The medical historian Mary Fissell begins her history of abortion with an account of her visit to a cemetery in south London to see the grave of Eliza Wilson, a 32-year-old dressmaker from Keswick who died in 1848 after an abortion went wrong. Historians have estimated that by the early 19th century, half of births in London were conceived out of wedlock, and that by 1850 rates of illegitimacy were the highest they had ever been. In a big city, filled with young migrant workers, there was clearly a lot of bed-hopping, and plenty of cads who could disappear and evade community pressure to arrange a shotgun wedding. A single woman who found herself pregnant and abandoned, however, had few good options. If she kept the baby, she would likely lose her job and be refused medical care. Places such as London’s Foundling Hospital would not care for babies left anonymously or born out of wedlock, because they did not want to be seen to encourage extramarital relations. Abortion was one solution, and pills were widely available in Victorian Britain and marketed using coded terms such as “female obstruction pills”, the obstruction referring to a delayed period. What made Wilson’s story unusual, then, was not that she had an abortion but that she died from one, after contracting an infection.
Wilson was the first woman Fissell researched, having found newspaper stories about her death. Her case attracted media attention as the two midwives who treated Wilson and her married lover were charged with murder following her death. After a high-profile court hearing, all three defendants were either acquitted or had their charges dropped. At the time, abortion was criminalised and could carry the death penalty, but convictions were rare and, as the jury’s response in the Wilson case suggested, abortion was generally tolerated.
Fissell, a professor of history at John Hopkins University in Baltimore, largely tells her history of abortion through the lives of women such as Wilson, those who tried to end their pregnancies, and the midwives and doctors who helped them do so. We can rarely hear from the women who had abortions directly – they are usually spoken for, the subject of medical records, court hearings and salacious newspaper clippings – and yet Fissell does a great job of providing a sense of their wider world and how they viewed their options, or, more frequently, lack of options. As she rightly observes, a woman’s experience of childbirth, pregnancy and abortion is inseparable from the rest of her life, her work, her relationships, her social status and freedoms. The human stories make this history a compelling read, and it means that even as Fissell covers over 2,000 years of human history she can remain rooted in the concrete, the personal, the everyday complexity and messiness of individual lives.
We learn of an enslaved singer who lived in Ancient Greece in the fourth century BCE and was referred to a doctor by her enslaver after she fell pregnant. The doctor instructed her to jump up and down vigorously and recorded that on the sixth or seventh jump something fell out of her vagina onto the floor. Based on the doctor’s description, contemporary historians have been able to estimate how progressed her pregnancy was (but Fissell does not share these estimates). The story illustrates how in Ancient Greece abortion was seen as something routine, neither sinful nor shameful – no secrecy surrounded this visit to the doctor. Other doctors during this period studied aborted foetuses to better understand conception; abortion was clearly a regular part of their practice.
A first-century AD text, “On Simples”, listed herbal remedies that could be used to regulate periods, bring on contractions and induce abortions. Some of the herbs listed would remain in use for millennia, documented in medical texts mostly written by men, and shared between women and across great social divides, between servants and mistresses, indigenous women and colonisers.
By the Roman period, however, attitudes towards abortion had hardened. Fissell argues that this shift was a reaction to women’s increasing freedom, as men in first-century Rome complained that women were using abortions to hide adulterous affairs or because they wanted to stay thin. A similar pattern repeats over the centuries. History is marked by periods in which abortion is accepted, and by harsh crackdowns that tend to be driven less by what abortion is than what it is seen to represent: a decline in sexual morality, and women rising too high above their station. Historically, objections to abortion have rarely centred on concerns for the foetus. Often, abortion has been conceived as a kind of property crime. In Rome, a foetus was seen as the father’s property, not something a mother could choose to discard. In 17th-century Caribbean colonies, where enslaved women used abortion as a form of resistance to avoid giving birth to a child destined to be enslaved, slave owners opposed abortion because it deprived them of future capital.
