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Chapter 7 Repercussions
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Chapter 7

"There is . . . more difficulty in locating abortionists today than there used to be," reported Dr. Alfred Kinsey, director of the Institute for Sex Research in Indiana. "The laws have made it more difficult . . . to find a physician who will perform it, and that has raised the cost of abortions."[1] Abortions became harder to obtain, more expensive, and more dangerous as a result of the new repression as hospitals cut access to legal therapeutic abortion and the state shut down established clinics. Accounts of illegal abortions in the 1950s and 1960s feature a new level of secrecy. Blindfolding and taking women alone to unknown places for their abortions became the norm. What had been a fairly open practice became more clandestine as abortionists devised ways to avoid police detection.

With the new repression of abortion, a discretionary and discriminatory system developed in which class and racial privilege came to the forefront. Those few who received safe, legal, therapeutic abortions in hospitals were almost all white women with private health insurance. Yet almost every woman who looked for an abortion had a difficult time obtaining one, and many endured frightening and dangerous procedures. Inequality reached into the world of illegal abortion as well. Low-income women and African American and Latina women suffered more of the iii effects of criminal abortion than white and wealthy women. By the early 1960s, the deadly inequality in access to safe abortions by race and class became glaringly obvious. While observers rec-


ognized and deplored the racism and elitism of the abortion system, awareness of the system's inherent sexism remained buried.

Women continued to abort their pregnancies, despite the state and medical repression of abortion. In fact, demand for abortion may have increased in the fifties and sixties. It certainly intensified. Structural changes in women's lives magnified the demand for abortion at the precise moment that the availability of abortion was being severely limited. As Rosalind Petchesky has demonstrated, when women's opportunities and responsibilities expanded in the 1950s and 1960s, their need to control their reproduction grew. Growing numbers of women entered college and the workplace in this period, and both of these male-defined territories required that women postpone and control childbearing. The number of women attending college rose, but this increased attendance was a distinctly middle-class phenomenon, and twice as many white women as black women completed college. Schools and businesses did not provide day-care services and were not structured flexibly so that women could arrange their work around child rearing; yet gender arrangements continued to require that mothers take the entire responsibility for child rearing. Once a woman was visibly pregnant, her school would expel her and her boss fire her. Women were caught in a double bind—required to control their reproduction and forbidden the means of doing so. Many who sought abortions in the postwar period had no room in which to maneuver. Abortion was the only option.[2]

In the early twentieth century, in contrast, married women who wanted abortions had a bit more flexibility if getting one proved difficult. Their reproductive control could aim for decreasing the number of children rather than require absolute infertility for years at a time. For many, if their contraceptive or abortion attempts failed, they could incorporate another child into the family more easily than could women of the fifties. Early-twentieth-century women who did piecework or took in boarders could watch a child in their workplace—their home. It may not have been desirable or easy, but it was possible to adapt to another child. As married women increasingly entered the workforce outside their homes, they did not have that option. Women in school or in the workplace, married or not, needed to control the timing of their childbearing precisely.[3] Some managed both to bear children and keep jobs. African American women have a long history of combining wage earning and child rearing, but it was hard, and they hoped to avoid having to do both at the same time.[4] The structure of


education, the economy, and gender helped generate women's need for abortion.

The requirement that unmarried female students remain childless and maintain at least the image of virginity made sex with men, with its risk of pregnancy, dangerous. For a single woman in high school or college, to bear a child meant the abrupt halt to her education. If she carried the pregnancy to term and bore an "illegitimate" child, she would be stigmatized and kicked out of school.[5] If she legitimated the pregnancy by marrying, she was unlikely to continue her education because she would be required to devote herself to full-time child rearing. The new husband and father might have to drop out of school too in order to find a job to support his family. If these were unattractive options, the student could bear a child and give it up for adoption, although that often meant being closeted in an unwed mothers home. Resolving the problem of illegitimate children by leaving them with adoption agencies soared during this period.[6] The growing importance of unwed mothers homes and adoption can be explained by several factors—cultural pronatalism, the mistreatment of single mothers, and the increased difficulty of obtaining abortions. Yet many women found it heartbreaking to give up infants, for whom they knew they could not provide at that time in their lives.[7] In short, pregnancy threatened to destroy a young woman's life and ambitions.

