Abortion past and present

Hospitals and physician practices will become a battlefield in the coming struggle to preserve reproductive health rights

Dr. Allan Weiland learned “what desperate people will do when they feel they have no other choice” while making rounds as a medical student at Cook County Hospital on Chicago’s near west side. The time: the late 1960s. The place: the septic abortion ward.

The ward’s 20 beds were filled with women, most of them young, most of them poor, who had suffered severe injuries from illegal or self-induced abortions. Patients had perforated uteruses, bladders and intestines from the blunt objects inserted in their bodies. Some had used carbolic acid to wash away their unwanted pregnancies and suffered “horrific burns.”

“The septic abortion ward was full every day,” Weiland recalled. “Somebody died every week on that ward.”

The physician’s recollections were recorded in the new documentary “The Janes,” now streaming on HBO (see the trailer here). It tells the story of a collective of young college-educated women who organized safe, illegal abortions in what was then the nation’s second largest city; who were busted by the Chicago police in 1972 after facilitating more than 11,000 abortions; but saw their cause vindicated, and their cases dropped, when the Supreme Court in January 1973 ruled in Roe v. Wade that a woman’s right to privacy included the right to end an unwanted pregnancy.

For the past half century, that ruling turned what had been an unsafe and illegal industry largely controlled by organized crime into a safe and legal procedure. For more than half of the 650,000 American women who get abortions each year, it is now performed at home with pills. But the Supreme Court’s imminent decision in Dobbs v. Jackson Women’s Health Organization will criminalize abortion in much of the country. That decision will inevitably lead to an underground industry to serve those women’s needs.

Many of the people who read my articles are involved in one way or another with the provision of health care. My message today is to you, especially if you practice medicine in one of the 18 states, many of them heavily populated, where abortion will immediately become illegal or could become so in the next few months. Another 10 states will likely impose severe time limits on access to abortion, some so early that many women will not realize they are pregnant until after that time limit has passed.

Women with money, or from families with money, or are well-educated, or have friends and contacts in liberally-run states, will have options. They will be able to fly to New York or Illinois or California, where abortions will remain legal. They will be able to get pills from friends in the mail.

But many working-class women, poorly educated women, socially isolated women who’ve never ventured beyond the borders of their hometown, much less to a faraway city, will do what desperate women have always done when this age-old medical procedure is criminalized. They will search out local illegal alternatives, some of which will be poorly performed and land them in the hospital.

Prepared?

Is your institution prepared to recreate the septic abortion wards of yore – especially if you’re a hospital serving the barrios of Houston, the slums of Birmingham, or the small towns of rural Oklahoma? Will you take these injured women in? Will you complete the botched abortion to save the life of the woman? Will you report them to the police? You had better start getting your policies in order because the day is coming when women injured during an illegal abortion begin showing up on your doorsteps.

“Abortion is, inevitably, an issue of economic justice,” Susan Faludi wrote in today’s New York Times. “The right to an abortion is not just about choice but fundamentally about the survival of women who have no choice, who are faced with dire necessity. That is, the vast swaths of women segregated in low-paying pink-collar occupations, women unable to reclaim jobs lost in a pandemic that drove them out of the work force at four times the rate of men, women unable to afford education or decent housing or child care and soon, it seems, unable to get an abortion when they need or want one.”

Local crusaders

You had better start lining up your lawyers, too. There will be no shortage of local prosecutors in states where abortion has been criminalized willing to cater to a minority movement that over the past half century has sought to impose its religious views on the majority of Americans who believe in women’s autonomy and their right to reproductive choice.

Think about a situation where a three-months pregnant woman shows up in the ER after a botched abortion with a perforated uterus. The fetus is still inside her. Will you provide counsel to the ER doctor who removes the fetus to repair the uterus when that abortion is challenged in court, the prosecutor claiming it wasn’t necessary to preserve the life of the woman? If you are the outside counsel to the hospital administration, will you be ready to make the medical determination that the physician’s actions were defensible?

The pressure to take a stand, especially if you’re a provider in a state that bans abortion, is coming. Hospitals perform just three percent of abortions in the U.S. with Catholic hospitals, which own approximately 20% of all beds, performing none. Others, even in liberal states, have highly restrictive policies that prevent physicians from using their facilities to perform many abortions.

A few weeks ago, I contacted my own provider – Advocate Aurora Health, which owns 26 hospitals in Illinois and Wisconsin – to learn its policy on abortion. It is affiliated with the United Church of Christ, which supports abortion rights and whose clergy provided consultation services for The Janes in the Sixties and early Seventies, and the Evangelical Lutheran Church, which opposes abortion after 24 weeks. “While adhering to all federal and state laws, in Illinois we also look to our faith partners for guidance,” a spokesperson wrote back. “We follow narrow guidelines to stipulate the conditions under which pregnancy terminating procedures may be performed.”

That is the path of least resistance. Who needs the tsuris, especially when there’s not much money to be made in performing the simple procedure.

However, hospitals won’t be able to get away that easily, especially in areas of the country where abortion clinics are rapidly disappearing. Katha Pollitt, writing in the Nation magazine late last month, dismissed this business-as-usual stance and signaled grass roots activists are going to make hospitals a major target as they look to preserve abortion rights in Red and Blue states alike.

“We need to pressure hospitals to rise to the challenge and give women an uncomplicated, legal service that one in four of them will need during their fertile years,” she wrote. “Indeed, not do so is a kind of malpractice akin to refusing to treat someone for a widespread, easily cured, but potentially fatal condition because it’s just too much of a bother.”

Some pundits have declared the coming Dobbs decision, whose draft by Justice Samuel A. Alito Jr. was leaked in early May, as momentous as the Dred Scott v. Sanford decision of 1857, which declared African Americans had no rights and the federal government had no authority to ban slavery in its territories. The decision polarized public opinion and, some historians argue, made the Civil War inevitable.

The coming anti-abortion decision won’t lead to war. But it will lead to widespread protests and, over the long-term, intense civil strife comparable to what was seen during the civil rights, antiwar and women’s rights movements of the late 1960s and early 1970s. Hospitals and physician practices will inevitably become major battlegrounds during that struggle because abortion is health care and denial of reproductive health services is the denial of women’s rights. Refusing to take a stand will not be an option.