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The practice of abortion, the termination of a pregnancy so that it does not result in birth, dates back to ancient times. Pregnancies were terminated through a number of methods, including the administration of abortifacient herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques.
Abortion laws and their enforcement have fluctuated through various eras. In many western nations during the 20th century various women's rights groups, doctors, and social reformers successfully worked to have abortion bans repealed. While abortion remains legal in most of the West, this legality is regularly challenged by anti-abortion groups.
The written evidence of abortion reflects the interests of class and caste. Fines are listed in the Code of Hammurabi, ca. 1760 BCE, for the crime of causing a miscarriage through assault, with the amount varying according to the social rank of the woman. The Vedic and smrti laws of India reflect a concern with preserving the male seed of the three upper castes; and the religious courts imposed various penances for the woman or excommunication for a priest who provided an abortion. The only evidence of the death penalty being mandated for abortion in the ancient laws is found in Assyrian Law, in the Code of Assura, c. 1075 BCE; and this is only imposed on a woman who procures an abortion against her husband's wishes. The first recorded evidence of induced abortion is from the Egyptian Ebers Papyrus in 1550 BCE.
Many of the methods employed in early and primitive cultures were non-surgical. Physical activities like strenuous labor, climbing, paddling, weightlifting, or diving were a common technique. Others included the use of irritant leaves, fasting, bloodletting, pouring hot water onto the abdomen, and lying on a heated coconut shell. In primitive cultures, techniques developed through observation, adaptation of obstetrical methods, and transculturation. Archaeological discoveries indicate early surgical attempts at the extraction of a fetus; however, such methods are not believed to have been common, given the infrequency with which they are mentioned in ancient medical texts.
A Chinese record documents the number of royal concubines who had abortions in China between the years 515 and 500 BCE. According to Chinese folklore, the legendary Emperor Shennong prescribed the use of mercury to induce abortions nearly 5000 years ago.
Much of what is known about the methods and practice of abortion in Greek and Roman history comes from early classical texts. Abortion, as a gynecological procedure, was primarily the province of women who were either midwives or well-informed laypeople. In his Theaetetus, Plato mentions a midwife's ability to induce abortion in the early stages of pregnancy. It is thought unlikely that abortion was punished in classical Greece. However, a fragment attributed to the poet Lysias "suggests that abortion was a crime in Athens against the husband, if his wife was pregnant when he died, since his unborn child could have claimed the estate."
The Stoics believed the fetus to be plantlike in nature, and not an animal until the moment of birth, when it finally breathed air. They therefore found abortion morally acceptable. The Greek playwright Aristophanes noted the abortifacient property of pennyroyal in 421 BC, through a humorous reference in his comedy, Peace.
The ancient Greeks relied upon the herb silphium as an abortifacient and contraceptive. The plant, as the chief export of Cyrene, was driven to extinction, but it is suggested that it might have possessed the same abortive properties as some of its closest extant relatives in the Apiaceae family. Silphium was so central to the Cyrenian economy that most of its coins were embossed with an image of the plant. Pliny the Elder cited the refined oil of common rue as a potent abortifacient. Serenus Sammonicus wrote of a concoction which consisted of rue, egg, and dill. Soranus, Dioscorides, Oribasius also detailed this application of the plant. Modern scientific studies have confirmed that rue indeed contains three abortive compounds. Birthwort, an herb used to ease childbirth, was also used to induce abortion. Galen included it in a potion formula in de Antidotis, while Dioscorides said it could be administered by mouth, or in the form of a vaginal pessary also containing pepper and myrrh.
In Aristotle's view, abortion, if performed early, was not the killing of something human, and Aristotle would permit abortion if the birth rate was too high, but only at a stage before life and sense had begun in the embryo. Aristotle considered the embryo to gain a human soul at 40 days if male and 90 days if female; before that, it had vegetable and animal souls.
