Abortion, pt. 1

It feels like each week a new state seeks to overturn individual liberties, the rulings of local courts, the ruling of state courts, the ruling of the Supreme Court, and reinterpret the Constitution. Last week, my home state of Louisiana joined the wave of states participating in a violation of civil liberties with the passage of a “heartbeat bill.”

This is not new ground, really. Since the Amendments were first outlined, there has been discussion even disagreement on the rights of humanity and specifically American citizens. The Civil War was, perhaps, the greatest crisis in Constitutional history. Whether one believes the traditional narrative that the Civil War was a result of slavery, or whether one believes the Civil War was a result of the large umbrella-tent term “state’s rights” depends entirely on one’s ability to accept the witness of substantial historical record, the testimony of thousands of documents all agreeing to the similar experience of the same event, and the continued evidence of racism and classism in America. Which is to say, there are incompatible narratives all around us and abortion is yet another example of disagreement over the limits of the Constitution. Namely, whether the Constitution holds all humans in equal esteem or whether “all men are created equal” means all white penis-evident heteronormative cisgender males who are willing to kill to protect rights that support their inheritance of a strong patriarchy.

Abortion has a long history that predates the recent wave of civil disagreement. In fact, abortion was not “invented” after the passage of Roe v. Wade in 1973. It has a long and sustained history predating human (yes, human) civilization. There is, after all, evidence of mammals killing their young immediately after birth and there is evidence of mammals behaving in such a way to terminate a pregnancy, even self-induced harm through the usage of abdominal pressure, sharpened instruments, and other techniques like abortifacient herbs and medicinal remedies. My grandmother, a god-fearing, Bible-reading, man-respecting woman from the “cricks and hollers of West Virginia” said that when she was young in the 1930s and 40s, women would “spray Lysol up their… you know… their insides”, drink or “swab themselves” with bleach, drink alcohol excessively, “jump up and down” or take drastic measures like jumping and tumbling off hills, having a friend punch one another in the stomach, or “taking a wooden spoon and shaking it around inside, beating it and getting all of whatever was up there out.” Laws concerning abortion, however, are new. The successful repeal of abortion bans is an even newer event, primarily in the latter half of the Twentieth Century. And it is here, the focus on laws, that so much of contemporary discourse gets lost as either side of the debate (and those who insist they are “in the middle” and “understand both sides” even as they maintain a fixed position leaning to one side or the other). Instead of talking about morality or religious belief, personal or biomedical ethics, or the legal emancipation of women to make decisions for their own body, we talk about law as though this were synonymous with each of the aforementioned.

To help ground this, the following is a transcript from May 20, 2019 between NPR host Mary Louise Kelly and Karissa Haugeberg, assistant professor of history at Tulane University in New Orleans, where they discussed what it was like to get an abortion before the 1973 ruling of Roe V. Wade.

MARY LOUISE KELLY: If the ultimate goal of these abortion bans is to overturn Roe and go back to the way it was before that landmark decision, let’s paint a picture of what it meant to get an abortion back then. Karissa Haugeberg is here to help us do that. She teaches history at Tulane University, and she joins me now. Professor Haugeberg, welcome.

KARISSA HAUGEBERG: Delighted to be with you.

KELLY: Start with the numbers. Before the Roe versus Wade decision 1973, how many American women got abortions?

HAUGEBERG: Scholars will probably never be able to answer that question with precision precisely because the procedure was illegal. But scholars estimate that between 20% and 25% of all pregnancies ended in abortion before Roe v. Wade.

KELLY: Well, that prompts me to the next thing I want to ask you about, which is, how risky was it when a woman did decide that she wanted to get an abortion in those days pre-Roe versus Wade – because I think the picture a lot of people maybe have in their head is of back-alley abortions or of women using coat hangers or drinking rat poison to induce abortions.

HAUGEBERG: Immediately before Roe v. Wade, officially approximately 200 women died per year. Historically, the most commonplace method that women have used when they haven’t been able to obtain legal abortions is self-induction. Those are the horror stories that you hear of women trying to fall down stairs or ingesting poisons or using instruments to try to induce an abortion.

