Abortionist, page 24
If abortion had been secret but accessible before, in 1951 the signs were increasingly clear that the authorities were stepping in to manage what had for so long been women’s personal business. And they were not alone in carving out a public stake in the terrain of pregnancy. In fact, the spectacular abortion raids in Portland and in most cities in the country in these years were only the most public aspect of what had become a whole new set of postwar constraints on pregnant women.
By the late 1940s, new, oppressively supervisory structures in the fields of medicine, law, and criminal justice had emerged to govern the meaning and the course of the pregnancies of millions of women. The existence of those structures often made the decision to end a pregnancy much more dangerous than it had ever been before. The rise of police raids on abortion offices was only one element in a new cultural, medical, and legal commitment to the proposition that pregnant women must stay pregnant, no matter what. This meant ensuring that the abortion decision would be taken out of the hands of women and placed in the hands of experts.
In medicine, a great many doctors began to take an aggressive position against abortion after several generations of doing fairly large numbers of abortions themselves, looking the other way, or even facilitating, through referrals, countless illegal abortions. It was a fact that before the war, many women found cooperative doctors because the list of approved medical indications for abortion, which kept expanding through the thirties, justified thousands of “therapeutic abortions.” And even women who didn’t have a medical problem had little trouble finding one of the thousands of illegal practitioners across the country who practiced undisturbed, in the shadow of the law. One way or another, women who wanted to end their pregnancies found a way. But after the war things changed. Many doctors said abortion wasn’t necessary any more.
For one thing, the list of illnesses that doctors had defined as incompatible with pregnancy began to shrink year by year with the advent of new therapies and technologies. By the early fifties, influential physicians began to stand up and make the claim that there were almost no medical contraindications to pregnancy left. Even a woman with breast cancer or cardiovascular disease, who could have gotten a routine hospital abortion in the thirties, was told after the war to go home and not worry about the baby.
The doctors’ turnabout, however, did not stop the ever larger number of women who had grown accustomed to a certain degree of abortion availability from coming to their offices, begging for abortions or referrals to abortionists. It was a terribly awkward situation all around, and most doctors were simply not willing to break the law, no matter what their private thoughts might be about abortion. But they still had to find a way to deal with all these women in their offices.
Doctors dealt with these women by explaining to them and to each other that pregnancy no longer represented an added burden or an increased strain on a woman, even one with a preexisting illness. In many cases, of course, this rationale had the effect of diminishing the relevance of a pregnant woman’s condition and her own assessment of it. Doctors implied now that pregnancy was an event that transcended a woman’s body and had, in an odd way, ceased to be a medical issue.
In these postwar years, pregnancy became fundamentally a moral issue. As new imaging technology allowed doctors to construct the fetus as a little person, they tended more and more to describe pregnancy first as a process of fulfillment and realization for the fetus, and to refer to the pregnant woman’s body in terms that suggested a safe reproductive container. Now the pregnant woman, along with her physician, had the moral duty to keep the container fit. One obstetrician explained the suitability of women for this role: “Woman is a uterus surrounded by a supporting mechanism and a directing personality.” Completely effaced, the woman-as-uterus simply housed the child.
As doctors adopted these ideas, the number and the rate of therapeutic abortions performed in hospitals plummeted all over the country. But women did not necessarily accede to the new medical definition of pregnancy. They did not stop seeking abortions. Ruth Barnett and her underground colleagues in Portland and elsewhere knew that. And so did hospital-affiliated obstetricians and gynecologists whose dilemma was graver than ever. In some ways, the situation was paradoxical. On the one hand, many people believed that doctors were scientific and humanitarian heroes for subduing the dangers of pregnancy and for developing methods to conquer diseases threatening to pregnancy and the pregnant female. On the other hand, state laws still required that a pregnant woman’s life be endangered in order for her to get an abortion. This meant that legal demands could not be squared with medical advances that claimed to have virtually removed the basis for medical judgments recommending abortion. Nor, of course, could legal demands be squared with the determination of many women to get abortions, the law and their doctors’ proscriptions notwithstanding.
There is no question that doctors were feeling the squeeze from all sides and from within their own ranks, as well, since any two doctors would be likely to disagree about which woman should be given permission for an abortion under which conditions. Nevertheless, doctors still had a legal responsibility to make the decision. And they were still interested in holding on to their medical authority to do so. So many physicians struggled to find new grounds for medical decision making about abortions. To a significant extent, psychiatrists helped out in the crisis, providing myriad esoteric ways of selecting who should and who shouldn’t be permitted an abortion.
Even with help from psychiatrists, though, physicians felt a need for something more to strengthen their position as abortion decision makers. In the late 1940s and early fifties, they began to assemble themselves into hospital-based abortion committees. These were official groups from which professional, expert diagnoses and decisions regarding individual women could be issued in one voice. The abortion committees gave doctors legal protection and ensured that the “right” ratio of births to abortions was maintained in the hospital. The ratio varied from hospital to hospital, but doctors everywhere believed that a high ratio of births to abortions would protect the reputation of their hospital.
