When abortions are illegal, doctors can’t do them for fear of losing their license. That leaves women with nobody to turn to except rank amateurs or themselves. Clearly, such abortions are fraught with danger, and thousands of women lose their lives every year as a result. Legalizing abortion won’t change the number of abortions -- women, after all, have always resorted to abortion -- but it will ensure that abortions are done in clean, regulated facilities by competent physicians. Such abortions will be far safer, and women’s lives will be saved.
Every facet of this argument is flawed. :
When abortions were illegal, about 90% of them were done by doctors. Some did quiet abortions for a select few women. Others, like Jesse Ketchum, hooked up with prochoice organizations and received a steady stream of abortion patients. Dr. Alan Guttmacher, a strong advocate of legalizing abortion, wrote in 1959, “The technique of the well-accredited criminal abortionist is usually good. They have to be good to stay in business, since otherwise they would be extremely vulnerable to police action.” These same doctors continued to do abortions after legalization. In criminal practice, most physician abortionists held to a rigid 12-week cut-off, and would not perform the riskier late abortions. This is why so many criminal abortionists also ran baby-selling rings, and may in part explain prochoicers’ persistence is seeing adoption as somehow sinister. After legalization, with the fear of legal repercussions lifted, physician abortionists often became reckless, resulting in patient deaths. Milan Vuitch is but one example of the abortionist who had a clean record in his criminal practice, only to get sloppy in his legal practice, with women dying as a result.:
Non-physician illegal abortions were not as grim as propaganda paints them to be. The case of Geraldine Santoro, found dead in a motel room after her boyfriend attempted to perform an abortion on her, was held up as typical. As tragic as Gerri’s death was, her abortion was not typical of non-physician illegal abortions. Roughly half of abortions done by non-physicians were done by nurses, midwives, physician assistants, and other people with training in health care. The majority of these para-medical abortionists had a physician contact who provided training, equipment, medication, and consultation, and who would quietly treat any complications without reporting the abortion to authorities. And some non-physician abortionists who had no connection to the health care field -- the Jane syndicate in Chicago, for example -- still had physician training and support.:
There were indeed criminal abortions performed by rank amateurs -- such as Geraldine Santoro’s boyfriend, whose only training came in the form of a medical textbook he had somehow procured. But legalization has not entirely eliminated these abortions. For unknown reasons, some women still allow amateurs to perform their abortions, as did a California woman who died in 1990 after she failed to show up for her appointment at a local abortion clinic, instead allowing her boyfriend to attempt the abortion with a plastic tube.:
Another class of amateur abortions was and is what I call “Tupperware Party abortions.” After Harvey Karman invented the menstrual extraction (ME) technique of early abortion in the late 1960’s, feminist groups bought into Karman’s assurances that ME was so simple and safe that anybody could be trained to perform it safely. These groups formed tight-knit cadres that would gather in one another’s homes, train each other in the ME technique, and do abortions on each other. Afterward they would chat and have refreshments. Some groups would meet monthly and perform ME on all members of the group, regardless of whether or not pregnancy was suspected, as a combination female bonding and feminine hygiene ritual. These groups still persist, though not with the popularity they had before Roe v. Wade.:
And then there are the self-induced abortions, which accounted for a portion of those 6% of illegal abortions done by non-medical persons. Nancy Howell Lee’s groundbreaking research indicated that women who self-induced abortions were not ordinary women making a risk-benefit analysis and deciding on self-abortion as the lesser of two evils. These women tended to be emotionally unstable, with a very poor opinion of themselves, and with in many cases almost as much desire to die and be done with life as to abort the pregnancy. Lee’s findings are borne out by the psychiatric journal articles of the time describing self-abortion attempts as a special class of self-mutilating behavior common in women with certain psychiatric disorders. Self-induced abortions, like other forms of non-physician abortion, still persist, for a number of reasons, ranging from mental illness to New Age anti-physician sentiment. Women still die from such abortions.:
Although women did indeed die from illegal abortions, the situation was by no means as dire as the coathanger-impaled woman on every front lawn in America picture prochoice groups like to paint. Although abortion very likely had a high mortality rate in the 1930s -- a period when country doctors routinely performed any kind of surgery, not just abortion, on kitchen tables -- with the advent of antibiotics in the 40’s the mortality rate for abortion, as for all surgery, fell dramatically. And as new techniques were developed overseas, and emergency care was improving, and the use of new contraceptives was reducing the pregnancy rate, abortion deaths plummeted from about 200 in 1965 to about 100 in 1967. Without legalization, this trend would likely have continued, especially if there had been a widespread effort to reduce the number of abortions. Instead, abortion supporters pushed for legalization.:
