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HISTORY
OF ABORTION
Over
several centuries and in different
cultures, there is a rich history
of women helping each other to abort.
Until the late 1800s, women healers
in Western Europe and the U.S. provided
abortions and trained other women
to do so, without legal prohibitions.
The
State didn't prohibit abortion until
the 19th century, nor did the Church
lead in this new repression. In 1803,
Britain first passed antiabortion
laws, which then became stricter throughout
the century. The U.S. followed as
individual states began to outlaw
abortion. By 1880, most abortions
were illegal in the U.S., except those
``necessary to save the life of the
woman.'' But the tradition of women's
right to early abortion was rooted
in U.S. society by then; abortionists
continued to practice openly with
public support, and juries refused
to convict them.
Abortion became a crime and a sin
for several reasons. A trend of humanitarian
reform in the mid-19th century broadened
liberal support for criminalization,
because at that time abortion was
a dangerous procedure done with crude
methods, few antiseptics, and high
mortality rates. But this alone cannot
explain the attack on abortion. For
instance, other risky surgical techniques
were considered necessary for people's
health and welfare and were not prohibited.
``Protecting'' women from the dangers
of abortion was actually meant to
control them and restrict them to
their traditional child-bearing role.
Antiabortion legislation was part
of an antifeminist backlash to the
growing movements for suffrage, voluntary
motherhood, and other women's rights
in the 19th century. *For more information,
see Linda Gordon's Woman's Body,
Woman's Right, rev. ed. (New York:
Penguin Books, 1990).
At the same time, male doctors were
tightening their control over the
medical profession. Doctors considered
midwives, who attended births and
performed abortions as part of their
regular practice, a threat to their
own economic and social power. The
medical establishment actively took
up the antiabortion cause in the second
half of the 19th century as part of
its effort to eliminate midwives.
Finally, with the declining birth
rate among whites in the late 1800s,
the U.S. government and the eugenics
movement warned against the danger
of ``race suicide'' and urged white,
native-born women to reproduce. Budding
industrial capitalism relied on women
to be unpaid household workers, low-paid
menial workers, reproducers, and socializers
of the next generation of workers.
Without legal abortion, women found
it more difficult to resist the limitations
of these roles.
Then, as now, making abortion illegal
neither eliminated the need for abortion
nor prevented its practice. In the
1890s, doctors estimated that there
were two million abortions a year
in the U.S. (compared with one and
a half million today). Women who are
determined not to carry an unwanted
pregnancy have always found some way
to try to abort. All too often, they
have resorted to dangerous, sometimes
deadly methods, such as inserting
knitting needles or coat hangers into
the vagina and uterus, douching with
dangerous solutions like lye, or swallowing
strong drugs or chemicals. The coat
hanger has become a symbol of the
desperation of millions of women who
have risked death to end a pregnancy.
When these attempts harmed them, it
was hard for women to obtain medical
treatment; when these methods failed,
women still had to find an abortionist.
Illegal
Abortion
Many
of us do not know what it was like
to need an abortion before legalization.
Women who could afford to pay skilled
doctors or go to another country had
the safest and easiest abortions.
Most women found it difficult if not
impossible to arrange and pay for
abortions in medical settings.
With
one exception, the doctors whom I
asked for an abortion treated me with
contempt, their attitudes ranging
from hostile to insulting. One said
to me, ``You tramps like to break
the rules, but when you get caught
you all come crawling for help in
the same way.''
The secret world of illegal abortion
was mostly frightening and expensive.
Although there were skilled and dedicated
laywomen and doctors who performed
safe, illegal abortions, most illegal
abortionists, doctors, and those who
claimed to be doctors cared only about
being well rewarded for their trouble.
In the 1960s, abortionists often turned
women away if they could not pay $1,000
or more in cash. Some male abortionists
insisted on having sexual relations
before the abortion.
Abortionists emphasized speed and
their own protection. They often didn't
use anesthesia because it took too
long for women to recover, and they
wanted women out of the office as
quickly as possible. Some abortionists
were rough and sadistic. Almost no
one took adequate precautions against
hemorrhage or infection.
Typically, the abortionist would forbid
the woman to contact him or her again.
