Knitting needles. Arsenic. Deliberately falling. These are just some of the methods that women used to self-induce abortion in the early twentieth century, when abortion was illegal.
This is not simply a subject confined to history books any more. Evidence suggests that self-induced abortion is rising once more, thanks in large part to political efforts that prevent women — especially poor women and women of color — from obtaining an abortion in a safe medical setting. In Texas, where efforts to curtail access to abortion have been particularly effective, researchers estimate that anywhere from 1.7 to 4.1% of women of childbearing age have attempted to induce an abortion themselves.
Researchers defined self-induced abortion as any attempt by a woman to end a pregnancy herself. The most common method of self-induced abortion among Texas women surveyed was to use the drug misoprostal, which is fairly effective in ending early pregnancies and is used by many clinics in the United States. The drug is widely available in Mexican pharmacies, and some Texas women are able to access the medication that way, although they are compelled to take it without medical supervision. However, not all women have the option of buying misoprostal across the border. Other common methods included herbs, homeopathic remedies, and punching oneself in the abdomen. This suggests that for many women, the state of reproductive healthcare has actually gone backwards in recent years.
On March 2, the Supreme Court heard arguments on the constitutionality of the Texas law HB2, which imposed significant restrictions on abortion providers. Since the law was passed in 2013, more than half of the clinics providing abortions in the state have shut down. When the Court decides on the matter of HB2, it should take into consideration both the past and present of self-induced abortion.
As historian Leslie Reagan has demonstrated, abortion was hardly uncommon during its era of illegality, which spanned roughly from 1867 to 1973.1 According to Reagan, self-induced abortion was most common during the earlier portion of this period. As scientific medicine gradually gained a foothold in American society, more women sought abortion from licensed practitioners, even though the practice was still illegal. But the most desperate, those who could not access a clinician (qualified or otherwise), performed self-induced abortions. A midwife was oftentimes more likely to assist with an abortion than a licensed doctor, and indeed many midwives assisted abortion attempts.
Yet when a self-induced abortion went wrong, women were forced to seek help from allopathic physicians. Women who used sharp objects to attempt inducing an abortion frequently suffered from perforation of the uterus, which was sometimes fatal. Records of these instances from surgical journals allow us to glimpse into histories that would otherwise be lost.
In 1908, Chicago surgeon Aimé Paul Heineck compiled a list of 160 cases of wounds perforating the uterus. Typically, perforations occurred after the insertion of a surgical instrument or other foreign object. All examples had occurred within the prior fifteen years and had been written about in medical journals in English, French, or German. Although not all cases pertained to abortion (self-induced or otherwise), many of them did. Heineck described each situation with clinical detachment:
These records are, of course, frustratingly incomplete. They cannot tell us of the women’s own perspectives on their abortions, their hopes and fears and experiences. We are left to imagine on our own the thoughts and feelings of a woman who removed large portions of her intestines in an attempt to end her pregnancy.
While incomplete, such records should be required reading for justices, legislators, and advocates who would limit access to safe and legal abortion. Denied the opportunity to access abortion legally, these women risked death and serious injury to end their pregnancies. Surely, they were well aware of the risks they took.
The actual, immediate dangers of self-induced abortions were clearly plentiful. Yet some physicians believed that the long-term effects could be just as harmful — and wanted to use questionable associations to dissuade women from performing their own abortions.
Dr. D.T. Quigley wrote to the Journal of the American Medical Association in 1907 discussing the alleged dangers of self-induced abortion:
While Quigley’s comments may be considered pseudoscientific from a contemporary standpoint, his remarks nevertheless reveal that a sizeable number of women were attempting self-induced abortions with whatever instruments they found on hand. Were that not the case, it would hardly be necessary to convince women that placing a crochet hook in the uterus could cause cancer. When considering Quigley’s claims, it is hard to avoid comparison to contemporary anti-abortion activists who claim that abortion increases the risk of breast cancer.
In some sense, Quigley did not triumph. In the 64 years between his letter to the Journal and the 1973 Roe v. Wade decision, many women attempted to perform their own abortions regardless of the real and imagined risks. Oftentimes, they used the same objects they found in their own households.
And as reports from Texas reveal, such attempts at self-induced abortion sadly are not relics of the past. While researching this subject, I came across an alarming number of young people who asked other Internet users to provide them with information about how to induce an abortion. One venue frequently utilized was Yahoo! Answers — not exactly a reliable source of medical information.
The story of self-induced abortions is not yet over. But it is possible to create a world where no woman has to turn to a coat hanger, or Dr. Google, in order to obtain a necessary and legal medical procedure. U.S. Senate and Supreme Court, this is in your hands.
- Leslie J. Reagan, When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867-1973 (Berkeley and Los Angeles: University of California Press, 1997). Return to text.
- Aimé Paul Heineck, “Perforating Wounds of the Uterus Inflicted During the Course of Intrauterine Instrumentation,” Surgery, Gynecology and Obstetrics 4:4 (October 1908): 424-448. Return to text.