the physician–patient relationship. Her book documents not only how these laws harm pregnant people and children but also why they so often remain invisible in the national debate. As Goodwin frames it, these women are the proverbial “canaries in the coal mine.” Their cases, she argues, foreshadow how states will regulate all pregnancies if they have the legal power to recognize capacious fetal rights.

Goodwin weaves history throughout her narrative. She starts with the eugenics movement of the early twentieth century and the spread of compulsory sterilization legislation. Goodwin highlights the uneven application of the laws—and what that application presaged for later debates about sex and reproduction. Much as eugenicists sought to sterilize women deemed unfit because of poverty, promiscuousness, or addiction, contemporary law singles out a similar class of women for surveillance and punishment. These forgotten women are at the heart of Goodwin’s story. She chronicles better-known episodes, such as the effort to prosecute pregnant drug users in the 1990s. But Policing the Womb is so valuable partly because it shows how the criminalization of pregnancy continued well after higher-profile incidents faded from the headlines.

Naturally, Policing the Womb also reconsiders abortion law, the body of rules most often associated with the criminalization of pregnancy. Goodwin shows how much perspective we gain by centering the perspectives of marginalized women. In revisiting the history behind the criminalization of pregnancy in the nineteenth century, for example, she shows how criminal laws introduced and then sidelined and stigmatized Black midwives. Later, she spotlights cases dealing with the Medicaid funding of abortion. These decisions, Maher v. Roe and Harris v. McRae, reflect a theme that runs throughout Policing the Womb: the state erases its own responsibility for past acts of discrimination and frames poverty (and diseases of poverty) as the fault of pregnant women.

Perhaps the most compelling chapters in Policing the Womb expose the extent to which medical professionals, rather than judges or lawyers, interpret and enforce laws penalizing pregnancy. In recent decades, legal historians have reconsidered crucial legal questions by looking “from the bottom up,” studying how lay people implement and even redefine the law. Policing the Womb provides a lucid account of how physicians, nurses, and other medical practitioners have become the primary enforcers of rules criminalizing pregnancy—often at the expense of their traditional roles as the patient’s fiduciary.

Goodwin’s argument is original and compelling, and Policing the Womb fills several important gaps in the literature on reproduction and the law in the United States. However, although Goodwin’s work is very persuasive, one wonders whether the treatment of the women she spotlights truly foreshadows what is to come for all pregnant people if states enact more sweeping fetal protective policies. Before 1973, when the Supreme Court recognized a right to abortion in Roe v. Wade, abortion rules demeaned, shamed, and threatened all women. Nevertheless, wealth and whiteness allowed many women to navigate laws that allowed for abortions in cases of a threat to a patient’s life or later rules that made exceptions for health, rape, incest, and fetal disability. Then as now, the law disproportionately punished poor, nonwhite women. These patients also died far more often during illegal abortions.

As Goodwin shrewdly argues, the same was true of eugenic sterilization policies. State lawmakers overwhelmingly sterilized poor men and women who depended on the state, including those in state institutions and those who relied on some form of welfare program. The racism and classism captured in Policing the Womb are startling, even for an expert in the field. Goodwin’s narrative may be more the story of a reproductive caste system, one that has survived multiple legal and cultural upheavals. This system may endure beyond the potential demise of Roe.

But readers will find Policing the Womb valuable regardless of whether states further expand the punishment of pregnant people. This is true in part because it casts the campaign to overturn Roe in a different light. For decades, the antiabortion movement has worked to chip away at abortion rights in the hope of seeing Roe overturned. Often, scholars of this campaign focus on abortion restrictions. Goodwin closely examines other laws intended to recognize fetal personhood (and thereby to make Roe a constitutional outlier). Scholars supportive of reproductive justice primarily address how the fight to reverse Roe has already eliminated abortion access for pregnant people, especially those who have fewer resources (or those who live in states with larger antiabortion majorities). Goodwin shows that the campaign to dismantle Roe has had effects well beyond abortion access. This effort has legitimized the criminalization of pregnancy and distorted the physician–patient relationship.

More than anything, Policing the Womb reminds readers that to care about the criminalization of pregnancy, we should not need poor, nonwhite women to be “canaries in the coal mine.” Goodwin questions how rules that harm pregnant people and criminalize pregnancy have continued to thrive decades after the rejection of eugenics—and despite the vigorous insistence of abortion foes that they would never support the punishment of pregnancy.

As Goodwin notes, there is no simple answer to this question. But indifference seems to be part of the equation, especially among those who advocate for legal abortion. In 1976, pro-choice forces did not focus on battling the Hyde Amendment, a measure that prohibited Medicaid funding for abortion. Even after the Supreme Court upheld the funding ban, abortion rights supporters did not prioritize eliminating it. Support for the Hyde Amendment became a matter of bipartisan consensus. In later decades, when abortion rights supporters criticized the criminal prosecution of pregnant drug users, the pro-choice movement presented the effort as a stealth attack on Roe. The harm done to poor, pregnant people did not receive as much attention. The antiabortion movement, by extension, prioritized laws that affected low-income women and nonwhite women because these statutes seemed easier to pass and more likely to survive in the Supreme Court. Too often, even those who worked on issues of reproductive health prioritized some patients over others. Poor women took center stage only when they could convincingly claim to be canaries in the coal mine—when their circumstances presaged something for women who had the means to donate money, shape policy, or influence the law.

Policing the Womb pleads with readers to put an end to this history of indifference. By telling the stories of specific patients, Goodwin humanizes those who have been stigmatized or dismissed as “bad mothers.” She shows that efforts to protect or dignify fetal life have profound consequences for children as well as women. And she teaches us how different debates about reproduction in the United States could become if we paid attention to all pregnancies. The picture she paints shows that the time to debate the criminalization of pregnancy is not after the possible overruling of Roe. It is now.