The Road Before Roe

Nathan Connolly: For nearly 100 years before Roe v. Wade, abortion was illegal in every state across the country. But even though it was criminalized, abortions didn’t come to a halt. Instead, historian Leslie Reagan says, it just made it more difficult for women to find the proper care.

Leslie Reagan: It was devastating, particularly on poor women and women of color because of the inequity in terms of access to safe people. It was devastating by the ’40s, ’50s, and ’60s, and ’70s in terms of making women feel like criminals, making them feel deviant, for taking away their ability to make decisions about their lives, and for making them feel endangered and, in fact, endangering their lives.

Nathan Connolly: Reagan investigates the century leading up to Roe in her book, “When Abortion Was a Crime.” She says that by the mid-20th century, women seeking an abortion and the physicians performing them faced serious threats. But before then, there was a time when abortion was accessible despite it’s illegality.

Leslie Reagan: Yes, interestingly, in the 1930s abortion’s fairly available. This has a lot to do with both the Depression and the high demand for abortion at the time. By the 1930s, you increasingly have these specialists who were excellent at it. So more people are able to go to these really superb providers. At the same time, you have people doing their own self-induced abortions because it still always depends just whether a woman is able to get the information about who to go to for the procedure or whether she has the money. So there are going to be plenty of people, depending on where they live, how much money they have, and information are going to try their own methods.

Leslie Reagan: That could be taking herbs, taking different kinds of medicines, or using some sort of instrument to induce an abortion. Clearly, people who had more money and had the right connections would find the better practitioners more easily. But it’s not guaranteed by being in the middle classes or having money. It would be finding the right person. And then of course, there are people who never could and never would go and ended up carrying pregnancies through that were not what they wanted to do. But definitely during the Depression, there’s evidence that the numbers of abortions really did go up because people didn’t have money and women would lose their jobs.

Nathan Connolly: This is fascinating because you’re shedding light on not just obviously the practice and procedure of getting an abortion, but the social impact of pregnancy itself, that it is actually a variable in women’s lives that has tremendous consequences in terms of how they have a civic presence, whether they are part of a community, whether they can support themselves. The pregnancy itself becomes something that women have to uniquely negotiate in public life.

Leslie Reagan: Yes, yes. We just talk about abortion as a thing and an event when really abortion is part of an entire life around reproduction and pregnancy and decisions that people have to make at a particular moment, and a moment in time historically that has to do with the family, the economy, education, all kinds of things. It’s about the time period they’re in. Whereas I’m talking about the 1930s and thinking about being a single parent, that was a time where that was extremely difficult to do, the stigmatization, particularly of middle class white women and what would happen with their families, the loss of family, loss of jobs, loss of education. You get kicked out of school into the 1950s, ’60s.

Leslie Reagan: More tolerated among the African American community where families could accept that. You could still be part of the community. But less so among middle class Blacks, they wanted their daughters and sons to be as respectable … That was a sign of respectability. They also would tend to go to use abortion the same way if they were unmarried because it also had to do with future possibility for education and class status. But now post-Roe and post all of the changes with the movements around sexual freedom in the ’60s and ’70s and ’80s, single women can have children, which is a big change and a big improvement, I think.

Nathan Connolly: Just to figure the dilemma facing, say, your general practitioner who’s a physician, to know about different safe procedures for ending a pregnancy on the one hand, but this whole other landscape, emotional, financial, the civic and political around the meaning of pregnancy. They almost have to be expert enough to be able to manage all the different kinds of cases that come to them where a woman has to figure out what to do or how to manage a pregnancy.

Leslie Reagan: Yes, well, some of the practitioners who we’re talking about, the really excellent specialists, the way they become these specialists does grow out of their awareness of the lives of women who are seeking abortionists. One doctor who becomes a specialist, Ed Keemer, in his particular case he said no. He had been taught in medical school you absolutely do not perform abortions. Dr. Ed Keemer is an African American doctor who was trained at Meharry Medical School in Tennessee, the historically Black college, a very prominent medical school. He had trained, as doctors were, that this is part of your reputation. You do not perform abortions.

