The History of Abortion in the US
Karissa Haugeberg on Roe v. Wade, Nixon, and courting the evangelical vote.
By now you’ve heard about the leaked draft document written by Justice Alito suggesting the Supreme Court overturn Roe v Wade. A few hours ago Chief Justice Roberts confirmed the authenticity of the draft.
There is of course rage. And projection about what this will mean — for women, for states, for the upcoming election. What this means about the spine of a Democratic Party that has control of the House, Senate, and the presidency. What this means about the structure of the GOP. While it’s tempting to politick in moments like this, we’re very staunchly not here to tell you how we feel, or assume how you feel — so here’s what we know about the history of abortion in the United States.
The most important reminder is that abortion was never about morality — until it was only about morality.
This interview with Karissa Haugeberg, an assistant professor of history at Tulane University and author of Women against Abortion: Inside the Largest Moral Reform Movement of the Twentieth Century, was conducted by Tatti Ribeiro for franknews. Originally published on 3.21.2020.
Can we begin by framing abortion in a historical context? Abortion has gone through different legal phases: from unregulated to regulated and then to reform of that regulation. Is that correct?
Yeah. I'll just begin with this: women have always had abortions. That in and of itself is not a new phenomenon. Women have always sought abortions no matter what the legal status of abortion has been.
Until the 1820s, women were permitted to have an abortion before “quickening.” Quickening was the moment a woman recorded that she felt the fetus move. Basically, people had to trust a woman's judgment and what the woman was saying. As long as the woman claimed that she hadn't felt the fetus move, no crime had been committed.
And that is until when?
Until about 1821.
Okay, wow. So when did contemporary abortion law start to change and why?
The first more contemporary anti-abortion law was passed by Connecticut in 1821. The first wave of abortion laws is that they were largely poison control measures; they did not target women. The laws resulted from concern about unregulated salesmen who were selling abortifacients — herbal remedies or pills that were unsafe and harming, and sometimes even killing women. It could be argued that really the intent of the laws was to protect women's health, protect them from these unlicensed, unregulated entrepreneurs.
There was a really thriving trade of abortion practice at this time. Typically, women just went to their networks of other women, similar to the advice networks set up for figuring out who to deliver your baby. It wasn't uncommon for the midwife to also be an abortion provider. There was just very little attention paid to this. It was all considered a private issue, personal, medical. The state just wasn't that interested in regulating it.
During this time, whether it's a conversation between a woman and their physician or amongst the family, is there any moral argument being made?
There was not a whole lot of moral discourse about abortion, except in the Catholic Church. The Catholic Church has been consistently anti-abortion, but it didn't have a lot of political sway in the 19th century. They weren't politicians, for the most part, they weren't influential lobbyists, so this moral argument was pretty small and limited to the Catholic Church. One thing to note is that Catholicism is associated with immigrants in the early 19th century. For middle-class white Protestant Americans, abortion just was not one of the moral issues they were talking about.
Things started to change in the middle of the 19th century. It was physicians who really led the charge to criminalize abortion.
Why was that the response of physicians?
This coincided with the professionalization of medicine in the United States. At this time, physicians in Europe at this time already had to be members of a guild, go to college, and pass exams in order to be admitted to practice medicine. In the United States, up until the middle of the 19th century, a person could go to college for a year, graduate from high school, hang out a shingle, and call themselves a doctor.
Beginning in the 19th century, physicians tried to professionalize and institute national standards; they wanted to make everyone graduate from college and make people pass an exam in order to be admitted to the American Medical Association.
In part, they were trying to take business away from midwives. They understood abortion and labor to be lucrative; they saw it as an easy way to establish a relationship with a future client. If a physician delivers a baby, perhaps those women will return to when the children get sick. It was a targeted business decision that was made to establish their authority. They argued that abortion was profoundly dangerous, which it really wasn't – it was safer than actual childbirth.
Physicians also began to use the moral rhetoric that we now associate with ministers. They started talking about how it was just so immoral that these women were making this decision. Several of these prominent physicians would say things like, "Abortion is murder, but it's sometimes necessary. That's why you need a physician to intervene, to figure out if this is an acceptable time to commit this act." They wanted to provide this moral authority to arbitrate whether it was permissible or not.
