History of Abortion in the US: Before Roe

Undoubtedly, history is vital in understanding the public health issues that our nation faces in the present day. Regarding abortion, it is likely that our future will mimic the past if the Supreme Court overturns Roe v. Wade.

This is the beginning of a series investigating the past, present, and future of abortion rights in the United States. Hopefully, this will lead you to a greater understanding of the current landscape women must navigate to obtain an abortion and how that might change if the Court dismantles Roe.

In the coming weeks, I will discuss Roe and other relevant abortion legislation since 1973. After that, I will describe the current state of abortion and draw from history to infer what a post-Roe America could look like for millions of women.

First, I will outline the tradition of abortion practice throughout American history and the trajectory that led to the 1973 case that affirmed women’s legal right to choose. The information included in this presentation is from When Abortion was a Crime: Women, Medicine, and Law in the United States, 1867-1973 by Leslie J. Reagan. This book, initially published in 1997, has been re-released this year with a new preface as its content is more relevant than ever. I compiled the information about abortion law and practice into short periods to highlight overall trends and important events.

Timeline

18th Century to Mid 19th Century

Blurb: Abortion was common in the 18th century. It was not always legal, but generations of Americans accepted the practice. Data shows that thousands of women in this period ended their pregnancies by different means, with and without medical intervention.

Slides

• Pregnancy was conceptualized differently during this time. Life was not thought to begin at conception. Instead, people believed it began at quickening (when the pregnant women first felt fetal movements at approximately the 4th month)
• Until quickening occurred, a missed period was simply considered "blocked menstruation." There were many home remedies for "bringing on the menses," which would now be considered abortions.
• Abortion was widely accepted and common; it took place in the homes of women as well as midwives' and doctors' offices. In most states, abortion was legal before quickening, which was still a subjective experience for a woman.
• The earliest laws surrounding abortion were poison control measures that sought to prevent the use of certain abortifacients that often killed the woman who took them.
• In the 1840s, the abortion business boomed as many providers entered the market for which there was high demand.
• The Catholic Church was not opposed to abortion at this time, initially accepting early abortion.

Late 1800s

Blurb: As professional organizations of physicians and the Catholic Church began to speak out against the practice of abortion, new criminal abortion laws emerged. Nonetheless, abortion in practice was relatively unchanged. This period began a long era of the juxtaposition of an increasingly criminal stance on abortion yet continued access to the procedure.

Slides

• In 1857, the newly organized American Medical Association took the stance that abortion should be illegal at every pregnancy stage and began advocating for legal change.
• However, though this was the expressed view of the medical establishment, many doctors still supported abortion and continued to provide abortions or refer to providers who did
• In 1869, the Catholic Church condemned abortion for the first time.
• In the 1880s, abortion laws began to pop up increasingly. Physicians supported and even led the fight for these laws. Their stance on abortion was entwined with the growing anxiety about immigrants and population expansion.
• All abortion laws in this time made exceptions: therapeutic abortions were permitted to save a woman's life. But the definition of what constituted a therapeutic abortion was determined by individual physicians, and there was no universal definition of accepted conditions.
• Abortion remained widely available during this time. Healthcare was an ununified system, with great autonomy of providers, which allowed circles of abortion providers to continue to work despite growing legal pressure.
• Evidence shows that women and their loved ones widely accepted abortion.
• The media played an influential role in changing the narrative around abortion. For instance, the Chicago Times ran an expose on abortion, creating the "child murder" or "infanticide" narrative. The media described abortion as something that "frivolous" women used to avoid having children in favor of developing their career and social life. This negative press led many in the medical community to believe that being involved in abortion would threaten the trustworthiness of the profession.

Early 1900s

Blurb: While the situation around abortion had become increasingly hostile over the past few decades, evidence demonstrates that women still had abortions for various reasons at the turn of the century. As abortion practice became secretive due to new laws, more women died from their abortions, further casting the procedure in a negative light.