The ability to control their reproduction through abortion enabled women (and men) to continue their education and fulfill societal, familial, and personal goals. The postwar prohibitions on access to birth control and condemnation of childbearing outside of marriage compelled people to marry grooms and brides they did not want to marry. Yet the ideology of romance urged couples to marry for love. Some women bravely chose the danger of abortion for the possibility of a happier future rather than the certainty of a miserable marriage. Abortion was a positive good for women because it allowed them to make decisions about their own futures, delay marriage, be selective about husbands, and improve their lives through education and independent wage earning. For young men as well, the ability of their girlfriends to obtain abortions meant that they could complete their educations and have greater control over the timing of marriage and choice of partners. The constraints facing young unmarried women remain much the same today: contraception and abortion are essential. What is new is that growing numbers of middle-class, single, white women bear children without facing complete social ostracism, though the problems of


finances and child care persist. Meanwhile, the New Right is desperately working to restigmatize women who have sex and bear children outside of marriage.[8]

The near impossibility of obtaining birth control in the fifties and sixties raised the danger of intercourse and the fears felt by single women. Physicians and birth control clinics refused to provide contraceptives to unmarried women. In the late 1960s, the health clinic at the University of Illinois in Chicago insisted upon seeing a marriage license before providing birth control. Though some women managed to circumvent these restrictions, all that was left to most to prevent pregnancy were methods that interrupted the flow of lovemaking and required male cooperation—withdrawal, not one of the most effective methods, or condoms. Nonetheless, fortunate women who managed to obtain contraceptives or had careful and trustworthy boyfriends could still find themselves pregnant and in desperate need of abortion.

Unmarried college women feared having their sex lives discovered by college officials or parents. As one 1945 graduate of the University of Wisconsin in Madison recalled, she and other students "hoped that the university authorities . . . knew nothing including your name. College was then in loco parentis and you were put on probation or expelled should the Dean become blatantly aware of all the hanky-panky going on." If students found themselves pregnant, they needed to keep both the pregnancy and their sexual activity secret. One way to do that was by having an abortion. When Rose S. got pregnant at nineteen despite her use of a diaphragm, she "confirmed the pregnancy by seeing, under a false name and equipped with a Woolworth-bought wedding ring, a gynecologist . . . (chosen at random from the phone book)." She acted under a false name because, she explained, "What seemed of paramount importance to me . . . was the secrecy: I not only didn't want anyone in authority to know, I was also anxious that no word leak out to any of my friends and, certainly, family." Once she had confirmed her pregnancy as a "married" woman, as an unmarried college student she arranged for an abortion with "an expert" doctor in Chicago. She had previously accompanied a friend to Chicago for an abortion; she now traveled by train to Chicago for her own abortion at an office much like the Dr. Gabler-Martin clinic on State Street. She had a 6 A.M. appointment, paid $250, more than twice the cost of her out-of-state tuition, and by 9 A.M. was going home by train. The abortion was successful and no one at the university ever discovered it. In later years she more openly discussed her abortions with friends and, when asked for


help in locating an abortionist, she had names and telephone numbers ready in her address book.[9]

College students' need for secrecy could be fatal. One woman, who had gone to a southern women's college, remembered another student who had an illegal abortion. "She was too frightened to tell anyone what she had done," she recalled, "so when she developed complications, [she] tried to take care of herself. She locked herself in the bathroom between 2 dorm rooms and quietly bled to death." College students learned a chilling lesson that year about womanhood and the dangers of sex and pregnancy and, perhaps, of the danger of silence as well.[10]

Many more sought out illegal abortionists, but the police crackdown made them harder to find and more expensive. Medical observers agreed that fewer abortionists practiced in New York City. in 1955 than had in 1940. The "sharp crackdown" on abortionists in New York had not only reduced their numbers, but the prices charged by the remaining few had more than tripled. Chicago newspaper reports in the 1950s showed that the average fee for abortion in Chicago had more than quadrupled to $325 compared to the average fee of $68 charged in the early 1940s at the Gabler-Martin clinic. One magazine investigated abortion in nine cities in 1955 and found that prices charged by physician-abortionists ranged from $200 to $500.[11]

Finding the money needed to pay for an abortion was a hardship for most. Abortionists could charge hundreds or thousands of dollars depending on the woman's finances. One Chicago woman reported that a friend of hers dropped out of school in order to earn the $500 needed for an illegal abortion. While she worked, her pregnancy progressed. When she was six months pregnant, she had her abortion "in an apartment . . . with no medical backup services." [12] Others took their furniture to pawn shops to raise money for abortions.[13]

There was a notable shift in illegal abortion practices in this period. It was not until the postwar period, quite late in the history of illegal abortion, that women's descriptions of illegal abortions included meeting intermediaries, being blindfolded, and being driven to a secret and unknown place where an unseen and unknown person performed the abortion. Popular magazines at the time emphasized the newly clandestine nature of abortion. When Ebony , an African American magazine, covered illegal abortion in its January 1951 issue, it presented abortion as dark and dangerous. A series of dim photographs showed a woman meeting an unknown "contact-man," a cramped room in which the abortionist operated, and police crowded around a bed


where a woman had died as a result of her abortion. The emphasis on death was not new in abortion coverage; the depiction of a woman alone meeting an unknown connection was.[14]

