Our Bodies, Ourselves (73 page)

In rare instances, pain may also indicate ectopic pregnancy, when an embryo is implanted outside of the uterus, most commonly in a fallopian tube. A growing pregnancy can stretch and burst the tube, causing severe pain and bleeding in your abdomen. Although ectopic pregnancy is rare, it poses serious health risks and requires immediate medical attention. An ectopic pregnancy is not removed by vacuum aspiration or medication abortion using mifepristone. It is usually treated with methotrexate or surgery. (For more information, see
“Ectopic Pregnancy,”
) In very rare cases, severe pain without an accompanying fever can be the sign of a lethal infection caused by the bacterium
Clostridium sordellii
.

If you have a sustained fever of 100.4° Fahrenheit or above, you may have an infection. Misoprostol can cause a short-term fever. However, if your temperature remains elevated many hours, or if you have severe pain, call your provider.

Symptoms of pregnancy, such as nausea, bloating, or breast tenderness, typically resolve within a week or two following an abortion. If these symptoms persist, you may still be pregnant and should visit your provider. Taking a home pregnancy test is not useful, because you can continue to test positive for four to six weeks after a complete abortion, due to pregnancy hormones that are still in your body. Also, if you began using a hormonal birth control method (the Pill, patch, or vaginal ring) right after the abortion, know that these can cause pregnancy-like symptoms, particularly during the first few months of use.

Your abortion provider can tell you about the different types of contraception available and give you a method or prescription before you leave the clinic, if you so choose. Most contraceptive methods can be started immediately following the abortion—
see chart
.

Condoms are the only method of birth control that also protect against sexually transmitted infections (STIs). To protect yourself from HIV/AIDS and other infections, use condoms even if you are using another form of birth control. For more information on contraception, see
Chapter 9
, “Birth Control.” For more information on preventing STIs, see
Chapter 10
, “Safer Sex.”

Abortion has been used to control fertility in every known society, regardless of its legality. It was practiced legally in the United States until about 1880, by which time most states had banned it except to save the life of the woman. Antiabortion legislation was part of a backlash against the growing movements for suffrage and birth control—an effort to control women and confine them to a traditional childbearing role.
26

It was also a way for the medical profession to tighten its control over women's health care,
27
as midwives who performed abortions were a threat to the male medical establishment. Finally, with the declining birthrate among whites in the late 1800s, the U.S. government and the eugenics movement were concerned about “race suicide” and wanted white U.S.-born women to reproduce. More than most other medical procedures, the legality of abortion is linked to women's status and political power, as well as to
the population and economic objectives of the society.

 

Even when it was illegal, abortion was widely practiced. The ability of a woman to obtain an abortion at all, let alone one that was safe, depended upon her economic situation, her race, and where she lived. Women with money could often leave the country or find a physician who would perform the procedure for a high fee. Poor women, for the most part, were at the mercy of incompetent practitioners with questionable motives. Often unable to find a provider, poor women and women of color disproportionately turned to dangerous self-abortions, such as inserting knitting needles or coat hangers into the vagina and uterus, douching with dangerous solutions such as lye, or swallowing strong drugs or chemicals. All women were subject to the desperation, shame, and fear created by the criminalization of abortion.

I had an illegal abortion, which led to infection, and I was close to death. I ended up in a legal hospital with a real doctor who managed to pull me through. Thank god the pregnancy was terminated. All this rubbish about guilt feelings is just that. Ask me if I would do it again knowing the risks—YES—absolutely. Thank heaven it's legal now, so women don't have to endure life-threatening situations
.

When I was 15 and pregnant, abortion was illegal. I was denied any choice—I had a baby that I gave up for adoption. This experience has been a driving force in my life. I became an ob-gyn; I do abortions because I am totally committed to making sure that other women have the options that I didn't have
.

Laws prohibiting abortion took a heavy toll on women's lives and health. Because many deaths were not officially attributed to unsafe, illegal abortion, it's impossible to know the exact number. However, thousands of women a year were treated for health complications due to botched, unsanitary, or self-induced abortions; many died, or were left infertile or with chronic illness and pain.

This controversial photograph first came to widespread notice when it appeared in
Ms
. magazine in the early 1970s. It was later included in
The New Our Bodies, Ourselves
as a depiction of an anonymous victim of an illegal abortion. We now know that the photo is of Geraldine Santoro. The story of her life and tragic death from an illegal abortion is told in the documentary film
Leona's Sister Gerri
. (Files of Dr. Milton Halpern, former medical examiner, New York City.)

