No Choice

CHAPTER 1

Women’s Business

HER NAME WAS Phaenarete.

Not much is known about her, beyond the fact that she was the mother of Socrates. But Phaenarete was a midwife who provided abortion care as part of her full-spectrum reproductive health repertoire, and her work is referenced, briefly, in the philosopher Plato’s Theaetetus. I imagine her as powerful, tall and strong and connected to the earth like the cypress tree, which is said to exist between the worlds of life and death. Midwives tread that threshold, working in the in-between, that liminal space of pregnancy and birth, potential for life and life itself, and also potential for death. It takes bravery to labor in that space, physical and emotional fortitude, and mental acuity. Phaenarete was what we would now call an obstetrician. She was a pharmacist, a priestess, a wise woman. Language, to her and other midwives of her time, was healing medicine to be prescribed with the same weight as herbal remedies. I like to think of her walking the streets of Athens, among the ridged stone columns, head held high, being warmly greeted by friends and neighbors—some of whom she had guided through childbirth, others of whom she tended through abortion. This, to me, is an image of reproductive health utopia. Community based, stigma free, and respected.

Though I am a journalist, I am also a human being with her own values and, as some would call them, biases, so I should disclose up front that abortion rights as discussed in this book are grounded in the belief that all people deserve the freedom to choose whether they wish to reproduce and how to manage their families on their own terms. This is known as the reproductive justice framework, and it was founded by a group of Black women in 1994 who sought to fill in the gaps for the lives of low-income women and women of color in the abortion rights movement, which was largely led by upper-middle-class white women.

For as long as people could get pregnant, they have sought ways to control their reproductive lives with contraceptive practices and abortion care. It’s impossible to imagine a society without abortion: it’s an experience that spans communities, continents, civilizations. Academics and anthropologists say that induced abortion is likely “a universal cultural phenomenon,” and there are hundreds of tribal writings that mention abortion practices. Even so, power dynamics in modern society deeply affect abortion—from knowledge of the procedure, to whose story gets told and in what way, and who gets what kind of care. So, too, have those dynamics existed throughout time—men have traditionally controlled women’s bodies, whiteness has been privileged as somehow more worthy of care, some strains of religion attract more money and influence than others—and none of it has any basis in science or even fuzzier standards like worthiness. It’s all made up, a fiction, perhaps even a lie. For this reason, laying out the history of reproductive care practices and the forces that have influenced the distribution of those practices is crucial.

In Euripides’s classic Greek tragedy Medea, first produced in 431 BCE, a key declaration is delivered by the play’s namesake: “I would rather stand three times with a shield in battle than give birth once.” This sentiment seems utterly reasonable in context. Death in childbirth was routine, sometimes from exhaustion and uncontrollable hemorrhaging and babies in breech, occasionally from infection. Still, there doesn’t seem to be much recorded history of abortion in ancient Greece, though women did certainly seek out ways to manage their fertility, and records of abortive methods exist. In the first century, the physician and pharmacologist Dioscorides wrote a series of books called De materia medica (Materials of Medicine) that included a wide range of recommended oral contraceptives and fourteen forms of abortifacients or emmenagogues, which are herbs that are used to encourage menstrual flow. Plato mentions contraception, pain management in birthing, and abortion in his writings. He also recommended abortion, though he was open to infanticide, for all women older than forty. (He also was an early eugenicist, advocating for government-controlled selective breeding in order to create a clear social order: the intelligent and well bred would be rulers while the least intelligent or those with the least desirable traits would be workers.) In Theaetetus, in which Plato meditates on the nature of knowledge, Socrates, who is traditionally regarded as Plato’s teacher, said: “And furthermore, the midwives, by means of drugs and incantations, are able to arouse the pangs of labor, and, if they wish, to make them milder, and to cause those to bear who have difficulty in bearing; and they cause miscarriages if they think them desirable.” Not much is discussed regarding the morality or immorality of abortion, but Aristotle concluded that a male fetus’s soul bloomed into existence after forty days. Plato maintained that life began at birth and not before.