Leslie Reagan: He had said no to a woman who then later committed suicide because of the shame associated with being pregnant and that stuck with him. He felt responsible. He could have done differently. And on top of it, his wife, who was also a physician, pushed him because she pointed out to him the reality that, in fact, the two of them had needed an abortion as well, that when they were in medical school they too had needed an abortion. That’s a very interesting story about how people’s lives work, that when they’re in a situation and getting an education, they probably couldn’t afford to get married. Perhaps she would have been kicked out of school, I don’t know.

Leslie Reagan: Yet when it came to it later on, he said no. So he felt whatever he felt as a doctor or he felt that it was dangerous or he felt that it would be bad for his reputation. She pointed out, “We can’t do that. We need to have some integrity about our own lives and be honest about it.” To the good, he heard that and he then went and trained himself with another excellent physician and he became someone who was known in the community in Detroit for providing abortions along with all general medical care and childbirth in the African American community in Detroit.

Nathan Connolly: Dr. Keemer’s performing abortions in Detroit and he falls under some pretty heavy attention by local law enforcement apparently.

Leslie Reagan: Yes. What happens is he’s a very good … He’s providing abortions and general medical care in the Black community. He’s a very respected doctor. He’s mostly taking care of Black patients, but occasionally white patients will cross to the other side of town. So it ends up that a white woman goes in, sees the doctor and names him. He is raided. Police come in and raid his clinic and arrest him, the nurses, and patients in the clinic. This was really becoming a standard practice where the police don’t just arrest him. They stake out the clinic and their goal is to arrest as maybe people as possible and hopefully catch the provider in the middle of performing an abortion and then arrest all the patients.

Leslie Reagan: They would collect everything, the instruments, the surgical table, grab all the patient records, and everything they could and swoop everything up during a raid. Then following that, they obviously interviewed everybody, interrogated them, asked questions, and then this went to trial. Although he had a lot of support from the community and people supporting him, he was convicted. His sense of it was that the reason that this came to trial and that they came after him was really that he was with a white woman performing this procedure and that this was intolerable. The vision of a Black man with his hands between her legs performing an abortion was just not to be tolerated.

Leslie Reagan: There are other cases like this. There are quite a number of cases where that seems to be the tipping point where there are white patients and Black providers.

Nathan Connolly: There’s also Josephine Gabler in Chicago. Who was she?

Leslie Reagan: Dr. Gabler, like Keemer, she’s another physician who also had a long-running practice in Chicago and she served as a center for the entire region, where people came in from other states to her office. It was just the way clinics, like any other doctor’s office. They came in. They’d see a receptionist. They sat in the office with other patients. The one thing that would make it very clear that it was not a legal practice like all others was that the patients when they came in they had a folded-up fabric towel or something put across their eyes so they wouldn’t see the doctor. They wouldn’t be able to identify the doctor if it ever came to that with a prosecutor or police.

Nathan Connolly: Given the lengths to which doctors would go to maintain some kind of anonymity, there was an awareness of the kinds of punishments that were meted out to them if they were caught performing an abortion. What might some of those punishments have been at that time?

Leslie Reagan: There is an awareness, although I think what is actually really very surprising is how openly this was done. This was advertised. They had business cards. People got their names. In fact, they knew Dr. Gabler. Dr. Keemer, they knew. But then what changes, as I was talking about with Keemer, is that there starts to be a change. Because it’s against the law, you can have prosecutors or police who will demand kickbacks or threaten them or suddenly intervene. But it does begin to change. In some places, they will do raids in the 1930s. But really in the 1940s across the country you begin to see the police raiding clinics.

Leslie Reagan: They are going into these clinics that have been established for years that have open practices that everybody knows about, that have been tolerated and pretty much ignored by police and prosecutors.