The Oath is part of the Hippocratic Corpus. Often ascribed to Hippocrates, the Greek physician, the Corpus is believed to be the collective work of Hippocratic practitioners. The Oath forbids the use of pessaries to induce abortion. Modern scholarship suggests that pessaries were banned because they were reported to cause vaginal ulcers. This specific prohibition has been interpreted by some medical scholars as prohibiting abortion in a broader sense than by pessary. One such interpretation is by Scribonius Largus, a Roman medical writer: "Hippocrates, who founded our profession, laid the foundation for our discipline by an oath in which it was proscribed not to give a pregnant woman a kind of medicine that expels the embryo or fetus." Other medical scholars disagree, believing that Hippocrates sought to discourage physicians from trying dangerous methods to abort a fetus.
Regardless of the Oath's interpretation, Hippocrates writes of advising a prostitute who became pregnant to jump up and down, touching her buttocks with her heels at each leap, so as to induce miscarriage. Other writings attributed to him describe instruments fashioned to dilate the cervix and curette inside of the uterus.
Soranus, a 2nd-century Greek physician, recommended abortion in cases involving health complications as well as emotional immaturity, and provided detailed suggestions in his work Gynecology. Diuretics, emmenagogues, enemas, fasting, and bloodletting were prescribed as safe abortion methods, although Soranus advised against the use of sharp instruments to induce miscarriage, due to the risk of organ perforation. He also advised women wishing to abort their pregnancies to engage in energetic walking, carrying heavy objects, riding animals, and jumping so that the woman's heels were to touch her buttocks with each jump, which he described as the "Lacedaemonian Leap."
Soranus offered a number of recipes for herbal bathes, rubs, and pessaries. In De Materia Medica Libri Quinque, the Greek pharmacologist Dioscorides listed the ingredients of a draught called "abortion wine"– hellebore, squirting cucumber, and scammony– but failed to provide the precise manner in which it was to be prepared. Hellebore, in particular, is known to be abortifacient.
No evidences exists for the illegality of abortion under the Roman republic. Attitudes changed with the spread of Christianity and around 211 CE emperors Septimius Severus and Caracalla banned abortion as infringing on parental rights; temporary exile was the punishment.
This new attitude is reflected in the third century legal compilation Pauli sententiae (attributed to Julius Paulus Prudentissimus):
[T]hose who administer a beverage for the purpose of producing abortion, or of causing affection, although they may not do so with malicious intent, still, because the act offers a bad example, shall, if of humble rank, be sent to the mines; or, if higher in degree, shall be relegated to an island, with the loss of a portion of their property. If a man or a woman should lose his or her life through such an act, the guilty party shall undergo the extreme penalty."
And also Ulpian, as it appears in the Digest regarding to the institution of curator ventris (protector of the womb): "An unborn child is considered being born, as far as it concerns his profits." Despite this, abortion continued to be practiced "with little or no sense of shame."
Suzanne Dixon, a senior lecturer in the Department of Classics and Ancient History at the University of Queensland, writes that abortion was a threat to traditional power structures in the classical Roman world. A husband had power over his wife, her body, and their children. She explains that writings from the classical world portray abortion as expressions of an ideological agenda where men maintain or reestablish patterns of power between the sexes, not as information about historical realities.:27 Punishment for abortion in the Roman Republic was inflicted as a violation of the father's right to dispose of his offspring.:3 Because of the influence of Stoicism, which did not view the fetus as a person, the Romans did not punish abortion as homicide.
Tertullian, a 2nd- and 3rd-century Christian theologian, also described surgical implements which were used in a procedure similar to the modern dilation and evacuation. One tool had a "nicely-adjusted flexible frame" used for dilation, an "annular blade" used to curette, and a "blunted or covered hook" used for extraction. The other was a "copper needle or spike." He attributed ownership of such items to Hippocrates, Asclepiades, Erasistratus, Herophilus, and Soranus.
Tertullian's description is prefaced as being used in cases in which abnormal positioning of the fetus in the womb would endanger the life of the pregnant women. Saint Augustine, in Enchiridion, makes passing mention of surgical procedures being performed to remove fetuses which have expired in utero. Aulus Cornelius Celsus, a 1st-century Roman encyclopedist, offers an extremely detailed account of a procedure to extract an already dead fetus in his only surviving work, De Medicina.
