A Long History of Abortion

Looking to the past for context and perspective as the U.S. abortion care landscape changes dramatically.

The Supreme Court decision overturning Roe v. Wade ended women’s nationwide legal right to abortion after nearly 50 years.

Several states with so-called trigger laws banning abortion moved to implement these immediately. Although some of these laws have since been challenged in court, within a few months it’s expected that women living in about half the states will have very limited or no access to abortion care. Most of these laws—predominantly in the Midwest, South, and Plains states—make no exception for rape or to safeguard a woman’s health, until she is at risk of death.

Limiting health care access amid rising maternal mortality rates.

These restrictions on women’s health care occur while the U.S. continues to have a maternal mortality rate much higher than in other developed nations. According to the latest statistics from the CDC, this rate is rising, and health disparities persist: Black women are three times more likely to die from pregnancy-related causes compared with White women.

Women who have historically been most marginalized will be disproportionately affected by the Supreme Court’s decision, which is expected to affect many women’s  access to high-quality health care. A statement by the National Academies of Sciences, Engineering, and Medicine notes, “The risks are especially acute for women of color, women from low-income backgrounds, and women living in rural areas.”

An ahistorical decision?

In overturning Roe v. Wade, the Supreme Court justices in the majority opinion said, “the right to abortion is not deeply rooted in the Nation’s history and tradition.” Yet according to both historians and AJN’s archives, the history of abortion in this country is much lengthier—and more nuanced—than this opinion suggests.

Historians—particularly historians of women’s history, public health, and medicine—have taken to various platforms (social media, newspapers, online forums) in recent weeks to explain this history. Major U.S. historical organizations released a shared statement saying the Supreme Court opinion “inadequately represents” the history of abortion and embraces “a flawed interpretation of abortion criminalization.”

Common law and abortion.

In her book When Abortion Was a Crime, Leslie Reagan, a professor of history at the University of Illinois at Urbana-Champaign, explains that under common law until the early 1800s, it was legal to end a pregnancy in its early stages:

“Abortions were illegal only after ‘quickening,’ the point at which a pregnant woman could feel the movements of the fetus (approximately the fourth month of pregnancy). . . .The term abortion referred only to the miscarriages of later pregnancies, after quickening. What we would now identify as an early induced abortion was not called an ‘abortion’ at all.”

Women in the 18th and early 19th centuries “remained largely in control of their fertility,” as they had for millennia, said Elizabeth Masarik, PhD, an assistant professor of history at SUNY Brockport, in a podcast last year. “Women were the ones that held the wisdom of how to space their births, how to prevent conception and use birth control, how to restore the menses when necessary, and how to produce an abortion.”

Even women who had limited power over their reproductive lives utilized this knowledge. Crystal Lynn Webster, an assistant professor of history at the University of British Columbia, noted in an essay in December that “slavery depended upon the control and exploitation of Black women’s reproductive abilities,” yet these women still “asserted power in their own health” by using traditional knowledge and herbs to control their reproductive lives, “even by terminating pregnancies.”

Historical evidence indicates these practices were well-known and uncontroversial. Domestic medicine handbooks included herbal recipes that described how to end a pregnancy. In fact, Benjamin Franklin included an abortion recipe in a textbook he published in 1748. As Molly Farrell, associate professor of English at the Ohio State University, explained in an article in May:

“Abortion was so ‘deeply rooted’ in colonial America that one of our nation’s most influential architects went out of his way to insert it into the most widely and enduringly read and reprinted math textbook of the colonial Americas—and he received so little pushback or outcry for the inclusion that historians have barely noticed it is there.”

Toward criminalization.

The first state abortion laws in the 1820s and 1830s were intended to protect women from the commercialization of drugs that were used as abortifacients, says Reagan, noting that these “had become a profitable product sold by doctors, apothecaries, and other healers.” Citing the work of historian James Mohr, she explains:

“The first statutes governing abortion in the United States. . . were poison control measures designed to protect pregnant women. . . .It is crucial to recognize what these early-nineteenth-century laws did not cover: they did not punish women for inducing abortions, and they did not eliminate the concept of quickening.”

By the middle of the 19th century, however, states began enacting stringent abortion laws that applied to all stages of pregnancy. These laws were the result of a variety of factors, one of which was a push by physicians to professionalize and control medical practice, including women’s health care. By 1910, abortion was illegal in every state.

Abortion in AJN archives going back to 1900.

An article about the work of visiting nurses in Chicago published in AJN’s first issue* in 1900 highlights how induced abortions were regulated and the way nurses navigated these care situations:

“The rules of the [visiting nurse] association forbid the nurse taking care of. . .criminal abortion cases, but some. . .are attended by them, because the patients usually deny the fact that they are produced, and the nurse ordinarily has no proof that they are.”

A search of AJN’s archives reveals relatively frequent mention of abortion, often in the context of the nurse’s role in caring for women who had illegal procedures. In the April 1931 issue, in a column titled “Ethical Problems,” caring for a patient who was suspected of having an abortion is cited as an example of a professional ethical dilemma “met constantly by public health nurses.”

An article titled “Abortion,” published in August 1939, was written by physician Fred Taussig and includes a thorough examination of the causes, prevention, and treatment of spontaneous and induced abortions. It also describes the circumstances in which the latter were legal and considered to be medically necessary at that time:

The reasons for this forceful interruption of pregnancy are at times justified, when the physical condition of the mother is such as to make the continuance of the pregnancy a danger to her life or health. Nephritis, tuberculosis, heart disease, and certain other organic disease may necessitate such action. In these cases we speak of therapeutic abortion. In almost every part of the world and in most of the states in our country such abortions are authorized legally.

A growing openness to discuss the topic in the 1960s.

During the 1960s, an increasing number of articles about abortion were published in AJN, highlighting a growing openness to discuss the topic and the liberalization of state laws. At this time, abortion was mentioned in the context of teen pregnancy, septic abortion crisis care, and nurses’ attitudes toward induced abortion, among other examples.

AJN’s archives provide a valuable overview of the breadth of abortion-related care provided by nurses and physicians, prior to the federal right to abortion that was affirmed by Roe v. Wade in 1973. They also offer insight into the care situations nurses may increasingly face as many states again pursue and enact abortion bans, restricting women’s access to necessary and high-quality health care.

Additional resources.

Further historical context about abortion and related health issues can be found in the Reproductive History Syllabus compiled by Nursing Clio, a peer-reviewed, open-access blog “that ties historical scholarship to present-day issues related to gender and medicine.” The syllabus includes links to relevant articles, books, and essays.

*Editor’s note: please click on PDF under “download” in the left sidebar of the article landing page for best versions of this and several of the older archived AJN articles referred to in this article.