Ancient Greek medicine also often attributed female maladies to an idle womb. If one’s wife was not having sex frequently enough, it was said that inactivity could dry her uterus into lightness, and it might float up inside her body to seek moisture from other organs, resulting in some sort of hysteria. This theory led the Greeks to their word for hysteria: hystera is the Greek word for “womb.” It should be apparent here who is wielding the power in this situation, and this sort of ideology also serves to present women as disempowered, helpless even when it comes to their own bodies. It’s a pattern we see play out over and over again throughout time—one party presents another party as incapable of autonomy, when, in fact, the former is simply seeking a means to control the latter. To that end, it appears that abortion was acceptable in particular cases in which a woman was enslaved by someone who felt a pregnancy detracted from her material worth, which would in turn jeopardize a source of revenue for her owner; one example in the Hippocratic texts involves a “valuable singing girl.” Because successful pregnancies that resulted in a live childbirth were precious in ancient Greek and Roman society, the abortion methods mentioned in the Hippocratic text were likely used for spontaneous miscarriage in instances where the pregnancy was clearly abnormal.

For the ancient Romans, meaning roughly from the eighth century BCE to the fifth century CE, as in modern America, it appears class was a major factor in who was able to control their reproductive circumstances—not surprising, given that economic power has also been a force that has bent and twisted the course of history. Though abortion was legal in both the republic and, later, the empire, wealthy Romans seem to have borne fewer children; literature from that time portrays such women as disinclined toward childbirth and more prone to seeking abortions, sometimes to maintain vanity (though all the texts were written by men, so take it with a pillar, not a grain, of salt). Another factor was economic. For those upper-class families, if a girl was born, she came into the world, pink and squalling and unaware of the expectation that her parents would provide a substantial dowry when she was to be married. Ultimately, men were able to exercise power over the women they married because their status as the legal heads of the family gave them ownership over any pregnancy. If a man were to exert his authority over the fate of a pregnancy, the fetus was understood to be his property; the discussion was not centered on morality. (The Old Testament of the Bible assumes a similar stance.)

Soranus of Ephesus, an esteemed Greek physician who practiced in Rome, penned detailed instructions on the conditions that demanded abortion care rather than birth, such as a contracted pelvis and swelling and fissures in the uterus that could complicate delivery. The Romans were also interested in ways to prevent unwanted pregnancy, and the contraceptive methods of the time are entertaining, though they also call for skepticism. One ritual involved splitting open the head of a hairy spider, extracting the worms that habitate therein, and then wrapping those worms in strips of deer flesh to be worn as an amulet by the woman. We have Pliny the Elder to thank for this visual, one of the many medical remedies recorded in his thirty-seven-book series Natural History, which is considered the oldest surviving scientific encyclopedia and perhaps the most complete picture of cultural knowledge that exists from ancient Rome. By today’s standards, it is of deeply dubious scientific accuracy in its medicinal and biological suggestions, meaning, don’t try this at home. The Greeks, Romans, and Egyptians all produced records of pregnancy termination. Some inserted papyrus and dry sponges into the uterus in an effort to cause it to expel its contents along with the foreign substances; others used herbal irritants, like laurel and peppers. Vaginal instruments, perhaps used for early abortion care, have been uncovered within the ruins of Pompeii.

In ancient Egypt, the Ebers Papyrus, which details herbal remedies and medicines and dates back to circa 1550 BCE, lists an impressive series of abortion methods. Some of those ingredients described are still used in the Middle East and North Africa. Egyptian historical materials share a great deal of commonality with the Greek Hippocratic texts, too much to be coincidental, some scholars say, but there is no documented evidence that connects them.

