Debunking the Coat-Hanger Myth

The coat-hanger has become the pro-choice movement's rallying cry and you will often hear the claim that when abortion was illegal, large numbers of women either attempted abortion on themselves with sharp or caustic liquids or went to back alley, medically untrained, practitioners, and often died in the process. And they further make the claim that if abortion is restricted or made illegal again, abortion will become unsafe and women will resort self-induced abortion or dangerous means of obtaining one. But how accurate or true are these claims? Abortion right advocates also often make their claim by touting individuals cases of illegal abortions which led to death, such as Gerri Santoro, but while these cases are tragic, individual cases of ancedotal evidence does not make for a strong case. So let's take a look at the facts of abortion practice before legalization:

"Mary Claderone (then Medical Director of Planned Parenthood) and Nancy Howell Lee (a pro choice researcher) both investigated the practice of criminal abortion in the pre-legalization era. Calderone estimated that "90% of all illegal abortions are presently (1960 - ed) being done by physicians." Calderone further estimated that 8% were self-induced and that 2% were induced by someone other than the woman or a doctor. Lee estimated that 89% of pre-legalization abortions were done by physicians, an additional 5% by nurses or others with some medical training, and 6% were done by non-medical persons or the woman herself. Calderone's numbers came from "43 men and women from the various disciplines of obstetrics, psychiatry, public health, sociology, forensic medicine, and law and demography." Lee interviewed women who had undergone pre-legalization abortions. The discrepancy between Lee's and Calderone's breakdowns of non-physician abortions is probably due to sampling errors."
And on the 5% of amature and self-induced abortions: "Lee's interviews with women who had self-aborted found a different picture from the women who had sought professional (however illegal) abortions. These self-aborting women tended to be less rational, and more self-destructive, than the women seeking competent abortionists. Lee also found that the women attempting self-abortion were likely to have had a death wish at the time of the abortion.
This finding is in keeping with psychiatric literature of the time, which treats self-induced abortion as a peculiar manifestation of the self-mutilating behavior common in patients with certain psychiatric disorders. Self-mutilation in patients with these disorders can range from superficial cuts and cigarette burns to self-trepanning (drilling holes in the skull), enoculation (gouging the eyes out), and amputation of limbs.
Mutilation of the genitals is not rare in these patients, and self-induced abortion was often regarded as an extreme form of genital mutilation aimed at attacking the patient's own femininity. It was in the political context, not the psychiatric or psychological context, that self-induced abortions were considered to be the expected behavior of normal women. This politicized view of self-aborting women eclipsed the reality, and case studies stopped showing up in the literature, although occasional stories still do make it into the newspaper.
This is not to say that all women who self-induce abortions are mentally ill. Investigators of post-Roe self-induced abortion injuries and deaths found other factors, such as distrust of the medical profession, a perception of home herbal abortion as more "natural," cultural preferences, and "ideosyncratic" factors nobody could readily explain. These women, however, carefully research abortion methods and use common sense and intelligence to select a method likely to be efficacious and comparatively safe.(source)

Just how many criminal abortions were there before legalization? This is an excellent question, and a difficult one to answer.

Abortion-rights advocates often parrot the claim, "There were 5,000 to 10,000 unsafe abortion deaths before legalization." This claim is nothing more than a well-established myth. In debunking this myth, let's look at the source:

"In the case of the 5,000 - 10,000 claims, the original source was a book -- Abortion, Spontaneous and Induced -- published in 1936 by Dr. Frederick Taussig, a leading proponent of legalization of abortion. Taussig calculated an urban abortion rate based on records of a New York City birth control clinic, and a rural abortion rate based on some numbers given to him by some doctors in Iowa. He took a guess at a mortality rate, multiplied by his strangely generated estimate of how many criminal abortions were taking place, and presto! A myth is born!
Even if Taussig's calculations, by some mathematical miracle, had been correct, they still would have been out of date by the end of WWII. Antibiotics and blood transfusions changed the face of medicine. But not only are the Taussig numbers dated, they were never accurate to begin with. At a conference in 1942, Taussig himself appologized for using "the wildest estimates" to generate a bogus number. Although it took Taussig six years to reject his own faulty calculations, at least he did admit that he'd been wrong. Other abortion enthusiasts lacked Taussig's compunctions. Bernard Nathanson, co-founder of NARAL, admitted that he and his associates knew that the claims of 5,000 to 10,000 criminal abortion deaths were false. They bandied them about anyway, Nathanson confessed, because they were useful. This, too, is old news -- Nathanson came clean over twenty years ago." (source)