Recent narratives of illegal abortions in this period confirm the covert character of the abortion underground. These oral histories and written accounts have been produced as a result of efforts to excavate and preserve women's experiences of the era of illegal abortion. Many informants have told their stories in the hope that their personal histories will generate understanding among politicians and the public about the necessity of legal abortion. The accounts are individual, but patterns stand out and have helped draw a portrait of abortion during the decades immediately preceding Roe v. Wade .[15] When one woman met her connection in Baltimore, he blindfolded her and walked her up the stairs, down the halls, and down the stairs to thoroughly confuse her before taking her into a hotel room where the abortionist introduced a catheter. A woman who went to Tampa for an abortion in 1963 recalled being examined by the doctor, then being put in a van with several other women, the entire group blindfolded, and then driven to an unknown location where the abortions were performed. A nineteen-year-old from Madison, Wisconsin, went to Chicago where she "waited on a street corner, was picked up, blindfolded, and driven to a motel in a Cadillac." She commented later, "I know the person who did the abortion was not a doctor. I went through with it because I was desperate."[16]

The clandestine nature of illegal abortions, even if women survived them, sharpened women's awareness of the danger and illegality of abortion. If the Madison woman had experienced any problems, no friend or relative would have been able to find or help her. One woman recalled her fear when she took a friend to the illegal abortionist whom she had previously visited herself: "As I handed her over to strangers at the outside door of the apartment building where the abortion was to be performed, then met the mysterious contact in the park who carefully counted the money, and then waited, waited and waited, I realized how totally at the mercy of unknowns and unknowables my friend was, and I had been." A Detroit student, who found she was pregnant in the spring of 1968, went with a friend to an abortionist who "was upstairs over a store. We were both scared to death . The man did the abortion and said not to call him if I had problems." Almost twenty years later the woman seemed to breathe a sigh of relief as she wrote, "Luckily I was O.K."[17]

These memories of illegal abortion point to another element of dan-


ger in these secret, anonymous abortions: concern about the medical credentials of the abortionist. One woman remarked that she knew her abortionist was "not a doctor"; another reported a woman who had an abortion six months into her pregnancy "with no medical backup services." Such observations tell of women's fears at the time, which they forced themselves to ignore in the face of their need to avoid bearing a child. At the same time, they point out that what these women accepted as necessary then is unthinkable to them today. Unlike the working women of early-twentieth-century Chicago, most women in the fifties and sixties trusted only white-coated physicians for medical care and knew nothing of other practitioners and their skills. One set of oral histories suggests, however, that some black women may have been more aware and trusting of the alternative practitioners in their neighborhoods than were white women.[18]

Furthermore, having abortions in nonmedical settings alarmed women, and rude abortionists demeaned them. A Milwaukee woman had an abortion without anesthesia and reported that "the 'doctor' smoked a cigar during the entire time." One Chicago abortionist worked "in a dirty T shirt," treated his patients in twenty minutes, "then pushed them out" of the hotel where he worked into a waiting limousine. Another abortionist reeked of alcohol and performed the abortion in the kitchen.[19] The unprofessional demeanor of these abortionists disconcerted many; dirty rooms and drunk practitioners made women worry about injury and infection.

Some abortionists took advantage of their clients' vulnerability in this increasingly secretive situation to sexually harass and exploit them. These men equated abortion with sexual availability and tried to turn their patients into prostitutes. One woman, who had an illegal abortion in the mid-1950s after being raped, recalled the humiliation she felt when the abortionist remarked, "'You can take your pants down now, but you shoulda'—ha!ha!—kept'em on before.'" When he finished the abortion, for which he charged $1,000, he offered to return $20 if she would give him "a 'quick blow job.'" Other abortionists insisted on a trade: sex for abortion. When one sixteen-year-old was propositioned, she walked out. Because she refused to be sexually exploited in exchange for an abortion, she was compelled to give birth and give her child up for adoption.[20]

Since abortionists provided an illegal service, anyone could enter the trade. The crackdown on abortion coupled with the growing demand inevitably attracted more people to this lucrative business that required


no specific training. Some women found respectful and skilled abortionists, including both physicians and nonphysicians. Others went to untrained practitioners, including motorcycle mechanics, bartenders, and real-estate agents, who knew little more than that women needed abortions and that inducing them was profitable.[21] The varying prices and the sexual harassment of patients, the unsafe and unsure conditions, could flourish in the black market. Without regulation to ensure competence, all abortion patients were vulnerable.

Illegal abortionists made women go through more connections, shell out more money, and often submit to blindfolding in order to obtain an abortion. Those who went the legal abortion route experienced a different, but similar, set of trials. The therapeutic abortion committees instituted in most hospitals by the 1950s forced women to see more physicians (which meant paying more), have their cases reviewed by a committee, and perhaps submit to interviews. Either way, women looking for abortions had to get around more barriers to obtain them.

