Coathanger abortions

One of the strongest images in the abortion-advocacy arsenal is that of the desperate woman who, unable to arrange a legal abortion, harms or even kills herself in an attempt to do the abortion herself. There is no denying that some pregnant women attempt, and even die from, grotesque attacks on their own bodies. But is this phenomenon really caused by lack of "access" to legal abortion? Or is there something else going on?

The fact is, most women who encounter trouble arranging a professional abortion will quickly adapt to the pregnancy and even come to welcome the baby. Dr. Aleck Bourne, who in 1938 successfully fought the British law against abortion, said in his memoirs:

Those who plead for an extensive relaxation of the law [against abortion] have no idea of the very many cases where a woman who, during the first three months, makes a most impassioned appeal for her pregnancy to be 'finished,' later, when the baby is born, is thankful indeed that it was not killed while still an embryo. During my long years in practice I have had many a letter of the deepest gratitude for refusing to accede to an early appeal.

Bourne was not the only proponent of legalization who noted that women often changed their minds about abortion. One of the observations of the 1955 Planned Parenthood conference on induced abortion was that, given the chance to work through their problems, most women who sought abortions would reject abortion.

The conference further noted, and Nancy Howell Lee's research confirmed, that the situation before legalization was not one of hoards of women wielding coathangers on themselves. Most women who initially requested abortion changed their minds. Those who persisted in wanting to abort typically managed to arrange an abortion by a physician or a trained para-medical professional with a physician providing backup.



How, then, do we explain the women who turned up in emergency rooms and morgues, horribly injured by aggressive attacks on their own gravid wombs?

First, we have to take into account the fact that these self-abortion attempts very rare. Nancy Howell Lee's research found that serious home abortions were attempted by about 2 percent of women who persisted in wanting to abort. (A greater number made harmless attempts such as hot baths, running up and down the stairs, drinking things like parsley tea, and so forth.) The Planned Parenthood conference estimated that amateur abortions (those performed by people with no medical training or supervision) made up perhaps 8 percent of pre-legalization abortions. But though these tragedies were rare, advocates of legalization held them up as proof that society has an obligation to make professional abortion readily available.

Second, we have to take into account the shocking fact that such abortion attempts persist, even with legal abortion readily available.

Why is it that some women, with legal abortion available, and with information on "self-help" abortions available, will attack their own bodies, or allow someone else to do so? To say that they were simply trying to dislodge an unwanted fetus is facile; there are far safer, less painful means of trying to get rid of a fetus. There is obviously something else going on.

The most coherent explanation for these self-mutilative abortions is evident in the very damage that they do to the woman's body. These self-abortion attempts are most likely manifestations of self-injury, a phenomenon seen in women (and occasionally men) with certain types of mental illness. The injuries range from bruises and scratches to amputation, putting out eyes, or castration. Some of the reasons people self-injure include easing tension, expressing emotional pain or rage, self-punishment, expressing or repressing sexuality, or manipulating others. It's easy to see how a woman who is already predisposed to self-harm might respond to pregnancy with self-injury purely because that's her usual coping mechanism anyway.  (Self-harm behaviors also show signs of being contagious, with members of a social group imitating others who self-harm.)

Nancy Howell Lee found that the women who attempted aggressive self-induced or other obviously dangerous abortions tended to be self-destructive, and to themselves view the abortion attempt as more of an attack on themselves than as an attempt to dislodge the fetus.

Given what we know about self-abuse, and about "coathanger" abortions, it is reasonable to conclude that aggressive self-abortion attempts are best understood as a type of self-harm, and not as attempts to end an ill-timed pregnancy. The best service we can do to women who might attempt such abortions is to provide the best supportive and psychiatric care to self-injurers, and to ensure that professionals are aware that a self-induced abortion might be attempted by these patients.

Conveying messages that such behaviors are normative and to be expected will only make them more common. If the abortion-rights movement is serious about preventing "coathanger" abortions, they'd do well to stop presenting them as if they're a rational and common alternative to the neighborhood abortion facility.

Legalizing abortion did nothing for these women; it merely swept the problem under the rug. We need to bring it back into the open and address it rationally and compassionately.

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