ALL MODERN societies struggle to define the proper relationship between the state and the private lives of the citizenry, and sexual behavior is often the central arena of this conflict. The state becomes involved in the regulation of sexuality though legislation. through the provision (or lack of provision) of sexually related services such as contraception. and through ideological messages. Yet such attempts at regulating sexuality are often resisted. Some argue that the state simply has no business intervening in this most private sphere of human activity. Others. while acknowledging the legitimacy of state involvement. disagree strongly about the character and...

THREE GROUPS—the family planning establishment, the feminist movement, and the “profamily movement”—have long-standing interests in some or all of the areas germane to family planning work: the legalization of contraception and abortion; the government’s role as provider of social services; the proper design of health care services; and, perhaps most significantly, the public management of sexuality. Each of these groups has articulated a certain version of what family planning should be (or not be, in the case of the profamily movement). Each, more to the point, would like to see its principles put into practice by those at...

WHAT IS it like to work on the front lines of family planning? What do the daily routines of family planning workers have to tell us about broader issues of public policy in this controversial area? I will attempt to answer these questions by reporting on the experiences of a group of counselors at a place I am calling “Urban,”* a private, nonprofit clinic located in a major east coast center, “Northeast City.” This chapter will introduce the reader to Urban and those who work there, as well as describe the range of research activities that produced the material for...

THE MAJOR themes that characterize contraceptive work at Urban (as opposed to abortion) were the counselors’ struggles to claim a “social” as well as medical meaning for contraception and to upgrade their assignments in the face of the very routine character of this work. These issues influenced counselors’ training, their work routines, and, especially, their reactions to these tasks.

Work in the contraceptive clinic consisted of delivering presentations (“raps”) to groups of new patients, filling out a chart, for each patient visiting the clinic, and—the primary task—doing an intake interview with each patient before she passed on to...

MANY ASPECTS of the new field of abortion counseling remain unclarified. Counselors must find solutions to problems not covered by their training, negotiate questions involving the division of labor with other staff members, especially physicians, and respond to the moral dilemmas raised by abortion itself. I find it useful to consider abortion work as a special instance of “dirty work,” drawing on the formulation of Everett Hughes. It is clear that the controversial status of abortion in the larger society (in spite of its legality) has reverberations inside the clinic. The tactical decisions made by Urban counselors and their supervisors...

EACH ASPECT of family planning work presented certain difficulties as well as rewards. The family planning counselor clearly experienced her work as having a fundamental impact on her sense of “self,” as evidenced, for example, by counselors’ occasional fears of being perceived as merely “pill-pushers” or of Urban’s coming to resemble an “abortion mill.” The routine, uninteresting aspects of the job were a source of frustration, and, in classic fashion, set off aspirations for a higher degree of “professionalization” and autonomy, as shown most dramatically in the upgrading of the birth control interview. In a number of unresolved “division of...

ISSUES THAT emerge in the course of family planning work—contemporary sexual behavior, the status of women, and the role of the family in sexual decision making—demand responses from counselors. The family planning establishment, the feminist movement, and the profamily movement have all influenced their responses, yet none offers a fully adequate moral or programmatic vision. Instead, the distinctive professional ideology that characterizes family planning workers resonates with certain aspects of each group’s program.

It is time to consider counselors as front-line workers who are actively engaged in policy creation as well as implementation. Their unique relationship to the...