Hospital abortion committees not only reviewed physicians' medical decisions in order to uphold new hospital standards, but in some cases also reviewed women's sexual histories and upheld the old sexual double standard. The review policies allowed doctors so inclined to punish 211

unmarried women for their sexual behavior. One committee, which had initially approved a therapeutic abortion, reversed its decision when it learned the woman was unmarried. Some committee members, another member observed, seemed to regard premarital intercourse as a "crime." "Now that she has had her fun," one committee member complained, "she wants us to launder her dirty underwear. From my standpoint she can sweat this one out." Pregnancy exposed an unmarried woman's sexual activity. This hostile physician acted on the common view that such a woman deserved the shame of pregnancy and childbearing out of wedlock as punishment for her sexual misbehavior (and, perhaps, pleasure). Sex itself, and independent female sexuality in particular, this doctor seemed to feel, were "dirty" and repugnant.[22] As these remarks suggest, discomfort about sex could easily pervade committee proceedings. Yet we know of these mean remarks because another doctor reported them as an example of the abuses that occurred in this system. Medical hostility to women seeking therapeutic abortions has been overdrawn.[23] Nonetheless, no matter how sympathetic some individual physicians were, the committee system lent itself to differential assessments of abortion patients.


Yet medical understanding helped open access to abortion along a new path at the same time that it was being increasingly restricted. Psychiatric indications for therapeutic abortion, dismissed as ludicrous earlier in the century,[24] gained new credibility in the 1940s and 1950s. Analysis of therapeutic abortion trends in New York City between 1943 and 1947 showed that abortions for mental illness had "increased steadily" over the period. By 1947, a fifth of the therapeutic abortions had been induced for psychiatric reasons.[25] A study of sixty of the nation's hospitals found that between 1951 and 1960, psychiatric indications accounted for nearly half of all therapeutic abortions.[26] The growing importance of psychiatric indications arose out of the decline of medical complications requiring therapeutic abortion as well as the growing legitimacy of psychiatry.[27]

Physicians and their private-paying female patients together made psychiatric reasons the primary indication for therapeutic abortion. The ambiguity of psychiatric indications made them flexible and available as a category for justifying abortions needed by women. The most important indication for therapeutic abortion at the turn of the century, pernicious vomiting, had been similarly imprecise. Just as late-nineteenth-century and early-twentieth-century women mimicked the symptoms of this dangerous condition to get abortions, in the 1950s and 1960s some women feigned psychiatric problems.[28] Middle-class women, who knew of therapeutic abortion as a possible solution to unwanted pregnancies, demanded them of their doctors in the way that American women always had, but they now referred to a different set of symptoms.

By the 1960s, it was widely known that a woman might obtain a therapeutic abortion if she found the right psychiatrists and said the right words. Women learned to speak of their emotional distress and suicidal intentions. The abortion committee at Mt. Sinai in New York, for example, accepted psychiatric indications only in cases of threatened suicide. "The law says that one may abort to save the life of the mother," Dr. Alan Guttmacher explained, "therefore we insist that suicidal intent must be present in the psychiatric patient in order to validate abortion."[29] One psychiatrist recalled that when women asked him to recommend therapeutic abortions, he simply did so by writing letters that said they were suicidal. He did not question the women seeking his help and, unlike some psychiatrists who doubled their fees, charged nothing. Believing women should be able to decide for themselves and that denial of abortions caused emotional problems, he helped women obtain legal abortions. As word got through the grape-


vine, more women came to him. Eventually he found the demand overwhelming and, worried that his colleagues might suspect him of extracting huge fees from the women, he ended his involvement.[30]

The suicide threat by no means guaranteed abortion. So many women threatened to commit suicide, the head of a Baltimore hospital's abortion committee recalled, that the claim was "ignored." She told a tragic story of a pregnant teenager who tried to kill herself after learning that her request for a therapeutic abortion had been rejected. The committee reconsidered her case and decided to hospitalize her through her pregnancy in order to save her life. Physicians were using the hospital to enforce childbearing. In the end, this teenager so disrupted the hospital with her multiple suicide attempts that the abortion committee reconsidered a second time and agreed to a therapeutic abortion. Her abortion was granted less because of her own mental health than because of the needs of the hospital and its staff. This particular case highlights the subjectivity of the entire committee system.[31]

Abortions for psychiatric reasons were particularly important for unmarried women in college. One study of the Affiliated Hospitals of the State University of New York at Buffalo found that growing numbers of young, unmarried women were being aborted. The proportion of unmarried women among therapeutic abortion patients had shot up from 7 percent in the 1940s to 41 percent in the early 1960s. Of the single women, almost every one had a therapeutic abortion for psychiatric reasons, 94 percent compared to 48 percent of the married patients. "Possibly, married people are better adjusted and unmarried teen-agers more unstable," the physicians remarked, "but the more likely explanation is that our culture threatens the unmarried gravida with a social stigma which she desperately wishes to avoid by means of abortion."[32] One might add that unmarried college women found sympathy among physicians at university hospitals, who could identify with them as students as well as with their class and race. Such sympathy led them to suggest, along with other reformers in the mid-1960s, that the laws (not sexual behavior, interestingly) needed to change.