What is the response then from women at the time?
The way women talked about abortion was wrapped into a critique on how men were treating women. It wasn't until well into the 20th century that marital rape was considered a crime, so a lot of these feminists pointed out that so long as men are entitled to their wives' bodies, these women are always going to be vulnerable. It's going to put them at risk of needing abortions if they want to control their fertility because this is before there's reliable birth control. That's part of the context. They see abortion as potentially dangerous and it seems really unfair to women that they have to subject themselves to this potential danger because of all these ways in which women lack equality.
Right. Is family planning a part of the conversation at this point, also? Obviously, like you're saying, there's a lack of access to reliable birth control. Is that a consideration from women in this discussion?
That’s a really good question and, in a sense, one could argue that the history of abortion demonstrates that women have always sought to plan their families. We can look from the perspective of 2020 and say, "Yeah, it looks like those women were committed to family planning." They wouldn't have used those words to describe what they were doing, but that's it. That is what they were doing.
In the 19th century, a lot of women who got abortions were married women who were trying to control the spacing in between having children, arguing that in order to be good moms, they needed to not have five children under the age of five. Alternately, women who were single often turned to abortion in order to remain marriageable because it was so hard to find a partner who was willing to marry you if you had a child out of wedlock. The rhetoric of family planning really gets popular in the 1910s and 1920s with Margaret Sanger's activism.
And by the 20th century, every state in the United States has classified abortion as a felony.
That's correct. Again, it was physicians who drove that campaign. They're the ones who lobbied state legislatures to criminalize abortion. A lot of states made providing or even seeking an abortion a felony offense.
More abortion providers were prosecuted than women, and the reasons for that are two-fold. One, often what triggered these prosecutions was a woman dying, so there wasn't a woman there to prosecute. The second reason they would often offer women a plea deal if they agreed to testify against the person who performed the abortion. Like in the drug trade, they're always after the supplier.
Right. Yeah, they're getting the little guy to slip.
Exactly.
Culturally and, I guess, politically, what propelled us from this place where every state has classified abortion as a felony to Roe v. Wade?
One thing that plays a big role in abortion access is the state of the economy. When the economy was doing poorly during the Great Depression, authorities turned a blind eye and the abortion rate spiked. This was true globally. People were attempting to practice family planning when they could not put food on the table. So even though abortion was still illegal, authorities really diminished prosecutions because they understood that if people are suffering and they were to go after this source of relief, it would be enormously unpopular. Conversely, when the economy was doing well, there tends to be this renewed emphasis on promoting the family. Think about the baby boom of postwar America. There was a renewed crackdown on criminal abortion in the 1950s and 1960s. That's really when we see the unregulated market really taking off in the United States.
When prosecutions start ramping off, doctors stopped providing abortions because they were afraid of going to jail or losing their practice, so this teeming criminal enterprise opened. Low and behold, you see the death rate just spike because instead of turning to physicians, women are increasingly turning to underground, unlicensed people. This is where you hear these horror stories, or if you've ever seen that photo of the woman who's lying in a pool of her own blood on the floor, that's taken in this era in the 50s and 60s. Hospitals end up having to open up entire wards called septic wards to treat women dying of blood infections, like bacterial infections from using knitting needles or ingesting Lysol, trying to throw themselves down stairs.
It is also coinciding with more women going to college, so they're wanting to delay their pregnancies in order to maybe go to law school or medical school. Women's lives were changing so much after the war, and yet these laws remained unchanged. Suddenly, affluent white people started to see their daughters dying, friend's daughters dying, so there was real public outcry.
One additional factor is that there was an outbreak of German measles. When women contract German measles when they're pregnant, it can result in birth defects or a loss of a pregnancy. Americans came into contact with women who had wanted pregnancies, were mothers, and then were suddenly in this position to want an abortion and couldn't get them. There's something about being, again, affluent white middle-class mothers who want another child but needs an abortion that suddenly makes Americans more sympathetic to the issue. This propelled state legislatures at the state level to begin liberalizing abortion laws.
During the 50s and 60s, the view on abortion was divided along religious lines, rather than party lines.
There was a section of Catholic voters opposed to abortion access that was a really big part of the New Deal Democratic coalition. And then you look back to Barry Goldwater, who was staunchly pro-choice.