The massive growth of Christianity brought a change in attitude regarding abortion, and of course, the Christian church in all its forms has, for centuries, played a part in how society discusses ending pregnancy. Jewish traditions, by contrast, have consistently prioritized the life of the pregnant person over that of an embryo or fetus. The first known Christian writings conflict with Roman cultural attitudes about abortion. The Didache, one of the earliest known Christian texts, which is also known as the Lord’s Teachings Through the Twelve Apostles to the Nations, comes out against intentionally ending a pregnancy. (Still, it has ultimately not been accepted into the canon of the New Testament.) While there is an Old Testament passage regarding fetal life in the Bible, there are no explicit mentions of abortion and no moral judgment cast upon shedding a pregnancy by choice. The aforementioned passage is in Exodus, where biblical laws over who is owed damages in the instance of a miscarriage caused by outside violence are detailed. The Hebrew translation states: “When people who are fighting injure a pregnant woman so that there is a miscarriage, but no other harm occurs,” financial compensation to the family affected is in order. In the Greek translation, however, there’s more emphasis on the fetus: “If two men fight and strike a pregnant woman and her child come forth not fully formed, he (the striker) will be punished with a fine.” According to the Rabbi Danya Ruttenberg and the Rev. Katey Zeh, when the Hebrew Bible began to be translated into the Greek Septuagint, the Hebrew word ason, meaning “harm,” “damage,” or “disaster,” became the Greek exeikonismenon, which is more like “from the image.” As a result, the passage from Exodus becomes: “When men fight, and one of them pushes a pregnant woman and miscarriage occurs, but it is not in the form.” Ruttenberg and Zeh say the original “harm” in Hebrew refers to the death of the pregnant person, which means the Greek Septuagint takes away the emphasis of harm to the pregnant person and places it instead on the fetus and its developmental stage. Some scholars also understand this change to have happened in the cultural context of the Greco-Roman period.

This translation has raised questions for evangelicals about where the line is in gestational development. What is considered fully formed, a true life, and what is simply potential? Many early theologians fell somewhat in line with Aristotle’s theory that there were three stages to the development of the soul: the vegetable soul very early in pregnancy, the animal soul, and, finally, the human soul, which is imbued when the fetus begins to move in the womb. Augustine of Hippo, an early Christian theologian whose work deeply influenced the development of early Western Christianity, deferred to Aristotle, and was horrified that people were having sex for more than just procreative purposes, which he deemed to be sinful. So, too, in his eyes, was abortion at any stage.

Despite the pattern of oppression, women throughout time have passed along knowledge and remedies to take care of “women’s business.” As Barbara Ehrenreich and Deirdre English wrote in their first edition of Witches, Midwives, and Nurses: A History of Women Healers: “Women have always been healers… they were called ‘wise women’ by the people, witches or charlatans by the authorities. Medicine is part of our heritage as women, our history, our birthright.” Goddesses in ancient Greece and Egypt were worshipped for their curative powers. Isis was the goddess of medicine, and Athena, Hera, and Leto were known as healers, too. While many of the civilizations mentioned here were built to favor male leadership, women found power in their own ways, even if they were not often allowed the authority to chronicle the cultures they created.

People indigenous to America have a long, intimate knowledge of which herbs can help a woman control her body. Stoneseed and dogbane, which have natural contraceptive properties, were used by the Shoshone peoples and the Bodéwadmi to prevent pregnancy. Studies of indigenous cultures also turn up evidence of commonplace abortion practices. A South American matrilocal native tribe known as the Wichí reportedly abort the first pregnancy of any member as a matter of routine, to make the childbirths that follow easier. American native tribes also have documented abortion practices that prioritize the health and well-being of the person carrying the fetus and their quality of life. Abortion rights advocate Lawrence Lader writes that in such communities, “abortion is so commonplace that… guilt and psychic damage [are] virtually unknown,” an assertion that bears out in more recent research.

