What the story of alley abortions can teach us about an egg-free future

A metal hanger cannot speak, but it can send a message. Long a symbol of the dangers faced by people trying to end pregnancies in the years before Roe v. Wade, hangers replace an entire inventory of physical horrors, most of which never involved hangers, specifically. In recent weeks, protesters have done so hangers shipped to the Supreme Court in an effort to evoke that bygone era – from the so-called alley butchers who failed surgical procedures and sexually harassed patients, to the terrible hardships individuals faced aborting at home. The message is simple and brutal: without a safe and legal abortion, protesters believe, people will die.

In the years since roe deer became the law of the country, the medical landscape of abortion has changed dramatically. Today abortion is extremely safe – safer than birth. So sure, in fact, that it’s not always obvious what made illegal abortions dangerous. Or, for that matter, what were the coat hangers for.

And that’s why those objects still have important stories to tell us, historians told me. Because while the most physically violent methods of abortion of the past have become medically obsolete, the march of scientific progress has not eliminated the shame, fear and despair experienced by people who are pregnant, who do not want to be and live in. a society where there is no simple and legal access to abortion. Coat hangers don’t just tell us about the dangers of poor medicine practiced poorly, these historians said. Instead, hangars also speak of the desperation that can lead people to those dangerous procedures in the first place.

“The whole phrase ‘butcher in the alley’ is an exaggeration because there were a lot of good practitioners who were perfectly safe,” said Leslie J. Reagan, a history professor at the University of Illinois at Urbana-Champaign and author. of “When Abortion It Was a Crime”.

Even in the past, the dangers of illegal abortion did not concern the abortion itself. No one knows how many illegal abortions were performed each year, before the Roe, but researchers in the early 1990s estimated that at the time it was on par with the annual number of legal abortionstherefore more than 1 million. People with money and connections could always be safe, and many people survived, historians I spoke with said. Illegal abortions were primarily dangerous for people who were locked out of better options.

Legal abortions in hospitals, for example, occurred with some regularity. These records were kept hospital by hospital, so it’s rare to have data even across town, but University of Vermont historian Felicia Kornbluh pointed me to a 1965 document that found that New York City hospital review committees had approved 4,703 so-called therapeutic abortions between 1951 and 1962. In those cases, the actual technique used was something called dilation and curettage, or D&C. Also often referred to as “surgical abortion,” D&C is still used today as a treatment for both abortion and miscarriage. Doctors dilate the cervix – widening the opening between the vagina and the uterus – and use a sharp instrument to scrape the contents of the uterus.

Before Roe, in the 1950s and 1960s, legally aborting in a hospital was not easy. A patient could get a D&C if she was already experiencing a natural miscarriage. If not, patients who have requested one should present a case to their doctors, who should then bring the situation before a hospital review committee. The patient would probably have been examined by other doctors and would have had to answer questions: in practice, they needed to prove that the abortion was medically or psychologically necessary. But necessity wasn’t the only factor at play. “There are studies showing that almost all of them have been done on people with private insurance,” Reagan said. Uninsured patients, as well as black and brown patients regardless of insurance status, had a much harder time getting approval. In her next book, “A Woman’s Life is a Human Life,” Kornbluh records that East Harlem Metropolitan Hospital approved five white women’s applications for every black woman. The hospital was even less likely to approve the Puerto Rican women’s requests. And Reagan has documented cases where black women were denied abortion even though they did rubella infections during pregnancy – something that can kill a fetus or leave it with life-long complications, including deafness, heart defects and intellectual disabilities. (Others were lied to and told they didn’t have it.)

People who have been denied, or who have never had any hope of obtaining, a hospital abortion are left with only illegal options. Both trained doctors and untrained practitioners offered D&C, but that procedure was considerably more dangerous in illegal settings. With no sterilized equipment and easy access to antibiotics and pain relievers, doctors used stealth practices that optimized speed and offered no space for follow-up care, and doctors sometimes had no idea what they were doing. Carole Joffe, a professor of obstetrics and gynecology at the University of California, San Francisco, interviewed qualified doctors who practiced illegal abortion during this time and wrote about their experiences. A doctor told her that she used to explain the challenges of running a D&C by telling her residents it was like being blindfolded and trying to scrape the inside of a wet paper bag without cutting the paper. Possible, but not easy. “D&C in competent hands are safe, but in incompetent hands it is very easy to puncture the uterus,” said Joffe.

To avoid trying to perform the difficult D&C in clandestine circumstances, illegal abortionists sometimes opted instead of simply inducing a miscarriage enough for their patient to go to the hospital and get one without any problems. They often did this by inserting a foreign object, such as a hollow tube catheter, through the cervix. In some cases, they might use a type of catheter with a balloon on one end. Filled with saline, it would put pressure on the cervix, as a fetus’s head would towards the end of pregnancy, causing it to dilate completely. Just inserting any catheter could cause a miscarriage while the body was trying to expel the object. These methods didn’t work all the time, though. They could cause bleeding and embolisms. And the catheters had to be left in for a while, along with gauze wrapped in the patient’s vagina to block the blood. This could lead to infections and with patients trying to hide from the authorities, they often did not seek treatment until death.

People who could not find or afford an illegal abortion often tried to give one to themselves. It’s impossible to say how many of these have happened each year, but there are records showing thousands of people who entered emergency rooms with septic infections of the uterus and reproductive organs in the 1960s, Reagan said. This is where coat hangers come into play, Joffe said, as one of many objects that people would try to insert through their cervical openings. The goal wasn’t necessarily to complete a home abortion, but rather to induce enough bleeding and miscarriage symptoms to allow the person to go to the hospital, say they were having a miscarriage naturally, and get a D&C hospital. But perforation, bleeding, and infection were all risks.

Even less reliable and more dangerous were a number of suppositories, tinctures, herbs, and home remedies that many people have tried. A doctor told Joffe to treat a patient who had a catheter inserted into her cervix and poured turpentine into it, literally cooking the inside of her uterus, which needed to be removed. Others have told stories of potassium permanganate tablets, sold over the counter, that people put into the vagina to induce bleeding and get hospital D&C. But the tablets could easily eat through the vaginal lining, causing bleeding and destroying the cervix.

It’s very unlikely that anyone will go back to performing D&C or catheter abortions, Reagan and Joffe said. Even if Roe is overturned, doctors and other people who want to challenge him are much more likely to offer patients abortion pills. while pill abortion can be a physically painful and psychologically intense experience for some people, the existence of these pills drastically changes the calculation when it comes to the risks of illegal abortion. They are much easier to obtain and hide, much safer to use and if a patient is concerned about side effects she can seek treatment knowing that no one will be able to tell the difference between the effects of a pill and a natural miscarriage. .

But both Reagan and Joffe have said that the existence of abortion pills will not eliminate the risk if abortion becomes illegal. Just as there were some people who could have an abortion more easily than others before Roe, there will also be those who can do it later. Meanwhile, some of the most vulnerable people – the poor, people living in very rural areas, people who can’t take a break to drive to another state in search of pills – will still end up with only desperate options left. Reagan was particularly concerned that websites selling fake abortion pills would fool people who have no idea they haven’t received the real thing. And both she and Joffe worried about how lawlessness and rising stigma could push more people into dangerous home-based methods, with social media becoming the new alley. Even with abortion still legal, there are occasional cases of people – usually young people – trying to have an abortion on their own, Reagan said.

The abortion methodology has improved, Reagan and Joffee told me. But as long as despair exists for an abortion – and easy access doesn’t exist – some people will still be in danger.