The first country to legalize abortion in the twentieth century was the Soviet Union. In November 1920, after Vladimir Lenin, the first head of the USSR, insisted that no woman should be forced to bear a child against her will and that women should be guaranteed the right of deciding pregnancy for themselves, abortion was made legal. A second motivating factor, however, was the government’s effort to eliminate the medical havoc of widespread criminal abortion. The Soviets estimated that up to 50 percent of women became infected during the course of undergoing an illegal abortion and perhaps as many as 4 percent of them died. Interestingly, the Malthusian belief in the dangers of overpopulation that was so prevalent in the west was not an issue in the new Soviet state because Karl Marx, and for that matter Lenin, regarded such concerns as a unique problem of capitalism. Once legalized, the number of legal abortions rose rapidly, whereas illegal abortions dropped drastically. American observers of the Soviet experience reported almost an assembly line procedure, with abortions in a Moscow hospital being done every eight minutes by a two-person team. What was most upsetting to the observers, however, was the lack of any counseling or the availability of any contraceptive materials.
In the 1980s and 1990s, when state legislatures and supreme courts began to impose limits on the right to choose abortion guaranteed in Roe v.Wade (1973), many marches such as this one were held to demonstrate public support for upholding reproductive rights.
Without warning and for no apparent reason, in 1936 the Soviet government reversed itself and banned legalized abortion. This coincided with a general effort to abandon many of the human rights victories originally established by the early Bolsheviks such as easy divorce, progressive education, and avant-garde schools of music and literature. The ban also indicated the increasing power of Soviet premier Joseph Stalin and it was not until after his death that the Soviet state in 1955 again legalized abortion. Again the official explanation was to eliminate the harm caused by illegal abortions and to allow women to decide for themselves the question of motherhood. Although contraceptives were more available in the Soviet Union than they were earlier, there was no concentrated contraceptive information until after the collapse of the Soviet Union. Abortion, however, since its legalization, has remained widespread.
Following the Soviet example, other Eastern bloc nations followed suit. Bulgaria, Hungary, and Poland legalized abortion in 1956, Rumania legalized it in 1957, and Czechoslovakia started with unrestricted abortions but tightened its controls in 1962.Yugoslavia, not in the bloc but influenced by Soviet examples, established modified controls over abortion in 1960. East Germany was the last to legalize it but one reason for the delay is that it had the most effective contraceptive educational and dissemination system among the Communist countries. When the Soviet Union collapsed, there were efforts to criminalize abortions, particularly in Poland, but generally such efforts proved unsuccessful in the long run.
It was the threat of population growth, combined with the devastation resulting from Japan’s defeat in World War II, that led the Japanese Diet (parliament) to enact in May 1948 the Eugenic Protection Law. The original law legalized abortion only for women whose health might be impaired from the “physical or economic viewpoint,” but these laws were soon extended to allow abortion at the woman’s request. Abortion became the standard method of birth control in Japan, with the result that the Japanese birthrate, 34.3 per 1,000 in 1947, had dropped to 16.9 by 1961. Like the Soviet Union, the Japanese paid little attention to contraception alternatives even though Margaret Sanger had been invited to Japan as early as 1922.The government, which opposed the invitation but eventually allowed her to enter, was then dominated by a militarist bloc and proponents of territorial and population expansion, who opposed the efforts of various women’s groups to encourage the use of contraceptives. With the government still in opposition, Sanger’s initial effort in Japan to popularize birth control was a failure. Sanger was again invited in 1950 by a revived Birth Control Association but her initial invitation was blocked by General Douglas MacArthur under pressure from the Catholic Women’s Club ofTokyo. After MacArthur’s removal from command, Sanger made a triumphal return to the country. The favored method of family planning, however, remained abortion.
In Europe, the first country to legalize abortion was Iceland in 1934. Sweden followed in 1938, Denmark in 1939, Finland in 1950, and Norway in 1960, although the actual Norwegian practice of abortion generally followed that of the other Scandinavian countries even before the law was changed.Various modifications were made in the laws of all the countries, but all of them have a rather formalized procedure for approving abortions, and it is known that those women denied approval often get illegal ones anyway.
In Great Britain, the early advocates of birth control were antiabortion, although a number of spokespersons for legalized abortion began to appear in the 1920s. Their numbers grew large enough by 1936 to found the Abortion Law Reform Association. A turning point in British public opinion about abortion was a 1938 legal case involving a London surgeon, Aleck Bourne. Bourne was convinced that it was good medical practice for a physician to perform an abortion on a woman under certain circumstances but he wanted to make certain the courts agreed. He tested his beliefs by giving an abortion to a fourteen-year-old girl who had been raped by soldiers and who had been referred to him by the Abortion Law Reform Association. When the operation was completed, he notified the police, was arrested, and went to trial.The case attracted much attention and Bourne received support from not only a significant portion of the medical community but from important individuals and groups from all segments of society. The jury agreed and acquitted him on the grounds that the operation had been necessary to preserve the life of the woman who otherwise, based on psychiatric testimony, might have suffered a physical or mental trauma. Other court cases strengthened the Bourne decision and Canada and other Commonwealth nations subsequently passed laws justifying abortion if it was necessary to preserve the mental health of a patient, as well as for physical or health reasons.