Often she wouldn't know his or her
real name. If a complication occurred,
harassment by the law was a frightening
possibility. The need for secrecy
isolated women having abortions and
those providing them.
In the 1950s, about a million illegal
abortions a year were performed in
the U.S., and over a thousand women
died each year as a result. Women
who were victims of botched or unsanitary
abortions came in desperation to hospital
emergency wards, where some died of
widespread abdominal infections. Many
women who recovered from such infections
found themselves sterile or chronically
and painfully ill. The enormous emotional
stress often lasted a long time.
Poor women and women of color ran
the greatest risks with illegal abortions.
In 1969, 75% of the women who died
from abortions (most of them illegal)
were women of color. Of all legal
abortions in that year, 90% were performed
on white private patients.
The
Push for Legal Abortion
In
the 1960s, inspired by the civil rights
and antiwar movements, women began
to fight more actively for their rights.
The fast-growing women's movement
took the taboo subject of abortion
to the public. Rage, pain, and fear
burst out in demonstrations and speakouts
as women burdened by years of secrecy
got up in front of strangers to talk
about their illegal abortions. Women
marched and rallied and lobbied for
abortion on demand. Civil liberties
groups and liberal clergy joined in
these efforts to support women.
Reform came gradually. A few states
liberalized abortion laws, allowing
women abortions in certain circumstances
(e.g., pregnancy resulting from rape
or incest, being under 15 years of
age) but leaving the decision up to
doctors and hospitals. Costs were
still high and few women actually
benefited.
In 1970, New York State went further,
with a law that allowed abortion on
demand through the 24th week from
the LMP if it was done in a medical
facility by a doctor. A few other
states passed similar laws. Women
who could afford it flocked to the
few places where abortions were legal.
Feminist networks offered support,
loans, and referrals and fought to
keep prices down. But for every woman
who managed to get to New York, many
others with limited financial resources
or mobility did not. Illegal abortion
was still common. The fight continued;
several cases before the Supreme Court
urged the repeal of all restrictive
state laws.
On January 22, 1973, the U.S. Supreme
Court, in the famous Roe v. Wade
decision, stated that the ``right
of privacy...founded in the Fourteenth
Amendment's concept of personal liberty...is
broad enough to encompass a woman's
decision whether or not to terminate
her pregnancy.'' The Court held that
through the end of the first trimester
of pregnancy, only a pregnant woman
and her doctor have the legal right
to make the decision about an abortion.
States can restrict second-trimester
abortions only in the interest of
the woman's safety. Protection of
a ``viable fetus'' (able to survive
outside the womb) is allowed only
during the third trimester. If a pregnant
woman's life or health is endangered,
she cannot be forced to continue the
pregnancy.
Abortion
After Legalization
Though
Roe v. Wade left a lot of power
to doctors and to government, it was
an important victory for women. Although
the decision did not guarantee that
women would be able to get abortions
when they wanted to, legalization
and the growing consciousness of women's
needs brought better, safer abortion
services. For the women who had access
to legal abortions, severe infections,
fever, and hemorrhaging from illegal
or self- induced abortions became
a thing of the past. Women health
care workers improved their abortion
techniques. Some commercial clinics
hired feminist abortion activists
to do counseling. Local women's groups
set up public referral services, and
women in some areas organized women-controlled
nonprofit abortion facilities. These
efforts turned out to be just the
beginning of a longer struggle to
preserve legal abortion and to make
it accessible to all women.
Although legalization greatly lowered
the cost of abortion, it still left
millions of women in the U.S., especially
women of color and young, rural women,
and/or women with low incomes, without
access to safe, affordable abortions.
State regulations and funding have
varied widely, and second-trimester
abortions are costly. Even when federal
Medicaid funds paid for abortions,
fewer than 20% of all public county
and city hospitals actually provided
them. This meant that about 40% of
U.S. women never benefited from liberalized
abortion laws.
During the late 1970s and early 1980s,
feminist health centers around the
country provided low-cost abortions
that emphasized quality of care, and
they maintained political involvement
in the reproductive rights movement.
Competition from other abortion providers,
harassment by the IRS, and a profit-
oriented economy made their survival
difficult. By the early 1990s, only
20 to 30 of these centers remained.
