“Abortion has long been an option for women, as far back in the historical record as we can see,” Mary Fissell, a historian of medicine at Johns Hopkins University, informs us at the start of Pushback: The 2,500-Year Fight to Thwart Women by Restricting Abortion, her eye-opening account of undesired pregnancy and its intentional termination across the millennia.
Imagine if Justice Samuel Alito’s majority opinion in Dobbs v. Jackson Women’s Health Organization (2022), in which the Supreme Court repudiated the right to abortion, began with those words instead of his presumptuous first sentence: “Abortion presents a profound moral issue on which Americans hold sharply conflicting views.” I say presumptuous because while Alito and the four justices who joined his opinion—all raised in the Catholic Church—no doubt do believe that abortion presents a “profound moral issue,” that is not a view shared by all Americans, many of whom believe that forcing a woman to carry a pregnancy to term is where the moral problem lies.
Of course, even if Alito had begun with Fissell’s words, the outcome in Dobbs would not have been different; these justices were going to find a way to overturn Roe v. Wade, which was, after all, what they had been put on the Court to do. But a gesture toward the real history of abortion instead of the cherry-picked history of its criminalization would have made for a more honest opinion. The fact is that women determined to end their pregnancies have rarely waited for the blessing of a legislature or a court. And in the absence of official permission, they are not likely to be deterred, as David Cohen and Carole Joffe document in After ‘Dobbs’: How the Supreme Court Ended ‘Roe’ but Not Abortion. Although in the immediate aftermath of Dobbs a dozen states banned abortion and six others erected daunting obstacles to accessing it (a number that has since increased), Cohen and Joffe point out that there are more abortions in the US today than there were when Roe was the law.
Fissell leaves no doubt that she supports the right to abortion, but taking on the Supreme Court is not her goal. Her project is deeper: she aims not only to unearth the history of abortion but to interrogate it. Abortion has always been with us: women in ancient Greece could avail themselves of more than one hundred plants known to induce miscarriage, and Benjamin Franklin’s 1748 printing of a medical self-help booklet that offered similar information went through at least twenty editions. Societal responses to the inescapable fact of abortion have varied widely over time, from a collective shrug to widespread tolerance despite nominal condemnation to prohibition with the full force of criminal law.
The question is, what accounts for the variation in attitudes toward abortion over the centuries, for the ebb and flow of women’s control over their reproductive lives? Fissell’s argument is that the history of abortion is in essence the history of women, with their access to abortion at any given time reflecting society’s expectation of their proper role. Restrictive periods tend to coincide with moments when women were stepping out of those assigned roles, and the new realities of their lives were running up against old expectations. “Abortion restriction has often been gender backlash,” Fissell writes.
Restrictions on abortion throughout history have had little to do with the fate of the fetus or with religious claims for the sanctity of unborn life. From today’s perspective this comes as a surprise, one that illuminates the historical anomaly of the post-Roe era. Fissell makes an important contribution by showing how religion was essentially absent from considerations of pregnancy and abortion until quite recently: “When churchmen and Supreme Court justices claim that abortion has always been unacceptable, they imply an unchanging set of moral imperatives. Such is simply not the case.”
With religion removed, the reasons for the toleration or disfavor of abortion across history become all the more interesting, involving life as it was lived rather than doctrine delivered from above. Fissell tells each era’s abortion story through the experiences of individual women, some of whom are identifiable and some of whom, because of their circumstances, were not deemed worthy of having their names recorded.
For example, the book’s first chapter tells the story of “the singer,” an enslaved woman in ancient Greece whose owner summoned a doctor to help take care of a possible pregnancy. Since the young woman was hired out as an entertainer and sex worker, pregnancy would be in neither her interest nor her enslaver’s. The doctor advised her to jump up and down vigorously. After six or seven jumps, a small piece of material, which the doctor described in great detail in his written report on the consultation, fell out of her vagina. Was this an abortion? Whatever the Greeks might have called it, it was evidently a routine occurrence without opprobrium. Fissell notes that elite Greek families had surprisingly few children, given the young age at which women married: abortion might have been a reason, she suggests.
Rome was different. The need for a constant supply of citizens to administer a growing empire gave rise to a strongly pronatalist culture. Laws enacted in the reign of Augustus imposed penalties on single people for remaining unmarried and on married couples for not having children. Abortion was still common but was seen as a sign of immoral behavior. “Abortion became weaponized,” Fissell writes, “a way to take down a political opponent, as emperors began claiming the authority of sexual virtue.”
