People’s History of Abortion Care in the United States

Content warning: This document collection includes mention of sexual violence.

By Wesley Hogan

Whatever a person’s stance today on abortion and contraception, it is often quite a distance from people’s approaches to abortion and contraception in earlier eras of U.S. history. Indigenous people and European colonists alike were clear that for free people, early abortion was legal and morally neutral through the time of “quickening,” or the first movement of the fetus (usually in the fourth month of a nine-month pregnancy). Since enslaved women were treated as property, they did not have legal right to their own body. Enslavers often punished them for using abortifacients, or a substance that induced the end of a pregnancy, because it deprived enslavers of more people-as-property. The idea of the rights of the “unborn” did not emerge until the 20th century.

While it is clear that agreed-upon community values on abortion and birth control have changed over time and place, these documents can help Americans today sort through these historic shifts, and decide for themselves.

Pre-Colonial and Colonial Eras

For many years, the oldest known human inhabitants of the continent were thought to date to 14,000 years ago. A claim in 2021 that human footprints in the New Mexican mud dated to 21,000-23,000 years ago has recently been corroborated by a team of researchers at the US Geological Survey and UC-Berkeley. So what about the earliest and longest-known inhabitants of North America — how did Indigenous nations approach abortion care? At the time of contact, somewhere between 8 and 18 million people lived north of modern-day Mexico. For at least 16,000 years prior to European colonization, collectively these Indigenous Americans successfully reproduced over 6,400 generations of human beings. While each North American Indigenous nation approached reproductive care in unique ways, below students can examine approaches by two, the Haudenosaunee (ho-den-oh-show-knee), spread out across what is today upstate New York, and the Cherokee, covering large parts of the southern Appalachian ridge in today’s North Carolina, Tennessee, and Georgia.

The Puritans brought English law on abortion care to Massachusetts, where it was both morally neutral and legal until quickening. They changed much of England’s legal system when they established their new community as a “city upon a hill” a new model to humans everywhere, but kept English law’s approach to abortion care as a woman’s issue, part of Puritan family life. Women could choose when and if they would become mothers — whether for the first time or the fifth time — under English Common Law.

In 1656, Elizabeth Keye successfully sued for her freedom (her mother was an enslaved Angolan owned by her father a white, property-owning Englishman and member of the Virginia legislature). Fewer than 150 women of African descent were resident (both free and enslaved) in the Virginia Colony at the time of the suit; 15,000 English settlers populated the colony. Keye won her suit based on centuries of Anglo-European legal custom of both patrilineal descent and the traditions of Christianity. However, in 1662, the Virginia Legislature reconsidered, overturning centuries of English Common Law: “All children borne in this country shall be held bond or free only according to the condition of the mother.” With this gigantic change from English Common Law, the Virginia legislature racialized reproduction. Only white women could produce white children. Enslaved Black women’s children were all enslaved, even if their biological father was white. A century later, the United States expanded this law for the entire country — enslaved Black women reproduced enslaved children, white women reproduced white children. The condition of the mother, not the father, determined a child’s legal fate. Enslaved African American women did not have body autonomy, that is, they were not legally entitled to determine what happened with their reproduction. They were not allowed to use either contraception or abortion. Instead, the person enslaving them got to decide this. It was not until the Civil War ended that now-freed women could legally determine their own reproductive lives.

People living in Colonial America understood pregnancy differently than today. Midwives were women who helped women during labor, delivery, and recovery from birth. European, Indigenous, and African cultures all had midwives; in North America, most babies born before the 20th century were delivered by midwives. From the colonial period through the Constitutional era (1786–1791), abortion was of little interest to U.S. lawmakers, who considered it “women’s business.” Midwives, physicians, and the public alike did not believe a pregnancy could be confirmed during the first trimester, as people thought the absence of a menstrual cycle could result from a blockage as much as from pregnancy.

