Though the Roe v Wade decision invalidated antiabortion laws throughout the United States, this did not automatically create an infrastructure of trained and available providers of easy and safe abortion. The fact that the Roe v Wade litigation was necessary in the first place reflects the fact that antiabortion constituencies had been able to enact the oppressive tangle of statutes the Supreme Court was to find unconstitutional. The forces that created those statutes were still around, ready to seek other means to continue the battle for involuntary parenthood.
Carol Joffe's book examines the abortion climate for the last 200 years, focusing on those she calls "Doctors of Conscience," the physicians and others who for ideological reasons provided abortions when the practice was illegal, and those who later have sacrificed safety, income, and prestige to provide the medical services needed post Roe v Wade. The historical data in general repeat the story TFC members heard at a public meeting in 1989, reported in a book review by Stephanie McElhaney. Until the mid 19th century, abortion was only minimally regulated. The prevailing common law required no restrictions at all until "quickening" (between the 4th and 6th months), and little regulation thereafter. Abortion was freely advertised in the newspapers of the day. The drive to criminalize abortion started in mid-century and peaked in the early 1880's, led by a variety of motivations. The most important protagonist was the American Medical Association, which made criminalization of abortion a high priority.
The public reasons advanced for this position were "morality" and the "extreme hazard" of the procedure. The true reasons had more to do with turf battles between university-educated physicians and the self-taught "healers" who competed with them. Abortions were more commonly the province of this latter group, practitioners whom the doctors felt lowered the prestige of their profession. Abortions were also felt to be denigrating to the physician for a reason that some still cite today: these operations were a procedure requested by the woman patient, rather than prescribed by the doctor. The physician thus became a mere mechanic, responding to the diagnosis and prescribed treatment dictated by his female patient, an intolerable sleight to his professional status. The AMA's Committee on Criminal Abortion wrote a position paper in 1871 describing the woman who sought an abortion. "She becomes unmindful of the course marked out for her by Providence, she overlooks the duties imposed on her by the marriage contract. She yields to the pleasures--but shrinks from the pain and responsibilities of maternity-- " (there was a good deal more along the same line.) The result of all this was to drive the abortion business underground, as the doctors succeeded in getting all states to pass antiabortion legislation. Contraception was deemed immoral and was banned on much the same basis as abortion. Not until 1937 did the AMA endorse contraception as "normal sexual hygiene in married life", but only under strict medical supervision.
From the first, there were disagreements between those physicians who wanted looser guidelines for abortion and those who were for rigid control. There were always cases of abortions required to save a mother's life, and to decide which were to be permitted, therapeutic abortion committees were appointed by hospitals. These committees were much more permissive for private patients than for those in the wards. They also frequently required sterilization of the mother as a condition for an approved abortion. Whether this was to prevent the same woman from appearing before them again, a medical opinion that pregnancy would always be hazardous to this patient, or punishment for seeking an abortion is hard to tell. Perhaps all three to varying degrees. Illegal abortionists soon learned that patients who developed complications and were referred to certain obstetricians for treatment always received hysterectomies. Other physicians always laid such patients open with gigantic incisions. It is hard to view such actions as anything but punitive and vindictive.
Reflecting more lenient times, in 1970 the AMA adopted a resolution endorsing liberalized abortion laws. They called, however, for "sound clinical judgement". Doctors were still uncomfortable in the role of "rubber stamp" to a woman's decision to have an abortion.
With this as background, the book describes the careers of a number of doctors who both before and after Roe v Wade found their calling in helping women and girls with problem pregnancies. Some were arrested, others were tolerated due to strong public support. Once abortion was decriminalized, first in certain liberal states and then nationwide by the Supreme Court, it was assumed that non-Catholic hospitals would quickly provide arrangements for abortion services. This did not happen. Anti-abortion doctors were widely entrenched, and the course of least resistance was to do nothing. In this situation, free-standing abortion clinics soon were established, staffed in some cases by doctors who had done illegal abortions in the past. In this development, Roe-Doe v Bolton was a vital companion decision to Roe v Wade. The Roe-Doe decision expressly stated that abortion provision could not be limited by law to hospital practice.
A great surprise in the operation of the new clinics was the very low level of complications. The doctrine long taught in medical schools was that abortion was a terribly dangerous procedure, with a high probability of adverse consequences. This may have been wishful thinking on the part of antiabortion professors or simply a deduction based on the huge number of emergency room treatments given to women injured or infected by unqualified abortionists. Indeed, it was the constant confronting of such patients in hospital emergency rooms that led to the practice of abortion by many of the doctors interviewed for this book.
Clinics, however, are not seen as the ideal solution. They isolate their doctors from mainstream medicine, they present highly visible targets for fanatic protestors, and they do not supply a training ground for the next generation of abortion skills as would a teaching hospital. Clinics are also especially vulnerable to the politics of the sitting president. President Clinton dispatched marshals to protect clinics; the Bush administration went to court on behalf of Operation Rescue in a clinic harassment case.
The book also provides a discussion of late developments. A recent tactic of zygote rights activists is to set up malpractice lawsuits against doctors who do abortions. Antiabortion groups are recruiting women to do the suing and sympathetic doctors to testify on the side of the plaintiffs. How far they get with this ploy may depend upon how successful they are at keeping juries free of even one pro-choice panelist. Of course, court decisions may develop which dispose of all such lawsuits as a class.
A hope for the future is RU-486, which is capable of terminating early pregnancies (8-9 weeks) without need for an operative procedure. As this and other chemical abortifacients become more widely available, we can expect to see abortions provided in far more medical venues. This would make life much more difficult for the opposition.
This book is especially valuable because the author took the trouble to interview a great many doctors who were early provides of abortion, both before and in the immediate aftermath of Roe v Wade. These people are growing older, and this source of the true story of the struggle for choice will soon be gone. This history is a vital one, and Joffe's book is a valuable resource.
Last Modified June 8, 1997