Writing the History of Legal Abortion

The following is an excerpt from 2015’s Abortion after Roe by Johanna Schoen, recipient of the William H. Welch Medal from the American Association for the History of Medicine. Schoen sheds light on the little-studied experience of performing and receiving abortion care from the 1970s–a period of optimism–to the rise of the antiabortion movement and the escalation of antiabortion tactics in the 1980s to the 1990s and beyond, when violent attacks on clinics and abortion providers led to a new articulation of abortion care as moral work.

The topic of abortion has captivated writers for decades. Given that it touches on questions of sex, life, death, and morality, this attention is not surprising. Scholars tracing the history of women’s health activism have chronicled the history of feminist challenges to illegal abortion, the emergence of the women’s health movement, and the establishment of feminist clinics which emerged as a result. Others have traced the roots of antiabortion activism, the escalation of violence, and the impact on the pro-choice movement. A third group of scholars have analyzed the impact of policies limiting women’s access to abortion. They have charted changes to abortion funding, tracked policies that regulate access to abortion, and analyzed the impact of legal decisions. But despite the fact that policy approaches to abortion and the cultural climate surrounding abortion care underwent a fundamental shift over the past four decades, we lack a comprehensive study of the events that have changed the experiences of abortion care since 1973 and of the impact that these events have had on the abortion experience. For the pre-Roe period, the history of abortion is well documented.

Contrary to popular belief, abortion was not always illegal. Until the middle of the nineteenth century, abortion was largely unregulated. Historians have illustrated that anxieties about women’s changing roles and declining birth rates, coupled with the desire of ob-gyns to establish themselves as the primary health care providers for women’s reproductive needs, led to a public campaign that culminated in the criminalization of abortion by the late nineteenth century. Although abortion remained criminalized until the early 1970s, women continued to seek the procedure. As the twentieth century progressed and law enforcement cracked down on illegal abortion, women obtained illegal abortions at increasingly higher risks to their life and health.

Feminist scholars have noted that changes in medical technology, in particular the widespread dissemination of ultrasound images, significantly shaped the social meaning of pregnancy—and by extension the meaning and experience of pregnancy termination. How abortion providers and their patients understood the provision of abortion care shifted as larger cultural understandings about pregnancy and the fetus changed. If many viewed abortion in the 1970s as central to women’s emancipation and a right that women should have, this view began to change in the 1980s as the proliferation of fetal images began to contribute to a reshaping of the public understanding of the fetus. As fetal images gained in prominence, antiabortion activists began to articulate fetal interests and rights and to advance the notion that a fetus might have interests that stand in opposition to the interests of the woman carrying the fetus. Much has been said about the rhetoric and stigma attached to abortion resulting from these changes. But we know little about the impact that this debate has had on the experience of those delivering and receiving abortion care: abortion providers and their patients.

Indeed, anyone researching the history of legal abortion will find the record curiously silent on positive depictions of the abortion experience. The silence surrounding the abortion experience—having one and performing them—has been “a productive taboo,” reinforcing myths that abortion is never easy and positive but at best hard, at worst harmful to women. Since the early days of legalization, writers discussing legal abortion have repeated pre-Roe tropes that characterized women seeking abortions as mentally deranged and physicians performing abortions as immoral and greedy. Legalization did not remove the shame that came with having an abortion. While women spoke and wrote more openly about their illegal abortions in the years after legalization, they were silent about their legal abortions. In addition, feminists, most likely to break the silence surrounding abortion, were also most critical of the male medical professionals who performed abortions. By the late 1980s, antiabortion writers had begun to dramatize the abortion experience from an antiabortion perspective, and accounts of abortion ranged from ambivalent to hostile. Gory descriptions of abortion procedures successfully pushed women and providers into the defensive, silencing an already taciturn community and leaving abortion providers and their supporters unprepared to defend the integrity and independence of medical practice as it relates to the performance of abortions particularly after the first trimester. Looking back at the rhetoric surrounding legal abortion, one observer noted in 2003 that conservatives, not liberals, had won the struggle around abortion rights.

Given the sensitive nature of this topic, where and how I collected material shaped my personal editorial decisions and determined whether or not I could write about the information I found. While I decided not to shy away from sensitive topics inside the abortion provider community, I was careful—when addressing sensitive issues—to use only information from public records accessible to anybody. Although research in archival records and oral history interviews with abortion providers generally yielded material I could actually draw on, attendance at the annual meetings of NAF or research at its offices could only inform my understanding of events and experiences. And because my interest in the experience of abortion care is both politically sensitive and very personal to those narrating their experiences, it is by nature anecdotal and individual. Still, writing about the experience of abortion care and the impact that the abortion conflict has had on women and abortion providers is a pressing theme. It exposes how all abortion is marshaled into the single groove of morality, successfully excluding any consideration that places women’s control over their lives at the center of the debate.

Abortion is—and always has been—a key arena for contesting power relations between women and men. Feminists argued with male medical professionals about who should be in charge of performing abortions and how abortions should best be performed. In addition, the belief that women are incapable of acting as moral agents and cannot be trusted with the decision whether or not to end a pregnancy remains pervasive after forty years of legal abortion. Women’s ability to control their own lives and bodies, however, depends on their ability to control the most private and personal aspects of their lives: whether and when to bear children. As this book will illustrate, while the legalization of abortion made abortion accessible to most women, abortion became highly politicized and stigmatized as antiabortion activists and legislators challenged women’s ability and right to decide on abortion.

Johanna Schoen is professor of history at Rutgers University and author of Choice and Coercion: Birth Control, Sterilization, and Abortion in Public Health and Welfare.