Justice  /  Book Review

Abortion's Past

Before Roe, abortion providers operated on the margins of medicine. They still do.
Doug Mills/Associated Press

Doctors of Conscience does not offer detailed accounts of individual women seeking abortions, or the oft-quoted public health statistics on the morbidity and mortality of illegal abortion. Rather, Joffe captures the “lengths to which women would go” to control their reproduction in horrific snapshot images that come from the health professionals who treated them: emergency rooms teeming with women bleeding from corrosive agents, broken Coke bottles, catheters, and coat hangers; late-night operating rooms crowded with stretchers holding women who waited to have their instrumented uteruses evacuated or removed; a woman delivered to the emergency room with a paper bag containing eight feet of her intestines. This collective human suffering is attended by a palpable paranoia permeating the wards in which it occurred—the pervasive police presence; physicians, under the threat of the law, forced to grill patients about the identities of their abortionists in the moments before they died. No less chilling is the insidious misogyny that stigmatized these women, and devalued their lives. As one physician recounts, the special wards of public hospitals where women suffered and often died from septicemia, or overwhelming infection, were referred to as “septic tanks.”

Much of the powerful storyline of Joffe’s book describes the methods by which doctors of conscience opposed these atrocities, and the consequences they suffered even at the hands of their own colleagues. But its political heart lies in her observation that the bulk of the medical community failed to act responsibly. Countering the common assumption that the emergence of an organized anti-abortion movement led to the marginalization of abortion and its providers, Joffe asserts that the mainstream medical establishment itself had long before relegated abortion to the “back burners” of women’s health care.

This argument makes sense in view of the historical relationship of the medical establishment to women’s reproductive health. Linda Gordon, Rosalind Petchesky, and others have documented that women practiced contraception and abortion throughout history, usually within the context of female-dominated and community-based networks of midwives, kin, and lay healers. Until the mid-nineteenth century in the United States, abortion before “quickening” (perceived fetal movement usually occurring at about 20 weeks gestation) was neither subject to governmental regulation nor considered to be morally wrong, even by religious authorities.