By associating abortion decisions with a scientifically objective group of doctors, and with the probity of the profession, committee members could disassociate themselves personally from widespread concerns that an unreasonable number of abortions—legal and illegal—were being performed. Through the committee, doctors could diminish their individual vulnerability and perhaps their crises of conscience. And they could promote an aura of medical solidarity and legal compliance. For all these reasons, many doctors were satisfied that hospital abortion committees were a good solution.
As might be expected, unhappily pregnant women were not so thrilled with them. Imagine the physically exhausted mother of three little ones, determined to have no more children, being told by her doctor that abortion was unnecessary and immoral. Imagine that the woman was determined enough to persist and make an application to the abortion committee (a humiliating and coercive innovation, from her point of view, that no one had even heard of last year). Dr. Alan Guttmacher, a great champion of these committees, wrote a description at the time of how his committee worked at Mt. Sinai Hospital in New York. “The director of the obstetrical and gynecological service is chairman of the permanent abortion committee. The other members are the chief, or a senior attending, from the departments of medicine, surgery, neuropsychiatry, and pediatrics. The board has a scheduled weekly meeting-hour, and convenes routinely whenever a case is pending. No case is considered unless the staff ob-gyn desiring to carry out the procedure presents affirmative letters from two consultants in the medical field involved. Five copies of each letter must be filed at least forty-eight hours in advance of the meeting. The ob-gyn whose case it is, and one of the two consultants who made the recommendation must make themselves available at the meeting for further information when desired. In addition, if the chairman feels that an expert from some other department would be helpful in arriving at a proper decision, this specialist is requested to attend as a non-voting member. The case is then carefully discussed and if any member of the five on the committee opposes therapeutic interruption, the procedure is disallowed.”
Women who went through this ordeal in the fifties and sixties remember their experience with the abortion committee as among the most awful of their lives. Many could not bring themselves to submit to such a process and went off on their own, in search of an abortionist. Many women did submit and were denied, but emerged with their determination undiminished. These women, too, often went into the so-called back alley.
It is a shocking fact that many women who were “successful” with the committee found out, to their horror, that they had been granted permission to have an abortion only if they agreed to be sterilized at the same time. One doctor explained, “A serious effort is made to control the need for dealing with the same problem in the same patient twice.” One doctor who objected to this practice drew the most pointed analogy he could to explain why. “For some while now, I have called attention to this irrational policy of insisting that a patient be sterilized at the time of the therapeutic abortion as a guarantee that the patient will not return again pregnant seeking another therapeutic abortion. Such an argument possesses hardly less logic to recommend it than one which advocates amputation of the penis along with routine leutic therapy because, unless this is done, the patient may return with another chancre sore.” Another doctor, equally angry at his colleagues for their hostility to women seeking abortions declared, “The fairly common practice of insisting on sterilization if an abortion is permitted may have arisen from dealing with epileptics or feeble-minded women. It carries on as a punishment or a threat—as if the physician is saying: ‘All right, if you do not want this baby, you are not capable of having any.’ ”
Studies conducted at the time showed that sterilization had indeed become a fairly common practice in the early fifties. Over fifty-three percent of teaching hospitals made simultaneous sterilization a condition of approval for abortion, and in all U.S. hospitals, the rate was 40 percent. One doctor, unhappy about the fact that unwillingly pregnant women were being forced to accept sterilization, observed that the practice had the effect of driving women to illegal abortionists to escape the likelihood that dealing with law-abiding physicians would entail the permanent loss of their fertility. He added, “I would like to point out because the package [therapeutic abortion/sterilization] is so frequent, I therefore consider them fortunate to have been illegally rather than therapeutically aborted and thus spared sterilization.”
The doctor had a good point. It was, however, a point rarely made at the time, but many of this man’s colleagues knew it was true, even as they proceeded, week after week, to gather in their abortion tribunals and warn each other that, as one put it, “the physician must have a high index of suspicion for the patient who tries to pull a fast one.” Another doctor spoke for many committee members when he raised the spectre of the “clever, scheming women, simply trying to hoodwink the psychiatrist and obstetrician” when they appealed for permission to abort.
Despite what they could plainly see in their own offices and at the weekly committee meetings about the determination of ordinary women to make their own decisions, doctors bolstered their personal righteousness about intervention by referring to the hefty and growing body of literature affirming that women’s role on earth was to have children, and that a woman’s healthy sex life was predicated on her desire to have children. Two leading postwar experts in the psychology of women argued that women who insisted on separating sex and procreation, by deciding to abort, for example, were consigned to the hell of “sexual limbo.” A day after the raids, a Portland doctor expressed his pleasure at the police action. He believed in stamping out abortion because the operation caused guilt complexes, frigidity, and divorce. Stamp out abortion, he believed, and these neurotic symptoms would die off naturally. Many doctors told each other about women like “Laura,” whose case exemplified the problem. After her abortion, Laura “lost her sexual desire and moved to a separate bedroom. So seriously was her marriage affected that Laura was sent to a psychiatrist for treatment. She was on the brink of divorce. And all this was caused by interrupting the most vital biologically sacred function of womanhood—conception.” In line with this 1950s orthodoxy, the committee doctors forced a woman who did not want to carry any given pregnancy to term to declare herself insane. That was what the structure demanded.
