Encounters with the State: A Study of Pathways to Pregnancy Prevention and Termination in Phoenix, Arizona by Melissa Janel Martinez A Dissertation Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy Approved November 2016 by the Graduate Supervisory Committee: Madelaine Adelman, Chair Ann Hibner Koblitz Doris Marie Provine ARIZONA STATE UNIVERSITY December 2016 ABSTRACT This research project analyzes women’s dynamic pathways to pregnancy prevention and termination in Arizona. Two levels of analysis guide the study: The first is a cultural analysis of the socio-legal conditions that shape the channels to birth control and abortion. During this historical moment, I analyze the fight over increasing (and calls for more) legal constraints against contraception and abortion, coupled with decreasing individual access to reproductive health care information and services. This dissertation includes an examination of the struggle over reproductive health on the ground and in the legal arena, and real pushbacks against these constraints as well. The second is an analysis of how women seek out contraception or abortion within the US socio-legal landscape. The study qualitatively examines narratives from 33 women in the greater Phoenix, Arizona area, a region emblematic of the political contest over the legal regulation of women’s reproductive health currently unfolding nationally. Ultimately, the state is implicated in the various resources and barriers—people, places, processes and policies—that inform women’s pregnancy prevention. These experiences can illuminate the ways that reproductive health care is shaped by intersecting and sometimes competing ideologies, and how women encounter them in their daily lives. The study theorizes the embodiment of women’s local encounters with the state within a cultural context of contested law and policy reform. i In loving memory of my grandmother, Janel Hangartner (1934-2004), the strongest woman I have ever known. ii ACKNOWLEDGMENTS This dissertation would not have been possible without the many inspirational women in my life. While undertaking a PhD has proven to be a life-changing experience for me, this project was certainly no individual feat which must be acknowledged. First and foremost, I owe a debt of gratitude to my dissertation committee chair, Dr. Madelaine Adelman. Your constant encouragement, guidance and intellectual insight have been invaluable resources for me throughout the program. I am particularly grateful for time you spent on detailed feedback, which pushed my analytical thinking further. Working with you over the past four years has been an absolute pleasure – so, sincerely, thanks a million, Maddie. Special mention goes to my remaining committee members, Dr. Ann Hibner Koblitz (ASU Women and Gender Studies) and Dr. Doris Marie Provine (ASU Justice and Social Inquiry). Within the classroom and during dissertation research, you both expanded my intellectual and analytical insight on reproductive politics and socio-legal research, respectively. I am genuinely grateful to you both for the continual support and timely feedback throughout the project. Next, I am indebted to my academic mentor, Dr. Eve Darian-Smith in Global Studies at the University of California, Santa Barbara. You encouraged me to continue my higher education, first, with my Master’s and, again, with my doctorate. Your confidence in my intellectual capabilities fostered my enthusiasm for socio-legal research early in my undergraduate education. I would not be here today without you, Eve. I must also recognize that the study would not have been possible without the sample of incredible women who shared their personal stories with me. Thank you for iii spending time and allowing me into your lives. You all are the reason I remain impassioned to pursue this kind of research now, and throughout my academic career. To my Momma – my best friend, my rock, my unwavering ally – I offer a million thanks for always being there. Our weekly chats helped to quell my anxieties and keep me going. Please know that I love you so much – and just as I came from you, so did this academic feat. To my Daddy and my Brudder (aka Matty) – thank you to both of you for talking sense into me anytime I needed it. More, thank you for showing me what it looks like when thoughtful men align with women rather than undermine them. Also many thanks to my closest friends, Jessica Burrell and Abby Vercauteren, who offered words of encouragement throughout years of my venting over the program and my dissertation. Our relaxing nights watching Girls and drinking white wine helped me recharge my batteries and maintain my determination. Thank you to Arizona State University’s School of Social Transformation. Specifically, I