In Book 9 of Refutation of all Heresies, Hippolytus of Rome, another Christian theologian of the 3rd century, wrote of women tightly binding themselves around the middle so as to "expel what was being conceived."
In contrast to their pagan environment, Christians generally shunned abortion, drawing upon early Christian writings such as the Didache (c. 150 A.D.), which says: "…do not murder a child by abortion or kill a new-born infant." Saint Augustine believed that abortion of a fetus animatus, a fetus with human limbs and shape, was murder. However, his beliefs on earlier-stage abortion were similar to Aristotle's, though he could neither deny nor affirm whether such unformed fetuses would be resurrected as full people at the time of the second coming.
The technique of massage abortion, involving the application of pressure to the pregnant abdomen, has been practiced in Southeast Asia for centuries. One of the bas reliefs decorating the temple of Angkor Wat in Cambodia, dated c. 1150, depicts a demon performing such an abortion upon a woman who has been sent to the underworld.
Japanese documents show records of induced abortion from as early as the 12th century. It became much more prevalent during the Edo period, especially among the peasant class, who were hit hardest by the recurrent famines and high taxation of the age. Statues of the Boddhisattva Jizo, erected in memory of an abortion, miscarriage, stillbirth, or young childhood death, began appearing at least as early as 1710 at a temple in Yokohama (see religion and abortion).
Physical means of inducing abortion, such as battery, exercise, and tightening the girdle– special bands were sometimes worn in pregnancy to support the belly– were reported among English women during the early modern period.
Māori, who lived in New Zealand before and at the time of colonisation, terminated pregnancies via miscarriage-inducing drugs, ceremonial methods, and girding of the abdomen with a restrictive belt. Another source claims that the Māori people did not practice abortion, for fear of Makutu, but did attempt abortion through the artificial induction of premature labor.
Botanical preparations reputed to be abortifacient were common in classical literature and folk medicine. Such folk remedies, however, varied in effectiveness and were not without the risk of adverse effects. Some of the herbs used at times to terminate pregnancy are poisonous.
A list of plants which cause abortion was provided in De viribus herbarum, an 11th-century herbal written in the form of a poem, the authorship of which is incorrectly attributed to Aemilius Macer. Among them were rue, Italian catnip, savory, sage, soapwort, cyperus, white and black hellebore, and pennyroyal.
King's American Dispensatory of 1898 recommended a mixture of brewer's yeast and pennyroyal tea as "a safe and certain abortive." Pennyroyal has been known to cause complications when used as an abortifacient. In 1978 a pregnant woman from Colorado died after consuming 2 tablespoonfuls of pennyroyal essential oil which is known to be toxic. In 1994 a pregnant woman, unaware of an ectopic pregnancy that needed immediate medical care, drank a tea containing pennyroyal extract to induce abortion without medical help. She later died as a result of the untreated ectopic pregnancy, mistaking the symptoms for the abortifacient working.
A variety of juniper, known as savin, was mentioned frequently in European writings. In one case in England, a rector from Essex was said to have procured it for a woman he had impregnated in 1574; in another, a man wishing to remove his girlfriend of like condition recommended to her that black hellebore and savin be boiled together and drunk in milk, or else that chopped madder be boiled in beer. Other substances reputed to have been used by the English include Spanish fly, opium, watercress seed, iron sulphate, and iron chloride. Another mixture, not abortifacient, but rather intended to relieve missed abortion, contained dittany, hyssop, and hot water.
The root of worm fern, called "prostitute root" in the French, was used in France and Germany; it was also recommended by a Greek physician in the 1st century. In German folk medicine, there was also an abortifacient tea, which included marjoram, thyme, parsley, and lavender. Other preparations of unspecified origin included crushed ants, the saliva of camels, and the tail hairs of black-tailed deer dissolved in the fat of bears.
