Dr. Gillian Frank on the Decimation of Roe v. Wade

“It's not a simple end of abortion.”

Well, that was a Terrible, Horrible, No Good, Very Bad, Unprecedented, Precedent-Destroying Week at the Supreme Court. To help make sense of SCOTUS’ reversal of Roe v. Wade, I spoke to Dr. Gillian Frank, a historian of sexuality and religion. This is the first of a series of Skipped conversations on how Roe fell, and where we go from here.

Dr. Frank writes on the intertwined histories of religion, sexuality, and gender in the US, and is the co-host of Sexing History, a podcast about how the history of sexuality shapes our present. We chatted about the history of antiabortion laws, the public health crisis that's assuredly about to arise, and how the fight for abortion rights doesn't end now. 

A condensed transcript edited for clarity is below. Paying subscribers can access audio of the full conversation here. I hope you learn as much as I did.

Dr. Frank questioning whether this was a good idea

Ben: Dr. Frank, it’s a pleasure to chat with you, albeit under such disturbing circumstances.

GF: Thanks for having me.

Ben: To ground our conversation, could you talk about the rise of the first anti-abortion laws in the 19th century?

GF: Sure, though before we get to the restrictions, we need to note that abortion was widely practiced for most of American history up until the 1860s, 70s, and 80s. But then, a confluence of factors led to new restrictions on abortion. 

The first factor was the professionalization of physicians. With the founding of the American Medical Association (AMA) and the regulation of physicians, physicians tried to normalize and seize power over medical practices. Part of that meant stamping out what we would now call quacks or untrained unskilled physicians. But it also meant seizing power from skilled medical practitioners such as midwives, who offered competition and covered all the things an OB/GYN would cover, including abortion. 

Ben: Might I wager a guess that most of the members of the AMA, if not all, were white men?

GF: That would be correct, yes.

Ben: Well, as long as we are consistent.

GF: The second factor was the coincident rise of social purity movements. People like Anthony Comstock and others had huge concerns about what they called the “moral degradation” of American society. Comstock was a religious fundamentalist.

And he, like many white Protestants, feared that the arrival of Catholic Eastern Europeans meant good Protestant stock was declining. 

Anthony Comstock, one of the original architects of anti-abortion restrictions

Ben: It's just a pure coincidence that his name is Comstock and he's worried about the population's “stock”?

GF: I had never thought of it that way, but yes, pure coincidence. And so Comstock, joined by others, went from town to town, city to city, state to state, to campaign for abortion restrictions. Their efforts succeeded. 

In the 1880s, state by state, legislators pass what are called Comstock Laws, banning information about abortion and contraception, as well as banning abortion except to save the life of the mother. By the late 19th century, we see the completion of a shift from abortion being widely practiced to abortion being tightly restricted and in the domain of licensed male physicians.

Ben: After the Comstock Laws spread, what options did women face when seeking an abortion?

GF: Of course, the demand never stopped. The question then is: who did women go to? Where did they get abortions? 

One answer is that, as we fast forward, to the 1920s and 1930s, most cities and towns had a reliable full-time abortion provider. Members of the medical establishment felt if our patient needs an abortion, we can at least send them to the known provider and have them do the procedure, and then we can tidy up the aftermath. 

At the same time, unskilled people knew there was a strong demand for abortion, and many women turned to a black market that emerged. Newspaper headlines would regularly describe how people would seek out a gas station attendant or a trusted friend or someone who knew someone who said they could supposedly do an abortion.

Skilled or not, all of these practitioners operated outside the law. As a result, expenses went up, safety went down, and there were fatalities.

Ben: Wow, okay.

GF: Now, post-1940s demand isn't ceasing. In fact, demand for abortion is growing as part of a post-war, sort of sexual loosening up.

Ben: The post-World War II orgy, if you will.

GF: I wouldn't phrase it that way, but I'm sure there were some. 

And around the same time, there's a strong push to establish the so-called “nuclear family.” As women are pushed out of full-time work into part-time or homemaking work, we see a tightening of abortion restrictions.

Not coincidentally, in the 40s, Catholic physicians conduct a survey of how their hospitals are treating abortions. What are the numbers of abortions that they're providing versus, say, hospitals like Johns Hopkins or others that are Protestant, secular, or just non-Catholic? 

And they find that there's a wide discrepancy, suggesting that non-Catholic hospitals are providing a lot of illegal abortions.

This leads to another round of regulation that spurs hospitals to self-regulate for fear of violating the law. Hospitals introduce hospital committees to review every abortion case that comes in. These committees basically became a way of driving down the abortion rates that were legal and accessible. 