In the United States, even when abortion was outlawed, therapeutic abortions were permitted when in the physician’s opinion continued pregnancy was dangerous to the mother’s life. Decisions in such cases depended on both the individual physicians and the medical communities in which the operation took place. The number of such abortions began to grow in the 1950s and 1960s as many physicians took into consideration the emotional health of the woman as well as her physical problems. Still, the overwhelming number of abortions were illegal ones, and in the early 1960s minimal estimates were that at least between 400,000 and 640,000 illegal abortions took place every year. The growing ability to lessen by the use of antibiotics the danger of infections was a major factor in changing attitudes about abortion in the medical community and probably made the profession more willing to extend the definition of what constituted therapeutic abortions. The difficulty was that such procedures were more likely to be limited to the well-to-do, who often had a relationship with their private physician, and this left most of the poor and most needy excluded.
The first move for change came from the legal rather than the medical community, with the publication of the Model Penal Code adopted by the American Law Institute in the 1950s. The proposals were modest, providing for termination of pregnancy when the physical or mental health of the mother was greatly impaired; when the child might be born with a grave physical or mental defect; or when pregnancy resulted from rape, incest, or other felonious intercourse, including illicit intercourse with a girl under the age of sixteen.
Public interest focused on abortion laws in 1962 with the case of Sherri Finkbine, a Phoenix, Arizona, mother of four, who had taken the tranquilizer thalidomide during the first few months of her fifth pregnancy. Because the drug had not been approved by the Food and Drug Administration (FDA), it had not been marketed in the United States. Finkbine’s husband, however, had returned from Europe with a bottle of thalidomide, which still contained some pills he had taken, which she used. Two months later the news of the deformities that the pill was causing in European children— notably stunted or missing arms and legs—was made public. Finkbine panicked, fearful that her child would be deformed, something with which she believed she could not cope. She consulted her physician, who estimated that the chances of her infant being born deformed were at least 50 percent. He then arranged to admit her to the hospital for a therapeutic abortion. The story reached the newspapers through a friend of Finkbine’s, and the news of a potential thalidomide baby in the United States received national publicity. Fearful of publicity about an abortion being performed by its staff, the hospital canceled the abortion. The distraught Finkbines flew to Los Angeles, planning to travel to Japan for the abortion, but the Japanese consulate, also afraid of negative publicity, refused them a visa. The couple then flew to Sweden, where Sherri had the abortion. The fetus was found to be deformed.
The publicity led to a greater focus on the abortion issue and gave publicity to groups encouraging a change. The American Civil Liberties Union went on record as regarding abortion as part of a woman’s right to have control of her own body. In California, the Committee for Therapeutic Abortion, a coalition of civil libertarians, women’s organizations, physicians, and liberal religious groups, was established in 1965. The next year the National Organization for Women was established, with reproductive rights as one of its major concerns. The National Association for the Repeal of Abortion Laws was established in 1968.
Beginning in 1967, several states modified their antiabortion laws, using all or part of the proposals of the American Law Institute. By 1970 thirteen states had passed such legislation and others were considering it. The advocates for legal reform also worked through the courts, so that by 1972 federal court decisions had liberalized abortion privileges in three jurisdictions. In 1973, the case of Roe v.Wade (one of several abortion cases being appealed) was decided by the U.S. Supreme Court, which ruled that abortions were a constitutional right and laws prohibiting them were null and void, although the rights of states to regulate abortions under certain conditions were recognized.The anonymous Jane Roe, who brought the suit in Texas, was later identified as Norma McCorvey. The decision did not help her because the court procedure took so long that she had already delivered her baby and put it up for adoption by the time the Supreme Court rendered its decision. In its ruling, the Court held that for the first three months of pregnancy the matter of abortion was to be decided by the woman and her physician. During the remaining six months the states were permitted to regulate the procedures used in order to ensure reasonable standards of care. Only in the last ten weeks of pregnancy, however, could the state ban abortion unless it was necessary to preserve the life of the mother. In spite of various legal challenges that have emphasized the power of the states to regulate abortions, this is essentially the law that remains today.
