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Occupying the Waiting Room: 40 Years of Health Care Needs
by Lori Adelman
In 1970, something electrifying filled the air in New York.
Feminist organizing was in high gear. Betty Friedan planned a march and rally to mark the 50th anniversary of women's right to vote in August, called the New York City Women's Strike for Equality.
Two years earlier in 1968, the New York Radical Women developed the phrase "consciousness-raising" to describe its method of organizing for women's liberation.
That same year, young New York feminists participated in the now famous demonstrations outside of the Miss America Pageant, crowning a live sheep as Miss America and setting up a "freedom trashcan" in which they disposed of items they identified as offensive: girdles, wigs, copies of Playboys, false eyelashes. (Bras were seized for description by the media, fueling the "bra burning" myths that exist to this day.)
The next year, the feminist group Redstockings held the first-ever abortion speak-out in New York City, where Gloria Steinem discussed her abortion in public for the first time (Steinem has called her abortion "a pivotal and constructive experience.")
And then, on April 9, 1970, the New York State Assembly voted to legalize abortion, the first state in the U.S. to do so. As the New York Times reported, the law was decided by the last-minute change of a single vote. (The next day, the Beatles announced their breakup. Talkin' 'bout a revolution, indeed.)
By the time that Roe v Wade was decided by the U.S. Supreme Court on January 22, 1973, the country's most liberal abortion law had been in effect for almost three years in New York State.
Sizing Up the Data
New York's early entree into legal abortion provision offers a window into exploring the realities of abortion for women from then until today.
Most abortion data in the United States picks up sometime around 1973, the same year that Roe v. Wade took effect.
Of course, abortion statistics in any time period can be difficult to obtain, and the statistics that are available are frequently approximations rather than exact figures. Much of this is due to incomplete reporting (some states have laws on the books prohibiting the release of abortion figures), and some of it is related to the stigma associated with the procedure, which can make women more likely to underreport, as described by the Guttmacher Institute in an explanatory publication.
But it's clear that as early as 1970, there were significant and relatively well-documented instances of women obtaining abortion. In a paper published in 1970 by Dr. Edwin M. Gold, Professor-in-Residence for Maternal and Child Health at the University of California School of Public Health, wrote "as we enter the decade of the 1970s, progress continues … considerations for abortion are now a matter of consent between the woman and her physician."
In 1970 there were 44,000 reported abortions in New York State. But in the year after abortion was legalized that figure increased six times over to 268,573, and then increased again the next year to 299,891, according to data from the Centers for Disease Control and from state health departments.
That's more women getting abortions in one year – 1972 – than people who marched in the entire historic 1963 Civil Rights March on Washington, even counting only reported figures. The number of women who obtained abortions in 1972 could fill roughly 4,000 school buses; if the women were to lay end to end, they'd stretch 300 miles, longer than the distance from New York to Virginia.
In part, these numbers are so high precisely because New York was the first state to allow the procedure; women who could afford it flocked to the state in substantial numbers, especially from neighboring New Jersey.
Who Are the Women? Then and Now
Imagine the waiting room of a typical abortion clinic in New York City in 1972, a year before the Roe v. Wade decision.
Of 10 hypothetical patients in the room, most would have been white, childless and young -- in their teenage years or low-mid twenties. Most likely, three or more of them were over 13 weeks pregnant.
Now compare that to the New York of today. According to the CDC, New York follows a similar trend to national statistics, in which the annual number of legal induced abortions increased gradually until it peaked in 1990, and then declined in most years after that.
In 2010, New York State saw 123,849 abortions -- less than half the number in 1972. Still, that's 507 per 1,000 live births, making New York the state with both the highest number of total abortions and the highest ratio of abortions to live births. In New York City, that ratio is even higher, with 757 abortions occurring for every 1,000 live births.
In addition, there have been striking changes in the demographics of abortion. Compared to 30 years ago, women having abortions today are older and more likely to be mothers and minorities.
Consider today's statistically typical U.S. waiting room: if there were 10 patients in the room, six would already have one or more children. Only one of them would be over 13 weeks pregnant. Two would be teenagers, and five would be in their 20s. Four of them would be white, three of them would be black, and two of them would be Hispanic. Four would identify as Protestant, and three more as Catholic.
In some ways, it's a far cry from the earlier reality. But while this (admittedly rather crude) exercise does get at some important shifts in demography, it doesn't capture the entire shifting tide of abortion then and now. The last major shift in the realities of abortion lies not in who, but in how.
Shifting from Surgery to Abortion Pills
RU 486 or Mifepristone (commonly known as the "abortion pill") was first introduced in the late 1980s, and it has since begun to revolutionize the way abortion is performed in the U.S. and around the world.
While most abortions are still performed surgically, medical nonsurgical abortions as a percentage of total abortions in the United States have increased every year since the Food and Drug Administration (FDA) approval of Mifepristone in September of 2000. The latest figures from the Guttmacher Institute estimate that medical nonsurgical abortions now account for 17 percent of all nonhospital abortions, and counting.
This option, of course, was not available to women in the 1970s, and represents a dramatic shift in the reality of abortion for many women. What was once a surgical procedure that required anesthesia and had to be performed in a hospital or doctor's office, can now be performed in the privacy of one's home, with neither surgery nor anesthesia required unless complications arise.
This technological development has made it easier for women to gain access to abortion, and not only in places and situations where it would be otherwise legal.
The International Women's Health Coalition (IWHC) notes that because mifepristone is a registered abortion drug, its sale and use are not permitted in most countries with restrictive abortion laws. But a lesser known anti-ulcer medication known as misoprostol, which is registered under various trade names in more than 85 countries, can often be used as a substitute with 85 percent percent success rates. Misoprostol offers a safe and accessible alternative for women who have no other option. In the U.S., misoprostol is approved for sale as an ulcer prevention medication, but can be used legally for other purposes including medical abortion. Still, there are significant barriers to access in the U.S. and abroad, including lack of knowledge regarding the process and legality of this method, as described in a 2009 publication prepared by Gynuity Health Projects and the Reproductive Health Technologies Project.
Since users are not likely to report use of the product outside the law, it's hard to say with accuracy the extent to which this technology is being utilized on the ground.
But when considered with shifts in abortion laws and demographics, it's clear that the reality of abortion in the U.S., and globally, is ever-changing, and has been since the historic New York State legalization, and even before that. IWHC Program Officer Audacia Ray acknowledged some of the far-reaching implications of the technology in a blog post, writing that access to safe abortion has changed over the past several decades not just because of shifting legal and funding landscapes, but because of health technologies. "For thousands of years, women have used herbal remedies to end unwanted pregnancies, but more recently medicines developed in labs provide a non-surgical safe abortion option," she said.
Reality Changes
Progress is not linear, and increased access to safe abortion services can never come fast enough. But it's worthwhile to note how much the realities of abortion have changed since the 1970s, and to remember that before history was made in the Supreme Court, health outcomes and realities were already shifting for women because of tireless advocacy and pioneering activism on the ground. And the story is still being written.
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CURRENT ISSUE
Winter 2012
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