Abortion has a recorded history that dates back over 5000 years ago when according to Chinese folklore; the legendary Emperor Shennong prescribed the use of mercury to induce abortions. The first record of termination of pregnancy is from the Egyptian Ebers Papyrus in 1550 BC. Chinese records document the number of royal concubines who had abortions in China between the years 500 and 515 BC.
Pregnancies were ended through a number of procedural methods that included deep abdominal massage; sharpened instruments; herbal medicines taken by mouth or inserted vaginally; various liquids flushed into the intrauterine cavity, as well as other techniques.
Abortion laws have fluctuated throughout the centuries. Before the mid 1500’s the Catholic Church and governmental laws focused on “quickening” (where the mother feels fetal movement) to determine whether or not an abortion was permissible. Prior to quickening, abortion was lawful. It wasn’t until the 18th and 19th centuries that physicians, clergymen and politicians pushed for the outright ban of abortion which they were successful in prohibiting by the beginning of the 1900’s in the U.S.
Abortion continues to be legal in this country but there is not a day that goes by when the legislature, prosecutors, and others in the justice system are either striving to make abortion illegal, or making the steps to obtain an abortion so arduous for women, that it is becoming more difficult for what should be a private decision between a woman and her Physician to occur.
Many of the methods used to perform abortions many years ago were mostly non-surgical in nature. Techniques such as weightlifting, diving, paddling, strenuous labor, climbing, fasting, pouring hot water onto the abdomen, lying on a heated coconut shell, and irritant leaves were some of the techniques used to allow an abortion to occur. There have been surgical instruments dating back thousands of years that were found through Archaeological discovery. Most of the instruments were never mentioned in old medical texts.
Midwives and informed laypeople were the main two groups that were primarily responsible for performing termination procedures in early history. Abortion became well documented in the 2nd century by a Greek physician named Soranus. He suggested that some women should have an abortion due to their emotional immaturity. He described enemas, fasting, bloodletting, energetic walking, riding animals, and even jumping so that a woman’s heels touched her buttocks with each jump (Lacedoemonian Leap) as abortion methods.
Abortion surgical tools are described in anciant religious texts. Tertullian, a 2nd and 3rd century Christian theological described surgical instruments and techniques that are very similar to the modern day dilatation and evacuation. These instruments were used when a pregnant woman’s life was in danger, or if the fetus was dead in the uterus.
There were women who practiced sitting over a pot of steam. Candles, glass rods, penholders, curling irons, spoons, sticks, knives, and catheters, coat hangers, knitting needles, douching with dangerous lye solutions, swallowing strong drugs and chemicals, were all used in an effort to self-induce abortion. Millions of women had self-induced abortions and thousands of those women died. There were more abortions performed per capita in the late 19th century than are currently performed.
The techniques of abortion improved in the 19th century. In 1870, abortions were performed by flushing the inside of the uterus with injected water. Around this time, the social perception of abortion started to change. Married women began not wanting any more children and routinely sought out abortion. White Anglo-Saxon men were alarmed in the late 1800’s when the U.S. government warned against the danger of “race suicide” and urged white native born women to reproduce when there was a dramatic decline in the white birth rate. After 1880, abortion was criminalized by in every state of the union. Making abortion illegal was meant to do two things. 1) Budding industrial capitalism relied on women to be household workers, and reproduce, and therefore keep women in their traditional child-bearing role. 2) Male doctors wanted total control of the medical profession. They saw midwives who attended births and performed abortion as a threat totheir economic and social power. The American Medical Association which was started in the 1860’s actively took up the anti-abortion movement to eliminate midwives.
Between 1820 and the 1900, abortions became illegal in all States. Laywomen and Physicians performed illegal abortions after this time. Women who could afford safe abortions would pay as much as one to two thousand dollars to have them performed. There were abortion facilities overseas where well-to-do patients would go to have their abortions performed. The majority of patients either had to attempt to self-induce their abortion, or rely on people who performed terminations under un-sterile and unsafe techniques. Thus, the high rate of maternal morbidity and mortality. Women who were victims of these botched abortions came to hospital emergency wards for treatment. Septic abortion wards were set up in the majority of city hospitals in the 1940’s to 70’s. Some women died of abdominal infections, sepsis and bleeding. There were many women who recovered from these infections but found themselves to have chronic pelvic and abdominal pain, to be painfully ill or left sterile. The emotional stress from having the procedure performed and going through the crisis left permanent scars on the patient for the remainder of her life. Poor women and women of color ran the greatest risks with illegal abortions.