Fast-forward 1,840 years, and we find that pronatalism motivates the successful campaign to criminalize abortion in the United States during the mid-nineteenth century. Combined with nativism in the face of rising immigration, pronatalism was a powerful force. Would the American West “be filled by our own children or by those of aliens?” asked Horatio Storer, a physician who was leading the charge to make abortion a crime.* He and his allies were responding to the widely observed fact that white middle-class married women were having abortions instead of babies. One writer at the time argued that while “we can forgive the poor deluded girl,—seduced, betrayed, abandoned,” married women who had abortions should be condemned for refusing the motherhood that nature intended.
I’m guessing that Fissell’s manuscript had already been completed by the time of the 2024 presidential campaign, when old footage of J.D. Vance denigrating “childless cat ladies” went viral and the Republican Party became a cheering squad for natalism. Otherwise she might well have noted how pronatalism has driven the party into an awkward place, caught between opposition to abortion and a sudden, contradictory embrace of in vitro fertilization. The Alabama Supreme Court’s ruling in February 2024 that the embryos created as part of the IVF process were the legal and moral equivalent of children brought the “fetal personhood” argument out of the shadows and appeared to threaten the future of a process in which unneeded embryos are either destroyed or consigned to a kind of frozen Bardo.
Responding to a public outcry, the Alabama legislature quickly passed a law to immunize people providing or receiving IVF services from liability. President Donald Trump, ever an astute observer of the winds blowing through his base, has since taken to calling himself the “fertilization president.” Earlier this year he issued an executive order titled “Expanding Access to In Vitro Fertilization,” in which he promised to make the procedure “drastically more affordable” by “easing unnecessary statutory or regulatory burdens.”
The response to the Alabama decision would seem to undercut Mary Ziegler’s thesis in Personhood: The New Civil War Over Reproduction. She argues that the movement toward fetal personhood is sufficiently potent to demand our attention. Ziegler, a law professor at the University of California, Davis, is a prolific writer on abortion; this is her seventh book on the subject in the past ten years. She has argued persuasively before, as she does here, that “the reversal of Roe was never the US antiabortion movement’s ultimate goal” and that “it has always been a fetal-personhood movement.” Simply returning to the pre-Roe status quo would leave states free to permit abortion, as a growing number in the pre-Roe period had done. To actually prohibit abortion, they recognized, would require elevating the fetus to the status of a born person, either by legislation or by an extension of the constitutional guarantee of equal protection. While efforts to pass either a “human life bill” or a constitutional amendment failed nearly half a century ago, that goal is now being pursued by a new generation of activists, several of whom Ziegler profiles.
Toward the end of this book, she glances at the Alabama decision without confronting the implications of the public’s overwhelming response in favor of IVF. In Ziegler’s narrative of its history, the fetal personhood movement may have peaked forty years ago during the moral panic over crack cocaine. Women whose newborns showed symptoms of maternal drug use faced prosecution and loss of custody, essentially for the crime of fetal abuse. Or perhaps the peak came with President George W. Bush’s opposition to federal funding for medical research using stem cells from embryos. In any event, those moments have passed. In 2011 Mississippi voters had a chance to adopt a fetal personhood amendment to the state’s constitution. It failed decisively.
Perhaps the fetal personhood movement has simply morphed into today’s pronatalism. “I want more babies in the United States of America,” Vice President Vance told the antiabortion crowd at this year’s March for Life. More fetuses, more babies. More IVF, more fetuses. It may seem illogical for an administration that wants more babies to propose cutting support for the childcare programs that make parenthood more affordable, but the point is not to make life easier for working mothers. The point is to induce more mothers to stay home, where they belong. (The MAGA fixation on raising the birth rate has veered into the parodic. Sean Duffy, the secretary of transportation, announced in February that his department would favor “communities with marriage and birth rates higher than the national average” in awarding federal grants, loans, and contracts.)
The emergence of pronatalism fits Fissell’s argument neatly. In post-Reformation Europe, women who had abortions faced growing prosecution not just because of religious objections but also because of political concerns for civic order; abortion was a sign that illicit sex had taken place, which in turn held up an unflattering mirror to the men who were supposed to be in charge. “Single women were increasingly seen as a problem group whose sexual behaviors needed to be monitored closely,” Fissell writes.
In the seventeenth and eighteenth centuries, abortion acquired a very different significance in slaveholding areas of the Caribbean and the American South: it was an act of defiance by women who were regarded as property and an economic crime “depriving an enslaver of potential chattel.” “I bought her to breed,” an angry slaveholder wrote in a letter about a woman on his plantation who had apparently failed to get pregnant.
“Women did not want to bear children into perpetual servitude and so ended pregnancies,” Fissell writes. She tells of Mary Gaffney, an enslaved woman who “refused to have children that would enrich her enslaver” and so chewed cotton root to avoid having a child with the man to whom the slaveholder had married her. After emancipation Gaffney evidently suspended her chewing and had five children with her husband.
