History of Abortion, #2History of Abortion, #2

January 30, 2008 January 30, 2008

Sociology of AbortionSociology of Abortion

Today’s TopicsToday’s Topics

Mini-course, “sociology of professions”Mini-course, “sociology of professions” 1919thth century physicians’ campaign century physicians’ campaign

against abortion—a professionalizing against abortion—a professionalizing projectproject

The Century of Criminality—1870s-1973The Century of Criminality—1870s-1973 Forces leading to legalizationForces leading to legalization Roe v WadeRoe v Wade: aftermath in the medical : aftermath in the medical

community—what happened, what didn’tcommunity—what happened, what didn’t

Key concepts in sociology of Key concepts in sociology of professionsprofessions

What does it mean to be a What does it mean to be a “powerful” profession?“powerful” profession?• License and mandate, state-protected License and mandate, state-protected

monopolymonopoly• Autonomy to set terms of practiceAutonomy to set terms of practice

““Professional dominance”Professional dominance”• Specialized body of knowledge on which Specialized body of knowledge on which

to make claims for aboveto make claims for above

1919thth century physicians’ campaign century physicians’ campaign against abortionagainst abortion

Diversity of health care providers in 19Diversity of health care providers in 19thth century U.S.—midwives, lay healers, century U.S.—midwives, lay healers, “medicine men”, homeopaths, etc—and “medicine men”, homeopaths, etc—and “regular” or “elite” physicians (university-“regular” or “elite” physicians (university-trained)trained)

AMA campaign against abortion is part of a AMA campaign against abortion is part of a larger campaign of “regulars” to assert larger campaign of “regulars” to assert professional dominance—abortion is professional dominance—abortion is particularly fruitful area, because of particularly fruitful area, because of midwife and lay involvement midwife and lay involvement

““Regular” Physicians and AbortionRegular” Physicians and Abortion

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

The “Century of Criminalization” The “Century of Criminalization” 1870s—19731870s—1973

Who was providing abortions?Who was providing abortions?• ““regular” doctors, in hospitals, for regular” doctors, in hospitals, for

“medically indicated,” legal abortions (very “medically indicated,” legal abortions (very small number)small number)

• ““butchers”—some medical, some laypeoplebutchers”—some medical, some laypeople—inept and/or unethical—their activities led —inept and/or unethical—their activities led to death and injuriesto death and injuries

• nurses, midwives, others with some medical nurses, midwives, others with some medical trainingtraining

• ““doctors of conscience”doctors of conscience”• many women attempted self-abortionmany women attempted self-abortion

(deaths from illegal abortions? 1-5 (deaths from illegal abortions? 1-5 thousand yr?)thousand yr?)

The motivations of “doctors of conscience”The motivations of “doctors of conscience”

Compassion—”we were like sisters…” Ethel Bloom, Compassion—”we were like sisters…” Ethel Bloom, D. of C., p. 72; D. of C., p. 72; overwhelmed by hopelessness of overwhelmed by hopelessness of patient’s situation, Peter Smith, p.71patient’s situation, Peter Smith, p.71

Outrage at hypocrisy—”I have a different code for Outrage at hypocrisy—”I have a different code for my family”…Morris Fischer, p.64my family”…Morris Fischer, p.64

Encounters with victims of botched abortions—Encounters with victims of botched abortions—either self-attempts or by butchers— Ken Gordon, ”I either self-attempts or by butchers— Ken Gordon, ”I have been haunted by that girl ever since”…p. 58. have been haunted by that girl ever since”…p. 58.

Numbers of illegal abortions? Estimates of 600k—Numbers of illegal abortions? Estimates of 600k—1.2 million per year1.2 million per year

Changing political climateChanging political climate Impact of Finkbine case—mobilized general Impact of Finkbine case—mobilized general

public (1962)public (1962) Rise of women’s health movement (late Rise of women’s health movement (late

1960s)1960s) Impact of San Francisco 9 case—mobilized Impact of San Francisco 9 case—mobilized

medical community—(1966)medical community—(1966) ““We do not believe that violation of an We do not believe that violation of an

archaic statute is unprofessional conduct, nor archaic statute is unprofessional conduct, nor that it is unprofessional for a physician to that it is unprofessional for a physician to conduct himself in accord with the ethics of conduct himself in accord with the ethics of community, the wishes of patients and the community, the wishes of patients and the best medical judgments of doctors.” Edmund best medical judgments of doctors.” Edmund Overstreet, vice-chairman of ob/gyn, UCSFOverstreet, vice-chairman of ob/gyn, UCSF