Another method that women commonly used was turning to the unregulated market. And some women were able to find providers who were willing to perform abortions safely but criminally at great risk to their professional careers and at risk of being imprisoned themselves.

KELLY: Stay with the question of providers for a moment. As you know, the new Alabama law would make performing abortions a felony. But you are describing that there were, pre-Roe versus Wade, competent doctors and midwives and others who were performing abortions. How did that work?

HAUGEBERG: So one thing that’s kind of interesting is that throughout the period when abortion was criminalized beginning in the mid-19th century – for the most part, physicians were the people who were providing it as well as midwives. And as long as a physician was offering the service, until about the 1930s, they were less vulnerable to being prosecuted or having a police raid their practice. And so there was a vibrant word-of-mouth network that enabled many women to find safe providers. But again, they were always operating in a gray area.

KELLY: So big picture, what aspects of history might repeat should today’s Supreme Court overturn Roe versus Wade?

HAUGEBERG: So when we look at the provision of abortion in the immediate pre-Roe period, I think it’s actually very instructive. We had a patchwork system where women in certain places, like New York, and in certain areas – for example, cities – had much better ability to be able to get to a licensed provider and to afford a provider than women who lived in rural areas. So even in 1971, a woman who lived in rural Louisiana had very little ability, often, to be able to afford to get to New York.

And I think that’s one thing that I see coming back – is that we’re returning to this period where geography matters tremendously, that women in certain states will have the ability to exercise the right to abortion while it’s quickly disappearing and diminishing for women in rural states and in states that have a higher proportion of African-Americans.

KELLY: Let me flip the question around and ask what might look quite different in 2019 from the way things looked in 1971, 1972?

HAUGEBERG: Well, among the differences are some of the technologies. And there are concerted efforts to try to get abortion pills into states that are passing these criminal prohibitions on abortion.

KELLY: So options to terminate a pregnancy chemically, which may not have been available and certainly weren’t widely available in the early ’70s.

HAUGEBERG: Precisely. But if the recent history on contraception and these states’ reluctance to cover contraception is any guide, it wouldn’t be surprising if next there will be a crackdown even on these other chemical options.

In discussing ancient history, we must always make a distinction between the records of Eastern and Western cultures as they approach law and punishment, motives, and autonomy very differently.

The Vedic laws of India during the premodern era reflect a concern for preserving the male seed of the three upper castes: the Brahmin (poets and teachers, what Westerners might call “the wealthy” who had disposable time to give wise sayings, the literacy to read, and the ability to commit their reflections to paper), Kshatriyas (political leaders and warriors/soldiers), and the Vaishyas (farmers, traders, merchants or the semi-literate who were able to produce something tangible and corral or enslave others to achieve these ends). The Shudras or laborers and the Dalits or outcasts were inessential. If this feels familiar to Western readers, it should since American politicians continue to pay flattery to the rich, other politicians, and the “breadbaskets” and “coal miners” of this nation. The lower castes of American society – those who live paycheck to paycheck, who did not benefit from the educational system, who had difficulty in life but have tried to eak out a living nonetheless are often forgotten. Said another way, “nobody is going to cry if a poor black girl turns up dead. It’s only a ‘missing person’ if a pretty white girl goes missing” and it is often the case that those in power show disregard if not blatant contempt for the conditions and quality of life those over whom they govern experience as a result of this invisible caste system in America.

In the epic Ramayana, there is a description of the practice of abortion performed by surgeons or barbers. Scholars date the text developing between the 7th and 4th centuries BCE, with later stages developed up to the 3rd century CE, so whether a scholar takes a conservative or more generous position, we have evidence here of abortion as a common practice between the 7th Century BCE and the 3rd Century CE. Note that abortions are a medical procedure in India. This is in contrast to the death penalty for abortion in the Code of Assura of Assyria dated to 1075 BCE – and even then, the death penalty was imposed against a woman because she sought an abortion (again, described as a medical procedure) against her husband’s wishes. The first recorded evidence of induced abortion is from the Egyptian Ebers Papyrus in 1550 BCE, but many methods were non-surgical, which is to say, non-invasive. Physical activities like strenuous labor, climbing, paddling, weightlifting, and diving were common techniques as were the use of irritant leaves, fasting, bloodletting, pouring hot water into (and into) the abdomen – even sitting on a heated coconut shell and in virtually all cultures, abortion techniques developed through observation and experience, the adaptation and advancement of obstetrical methods, and transculturation or the merging and converging of cultures with as much as against one another.

