The landmark case Roe v. Wade redefined family: it is now commonplace for Americans to treat having children as a choice. But the historic decision also coincided with widening inequality, an ongoing trend that continues to make choice more myth than reality. In this new and timely history, Matthiesen shows how the effects of incarceration, for-profit healthcare, disease, and poverty have been worsened by state neglect, forcing most to work harder to maintain a family.