Most of the opposition coalesced under the collective title of “right to life.” The radical fringe of these groups bombed abortion clinics or chained themselves to clinic doors to block entrances, and even murdered physicians who performed abortions. More mainstream members worked through the political process to weaken the right to abortion by passing restrictive state laws requiring the husband’s consent, requiring parental consent for minors, cutting off public funding, and/or adding procedural requirements such as waiting periods.
The ideological and political make up of the Supreme Court as well as other federal courts changed during the administration of Ronald Reagan (1981-1989), who insisted on an antiabortion litmus test for his court appointees. President George H.W. Bush (1989-1993) followed the same path but not quite as zealously. Bill Clinton’s ascendancy to the presidency in 1993 marked the abandonment of such a policy, although the battle continues as it did for any method of birth control. George W. Bush, elected in the year 2000, is openly antiabortion, and has talked about appointing one of the antiabortion justices as Chief Justice.
Increasingly, countries in Latin America, Africa, and Asia have allowed abortion. China uses it extensively; India, less so. Abortion still remains a controversial issue in many parts of the world.
When performed under aseptic conditions by a competent professional, abortion is a relatively safe procedure. When performed by inexperienced people or under unhygienic conditions, as so often happens in the case of illegal abortions, it is much more dangerous, not only in terms of maternal deaths, but in terms of long-term complications. Techniques vary with the stage of fetal development at which an abortion is sought. It is easiest during the early stages of pregnancy and both more complicated and dangerous in later stages.
Early abortion, sometimes called by its advocates postcoital contraception or menstrual regulation, can be brought about by several methods that rely on hormones or mechanical techniques. Various combinations of the hormones estrogen and progesterone (components of the oral contraceptive) are capable of terminating a pregnancy or bringing on the menses, although this has not been widely publicized. The FDA has been reluctant to formally approve any hormones for this purpose, more from political considerations than safety concerns, but in recent years has become more public about it, and in the year 2000 approved RU-486. There are many people who consider any contraceptive administered after an unprotected act of intercourse to be an abortifacient, and given this assumption, there are many clinics that do not prescribe any postcoital contraceptives, whereas others may limit their use to rape victims.
For contraceptive pills such as Orval, with 50 micrograms of estrogen and 0.5 milligrams of progestin, a total of four tablets should be taken in divided doses, an initial two, and then two twelve hours later. The series must start within seventy-two hours of the incident of unprotected intercourse, but preferably within twenty-four hours. Other pills vary in the doses. A postcoital insertion of a copper intrauterine device (IUD) has also proved effective in regulating menses by preventing implantation of the fertilized ovum in the uterus. IUDs that release hormones would have the same effect. All these procedures can be called menstrual regulators rather than abortifacients because no egg has been implanted.
Another method of bringing about an early abortion is menstrual extraction. This involves the insertion of a Karman cannula (tube) into the uterus and the removal of menstrual blood and tissue. A syringe or a suction machine is used to extract the uterine lining. This method is also regarded as a menstrual regulator and is often prescribed for a woman whose period is late; in fact, some women have used it to shorten the length of a menstrual period. No pregnancy test is required but casual use of the technique is not recommended because of the risk of hemorrhage and infection. The method was originally developed by Sir James Simpson in the nineteenth century to regulate menstruation and has been improved upon by later generations of physicians, most of whom refused to regard it as an abortion technique even though it was used for that purpose. It was not until the late 1950s, when a Chinese medical journal referred to it as a way of performing abortions, that Western medical journals were willing to discuss this use.
A traditional abortion technique, known by the ancient Greeks, is dilation and curettage (D&C). It is also used for a variety of purposes other than abortion, including taking biopsies to detect malignancies, dealing with prolonged bleeding from the uterus, and removing unexpelled placenta after childbirth. It involves dilation of the cervix and cleaning out the uterus with a curette. In unskilled hands it can lead to infection. Usually laminaria (cervical tampons that swell to three or five times their original diameter when placed in a moist environment) are used to dilate the cervix.
Midtrimester abortions (between the fourth and sixth months) are more difficult. Although D&C and vacuum aspirations are used early in this three-month period, both become increasingly risky and difficult as pregnancy advances. For most such late abortions a hypertonic saline solution is used.This method was first described in 1939 by a Rumanian physician but it was not used in the United States or in Western Europe until the 1960s. It involves the instillation of hypertonic saline (a 20 percent sodium chloride solution) in the amniotic sac or into the extraovular space (between the amniotic sac and uterus). A second method is the administration of prostaglandins, which encourage uterine contractions and are administered similarly to the hypertonic saline solution. Prostaglandins can also be given intravenously, intramuscularly, intravaginally, orally, or rectally. Third-quarter abortions require major surgical intervention and should generally be avoided unless the life of the mother is threatened.