Physical or Mechanical Methods

Soranus of Ephesus (late 1st century/early 2nd century AD) was born in Asia Minor. Having studied in Alexandria and later practicing medicine in Rome (from 98AD to perhaps as late as 138AD), the Greek physician wrote many works concerning medical topics. Gynecology is one of the most important because it gives great insight into ancient gynecological and obstetrical practices at their height in the ancient world. In Gynecology, Soranus tells his reader about mechanical methods to induce abortion including vigorous exercise, carrying abnormally heavy weights, leaping violently (also recommended by Hippocrates), and a process of being shaken by wild or even controlled animals, as in taking a carriage ride driven over rough terrain. Soranus also prescribes walking energetically for 30 days after conception, followed by violent exercises to abort the fetus. Although these methods seem unnecessarily violent and even painful compared to today’s methods, they were believed to be effective means of abortion during the ancient world.

Methods Using Drugs or Herbs

Several methods of abortion relied upon herbs, as is evidenced in the texts provided by Soranus and Dioscorides, a Greek physician, pharmacologist, botanist, and author of De Materia Medica. In order to abort the fetus during the early months of pregnancies, Soranus and Dioscorides suggest dietary diuretics, laxatives with pungent clyster, and lupine beans, which are poisonous unless properly prepared. Several recipes including the plant silphium are prescribed, but this plant is now extinct and its effectiveness can only be estimated through a distant relative of the species. This relative seems to provide evidence for an effective abortifacient, which can cause abortion before the middle of the second trimester of pregnancy. Any form of abortion after the second trimester was believed to be highly dangerous for the mother. Other drugs such as the squirting cucumber, black hellebore, pellitory, and panax balm are also recommended for oral intake in order to abort the fetus, but exactly how one goes about orally or herbally aborting a fetus remains debated.

Soranus suggests two methods to induce abortion: “use diuretic decoctions which also have the power to bring on menstruation, and empty and purge the abdomen with relatively pungent clysters; sometimes using warm and sweet olive oil as injections, sometimes anointing the whole body thoroughly therewith and rubbing it vigorously, especially around the pubes, the abdomen, and the loins, bathing daily in sweet water which is not too hot, lingering in the baths and drinking first a little wine and living on pungent food.” The second method describes specific steps to be taken to remove the fetus from the uterus. First the womb must be separated from the uterus. In order to create the separation, empty the abdomen and purge it with warm and sweet olive oil as injections. Then bathe the whole body in sweet water, lingering in the tub, drinking a little wine first and eating pungent food. If at this point, it is not effective, then sit in a bath of linseed, fenugreek, mallow, marsh mallow, and wormwood. have injections of old oil, alone or with rue juice or with honey, iris oil, or absinthium with honey, or panax balm spelt together with rue and honey or Syrian unguent. If it is still not effective, then take a meal of lupines with ox bile and absinthium. Before abortion, take protracted baths, little or no food, use softening vaginal suppositories, abstain from wine, and be bled in large amounts. Then follow the procedures by having the pregnant woman shaken by wild animals, followed by a soft vaginal suppository, used as a “gentle” abortive vaginal suppository, such as myrtle, wallflower seed, and bitter lupines in equal amounts. Then mold to the size of a bean with water. (See appendix for other vaginal suppositories used as abortifacients. A major danger of this type of abortion is that it can lead to air in the uterus, which leads to major complications and infections.)

