A Safe, Easy, Illegal Abortion

In a 1965 article for The Atlantic, a woman wrote about a relatively seamless experience that was—and still is—largely limited to white women of a certain economic status.

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“Few women, gossips or not, discuss their abortions at the bridge table,” a woman identified only as Mrs. X wrote in The Atlantic in 1965. “Any woman of childbearing age who knows a reliable man in this field has a stake in keeping him in business. She may need him herself, or have a close friend who will.”

So when Mrs. X—a married, middle-class mother of three living in a large East Coast City—found herself with an unwanted pregnancy at age 46, “I started out by going through my address book and selecting five close friends who had the following in common: All were intelligent, well educated, sympathetic, and discreet.”

And all five, as it turned out, had doctors’ names they could offer her. The rest of her account details a series of surprises: the cleanliness of the office, the speed of the procedure, and most importantly, the ease with which she found someone willing to perform it. “Five people, of my limited acquaintance, knew five different abortionists within a few square miles of each other,” she marveled, and “four of the five abortionists recommended to me were duly licensed physicians. Is this extraordinary?”

She went on to answer her own question: “There must be hundreds like me from coast to coast, who for sober and considered reasons daily undergo the same fears, search for the same kinds of operative resources, and find the money necessary to terminate the pregnancy. I am sure that my experience is not unique.”

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.

Today, the relationship between class and abortion access is no less messy. Since Roe v. Wade was decided in 1973, poor and minority women have come to represent a growing share of the abortions performed in the U.S. each year, in part because low-income women are at higher risk of unintended pregnancy than their wealthier peers. Even so, as of 2011, only 22 percent of abortion clinics were located in minority-dominant neighborhoods, and as my colleague Olga Khazan reported earlier this year, the recent wave of laws instating waiting periods (among other restrictions) has made abortion into a greater logistical hassle that may disproportionately deter low-income women. According to a 2013 Guttmacher report, the average cost of a first-trimester abortion was $470, not counting the other costs associated with getting to and from the procedure: an average of $198 in lost wages, $57 in childcare expenses, and $44 in transportation expenses.

“Is this extraordinary?” X wondered of her experience in 1965.

Then, as today, the answer is: It depends who’s being asked.