In a year that marks the return to the White House of a Republican administration with a conservative agenda, it’s not surprising that much of the public discourse over abortion rights in the U.S. revolves around the consequences of two pivotal Supreme Court decisions: the Court’s 1973 ruling in Roe v. Wade that guaranteed a constitutional right to abortion based on the right to privacy, and the 2022 ruling in Dobbs v. Jackson which reversed Roe, thereby freeing individual states to pass legislation that regulates abortion access.
The latter decision unarguably constitutes a significant setback in the struggle for reproductive rights for American women, but the history of access to abortion—and a sense of what the future might hold—may best be understood by taking the long view, across cultures. In Pushback: The 2,500-Year Fight to Thwart Women by Restricting Abortion, historian Mary Fissell does just that. Starting with the story of an enslaved woman in ancient Greece who becomes pregnant after being hired out as a prostitute by her enslaver, Fissell presents a series of case studies. Each one illustrates how women continued to have abortions through the centuries despite changing mores, laws, the influence of the church, and the irregular availability of experienced or qualified providers. The stories also demonstrate a pattern: as women gained more social and economic freedoms, the laws governing abortion became more restrictive, with the pendulum eventually swinging back in the opposite direction to a more liberal stance on abortion.
The enslaved woman in ancient Greece would likely have faced no moral sanction for seeking an abortion—her value lies in her continued availability as a sex worker, and, in her case, a singer. Documents suggest that women in her position would have had the knowledge to end her pregnancy, most likely with an herbal abortifacient, though squatting, jumping and sneezing were also recommended methods of preventing pregnancy immediately after sex. In ancient Rome, the focus on controlling fertility was somewhat different; Roman women had greater freedoms than their Greek sisters, raising concerns about adultery, which Augustus declared as a criminal offense. With a focus on increasing the number of upper-class Romans who would rule the growing empire, controlling the fertility of elite married women was one way to achieve this end.
Leaving antiquity behind, Fissell nimbly guides us through the Middle Ages. In an era where Christianity is on the rise, and the issue of ensoulment is linked to the experience of quickening (when the pregnant woman first feels the fetus moving), the story of Brigid of Kildare was recorded. Brigid, a holy woman whose historical existence cannot be confirmed, was said to have helped a young woman miraculously end her unwanted pregnancy (a subsequent miracle attributed to Brigid helped a woman preserve her chastity). The Church’s codified position on abortion was still more than 500 years away and for many of these early Christians, discussions of ensoulment notwithstanding, concerns around abortion as a means of covering up illicit sex appear to have weighed more heavily than any harm to the fetus.
In early modern Europe, in some parts of the continent, abortion had become a capital crime punishable by execution, a development that reflected “a larger cultural shift that sought to control female sexuality in the interests of Church and state.” The story of Anna Harding who went on trial in 1618 was a case in point. Against the background of a witchcraft panic, Harding admitted to providing both married and unmarried women with herbal and floral preparations to end their pregnancies. A “confession” under torture to having consorted with a demon led to Harding’s conviction and being burned at the stake.
Indeed, herbal preparations to end unwanted pregnancies were common to societies as disparate as enslaved women in the Caribbean, who used abortions as an act of resistance, to Victorian women of all classes who sought abortions for many of the same reasons as women do today. Use of one of the herbs best known to induce abortion, pennyroyal, persisted up through the early 20th century, although not without risk to the pregnant woman.
By this time, the idea that life begins at conception had gained a greater hold in the United States. Hugh Hodge, a professor of medicine at the University of Pennsylvania, argued this “scientifically-based” premise as early as 1839, while the Pope’s 1869 declaration that life begins at conception would have been presented as divine revelation, though Fissell posits that concern on the part of European monarchs in Catholic countries worrying about depopulation and “degeneration” may well have influenced the pronouncement.
The story of Beatrice J, a Baltimore woman, who safely achieved two self-managed abortions in the 1940s through the aid of a catheter and ergot pills to induce uterine contractions, serves as a more modern example of women who had ended a pregnancy going on to administer abortions to others. In Beatrice’s case, after her trusted pharmacist helped set her up as an abortion provider, an undercover police operation exposed her practice. A trial followed, but charges were ultimately dismissed by a progressive judge on the basis that the “client” who visited Beatrice was not actually pregnant.