Psychiatric indications for abortion sometimes incorporated social and familial reasons, just as tuberculosis had in the past. For example, some psychiatrists regarded therapeutic abortion as a way to prevent future psychiatric problems among the children of women who did not want to bear them. "Most psychiatrists recognize that the woman who states she does not wish to have a baby is unlikely to be a good mother," remarked one psychiatrist in 1955, "and, in the end, we may


have several sick children as a result."[33] However, there was a major difference between the socioeconomic indications accepted in the 1930s and those associated with psychiatric indications in the 1940s and 1950s. The former anticipated helping low-income women already overburdened with a large family and housework; the latter primarily served middle-class patients who knew of the indication and could afford psychiatrists.

The new acceptance of psychiatric indications for therapeutic abortions put psychiatrists at the center of tense decisions about when abortions should be performed. If no other medical indication could be found, physicians treated psychiatrists as a last resort, thus making them the final gatekeeper in access to therapeutic abortion. Psychiatrists found themselves under pressure to approve abortions. While the psychiatrist might sympathize with the patient, the nebulousness of the law, Dr. Theodore Lidz felt, required the psychiatrist to be "conservative in his judgment."[34]

Some psychiatrists objected to psychiatric indications out of animosity toward the independence of women. "We know that woman's main role here on earth is to conceive, deliver, and raise children," stated Dr. Sidney Bolter. "The psychiatrist," he warned, "has become the unwitting accomplice" in abortion, taken advantage of by women and their doctors. He urged his colleagues to reverse the trend and to look for psychiatric reasons to advise against therapeutic abortion.[35] Psychiatrists like Bolter were fighting a losing battle, however. The practice of inducing therapeutic abortions for psychiatric reasons continued to rise,[36] though the number performed for this indication never made up the overall decline in therapeutic abortion.

Rubella, which threatened fetal defects, was another new and important indication for abortion from the mid-1950s through the early 1960s. Research had shown that among women who had German measles, or rubella, a few weeks prior to conception or in early pregnancy, about a third of the children would be born with serious defects. Obstetricians generally agreed that a therapeutic abortion should be performed if the fetus had been exposed to rubella during early pregnancy.[37] The response to the dangers of thalidomide, a tranquilizer that could cause fetal defects that became widely known as a result of the Sherri Finkbine case in 1962, showed that much of the public accepted abortion when damage to the fetus was likely.[38]

The acceptance of maternal rubella as an indication for abortion may be read as eugenic, as a method for "improving" the population, but it


was neither mandatory nor part of a government program. A distinction must be made between actions taken because they have been imposed by powerful agencies, such as the government or an employer, and decisions made by concerned potential parents. Perhaps this indication should be understood as implicitly taking family capacities and values into consideration and tacitly recognizing a parental right to determine whether they could care for a child born with congenital defects. As Petchesky comments, how to respond to such a possibility is inherently a moral question, and these questions are "inevitably hard ," but there is a tremendous difference between a moral question and the political question of who shall make the decision. Furthermore, the social context is crucial. The availability of services for disabled children and their parents influences future possibilities and the ethical choices that potential parents may make. As Michael Bérubé has shown, the lives of the disabled, specifically those born with Down's syndrome, have radically changed in recent years, as have our ideas about the possible future in store for disabled children.[39] Finally, distinctions must be made between decisions about pregnancy and attitudes toward actual children. The same individual who might decide to abort a pregnancy with evidence of fetal defects could devote themselves to a child born with various problems; parents who love and care for a disabled child might seek abortion in order to avoid another. Individual women and their partners regularly face these difficult questions today when they undergo amniocentesis.[40]

Despite new indications, the number of therapeutic abortions dropped dramatically in the two decades following the creation of hospital abortion committees. Individual hospitals boasted of their success in reducing therapeutic abortions since the institution of review committees. Two studies of abortion trends in New York City, the only region that collected long-term data, confirmed their claims. By the early 1960s the number of therapeutic abortions performed in New York City was less than half the number induced twenty years earlier. In the 1940s, New York City physicians performed an average of 710 therapeutic abortions per year; by the early 1960s, they performed fewer than 300. Standardizing these statistics to one thousand live births, the usual method for analyzing trends in maternal health, the rate of therapeutic abortions dropped at an even faster rate: 65 percent between 1943 and 1962.[41] (See figure 2.)

The new restrictions on abortion hit women of color hardest. Racial and economic discrimination limited their access to medical care in


Figure 2. Therapeutic abortion cases, New York City, 1943-1962.