For white women in colonial America, ending a pregnancy by ingesting an abortifacient was common and unproblematic—even though it was nominally prohibited. Benjamin Franklin’s little booklet circulated widely in the colonies and even appeared in a German translation. “Women in colonial America regulated their fertility using plants, and everyone knew about it,” Fissell writes, adding that “abortion was simply not understood as the kind of misdeed that was worth prosecuting unless it were part of a larger array of bad behavior.”
It hardly bears noting that the practice Fissell describes, beginning in ancient times, was medication abortion, seemingly more controversial today than it was then. Abortion was illegal in Victorian England, but advertisements for abortion-inducing medications, often compounded from the same herbs that women had been using for that purpose for centuries, frequently appeared in newspapers. The most common coded description was “female obstruction pills,” which promised to cure a woman of whatever was obstructing her monthly period.
The Victorian law made a distinction between abortions performed before and after quickening, the point during the second trimester when a woman could feel fetal movement. Only after quickening was abortion regarded as a serious offense. That demarcation gave pregnant women considerable power, since only they knew what they were feeling. But after the stethoscope was invented in 1816, doctors could use it to detect a fetal heartbeat, and they began to object to maintaining the quickening distinction. They were also objecting, if implicitly, to the autonomy that the distinction granted to pregnant women.
Some doctors in the US began to echo these objections, although their numbers were small and they had trouble making their voices heard. Dr. Hugh Hodge, a professor at the University of Pennsylvania, gave a lecture to medical students in 1839 arguing that though an embryo was housed in a woman’s body, it had a separate existence. The university did not publish the lecture until fifteen years later.
Some of the antiabortion doctors held notably negative views of their female patients. In an article published in 1859, a Harvard obstetrics professor, Walter Channing, described refusing to perform an abortion for a wealthy married woman who already had an unweaned ten-month-old. She and other women of her class who resisted having more children displayed “self-indulgence in most disgusting forms,” Channing wrote.
Religion appears to have played only a very minor part in the doctors’ crusade against abortion in mid-nineteenth-century America. The issue wasn’t God, evidently; it was women. “The clergy were notably quiet during the mid-century anti-abortion campaign, much to some doctors’ disgust,” Fissell writes. The Catholic Church’s decision in 1869 to do away with the quickening distinction and deem abortion a sin from the moment of conception made little impact in a country that was largely Protestant.
Later, of course, religion did come to play a significant part in the evolution of abortion policy, a part more subtle and complex than today’s reductive abortion conversation tends to reflect. In his new book, Abortion and America’s Churches: A Religious History of ‘Roe v. Wade,’ Daniel K. Williams, a longtime student of the religious right, observes that the Supreme Court’s 1973 decision, signed by six Protestant justices and one liberal Catholic justice, reflected the consensus that mainstream Protestant denominations had reached on the issue. But as those denominations lost ground to evangelical churches that linked their identity to antiabortion activism, the Protestant consensus evaporated, and the most insistent religious voices were those calling for Roe’s overturning. Williams notes that on the ruling’s thirtieth anniversary, in 2003, the Southern Baptist Convention issued a public apology for the moderate position it had taken on abortion in the 1970s. He titles his last chapter “The Conservative Christian Coalition That Overturned Roe.”
Given the structure of Fissell’s book, her account of abortion in the decades before Roe v. Wade is necessarily compressed. By the beginning of the twentieth century, abortion, which had been illegal nowhere at the nation’s founding, was illegal in every state. And yet it remained common. “The gap between what the law said and what women actually did remained substantial all the way up to Roe v. Wade,” Fissell observes.
The leading source on this period is Leslie J. Reagan’s When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867–1973 (1997), on which Fissell relies. During the Depression, according to Reagan, “women had abortions on a massive scale.” Not only were children a financial burden, but women were often fired from their jobs when they married, leading couples to delay marriage but not necessarily sexual relations. While illegal and often clandestine, safe abortions performed by reputable physicians were fairly common, and the authorities looked the other way.
That changed in the 1940s, when “the assault on female independence and the promotion of maternity began,” Reagan reports, noting that the Ladies’ Home Journal during this period urged women “to correct the mistakes of the 1920s and ’30s” by having many babies. The result of the era’s pronatalism was a harsh backlash against abortion. Police raids of physicians’ offices were common and breathlessly reported, and women were forced to testify at trial against their doctors. Abortions became harder to obtain and more dangerous. In New York City in the early 1960s, half of the maternal deaths of Black women were due to abortion, compared with one quarter of the maternal deaths of white women. In the face of this unacceptable situation, it is not surprising that the public health profession led the early calls for reform. This was the situation on the eve of Roe. And it is chillingly similar to the situation today.