Slides

• Women sought abortions for reasons such as delaying childrearing, ending childbearing, and fearing spousal abuse. Most women who received abortions were already married and had children.
• Women had knowledge of abortion that they used to help each other. They helped their friends induce abortions and referred them to providers.
• The birth control movement asserted that it was different from abortion and argued against termination.
• Both midwives and doctors performed abortions. Wealthier women were more likely to see a physician, whereas working-class women tended to be cared for by midwives. While the abortion complication rate did not differ between the types of practitioners, this difference set the stage for disparities in years to come.
• Physicians, threatened by midwives entering their profession, blamed them for abortion and sought to differentiate themselves from this group. They used midwives as a scapegoat for maternal mortality and fought to bring midwives under greater scrutiny and tighter control.
• Many mothers died during their abortions due to unsafe conditions and unreliable providers.
• The media coverage of women who died from abortion complications was intended to fuel the discourse against abortion, and it was successful. Newspapers attempted to create the illusion that abortion equated to death.
• Abortion providers were increasingly prosecuted, primarily if they caused a women's death.

1920s and 1930s

Blurb: By this time, physicians successfully curbed the practice of midwifery, but abortions still occurred. States increasingly prosecuted doctors for causing the deaths of women due to abortion complications. Women were often denied medical attention when experiencing obstetrical complications until they gave a dying declaration exposing their abortion provider to state officials. Abortion became more and more dangerous for women across the country.

Slides

• Physician control over midwifery was successful as midwives dwindled in number in many northern cities as obstetrics became a more established specialty.
• Abortion was further medicalized. The procedure was removed from private offices and restricted to hospitals and clinical settings. Contrary to the prevailing perception that abortions in this era were performed by the "back-alley butcher," most abortions were performed by physicians.
• Despite the profession's stance, women pressured doctors into helping them obtain wanted abortions—some medical professionals began to expand the definition of what should be considered a therapeutic abortion.
• As the Great Depression hit the nation, many women found having an abortion necessary because they could not afford another child. Increasingly, younger women delayed childbearing to obtain an education and avoid the rampant discrimination against pregnant women in the workplace.
• A study found that women aborted 20% of all pregnancies, and 10-23% of American women had abortions in their lifetime. The rates of abortion were constant across demographics, including race and religious affiliation.
• Physicians were increasingly prosecuted when women died due to an illegal abortion. Authorities obtained dying declarations from women when they sought care for abortion complications. These women were harassed on their deathbeds until they exposed their abortionists.
• Physicians would deny helping a woman with complications until she told who her abortion provider was in order to exonerate themselves. Since a miscarriage cannot be differentiated from abortion complications, all women in obstetrical distress were considered suspect. Women suffered because of doctors' desire to protect themselves.
• The criminalization of abortion only made the procedure more dangerous as it decreased the number of well-trained and careful providers.
• Poor women were forced to use the most dangerous abortion methods, including self-induced abortion and unskilled providers. They were also more likely to delay seeking medical care if they had complications.
• On the other hand, wealthier women had greater access to trained professionals and often avoided investigation by state officials.

1940s

Blurb: The states' attacks on abortion became more severe, and thus, physicians and hospitals took a more significant regulatory stance. Abortion only became more dangerous as thousands of women died yearly due to septic complications. It became clear that the antiabortion stance of organized medicine was not aligned with the views of individual providers. Physicians disagreed on the conditions that allowed therapeutic abortions but were hesitant to express their opinions publicly.

Slides

• Growing numbers of women appeared in hospitals for care following illegal abortions.
• Public health officials identified illegal abortions as an essential determinant of maternal mortality. 12.8% of maternal deaths are due to septic abortion, equating to 15,000 women dying yearly.
• Physicians began to reconsider their stance. The number of women dying from abortions pushed some to reconsider abortion legislation, but few were outspoken due to fear.
• 68% of medical students indicated that they would support abortion and perform it if it was legal
• Many physicians began to broaden the concept of therapeutic abortion rather than advocate for the legalization of abortion. Physicians now performed abortions for tuberculosis, extreme vomiting, weight loss, and social situation reasons.
• New aggressive state suppression of abortion led to shutting down clinics that had operated for years. As they raided established practices, state officials exposed the records of patients. They used this information to question women who had been to the clinics to prosecute them.
• As many women survived sepsis due to blood transfusion and antibiotics, officials now questioned healthy women about abortion, not just those on their deathbeds. They often forced women to testify in court about their abortion, which was traumatic and often occurred under duress.
• Women feared the public shame that came with the press exposing women in their communities whose names were found in an abortion clinic's records.
• Hospitals imposed new rules to regulate therapeutic abortion practice as physicians desired to expand the practice. Hospitals across the country created committees that deliberated whether a physician could be authorized to perform an abortion. This took legal abortion out of the hands of general practitioners in non-hospital clinics. They rejected as many as half of the proposed abortions, and data shows that doctors performed half the number of therapeutic abortions as in previous years.