SOURCES: Christopher Tietze, "Therapeutic Abortions in New York City,
1943-1947," AJOG 60 (July 1950): 147; Edwin M. Gold et al., "Therapeutic
Abortions in New York City: A 20-Year Review," AJPH 55 (July 1965): 966, table 2.
NOTE: The average ratio per one thousand live births from 1943 to 1947 is given as
5.1 Data for 1951 to 1962 are reported as totals over three-year intervals. I plot an
annual mean at the midpoint year.

general and to safe therapeutic abortions in particular. For the entire period between 1943 and 1962 in New York City, white women had over 91 percent of the therapeutic abortions performed in the city. Furthermore, the decline in the number of therapeutic abortions between 1951 and 1962 was highest among Puerto Ricans and lowest among whites. Public health officials noted that "the disparity . . . between ethnic groups has been widening over the years" and believed it a "medical responsibility . . . to equalize the opportunities for therapeutic abortion."[42] (See figure 3.)

Class inequality in the practice of legal, therapeutic abortions appeared in individual hospitals. Physicians performed the overwhelming majority of therapeutic abortions for private-paying white patients. They performed very few for low-income ward patients. Dr. Robert E. Hall of Columbia University. found that at Sloane Hospital in New York, private-paying patients received four times as many therapeutic abortions as did nonpaying ward patients. All but one of the private patients were white. The ward patients were more racially mixed, includ-


Figure 3. Therapeutic abortion, by race, New York City, 1943-1962.

SOURCES: Christopher Tietze, "Therapeutic Abortions in New York City.,
1943-1947," AJOG 60 (July 1950): 147; Edwin M. Gold et al., "Therapeutic
Abortions in New York City: A 20-Year Review," AJPH 55 (July 1965): 966, table 3.

NOTE: Data for 1943 to 1947 are reported as a mean, which I plot for 1945. Data
for 1951 to 1962 are reported as totals over three-year intervals. I plot an annual mean
at the midpoint year. In the original data for 1951 to 1962, "nonwhite" and "Puerto
Rican" are reported separately. Abortion rates for women of color are the weighted
average of rates for "nonwhite" and "Puerto Rican."


ing African Americans, Asians, and whites. Therapeutic abortion practices at other hospitals around the country, including those in Chicago, paralleled the practice at Sloane. Hall conducted a national survey of major hospitals and concluded that, "The over-all frequency of therapeutic abortions at 60 outstanding American hospitals is 3.6 times higher on their private services than on their ward services."[43] Municipal hospitals, where the indigent received medical care, performed the fewest therapeutic abortions.[44]

Furthermore, observers noted a pattern of performing abortions for reasons of mental illness more often for private-paying patients than for low-income ward patients. Across the country, Hall reported, physicians treated private patients more liberally. Between 1951 and 1960 at Sloane Hospital, half of the private patients who had therapeutic abortions had them for psychiatric reasons, compared to less than 20 percent of the ward patients.[45] Another physician reported that the "biggest problem" at the university hospitals in Cleveland was abortions performed for "questionable psychiatric reasons, involving members of the medical staff's families."[46]

Middle-class women not only had the necessary ability to pay for consultations, but also enjoyed a more subtle class advantage in gaining the support of their psychiatrists, who were generally of the same class and racial background. Though most women who obtained therapeutic abortions were middle-class and white, the availability of legal abortions to this group should not be overstated. Very few therapeutic abortions were performed.[47] Most middle-class women who had abortions, like low-income women, had illegal abortions.

Dr. Hall pointed to sterilization practices as additional evidence of a double standard in the treatment of low-income patients. When ward patients obtained therapeutic abortions, they were sterilized more than twice as often as private patients.[48] The propensity to sterilize low-income women of color matched the calls by some public officials for forced sterilization of poor, unmarried mothers. These coercive sterilization proposals, based in racist stereotypes and designed to be punitive, were aimed at low-income black women.[49] Some physicians carded out the implied social policies by sterilizing black women without their consent. Not every sterilization was coercive, but the higher incidence in poor and nonwhite populations was cause for concern. The ease with which doctors sterilized poor women, a crucial issue to black feminists and other feminists of color by the 1970s, was already apparent in 1965.[50]


Some physicians and hospitals devised their own coercive sterilization policies as a way to legitimate and limit therapeutic abortions: they insisted that women accept sterilization in exchange. Chicago physicians reported in 1939 that when they found therapeutic abortion necessary, they preferred to sterilize the woman at the same time in order to avoid performing additional therapeutic abortions in the future. If a woman agreed to an abortion but refused sterilization, the doctors' "general policy" was "to decline to interfere because of the likelihood that the problem will develop again." In an eight-year period at the Chicago Lying-In, 67 percent of the women who had therapeutic abortions were sterilized at the same time.[51] Gynecologists around the country agreed to perform abortions only as part of a "package deal," as this policy became known.[52] Media and medical warnings that criminal abortions caused sterility came terribly true for some women who had legal abortions in hospitals. Some psychiatrists criticized these sterilization policies for being deliberately "punitive" toward women needing abortions.[53] At the same time, hospitals restricted access to sterilization sought by patients.[54] While black women were being sterilized against their will, others who wanted sterilization found it equally impossible to have their wishes respected.[55]

Both the refusal to sterilize women who sought it and the forced sterilization of others underscore the fundamental medical assumption that reproductive decisions would be made by physicians and the rejection of patient-defined needs. Furthermore, the contradictory sterilization policies revealed the medical profession's racial and class identification. Many physicians had adopted a population control view—they believed that low-income women and women of color had "too many" children and should be prevented from having more while affluent white women should not be permitted to avoid childbearing. These attitudes, coupled with the belief that the medical profession had responsibility for reproductive decisions, led many doctors to act on behalf of what they considered best for public policy, rather than on behalf of patients' expressed needs. Plainly, some women refused the package deal and some doctors respected their patients' views. Yet the underlying assumptions about medical control over reproductive decisions helped make abuse possible.

