Woman Troubles
Twenty-First Century Abortion Discourse and
Nineteenth Century Abortion Practice

Jeannie Ludlow


ell, you know,  illegal abortions aren’t all bad.” Last fall, I found myself saying this somewhat unlikely sentence to the honors students in an Introduction to Women’s Studies course I was teaching. Several of them frowned, and the student who had questioned me shook her head. We were reading Marge Piercy’s 2005 novel, Sex Wars, set in postbellum New York city. The novel traces the confluence of the careers of Elizabeth Cady Stanton, Victoria Woodhull, and Anthony Comstock in the 1870s. The students had just read the section of the novel in which Comstock, the self- (and then government-) appointed vice officer of late nineteenth-century New York City, sets up a sting and arrests Madame Restell, the notorious abortionist, in her palatial 52nd Street mansion (Piercy 183-4). During the sting, Comstock pretends to be inquiring into Restell’s services for a “lady in need.” When he asks about the safety of the abortion operation, Restell answers, “I’ve lost only one patient in forty years of practice. There’s not a doctor in Manhattan who can match that record. With my one failure, it was because she lied to me about how far along she was. Now I make a thorough examination before I begin” (369).

In class discussion, the students seemed to be talking around Restell’s presence in the novel, a problematic response, since her arrest signals a major turning point in Comstock’s career. When I mentioned Restell, one of the students asked, “is abortion legal at this time?” I explained that no, it was not, which is why Comstock is setting up Restell for arrest. The student frowned. “Then why didn’t Piercy write about all the women [Restell] killed?” For a moment, I was puzzled. At that time, I really didn’t know the story of Madame Restell, aka Ann Summers Lohman, well enough to assert the accuracy of Piercy’s characterization of her. Still, we had been very clear (I thought) that Piercy was writing historical fiction, basing her novel on real events and people, and not writing an academic study of the time. In fact, I had assigned Helen Horowitz’s historical study of Comstock’s pursuit and conviction of Victoria Woodhull to accompany our reading of the novel; Piercy acknowledges Horowitz as one of her sources, and my intention was that the students could begin to understand the relationship and distinction between  historical fiction and historical scholarship through the paired readings. In addition, Piercy puts the claim of only one lost patient in the mouth of the abortionist herself, thereby providing space for a reading of the claim as spurious.

“Women she killed?” I asked.

“Yeah,” another student said, “doing illegal abortions.”

Then I got it. My students were unable to imagine the possibility of safe illegal abortions.

On one level, this inability might reflect a great success for those of us who work as activists for abortion rights. As a clinic worker, activist, and scholar, I’ve dedicated a lot of energy to educating students and the broader community about the risks of recriminalizing abortion in the U.S. I’ve given guest lectures to high school and university courses and written countless letters to the editor of the local papers. Each day, I wear a coat hanger earring to symbolize the threat of self -induced abortion that accompanies recriminalization, and I’ve participated in a documentary film called “The Coat Hanger Project,” due out late this year. The BGSU campus NARAL group, for which I was faculty advisor, created a campaign with small magnets featuring a hanger and the words, “If you don’t know what this has to do with women’s rights, ask someone over forty.” And in that very honors class, I had assigned Jane Gillooly’s 1994 documentary, “Leona’s Sister Gerri,” which tells the story of Gerri Twerdy Santoro, whose body lying facedown on a motel room floor has come to represent the dangers of illegal abortion. No one could argue that my students took legal abortion for granted.

But that day I realized that the concern voiced by many abortion rights advocates — that young adults don’t fully comprehend the critical position U.S. women are in vis-á-vis abortion rights, that they take the legality of abortion for granted — may be too narrowly focused. We may be missing an important aspect of what we should be worrying about. Many young adults do not understand what recriminalization might mean in terms of women’s health and safety, but even more don’t know the history of women’s (and men’s) extra-legal caring for women’s health, often in the face of legal and institutional obstacles. When we caution against the evils of the “back alley,” we certainly make a strong statement for continued access to legal abortion. But in doing so, we elide important historical information about midwifery, medical history, women’s resistance to the institutionalization of health care both in the 1860s-70s and in the 1960s-70, and women’s access to self-care today. In the process, I argue, we may be missing out on some creative and powerful ways to resituate the discourse of abortion within the trope of women’s empowerment.