Throughout history, in societies where abortion is tolerated and those in which it is outlawed, Fissell finds evidence of women securing what doctors today would call “self-managed abortions”. She writes of enslaved women chewing cotton root in secret, married women discretely taking pills because they cannot afford another baby, and young, single women doing what young single women have for centuries done when a period comes too late. Some of these women might not have seen themselves as ending a pregnancy, they might have intended simply to regulate their menstrual cycle. Their experiences are rarely documented, because their abortions were safe and unremarkable, a private thing.
For much of human history, maternal mortality rates have been so high that abortions were, statistically speaking, a much safer option. Some mothers may have chosen to take abortifacients for precisely that reason. Fissell draws on an array of sources – the plots of popular plays and novels, newspaper advertisements, medical texts – to show how common medical abortions have been throughout the ages. Figures are hard to come by, but it is estimated for example that in 1950s America – when the country was undergoing a “moral panic” over abortion, Fissell writes – more than one million abortions were performed each year.
Many of Fissell’s readers will no doubt wonder if history can offer insights into how abortion rights can be reclaimed. As of late 2024, 40 per cent of the world’s women of reproductive age were living in places with restrictive abortion laws, and the overturning of Roe vs Wade in the US makes clear that hard-won reproductive rights can easily be lost. This is where Fissell’s decision to centre her history on women’s stories, rather than legislative change, is limiting. She does not explore in depth, for example, how US feminist groups succeeded in establishing a woman’s constitutional right to abortion in 1973, or why in 1967 the Abortion Act, which made abortion legal in Great Britain, was passed. In researching her book, Fissell found cause for optimism, as “like wildfires, moral panics burn out, and times of toleration usually follow”. But when they threaten human life, we don’t let wildfires burn uncontrolled. A young woman living in Alabama doesn’t have the luxury of waiting things out; I struggled to share Fissell’s optimism.
To anyone who still needs convincing, Abortion makes clear that restricting women’s reproductive freedom is both dangerous and self-defeating. “Prohibition ruins lives in the short term and often fails in the long term,” Fissell writes. Ed Keemer, a black Detroit physician who became one of the city’s leading abortion providers in the decades before Roe vs Wade, explained that he began providing abortions after a teenager he turned away, because he didn’t want to break his professional code of ethics, killed herself rather than continue with her pregnancy. Since the 2022 Dobbs ruling overturned Americans’ constitutional right to abortion, the number of legal abortions in the US has increased, Fissell notes. She could have added that infant and maternal mortality have risen in states that have since introduced restrictive abortion laws.
Publicly, at least, many anti-abortion activists in the US have framed their argument in terms of their moral concern for foetuses. (That the red-state lawmakers obsessed with protecting the unborn do not extend the same moral concern to babies and their mothers suggests their motivation continues to be a desire to control women.) In the UK, some MPs want to reduce the upper limit for abortion from 24 weeks to 22, as a small number of babies have survived after being born at 22 weeks. It is easy in such a climate to get drawn into moral debates over when personhood begins, and how we balance the rights of the mother and the foetus. Where now we talk about detectable pulses and medical viability, previous generations placed value on the “quickening” or “ensoulment”.
But the perspective that Fissell’s book slyly advances is that these debates are something of a distraction, because there is a strong case for supporting liberal abortion laws on purely pragmatic grounds. Regardless of anyone’s personal views on abortion, the truth is that women have always had them, they have them when they are legal and when they are banned, and sometimes they feel guilty or relieved, or both, or they feel nothing at all. All bans do is make it more likely that women will die trying to end their pregnancies or die for want of better obstetric care. The other, depressing truth is that campaigners have been making this exact point for decades. This appeal to good sense – to the facts of the matter – doesn’t seem to make much difference.
Abortion: A History
Mary Fissell
Hurst, 288pp, £25
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This article appears in the 26 Mar 2025 issue of the New Statesman, Putin’s Endgame