Before abortion was legalized, some dedicated and well-trained physicians and other medical practitioners risked imprisonment, fines, and loss of their medical licenses to provide abortions.
28
Through word of mouth, women found out how to obtain abortions. By the 1960s, the Clergy Consultation Service on Abortion, a network of concerned pastors and rabbis, and feminist groups had set up referral services to help women find safer illegal abortions.

In Chicago, a group of trained laywomen called the Abortion Counseling Service of the Chicago Women's Liberation Union went even further, creating an underground feminist abortion service. The group, whose code name was Jane, provided safe, inexpensive, and supportive illegal abortions. Over a four-year period, the group provided more than 11,000 first- and second-trimester abortions with a safety record comparable to that of today's legal medical facilities. Laura Kaplan, a former Jane member and the author of
The Story of Jane
, describes the women involved:

We were ordinary women who, working together, accomplished something extraordinary. Our actions, which we saw as potentially transforming for other women, changed us, too. By taking responsibility, we became responsible. Most of us grew stronger, more self-assured, confident in our own abilities. In picking up the tools of our own liberation, in our case medical instruments, we broke a powerful taboo. That act was terrifying, but it was also exhilarating. We ourselves felt exactly the same powerfulness that we wanted other women to feel
.
29

Throughout the world, wherever abortion is illegal and unsafe, committed people take enormous risks to provide safe abortions clandestinely, to treat women who have complications, and to help women find safe providers.

In the 1960s, inspired by the civil rights and antiwar movements, women organized a women's liberation movement. They fought, marched, and lobbied to make abortion safe and legal. At speak-outs, women talked publicly for the first time about their illegal abortion experiences. The women's movement, joined by sympathetic allies within the medical profession, made visible the millions of women who were willing to break the law and risk health and life to obtain an abortion. The movement also connected abortion rights to gender equality.

Between 1967 and 1973, about one-third of states reformed (fourteen) or repealed (four) restrictive abortion laws. Changes included allowing women access to abortion in certain circumstances, such as when the pregnancy was the result of rape or incest. In 1970, New York became the first state to legalize abortion on demand through the twenty-fourth week of pregnancy (Hawaii had earlier legalized abortion through twenty weeks, but only for residents of that state). Two other states (Alaska and Washington) followed, and women who could afford it began flocking to the few places where abortions were legal. Feminist networks offered support, loans, and referrals and fought to keep prices down. But for every woman who managed to get to New York, many others with limited financial resources or mobility still sought illegal abortions.

On January 22, 1973, the U.S. Supreme Court struck down all existing criminal abortion laws in the landmark
Roe v. Wade
decision. The court found that a woman's decision to terminate a pregnancy in the first trimester was protected under the “right of privacy . . . founded in the Fourteenth Amendment's concept of personal liberty.” The court allowed states to place restrictions in the second trimester to protect a woman's health and in the third trimester to protect a viable fetus. However, the Court held that if a pregnant woman's life or health were endangered, she would not be forced to continue the pregnancy at any stage.

The positive impact of
Roe v. Wade
on women's health in the United States was enormous. Fatal infections and hemorrhage due to abortion complications mostly became things of the past. However, the court did not secure abortion access for all women. Almost immediately after
Roe
passed, opponents of abortion rights began mobilizing, though it was not a major political issue for the Republican or Democratic parties as it is today.

Though unable to ban abortion outright, abortion rights opponents, through legislation and subsequent Supreme Court decisions, have created hundreds of state restrictions that make it extremely difficult for many women to obtain abortions. These state restrictions, which include excluding abortion from insurance funding, demanding that teens consult with one or both parents, and creating mandatory waiting periods and counseling sessions, have been devastating for the most vulnerable women: young women; women with low incomes, a disproportionate number of whom are women of color; women who live in rural areas; and women who depend on the government for health care.

Some abortion rights opponents go further in their efforts to impede women from having abortions by blocking access to clinics and harassing and intimidating abortion providers, patients and supporters. Operation Rescue gained notoriety in the 1980s for blockading clinic entrances, which provoked tens of thousands of arrests nationwide. Clinics have also been the targets of bombings, arson, anthrax threats, and acid attacks.

The massive protests and invasions of clinics
decreased after Congress passed the Freedom of Access to Clinic Entrances Act (FACE) in 1994, but FACE has not stopped the strategy of harassing individual doctors and their families by picketing their homes, circulating wanted posters with their pictures, publicizing their names online, or participating in direct violent attacks against doctors and clinic staff, including murder. Harassment and violence against providers have led to a sharp decrease in services.