Content warning: This is a story about abortion. It includes descriptions of medical procedures. *I am in no way encouraging the procedures described in this piece, nor am I condoning self-administered medical care in general.*
Let’s take a step back to the 1960s, a pre-Roe v. Wade era. Abortion is illegal in 30 states, legal only under specific circumstances in the 20 others. Difficult to imagine a time like that, huh?
Carol Downer, mother of six and Los Angeles resident, starts hearing of protests. This is the second-wave feminist movement, focused heavily on reproductive rights. She learns of the pushback against back alley abortions, the fight for abortion to be legalized. A reminder, it wasn’t until 1972 that the contraceptive pill was legally available to everyone. With little access to contraception, obviously rates of unwanted pregnancies—and thus, abortions—were higher. Downer herself had an illegal abortion in 1963.
She got a phone number from a friend, went to an “office” to meet a man who she assumed was a doctor and endured a painful procedure without anesthesia. The man didn’t explain what he was doing, so she can’t say definitively what method he used. He just told her to call back in a week. When she did, he informed her he had left gauze in her vagina and now she had to remove it. She found the gauze had hardened. It was a long and gruesome time spent, pulling the now sharp and inflexible material out little by little. (I couldn’t find any evidence that leaving gauze in the vagina is common practice or safe. Instead, I learned gauze should not be left in wounds for more than two days due to risk of infection.)
With her experience and all the other stories of illegal abortions she’d heard in mind, Downer attends a meeting held by a national feminist group. The meeting inspires her to brainstorm: What can she do to help the fight?
Downer lands on a controversial idea. Instead of waiting on legislators, pro-choice activists could take matters into their own hands and learn how to do abortions themselves.
You see, if you’re wealthy, you can find a doctor to perform an illegal abortion. However, those without substantial funds are forced to resort to riskier alternatives. During the ’60s, abortions were often performed by people with little to no medical training. Seeing as other laypeople could do it, Downer believed it was well within the realm of possibilities that she and others could learn the skill as well.
She begins shadowing at an illegal clinic. Never before had she seen a vagina or cervix or understood where any of her own basic sexual organs were located. She describes these parts of the body as only accessible to “doctors and boyfriends or husbands” at the time. In this clinic, however, the mystery of uterine anatomy is revealed to her. Downer realizes, it’s actually pretty simple. She watches many procedures, IUD insertions and early-term abortions. Downer practices performing abortions herself and begins recruiting others to learn the procedure.
While the notion of those outside the medical community performing abortions may seem outlandish, it’s important to note the long history of midwives who oversaw gynecological care. It wasn’t until the mid-1800s, that the male-dominated medical establishment claimed such responsibilities. Once they did, the information became more inaccessible to patients. Gynecologists, 93% of whom were men in 1970, often wouldn’t answer patients’ questions. They took an “I know all, just trust me” approach.
Learning about this anatomy was radical in and of itself. Downer starts traveling with a group calling themselves “the self-helpers.” They hold gatherings where they pass out speculums (a medical device that allows a better view of the cervix and vagina). Attendees are curious about their own bodies and excited to have this information made accessible.
A CDC physician taught them how to do pap smears more effectively than most gynecologists at the time. They learned how to do pelvic exams. As more and more of the self-helpers learn these techniques, underground clinics pop up. They encourage curiosity, make sure patients are well informed and perform early abortions.
Lorraine Rothman, another self-helper, takes the suction device they learned to use when shadowing at the clinic and improves upon it. She names the new device the “Del-Em.” At the time, abortions were popularly done by dilation and curettage (D&C). This technique requires a significant dilation of the cervix, then the contents of the uterus are painfully scraped out. With the Del-Em, a small flexible tube called a cannula is inserted into the cervix. A syringe creates a vacuum which suctions out the contents of the uterus through the cannula. This technique only works in the first few weeks of pregnancy.
They refer to this method as Menstrual Extraction (ME). Because ME is performed during or shortly after a period, often with no pregnancy test, it may exist within a legal gray area. ME has other uses aside from abortion; it’s been used to shorten periods and for fertility awareness. With tweaks, they used the method to fertilize a patient who wanted a child, with donor sperm, resulting in a pregnancy. There’s even a story in Downer’s book A Woman’s Book of Choices that explains how one self-helper utilized ME to curtail a patient’s post-miscarriage bleeding in a blizzard. While there’s no concrete data, there’s also no evidence of major complications as a result of abortions performed by the self-helpers. Similar processes are utilized in other countries to circumvent abortion laws.
In 1972, the police were aware of the self-helpers. They eventually raided the clinic and Downer was charged with practicing medicine without a license. After an especially publicized case, the prosecutors couldn’t prove Downer had actually performed any abortions or practiced medicine. She was found not guilty.
Shortly after, Roe v. Wade was decided. Many of the underground clinics found doctors and became legal abortion sites. Downer went on to manage legal clinics.
While their medical methods may be irrelevant today (again, not recommending laypeople attempt any medical procedures), the self-helpers’ determination to pursue bodily autonomy and desire to educate are aspirational. They claimed their own agency and brought about a wave of self-determination. In treating each other with respect and encouraging an open dialogue, basic health information was made more accessible.
Reproductive rights are intrinsically linked to other, basic human rights. In realizing women and trans people are not explicitly guaranteed bodily autonomy in the United States, we understand how much power the Supreme Court holds. We are one of the only “developed” countries that does not assert gender equality in our constitution. Instead, many of our rights hinge on the right to privacy and the court’s interpretation of what that means. At any time, the Supreme Court can roll back decisions that make contraceptives accessible, allow women to have credit in their own names and more. It feels like we’ll be trapped in the same battles—for agency, autonomy and access to healthcare—until these rights are explicitly codified.
It looks like the fight for equality and self-determination continues…