And so, entering the 50s, we have what we might call a quiet sexual revolution going on and less access to safe abortions. What happens? Again, rising body counts. 

Ben: In other words, a public health crisis.

GF: Right. A public health crisis emerges. Lawyers are aware of it. Police are aware of it. The clergy is aware of it. 

Ben: How does this growing mass awareness coalesce into a pro-abortion movement? In your work, you describe a religious alliance that forms, almost like a priest, a minister, and a rabbi walk into a bar and decide to support women’s rights.

GF: Yes, minus the priest at this point. 

The early abortion rights movement is largely coming from professionals. Physicians, lawyers, and clergy who believe that they should have the autonomy to make decisions with their patients.

As for the clergy, it’s mainly ministers from mainline Protestant denominations, as well as rabbis from reform and conservative denominations. They've already been on board with contraception for decades and see family planning as an ethical duty and sex for pleasure within marriage as natural, normal, and desired.

One of the big galvanizing factors was German measles, aka the rubella epidemic, which was causing a lot of fetal deformities. And there was a scare over thalidomide, a tranquilizer that also led to birth defects. So religious figures worried about the health of fetuses. (You can hear the ableist language of the decade.) 

Male lawyers, clergy, and physicians begin to see it as a moral outrage that when women they deemed worthy—i.e. women who were white, middle- and upper-class, and married—needed abortions, they had to either fly abroad or just couldn’t get them. 

Meanwhile, a growing women's liberation movement and second-wave liberal feminist movement are also seeing sexual matters as essential to recognizing the politics of oppression, and how to activate your own life to have full empowerment and social equality. Abortion becomes central to this conversation.

So, by the mid-60s, in California, New York, and other states, legislatures are considering abortion law reform. There's an emergent consensus about: what does it mean if hundreds of thousands of people a year are violating the law? 

And I haven't even gone down the full list of all the people who are concerned about abortion. But, long story short, by 1970, New York has legalized abortion with no residency requirements. Hawaii does the same around the same time. Kansas comes next. And then a whole other slew of states follow suit.

Ben: So, over generalizing, in a story that we’ll explore another time, this momentum leads to the Supreme Court's decision in Roe v. Wade in 1973. 

Something that occurred to me while reading your work, and which has occurred to me throughout the conservative push to overturn Roe is: isn't it very clear that we're heading toward another public health crisis? Why wouldn't there be more momentum toward stopping this public health crisis?

GF: Your basic question is what happens next?

Ben: It is, yes, but I hate to be too explicit about that in front of a historian.

GF: Okay. Will this create a public health crisis? Inevitably. 

By denying medical access, by making abortion more expensive, by trying to criminalize it, by increasing the social stigma around it; by empowering states to demonize those who seek and provide abortions and those who share information about the procedure; all of these things will have repercussions, the least of which is that for women who want to terminate a pregnancy in states with very restrictive laws, it'll become more time consuming, more expensive, and more difficult. 

These demotivating factors will be able to snare some, but if the past is any indication, many other folks are going to attempt self-managed abortions. 

Now, the past is not the same as the present. We have new technologies, new ways of getting information. But will there be people left behind? Inevitably. What will be the mental health, economic, or public health consequences of folks compelled to have children they don't want? As many people are pointing out, this oppression will have negative, cascading effects on people's lives. And for folks who inevitably end up traveling great distances, taking lots of time, and spending more money on abortion? Well, all of these things wear on a person and make an ordinary medical procedure traumatic. 

I can't predict body count. I can't predict maternal mortality. But I’d emphasize that the difference between now and in the past was, pre-Roe, there was not a political party that uniformly made anti-abortion its platform. In the past, both Democrats and Republicans were split over abortion.

Ben: As in, until even a couple of decades ago, members were split within both parties.

GF: Yes, split within both parties. But the ways in which the Republican Party has become radically conservative, if not outright anti-democratic and authoritarian, make for a different situation today.

In the past, you would almost never offer criminal penalties to someone seeking an abortion. Republicans are floating those penalties now and trying to expand a much greater punitive regime. This is an anti-abortion regime on steroids as compared to the past.

Ben: Wow. I suppose the increasing radicalization of this regime suggests there's no silver lining at the moment.

GF: No, I won't say there’s a silver lining, but I will say that it's not hopeless; that for decades now there have been groups preparing for this day; that there are many activists on the ground already creating infrastructures, and they have been creating infrastructures. 

This story doesn't stop with the decimation of Roe v. Wade. It's not a simple end of abortion. Rather, it's a transformation of how it can be accessed. It’s part of an ongoing struggle to provide health and dignity to millions of Americans.

Ben:  Thank you for that reminder, and for your time today.

GF: Real pleasure to speak with you.