Abortion laws remained unchanged until the late 1960’s and early 70’s when there were certain women’s rights movements occurred. In the early 1960’s thalidomide had been used to prevent nausea and vomiting and was found to be cause severe birth defects. From 1962 to 1965, a German measles outbreak took place which caused approximately fifteen-thousand birth defects to occur. Pregnant women were not able to seek legal abortion due to the strict laws that were in effect at the time. Prior to Roe v Wade, there were an estimated 1 million illegal abortions performed in the U.S. There were 5000 maternal deaths and over 100,000 hospital admissions due to botched, unsafe abortions of the 1 million illegal abortions performed. A movement by women’s rights groups, lawyers, and physicians who had witnessed a lot of the maternal morbidity and mortality began to seek ways to make abortion legal. They argued that women must be able to control the number of pregnancies in order to secure equal status. In order to have full equality, patients must be able to control when, and the number of children they have. In Japan and Eastern Europe, abortion was legal on demand and in other parts of Europe; abortion was protected to protect the mother’s health. Concerns about rapid population growth started becoming a concern since in many countries discussion and dispensing of birth control were illegal.
The Comstock law was passed in 1873 in the U.S. which made it a crime to sell, distribute, or own abortion-related products and services, or to publish information on how to obtain them.
Making abortion illegal will not eliminate the need for abortion nor prevent its practice. Women who do not want a pregnancy have always found a way to abort, even if it meant at the risk of dying. This is very important to understand. The number of bortions will not decrease if they become illegal. Making abortion illgeal will only lead to the endangerment of women’s lives; especially poor and indigent women unable to seek safe abortion due to the prohibitive costs and lack of access to appropriate medical personnel and equipment.
The beginning of modern day suction technology was first described in the 1800’s and practiced in the China, Japan, and the Soviet Union before being introduced to Britain and the United States in the 1960’s. The invention of the Karman cannula, which is a flexible plastic tube, replaced earlier metal models in the 1970’s which reduced the occurrence of complications. It also allowed suction-aspiration methods to be possible under local anesthesia.
In 1970 when the State of NY allowed abortion on demand, the maternal morbidity and mortality rate decreased by 50%. There was no change in the total number of abortions performed. It provided for abortion to be performed in a lrgal and safe manner.
Menstrual Extraction procedures had been performed for almost 50 years in other countries prior to being performed in the US in 1971. Lorraine Rothman and Carol Downer, the founding members of a feminist self-help movement, invented the Del-Em, a safe, suction device that women used to perform abortions on each other safely. This early abortion technique was called a menstrual extraction. There was a resurgence of this technique in the mid-90’s in the U.S. as a method of surgical abortion. This resurgence is due to early pregnancy detection (a week after conception) and the growing demand for safe and effective early surgical abortion.
In 1973, The U.S. Supreme Court in Roe v. Wade, declared all individual state bans on abortion during the first trimester to be unconstitutional. The “right of privacy” founded in the Fourteenth Amendment concept of personal liberty encompasses a woman’s decision to terminate her pregnancy. Through the end of the first trimester of pregnancy, only a pregnant woman and her doctor have the legal right to make the decision about an abortion. The court allowed states to regulate but not stop abortions in the second trimester of pregnancy. States are able to restrict second trimester abortions in the interest of a woman’s safety. And States are able to stop abortion during the third trimester unless abortion is in the best interest of the woman’s health. This is due to the protection of a ‘viable fetus” (able to survive outside the womb) and allowed only during the third trimester.
In 1973, The U.S. Supreme Court in Doe v. Bolton declared that “health” includes physical and mental health. Mental health must take into account the moral, ethical, family, age, and psychological factors of the patient. The Physician after this evaluation can determine whether the abortion procedure can be performed.
Obviously, abortion will continue whether abortion is legal or not legal. It is the safety of millions of women’s lives at stake if the choice to obtain legal abortion is taken away.