Nathan Connolly: What explains the uptake in this kind of enforcement?

Leslie Reagan: I think there’s a combination of factors. They are now using the tactics that they’ve been using during Prohibition on the gangsters as we know who are involved in selling liquor. And then of course, when you eliminate Prohibition they’ve got all the police and equipment and the methods. So partly they’re switching those methods. I think this is part of it, that they see these clinics are available. For some prosecutors, it’s a great thing to go do and say, “See, I’m enforcing the law.” But also I do see it as part of what we tend to think of as the 1950s, of the demand for conformity from women and against sexual deviance and what we call McCarthyism.

Leslie Reagan: Others have found that it begins in the ’40s, and you can really see it here with abortion is the association. Abortion is associated with Communism and the free sex and free love of Communism. It’s always being equated with Communism. There’s some of this happening too, that they’re really going after them in the ’40s and ’50s.

Nathan Connolly: That’s really remarkable because, I mean, I’ve studied a little bit about raids on number houses or obviously the kinds of attacks on queer spaces and any of these massive anti-vice campaigns in the ’40s and ’50s have tended to revolve around known haunts of illegality and immorality. It sounds like what you’re describing is that these women’s health outfits were similarly swept up in this moment of just blanket reform for the interest of scoring certain political points in the morality column, so to speak.

Leslie Reagan: Yeah. Yeah. I think so. I mean, the people who get caught in the raids are forced to speak in court cases. There are some raids where they are arrested and they are forced into gynecological exams with the police nearby. It’s all under the, “This is for her safety. We have to make sure that they’re okay.” They’re also told, “If you don’t, we’ll put your name in the paper. We’ll put your picture in the paper.” Some of them are held as hostile witnesses in jail until they testify. So there’s lots of ways to punish and threaten the people who have abortions without actually prosecuting them.

Nathan Connolly: In the early 1970s, you have a handful of states that begin to legalize abortion. What impact does this have on women’s mortality rates?

Leslie Reagan: The legalization of abortion is really important. By the 1950s, illegal abortion accounts for almost 50% of maternal mortality in the United States. Now, we’ve been talking about that there are illegal abortions that are quite safe. There’s doctors doing legal therapeutic abortions that are safe. But still, illegal abortions are accounting for almost half of all maternal mortality. People know that they can perform safe ones. So when it’s legalized in New York in 1970, the following year maternal mortality fell 45% after it legalized. The city reported in 1971, New York City experienced its lowest maternal mortality rate ever on record. That’s pretty incredible.

Leslie Reagan: As states legalized, they had similar kinds of reports. They saw huge drops in maternal mortality.

Nathan Connolly: Leslie, how would you describe then the impact of criminalization on women’s lives, taking your historical view? And to what extent do women’s lives change as decriminalization took effect over the 20th century?

Leslie Reagan: The decriminalization of abortion has been incredibly important not only for making this procedure safe and accessible even though it has been uneven in terms of access and it has gotten worse. We’re pretty close to the days of pre-Roe in terms of the unevenness around the country where it’s quite accessible in California and New York, Illinois, and then in some states, there’s one provider or none and people have to wait 72 hours. Teenagers have to get parental consent. But decriminalization has meant that it honors the decision of women and trans people who get pregnant to make decisions about their own lives, about their pregnancies, about their futures.

Leslie Reagan: I would also say it’s not only about women and abortion. It applies to everybody, to be able to make decisions about your life, to have respect from medicine as a patient, to have privacy recognized. I think this is something that’s often not understood really that Roe v. Wade really recognized the rights of patients and the freedom of sexuality and the autonomy of your body. This is something we all now depend on. As that is lost or as that is attacked, we all lose.

Nathan Connolly: Leslie Reagan is a history professor at the University of Illinois Urbana-Champaign. She’s the author of the book, When Abortion Was a Crime: Women, Medicine, and Law in the United States 1867 to 1973.