Who Were the "Back Alley Abortionists"?

Roe vs. Wade might be overturned this summer. Of course, the abortion lobby is ramping up the hysteria and predicting that we'll go back to the Dark Ages when the typical abortionist was a greasy old drunk with a coat hanger and thousands of women were dying per year. Let's take a look at that claim, shall we?

Data Manipulation

One common alarmist claim is the hoary old assertion that 5,000 to 10,000 women were dying annually in the US from criminal abortions prior to legalization. However, with prolifers on social media blasting that out of the water, the switch has been to doing a bit of data massage.

Indeed, there were more women dying from abortion complications annually prior to legalization than after legalization. But merely pointing this out is disingenuous. 

What abortion-rights advocates conveniently omit is what was happening before legalization. What was happening? Abortion deaths were plummeting, (see graph, right).

Credit is due not to legalization since, as you can clearly see, neither the first states legalizing abortion nor abortion-rights advocates' beloved Roe vs. Wade made so much as a blip in the trend. What was keeping women from dying was improvements in medical care. Thus, modern abortionists and their cheerleaders are claiming credit for other people's hard work.

The fallacy that legalization reduced abortion deaths is only half of the lie. The other is the claim that prior to legalization, women either reached for a rusty coat hanger or sought out a rank amateur who would do as bad a job with medical instruments as the woman would have done with the improvised fetus dislodger.

The Abortionists

Let us turn to the experts on that issue. In 1955, Planned Parenthood Federation of America held a conference on induced abortion in the United States. As PPFA's medical director, Mary Calderone, concluded in "Illegal Abortion as a Public Health Problem" (American Journal of Public Health, July 1960), roughly 90% of pre-legalization abortions were performed by doctors, about 8% by the woman herself, and about 2% by non-physicians.

Nancy Howell Lee published her data based on interviews with women who had obtained abortions before legalization (The Search for an Abortionist, University of Chicago Press, 1969), and concluded that 89% of pre-legalization abortions were done by physicians, an additional 5% by nurses or others with some medical training, and 6% were done by non-medical persons or the woman herself.

Since both sources agree on the approximate 90% perpetrated by physicians, this number is probably fairly accurate. They disagree on the breakdown of non-physician abortions. I estimate that numbers were probably about 5% trained non-physicians (nurses, midwives, surgical technicians, etc.), 3% untrained accomplices, and 2% the woman herself.

The Quality of the Abortionists

Mary Calderone didn't classify the typical illegal physician-abortionist as a quack:

Call them what you will, abortionists or anything else, they are still physicians, trained as such; and many of them are in good standing in their communities. They must do a pretty good job if the death rate is as low as it is

     Alan Guttmacher     

Alan Guttmacher, then-PPFA President and the man for whom the AGI is named, concurred:

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. (M.D. Babies by Choice or by Chance, 1959)

As far as I've been able to see in my research into pre-legalization abortion deaths, the only circumstances under which quack abortionists of the "back-alley butcher" type were able to thrive was in communities where abortion was perceived as an ordinary and reasonable thing for a woman to do and any abortionist was seen as a helpful, well-meaning person who ought not to be punished even if he killed his patient. Where abortion was frowned upon, prosecution not only of the abortionist but of accomplices as well was the norm. In other words, a strong abortion-rights presence protected all abortionists, including quacks.

What Impact Does Legalization Actually Have?

Ketchum

As I've already noted, legalization had no effect on mortality whatsoever. Most abortions were already being done by doctors, and any improvement gained from the few lay abortionists mostly going away was offset by an increase in slovenliness among many doctors once the threat of prison was taken off the table if they called attention to themselves by injuring a woman.

I know of four criminal abortionists who were not connected to any women's deaths in their "back alley" practices but each went on to kill two women in the "safe and legal" era.

Munson

Benjamin Munson sent Linda Padfield and Yvonne Mesteth home with fetal parts still in their bodies, leading to fatal infections. Jesse Ketchum performed hysterotomy abortions in his office, letting Margaret Smith and Carole Schaner bleed to death. Milan Vuitch used dirty instruments, left anesthetized and unconscious patients unattended for hours on end, and kept patients in his home overnight when they suffered complications. Georgeanna English and Wilma Harris died at his hands.

Gosnell

The most famous -- nay, infamous -- "back alley butcher" who hung out his shingle legally was Kermit Gosnell. His Philadelphia "house of horrors" was flea-infested and littered with cat feces. Patients were doped within inches of their lives by unqualified staff -- two of whom had never even finished high school -- before Gosnell even showed up every evening. Viable babies were routinely delivered alive then killed vial "snipping" -- cutting through their spines with surgical scissors. Semika Shaw and Karnamaya Mongar died under his dubious care.

Vuitch

Abortion-rights supporters tend to dismiss such men as "outliers." Far from it. Vuitch and Munson both enjoyed high status. Vuitch's New York Times obituary praised him as a "fighter for abortion rights." Munson was a member of the prestigious National Abortion Federation. While not as high-profile as Vuitch or Munson, Ketchum got regular referrals from Clergy Consultation Services, a network that arranged abortions prior to Roe vs. Wade. None of these men were renegades that no reputable abortion-rights supporter would go near. They were as mainstream as it was possible to be.

As for Gosnell, he worked part-time at a National Abortion Federation member clinic which would collect his fee then turn patients over to him for late, sometimes illegally late, abortions. These women ended up moaning and writhing on the blood-stained recliners at Gosnell's facility. The word to describe him isn't "outlier." It's "employee."