How Was Abortion Performed Back in the Day and Today
An abortion is a medical or surgical procedure that deliberately ends a pregnancy before an embryo or fetus is born. Opponents of abortion typically object to the practice for religious or ethical reasons, contending that the procedure constitutes the cruel termination of what they consider to be a viable human life. Those who support a woman’s right to choose an abortion argue that access to safe, legal abortions is a human right. In Roe v. Wade (1973), the US Supreme Court ruled that the Constitution protects a woman’s right to an abortion through the end of the first trimester, or the twelfth week of pregnancy. After twelve weeks, a woman’s access to abortion may be restricted based on the discretion of the states, as well as the level of risk that the pregnancy poses to the woman’s health.
During the 1800s, all surgical procedures, including abortion, were extremely risky. Hospitals were not common, antiseptics were unknown, and even the most respected doctors had only primitive medical educations. Without today’s current technology, maternal and infant mortality rates during childbirth were extraordinarily high. The dangers from abortion were similar to the dangers from other surgeries that were not outlawed. As scientific methods began to dominate medical practice, and technologies were developed to prevent infection, medical care on the whole became much safer and more effective. But by this time, the vast majority of women who needed abortions had no choice but to get them from illegal practitioners without these medical advances at their disposal. The “back alley” abortion remained a dangerous, often deadly procedure, while areas of legally sanctioned medicine improved dramatically. The strongest force behind the drive to criminalize abortion was the attempt by doctors to establish for themselves exclusive rights to practice medicine. They wanted to prevent “untrained” practitioners, including midwives, apothecaries, and homeopaths, from competing with them for patients and for patient fees.
If it were up to me, all criminal sanctions against abortion would be revoked, making abortion available at the request of the only person who counts—the one who is pregnant. And as with all pregnancy care, abortion would be free at the point of care and universally accessible from very early on in pregnancy. Canada has proved that no criminal law is feasible and acceptable (Kassebaum N. J., Bertozzi-Villa A., 1990). Sweden has proved that abortions after 18 weeks can effectively disappear with very good services, and WHO has shown that first-trimester abortions can be provided safely and effectively at the primary and community level by trained mid-level providers and provision of medical abortion pills by trained pharmacy workers. Finally, web- and phone-based telemedicine services are showing that clinic-based services are not required to provide medical abortion pills safely and effectively. But to achieve these goals, or something close to them, it takes a strong and active national coalition, a critical mass of support, and—with luck and knowing what the goalposts are—less than 100 years of campaigning to make change happen on the ground (World Health Organization. 2012).
In essence, medical training should include all aspects of reproductive health—contraceptive counseling, pregnancy options counseling, and abortion services—along with the current training about treating sexually transmitted diseases and managing normal pregnancy and childbirth. And those physicians who choose to provide abortions as part of their routine practice shouldn’t be restricted from practicing in any hospital or clinic across the country. Abortion should be recognized and accepted as a key component of comprehensive medical care.
World Health Organization. Safe abortion: Technical and policy guidance for health systems. Geneva: WHO; 2012.
Kassebaum N. J., Bertozzi-Villa A., Coggeshall M. S., et al. “Global, regional, and national levels and causes of maternal mortality during 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013” Lancet. 2014;384(9947):980–1004.
World Health Organization. Primary Health Care: Now More than Ever. World Health Report 2008. Geneva: WHO; 2008. p. 65