19th century medicine saw advances in the fields of surgery, anaesthesia, and sanitation, in the same era that doctors with the American Medical Association lobbied for bans on abortion in the United States and the Parliament of the United Kingdom passed the Offences against the Person Act 1861.
Various methods of abortion were documented regionally in the 19th century and early 20th century. A paper published in 1870 on the abortion services to be found in Syracuse, New York, concluded that the method most often practiced there during this time was to flush inside of the uterus with injected water. The article's author, Ely Van de Warkle, claimed this procedure was affordable even to a maid, as a man in town offered it for $10 on an installment plan. Other prices which 19th-century abortion providers are reported to have charged were much more steep. In Great Britain, it could cost from 10 to 50 guineas, or 5% of the yearly income of a lower middle class household.
In France during the latter half of the 19th century, social perceptions of abortion started to change. In the first half of the 19th century, abortion was viewed as the last resort for pregnant but unwed women. But as writers began to write about abortion in terms of family planning for married women, the practice of abortion was reconceptualized as a logical solution to unwanted pregnancies resulting from ineffectual contraceptives. The formulation of abortion as a form of family planning for married women was made "thinkable" because both medical and non-medical practitioners agreed on the relative safety of the procedure.
In the United States and England, the latter half of the 19th century saw abortion become increasingly punished. One writer justified this by claiming that the number of abortions among married women had increased markedly since 1840. In the United States, these laws had a limited effect on middle and upper class women who could, though often with great expense and difficulty, still obtain access to abortion, while poor and young women had access only to the most dangerous and illegal methods.
After a rash of unexplained miscarriages in Sheffield, England, were attributed to lead poisoning caused by the metal pipes which fed the city's water supply, a woman confessed to having used diachylon — a lead-containing plaster — as an abortifacient in 1898. Criminal investigation of an abortionist in Calgary, Alberta in 1894 revealed through chemical analysis that the concoction he had supplied to a man seeking an abortifacient contained Spanish fly.
Women of Jewish descent in Lower East Side, Manhattan are said to have carried the ancient Indian practice of sitting over a pot of steam into the early 20th century. Dr. Evelyn Fisher wrote of how women living in a mining town in Wales during the 1920s used candles intended for Roman Catholic ceremonies to dilate the cervix in an effort to self-induce abortion. Similarly, the use of candles and other objects, such as glass rods, penholders, curling irons, spoons, sticks, knives, and catheters was reported during the 19th century in the United States.
Abortion remained a dangerous procedure into the early 20th century; more dangerous than childbirth until about 1930. Of the estimated 150,000 abortions that occurred annually in the US during the early 20th century, one in six resulted in the woman's death.
Access to abortion continued, despite bans enacted on both sides of the Atlantic Ocean, as the disguised, but nonetheless open, advertisement of abortion services, abortion-inducing devices, and abortifacient medicines in the Victorian era would seem to suggest. Apparent print ads of this nature were found in both the United States, the United Kingdom, and Canada. A British Medical Journal writer who replied to newspaper ads peddling relief to women who were "temporarily indisposed" in 1868 found that over half of them were in fact promoting abortion.
A few alleged examples of surreptitiously-marketed abortifacients include "Farrer's Catholic Pills," "Hardy's Woman's Friend," "Dr. Peter's French Renovating Pills," "Lydia Pinkham's Vegetable Compound," and "Madame Drunette's Lunar Pills." Patent medicines which claimed to treat "female complaints" often contained such ingredients as pennyroyal, tansy, and savin. Abortifacient products were sold under the promise of "restor[ing] female regularity" and "removing from the system every impurity." In the vernacular of such advertising, "irregularity," "obstruction," "menstrual suppression," and "delayed period" were understood to be euphemistic references to the state of pregnancy. As such, some abortifacients were marketed as menstrual regulatives. "Old Dr. Gordon's Pearls of Health," produced by a drug company in Montreal, "cure[d] all suppressions and irregularities" if "used monthly." However, a few ads explicitly warned against the use of their product by women who were expecting, or listed miscarriage as its inevitable side effect. The copy for "Dr. Peter's French Renovating Pills" advised, "…pregnant females should not use them, as they invariably produce a miscarriage…," and both "Dr. Monroe's French Periodical Pills" and "Dr. Melveau's Portuguese Female Pills" were "sure to produce a miscarriage." F.E. Karn, a man from Toronto, in 1901 cautioned women who thought themselves pregnant not to use the pills he advertised as "Friar's French Female Regulator" because they would "speedily restore menstrual secretions."
