For more than three decades, the public and policymakers have grappled with the contentious question of how much value should be accorded fetal life. Prior to Roe v. Wade (1973), courts viewed the interests of the woman and fetus as identical, or at least congruent. Roe's trimester framework, by according separate and potentially competing interests to the fetus at different stages in a pregnancy, provided a legal rationale for abortion opponents to try to establish fetal rights in a variety of contexts. Typically, the issue was couched as a maternal/fetal conflict where a range of women's actions are viewed as threats to fetal health.

As Rachel Roth persuasively argues, fetal rights policies are “often counterproductive to those goals, and always undermine women's equal standing as citizens” (p. 2). She demonstrates how fetal rights claims have been used to regulate women's lives in ways that do not apply to any other class of people. Because women are viewed as “potentially pregnant” for most of their adult lives, all women's autonomy is curtailed. Roth begins by succinctly showing how the abortion conflict serves both as the starting point and as a backdrop to all fetal policymaking, but her primary focus is on the spillover of fetal rights claims into over venues (workplace fetal protection policies, forced medical interventions on pregnant women, and substance-abuse policies targeting pregnant women).

The most significant strengths of this book are its comprehensiveness and readability. Roth links disparate fetal policy domains to demonstrate that in each, the extension of legal status to fetuses (and embryos) resulted in an erosion of women's citizenship status. (See also Cynthia Daniels, At Women's Expense: State Power and the Politics of Fetal Rights, 1993; Jean Schroedel, Is the Fetus a Person? A Comparison of Policies Across the Fifty States, 2000). Roth traces the evolution of policies, paying particular attention to historical and cultural factors that have been used for the argument that women must subordinate their rights and needs to ensure healthy offspring. For example, employer-mandated work-place fetal protection policies that exclude fertile women (i.e., nonsurgically sterilized women) from jobs that expose them to potentially hazardous substances originated in the early twentieth century with Supreme Court rulings, which allowed “protective” laws that discriminated against women in the workplace in order to ensure their reproductive capacities were not undermined.

In the section on forced medical interventions, Roth posits that the maternal/fetal concept is a “misnomer” because the conflicts really are “between women and medical authority and between women and state authority” (p. 90). Although this distinction appears to be a minor one, it has profound implications for women's autonomy. In no other situation can medical authorities, with the acquiescence of the judiciary, overrule a mentally competent individual's decisions about medical treatment. Roth critiques the Georgia Supreme Court's Jefferson v. Griffin Spalding County Hospital Authority (1981) decision allowing a forced cesarean section, showing that its understanding of Roe was flawed. The court held that a viable fetus has a right not to have its existence terminated arbitrarily and then awarded temporary custody of the fetus to state authorities, who immediately consented to a forced cesarean. Not only did the decision give no weight to Jefferson's right to bodily integrity, but as Roth points out, it also gave no weight to “the fact that the decision effectively awarded temporary custody of Jefferson herself to the state” (p. 117). She continues: “The court erred again by turning the state power upheld in Roe v. Wade—to stop an invasive medical procedure by banning abortions of viable fetuses—into the power to compel an invasive medical procedure” (p. 117).

Roth also claims that state attempts to use laws that were never designed to apply to fetuses, such as child abuse and murder statutes, in order to prosecute drug-using pregnant women are misguided. Not only are fetal abuse prosecutions constitutionally suspect, but they also work against the ostensible aim of promoting fetal health. Roth argues that involuntary drug screening of pregnant women in order to gather evidence for criminal prosecutions only discourages them from getting the necessary prenatal care.

Although Roth posits that all women's constitutional rights are threatened by the extension of legal rights to fetuses, she recognizes that not all women are equally at risk. Workplace fetal protection plans most directly impact working-class women, not professionals. Most of the forced medical interventions have been performed on immigrant women and members of minority religious sects, such as the Jehovah's Witnesses. In a similar vein, Roth shows that poor African American women are far more likely to be prosecuted for “fetal abuse” than are white women, even though drug-use rates are comparable.

Although a useful addition to the fetal policymaking literature, Making Women Pay has some shortcomings. Because Roth tries to cover so much ground, her analysis lacks the depth of works that focus on single-policy domains (e.g., Suzanne Uttaro Samuels, Fetal Rights, Women's Rights: Gender Equality in the Workplace, 1995). Moreover, the research only encompasses the period from 1973 to 1992. Thanks to the efforts of legislators and lawyers associated with the religious right, fetal policymaking is one of the most unsettled areas of the law, and so it is extremely important to use data that is as up-to-date as possible. But these are minor quibbles.

Overall, this is an excellent introduction to the area of fetal policymaking. I particularly recommend it for use in undergraduate classes. Roth does a superb job of making complicated legal arguments accessible to the general reader. Moreover, she effectively uses compelling stories of actual women's lives to put a human face on the negative consequences of extending rights to potential human life. How can one not feel the pain of Theresa Wright, who was forced to choose between being surgically sterilized or losing her high-paying job?