The most powerful path to reproductive autonomy has historically come from outside the medical establishment. In more recent history, women have banded together to provide medical care for one another and their communities—and were widely punished for it. In the Middle Ages, the number of female surgeons dwindled as male church and state leaders began to deem women the inferior sex, and formal education was reserved generally for males. By the mid-fourteenth century, laws were passed to regulate how surgery could be practiced and by whom, which further pushed women out of medicine. The creation of professionalized medicine was instigated by a desire to shift power and authority from women to men, while keeping the (unpaid) domestic expectations of women fully intact. During the Middle Ages, the health of the household remained a responsibility that was gendered female in Europe. Women were also hunted as witches for providing medical care, including obstetrical services, across Europe and what is now the United States from the fourteenth century to the seventeenth century. So-called witches were persecuted for any perceived sexual sin, including vague accusations of “lewdness,” but the medieval Catholic Church and the burgeoning Protestant Church also took great offense to the way female healers were core providers of reproductive health care, which encompassed contraception and abortion. Though abortion itself was not considered a crime by law, it certainly was seen as such in the eyes of the church, which doled out its own punishments accordingly. A fear of female sexuality was at the heart of the witch-hunt fervor, since witches were believed to have been seduced by Satan. One of the best-known treatises on the evils of witchcraft, Malleus Maleficarum, was written by Heinrich Kramer, a Catholic clergyman, who described women as inherently weak and deceptive: “Since [women] are feebler both in mind and body, it is not surprising that they should come more under the spell of witchcraft. For as regards intellect, of the understanding of spiritual things, they seem to be of a different nature than men.… But the natural reason is that she is more carnal than a man, as is clear from her many carnal abominations. And it should be noted that there was a defect in the formation of the first woman, since she was formed from a bent rib, that is, a rib of the breast, which is bent as it were in a contrary direction to a man. And since through this defect she is an imperfect animal, she always deceives.”

That fear is recognizable in the United States today. Our entire culture has been shaped by it, our laws and policies molded by would-be witch hunters. Even so, women continued to seek control over their reproductive agency in the face of patriarchal values, and in some ways, they were at an advantage given the lack of knowledge and fear held by men regarding their bodies. In the early nineteenth century and before, women shared ways to “restore the menses,” relying on drugs and herbal concoctions to bring forth what had been blocked by a pregnancy. It was seen as a simple solution to a disruption in bodily function and a way to bring the body back into balance. For example, to ward off pregnancy, a colonial Maryland woman said that she had “twice taken Savin; once boyled in milk and the other time strayned through a Cloath.” Savin, derived from juniper bushes, was often used because of its wide availability, given that the plant was native to the area. Colonial women also used herbs like pennyroyal, tansy, ergot, and Seneca snakeroot to expel the contents of the uterus.

Broadly, abortion wasn’t considered a matter for the legal sphere in the United States until shortly before the Civil War. Common law accepted abortion as fairly routine up until “quickening,” when the fetus can be felt moving within the uterus. The concept of quickening dates back to Aristotle, who said male fetuses quickened—that is, began to move—in the womb after forty days, while female fetuses take somewhere around eighty to ninety days to do the same. No one seems sure of where Aristotle’s idea came from, or how fetal gender was determined with any sort of accuracy during pregnancy, but the word itself comes from the root word quick, which was once a synonym for living. And no one is certain who first took up Aristotle’s idea as a viable way to view the subject of abortion in modern times, but states in the nineteenth century adopted quickening as the bright line up to which abortion was perfectly acceptable, and the courts hewed to the concept for most of that time. Decreeing abortion as acceptable up until quickening is, in a way, evidence that pregnant people were trusted in those times. After all, no one can tell that the fetus has quickened except the person carrying it.

Still, this is the point at which abortion began to be regulated. The General Assembly of Connecticut was the first to criminalize abortion, enacting a law in 1821 that banned abortion after quickening, though it specified cases where poison was used to induce a miscarriage. (The law was modeled after legislation passed in British Parliament in 1803.) Then came Missouri. Then Illinois. And New York. Sound familiar? More states followed. All this legislation was written and enacted by men.

The advent of so-called professionalized medicine in the twentieth century brought political and economic motivation for powerful people to frame abortion as an evil comparable to murder. The American Medical Association—which, until 1876, was exclusively white and male—launched its fight against abortion in 1859. Though some AMA-affiliated doctors may have been motivated morally, they were also threatened by the financial competition posed by midwives and healers, building on the momentum of the witch-hunt fervor of the Middle Ages that still simmered in the background. It wasn’t just men; as Alicia Gutierrez-Romine notes in her book, From the Back Alley to the Border. “Because women physicians tried desperately to distance themselves from midwives after the professionalization of medicine, many took a staunchly conservative anti-abortion stance. Female physicians often spearheaded anti-abortion and anti-midwife campaigns so that they would not appear tolerant, weak, or unprofessional.” The antiabortion movement in the United States was set in motion.

