On radio, television, podcasts, in print or perhaps speeches at conferences or on the floors of legislatures, the experts are debating abortion. But abortion does not lend itself to experts. Doctors do valuable research and are the saviors and sources of care for pregnant women, and lawmakers fashion laws and grant money for health care, but they are not the experts on abortion. Throughout history, a history that goes back thousands of years, women have taken care of each other while clerics, scientists, rulers, and philosophers shouted through their megaphones far above the rhythms of real life.
The language of Roe v. Wade says, “For the stage prior to approximately the end of the first trimester, the abortion decision and its effectuation must be left to the medical judgment of the pregnant woman’s attending physician.” This language parrots the wishes of the American Medical Association. The AMA was founded in 1847 to bring some badly needed order to the practice of medicine. One of their first targets was abortion, not because of moral objections (those came later), but because abortion was big business at the time, and many practitioners were not trained doctors. Since women were not allowed into the places where they could receive the proper credentials, almost all of the “attending physicians” at that time were men. When Roe was decided, this was still the case. But abortion is not solely a medical matter. Dealing with an unwanted pregnancy is worlds different from handling a diseased gall bladder or a broken leg. Doctors occupy only one corner of the room where the abortion decision is made. They don’t have the time or ability to assess factors that are not relevant when treating a diseased gall bladder or a broken leg. Among medical conditions, pregnancy uniquely involves a measure of consent. Sometimes the woman’s physical condition argues against continuing a pregnancy, but the more critical issues are outside a doctor’s purview. Is she safe at home? Is she married or single? What is her relationship to the child’s other parent? How many other people must she take care of? Is she financially stable enough to feed, clothe, and educate a child until adulthood? What is her support system? Her religious or moral beliefs figure into her decision, but unless she is contemplating the use of a coat hanger or dangerous substance to terminate her pregnancy, the medical decision involves a procedure safer than extraction of a tooth.
Lawyers and legislators are less qualified experts than doctors. Since one in three American women has an abortion, it would hold that many legislators have either had or been party to an abortion, too. I recall several female legislators admitting publicly that they had had one, but cannot remember a male lawmaker who revealed his involvement. Legislators can be master negotiators, organizers, and influencers but, with some notable exceptions, have not proven themselves reservoirs of courage when it comes to abortion. Besides, what do they know, other than what might have happened in their own family? Abortion is not a common subject of conversation, even in medical school. Legislators make decisions based on the prospects for their next election, which is not a valid consideration in matters affecting the health of half of their constituents.
My mother said, “The pain I went through giving birth to you is worse than any man feels on the battlefield.” When I was born, in the 1940s, the pain of childbirth was not well managed, and in those days there were no women in military combat units. Today, some women have experienced both pregnancy and combat injury. Their takes on my mother’s statement would be interesting to hear. Men do share frustration, panic, anger, loss, relief, and other strong emotions when handling pregnancy, but it is hard to explain the total disruption that pregnancy causes. For women, pregnancy is a bomb; for men, it’s a firecracker. Men have important contributions to make to the discussion, yet with the exception of a few recent articles, either they are ignored or they have chosen not to speak. Sometimes they are prevented from speaking by women who angrily push them out of the room; some men think they are not qualified to address a “women’s issue.” When a woman has any other kind of health problem, the opinion of her partner is rarely relevant, but in the case of abortion, the partnership is crucial to the welfare of the baby who would result from continuing the pregnancy. Because it is the pregnant woman who experiences a hundred percent of the physical risk, and often a hundred percent of the professional or financial risk of pregnancy, it would be unjust to give anyone else a veto over abortion, though people have tried unsuccessfully to do so. Yet we are foolish to establish a framework for action on abortion without engaging deeply with men, both as doctors and lawmakers and also simply as human beings.
Midwives were a critical segment of health care until they were banished. Most of the sins of women accused, killed, or burned at the stake as witches were in the area of midwives’ practice. When universities were first established in medieval times, at which point medical degrees were granted, only men were allowed to be students. One of the original aims of the American Medical Association, founded in the 1870s, was to give properly credentialed doctors (almost all male at the time) control over all aspects of health care, including pregnancy, thus marginalizing midwives. This effort was so successful that although most births in the U.S. in the early 19th century were attended by midwives, by 1980, only 1.1% were. Today, midwives, now called doulas, are once again proving their worth. Perhaps doulas rather than doctors should be consulted as the premier experts in abortion. They are tasked with dealing with the whole person, not just the pregnancy.
Though midwives traditionally reigned in the birthing room, most if not all historical writings on the issue are by men. Aristotle was interested in pregnancy, so were Socrates (his mother was a midwife), St. Augustine, St. Thomas Magnus, and many others. Modern writers on the history of abortion consult the same sources, and there aren’t many of them—an ancient Egyptian papyrus, a few sentences in Aristotle’s writings, an experiment or two performed by St. Thomas Magnus, etc. The majority of women, even wealthy women, were illiterate until around the 19th century. The mandate to educate women was a historical novelty, and still is in parts of the world. Even the keenly intelligent Abigail Adams was hesitant about her erudition, while writing some pretty magnificent letters to her husband John. One exceptional figure in medical history was the shadowy Trotula of Salerno, a female doctor practicing at the end of the medieval period. She was widely recognized as a transformative force in women’s health care, but all references and writings about her were created by men. There remain strong traces of the knowledge and skill of ancient midwives, but all has been passed down orally; the ladies of Appalachia were using the seeds of Queen Anne’s Lace as a contraceptive/abortifacient in recent times, and they didn’t get that knowledge from a book.
The decision to have or not to have an abortion involves other people in the family, has a place in historical practice, has lifelong effects, and influences demographics and a society’s political and spiritual life. Its history is muffled and hazy since no writings are available which describe what individual women, be they midwives or the pregnant women themselves, were learning, thinking, and experiencing. How wonderful it would be if an archaeologist discovered the daily journal of an ancient Roman midwife! The only expert when it comes to abortion is the woman herself. She takes into account medical, familial, spiritual, financial, physical, professional, and social data as she makes the decision. Perhaps a hundred or a thousand women could compile their reflections and produce a tome which had useful expertise. Other than that, we are left with predictions, suppositions, scientific evidence from one corner of the abortion room, statistics, sermons, pontifications from legislators and political candidates, the supposed reactions of one’s neighbors, and finally, the instincts and intelligence of each individual. Laws will not change that landscape, nor will punishments, threats, or promises. The abortion decision takes place within a limited time span, then disappears, either in the birth of a baby, or the continuance of daily life. It is one of the very few lifetime decisions where experts are of little help.
As abortion goes further and further underground after the Supreme Court’s Dobbs v. Jackson Women’s Health decision, perhaps doulas will be able to resuscitate some of the methods used centuries ago. The women of Appalachia might reacquaint themselves with the proper method of growing, harvesting, preserving and dosing the seeds of Queen Anne’s Lace. Whatever happens in our near future, women will find a way to maintain control over their lives, just as they always have. If the consistently gathered statistics are any guide, it will not matter whether they are Catholic, Evangelical, Jewish, or atheist, whether they live in the East, West, North, or South. Their consciences and their own judgment will be their guides.