David S. Cohen, a law professor at Drexel University, and Carole Joffe, a professor emerita of sociology at the University of California, Davis, wrote After ‘Dobbs’ as a follow-up not only to the 2022 decision but to their earlier book, Obstacle Course: The Everyday Struggle to Get an Abortion in America (2020). That book examined the effects of the increasingly onerous and arbitrary restrictions on access to abortion imposed by Republican-led states.
For their new book, they selected twenty-four abortion providers—mainly doctors and nonphysician clinic owners—and interviewed almost all of them three times: shortly before the Dobbs decision, immediately after, and finally six months later. Their aim was to record what was happening through the experiences of those who were living it, both in states where abortion had become illegal and in states where clinics were overwhelmed by the numbers of women seeking care they could not get at home.
To say that the result is necessarily a collection of anecdotes is not to diminish it; this is history as it unfolded. Some of the stories are almost unbearably poignant, such as that of Andrea Ferrigno, an administrator at a clinic that her uncle had once owned in McAllen, Texas. She recalls exchanging a defiant sign on the door that read “THIS CLINIC STAYS OPEN. ABORTION IS STILL LEGAL” with one saying “IT’S BEEN OUR HONOR TO SERVE YOU.” It was, she said, “our goodbye to the community.”
Dr. Leah Torres, the medical director of a clinic in Alabama, describes how she felt when “my profession became a criminal act.” She kept the clinic open to provide non-abortion health care, including care for trans people and those with HIV. But with women seeking abortions still showing up, the unanswered question was whether she could legally refer them for care outside Alabama:
So I had a patient come in. She was forty-four years old, about to be forty-five, and she’s pregnant. And she did everything she was supposed to. Took the birth control, used condoms, and she’s just devastated. Devastated. She has a grown adult child in their twenties. She absolutely does not want to be pregnant. She’s crying, and she’s upset. I can’t describe how it feels to say this, but in my mind, I have to think about “What if she’s a plant? She could be a plant. She could be an anti.”
Torres told the woman that in her medical judgment, abortion would be safer than carrying the pregnancy to term. “I can’t tell you what to do,” she said, “but for what it’s worth, I’m glad you would like an abortion. I’m sorry I can’t help you with that, but I’m glad you would like one.”
With abortion still legal in Illinois, the state quickly became a destination for women all over the Midwest and the South. Dr. Erin King, the medical director of a clinic in Granite City, near the Missouri border, describes preparing for an influx of patients if Roe was overturned, but she nonetheless felt overwhelmed by how many came, 85 percent of them from out of state. “Even though that’s heartbreaking, and it means turning some patients away who need abortions,” she tells Cohen and Joffe, “we also have to survive. We have to be functioning human beings to give good healthcare.”
Issues that Cohen and Joffe point out in the immediate aftermath of Dobbs remain unresolved, notably the future of access to the pills that now account for about two thirds of all abortions and the struggle to define the life-saving exception that states with abortion bans purport to offer. How imminent does death have to be, and who decides, now that the woman herself no longer has a say? Much of the post-Dobbs story remains to be written. What’s clear for now, the authors conclude, is that “the resilience of those seeking and providing abortion is unflagging.”
“Periods of acute repression have not lasted,” Fissell writes at the end of her book to explain why she sees “cause for optimism” in the current climate:
Like wildfires, moral panics burn out, and times of toleration usually follow. People go back to looking the other way, acting on an unspoken understanding that these things happen, that sometimes a woman cannot bear a child, or that women know best.
I can’t conclude without a comment on language. In the last few years, there has been a push in some progressive circles to avoid the word women in connection with pregnancy and abortion. Because trans men and nonbinary people may choose to bear a child or may become pregnant and seek an abortion, the argument goes, it is exclusionary and imprecise to use language suggesting that these options are available only to women. Thus people, persons capable of pregnancy, and patients have become the terms of choice. (“Patients” seems to be growing in popularity, but it is a baffling option, because those seeking abortions become patients only after they actually find their way to a doctor.)
I understand the argument for inclusivity and precision, but I think the focus is fundamentally, even dangerously, misguided. If the history that Fissell has unearthed means anything, it is that abortion is an urgent issue of autonomy for women; enabling abortion empowers them and restricting it confines them. “I say women because I’m writing about the past,” she writes apologetically in the book’s introduction. But the insights she offers about the past are especially valuable because they help us understand the present. As Fissell’s painstaking excavation shows, to fail to place women at the center of the abortion story is to erase women from their own history.
English (US) · 