Doctors also justified their committee work by referring to the force of women’s will to have children. They basically accepted the adage that nobody gets pregnant who doesn’t want to be. In this way, any and every pregnancy became a choice. It may well have been an unconscious choice (a favorite Freudian explanation in the fifties), but it was a choice nonetheless, despite what the woman herself might think she wanted. (A doctor said at the time, “If we have learned anything in psychiatry, we have learned to respect the unconscious far more than the conscious and we have learned not to take abortion requests at face value.”) In a cruel twist on the meaning of choice today, a woman who said she wanted an abortion could be understood to be proposing to violate her own choice to be pregnant.
As they made their way through this nightmare maze of newly conceived psychological and cultural ideas about pregnancy and abortion, many pregnant women declined the opportunity to become supplicants before the abortion panels. They did not accept the new definition of pregnancy that granted primacy to the fetus, nor did they give up the idea that a particular pregnancy could be dangerous or damaging to them. So while abortion boards were sitting in hospitals around the country, hundreds of thousands of women each year did the only thing they could. They sought out abortionists elsewhere.
And this is where the politicians and the police came in from time to time, when the political climate dictated that a raid would pay off. Law enforcement did not typically raise the issue of the meaning of pregnancy or motherhood, or of the sanity of women who sought abortions. But they did raise the public health issue of “dangerous operations.” Like the Oregon Journal, they raised the spectre of the abortionists’ torture-type instruments and the deaths of victimized young women. But Rolla Crick, the newspaperman, knew better than this. He knew that women in Portland were not dying from the operation, despite the fact that hundreds upon hundreds of abortions were being performed there each year. He was aware that reliable experts estimated that at the time of the big bust in Portland, about three deaths occurred for every ten thousand illegal abortions performed in the United States annually, and that number included self-induced operations.
Crick also knew that when things had been dangerous—in the thirties, for example, when the abortion rate in Portland was so high during the Depression, and there were no antibiotics—women had died: eleven women in 1934, nine women in 1935, fifteen women in 1936. But there had been no sensational raids then. As Crick put it, “The traffic flourished unchecked for many years.” The reporter and the other men who broke open Portland’s abortion business on July 6, 1951, were not insensible to the fact that the raids came at a time when the women on the tables were relatively safe in medical terms. But the irony was that the raids themselves (both the threat that they could occur at any time and the actual busts) were what put so many women in danger by exposing them, and what kept all women on edge.
But exposure was the name of the game in the fifties, and there were plenty of reasons why exposing abortionists and their clients was a fruitful pursuit. Some of the reasons were not so subtle, such as demonstrating that the D.A. and the cops were doing their job. Nor was it hard to see the raids as a bald statement of the determination of the city government and its agents to stop women from ending their pregnancies. It may have been a little harder for some citizens to read what might be called a municipal pro-natalist policy into the abortion raids, but many women in town knew that’s what the situation amounted to. With doctors closing ranks against abortion and the city cracking down on abortionists, every pregnancy meant a baby. There would be no way around it.
Reading a bit below the surface, the raids became a way to clarify what passed as “violation” in the new postwar world, and to clarify who was a “violator.” Conversely, it became a way of asserting which authorities and institutions were in charge. For example, transforming abortionists overnight into front-page criminals unmistakably affirmed the authority of doctors and of the law in this area. The law might have languished sadly in the past, but now, the raids suggested, things would be different. Similarly, exposing all those women in the clinics as transgressors made a double-barreled point, first that people shouldn’t be going around acting as if sex and babies could be separated from marriage, and second, that women were put on this earth to have babies, first and foremost. Moving against abortion and abortionists in 1951 shored up a lot of traditional notions about women and family that were indeed in need of repair.
Finally, the raids made for good newspaper sales. The Portland newspapers virtually stormed the public with abortion news, day after day. The abortion nests, the plush parlors, and the unclad girls steamed up the front page, and they titillated the readership no end. In some ways, the raids belonged to the newspapers because the newspapers packaged them up, dished them out, left them on front stoops all over town, and sold them by the hundreds from corner newsstands. The abortion raids were hot entertainment flavored with news, and Portland bought the product. As Maggie said years later in her own especially clear-sighted way, “We were headliners in those days, and it was an everyday thing. We’d be driving home and find ourselves behind a big Journal truck or an Oregonian truck, and we might have to stop while the newsboys threw the big bundles of papers out on the curb. There was always a crowd waiting for the paper and those big headlines. Everyone knew Ma was always good for selling the papers.”
