Sunday, May 28, 2023

Coat Hanger Abortions: How True an Image?

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 reproductive organs. But is this phenomenon really a sociological problem, caused by lack of "access" to legal abortion? Or is there something else going on?

Both anecdotal and statistical research show that most women who have trouble arranging a professional abortion will quickly adapt to the pregnancy and even come to welcome the birth of the baby. Dr. Aleck Bourne, who in 1938 successfully fought the British law against abortion, said in his memoir (A Doctor's Creed: The Memoirs of a Gynaecologist):

"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."

One of the observations of the 1955 Planned Parenthood conference on abortion was that given the chance to work through their problems, most women would reject abortion. The conference further noted, and Nancy Howell Lee's research (The Search for an Abortionistconfirmed, that the situation before legalization was not one of hoards of women wielding coat hangers on themselves. Most women who requested abortion rejected the option on giving the matter more thought. Those who persisted 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?

In exploring the issue of dangerous self-abortion attempts, we have to take into account the fact that these self-abortion attempts very rare. Nancy Howell Lee's research found that dangerous self-abortions were attempted by about 2 percent of the women she surveyed. The Planned Parenthood conference estimated that dangerous amateur abortions (self-attempted or attempted by obviously unqualified others) accounted for perhaps 8 percent of illegal abortions. But even though the self-aborting woman was a rare case, advocates of legalization held them up as proof that society has an obligation to make professional abortion readily available.

We also have to take into account the fact that such abortion attempts persist, even with legal abortion readily available. This is one of the dark, inexplicable secrets of the abortion advocacy movement. In 1982, CDC staffers published "Illegal-Abortion Deaths in the United States: Why Are They Still Occurring?" in Family Planning Perspectives. They noted that illegal abortions ranged from "self-help" abortions done by women who reject the medical establishment, to the stereotypical "coat hanger" abortions. They concluded that women seek illegal abortions for "idiosyncratic" reasons, and dropped the issue.

The "self-help" abortions do sometimes result in deaths. As recently as 1994, a young woman died as a result of attempting to abort with pennyroyal tea. But this was not a case of a massive attack on the reproductive tract; this woman was using what she thought was a safe, "gentle," and "natural" process. Such an attempt is a far cry from Drano douches and rusty coat hangers.

Why is it that some women, with legal abortion readily available, and with information on "self-help" abortions available, will viciously attack their own bodies, or allow someone else to do so? To say that they were simply trying to dislodge a 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 commonly seen in women (and occasionally men) with certain types of mental illness.

Most kinds of self-injury are cuts, bites, and burns with cigarettes. The injuries range from mild bruises and superficial scratches to amputation of limbs, putting out eyes, or castration. Some of the reasons people self injure include reducing tension, expressing emotional pain or rage, self-punishment, manipulativeness, feeling a sense of control of one's body, or expressing or repressing sexuality.

People who self-injure tend to be depressed, very sensitive, and acutely tense. One researcher (Herpertz) believes that some stress increases the anxiety and tension to an overwhelming state. The act of self-injury releases the tension. Some researchers believe that this may be due to brain imbalances; others think it is a learned behavior caused by childhood abuse and/or trauma.

Two researchers, Haines and Williams, found that self-mutilators tend to cope with problems by avoiding them, rather than with problem-solving techniques. This might explain why women who might otherwise self-mutilate will attempt a violent self-induced abortion rather than calmly assess how to arrange a legal abortion or adapt to the pregnancy and arrival of a new baby.

There are common characteristics to people who self-injure. They tend to dislike themselves, be hypersensitive to rejection, be highly impulsive, act based on their immediate emotions, not plan for the future, be depressed and/or suicidal or self-destructive, and be lacking in adequate coping skills. Now, how does all this relate to "coat hanger" abortions?

Observations on the traits and behaviors of people who self-harm are in keeping with the research by Nancy Howell Lee on women who sought and obtained pre-legalization abortions. She 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. Case reports I've read on self-induced abortion attempts also found that the women did not tend to perceive the fetus as "other," but as an embodiment of their own hated selves. In these cases, the attempt to self-abort was a bizarre attempt at self-destruction.

Given what we know about self-abuse, and about "coat hanger" abortions, it is reasonable to conclude that aggressive and dangerous self-abortion attempts are best understood as a type of self-mutilation, and not as rational attempts to end an ill-timed pregnancy. The best service we can do, therefore, to women who might attempt such abortions is to provide the best supportive and psychiatric care to self-injurers, and to ensure that professionals who work with these women are aware that a self-induced abortion might be attempted by these patients should they encounter an unintended or otherwise stressful pregnancy.

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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