How did it become contentious along party lines in the way we see it today? I can't really imagine a Democrat being elected with a non-pro-choice perspective.
No, absolutely. You hit the nail on the head. There's such a profound realignment that is kind of stunning if you look back at it.
In the early 1960s, in general, Democrats were slightly more anti-abortion than pro-choice. At the time, the Democratic Party was the home of many Catholics. And Republicans were slightly more pro-choice than anti-abortion.
How did this all change? A large part of that story has to do with the realignment of the Republican party. In the late 1960s, several of Richard Nixon's strategists knew they had a very close reelection coming up; their goal was to try to animate new voters to come out and vote for Richard Nixon.
At this time, evangelicals were somewhat of an afterthought politically, but Nixon's team figured out if they could mobilize evangelicals to come out and vote Republican, it could be a significant enough number of voters that it could enable Nixon to win.
So, they had to craft Nixon into somebody that could be considered a champion of evangelical values. So Nixon argued that school prayer was under assault, decried the legalization of birth control, pointed to the feminist movement as disrupting the traditional American family, and argued that “traditional” America was being upended by programs meant to promote desegregation. Abortion became one of these issues that Nixon previously didn't seem to care about that suddenly became pretty central to the campaign and its goal to win the new Moral Majority.
After Nixon was impeached, Gerald Ford represented the more typical Republican politician. He was deeply uncomfortable talking about abortion. Some people within the Republican party looked at Ford and his unwillingness to embrace this position aligned with this new right and said, "Look what happens when you step away from this emerging coalition. You lose."
They made sure that wouldn't happen again, and the most robust parts of Ronald Reagan's campaign were carried on the court the Moral Majority. The Moral Majority was happy to align with them. They saw if they could get out the vote for Republicans, they could maybe help select judges. And in 1979 that the Republican party for the first time adopts a pro-life plank as part of the Republican platform.
It's so late. That's so crazy.
Yeah, but it took a while to get there. It starts with Nixon, it continues with Reagan. And even at that time, it was still deeply uncomfortable within the party because you have all these Ford and George H. W. Bush-type people who were either pro-choice or thought it was uncouth to talk about abortion that way.
Right. Deal with that in private, please.
Exactly, they saw it as a private issue. And there were a lot of Republican politicians who openly identified as feminists – and it wasn't cynical feminism. They promoted gender equality. They were deeply uncomfortable with what was happening. You see a reckoning unfold in the Republican Party and the very conservative faction won.
By the time you get to George W. Bush, there is no question; if you want to win a primary, you basically have to be anti-abortion. As part of that reckoning, Republicans were able to take conservative Catholics away from the Democratic party. The degree to which the Democratic self-consciously became the party of choice … I mean, one could make that argument, there's almost a way in which that is what they were left with. The Democrats affirmed a pro-choice stance one year after the Republicans affirmed a pro-life stance. You see them following the lead of the Republican party.
Right. The Republican political line, by this time, is that this is morally reprehensible. It's a moral religious argument that they're making.
Absolutely. In this time period, in the 70s and '80s, you're not hearing as much about abortion as a horribly dangerous thing. You hear that a little bit in the grassroots, but the major politicians are using very moral, religious rhetoric to make these arguments that they are saving babies.
That makes a lot of sense. Again, by this time, what is the women's narrative? How are women talking about access to abortion and what it means to the feminist movement?
The feminist movement is radically altered by the 1960s and 1970s. Historically, the pill had just been made available, an effective form of birth control in the 1960s. Women began to see how the ability to control reproduction meant the ability to complete college. It meant the ability to go to law school. It meant the ability to begin a career. They very clearly saw the links between that ability to control reproduction, the ability to control one's body, and the ability to control one's destiny. Suddenly, you didn’t have to get married in order to survive economically. Abortion in the 1960s became embedded in this rising feminist consciousness in a way that it wasn’t before.
By the 1960s what is the physicians' stance? Did that change?
That has changed dramatically. Whereas physicians led the movement to criminalize abortion in the 19th century, by the late '60s they were among the groups that were calling for the decriminalization of abortion.
What changed?