Using roots and plants such as ergot, indigo, and cotton root, or turpentine and quinine, was common to resume one’s period, or “suppress the courses,” as Document #7 below calls it. Women widely used such abortifacients as a natural part of reproduction and people openly described these herbs and medicines in midwifery handbooks, pharmacy guides, and home medical literature. Early American medical books gave value-neutral instructions for “suppressing the courses.”

19th and Early 20th Century

In the early 1800s through the early 20th century, a coalition of doctors backed by the American Medical Association, the Catholic Church, and tabloid newspapers began to campaign to make abortion care a crime. By the turn of the century, this coalition largely succeeded in limiting women’s reproductive choices in an attempt to assert the authority, legitimacy, and status of scientific medicine — which excluded women — over female midwives. White male physicians, lawmakers, and social scientists expressed public and repeated anxiety that the low birthrate of the white middle and upper class Protestants would lead to white Protestant people becoming a minority in the country.

In response, lawmakers removed the quickening distinction from the statutory laws of 10 of the 26 states between 1821 and 1880. In these states, abortion became criminalized from conception. For the first time, it was illegal for free women to bring on their menses in the first months of pregnancy. The first state to do this was Connecticut in 1821 (Document #8), where the General Assembly passed the nation’s first bill banning medicinal abortion after quickening. Those who provided the medicine — not the pregnant woman — faced prosecution. Within 20 years, 10 of 26 states followed suit with similar laws.

While people still used abortifacients, and abortifacients continued to be covertly advertised and sold as a cure for “feminine complaints,” lawmakers, physicians, and religious leaders now attached significant stigma to abortion care. Indeed, between 1821 and 1900, the United States moved from being a nation without abortion laws of any sort, to a nation where abortion was made illegal and often criminalized. These state laws supported by physicians, legislators and religious leaders turned abortion from “women’s business” to officially taboo.

Comstock Laws

In 1873, the federal government joined the argument. The federal Comstock laws ushered in a new era, authorizing Anthony Comstock of the post office to search anyone’s mail for any “obscene, lewd, lascivious, indecent, filthy, or vile article, matter, thing, device, or substance.” Since at this time, Comstock judged information about birth control and abortion care to be obscene, all women residing inside the United States struggled to access information about reproduction, contraception and abortion care. Comstock laws made it extremely difficult for women to know about — much less control — their own bodies legally, socially, or culturally.

Dozens of states soon passed bills mirroring the federal Comstock laws. In some cases, these bills signaled the first extreme legal restrictions on reproductive rights. Georgia, for example, had no such laws on the books until 1876, when a new statute declared abortion care “an assault with intent to murder.” In short order, state legislators made all abortion criminal except when necessary to “preserve the life” of the pregnant woman. This 1876 law, and many similar laws passed around the country, remained virtually unchanged until the 1960s. Despite Comstock being a “zombie law” unenforced for nearly a century, in March 2024, Supreme Court Justices Alito and Thomas appeared to invoke its legitimacy in FDA v. Alliance for Hippocratic Medicine. In their reading, the law continued to restrict the sending of medication abortion via the U.S. mail.

Sterilization

At the same time as abortion care was criminalized, legislators and physicians engaged in widespread sterilization of those who were Black, Indigenous, Puerto Rican, or immigrants, as well as people who had intellectual or developmental disabilities. In 32 states between 1929 and the mid-1970s, more than 60,000 women were forcibly sterilized in the United States. For example, in North Carolina, between 1929 and 1975, the state ordered the sterilization of more than 7,600 people. Eighty-four percent of these were women. More than 2,000 of those sterilized were minors at the time of their sterilization, most of them victims of sexual violence. Black North Carolinians represented 39 percent of those sterilized overall. As the Civil Rights Movement crested in the later 1960s, Black women made up 60 percent of those sterilized, even though they were only 25 percent of the population. After California and Virginia, North Carolina conducted the third highest number of sterilizations in the country. While we think this content is difficult for high schoolers, historians are aware that teenagers were often targeted, and keeping this information from them now is thus ethically problematic.