Beacuse of escalating militant violence, blockades of abortion clinics, protestors tying themselves to suction machines in family planning offices, and arsons, in May 1994, President Clinton signed into law another tool to be used against anti-abortion militants, the Freedom of Access to Clinic Entrances Act (FACE), which allows for federal criminal prosecution of anyone who, “by force or threat of force or by physical obstruction, intentionally injures, intimidates, or interferes with any person obtaining or providing reproductive health services” (18 U.S.C.A. §248). The law also makes it a federal crime to intentionally damage or destroy the property of any reproductive health facility, and it permits persons harmed by those engaging in prohibited conduct to bring private suits against the wrongdoers. The law imposes stiff penalties as well for those found guilty of violating its provisions.
Violence by protestors continues to surround abortion ever since the 1973 Roe v. Wade decision that guaranteed a woman’s limited right to an abortion. Bombings, arson, and even murder have been committed by anti-abortion activists in the name of their cause. The National Abortion Federation counted more than three thousand violent or threatening incidents against abortion clinics between 1976 and 1994. In the 1990s, the extremist wing of the anti-abortion movement became even more violent, including murder as part of its tactics. Some extremists now view killing health care professionals who perform abortions as justifiable homicide.
Between March 1993 and the end of 1994, five staff workers at abortion clinics were murdered by anti-abortion zealots. Dr. David Gunn was fatally shot on March 10, 1993, outside an abortion clinic in Pensacola, Florida, by Michael Griffin, who was sentenced to life in prison. In August 1994, Dr. John Bayard Britton, age 69, who had replaced Gunn as circuit-riding doctor in northern Florida, and his escort, James Barrett, age 74, were shot repeatedly in the face with a shotgun as their car pulled into the parking lot of the Ladies Clinic of Pensacola. Minutes later, police arrested Paul Hill, an anti-abortion extremist. President Bill Clinton called Britton’s and Barrett’s killings a case of domestic terrorism. Hill was executed in September 2003. In December 1994, in perhaps the most gruesome incident of all, John Salvi killed two people and wounded five more when he opened fire in two Boston-area family planning clinics. Salvi was sentenced to life in prison, where he later committed suicide. Recently in March 2009, Dr. George Tiller was murdered while serving as an usher at the church he attended by an individual who believed that his murder was justified because he was “saving the unborn” from murder in the womb.
Abortion Pill History
In the 1980’s, researchers at Roussel Uclaf in France developed mifepristone, (RU486, mifepristone, Mifeprex) a chemical compound which works as an abortifacient by blocking hormone (progesterone) action. It was first marketed in France under the trade name Mifegyne in 1988. It is used to abort early pregnancies between three and nine weeks gestation in the U.S. Prior to approval of RU486 in the United States for medical abortion in the year 2000, the medical abortion was being performed by our experienced Physicians with other medications (Methotrexate and cytotec [misoprostol]) to terminate pregnancies. These non-surgical abortions were performed with medications that were found to stop the growth of early pregnancies, and then expelled in a manner similar to miscarriage. They were used “off label” which means that the medications are FDA approved for other indications besides abortion. In several European countries, nearly 50% of women choose to undergo abortion using the Non-Surgical Abortion process. Early abortions both surgical and medical are very safe and efficient when supervised and performed by an experienced and skilled Physician.
Despite the FDA giving preliminary approval for RU486 in the early 90’s due to its efficiency and safety record in terminating pregnancies, there was a lot of political pressure to prevent approval and to find a manufacturer that would produce the medication in the U. S. After many setbacks, there was finally approval by the FDA in the year 2000 for a medication specifically for terminating pregnancies without the use of surgery.
By giving the medication 24 to 48 hours prior to induction of labor in second and late term abortion patients, the delivery rate can be reduced from 16 to 18 hours to 6 to 8 hours. Mifeprex is also effective for reducing fibroids in the breast, for treating endometriosis, and used as a morning after pill (emergency contraceptive).
History of Partial Birth Abortion
Intact dilatation and extraction was developed by Dr. James McMahon in 1983. It is very similar to a procedure used in the 19th century to save a woman’s life in the case of obstructed labor in which the fetal skull was first punctured with a perforator, then crushed and extracted with a forceps-like instrument, known as a cranioclast. It became known as the “partial birth abortion”.
