That much is true: Her experience was not unique. But nor was it universal. Mrs. X’s story illuminates a relationship between class and abortion that, 50 years later, is no less complicated.
In the decade before Roe v. Wade, 44 states allowed abortion in cases where a pregnancy would put a woman’s life in danger, according to the Guttmacher Institute. Four more states and the District of Columbia also had exemptions for health, and one for rape; only one state, Pennsylvania, outlawed abortion in all cases. In Mrs. X’s (unnamed) state, she discovered, so-called “therapeutic” abortions were limited to women with cancer, ectopic pregnancies, heart conditions, or severe mental illness, rendering her ineligible. But in many places, even a woman who met the health criteria for a legal abortion would need her doctor to help her make a case to a hospital review board. In some states, she would have needed a psychiatrist or second doctor to examine her and sign off on the need for the procedure.
Consequently, most legal abortions at the time were performed on women who had private insurance or could otherwise afford the review process—and, more than that, on women who could lay the groundwork for it. Whether a pregnancy constituted a “danger” was often a subjective call; the chance of securing a diagnosis was greater if a woman went to a doctor she knew well, skewing the odds against those who didn’t have the funds for regular healthcare.
“Of therapeutic—that is, in-hospital—abortions in New York City in the early ’60s, the majority of them for ‘psychiatric’ reasons, 93 percent were performed on white patients, 91 percent in private rooms,” the lawyer and women’s rights activist Harriet Pilpel wrote in The Atlantic in 1969, four years after Mrs. X described her experience. “The ratio of in-hospital abortions to live births in New York City was approximately one to 360 for private patients and something like one in 10,000 in municipal hospitals.”
Even among women unable to secure a therapeutic abortion, Pilpel observed, those with sufficient means could often still find a safe way to terminate their pregnancies. “The out-of-hospital abortions performed by doctors are obtained by the same group which accounts for the bulk of in-hospital abortions,” she noted: “the middle- and upper-class white women who can afford the hundreds or thousands charged for medical service outside the law.” Those who could swing an overseas trip could also choose to travel to Japan, Sweden, or the U.K., where abortion laws were more relaxed. (By the early 1970s, some travel agencies had package deals specifically for that purpose.)
At the same time, poor minority women—most of whom obtained illegal abortions from someone other than a doctor, or attempted to do it themselves—made up only a small percentage of in-hospital abortions, but comprised the majority of abortion-related deaths.