Two things. One, they were getting that uptick in women coming into the emergency room dying of criminal abortions. They were first-hand responders in watching what criminal abortion was doing to young women, and they were horrified by what they were seeing.
Two, they were afraid of being prosecuted for making the wrong decision. For example, if a woman came in suffering from a miscarriage and needed a D&C, there was always this specter of worry. Like, will people think I'm really just performing an illicit abortion and using this as a cover? What do I do when my state only has an exception for the life of the mother, but I know her health may suffer, and I go ahead and perform this. I'm technically not complying with the law. Am I vulnerable to being prosecuted?
Because the law just didn't match ordinary human experiences, these physicians believed that they weren't able to exercise their professional judgment. They resented that and they were afraid, so they worked to try to reform state criminal abortion codes so they didn't feel as nervous doing their profession.
Where do the nurses fit? As an overwhelmingly female-dominated industry in the medical field, it seems that they would be staunchly pro-choice. But that is not the case, at least in the 1970s. Could you elaborate on why that is?
As I was writing my first book, I kept coming across all these images of pro-life nurses; they formed some of the first anti-abortion groups. I was so stunned by this because there were all these physicians who were advocating for the decriminalization of abortion, so hy were nurses so different when they were working in the same hospital, with the same group of women? One of the things that I discovered was that in the late 60s and early 70s, many nurses did not have bachelor's degrees. Instead, after high school, they entered 3-year hospital-based nursing programs, like a nursing school. There's a really strong correlation between the amount of education a person has and their attitude about abortion. The more education one has, the more likely they are to be pro-choice. That's one possible explanation for why nurses tended to be more anti-abortion than women in other professions, like social work or teaching, compared to men in healthcare.
As I investigated more, I learned that it was more commonplace for women to get a second-trimester abortion in the 60s and 70s for a lot of reasons.
At the time, the procedure for performing a second-trimester abortion was called a saline abortion. I learned that this was administered by a physician injecting a woman's uterus with a saline solution, leaving the room, basically having minimal to no contact with that woman ever again. It was left to the nurse to stay with the woman while she labored and eventually miscarried.
There are ways in which this could be stressful. Some of these nurses weren't even trained or given directions as to how to dispose of these fetuses. It's not totally shocking that they found this to be upsetting. They resented this new workload that they had because, again, there was a massive influx of women as soon as abortion was decriminalized initially. These women felt overworked and overburdened, and they were doing traumatic work. I came to be more empathetic to these women who just felt they were left without a net.
Do you see a way to decouple the moral religious grievances that come with the abortion conversation from the conversation entirely? Is there a way that this can be something that is less polarized? Ultimately, is this always going to be a central stance of the Republican party? Do you see a way that changes?
In the short term, I don't see the Republican party abandoning this because it's been such a successful strategy for ensuring that they have a very stable, loyal base. Think of Donald Trump. A lot of people wonder how is it that a person who is, in many regards, pretty immoral in his personal life, definitely not religious, was able to garner the support of so many evangelical Christians? It's because of his promise to nominate anti-abortion judges.
From just a very cynical political calculation, I cannot imagine why a Republican would abandon that base. There's such a quid pro quo in this relationship. Why would someone running for Republican office abandon that loyal group of people who can help push them over the edge and win?
If we're being honest about this issue, in many ways, opposition to abortion is a religious belief. It's a belief about morality and when life begins. If we were to value a strict separation of church and state, I think it's possible to have a different political discourse.
If we agree that this is a moral religious issue, it's then inappropriate for us to have it at the focal point of public policy. Conversely, if we think about the right to abortion as a public health issue, it's inappropriate to take it away on grounds that are religious. If we are focusing on the ways in which this is key to keeping women's health safe, a moral argument is inappropriate. Again, if we can think about our obligation to separate personal moral religious beliefs from issues of the state secular issues about health, I think that would be tremendously helpful and important.
If we keep our attention on the medical reasons for abortion, there are not really compelling reasons to regulate it.
And is that something you can see happening?
I do not see that happening because, in a variety of contexts, including gay rights, the courts had been more permissive of religion and The Affordable Care Act. There is more emphasis placed on people protecting religious freedom than there is on protecting freedom from religion. So, I do not really see an end in sight to this so long as the courts continue to value religious expression over the ability to be free from religious controls.