Such advertising aroused criticisms of quackery and immorality. The safety of many nostrums was suspect and the efficacy of others non-existent. Horace Greeley, in a New York Herald editorial written in 1871, denounced abortion and its promotion as the "infamous and unfortunately common crime– so common that it affords a lucrative support to a regular guild of professional murderers, so safe that its perpetrators advertise their calling in the newspapers." Although the paper in which Greeley wrote accepted such advertisements, others, such as the New York Tribune, refused to print them. Elizabeth Blackwell, the first woman to obtain a Doctor of Medicine in the United States, also lamented how such ads led to the contemporary synonymity of "female physician" with "abortionist." The Comstock Law made all abortion-related advertising illegal in the United States (see history of abortion law).
A well-known example of a Victorian-era abortionist was Madame Restell, or Ann Lohman, who over a forty-year period illicitly provided both surgical abortion and abortifacient pills in the northern United States. She began her business in New York during the 1830s, and, by the 1840s, had expanded to include franchises in Boston and Philadelphia.
It is estimated that by 1870 her annual expenditure on advertising alone was $60,000. One ad for Restell's medical services, printed in the New York Sun, promised that she could offer the "strictest confidence on complaints incidental to the female frame" and that her "experience and knowledge in the treatment of cases of female irregularity, [was] such as to require but a few days to effect a perfect cure." Another, addressed to married women, asked the question, "Is it desirable, then, for parents to increase their families, regardless of consequences to themselves, or the well-being of their offspring, when a simple, easy, healthy, and certain remedy is within our control?" Advertisements for the "Female Monthly Regulating Pills" she also sold vowed to resolve "all cases of suppression, irregularity, or stoppage of the menses, however obdurate." Madame Restell was an object of criticism in both the respectable and penny presses. She was first arrested in 1841, but, it was her final arrest by Anthony Comstock which led to her suicide on the day of her trial April 1, 1878.
Although prototypes of the modern curette are referred to in ancient texts, the instrument which is used today was initially designed in France in 1723, but was not applied specifically to a gynecological purpose until 1842. Dilation and curettage has been practiced since the late 19th century.
The 20th century saw improvements in abortion technology, increasing its safety, and reducing its side-effects. Vacuum devices, first described in medical literature in the 19th century, allowed for the development of suction-aspiration abortion. This method was practiced in the Soviet Union, Japan, and China, before being introduced to Britain and the United States in the 1960s. The invention of the Karman cannula, a flexible plastic cannula which replaced earlier metal models in the 1970s, reduced the occurrence of perforation and made suction-aspiration methods possible under local anesthesia. In 1971, Lorraine Rothman and Carol Downer, founding members of the feminist self-help movement, invented the Del-Em, a safe, cheap suction device that made it possible for people with minimal training to perform early abortions called menstrual extraction. During the mid-1990s in the United States the medical community showed renewed interest in manual vacuum aspiration as a method of early surgical abortion. This resurgence is due to technological advances that permit early pregnancy detection (as soon as a week after conception) and a growing popular demand for safe, effective early abortion options, both surgical and medical. An innovator in the development of early surgical abortion services is Jerry Edwards, a physician, who developed a protocol in which women are offered an abortion using a handheld vacuum syringe as soon as a positive pregnancy test is received. This protocol also allows the early detection of an ectopic pregnancy.
Intact dilation and extraction was developed by Dr. James McMahon in 1983. It resembles a procedure used in the 19th century to save a woman's life in cases of obstructed labor, in which the fetal skull was first punctured with a perforator, then crushed and extracted with a forceps-like instrument, known as a cranioclast.
