As historian Leslie Reagan has demonstrated, abortion was hardly uncommon during its era of illegality, which spanned roughly from 1867 to 1973. According to Reagan, self-induced abortion was most common during the earlier portion of this period. As scientific medicine gradually gained a foothold in American society, more women sought abortion from licensed practitioners, even though the practice was still illegal. But the most desperate, those who could not access a clinician (qualified or otherwise), performed self-induced abortions. A midwife was oftentimes more likely to assist with an abortion than a licensed doctor, and indeed many midwives assisted abortion attempts.
Yet when a self-induced abortion went wrong, women were forced to seek help from allopathic physicians. Women who used sharp objects to attempt inducing an abortion frequently suffered from perforation of the uterus, which was sometimes fatal. Records of these instances from surgical journals allow us to glimpse into histories that would otherwise be lost.
In 1908, Chicago surgeon Aimé Paul Heineck compiled a list of 160 cases of wounds perforating the uterus. Typically, perforations occurred after the insertion of a surgical instrument or other foreign object. All examples had occurred within the prior fifteen years and had been written about in medical journals in English, French, or German. Although not all cases pertained to abortion (self-induced or otherwise), many of them did. Heineck described each situation with clinical detachment:
Number 73: “Catheter introduced in uterus to induce abortion. Perforation.”Number 98: “Attempted abortion. Inserted in uterus a No. 3 flexible bougie [surgical instrument]. Perforation of uterus.”Number 117: “Abortion. Perforated agent not stated. It was impossible to tell in this case whether the injury was caused by the measures taken to procure the abortion or by gangrene of the uterus.” (This patient died.)
Number 130: “Woman, two months pregnant, used instruments. Intestines was pulled out and cut 3 ft. Hanging from vagina was a piece of gangrenous gut, about 6 to 8 inches long.” (Another patient who died.)
Number 147: “Patient attempted self-abortion by introduction of a straightened hairpin.”2
These records are, of course, frustratingly incomplete. They cannot tell us of the women’s own perspectives on their abortions, their hopes and fears and experiences. We are left to imagine on our own the thoughts and feelings of a woman who removed large portions of her intestines in an attempt to end her pregnancy.
While incomplete, such records should be required reading for justices, legislators, and advocates who would limit access to safe and legal abortion. Denied the opportunity to access abortion legally, these women risked death and serious injury to end their pregnancies. Surely, they were well aware of the risks they took.
The actual, immediate dangers of self-induced abortions were clearly plentiful. Yet some physicians believed that the long-term effects could be just as harmful — and wanted to use questionable associations to dissuade women from performing their own abortions.