Eroding
Abortion Rights:
After Roe v. Wade
When
the Supreme Court legalized abortion
in 1973, the antiabortion forces,
led initially by the Catholic Church
hierarchy, began a serious mobilization
using a variety of political tactics
including pastoral plans, political
lobbying, campaigning, public relations,
papal encyclicals, and picketing abortion
clinics. The Church hierarchy does
not truly represent the views of U.S.
Catholics on this issue or the practice
of Catholic women, who have abortions
at a rate slightly higher than the
national average for all women.
Other religious groups, like the Mormons
and some representatives of Jewish
orthodoxy, have traditionally opposed
abortion. In the 1980s, rapidly growing
fundamentalist Christian groups, which
overlap with the New Right and ``right-
to-life'' organizations, were among
the most visible boosters of the antiabortion
movement. These antiabortion groups
talk as if all truly religious and
moral people disapprove of abortion.
This is not true now and never has
been.
The long-range goal of the antiabortion
movement is to outlaw abortion. Their
short-range strategy has been to attack
access to abortion, and they have
had successes. The most vulnerable
women--young women; women with low
incomes, of whom a disproportionate
number are women of color; all women
who depend on the government for their
health care--have borne the brunt
of these attacks on abortion rights.
The antiabortion movement's first
victory, a major setback to abortion
rights, came in July 1976, when Congress
passed the Hyde Amendment banning
Medicaid funding for abortion unless
a woman's life was in danger. Following
the federal government, many states
stopped funding ``medically unnecessary''
abortions. The result was immediate
in terms of harm and discrimination
against women living in poverty. In
October 1977, Rosie Jimeaanez, a Texas
woman, died from an illegal abortion
in Mexico, after Texas stopped funding
Medicaid abortions.
It is impossible to count the number
of women who have been harmed by the
Hyde Amendment, but before Hyde, one-third
of all abortions were Medicaid funded:
294,000 women per year. (Another 133,000
Medicaid-eligible women who needed
abortions were unable to gain access
to public funding for the procedure.)
Without state funding, many women
with unwanted pregnancies are forced
to have babies, be sterilized, or
have abortions using money needed
for food, rent, clothing, and other
necessities.
Although a broad spectrum of groups
fought against the Hyde Amendment,
countering this attack on women who
lack financial resources was not a
priority of the pro-choice movement.
There was no mass mobilization or
public outcry. In the long run, this
hurt the pro-choice movement, as the
attack on Medicaid funding was the
first victory in the antiabortion
movement's campaign to deny access
to abortion for all women.
Young women's rights have been a particular
target of the antiabortion movement.
About 40% of the one million teens
who become pregnant annually choose
abortion. Parental involvement laws,
requiring that minors seeking abortions
either notify their parents or receive
parental consent, affect millions
of young women. As of early 1997,
35 states have these laws; 23 states
enforce them. In some states, a physician
is required to notify at least one
parent either in person, by phone,
or in writing. Health care providers
face loss of license and sometimes
criminal penalties for failure to
comply.
Antiabortion forces have also used
illegal and increasingly violent tactics,
including harassment, terrorism, violence,
and murder. Since the early 1980s,
clinics and providers have been targets
of violence. Over 80% of all abortion
providers have been picketed or seriously
harassed. Doctors and other workers
have been the object of death threats,
and clinics have been subject to chemical
attacks (for example, butyric acid),
arson, bomb threats, invasions, and
blockades. In the late 1980s, a group
called Operation Rescue initiated
a strategy of civil disobedience by
blockading clinic entrances and getting
arrested. There were thousands of
arrests nationwide as clinics increasingly
became political battlefields.
In the 1990s, antiabortionists increasingly
turned to harassment of individual
doctors and their families, picketing
their homes, following them, and circulating
``Wanted'' posters. Over 200 clinics
have been bombed. After 1992, the
violence became deadly. The murder
of two doctors and an escort at a
clinic in Pensacola, Florida, was
followed by the murder of two women
receptionists at clinics in Brookline,
Massachusetts. A health care provider
spoke about the impact of the violence:
The
fear of violence has become part of
the lives of every abortion provider
in the country. As doctors, we are
being warned not to open big envelopes
with no return addresses in case a
mail bomb is enclosed. I know colleagues
who have had their homes picketed
and their children threatened. Some
wear bullet-proof vests and have remote
starters for their cars. Even going
to work and facing the disapproving
looks from co-workers--isolation and
marginalization from colleagues is
part of it.