Dioscorides (Riddle, 54-55) in a brief section describes an abortion wine made from several components of drugs. Evidence shows that the abortion wine world work effectively if mixed properly; however, Dioscorides provides the list of the ingredients, but not the directions to prepare the recipe. There is a possible explanation for Dioscorides’ omission of instructions on the preparation. Ancient rumors or fold stories tell us of venders selling certain “potions” for effective birth control. Their potions included common ingredients, but they were prepared in a “secret ” way in order to obtain effectiveness and a monopoly on the market. So whereas Dioscorides might have known the ingredients, he would not necessarily know the proper amounts, which implies that he knew of the existence of an abortion wine, but not its practice.

In any event, Indications of an impending abortion include: at first a watery discharge of fluid will appear, followed by an ichorous or sanguineous fluid (like water that meat has been washed in). At the moment of detachment of the fetus there will be a pure blood flow, then a clot of blood in the form of flesh (formed or unformed). Physical pain includes a heaviness or pain in the loins, hips, lower abdomen, groin, head, eyes, and joints, a gnawing in the stomach, and perspiration, sweats, chills, fainting, fever, possibly hiccups, cramps, or loss of voice. Other wise if the abortion or miscarriage is due to natural consequences, there may be a shrinking of the breasts, coldness of thighs, and heaviness in the loins.

Outside of the Greco-Roman Empire, an 8th-century Sanskrit text instructs women wishing to induce an abortion to sit over a pot of steam or stewed onions and the technique of massage abortion, involving the application of pressure to the pregnant abdomen, has been practiced in Southeast Asia for centuries until the present. One of the bas reliefs decorating the temple of Angkor Wat in Cambodia, dated c. 1150, depicts a demon performing such an abortion upon a woman who has been sent to the underworld. Japanese documents show records of induced abortion from as early as the 12th century. It became much more prevalent during the Edo period, especially among the peasant class, who were hit hardest by the recurrent famines and high taxation of the age. Statues of the Boddhisattva Jizo were erected in memory of an abortion, miscarriage, stillbirth, or young childhood death, began appearing at least as early as 1710 at a temple in Yokohama. Meanwhile, the native Māori people of New Zealand’s colonisation terminated pregnancies via miscarriage-inducing drugs, ceremonial methods, and girding of the abdomen with a restrictive belt. Another source claims that the Māori people did not practice abortion, for fear of Makutu, but did attempt abortion through the artificial induction of premature labor.

Many of the medical advances and practical methods known to and described by the ancient world were believed to be “magic” and related to superstition, as would be clear from the above survey of prohibitive medications, which is to say that those administering medicinal remedies by use of an apothecary were often accused of witchcraft or magic when their remedies failed. Such houses of healing often used surgical methods as well, which were also understood to be magic to the ancient world. Where a modern reader would identify literary figures losing limbs or appendages (for example, the loss of an eye by Odin or even that of Odysseus) as a tragic, the original audiences elevated those figures to mythological status, where fate and magic often played a part. In reconstructing ancient history, we must not only focus on the immediate object of inquiry but how that object was understood broadly in its original context. Finally, where we are able to deduce connections, we must also verify those assumptions against the chronicle of history which indicates overwhelmingly that magic and medicine were frequently wed. The staff of Hermes remains the universal symbol for medical practice some three millennia after first appearing. And, as student of history, we also routinely observe the following: that women’s health was viewed with suspicion across most cultures, that natural remedies (especially coming out of the Dark Ages into the Reformation) were viewed with suspicion, that the figure of the witch plays prominently in the care and health of women, and that many of the supposed “gaps” in relation to women and medicine are just as telling as the records put forward. Nonetheless, literary texts and medical texts provide the bulk of what we know concerning contraception and abortion in classical antiquity.

Surgical Methods

But what of that “medical procedure” indicated in the Code of Assura of Assyria? Although archaeological finds (Milne, 81) have provided evidence for the surgical removal of the fetus/unborn, it is believed (since such methods hardly ever appear in ancient medical texts) that this method of abortion was neither common nor frequently recommended.

In fact, readers are warned of the danger of separation of the womb and uterus that may occur if sharp-edged objects are used (Soranus Bk.I, Ch. XIX). This is, no doubt, a result of the state of medicine in the ancient world as much as it is fear of medical advancement.

Continued in part 2


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