As can be seen in Document #13, children were also sterilized. North Carolinian Elaine Riddick, 13, became pregnant after being raped by a man in her neighborhood. In an office building in Raleigh, five men met to consider her fate — among them the state health director and a lawyer from the attorney general’s office. Board members concluded that Riddick was “feebleminded” and doomed to “promiscuity.” They recommended sterilization. After a social worker threatened her illiterate grandmother, Maggie Woodard, with losing her access to state food rations, Woodard marked an “X” on a sterilization consent form. Riddick gave birth to her son at 14 via c-section, after which the doctor sterilized her without her knowledge or consent. By 1970 between 25 and 45 percent of Native American women and 33 percent of women in Puerto Rico, a U.S. colony, had been sterilized.

Today, only Alaska and North Carolina have outlawed forced sterilization. Thirty-one states and the District of Columbia allow forced sterilization of people under specific circumstances. For more information, see this 2019 report from the National Women’s Law Center.

The Comstock laws meant that women had very little control over the knowledge produced about their bodies, as well as very little access to information about reproductive care, for 100 years, between the 1870s and the 1970s.

Civil Rights and Women’s Movements

A dramatic shift in knowledge-ownership and knowledge-creation occurred with the Civil Rights Movement of the 1960s, and the 1970s feminist movement. Women in the Civil Rights Movement demanded medical care that included abortion care, and civil rights stalwarts like T. R. M. Howard responded. Civil rights activist Heather Booth activated her political network to form JANE, a safe underground abortion-care network in the 1960s. As scholar Ashley Farmer writes, “Before Roe v. Wade, lawyers, feminists, and Black Power activists like Florynce Kennedy worked to legalize abortion through Abramowicz v. Lefkowitz.” This was “a 1970 lawsuit that was the first constitutional challenge to abortion.” Flo Kennedy put women on the stand as expert witnesses, rather than medical professionals. Kennedy’s strategy of using women who had experienced illegal abortion eventually led to the Supreme Court deciding Roe v. Wade in 1973, that all of those who were pregnant had the Constitutional right to abortion care in the first six months of a nine-month pregnancy.

This was not a universally supported decision. In 1968, before Roe, Catholic bishops, doctors, nurses, lawyers, and housewives formed the National Right to Life Committee. They quickly expanded to include small numbers of non-Catholics, usually Protestants, Mormons, or Orthodox Christians. They stated their opposition to abortion care as a violation of the rights of the fetus. The graphic booklet, Handbook on Abortion, created by a Catholic doctor and nurse, John and Barbara Willke, quickly became “the bible of the pro-life movement.” New medical technologies such as the ultrasound allowed these activists to make a visual case that fetal bodies were equal to or had even more right to life than the pregnant mother.

Some groups who believed abortion morally wrong refused to participate in the political process and sought to end abortion care by “any means necessary.” In the 1980s and 1990s, Operation Rescue started the tactic of “rescue,” creating blockades in front of reproductive care clinics. Operation Rescue’s dramatic clinic blockades made it much more difficult to access abortion care. Extremists in this movement went further: Between 1977 and 2023, they carried out 531 assaults, made 383 death threats, three kidnappings, 42 bombings, 200 arsons, 492 clinic invasions, 18 attempted murders, and 11 murders of abortion care providers.

The women’s movement of the 1970s advocated for policy changes like equal pay for equal work, high quality child care, but too often centered white middle-class voices advocating legal abortion care. Black, Indigenous, Latinas, and women of color saw their struggle as wider than accessing abortion care: They demanded an end to programs sterilizing Black women, Indigenous women, Puerto Rican women, and immigrant women across the country. They led organizations advocating a “mother’s wage” to support low-income parents. They advocated for universal sex education as well as access to contraception, and high-quality, low-cost childcare.

Reproductive Justice

In the 1970s, and 1980s, these Black and brown women activists broadened the public’s understanding of abortion to insist on comprehensive access to healthy reproductive care — working at the same time to combat reproductive coercion and expand access to contraception and abortion. These issues, they insisted, could not be whittled down to a simple focus on abortion. CARASA, the Committee for Abortion Rights and Against Sterilization Abuse, linked race, class and gender analysis, anticipating the intersectional and human rights approaches of the Reproductive Justice movement led by Black, Indigenous, and women of color in the 1990s.

