From Back Alley to the Border is the first book-length examination of abortion in the American West and Mexico before Roe v. Wade (1973), focusing primarily on California between the 1920s and 1960s. In addition to detailing the “cat-and-mouse game” that played out between abortion providers and law enforcement during the era of criminalization, Gutierrez-Romine documents women’s persistent efforts to terminate unwanted pregnancies (193). With her book, Gutierrez-Romine demonstrates the instrumental role abortion providers played in the gradual process of legalization in California, the state that led the nation in abortion decriminalization. Amid recent attacks on abortion rights, Alicia Gutierrez-Romine’s From Back Alley to the Border is a necessary addition to the historiography of abortion law in the United States.

Organized chronologically and featuring the rise and fall of the Pacific Coast Abortion Ring (PCAR) in the 1930s, Gutierrez-Romine’s book builds a narrative of abortion providers as more than simply “criminal abortionists.” As Gutierrez-Romine details, law enforcement in the early twentieth century focused primarily on abortion-related deaths and prosecuted non-physician abortionists. While involved in the industry for profit, these abortionists provided essential services to women in need, including those who could not afford the services of private physicians—who, as chapter 2 illustrates, were more likely to escape prosecution due to their status as medical professionals. Chapters 3 and 4 explore the exception to this general rule, showing how black and women physicians faced both professional and legal troubles in their efforts to provide abortions. Chapter 5 details the rise of PCAR, an impressive coastwide “abortion mill” that provided safe abortions to hundreds, maybe even thousands, in California, Washington, and Oregon. Gutierrez-Romine asserts that PCAR’s ability to provide safe abortions forced a shift in the criminalization and prosecution of abortion in California. Since there were no fatalities, prosecutors could no longer rely on gruesome descriptions of botched abortions to indict and convict providers. Instead, law enforcement increased surveillance, gathered evidence, and compelled women who survived their abortions to testify in court. As chapters 6 and 7 detail, the prosecution of PCAR led to a harsh crackdown on abortionists in California and on physicians providing therapeutic abortions in hospitals. To avoid U.S. law enforcement, providers created a lucrative abortion industry in Tijuana, Mexico.

While Gutierrez-Romine’s book focuses primarily on the experiences of white women and white abortion providers, it offers a compelling racial analysis. Her chapter on black physicians provides important insights into early twentieth-century discourses of reproduction and racial uplift, and documents how black physicians provided abortions to women across racial and class lines. Additionally, Gutierrez-Romine’s history of the rise of an American abortion industry in Mexico explores the racialization of borderland spaces and how anti-Mexican discourse shaped the history of abortion legalization in California. While abortion on demand was not legal in Mexico, providers created a market for California women in border towns like Tijuana, where patients and practitioners evaded prosecution by California officials. As Gutierrez-Romine demonstrates, California physicians and abortion advocates drew on stereotypes of the border as a lawless place of vice to assert that the state needed to decriminalize abortion. “Tijuana abortions” were cast as especially dangerous, and physicians successfully argued that the state’s law forced desperate women into life-threatening situations (2).

From Back Alley to the Border also illustrates the construction and regulation of white womanhood. Gutierrez-Romine details how, in both newspapers and films, abortion-related deaths were used as “cautionary tales” for young white women about the consequences of premarital sex and rejecting the strictures of domesticity (8). Abortion fatalities became profitable for newspapers and feature films that circulated archetypal narratives of young white women victimized by irresponsible boyfriends and immoral abortionists. These narratives gained social and legal currency even though, as Gutierrez-Romine’s analysis of Los Angeles County Coroner’s office records from 1929–1938 in chapter 2 shows, most women who died from abortions were married and between the ages of twenty and forty-five. Her analysis of women abortionists in chapter 4 also offers significant insight into the boundaries of white womanhood. In addition to facing professional barriers in the field of medicine, women abortion providers were deemed more dangerous than male abortionists and cast as “violent criminals and murderesses who helped other women escape motherhood by essentially committing infanticide” (98). Like black physicians, women abortion providers were punished more harshly by law enforcement. Gutierrez-Romine shows how, in the face of inflammatory rhetoric and harsh sentencing, these women insisted on providing illicit abortions because of a desire to help other women and in pursuit of the lucrative profits available in the industry. As Gutierrez-Romine describes, abortionist Laura Miner “not only helped women exercise their own reproductive choices, but she also gained financial independence, stability, and the ability to provide a comfortable life for herself and her two children” (109).

In addition to documenting a complex underground abortion landscape on the West Coast, Gutierrez-Romine asserts that women were not silent about their abortions. Because women were compelled to testify in public about their experiences, Gutierrez-Romine contests the prevailing historical narrative of silence and secrecy around abortion in the era of criminalization. This is a crucial point that could have been bolstered by more direct quotes from women’s legal testimonies in the book, but ultimately the omission opens the door for further exploration. Another point that deserves deeper discussion is the role of disability in arguments for abortion decriminalization. Discussing how the fear of congenital disabilities from German measles and thalidomide changed the terms of the abortion debate in the 1950s and ’60 s, Gutierrez-Romine writes that “perfectly healthy white babies were valuable. Disabled babies, at this time, were not” (180). Concerns over “disabled babies” prompted physicians and parents to push for a broader understanding of therapeutic abortions for married couples. As Gutierrez-Romine insightfully points out, postwar notions of “better breeding” and the construction of a “new vocabulary of family planning and genetics” were instrumental in arguing for abortion access when a woman’s life was not at risk (181). These points beg for further analysis of the roles of ableism and eugenics in future histories of abortion decriminalization before Roe.

In all, Gutierrez-Romine skillfully narrates a complex history of abortion on the West Coast that highlights the role that providers played in challenging California’s anti-abortion statute in the early to mid-twentieth century. The book offers a compelling example of how anti-abortion laws have historically been ineffective in preventing people from terminating pregnancies and have, instead, forced women and providers into desperate and sometimes dangerous situations. From Back Alley to the Border also offers an unsettling picture of what the future looks like under new anti-abortion laws meant to chip away at Roe v. Wade. Or, as Gutierrez-Romine writes in her conclusion, what the present looks like for people for whom abortion is out of reach because of cost, distance, and state-specific restrictions. Gutierrez-Romine asks of the present moment, “Is legal-but-out-of-reach actually better than just plain illegal?” (199). Echoing reproductive justice advocates, Gutierrez-Romine asserts that “there are no rights where there is no access” (199). Her book effectively challenges readers to consider how legal and social frameworks come together to constrict people’s reproductive autonomy both in the past and in the present.

Natalie Lira