In addition, Fissell points out this was not an isolated example by any means. Even in the most restrictive settings and time periods, there appears to have been a fair amount of tacit acceptance. In the U.S., for example, “Physicians performed legal abortions for a variety of indications, and the rest, so-called criminal abortions, went largely unremarked. In the 1920s and ‘30s, abortion providers were rarely prosecuted, whether physicians or not, and the former were at risk only if a woman died.” Moreover, once antibiotics and blood transfusions became available in the 1930s and 1940s, the morbidity and mortality associated with these procedures would have been reduced.
The presence of abortion providers who practiced under the radar persisted throughout the ‘30s and early ‘40s, albeit with some providers using their own judgement as to who was morally deserving of their covert services. But the 1940s and 1950s also brought a more punitive attitude toward abortion in the United States. With an increasing number of arrests of providers administering safe abortions, dangerous practices became more widespread, as did abuses by practitioners, including sexual assault on clients. In turn, these tragic stories led to the underground movement of women and their allies who supported those in need, including the Jane Collective in Chicago, a group of women who risked criminal prosecution to help others obtain safe abortions.
While the individual stories of women seeking abortions constitute the throughline of Pushback, Fissell consistently addresses the broader factors that affected access in each of the societies she describes, including eugenics, racism, nativism, and concerns about fidelity and heredity. Enslavement and labor demands, the appropriation by physicians in the 19th century of care that was formerly the domain of midwives, and superstitions linking women’s fertility to fertility of livestock and crops, also come under scrutiny, as does the relatively recent shift of emphasis from the importance of the life of the mother to that of the fetus.
Readers might also consider the role of medical advances as factors that have altered our understanding of pregnancy, development of the fetus, and access to abortion. Among them was the development of simple urine tests that eliminate the uncertainty surrounding pregnancy, a means of confirmation light-years away from those early societies where pregnancy was confirmed by quickening. Sophisticated imaging of the fetus via ultrasound not only confirms pregnancy at an early stage, but packs an emotional punch. Moreover, the availability of medication through pharmacies and online sources for self-managed abortions, while under threat, has created a new landscape for pregnant women. This last means of obtaining an abortion, though formulated in a laboratory, suggests a new iteration of the herbal abortifacients used by so many generations past.
Pushback succeeds at being both highly readable and meticulously researched—the volume includes an extensive list of notes and references for each chapter. Fissell, who is the Inaugural J. Mario Molina Professor in the History of Medicine at Johns Hopkins University, also writes the Substack A is for Abortion: Snapshots from the Past. As a pre-modern historian of the 17th century, she particularly enjoys the kind of “detective work” that accompanies that study. But she was also pleasantly surprised by how much she enjoyed researching and writing on the modern period, where sources are more readily available, including data she found through Ancestry.com.
Fissell completed her manuscript before the start of the second Trump administration and aside from allusions to Roe v. Wade and Dobbs v. Jackson, Pushback does not explore the ways in which abortion became a flashpoint in our most recent national elections. (A description of politically motivated anti-vice campaigns that targeted abortion practitioners and pregnant women in the late 1940s and 1950s is included in the chapter dealing with that time period.)
But in a discussion with this writer, Fissell weighed in on current data that shows more American women than ever are having abortions despite the 2022 Dobbs ruling. “Restriction has an impact and makes abortion much more difficult and dangerous to access,” she said. “But it never stamps it out.” She also cited data that suggests roughly 66% of Americans think abortion is a decision that should be made between a woman and her doctor.
Interestingly, Fissell did wonder at the onset of her research for Pushback whether she might change her mind on the issue. In the end, she describes holding the same views as when she started. “Given that abortion was often shameful and secret if not [completely] illegal, I was amazed by how much I was able find out.” Her appreciation for insights from the reproductive justice movement deepened considerably as well, as it informed her understanding of women in earlier societies and the use of the term “choice,” then and now, for women in untenable circumstances.
“[Choice is] something a white woman with money can afford to have,” Fissell said. “Choice [does not apply to] a struggling waitress in a small Southern town who was raped and has two kids at home, and her wages won’t even cover their care…Casting the decision as choice means we don’t understand many women’s experiences.”
Pushback by Mary Fissell was published by Seal Press (2025).
Web image by Medhum.org.