In 1980, researchers at Roussel Uclaf in France developed mifepristone, a chemical compound which works as an abortifacient by blocking hormone action. It was first marketed in France under the trade name Mifegyne in 1988.
In the mid-to-late 19th century, during the fight for women's suffrage in the U.S., many first-wave feminists, such as Elizabeth Cady Stanton opposed abortion. In the newspaper she operated with Susan B. Anthony, The Revolution, an anonymous contributor signing "A" wrote in 1869 about the subject, arguing that instead of merely attempting to pass a law against abortion, the root cause must also be addressed. Simply passing an anti-abortion law would, the writer stated, "be only mowing off the top of the noxious weed, while the root remains. [...] No matter what the motive, love of ease, or a desire to save from suffering the unborn innocent, the woman is awfully guilty who commits the deed. It will burden her conscience in life, it will burden her soul in death; But oh! thrice guilty is he who drove her to the desperation which impelled her to the crime."
Around 1970, during second-wave feminism, abortion and reproductive rights were unifying issues among various women's rights groups in Canada, the United States, the Netherlands, Britain, Norway, France, Germany, and Italy.
Abortion has been banned or restricted throughout history in countries around the world. Multiple scholars have noticed that in many cases, this has caused women to seek dangerous, illegal abortions underground or inspired trips abroad for "reproductive tourism." Half of the world's current deaths due to unsafe abortions occur in Asia.
In the early 1950s, the Chinese government made abortion illegal, with punishments for those who received or performed illegal abortions written into the law. These restrictions were seen as the government's way of emphasizing the importance of population growth. As the decade went on, however, the laws were relaxed with the intent of reducing the number of deaths and life-long injuries women sustained due to illegal abortions as well as serving as a form of population control when used in conjunction with birth control. In the early 1980s, the state implemented a form of family planning which used abortion as a "back-up method"; and in 2005, there has been legislation trying to curb sex-selective abortion.
India enforced the Indian Penal Code from 1860 to 1971, criminalizing abortion and punishing both the practitioners and the women who sought out the procedure. As a result, countless women died in an attempt to obtain illegal abortions from unqualified midwives and "doctors." Abortion was made legal under specific circumstances in 1971, but as scholar S. Chandrasekhar notes, lower class women still find themselves at a greater risk of injury or death as a result of a botched abortion.
Japan is known today worldwide for its acceptance of abortion. It is estimated that two-thirds of Japanese women have an abortion by age forty, partially due to former government restrictions on contraceptive pills on 'public hygiene grounds'.
The Eugenics Protection Law of 1948 made abortion on demand legal up to twenty-two weeks' gestation so long as the woman's health was endangered; in 1949, this law was extended to consider the risk the child's birth would place on a woman's economic welfare. Originally, each case would have to be approved by a local eugenics council, but this law was removed from the law in 1952, making the decision a private one between a woman and her physician.
In 1964, the creation of the conservative right-wing nationalist political lobbying group called Seicho-no-Ie brought about a strong opposition to the abortion laws. This campaign reached its peak strength in the early 1980s, but ultimately failed in 1983.
In 1957, Romania legalized abortion, but in 1966, after a decline in the national birthrate, Nicolae Ceauşescu approved Decree 770, which criminalized abortion and encouraged childbirth. As a result of this decree, women were forced to seek out illegal methods of abortion that caused the deaths of over 9,000 women and left countless unwanted children abandoned in orphanages. Abortion remained illegal until 1989, when the decree was overturned.
There was intense public debate throughout the 1980s and 1990s over legal abortion reform. These debates portrayed abortion as un-Buddhist and anti-religious; abortion opponents ultimately labeled it as a form of Western corruption that was inherently anti-Thai and threatened the integrity of the nation. Despite this, in 2006, abortions became legal in cases of rape or foetal impairment. Mental health also became a factor in determining the legality of an abortion procedure. The strict regulations involved in qualifying for a legal abortion, however, cause approximately 300,000 women a year to seek illegal avenues according to scholar Andrea Whittaker, with the poorest undergoing the most dangerous of procedures.