Mail-Order Abortion: A History (and a Future?)

In early November of 2016, while the upcoming election dominated media in all its forms, a number of news outlets took note of a study being conducted by abortion providers in New York, Washington, Hawaii, and Oregon on the safety and practicality of providing abortions by mail. The methods of the Telemedicine Abortion Study, which is still ongoing as of 2017, are simple: the process of “TelAbortion” begins with a video consultation with an abortion provider. Following this virtual meeting, the participant is responsible for obtaining all necessary pre-abortion tests in person with a local health provider. If the participant is judged eligible for abortion, they will be sent “a package containing the necessary medications and other materials by overnight mail.”

The study, sponsored by the research group Gynuity Health Projects, caught little attention at the time — in part because the news and its readers had other, bigger things on their minds, and in part, perhaps, because the idea of abortion-by-mail seems a bit odd. We think of abortion as something that happens in a clinic, something that requires surgery, human contact, maybe even extended care. How could something so fundamentally physical and urgent happen through the casual, impersonal operation of the Post Office?

In some ways, the headlines evinced hope — that rare commodity for persons in need of reproductive healthcare in what one article grimly called “the Trump/Pence era.” “The Future is Now,” Rewire proclaimed. Tonic, an online health-focused project of Vice, optimistically told its readers that “the Post Office Could Solve” the problem of abortion access. But in that title, there’s also a sense of unstated surprise at the idea that such an outdated, irrelevant institution as mail could be the solution to the urgent modern problem of abortion access. On Care2.com, that combination of hope and bemusement comes out even more clearly: “The Future of Abortion Access Might Be Snail Mail.”

As a matter of fact, mail and abortion have a long, complicated history. For much of the nineteenth century, the mail was one of the primary ways in which a woman in need could procure an abortion. Indeed, receiving pills by mail was so crucial to abortion care in the nineteenth century that the post office was the first target of Anthony Comstock’s 1873 “Act for the Suppression of Trade in, and Circulation of, Obscene Literature and Articles of Immoral Use” — more commonly known as the Comstock Law, a decisive milestone in the effort of physicians and moralists to restrict American women’s access to contraceptives and abortion care. The Comstock Law did not outlaw abortion, but it did outlaw the transmission by mail of materials and information related to abortion. With passage of the Comstock Law, abortion care moved from the newspaper and the mailbag into the clinic, the operating room, and the proverbial back alley, where it has remained, at least in the public mind, ever since.

The most famous purveyor of mail-order abortions was a woman named Ann Lohman, better known in the New York Herald and other newspapers as “Madame Restell, Female Physician.” Her ads for “Monthly Female Regulating Pills” (guaranteed to deal with even “the most obstinate and long-seated cases of irregularity, suppression, &c.”) first appeared in the New York Sun in 1839, and quickly spread to other newspapers, spreading the word of Madame Restell’s Female Regulating Pills to cities around the country.

Each ad assured women not only that they would benefit from the expertise of a doctor with a “personal acquaintance with the peculiar physiology and anatomy of the female frame,” but that they could enjoy the benefits of this expertise simply by writing for a box of pills, which for the price of $1 would arrive at their home with “Mrs. Restell’s proper signature” written on the cover. Of course, anyone lucky enough to live within traveling distance of Mrs. Restell’s office on Greenwich Street could stop in for a consultation, but for those unable or unwilling to make the trip, the mail provided a convenient and affordable solution.

Madame Restell’s were not the only ads offering nineteenth-century women access to abortion through discreet letters and packages. In the golden age of the patent medicine, “regulating pills” for women were among the hottest items, popping up in advertising sections from coast to coast. From the 1840s to the 1860s, advertisements for “Dr. DuPonco’s Golden Periodical Pills for Females” appeared in countless newspapers, from the Republican Journal of Belfast, Maine and the Portsmouth Journal of Literature & Politics, to the Lowell Daily Citizen and News, the Albany Argus, and the West Jersey Press, to the Cecil Whig of Elkton, Maryland and the Alexandria Gazette.