The antiabortion movement continues
to mount new campaigns on many fronts.
Most recently, it has aggressively
put out the idea that abortion increases
the risk of breast cancer. In January
1997, the results of a Danish study,
the largest to date (involving one
and a half million women), showed
that there is no connection.s3 Unlike
previous studies, this one did not
rely on interviews and women's reports
but instead used data obtained from
population registries about both abortion
and breast cancer. Despite the lack
of medical evidence and the fact that
the scientific community does not
recognize any link, the antiabortion
movement continues to stir up fears
about abortion and breast cancer.
Legal
but Out of Reach for Many Women
We
have learned that legalization is
not enough to ensure that abortions
will be available to all women who
want and need them. In addition to
a lack of facilities and trained providers,
burdensome legal restrictions, including
parental consent or notification laws
for minors and mandatory waiting periods,
create significant obstacles. A minor
who has been refused consent by a
parent may have to go through an intimidating
and time-consuming judicial hearing.
Mandatory waiting periods may require
a woman to miss extra days of work
because she must go to the clinic
not once, but twice, to obtain an
abortion. If travel is required, this
can make the whole procedure unaffordable.
In other words, for millions of women,
youth, race, and economic circumstances
together with the lack of accessible
services--especially for later abortions--translate
into daunting barriers, forcing some
women to resort to unsafe and illegal
abortions and self-abortions.
WEAKENING
THE CONSTITUTIONAL PROTECTION FOR
ABORTION
When in 1980 the Supreme Court upheld
the Hyde Amendment, it began eroding
the constitutional protection for
abortion rights. Since then, there
have been other severe blows. In Webster
v. Reproductive Health Services
(1989), the Court opened the door
to new state restrictions on abortion.
In Hodgson v. Minnesota (1990),
the Court upheld one of the strictest
parental notification laws in the
country.
These trends were further codified
in Planned Parenthood v. Casey,
a 1992 decision upholding a highly
restrictive Pennsylvania law that
included mandatory waiting periods
and mandatory biased counseling. Two
frightening themes emerged in the
Casey decision. First, the
Court sanctioned the view that government
may regulate the health care of pregnant
women to protect fetal life from the
moment of conception so long as it
does not ``unduly burden'' access
to an abortion. Second, the Court
showed little concern for the severe
impact of state restrictions on women
with few financial resources.
In the aftermath of Casey,
many states have passed similar restrictions,
which have the effect of limiting
access to abortion, especially for
women with low incomes, teenage women,
and women of color.
These infringements on abortion access
have curtailed the abortion rights
of millions of women. In the face
of the unrelenting efforts of the
antiabortion movement, those of us
who believe that women should make
their own reproductive decisions will
have to become involved in the ongoing
struggle to preserve and expand abortion
rights.
REPRODUCTIVE
FREEDOM VS. POPULATION CONTROL
While
most women's health groups see the
fight for abortion rights in the context
of defending the rights of all women
to make their own decisions about
reproduction, not all advocates of
abortion rights share this understanding.
Some view legal abortion and contraception
as tools of population control.
Advocates
of population control blame overpopulation
for a range of problems, from global
poverty to ethnic conflict and environmental
degradation. Historically, this type
of thinking has led to a range of
coercive fertility control policies
that target Third World women. These
include sterilization without a woman's
knowledge or consent; the use of economic
incentives to ``encourage'' sterilization,
a practice that undermines the very
notion of reproductive choice; the
distribution and sometimes coercive
or unsafe use of contraceptive methods,
often without appropriate information;
the denial of abortion services; and
sometimes coercive abortion. For example,
HIV-positive women in the U.S. (who
are overwhelmingly women of color)
are often pressured to have abortions,
though only 20 to 25% of their children
will be HIV-positive and new treatments
during pregnancy have reduced the
likelihood even further.
Women with few economic resources,
especially women of color in the U.S.
and throughout the world, have been
the primary targets of population
control policies. For example, although
abortion has become increasingly less
accessible in the U.S., sterilization
remains all too available for women
of color. The federal government stopped
funding abortions in 1977, but it
continues to pay for sterilizations.