Other women took abortion into their own hands. The increased difficulty of locating an abortionist and the skyrocketing prices for abortion surely contributed to the numbers of women who attempted to self-induce their abortions. Douching with soap or bleach was one


common and frequently fatal method used by women trying to self-induce abortions. One man who worked in the 1950s at the Chicago Lying-In Hospital, which cared for both white, middle-class patients from the University of Chicago and poor, black patients from the nearby ghetto, recalled seeing young women coming to the hospital who had taken pills or been "injected with lye" to induce abortions. Desperate and low-income women used many of the methods used by previous generations. Some aborted themselves with instruments found at home, including the now infamous coat hanger. One woman described taking ergotrate, then castor oil, then squatting in scalding hot water, then drinking Everclear alcohol. When these methods failed, she hammered at her stomach with a meat pulverizer before going to an illegal aborfionist.[56]

The demand for abortion attracted entrepreneurs, and the illegality of abortion meant that the safety and efficacy of various drugs and methods went unregulated. In the early 1950s, sales of a vaginal pill used to induce abortion boomed, and growing numbers of women entered the hospital suffering from vaginal bums. The vaginal pill was the method of destitute women who could not afford to contact a doctor for an abortion but could buy pills. One patient at Cook County Hospital was a twenty-nine-year-old black woman who was described as "extremely pale, cold, and covered with beads of perspiration. . . . [Her] vagina was filled with clots of blood." She told the physicians that she had placed a "grey tablet" in her vagina in order to induce an abortion. When she bled twelve hours later, she believed she had aborted. The hospital treated her, gave her blood transfusions, and, after four days, sent her to the prenatal clinic. The tablet had both injured her and failed to cause an abortion.[57]

Thousands of women with abortion-related complications poured into the nation's hospitals for emergency care every year. Hospitals had entire wards devoted to caring for these patients. In Chicago, the results of the restriction of abortion could easily be seen in Cook County Hospital's wards. In 1939, Cook County Hospital treated over one thousand women for abortion-related complications; twenty years later that number had more than tripled. By 1962, the county hospital reported caring annually for nearly five thousand women with abortion-related complications. (See figure 4.) Though not all of the women who came in had had criminal abortions, physicians believed that most had either induced their own abortions or gone to an abortionist. Population growth alone might have been expected to increase the number


Figure 4. Abortion cases admitted annually to Cook County Hospital,
Chicago, 1921-1963.

SOURCES: David S. Hillis, "Experience with One Thousand Cases of Abortion,"
Surgery, Gynecology, and Obstetrics 38 (1924): 83; Augusta Webster,
"Management of Abortion at the Cook County Hospital," AJOG 62 (December 1951):
1326-1327; Augusta Webster, "Confidential Material Compiled for Joint Commission
on Accreditation (June 1964), Obstetrics Department-Accreditation, 1964. folder,
box 5, Office of the Administrator, Cook County Hospital Archives,
Chicago, Illinois.

NOTE: Although these figures include miscarriages and some therapeutic
abortions, physicians believed most of the cases to be the result of illegal abortion.

of cases, but abortionists' access to antibiotics should have mitigated that increase. This hospital's experience was duplicated around the country in hospitals large and small. In the mid-1950s, Los Angeles County Hospital saw over two thousand abortion cases annually. D.C. General's septic abortion ward always had fifteen or twenty extremely ill women in it.[58]

The incredible number of women suffering as a result of illegal abortions had an impact on attendants who knew that abortions could be safely induced. Physicians and nurses at Cook County Hospital saw nearly one hundred women come in every week for emergency treatment following their abortions. Some barely survived the bleeding, injuries, and burns; others did not. The experience at Cook County Hospital suggests the magnitude of the problem of abortion-related complications. Tens of thousands of women every year needed emer-


Figure 5. Women's deaths resulting from abortion, New York City, 1951-1962.

SOURCE: Edwin M. Gold et al., "Therapeutic Abortions in New York City,
A 20-Year Review," AJPH 55 (July 1965): 965, table 1.

NOTE: Data are reported as totals over three-year intervals. I plot an annual
mean at the midpoint year.

gency medical attention because of illegal abortion. For health-care providers, this was a problem that was increasingly hard to ignore.

