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.
WORKS CITED
Allan
Guttmacher Institute (AGI). 2003. “Lessons
from Before Roe: Will Past be Prologue?” Retrieved
19 June 2008 from
http://www.guttmacher.org/pubs/tgr/06/1/gr060108.html
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.