Legalization had a dramatic effect on the number of abortions -- which was what public health officials expected, even if this expectation was not voiced to the public. Carl Tyler, head of Abortion Surveillance at the Centers for Disease Control in 1970, testified to Congress that the number of abortions could be expected to skyrocket after legalization as more and more women came to consider abortion acceptable. Not only would the number of women availing themselves of abortion rise, but the number of abortions each woman sought over her lifetime would rise as well because abortion would be perceived as a safe and reliable alternative to the careful use of contraceptives. Tyler’s predictions about the abortion rate held true -- the number of abortions per year in the US increased dramatically, in some states increasing ten-fold in the decades following legalization. And the number of repeat abortions rose to nearly 50%, and has remained stable. Some US women routinely use abortion as their primary birth control method, and National Abortion Federation counselors have reported their facilities performing as many as 20 abortions on the same woman over the years. Tyler anticipated that as a result of legalization throughout the US, between 200 and 800 women would die annually from abortion complications. Tyler considered this an acceptable price to pay for the public health benefit he anticipated -- the eradication of child abuse by eliminating the births of “unwanted” children. :
Tyler wasn’t the only abortion advocate who anticipated that carte blanc legalization would not be a bed of roses. Three British doctors published a caveat in 1971 lamenting that “the public is misled into believing that legal abortion is a trivial incident.... There has been almost a conspiracy of silence in declaring its risks. Unfortunately, because of emotional reactions to legal abortion, well-documented evidence from countries with a vast experience of it receives little attention in either the medical or lay press. This is medically indefensible when patients suffer as a result. .... It is perhaps significant that some of the more serious complications occurred with the most senior and experienced operators. This emphasizes that termination of pregnancy is neither as simple nor as safe as some advocates of abortion-on-demand would have the public believe.” Dr. Albert Altchek, an American with more than 5.000 abortions worth of experience, reflected on the likely consequences of Roe v. Wade: “As one who was active in promoting [legalization], I was elated. However, in a short while an inner deep concern developed. [Roe] was based on ... the court’s finding that such abortion is safer than regular childbirth. The latter observation, based on a carefully controlled series of abortions performed in New York State, may not necessarily hold true if the floodgates of completely unsupervised abortion are suddenly opened nationwide.” (Note: Bernard Nathanson, who oversaw this "carefully controlled series of abortions", later admitted that the records used to "demonstrate the safety of outpatient abortions" were shoddy. The clinic where they were done later was caught charting a dead patient as "pink, responsive, alert". Yet we're supposed to base public policy on their records.)
Prochoice assurances that legal abortions would be regulated for safety have rung hollow. Although individual prochoicers tend to favor health and safety regulations, prochoice organizations consider any regulation at all to be government interference in the abortion choice and therefore intrusive and unacceptable. In every state, prochoice groups mobilize to attempt to neutralize any attempts at regulation. The most vociferous and successful such prochoice group is the Florida Abortion Council (FLAC). FLAC was organized in reaction to the Miami Herald’s expose of horrendous abortion mills operating in Dade County, Florida. There was much public outcry, and state officials closed some clinics and went to work, along with state legislators, drawing up a plan for oversight of abortion that would prevent such mills from operating. Owners of more reputable facilities banded together as FLAC, and developed a self-policing system, wherein they would form inspection teams and monitor one another’s clinics. They also lobbied the legislature and pulled strings in regulatory agencies to prevent government oversight of abortion. As FLAC co-founder Janice Compton-Carr said, “In my gut, I am completely aghast at what goes on .... But I staunchly oppose anything that would correct this situation in law.” They pointed to their own clinics as proof that oversight was unnecessary, glossing over the fact that membership was not only voluntary but burdensome, requiring member clinics to adopt expensive health and safety practices and to devote time to lobbying efforts, public relations, and the inspection of other member facilities. Of course, the facilities that are most in need of the kind of oversight FLAC provides are the least likely to seek it. Those abortion mills that do not adopt even rudimentary safety standards voluntarily are highly unlikely to embrace FLAC’s more stringent safety standards voluntarily. As Warren Hern pointed out, “Following good standards costs money. And people don’t want to do that.” As a result of FLAC’s efforts, Florida state officials may only inspect abortion facilities to ensure that a current, valid physician’s license is properly posted and that patient records are kept on file for two years. :
To the press and to the public, prochoice organizations and spokespersons will insist that unsavory abortion facilities are a fluke, and that there is not widespread disregard for patient safety. To each other, they tell a different story. Warren Hern wrote a letter to the editor opposing abortion clinic regulations in Colorado on the grounds that they constituted an unnecessary intrusion. After all, Hern said, doctors are professionals and good medicine is the norm in abortion. But to his fellow abortionists at a National Abortion Federation (NAF) meeting, he commented, “There’s a lot of crummy medicine being practiced out there in providing abortion services, and I think that some of the stuff I see coming across my desk is very upsetting.” A malpractice consultant told another NAF gathering, “There are a lot of really bad abortion places out there.” But most telling is an exchange that took place during the discussion period of a session at a NAF Risk Management Seminar. One abortionist described a case in which he noted that he had pulled out a section of his patient’s bowel. He replaced the bowel, sutured hole he’d made in the patient’s uterus, monitored her more closely after the procedure, and then sent her home without informing her of the mishap, hoping that all would be well. The moderator of the session was appalled, and chastized the doctor. He then asked if anybody else in the room ever did the same thing. He counted six people who raised their hands -- six people who, even after hearing him scold their colleague, were still willing to admit in front of their peers such a grave departure from standards. One NAF member, Bruce Stierer, later killed a patient under exactly those circumstances. If members if NAF, with its sterling reputation, its resources for supporting safety practices, its claims that all members uphold the highest standards, are so slipshod in abortion practice, what can the situation be in unaffiliated facilities?:
