A metal coat hanger cannot speak, but it can send a message. Long a symbol of the dangers faced by people living in the years before Roe B.C. Wade attempting to terminate pregnancies, hangers are synonymous with a whole range of physical horrors, most of which never specifically involved hangers. In recent weeks, protesters have sent hangers to the Supreme Court in an effort to conjure up that bygone era – from the so-called back alley butchers who screwed up surgical procedures and sexually molested patients, to the horrible lengths individuals went to to give themselves an abortion at home. The message is simple and brutal: Without safe and legal abortion, protesters believe, people will die.
In the years since Roe became law in the country, the medical landscape of abortion has changed drastically. Abortion is extremely safe today — safer than childbirth. So safe that it’s not always obvious what made illegal abortions unsafe. Or what the hangers were to the.
And that’s why these objects still have important stories to tell us, historians have told me. For while the most physically violent abortion methods of the past have become medically obsolete, advances in science have not eliminated the shame, fear and hopelessness of people who are pregnant, don’t want to become pregnant and live in a society where there is no easy, legal access gives for abortion. Coat hangers don’t just tell us about the dangers of bad medicine poorly practiced, these historians said. Instead, the hooks also speak volumes about the desperation that can lead people to these dangerous practices in the first place.
“The whole term ‘backyard butcher’ is an exaggeration because there were many good practitioners who were perfectly safe,” said Leslie J. Reagan, professor of history at the University of Illinois at Urbana-Champaign and author of When Abortion Was a Crime .”
Even in the past, the dangers of illegal abortion were not about the abortion itself. No one knows how many illegal abortions were performed annually before Roe, but researchers did in the early 1990s At the time, it was estimated to be equivalent to the annual number of legal abortionsso more than 1 million. People with money and connections could always get safe ones, and many people survived, said the historians I spoke to. Illegal abortions were primarily unsafe for those who were denied better options.
Legal abortions in hospitals, for example, took place with some regularity. These records were kept from hospital to hospital, so there is rarely even citywide data, but historian Felicia Kornbluh of the University of Vermont pointed this out to me a 1965 publication stating that New York City hospital review boards had approved 4,703 so-called therapeutic abortions between 1951 and 1962. In these cases, the actual technique used was what is known as dilatation and curettage, or D&C. Also often referred to as “surgical termination of pregnancy,” D&C is still used today to treat abortions and miscarriages. Doctors dilate the cervix — making the opening between the vagina and uterus wider — and use a sharp tool to scrape out the contents of the uterus.
Before Roe, in the 1950s and ’60s, getting a legal hospital abortion wasn’t easy. A patient might receive a D&C if she has already had a natural miscarriage. Otherwise, patients who request it would have to raise a case with their doctors, who would then have to take the situation before a hospital review board. The patient would likely be examined by other doctors and might have to answer questions – basically they had to show that the abortion was medically or psychologically necessary. But necessity wasn’t the only factor at play. “There are studies that show almost all of them have been done on people with private insurance,” Reagan said. Patients without insurance, as well as black and brown patients, regardless of insurance status, had a much harder time gaining admission. In her forthcoming book, A Woman’s Life Is a Human Life, Kornbluh reports that the Metropolitan Hospital in East Harlem has granted applications from five white women for every black woman. The hospital was even less likely to grant applications from Puerto Rican women. And Reagan has documented cases where black women have been denied abortions even though they have had them Rubella infection during pregnancy – something that can kill a fetus or cause lifelong complications, including deafness, heart defects, and intellectual disabilities. (Others have been lied to and told they didn’t have it.)
People who were denied a hospital abortion — or who never had any hope of having a hospital abortion — were left with illegal options. Both trained physicians and untrained practitioners offered D&Cs, but this procedure was significantly more dangerous in illegal settings. With no sterilized equipment and easy access to antibiotics and painkillers, doctors engaged in clandestine practices optimized for speed with no room for follow-up care, and doctors sometimes had no idea what they were doing. Carole Joffe, a professor of obstetrics and gynecology at the University of California, San Francisco, interviewed medical doctors who practiced illegal abortions during this time and wrote about their experiences. A doctor told her that he used to explain the challenges of performing a D&C by telling his residents that it was like trying blindfolded to scrape the inside of a wet paper bag without cutting through the paper. Possible, but not easy. “D&Cs in competent hands are safe, but in incompetent hands it’s very easy to perforate the uterus,” Joffe said.
To avoid trying to do the tricky D&C under covert circumstances, illegal abortifacies sometimes chose to miscarry just enough that their patient could easily go to a hospital and have one. They often did this by inserting a foreign object — like a hollow tube catheter — through the cervix. In some cases, they may use some type of catheter with a balloon on one end. Filled with saline, it would put pressure on the cervix like a fetus’ head would do towards the end of pregnancy, causing it to fully dilate. Merely inserting a catheter could trigger a miscarriage as the body attempts to expel the object. These methods have not always worked, although. They can cause bleeding and embolism. And catheters had to be left in for a while, along with gauze placed in the patient’s vagina to staunch the blood. This could cause an infection and since patients tried to hide from the authorities, they often did not seek treatment until near death.
People who couldn’t find or afford an illegal abortion often tried to get one for themselves. It’s impossible to say how many of these happened each year, but there are records showing that thousands of people came to emergency rooms with septic infections of the uterus and reproductive tract in the 1960s, Reagan said. That’s where the hangers come in, Joffe said, as one of many objects people would try to insert through their own cervical openings. The goal wasn’t necessarily to perform an abortion at home, but to induce enough bleeding and symptoms of miscarriage for the person to go to a hospital, say they miscarried naturally, and get a hospital D&C . But perforation, bleeding and infection were risks.
Even less reliable and more dangerous was a range of suppositories, tinctures, herbs, and home remedies that many people tried. A doctor told Joffe about treating a patient who had a catheter inserted into her cervix and poured turpentine into it, literally boiling the inside of her uterus, which had to be removed. Others shared stories about potassium permanganate tablets, sold over the counter, that people put in their vaginas to induce bleeding and maintain their hospital D&C. But the pills could easily eat through the vaginal lining, causing bleeding and destroying the cervix.
It’s very unlikely anyone will go back to backyard D&Cs or catheter abortions, Reagan and Joffe said. Even if Roe is knocked over, doctors and other people who want to oppose him are much more likely to offer abortion pills. While abortion by pill can be a physically painful and psychologically intense experience for some people, the existence of these pills drastically changes the calculus when considering the risks of an illegal abortion. They are much easier to get and conceal, much safer to use, and if a patient is concerned about side effects, she can seek treatment, knowing that no one can tell the difference between the effects of a pill and a natural miscarriage .
But both Reagan and Joffe said the existence of abortion pills will not eliminate risk if abortion becomes illegal. Just as before Roe there were some people who had easier abortions than others, there will be people after that. Meanwhile, some of the most vulnerable people — poor people, people who live in very rural areas, people who can’t make time to drive to another state in search of pills — are still becoming only desperate options to have. Reagan was particularly concerned that websites selling fake abortion pills could fool people who have no idea they aren’t getting the real thing. And both she and Joffe worried about how illegality and rising stigma might push more people toward dangerous methods at home, with social media becoming the new back alley. Even if abortion is still legal there are occasional human cases — usually young — trying to have an abortion themselves, Reagan said.
Abortion technology has improved, Reagan and Joffee told me. But as long as the desperation for an abortion persists – and the easy access does not exist – some people will still be at risk.