Physicians get on board—uneasilyPhysicians get on board—uneasily AMA votes in favor of legal abortion, 1970AMA votes in favor of legal abortion, 1970 ““At the AMA convention –as feminist groups At the AMA convention –as feminist groups

supporting legal abortion picketed outside supporting legal abortion picketed outside the convention hall—one doctor the convention hall—one doctor complained: “Legal abortion makes the complained: “Legal abortion makes the patient truly the physician: she makes the patient truly the physician: she makes the diagnosis and establishes the therapy.”diagnosis and establishes the therapy.”

““For the first time, except perhaps for For the first time, except perhaps for cosmetic surgery, doctors will be expected cosmetic surgery, doctors will be expected to do an operation simply because the to do an operation simply because the patient asks that it be done.” (patient asks that it be done.” (AJOG, 1972).AJOG, 1972).

Joffe, Joffe, D.of C., D.of C., pp. 46-47pp. 46-47

What Happened after What Happened after RoeRoe, What didn’t?, What didn’t?

Medical institutions did NOT establish Medical institutions did NOT establish standards for abortion carestandards for abortion care

Hospitals did not establish servicesHospitals did not establish services Ob/gyns did not establish training Ob/gyns did not establish training

(CREOG)(CREOG) ““A woman’s right to chose the A woman’s right to chose the

procedure is always circumscribed by procedure is always circumscribed by the physician’s right not to perform the physician’s right not to perform it.” (it.” (D.of C., p.48)D.of C., p.48)

Why this medical resistance to Why this medical resistance to normalizing abortion?normalizing abortion?

The lasting legacy of the pre-The lasting legacy of the pre-Roe Roe eraera

“ “ Academics departments of obstetrics Academics departments of obstetrics and gynecology [did not] welcome and gynecology [did not] welcome skilled abortionists to their ranks. Even skilled abortionists to their ranks. Even though abortion now was legal, a though abortion now was legal, a stigma remained on those who had stigma remained on those who had earlier performed legal abortions.” earlier performed legal abortions.” Philip Darney, M.D. (quoted in Philip Darney, M.D. (quoted in D.of C., D.of C., p.51)p.51)

Rise of Freestanding ClinicRise of Freestanding Clinic Technologies that made this possible—Technologies that made this possible—

vacuum aspiration; paracervical block vacuum aspiration; paracervical block (local anesthetic)(local anesthetic)

Advantages: lower cost, more supportive Advantages: lower cost, more supportive environment, including support staff, than environment, including support staff, than hospitalshospitals

Disadvantage: marginalization from Disadvantage: marginalization from mainstream medicine; well-defined target mainstream medicine; well-defined target for protestors—clinic blockades and sieges for protestors—clinic blockades and sieges

Today: over 90% of abortions take place Today: over 90% of abortions take place in freestanding clinics, some exclusively in freestanding clinics, some exclusively for abortion care, some with other servicesfor abortion care, some with other services

New technologies, new providers?New technologies, new providers?

1990’s—Return of “Manual Vacuum 1990’s—Return of “Manual Vacuum Aspiration” (MVA) to U.S. medicineAspiration” (MVA) to U.S. medicine

2000—FDA approves mifepristone (“RU-2000—FDA approves mifepristone (“RU-486”, “abortion pill”) for use in USA 486”, “abortion pill”) for use in USA (approved in France in 1988)(approved in France in 1988)

Hopes for “miffy” to increase number of Hopes for “miffy” to increase number of providers—slow start, but latest data providers—slow start, but latest data (Guttmacher Institute, 2008) shows (Guttmacher Institute, 2008) shows mifepristone accounted for 14% of all mifepristone accounted for 14% of all abortions in 2005 vs 6% in 2001. May be abortions in 2005 vs 6% in 2001. May be instrumental in slowing rate of decreased instrumental in slowing rate of decreased number of abortion providers.number of abortion providers.