Most disturbing, the number of women who died because of abortion increased . New York City data documented the worsening patterns of abortion. Between 1951 and 1962, the absolute number of abortion deaths nearly doubled in this eleven-year period, from twenty-seven deaths per year in the early 1950s to fifty-one per year in the early 1960s. The observed rise in abortion deaths was not simply a function of growing population. When standardized to one thousand live births, the rate of deaths as a result of abortion had practically doubled as well.[59] (See figure 5.)

The risk of dying from an abortion was closely linked to race and class. Nearly four times as many women of color as white women died as a result of abortions. Mortality data revealed the racial inequalities in access to safe abortions. Between 1951 and 1962, the number of abortion-related deaths of women of color more than doubled, from an average of nineteen abortion deaths per year to forty-one. (See figure 6.) In contrast, ten white women died per year because of abortion in the early 1960s. Abortion deaths accounted for half of the maternal deaths


Figure 6. Deaths resulting from abortion, by race, New York City, 1951-1962.

SOURCE: Edwin M. Gold et al., "Therapeutic Abortions in New York City:
A 20-Year Review," AJPH 55 (July 1965): 965, table 1.

NOTE: Data are reported as totals over three-year intervals. I plot an annual
mean at the midpoint year. In the original, "nonwhite" and "Puerto Rican" are
reported separately. Abortion rates for women of color are the weighted
average of rates for "nonwhite" and "Puerto Rican."


Figure 7. Percent of total maternal mortality resulting from abortion, 1927-1962.

SOURCES: U.S. Department of Labor, Children's Bureau, Maternal Mortality
in Fifteen States , Bureau publication no. 223 (Washington, D.C.: Government
Printing Office, 1934), 113; Edwin M. Gold et al., "Therapeutic Abortions in
New York City: A 20-Year Review," AJPH 55 (July 1965): 965, table 1.

NOTE: The 1927-1928 value is from the Children's Bureau study, which did
not include New York. The other values are calculated from the New York City
data reported in Gold et al. Data are reported as totals over three-year intervals.
I plot an annual mean at the midpoint year.

of women of color, compared to 25 percent of the maternal deaths of white women.[60]

The racial differences in abortion-related deaths and access to safe therapeutic abortions mirrored the racial inequities in health services in general and in overall health. Maternal mortality rates of black women were three to four times higher than those of white women. Black infant mortality was nearly double that of white infant mortality. Furthermore, white Americans could look forward to a longer life expectancy than African Americans. Whites saw physicians more often than African Americans did. Vital statistics revealed how racism took its toll (and how it still does).[61] Abortion contributed to the health problems of low-income women and women of color, but it was only one aspect of fatal inequalities in health care.

Finally, abortion was becoming an increasingly important factor in overall maternal mortality. (See figure 7.) Abortion-related deaths rose


as childbirth became safer. At the end of the 1920s, abortion-related deaths accounted for 14 percent of maternal mortality. By the early 1960s, abortion-related deaths accounted for nearly half, or 42.1 percent, of the total maternal mortality in New York City. Furthermore, when skilled practitioners performed this procedure, the mortality rate was lower than that for childbirth.[62] Abortion deaths were almost completely preventable.

Public-health statistics revealed an appalling picture of death and discrimination. Health-care workers and public-health officers observed women dying and thousands more hospitalized as a result of a procedure that could be safe but was not because it was illegal. The illegality of abortion had produced a public-health disaster—especially for low-income and minority women. Maternal mortality had been an important focus of public-health work and a measure of overall health since the early twentieth century. Public-health activists interested in reducing maternal mortality now had to turn their attention to one of the most important causes: illegal abortion.

The results of the criminal status of abortion became plain in the postwar period. Repressive policies designed to control abortion led to a deeply discriminatory and deadly system, a system stamped at every level with the power dynamics of race, class, and gender. Abortion was institutionalized in hospitals in two interrelated structures: the therapeutic abortion committee and the septic abortion ward. While a very small number of women came in through the hospital's front door for scheduled therapeutic abortions, many more abortion patients entered the hospital through the emergency room door. On the one hand, hospital abortion committees approved a few therapeutic abortions, which took place in sterile operating rooms for patients who recovered in private rooms; on the other, hospital abortion wards housed thousands of injured and infected women who had illegal abortions. Class and race defined these hospital spaces: private rooms belonged to a few privileged white women of the middle class; the wards were shared by low-income women of all races, together with some middle-class women who had illegal abortions. Sometimes the patients who were having legal abortions and the patients who needed emergency care stayed in separate sections of the same hospitals, but often they were segregated into different institutions. Private hospitals accepted private patients for therapeutic abortions; public hospitals cared for emergency patients with abortion-related complications. Public policy regarding


reproduction had been founded on the assumption that medical men alone, not women, had the right to make decisions about female reproduction. This denial of female autonomy lay at the foundation of the medical system's response to reproduction in general and hospital abortion policy in particular. The discriminatory abortion system was built into the hospital structure.


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