The conceptual frame “Reproductive Justice” was a response to the whiteness of the early feminist health movement. Its Black, Indigenous, and women of color creators defined it as:

(1) the right to personal body autonomy (freedom to make choices about one’s body);
(2) the right to have children;
(3) the right to not have children;
(4) the right to parent the children people do have in safe and sustainable communities.

This framework had noteworthy similarities to the Haudenosaunee approach to abortion care before European contact.

When historians return to primary sources from the time, we see that in different eras, what people considered “acceptable” versus “unacceptable” for abortion care changed dramatically. We find ourselves debating what made it acceptable in certain eras, unacceptable in other eras. We also debate why at times people felt it had no moral weight, and at other times felt it represented the essence of freedom or family.

This collection of primary documents is offered as an invitation to students to return to these sources, think through these questions, and generate new questions to illuminate the field.

Wesley Hogan is a research professor at the Franklin Humanities Institute and History. She is the author of On the Freedom Side: How Five Decades of Youth Activists Have Remixed American History and Many Minds, One Heart: SNCC’s Dream for a New America, and co–facilitates a partnership between the SNCC Legacy Project and Duke, the SNCC Digital Gateway. Part of her current work is to facilitate a team of medical clinicians, researchers, and students doing oral histories of reproductive care providers in the post-Roe era.

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Documents

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Document #1: Abortion Care on Turtle Island. Baron de Lahontan reports on his time among the Haudenosaunee, 1700

The focus of each generation of Haudenosaunee (also known by the French term, Iroquois) was to birth healthy children and eventually establish the next generation’s main family unit: the matrilineal longhouse. Neither sexual faithfulness nor monogamy was required to attain these ends. When European explorers, soldiers, and missionaries arrived, like French soldier Baron de Lahontan, they were surprised. Lahontan reported in 1700 that Iroquois “daughters have the command of their own bodies and may dispose of their Persons as they think fit.” What did Lahontan mean, “they have command of their own bodies?” Why do you think Lahontan was surprised by this?

Source: New Voyages to North-America by Baron de Lahontan, Illinois University Library

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Document #2: Cherokee Approach to Abortion Care, 1100 CE – 1800 CE

Cherokee society’s major goal was to secure the success of the next generation — distinct from the European colonists’ goal to pass property through the father’s line. Cherokee women shared their knowledge of contraception, menstruation, healthy pregnancy, and abortion only with other women. They knew that roots of Spotted Cowbane or Water Hemlock (cicuta maculate), prevented conception. They also used cotton root to induce abortion, and Black Haw to prevent miscarriage. Why do you think Cherokee women shared this herbal knowledge only with other women?

Spotted Cowbane	Cotton Root	Black Haw
Source: Water Hemlock or Spotted Cowbane, All-Creatures.org	Source: Cotton Root, from the Sacred Journey School of Herbalism Facebook page	Source: Black Haw, Master Gardeners of Northern Virginia, photo by Elaine Mills

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Document #3: Puritans’ Approach to Abortion Care, 1600s

In 1557, William Staunford summarized the English law requirements for homicide by stating that:

The thing killed must be in part of the world of physical beings (in rerum natura). So if one kills an infant in its mother’s womb, this is not a felony.

This law followed Christian Church teachings of the time that abortion was acceptable for married women until quickening, when Christians believed the soul entered the fetus. The legal status of abortion care remained like this — with women (rather than men, legislatures, or judges) deciding on abortion care — between 1200 and 1803 in England. The document makes a distinction between the “world of physical beings” and “the mother’s womb.” Why do you think the English made this distinction in the centuries before the invention of technologies like x-rays, ultrasounds, and CAT scans?

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Documents #4 and 5: African Women’s Approaches to Abortion Care in Enslavement, 1600s–1865