One of the biggest controversies to erupt in the late 1990s involved the debate over what is termed “partial birth abortion”. . Anti-abortion activists succeeded in having legislation passed in twenty-nine states that bans physicians from performing what doctors call dilation and extraction. It is used most commonly in the second trimester, between twenty and twenty-four weeks of pregnancy, when a woman suffers from a life-threatening medical condition or disease. In Stenberg v. Carhart, 530 U.S. 914, 120 S.Ct. 2597 (2000), by a vote of 5–4, the Court struck down Nebraska’s ban on partial-birth abortion. The Court ruled the statute was invalid because it lacked any exception to protect a woman’s health, noting that the state could promote but not endanger a woman’s health when it regulates the methods of abortion. It also concluded that terms in the statute were unconstitutionally vague such that it would affect not only partial birth abortion but also other constitutionally protected second-trimester abortion methods.
The importance of this decision lies in the fact that in early 2003 the U.S. Congress passed a nationwide ban on partial-birth abortions similar to the Nebraska law. The Congress had passed this law before, only to have Bill Clinton veto it. President George W. Bush said he would sign the bill if it reached his desk. If he did so, the Supreme Court could be called upon to decide whether Stenberg applied.
Description of Dilatation and Extraction (D&X; partial birth abortion) as written by Justice Kennedy in Carhart vs. Gonzales Supreme Court decision:
“Intact D&E, like regular D&E, begins with dilation of the cervix. Sufficient dilation is essential for the procedure. To achieve intact extraction some doctors thus may attempt to dilate the cervix to a greater degree. This approach has been called serial dilation. Carhart, supra, at 856, 870, 873; Planned Parenthood, supra, at 965.
Doctors who attempt at the outset to perform intact D&E may dilate for two full days or use up to 25 osmotic dilators. See, e.g., Dilation and I reach in and the fetus starts to come out and I think I can accomplish it, the abortion with an intact delivery, then I use my forceps a little bit differently. I don’t close them quite so much, and I just gently draw the tissue out attempting to have an intact delivery, if possible. App. in No. 05.1382, at 74.
Rotating the fetus as it is being pulled decreases the odds of dismemberment. Carhart, supra, at 868.869; App. In No. 05.380, pp. 40.41; 5 Appellant’s App. in No. 04.3379 (CA8), p. 1469. A doctor also may use forceps to grasp a fetal part, pull it down, and re-grasp the fetus at a higher level, sometimes using both his hand and a forceps to Cite as: 550 U. S. _ (2007) 7 Opinion of the Court exert traction to retrieve the fetus intact until the head is lodged in the [cervix]. Carhart, 331 F. Supp. 2d, at 886. 887. Intact D&E gained public notoriety when, in 1992, Dr. Martin Haskell gave a presentation describing his method of performing the operation. Dilation and Extraction 110. 111. In the usual intact D&E the fetus. head lodges in the cervix, and dilation is insufficient to allow it to pass. See, e.g., ibid.; App. in No. 05.380, at 577; App. in No. 05. 1382, at 74, 282. Haskell explained the next step as follows:
At this point, the right-handed surgeon slides the fingers of the left [hand] along the back of the fetus and hooks the shoulders of the fetus with the index and ring fingers (palm down). While maintaining this tension, lifting the cervix and applying traction to the shoulders with the fingers of the left hand, the surgeon takes a pair of blunt curved Metzenbaum scissors in the right hand. He carefully advances the tip, curved down, along the spine and under his middle finger until he feels it contact the base of the skull under the tip of his middle finger.
The surgeon then forces the scissors into the base of the skull or into the foramen magnum. Having safely entered the skull, he spreads the scissors to enlarge the opening. .The surgeon removes the scissors and introduces a suction catheter into this hole and evacuates the skull contents. With the catheter still in place, he applies traction to the fetus, removing it completely from the patient. H. R. Rep. No. 108.58, p. 3 (2003).
.(b) As used in this section. .(1) the term .partial-birth abortion. means an abortion in which the person performing the abortion. .(A) deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother, for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus; and
.(B) performs the overt act, other than completion of delivery, that kills the partially delivered living fetus;”
In 2007 Carhart vs. Gonzales was decided by the Supreme Court which states that performing a partial birth abortion is illegal. Due to the inhumane way that the procedure takes place was the reason for the outlawing of the procedure, in which it was declared that the Dilatation and Evacuation (D&E) procedure though it consists of removing tissue and limbs of the fetus from inside the uterus more acceptable though there was data presented that showed that the D&X was safer than the D&E procedure to the mother. Clearly the Supreme Court was concerned more of protection of the fetus than maternal safety.
We at Legal Abortion By Pill Clinic have never performed a D&X (partial birth abortion) procedure. We happen to agree with the Supreme Courts decision regarding this issue.
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