When There Was No Choice

Human Rights

At 77, Dr. Harry S. Jonas can still pinpoint the exact moment when he understood the importance of making abortion legal. The year was 1952 and he was an eager, young obstetrics-gynecology intern in Independence, Miss.. The specialty promised exciting pregnancies and bouncing babies, but his very first patient entered the hospital extremely sick. A mother of 12 children, she had tried�unsuccessfully�to induce an abortion. "She came into the hospital with her intestines hanging out her vagina," recalls Jonas. "Then she died."

For Mildred Hanson, the belief that abortion laws had to change came more gradually, even after she first learned about the danger of illegal abortions as a girl in rural Wisconsin. In 1935, when Hanson was 11, a woman on a neighboring farm died at home after having an illegal abortion. Hanson remembers her mother going next door to help the ailing woman, holding her while she died. The widower was left with six children, two of them in diapers.

By the time she finished her medical training in 1959, Hanson was seeing many patients with complications from illegal abortions. Some had gone to illegal practitioners. Others attempted the procedure themselves using rubber tubes, knitting needles, or potassium permanganate�a corrosive substance that could end a pregnancy but all too often only caused bleeding, ulcers and burns. And of course there were the wire hangers. Hanson eventually developed a reputation for being among a minority who would treat these women. She tended to their infections, bleedings, and wounds for almost two decades. And by the time abortions became legal, Hanson knew she would perform them.

Eugene Glick's first experience with illegal abortion was personal. His wife, who was then his girlfriend, was 19 when she got pregnant in 1951. Neither was ready to have a baby�she wanted to finish college and he was planning on going to medical school. They thought they were lucky to find an OB-GYN willing to perform the procedure illegally, but "he didn't even sterilize the instruments," as Glick remembers. Glick's wife got a serious infection and wound up needing major surgery.

When he got to medical school, Glick noticed his teachers willfully ignored the consequences of illegal abortions. "They didn't want it to even appear that they knew what to do," he remembers. But Glick couldn't overlook the desperation�and began finding ways to perform abortions even before they were legal. His hospital had an abortion committee, which would approve the procedure if a doctor determined that a pregnancy threatened a woman's physical or mental health. "We all knew which psychiatrist to send them to," says Glick. "All of us sort of bent the rules." Eventually, in 1977, after delivering 5,000 babies as an obstetrician, Glick started performing abortions full-time.

If their paths toward providing abortions were different, Hanson, Glick and Jonas have a few things in common. Like many other doctors committed to choice, they witnessed the devastating consequences of illegal abortions firsthand. This week, the 32nd anniversary of Roe v. Wade, the Supreme Court decision establishing the constitutional right to end a pregnancy, will occur just two days after our anti-abortion president celebrates his inauguration. With several Supreme Court appointments potentially at stake, it's worth remembering what those pioneering physicians learned through treating thousands of women who'd had unsafe abortions: Outlawing the procedure doesn't make it go away.

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Abortions were common well before New York decriminalized them in 1970 and Roe made them legal in the rest of the country in 1973. The Alan Guttmacher Institute, which does research on reproductive issues, reports that in 1930 almost 2,700 women died from illegal abortions�and that's just the number who had abortion recorded as their official cause of death. Almost one in 10 low-income women in New York City reported having attempted to end a pregnancy with an illegal abortion, according to one study done in the 1960s. In 1962 alone, almost 1,600 women were treated for incomplete illegal abortions in at Harlem Hospital. And there's plenty of current evidence showing the danger of outlawing the procedure. According to the World Health Organization, an estimated 80,000 women around the world still die each year of complications from illegal abortion.

Roe v. Wade quickly cleared up this country's illegal-abortion mess, almost overnight. Deaths from botched abortions slowed dramatically. The number of women admitted for unexplained miscarriages dropped precipitously. And doctors could finally spare their patients the dangers of untrained, illegal practitioners or self-inflicted injuries without risking jail time or their medical licenses.

Yet some physicians, especially younger ones, don't seem to grasp the grim situation women faced before 1973. "Doctors who weren't practicing before Roe don't fully understand about the kind of degradation and death that really resulted from illegal abortion," says Wendy Chavkin, chair of Physicians for Reproductive Choice and Health, and a professor of OB-GYN and public health at Columbia University. "As a result, they're more likely to be vulnerable to the attacks on abortion and decide that performing them is too much trouble. What they don't know is that, without legal abortions, their patients will suffer, die, or have drastically reduced life options."

The fading of collective memory helps explain why the number of doctors willing to perform the procedure is falling. There were only 1,819 abortion providers in 2000, down 11 percent from the 2,042 abortion providers in 1996, according to the Guttmacher Institute. And these days, as legal restrictions on abortion mount, most doctors who do abortions are over 65. Rather than performing the procedures in their offices or in hospitals, they've been forced to do them in freestanding clinics, where they and their patients are exposed to violence and harassment.

Hanson, who lived through darker times, has noticed the shift. "To perform an abortion in a hospital is harder today than it was before Roe," says Hanson.

"Before 1973, I had no trouble scheduling them. You just had to find two doctors to sign the form," she says, referring to the paperwork declaring that a pregnancy threatened a woman's mental health. "Now if you want to do an abortion in a Minnesota hospital, you have trouble finding an anesthetist and a circulating nurse who will do it. There's more anti-abortion sentiment." Nevertheless, Hanson still performs abortions at 81 because of "personal commitment," as she puts it.

In New York, William Rashbaum, a 78-year-old obstetrician and gynecologist, also continues to work well past what many think of as retirement age. As with other veteran abortion doctors, Rashbaum's career has spanned many eras. He saw "gobs and gobs" of women with complications from illegal abortions during his training in New York City in the 1950s. Then Rashbaum went on to provide medical advice and backup to illegal abortionists before Roe. (One, in New Jersey, sent a limousine containing a pale, bleeding patient and the piece of her intestine he had accidentally cut off to Rashbaum's office.) And after abortions became legal, he provided them. Now as his practice winds down, Rashbaum worries that the right to safe, legal abortion is slipping away. "You'd be crazy not to worry," says the white-haired physician. "Abortion has always had a stigma. And now, instead of things getting better, they're getting worse."

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