I certainly do not want to come across as suggesting that criminalization was some kind of ideal, or even benign, state to which we should return. Nor am I arguing that empowerment comes from experiencing disempowerment — far from it. Rather, I am interested in rethinking the way we talk about the history of “illegal abortion” in the U.S. in order to develop better strategies for educating people about the power of women’s activism in the past and for defending women’s abortion rights in the present. In this paper, I begin with descriptions of abortion practice in the mid-nineteenth Century (both institutional and extra-institutional) and abortion activism in the mid-twentieth Century. Then I explore how each historical moment might inform some aspect of contemporary political discourse around abortion in the United States.

Three Categories of Nineteenth Century Abortion Practice

The historical context for my understanding of nineteenth century abortion practice is the initial criminalization of abortion in the United States. The establishment of the American Medical Association (AMA) in the mid-1800s reflected and intensified tension between lay medical practitioners — like midwives, who had long provided care for patients and whose training consisted of apprenticeship — and physicians who were educated in medical schools. In Sex Wars, Piercy represents this tension in her depiction of the childbirth experience of Maggie Comstock, Anthony’s wife. After a prolonged labor and delivery, she is weakened and sick and the baby is “creased” and “bruised.” Maggie’s mother blames the doctor. “Should have had a midwife, not a doctor” she says, noting that the doctor’s “nasty devices” have marked the baby’s head. Anthony disagrees, countering that “[d]octors were the modern way” and midwives were rumored to “help women avoid pregnancy and even to abort” (248).

Until the mid-1800s in the United States, abortion was either a legal or a nonregulated practice controlled mostly by women. Pregnancy was legally and socially determined by quickening, which is when a pregnant woman first feels fetal movement (usually about 20 weeks for a first pregnancy, earlier for subsequent pregnancies). Midwives and kinswomen provided reproductive health care for women, from attending childbirth to helping them restart “blocked” menstruation and end pregnancies that were “not right.” Into this women’s realm stepped the AMA, insisting that formally educated doctors knew better than women how to determine pregnancy and how to take care of pregnant bodies. As Barbara Duden explains, the AMA had two related goals in establishing new definitions of the beginning of pregnancy: they wanted “to challenge the court’s reliance on women and jury matrons” to provide evidence of a woman’s pregnancy, which would limit women’s participation in court cases; and they wanted “to promote themselves as medical experts” (81). In other words, the redefinition of the beginning of pregnancy was focused not on the pursual of scientific truth but, rather, on the desire to suppress women’s expertise.

In service of establishing formally educated physicians as the best experts on women’s bodies, the AMA worked to criminalize lay medical practices, particularly midwifery and abortion. Between 1860 and 1880, the AMA campaigned hard for the criminalization of abortion, and by the late 1800s, all states had abortion laws on the books. It would be decades, however, before these laws were uniformly enforced (Solinger 10).

During this period of criminalization, institutionally sanctioned abortions were performed by AMA-recognized physicians only to save the life of a woman in labor when it became clear that delivery of a living baby from a living woman was not possible. I want to distinguish these nineteenth century emergency abortions from twentieth century “therapeutic abortions,” in which women went before hospital panels to obtain permission to abort legally, based on physical or mental incapacity to bear children (AGI 2003). I first learned about nineteenth century emergency abortions through my reading of a Textbook of Obstetrics and Gynaecology, published mid-century, which reveals that these abortions were accomplished with a variety of specialized perforating and forceps-like instruments which included cranioclasts, trepans, and basiotribes. The basic idea was to reduce the cranial circumference in order quickly to remove the fetal body with the least possible trauma to the woman’s body. When I shared the photos of the instruments with the abortion doctor with whom I work, he explained that during the time when this kind of emergency abortion was performed, we did not yet have the ability to transfuse blood nor did we have antibiotics to help reduce risk of infection. Therefore, the goal would have been the fastest and most efficient removal of the fetus, even if that meant mutilating it in the process.