1950s

• As official raids of abortionist offices intensified, fake raids and extortions took advantage of physicians and women.
• Abortion still occurred but became more secretive and more dangerous. Women were blindfolded and taken to unknown places to have their procedures performed by an unidentified person. Many women accepted these unsafe conditions because they had no other options. They were powerless against sexual harassment by providers who took advantage of the woman in the vulnerable situation.
• Birth control became available yet restricted to married women only. Unmarried women could still only rely on illegal abortion to control their fertility.
• Women often mimicked the symptoms of pernicious vomiting or pretended to have severe psychiatric problems to get approval for a therapeutic abortion which had become more complex.
• Abortion restrictions hit women of color the hardest. Those with access to safe abortions were wealthy white women with private insurance. Minority women accepted worse conditions, and some accepted sterilization in exchange for abortion.
• Hospitals opened entire wards dedicated to treating women with abortion complications to care for the influx of patients. From 1951-62, abortion-related deaths doubled across the nation, with four times as many women of color dying compared to white women.
• A small group of physicians began the earliest reform efforts, arguing that abortion was a public health problem. Psychiatrists were among the first to question abortion regulations as they were sympathetic to patients' emotional distress.
• In 1959, the American Law Institute proposed a model to clarify legal exceptions for therapeutic abortions. The Institute called for more liberal abortion laws in line with the ones laid out by physicians at a recent Planned Parenthood conference.

1960s

Blurb: In the years immediately preceding Roe, there was a culmination of abortion suppression to unprecedented new levels. The number of women dying from abortions pushed activists to take action. Class and race disparities became apparent, and this convinced more Americans that something needed to be done.

• In 1961, the Supreme Court determined that states could not violate the constitutional right to privacy against unreasonable search and seizure when obtaining records from abortion clinics to prosecute women.
• The Society of Humane Abortion proclaimed that abortion was a right and demanded a repeal of the laws. They framed abortion as an issue of reproductive liberty rather than the right of physicians to decide for their patients.
• Women's organizations formed and used new tactics. In speakouts, women openly discussed their abortions, taking the issue out of the private realm and into political places.
• In 1968, the American College of Obstetrics and Gynecologists approved the liberalization of abortion; 85% of OBGYNs supported the ALI model.
• American Public Health Association advocated for the support of abortion for all.
• Polls indicated that most physicians, Americans, and even a majority of Catholics believed abortion is a private decision.
• Research showed that abortion committees were inconsistent. Abortion committees in hospitals within the same city reached drastically different conclusions when given ten hypothetical scenarios.
• In 1969, the California Supreme Court found an abortion statute unconstitutional in People v Belous.

1970s

Blurb: Activism led to the legalization of abortion in many states. Eventually, one woman's case made it to the Supreme Court, which ruled that abortion was a private decision between a woman and her doctor; thus, states could not ban abortion before fetal viability.

Slides

• An organization called "Jane" in Chicago helped 3,000 + women a year from 1969-1973 get abortions. This was just one of many networks that helped women access safe abortion during the period when it was increasingly criminalized in most states.
• Several states began to legalize abortion. In 1970, reform bills in Hawaii, Alaska, and new York decriminalized abortion.
• In 1971, a court held that the Illinois abortion law was unconstitutional, and abortion became legal in Illinois.
• In 1973, the Supreme Court declared laws restricting abortion prior to fetal viability unconstitutional because they violated the rights of women and physicians to privacy.

Source:

Reagan, L. J. (2022). When abortion was a crime: Women, medicine, and law in the United States, 1867-1973. University of California Press.

Read this book for yourself: https://www.amazon.com/When-Abortion-Was-Crime-1867-1973-dp-0520387414/dp/0520387414/ref=mt_other?_encoding=UTF8&me=&qid=