The end result of legalization can be seen in trends in abortion mortality. In the years following Roe v. Wade, the trend of fewer maternal deaths from abortion every year reversed itself. The number of deaths reported continued to rise until 1976, when the CDC dismantled their system for actively seeking to learn of abortion deaths. Suddenly, the number of reported deaths plummeted, and continued to sink. There was nothing magical in abortion practice in 1976 to account for this drop. No new technique was invented, no sweeping changes in the law or in regulatory practice. The only thing that changed was how the data were collected. The drop in reported abortion deaths after 1976 reflects not a drop in actual mortality, but a loss of enthusiasm for identifying and addressing maternal mortality from abortion. :
The true situation is likely that Carl Tyler’s predictions were accurate. Based on his calculations about death rates, probably 200 women a year are dying from abortion complications. This number may have fallen somewhat in the late 1980’s, as saline and other instillation abortions fell out of favor. However, it is unclear what impact the growing acceptance of third-trimester abortions and the advent of chemical abortions will have. If the problems seen during clinical trials -- hemorrhage (one doctor reported how shocking it was to have patients checking in for follow up visits with blood running down their legs and pooling on the floor) and retained tissues (one patient still had not passed the fetus nearly 90 days after the abortion was initiated) - are paired up with the typical slovenly practices of American abortionists, the results are likely to be disastrous. Far from being a boon to women, chemical abortions are more likely to prove a boon to plaintiff malpractice attorneys.
What can be done? Sadly, very little can be done without the cooperation of prochoice organizations, because they are perceived as the most knowledgeable and the most concerned for women’s well-being. However, we have seen that they do much to exacerbate the problem, both by blocking efforts to improve oversight of abortion facilities and by promoting abortion as harmless.
First, the number of abortions needs to be dramatically reduced. The following measures, all of which meet with staunch opposition from prochoice groups, have been demonstrated to reduce the abortion rate:
Another factor influencing the number of abortions is women’s perceptions of the acceptability of abortion. Nancy Howell Lee’s research indicated that the single biggest determining factor of whether a woman would choose abortion was her perception of what her peers would do in her situation. Frederica Matthewes-Green’s research indicates that the majority of women undergoing legal abortions would prefer not to abort, but feel pressured into abortion by those close to them, either by overt suggestions or even coercion, or by subtle failure to offer support to the woman in continuing the pregnancy. Restoring the stigma to abortion, and educating women about resources to help them continue their pregnancies, would go a long way toward combating those dynamics and reducing the number of abortions. Prochoice groups, however, focus their attention of glamorizing abortion (through celebrity endorsements), “normalizing” abortion (by disseminating statistics and stories about aborting women), facilitating abortion (by recruiting abortionists and establishing funds to pay for abortions), and encouraging abortion (by pushing for mandatory abortion counseling for every pregnant woman and girl). But prochoice groups go beyond merely pushing abortion -- they actively seek to thwart others in their efforts to reduce the number of abortions. This can be most clearly be seen in their vitriolic attacks on centers offering women help in continuing their pregnancies.
The other angle in reducing abortion complications and mortality is to improve the quality of care in abortion facilities. Here again we see staunch opposition by prochoice groups. And even if prochoice groups were to become cooperative, regulation alone is not the answer. After all, many abortion facilities repeatedly fail health department inspections and manage to remain open despite patient injuries and deaths. What needs to happen is that we need to restore the abortionists’ motive to take all necessary precautions to protect their patients’ lives. Recriminalzation is one route that would achieve this end, but making the civil courts more friendly to the abortion-injured woman would also have a powerful impact.
There is another factor, a more sinister factor, that seldom gets taken into account. That is sexual exploitation of underage girls. Abortion facilities have long known that at least half of their underage patients are victims of incest or statutory rape. However, instead of reporting these crimes, these facilities perform the abortion as requested and return the girl to her abuser. Stiff criminal penalties for abusers, and for facilities that fail to report these crimes, would drastically reduce teen abortions and therefore reduce teenage abortion deaths.
The single greatest factor allowing the abortion rate to remain so astronomically high, and abortion practice to remain so slovenly, is prochoice organizations. The National Abortion Federation actually held a vote on whether to expel Warren Hern, a long-time member and staunch supporter of the organization, for his willingness to help abortion injured women pursue lawsuits against their abortionists. You would be hard-pressed indeed to find a more enthusiastic supporter of unregulated legal abortion than Hern, yet his willingness to place women’s safety above his political agenda has made him a pariah in the very movement he was instrumental in founding. As long as prochoice groups hold to their demands for unfettered abortion with no exceptions -- not even for the life of the mother -- women will continue to die needlessly.