“Powders and preparations” is the common name given for the most common type of extra-legal abortion in the nineteenth century. In Piercy’s book, Madame Restell explains to Comstock during his sting that the “lady” for whom he is inquiring should use the powders and syringe very carefully according to her directions. Then, if the lady’s menstrual flow does not “unblock,”  she will have to come in for a “simple operation” (369). In my research, I found several common herbs and other organic substances that were probably used in the making of these powders and preparations, including seneca root, black cohosh, aloe, myrrh, cotton root, rue, and ergot. Some of these substances likely were toxic to the fetus, while others induced strong cramping, basically starting the woman into premature labor and delivery. As Piercy demonstrates, the popular explanation for how they worked was that they removed the “blockage” that prevented a woman from having her period. However, their reputation as abortifacients was widespread, suggesting that most women knew what was really happening. Although these powders and preparations were most often used before quickening, at times they may also have been used post-quickening in an effort to induce “miscarriage.” Since this usage was less safe and less predictable than surgical methods, an experienced abortionist such as Madame Restell would not likely have prescribed powders and preparations after quickening.

Extra-institutional surgical abortion is what I am calling the “simple operation” that Madame Restell warns Comstock may be necessary for his lady friend. According to patient testimony provided to the New York Journal of Medicine and the Collateral Sciences in 1843, Restell accomplished this operation by “probing” the woman’s uterus with a “a piece of whalebone” (Browder 47-8). Most likely, this means that Restell inserted whalebone into the woman’s cervical opening, compromising the cervical plug and causing the uterus to contract and expel the fetus.

Nineteenth Century Women’s Agency

Taken together, the criminalization of abortion in the late nineteenth century and the categories of abortion most often performed at the time indicate important shifts in perceptions of women’s subjectivity. As Barbara Duden observes, the practice of defining pregnancy’s onset via quickening was an example of women’s agency: “it was taken for granted that women [quicken], make it public, and thereby establish the fact of a pregnancy” (79). Quickening, Duden asserts, “derived its decisive social power from the then acknowledged fact that women experience a bodily reality unknown to men” (81). When determination of pregnancy was shifted from women’s experience of quickening to doctors’ assessment, that agency was superceded by educated men’s “knowledge” of women’s bodies.

When doctors did perform abortions during the nineteenth century, they did so on women’s bodies that lacked agency because they were at risk of dying in childbirth. In the nineteenth century obstetric textbook I examined, the line drawings that illustrate how to perform the procedures represent the fetus, womb, and medical instruments with great detail, while the patient herself is represented by a simply-sketched body, and the same sketch is used for every picture in the abortion chapter, suggesting the patient’s lack of agency and individuality. She is merely a simple body with a complex condition. In contrast, lay abortionists followed women’s practice of determining pregnancy via quickening and provided women with the means to “unblock” the menses. These active words suggest that extra-legal abortion in the nineteenth century may have reinscribed women’s agency in some instances, while legal abortion and institutionalized health care functioned to limit or erase it. This is information that is elided by our almost-exclusive focus on maintaining legality; my students’ incredulity at Restell’s safety record reflects the erasure of an important aspect of medical history — the criminalization of woman-centered medical care achieved by the AMA.

Twentieth Century Abortion Practice

Another historical event that has been lost to our contemporary focus on legality is the work of abortion referral services in the mid-twentieth century. A hundred years after Madame  Restell was called “the wickedest woman in New York,” many major cities in the U.S. had “abortion referral services” that helped pregnant women find the best illegal abortions they could afford; perhaps the most famous of these is “Jane,” the Chicago Women’s Liberation Union abortion referral service that gradually became a provider service. Daniel Maguire's book and documentary film, both titled Sacred Choices, reveal that many of these services were provided by clergymen of all denominations, from  rabbis to priests to pastors. Thirty-five years after legalization, in the wake of the so-called “abortion wars” that have (re)defined institutionalized religion and feminism as diametrically opposed to one another, it is hard for many of us in the U.S. to imagine Baptist ministers and Catholic priests vetting illegal providers before providing contact information to pregnant women. The loss of this history of activist religious professionals only serves to reinscribe the schism between feminism and religion that popular discourse has naturalized.

