History of Abortion, #2

1. History of Abortion, #2 January 30, 2008 Sociology of Abortion

2. Today’s Topics • Mini-course, “sociology of professions” • 19th century physicians’ campaign against abortion—a professionalizing project • The Century of Criminality—1870s-1973 • Forces leading to legalization • Roe v Wade: aftermath in the medical community—what happened, what didn’t

3. Key concepts in sociology of professions • What does it mean to be a “powerful” profession? • License and mandate, state-protected monopoly • Autonomy to set terms of practice • “Professional dominance” • Specialized body of knowledge on which to make claims for above

4. 19th century physicians’ campaign against abortion • Diversity of health care providers in 19th century U.S.—midwives, lay healers, “medicine men”, homeopaths, etc—and “regular” or “elite” physicians (university-trained) • AMA campaign against abortion is part of a larger campaign of “regulars” to assert professional dominance—abortion is particularly fruitful area, because of midwife and lay involvement

5. “Regular” Physicians and Abortion “The objective of regular physicians was not simply to abolish all abortions, however. Rather, the AMA argument…was that physicians should control the terms under which ‘approved’ abortions were performed—that is, ‘legal abortions were now to be confined to those performed in a hospital, for ‘medically indicated’ reasons.” Joffe, Doctors of Conscience, p.28.

6. The “Century of Criminalization” 1870s—1973 • Who was providing abortions? • “regular” doctors, in hospitals, for “medically indicated,” legal abortions (very small number) • “butchers”—some medical, some laypeople—inept and/or unethical—their activities led to death and injuries • nurses, midwives, others with some medical training • “doctors of conscience” • many women attempted self-abortion • (deaths from illegal abortions? 1-5 thousand yr?)

7. The motivations of “doctors of conscience” • Compassion—”we were like sisters…” Ethel Bloom, D. of C., p. 72; overwhelmed by hopelessness of patient’s situation, Peter Smith, p.71 • Outrage at hypocrisy—”I have a different code for my family”…Morris Fischer, p.64 • Encounters with victims of botched abortions—either self-attempts or by butchers— Ken Gordon, ”I have been haunted by that girl ever since”…p. 58. • Numbers of illegal abortions? Estimates of 600k—1.2 million per year

8. Changing political climate • Impact of Finkbine case—mobilized general public (1962) • Rise of women’s health movement (late 1960s) • Impact of San Francisco 9 case—mobilized medical community—(1966) • “We do not believe that violation of an archaic statute is unprofessional conduct, nor that it is unprofessional for a physician to conduct himself in accord with the ethics of community, the wishes of patients and the best medical judgments of doctors.” Edmund Overstreet, vice-chairman of ob/gyn, UCSF

9. Physicians get on board—uneasily • AMA votes in favor of legal abortion, 1970 • “At the AMA convention –as feminist groups supporting legal abortion picketed outside the convention hall—one doctor complained: “Legal abortion makes the patient truly the physician: she makes the diagnosis and establishes the therapy.” • “For the first time, except perhaps for cosmetic surgery, doctors will be expected to do an operation simply because the patient asks that it be done.” (AJOG, 1972). • Joffe, D.of C., pp. 46-47

10. What Happened after Roe, What didn’t? • Medical institutions did NOT establish standards for abortion care • Hospitals did not establish services • Ob/gyns did not establish training (CREOG) • “A woman’s right to chose the procedure is always circumscribed by the physician’s right not to perform it.” (D.of C., p.48)

11. Why this medical resistance to normalizing abortion? • The lasting legacy of the pre-Roe era • “ Academics departments of obstetrics and gynecology [did not] welcome skilled abortionists to their ranks. Even though abortion now was legal, a stigma remained on those who had earlier performed legal abortions.” Philip Darney, M.D. (quoted in D.of C., p.51)

12. Rise of Freestanding Clinic • Technologies that made this possible—vacuum aspiration; paracervical block (local anesthetic) • Advantages: lower cost, more supportive environment, including support staff, than hospitals • Disadvantage: marginalization from mainstream medicine; well-defined target for protestors—clinic blockades and sieges • Today: over 90% of abortions take place in freestanding clinics, some exclusively for abortion care, some with other services

13. New technologies, new providers? • 1990’s—Return of “Manual Vacuum Aspiration” (MVA) to U.S. medicine • 2000—FDA approves mifepristone (“RU-486”, “abortion pill”) for use in USA (approved in France in 1988) • Hopes for “miffy” to increase number of providers—slow start, but latest data (Guttmacher Institute, 2008) shows mifepristone accounted for 14% of all abortions in 2005 vs 6% in 2001. May be instrumental in slowing rate of decreased number of abortion providers.