Back to the Back Alley? Abortion Rights and Realities in the Trump Era

On the first day of his presidency, Donald Trump reinstated the global gag rule on abortion. This is no great surprise; Trump is certainly not the first Republican president to restrict access to abortion when assuming office. Still, there is something different about the Trump election and administration: already, of course, when it comes to not only women’s autonomy but also the rights of refugees and immigrants, the new presidency has proven only too willing to implement harsh, divisive policies, to go further than previous administrations in implementing its particular view of morality.

The developments of the first few weeks of Trump’s government have many abortion rights activists and scholars wondering if we are entering a new reality: one that will, once and for all (and again) deny American women access to safe and legal medicalized abortion. Fears that we are headed “back to the backstreet” have been expressed by many in recent months and even years.

What if this new government does manage to overturn Roe v. Wade or make access to abortion impossible in other ways? What will that mean for ordinary women?

Where will we be then? Maybe, just maybe, we’ll be where we already are.

Let’s face it: the push in the twentieth century for access to legal and medicalized abortion in the United States has not been entirely successful. The victory of Roe v. Wade in 1972 was short lived. Ever since, we have seen the steady erosion of abortion rights across the nation, and particularly in the South. According to the Huffington Post, since 2010, “at least 54 abortion providers across 27 states ha[ve] either closed or stopped performing the procedure.” “In the first half of 2016,” writes Angelika Albaladejo, US “states proposed 360 restrictions on reproductive services, more than 60 of which have been signed into law.”¹

Maybe we’re going about this wrong. Where has medicalization and legal access to abortion actually gotten us? Beyond the problems of diminishing access to abortion providers, women who seek to terminate pregnancies also struggle with paying for the procedure and traveling to clinics. It is a sobering reality that poor women have fewer abortion rights. And for some women, their abortion experiences are less than positive. Many face protesters as they enter clinics, with the ever-present terror of anti-abortion violence. Let’s be clear — some women are traumatized not because of abortion itself, but because of the horrors and difficulties of the process.

But what is the alternative to this system that is eroding and, even when functioning, is not ideal — a world in which backstreet abortionists exploit desperate women and engage in dangerous, even life-threatening practices? Is the backstreet butcher the only way forward?

The fear of returning to the back alley is real, and it is justified. We have all heard or read the horror stories: the coat hangers, women dying of infection or bleeding to death, abandoned by ruthless illegal practitioners. Once you’ve seen the iconic photo of Gerry Santoro, you will never forget it. These things happened; women died.

It was long rumored in my own family that my own great-grandmother succumbed to a post-abortion infection in 1921. Recently I found her death record and discovered that it’s true. And women continue to die from unsafe abortion today: the World Health Organization estimates approximately 68,000 annual abortion deaths worldwide, mostly from sepsis.² According to the Guttmacher Institute, more than a million American women availed themselves of illegal or self-induced abortion before Roe v. Wade; in 1965, 200 women died as a result.

However, current research also challenges the backstreet butcher myth as overstated. Some women who visited illegal providers did die, and others became ill, but those were rare cases. While it’s impossible to know much about illegal abortion in the past (a topic that historians still need to interrogate), most illegal abortions likely were successful, but, of course, never made it into the historical record. We do have the example of the Jane collective: the underground abortion movement in Chicago in the 1960s and 70s. Here, women without medical training studied safe abortion techniques and performed over 12,000 successful and safe abortions. Oh, and they were affordable too.

Perhaps what we need now is a new movement: one that focuses on rethinking the medicalized model, which allows only physicians to practice abortion legally. One recent British study has suggested that nurses and midwives should be able to perform abortions legally.³

There is another way, however, and it has historical precedent: self-induced miscarriage via abortifacients. In many parts of the world, this kind of abortion is still the norm, particularly where medicalized abortion is criminalized. And it’s becoming so, more and more, even where abortion is permitted, particularly as access to doctor-facilitated abortion declines. In the past few years, cases of self-induced abortion via pills (misoprostol and mifepristone) have been on the rise. Women on Web will send abortion pills to women worldwide, and its website features not only success stories but also an animated video with detailed instructions. 100,000 women in Texas alone allegedly attempted abortion by pills purchased in Mexico in 2015. Before legal medical abortion was around, most women attempted self-abortion not through mechanical means but via herbs, potions, and pills.⁴ In recent years in the US and Europe, a feminist self-help literature focusing on educating women about self-abortion has publicized some of these herbal techniques.⁵

Many women desire to manage their reproductive health on their own and sometimes in private. They may want to induce abortion in a space they’re comfortable with, on their own timeline, and without the supervision of outsiders, even supportive doctors.

Indeed, women have long resisted the regulation of their reproductive rights, even when it is, on the surface, supportive of abortion. In the Soviet Union, where abortion was decriminalized in 1920, things didn’t go as expected. Government officials bemoaned the fact that most women, rather than availing themselves of the new, state-run, medicalized procedure, preferred instead to continue seeking the services of the babka or midwife/healer. She had a long history of successful reproductive care, she was discreet, and she was local.⁶ What does this tell us? Perhaps a system controlled by the medical profession and/or the state will never work.

Maybe it’s time to begin a new abortion rights movement — one that focuses on giving women themselves control over the process. How would this work, and how would we get there? I have no idea, but it’s worth thinking about. After all, is there any possibility of choice without autonomy?

Notes

1. Angelika Albaladejo, “A ‘Witch Hunt against Poor Women’: Across the Americas, Abortion Laws Are Harming Health and Security,” World Policy Journal 33.4 (January 7, 2017): 26–34. Return to text.
2. Teresa A Saultes, Diane Devita, and Jason D. Heiner, “The Back Alley Revisited: Sepsis after Attempted Self-Induced Abortion,” Western Journal of Emergency Medicine 10.4 (November 2009): 278–80. Return to text.
3. Sally Sheldon and Joanne Fletcher, “Vacuum Aspiration for Induced Abortion Could Be Safely and Legally Performed by Nurses and Midwives,” J Fam Plann Reprod Health (January 18, 2017). Return to text.
4. John M. Riddle, Eve’s Herbs: A History of Contraception and Abortion in the West (Cambridge, MA: Harvard University Press, 1997). Return to text.
5. Sage-Femme Collective, Natural Liberty: Rediscovering Self-Induced Abortion Methods (Las Vegas: Sage Femme!, 2008); Uni Tiamat, Herbal Abortion: The Fruit of the Tree of Knowledge (Las Vegas: Sage Femme!, 1994). Return to text.
6. Wendy Z. Goldman, Women, the State and Revolution: Soviet Family Policy and Social Life, 1917-1936 (Cambridge University Press, 1993), 285. Return to text.