Twenty-First Century Abortion Rights Discourse

So how might this historical knowledge change the contemporary discourse of the abortion rights movement in the U.S.? There are many possibilities in addition to claiming some connection between women’s rights and organized religions. For instance, the emergency abortion procedure that nineteenth century doctors used to save women’s lives is very clearly an early version of D & X abortion, which politicians and the press call “partial-birth abortion” and which was the first safe medical procedure to be outlawed because it made people uncomfortable. As I have argued elsewhere, the abortion advocacy movement’s defense of D & X in the face of the legal ban was lukewarm at best and seriously misguided at worst. When the ban was first introduced in the early 1990s, prominent abortion rights advocates said that the procedure was very rare and only performed to save the life of the mother; both of these statements are untrue. As the ban grew in popularity among the general public and abortion rights activists were confronted with their lies, they switched from “very rare” to “between a woman and her doctor” and neglected to say anything at all about how D & X is actually safer and less gruesome than other late second trimester abortion procedures. If these advocates knew that the practice of reducing the circumference of the cranium in order safely and quickly to remove an intact fetal body had been tested for over 150 years and found effective, would their defenses of D & X have been more robust?

The “powders and preparations” that Madame Restell and other nineteenth century abortionists prescribed for pregnant women provide for us an historical precedent to both self-induced herbal abortion, which has been proposed as one option for women living in places where access to abortion is denied through lack of providers and / or restrictive state laws, and to what we now call “medical abortion,” or RU-486. Currently, in the U.S., 87% of counties have no abortion provider working within them; in rural areas, 95% have no provider (AGI 2003). Most states have laws that limit access to providers, such as laws that prohibit abortion on public land (which in some states has been interpreted to include teaching hospitals attached to public universities) and laws that require women to make multiple trips to a clinic for one five-minute procedure. Our focus on legalization has led us to neglect the “graying of abortion providers” (the majority are now over fifty-five [AGI 2003]) and the failure of medical colleges to prepare new physicians to continue the work of their retiring colleagues. Legalization is necessary, to be sure, but it does not guarantee access. Without access, more women may turn to “natural” remedies and do-it-yourself abortion.

“Powders and preparations” also prefigure what we now call “medical abortion,” or RU-486. Once hailed as a way to make abortion truly a private matter because it could be administered by a woman’s physician in an office not equipped for surgery, medical abortion has not lived up to advocates’ hopes, and serious questions about its safety and effectiveness need to be answered. Our ability to argue for continued research into the safety of both herbal abortion and medical abortion might be strengthened by attention to the history of women’s use of “powders and preparations” to determine the timing of their childbirths.

Finally, the entire history of safe, extra-legal, extra-institutional abortions could provide us with a new way to think about abortion provision. Currently, “pro-choice” discourse tends to treat all abortion providers as heroes (witness “abortion provider appreciation day” sponsored by NARAL / Pro-Choice America, pleas for donations that capitalize on stories of providers’ being harassed, etc.). In the context of decreasing access to providers, we seem to have lost the ability to assess providers’ approaches to patient care and safety (or, perhaps, to act on that assessment). But the women who visited Madame Restell in New York in the mid-1800s and the women who contacted Jane in Chicago in the mid-1900s knew that there was a difference between good providers and bad providers, and they carefully sought out the providers who would end their pregnancies with care and compassion. Women in the twenty-first century deserve no less.

I propose that we look again at the history of illegal abortion and how that history might inform contemporary activism. We need to think about how we might damn in the strongest sense of the word those providers — legal and illegal, now and in the past — who exploited, assaulted, or killed women, who preyed on pregnant women’s vulnerabilities and fears. At the same time, I want those of us in the abortion rights movement to recognize and learn from those illegal providers who gave thousands of women the safest possible abortion care (for the times) while negotiating their professional existence with the legal systems of the day. And I want us to teach the next generation about them, too, before that part of women’s health history is lost.

An earlier version of this paper was presented at the National Women’s Studies Association annual conference, June, 2008.


Allan Guttmacher Institute (AGI). 2003. “Lessons from Before Roe: Will Past be Prologue?” Retrieved 19 June 2008 from

Browder, Clifford. 1988. The Wickedest Woman in New York: Madame  Restell, The Abortionist. Hamden CT: Archon.

Duden, Barbara. 1993. Disembodying Women: Perspectives on Pregnancy and the Unborn. Cambridge: Harvard UP.

Gillooly, Jane. 1995. Leona’s Sister Gerri. New Day Films.

Maguire, Daniel C. 2001. Sacred Choices. Fortress Press.

------. 2004. Sacred Choices and Abortion: Ten New Things to Think About.

Piercy, Marge. 2005. Sex Wars. NY: HarperPerennial.

Solinger, Rickie. 1994. The Abortionist. NY: The Free Press.