Because this is before the Centers for Disease Control began Abortion Surveillance Activities in 1968, and began looking at abortion mortality in earnest in 1972, all abortion deaths were typically counted together: legal (or "therapeutic"), illegal, and spontaneous (miscarriage). Mary Calderone, who was then Medical Director of Planned Parenthood, reported on a conference studying abortion in America. She indicated that in 1957, there were 260 abortion deaths nationwide. That number included all abortions: legal, illegal, and spontaneous. The caluclations based on state maternal mortality investigations are fairly close to Calderone's numbers based on national data. These numbers were based on alerting doctors, law enforcement, coroners, and hospital administrators, along with public records officials, of their responsiblity to report these deaths(source)However, even without the CDC's intervention, public health officials were watching maternal mortality in general, and abortion mortality in particular, very carefully. Mary Calderone, who was then Medical Director of Planned Parenthood, reported on a conference studying abortion in America. She indicated that in 1957, there were 260 abortion deaths nationwide. That number included all abortions: legal, illegal, and spontaneous. The caluclations based on state maternal mortality investigations are fairly close to Calderone's numbers based on national data. These numbers were based on alerting doctors, law enforcement, coroners, and hospital administrators, along with public records officials, of their responsiblity to report these deaths. (source).

So the numbers aren't as high as abortion-rights advocates would have you believe. Also, if you looks at statistical trends for abortion deaths from 1940 to 1970, the number of deaths actually began to decrease even before the legalization of abortion began in the 1960's, with 1,407 deaths in 1940, 744 deaths in 1945, 263 deaths in 1950, 224 deaths in 1955, 251 deaths in 1960, 201 deaths in 1965, and 119 deaths in 1970. Source: "Induced termination of pregnancy before and after Roe v. Wade" JAMA, 12/9/92, vol. 208, no. 22, p. 3231-3239.
Despite abortion-rights advocates crediting the legalization of abortion, much of the decrease in maternal/infant and abortion mortality during from that time period (from 1940 to 1970) can be better attributed to improvements in antibiotics (such as the finding of penicillin), improved access to blood products, improvements in surgical techniques, improvements in emergency medicine, broader access to adequate prenatal care, improved vaccinations, and improvements in environmental health/sanitation, to name a few.

Now regarding claims of what would occur if abortion were to become illegal again. Nicolas R.P. Lewine addresses one of the sources for these claims in an op-ed piece, entitled "Stumping for Stupak," published in the student newspaper, the Harvard Crimson:

The Harvard Crimson
"Stumping for Stupak" (Excerpt)
By NICOLAS R. P. LEWINE
Published: Thursday, December 03, 2009

...Finally, opponents of the Stupak amendment claim that the amendment would lead to more unsafe abortions, which are likely to harm women. Participants in an anti-Stupak rally in Harvard Square on Nov. 18 brandished coat hangers and handed out flyers that said legal restrictions on abortion “just make abortions dangerous.”
This claim likely has its roots in a 2007 Guttmacher Institute study of worldwide abortion that concluded that countries in which abortions were illegal had significantly higher rates of unsafe abortions. However, the fatal flaw in this conclusion is that the countries where abortions are illegal are almost entirely developing countries, including most of Africa. The countries where abortions are legal include the United States, Europe, and other already developed nations. Moreover, 97 percent of unsafe abortions were in developing nations. This argument attributes the disparity in unsafe abortions to legal restrictions while not addressing the fact that medical care in countries where abortion is illegal is vastly inferior, much less available, and often not performed by adequately trained professionals. So it is misleading to claim, based on this study, that making abortions illegal would cause a rise in unsafe abortions. (Moreover, it is important to remember that the Stupak amendment does not actually make abortions illegal.).... (source)

Prior to Roe v. Wade legalizing abortion across all 50 states, abortion law was left to the individual states deciding if and under what circumstances they permitted theraputic or elective abortion (source).  It is likely that we would return to this status with the state legislaters deciding if and and under what circumstances they permitted theraputic or elective abortion and most likely theraputic abortions would permitted in hospitals for rape/incest cases and where continuing the pregnancy endangered the woman's life.