am grateful to both Justice and Social Inquiry and Women and Gender Studies for practical help navigating the doctoral program and financial assistance provided throughout my doctoral work. Extended thanks to the ASU Graduate College for funding the final stages and completion of this project. Finally, I dedicate this doctoral dissertation to my grandmother, Janel Hangartner, whose loving memory continues to inspire me. Your life and spirit taught me what it means to be a strong woman in this world – to embrace the notion that, amidst society’s deep-seated shortcomings, there is still much to be gained from kindness, compassion and solidarity. iv TABLE OF CONTENTS CHAPTER Page 1 INTRODUCTION………………………………………………………………………1 A Note on Terminology…………………………………………………………...1 Literature Review………………………………………………………………….3 Reproductive Politics in the United States………………………………...5 Law and Society………………………………………………………….27 Encounters with the State and Social Stigma….………………………...………36 2 RESEACH DESIGN AND METHOD………………………………………………...41 Research Questions………………………………………………………………41 Epistemological and Methodological Approach………………………………....42 Methods……………………………………………………………………….….43 The Study Sample………………………………………………………………..49 Research Ethics………………………………………………...………………...52 Limitations…………………………………………………………………...…..53 3 ARIZONA’S SOCIO-LEGAL LANDSCAPE………………………………………...56 Arizona’s Historical Timeline………………………………………………..…..59 Current Trends in Arizona..……………………………………………………...69 Additional Contemporary Legislation in Arizona…………………………..…...79 4 EXPERIENCES WITH PREGNANCY PREVENTION IN ARIZONA……………...92 Encounters with the State………………………………………………………...94 Encounters with Medical Institutions…………………………………………..102 Encounters with Insurance Institutions…………………………………………119 v CHAPTER Page Encounters with Societal Pressures…………………………………………….136 Overall Satisfaction with Contraception………………………………………..139 Conclusions……………...…………………………...…………………………142 5 EXPERIENCES OF PREGNANCY TERMINATION IN ARIZONA……………...148 Before the Abortion…………………………………………………………….152 During the Abortion…………………………………………………………….161 After the Abortion………………………………………………………………177 Conclusions…………………………………………..…………………………181 6 CONCLUSION…………………………………………………………………….....186 Central Arguments………………………………….…………………………..186 Future Research………………………………………………………………...196 Pragmatic Implications……………………………………….………………...199 WORKS CITED……………………………………………………………………..…204 APPENDIX A LIST OF INTERVIEW QUESTIONS………………………………...……..221 B SAMPLE RECRUITMENT MATERIALS……...…………………………..224 C SAMPLE CHARACTERISTICS…………………………………………….226 D IRB APPROVAL DOCUMENTS…………………………………………...229 E US CENSUS DATA – ABORTION RATES BY STATE, 1973-1980……...234 F PLANNED PARENTHOOD ARIZONA IN-CLINIC ABORTION PRICING…………………………………………………………………...…..236 vi 1. Introduction Inspired by the escalating debate over reproduction in the United States, this research project analyzes women’s dynamic pathways to pregnancy prevention and termination in Arizona. The fight over increasing legal constraints against contraception and abortion remains pertinent. This project examines the struggle over reproductive health on the ground and in the legal arena, and real pushbacks against these constraints as well. First, the project offers a cultural analysis of the socio-legal conditions that shape the avenues to birth control and abortion in Arizona. Next, I investigate how women seek out contraception or abortion within this US socio-legal landscape, identifying encounters with the state along the way. In the end, different barriers and facilitators (some influenced by the state) inform women’s pregnancy prevention, and have larger implications on social stigma felt by different women. A Note on Terminology This project necessitates defining of both contraception and abortion as used throughout this dissertation. With regard to contraception (commonly referred to as birth control), I refer to mechanical hormonal methods or devices used to prevent pregnancy. My project is specifically interested in women’s interactions with the state, so my project limits itself to those forms of contraception that require interactions with a medical institution (state or otherwise) to obtain. This includes multiple forms of hormonal birth control (including the pill, ring, injection, etc.) and intra-uterine devices or the IUD (both copper or hormonal). This project has not included experiences with the hormonal implant for a couple reasons. While use of long-acting reversible contraceptives (LARCs) 1 like the implant and IUD1 continues to increase nationally, the hormonal implant is still only used by approximately 1%2 of women actively using contraception (Daniels, Daugherty and Jones 2014). Further, in the US in 2012, there were