During the 1970s, women's health activists
exposed various forms of sterilization
abuse (see section on sterilization
in chapter 13, Birth Control). Since
the 1980s, advocates have fought against
new policies that coerce women with
low incomes into using Norplant, a
long-term hormonal contraceptive.
In the Third World, in addition to
the widespread unavailability of desired
contraceptives, there is a long history
of coercive fertility control, primarily
funded and inspired by developed countries,
especially the U.S. (see chapter 26,
The Global Politics of Women and Health,
for the international dimensions of
population control).
The right to abortion is part of every
woman's right to control her reproductive
choices and her own life. We must
reject all efforts to coerce women's
reproductive decisions. The goals
of reproductive rights activists must
encompass the right to have children
as well as the right not to.
ABORTION
ACCESS IN THE U.S.
-
It is conservatively estimated that
one in five Medicaid-eligible women
who want an abortion cannot obtain
one.
-
In the U.S., 84% of all counties
have no abortion services; of rural
counties, 95% have no services.
-
Nine in ten abortion providers are
located in metropolitan areas.
-
Only 17 states fund abortions.
-
Only 12% of OB/GYN residency programs
train in first-trimester abortions;
only 7% in second-trimester abortions.
-
Abortion is the most common OB/GYN
surgical procedure; yet, almost
half of graduating OB/GYN residents
have never performed a first-trimester
abortion.
-
Thirty-nine states have parental
involvement laws requiring minors
to notify and/or obtain the consent
of their parents in order to obtain
an abortion.
-
Twenty-one states require state-directed
counseling before a woman may obtain
an abortion. (This is often called
``informed consent''; some critics
call it a ``biased information requirement.'')
-
Many states require women seeking
abortions to receive scripted lectures
on fetal development, prenatal care,
and adoption.
-
Twelve states currently enforce
mandatory waiting periods following
state- directed counseling; this
can result in long delays and higher
costs.
-
(Seven more states have delay laws
which are enjoined--i.e., not enforced
due to court action at the federal
or state level.)
Note: for sources on these statistics,
please consult the book's notes at
the end of this chapter.
ABORTION
WORLDWIDE
Unsafe abortion is a major cause of
death and health complications for
women of child-bearing age. Whether
or not an abortion is safe is determined
in part by the legal status and restrictions,
but also by medical practice, administrative
requirements, the availability of
trained practitioners, and facilities,
funding, and public attitudes.
While it is difficult to get reliable
data on illegal and unsafe abortion,
several well-known organizations and
researchers, including the World Health
Organization, the Alan Guttmacher
Institute, and Family Health International,
make the following estimates:
- Worldwide,
20 million unsafe abortions are
performed annually. This equals
one unsafe abortion for every ten
pregnancies and one unsafe abortion
for every seven births.
- Ninety
percent of unsafe abortions are
in developing countries.
- One-third
of all abortions worldwide are illegal.
More than two-thirds of countries
in the Southern Hemisphere have
no access to safe, legal abortion.
- Estimates
of the number of women who die worldwide
from unsafe abortions each year
range from 70,000 to 200,000. This
means that between 13 and 20% of
all maternal deaths are due to unsafe
abortion--in some areas of the world,
half of all maternal deaths. Of
these deaths, 99% are in the developing
world, and most are preventable.
- Half
of all abortions take place outside
the health care system.
- One-third
of women seeking care for abortion
complications are under the age
of 20.
- About
40% of the world's population has
access to legal abortion (almost
all in Europe, the former Soviet
Union, and North America), although
laws often require the consent of
parents, state committees, or physicians.
- Worldwide,
21% of women may obtain legal abortions
for social or economic reasons.
- Sixteen
percent of women have access only
when a woman's health is at risk
or in cases of rape, incest, or
fetal defects.
- Five
percent have access only in cases
of rape, incest, or life endangerment.
- Eighteen
percent have access only for life
endangerment.
Copyright � 1984, 1992, 1998 by the
Boston Women's Health Book Collective.
All rights reserved. Published by
Touchstone, a division of Simon
& Schuster Inc.
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