History of abortion

The practice of abortion 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. Many early laws and church doctrine focused on "quickening," when the initial motion of the fetus can be felt by the pregnant woman, as a way to differentiate when an abortion became impermissible. In the 18th–19th centuries various doctors, clerics, and social reformers successfully pushed for an all-out ban on abortion. In the 20th century various women's rights groups, doctors and social reformers successfully repealed abortion bans. While abortion remains legal in many Western countries, it is regularly subjected to legal challenges by pro-life groups.

Medical: Practice & methods of abortion

Prehistory to 5th century

The first recorded evidence of induced abortion is from the Egyptian Ebers Papyrus in 1550 BC. A Chinese record documents the number of royal concubines who had abortions in China between the years 500 and 515 BC. According to Chinese folklore, the legendary Emperor Shennong prescribed the use of mercury to induce abortions nearly 5000 years ago.

Many of the methods employed in early and primitive cultures were non-surgical. Physical activities like strenuous labour, 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.

References in classical literature

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 right to induce abortion in the early stages of pregnancy.

Hippocratic Oath
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 practioners. While the Oath forbids the use of pessaries (vaginal suppositories) to induce abortion, it did not prohibit 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/fetus."

Regardless of the Oath's interpretaion, 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' Gynecology
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".

Natural Abortifacients
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.

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.

Christian texts
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."

5th century to 16th century

An 8th century Sanskrit text instructs women wishing to induce an abortion to sit over a pot of steam or stewed onions.

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 circa 1150, depicts a demon performing such an abortion upon a woman who has been sent to the underworld. This is believed to be the oldest known visual representation of abortion.

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.

Natural abortifacients

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 terminiate 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". More recently, two women in the United States have died as a result of abortions attempted by pennyroyal, one in 1978 through the consumption of its essential oil and another in 1994 through a tea containing its extract.

Tansy has been used to terminiate pregnancies since the Middle Ages. It was first documented as an emmenagogue in St. Hildegard of Bingen's De simplicis medicinae.

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 unspecificied origin included crushed ants, the saliva of camels, and the tail hairs of black-tailed deer dissolved in the fat of bears.

17th-century to present

M?ori 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 M?ori people did not practice abortion, for fear of Makutu, but did attempt feticide through the artificial induction of premature labor.

Nineteenth 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 British Parliament passed the Offences Against the Person Act.

Various methods of abortion were documented regionally in the nineteenth and early twentieth centuries. 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 abortionists 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.

18th century to 20th century

In France during the latter half of the 19th century, social perceptions 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 practioners agreed on the relative safety of the procedure.

In the United States and England, the latter half of the 19th century abortion became increasingly criminalized. As access to medical abortions diminished, women often sought dangerous alternatives.

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 concotion 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.

Advertisement of abortion services

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.

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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 did not fail to arouse 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 lead 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).

Madame Restell

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 Restelle 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 lead to her suicide on the day of her trial April 1, 1878.

Development of contemporary methods

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 1800s, 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 MVA 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 is 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.

Social: History of abortion debate

Social discourses regarding abortion have historically been related to issues of family planning, religious and moral ideology, and human rights.

Prehistory to 5th century

Abortion was a common practice. Evidence suggests that late-term abortions were performed in a number of cultures. In Greece, 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 proprety of pennyroyal in 421 BC, through a humorous reference in his comedy, Peace. The ancient Greeks relied upon the herb silphium 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.

In Rome, abortion was practiced "with little or no sense of shame." There were also opposing voices, most notably Hippocrates of Cos and the Roman Emperor Augustus. Aristotle wrote that, "[T]he line between lawful and unlawful abortion will be marked by the fact of having sensation and being alive." In contrast to their pagan environment, Christians generally shunned abortion, drawing upon early Christian writings such as the Didache (circa 100 A.D.), which says: "... thou shalt not murder a child by abortion nor kill the infant already born." 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.

5th century to 16th century

Legal: History of abortion law

The history of abortion law dates back to ancient times and has impacted men and women in a variety of ways in different times and places. While laws regulating acceptable forms of abortion began with the Romans, widespread regulation restricting women's choice to have an abortion did not begin until the 13th century.

There were no laws against abortion in the Roman Republic and early Roman Empire, as Roman law did not regard a fetus as distinct from the mother's body, and abortion was not infrequently practiced to control family size, to maintain one's physical appearance, or because of adultery. In 211 AD, at the intersection of the reigns of Septimius Severus and Caracalla, abortion was outlawed for a period of time as violating the rights of parents, punishable by temporary exile. However, late Roman legislation is generally derived from a concern for population growth, and not as an issue of morality.

Historically, it is unclear how often the ethics of abortion (induced abortion) was discussed, but widespread regulation did not begin until the 18th century. One factor in abortion restrictions was a socio-economic struggle between male physicians and female mid-wives. In the 18th century, English and American common law allowed abortion if performed before "quickening." By the late 19th century many nations had passed laws that banned abortion. In the later half of the 20th century most Western nations began to legalize abortion. Abortion is an issue of reproductive rights, a sub-set of human rights. This controversial subject has sparked heated debate and in some cases even violence against abortion providers.

According to English common law, abortion after fetal movement or "quickening" was punishable as homicide, and abortion was also punishable "if the foetus is already formed" but not yet quickened, according to Henry Bracton.

17th century to 19th century

1920s to 1960s

1970s to present

See also

References

External links

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