Vox’s brand of “explanatory journalism” often relies on agenda-driven sources that assert highly questionable conclusions about history.
In “This is the future of abortion in a post-Roe America” Vox writer Anna North peddles a bizarre conspiracy theory while summarizing the legal history of abortion in the United States. Paraphrasing a law professor at UC Irvine, North claims that “male doctors” in the nineteenth century conspired to supplant midwives, who were “a racially diverse group” (by implication, all the doctors were evil white men, I suppose), which resulted in alienating women from their reproductive healthcare.
Her source is the book Policing The Womb: Invisible Women and the Criminalization of Motherhood by Michele Bratcher Goodwin, which from the title sounds totally agenda-free (<-sarcasm).
“For generations, most reproductive health care in this country, from labor and delivery to abortion, was provided by midwives,” she says. In other words, women controlled reproductive health care. Not just any women, a “diverse group” of African Americans, Native Americans, and whites. They performed their services in the home, and there were, for the most part, no laws against abortion before a pregnant woman could feel her baby move (called “quickening” in the past).
Here’s where things get dicey. “That began to change in the mid-19th century,” North writes, “when male doctors began an effort to supplant midwives and monopolize reproductive care.”
And then she moves on, with no further explanation for why doctors might want to advocate laws restricting abortion. This leaves the reader with the impression that the AMA advocated for restricting abortion in the United States simply because those dastardly white men (probably old too) wanted to take control over reproductive care away from women. The real reason, however, is because abortions performed by these midwives were often incredibly dangerous and involved methods like ingesting unregulated or untested poisons bought from the local apothecary.
Other reasons included advances in medical knowledge that erased “quickening” as a logical boundary between a developed and undeveloped fetus. The Hippocratic Oath taken by doctors specifically proscribed abortion and made doctors swear to “do no harm or injustice”. Many viewed abortion, then, as unethical and the amateurs who often performed it as quacks and charlatans.
Another reason doctors might have wanted to “monopolize reproductive care” is because giving birth at home attended by a midwife, or sometimes no one at all, was also incredibly dangerous. It is magnitudes safer to give birth in a hospital attended by a licensed physician. According to the CDC, in 1900 “for every 1000 live births, six to nine women in the United States died of pregnancy-related complications, and approximately 100 infants died before age 1 year. From 1915 through 1997, the infant mortality rate declined greater than 90% to 7.2 per 1000 live births, and from 1900 through 1997, the maternal mortality rate declined almost 99% to less than 0.1 reported death per 1000 live births.”
This chart shows how the infant mortality rate has declined precipitously since 1800, when 46 percent of children did not live to see their fifth birthday. The decline in infant and maternal mortality is directly related to, as Anna North puts it, “male doctors supplanting midwives” and monopolizing reproductive care (her characterization, not mine). According to the CDC, “Poor obstetric education and delivery practices were mainly responsible for the high numbers of maternal deaths, most of which were preventable.”
By no means am I an expert on the legal history of abortion or the history of medicine in the United States, but I can look at statistics and see with my own eyes how professional medical science has drastically reduced infant and maternal mortality in this country. The ideological blinders required to characterize doctors replacing midwives as the primary care providers for women as a sinister plot to hurt women instead of help them must be massive.
For thousands of years of human history, giving birth was a risky proposition, but it went from being dangerous for both mothers and infants to a routine procedure in a little over a century. If you care about women’s health and safety, the safety of giving birth and the health of babies, you can’t seriously argue that things were better off when midwives performed “reproductive care”.