As winter was beginning to cede to spring in 1873, Congress passed a new law that has become known as the Comstock Act. The legislation was a symptom of a growing societal moral panic, particularly among middle-class Christians, and it, too, was led into being by a man. (After all, men have the most to lose in the decay of the patriarchal family structure.) The story of Anthony Comstock is almost cliché: small-town New England white boy makes it to big, bad New York City to find it absolutely teeming with obscenity that threatens his worldview. Haunted by the knowledge that sex can be pleasurable for all parties involved, not just those with penises, and that sex can even be had in the name of fun, not just reproduction, he pledged to do what he could to make sure the word didn’t get out. As a well-connected political insider, he used his influence to persuade Congress to pass “An Act for the Suppression of Trade In, and Circulation of, Obscene Literature and Articles of Immoral Use.” This mouthful of a title eventually became known as the Comstock Act. While the law failed to clearly define what it meant by “obscenity,” it outlawed the distribution of “obscene, lewd or lascivious,” “immoral,” or “indecent” materials through the mail, which included information about contraception and abortion. (Emma Goldman, the white anarchist political writer who fought for women’s rights and gay rights, was not impressed, and she referred to Comstock as one of a cohort of “Puritanic eunuchs” in an essay, “The Hypocrisy of Puritanism,” published in the early 1900s.) Comstock was also a prolific book burner; he likely would have felt right at home in our modern Republican Party.

It’s no coincidence that abortion became heavily scrutinized and regulated in the nineteenth century, as women like Goldman were beginning to assert their own political power. As the twentieth century began, and women also declared their rights to sexual freedom, the attacks on reproductive autonomy escalated.

CHAPTER 2

Unfit

WE CANNOT CONSIDER ways women have worked to harness their own reproductive power without exploring the ways that power has been wielded against them, particularly for Black and brown women. Abortion rights are inextricably bound with reproductive justice, defined as “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities,” by SisterSong, the collective of Black women who coined the term. Enslaved Black women in the United States were not afforded a straightforward personal ideology of whether or not they wanted children, or how they wished to experience motherhood. “For slave women, procreation had little to do with liberty,” writes Dorothy Roberts in Killing the Black Body. “To the contrary, Black women’s childbearing in bondage was largely a product of oppression rather than an expression of self-definition and personhood.” Black enslaved women were often denied the dignity of choosing their sexual partners. Some enslavers forced enslaved people to “breed,” like livestock, based on favorable attributes that they thought might manifest in future laborers. Even mothers’ milk was not sacred: Black women were often expected to serve as wet nurses for their enslavers’ offspring, nurturing another generation of oppressors with their bodies. Further, enslaved Black women’s bodies were experimented on, notably by a white man named James Marion Sims, known as the “father of modern gynecology.” He did not use anesthetics on his victims. Under the brutality of the white gaze, Black bodies were reduced to chattel, a mere means to an end, and Black women were stripped of any sense of agency, their emotions and desires not taken into account.

Some enslaved Black women used sexual abstinence or herbal abortifacients as a form of rebellion, including “the infusion or decoction of tansy, rue, roots and seed of the cotton plant, pennyroyal, cedar gum, and camphor,” according to one 1860 medical record from a white physician in Tennessee. Care was rooted in community: enslaved women shared medical knowledge with one another and preserved that knowledge through generations. Dorothy Roberts writes that herbal skill was likely brought over from Africa and passed down through oral tradition by midwives who had been captured and taken to America to live out their lives in bondage. A refusal to bear children was a powerful statement for enslaved women; in doing so, they also denied their enslavers economic gains. In another common scenario, an enslaved woman raped by a white man might seek abortifacients in part to avoid the misplaced rage of her rapist’s wife. Still, these women were forced to consider their long-term survival. Some enslaved women were told they would be freed if they gave birth to a certain number of healthy children. As Loretta Ross and Rickie Solinger note in their book Reproductive Justice: An Introduction