And the periodical pills weren’t just available on the eastern seaboard. Women reading the Memphis Eagle and Enquirer, the Daily Ohio Statesman, the Weekly Racine Advocate, and even the Anamosa Eureka, published in Anamosa, Iowa, could order Dr. DuPonco’s Pills simply by following the directions in their local paper. In Anamosa, “Ladies … inclosing One Dollar by mail” to agents in Anamosa or Chicago could “have the Pills sent (confidentially) to any part of the country.”

The two factors highlighted in the Eureka ad — confidentiality and national access — are, unsurprisingly, two that remain highly relevant today. The website of the TelAbortion study emphasizes to readers and potential participants that the TelAbortion process “involves all the same steps and procedures” as a “normal” abortion, with one important exception: “you do not have to travel to an abortion clinic.” The power of that promise is self-evident to anyone who has followed news coverage of reproductive health care battles in the past twelve months: more and more, travel has become a key part of the national conversation on abortion. In 2013, the Guttmacher Institute found that one-third of U.S. women traveled 25 miles or more to obtain abortions; by 2015, the average distance to an abortion clinic was up to 200 miles in certain areas of the country. The existence of terms like “abortion desert” and “abortion travel agent” speak to the centrality of travel to the question of abortion access in modern America.

As for confidentiality: you don’t need to do much more than drive by Planned Parenthood on a protest day to know why the privacy of an abortion that arrives by mail would appeal as much to a person seeking abortion care today as it would to the woman writing to Madame Restell in 1839.

Is the Post Office really the future of abortion in the United States? Maybe, maybe not. The Telemedicine Abortion Study is a comparatively small project, currently available to women in only four states (states where, as it happens, regular abortion is relatively accessible as compared to the severe abortion deserts of the Midwest and Texas). Depending on the study’s results, the system of virtual consultations combined with in-person testing and overnight medical shipments may prove a viable solution to the access problem facing patients in the most politically conservative regions of the country. It’s not unreasonable to assume, though, that opponents of abortion will find ways around this solution as surely as they have found ways to restrict and eliminate brick-and-mortar abortion clinics around the nation. Perhaps for every Madame Restell, there will always be an Anthony Comstock.

In an age of urgency and uncertainty for reproductive rights, it’s hard not to want concrete solutions. But perhaps we can take something from the idea of TelAbortion already, apart from its potential practical affordances. In addition to offering the hope of access to women in need, the simple idea of abortion by mail suggests certain things about abortion itself, things that go against many popular myths and misconceptions about what this controversial procedure actually involves:

1. It frames abortion as a non-surgical medical issue. Too often, the idea of abortion in the public mind is associated with controversial, medically complicated late-term abortions, which require surgical intervention. The idea that abortion could be a matter of taking pills at home is a worthwhile reminder that two-third of abortions occur at eight weeks of pregnancy or earlier.
2. It honors the privacy of abortion by allowing patients to complete the procedure in their own homes. We all know that the political is personal and the personal is political; anyone with a uterus can appreciate intimately the inevitable mingling of private and public concern in the charged issue of abortion. But the opportunity to relieve abortion patients from the undue burden of public outcry in the process of medical decisions and procedures seems to me a valuable one.
3. It allows us to imagine abortion as a part of “normal” life. In the 1800s, Madame Restell and Dr. DuPonco’s pills were advertised alongside watches and jewelry, boots, magazines, ready-made coffins, hair dye, furniture, French dresses, and more. Today, the idea that abortion pills could arrive in the same mail shipment as your electric bill, your college textbooks, and that blender you ordered on Amazon Prime seems bizarre. But abortion, like electricity, books, and smoothies, is a part of life — not always the dramatic, emotionally traumatic experience we’re taught to assume it must be. Perhaps this is the greatest fear of those who seek to restrict and criminalize abortion in all its forms: the idea that it might, after all, be something mundane — a part of everyday life to be dealt with on practical, private terms; something ordinary.

And after all — what’s more ordinary than the mail?

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Featured imagge caption: 19th Pills, from ©Dittrick Medical History Center. Left; Tin box containing Pennyroyal tablets Right; Paper covererd wood box with pills of unknown composition*