Revolutionizing Women's Healthcare

The Feminist Self-Help Movement in America

Hannah Dudley-Shotwell

• Publisher: Rutgers University Press
• Year: 2020
• ISBN:
  9780813593043
• Topic: Sciences sociales
• Subtopic: Sociologie

Revolutionizing Women's Healthcare is the story of a feminist experiment: the self-help movement. This movement arose out of women's frustration, anger, and fear for their health. Tired of visiting doctors who saw them as silly little girls, suffering shame when they asked for birth control, seeking abortions in back alleys, and holding little control over their own reproductive lives, women took action. Feminists created "self-help groups" where they examined each other's bodies and read medical literature. They founded and ran clinics, wrote books, made movies, undertook nationwide tours, and raided and picketed offending medical institutions. Some performed their own abortions. Others swore off pharmaceuticals during menopause. Lesbian women found "at home" ways to get pregnant. Black women used self-help to talk about how systemic racism affected their health. Hannah Dudley-Shotwell engagingly chronicles these stories and more to showcase the creative ways women came together to do for themselves what the mainstream healthcare system refused to do.

1

Enacting Feminism

The Origins of Gynecological Self-Help

Letting us look at ourselves is like giving guns to the slaves—it gives us control over our own bodies.

—Unknown self-help group participant

Gynecological self-help activists put nascent feminist theories about bodily autonomy into action. The roots of this process began with women active in the broader feminist movement. Early self-help groups that consisted largely of White, middle-class participants mirrored the focus of White feminist and women’s health activism in their emphasis on reproductive rights, particularly abortion. Gynecological self-help activism borrowed from and expanded upon strategies developed in feminist consciousness-raising groups and abortion rights activism.

Gynecological self-help was contested terrain from its earliest iterations. Fed up with the way the state and the male medical establishment held authority over their health, self-help activists sought ways to control not only their own bodies, but also the messages and procedures associated with their health. They faced opposition from all corners, including other feminist organizations, reproductive rights advocates, abortion providers, and members of the medical community. Many such groups believed that self-help could be detrimental to women’s health or to the reproductive rights movement. Self-help activists also faced internal opposition, as different camps clashed over what constituted self-help and what methods were most effective for helping women gain autonomy over their own bodies. In particular, some self-help activists believed that self-examination and menstrual extraction were the keys to women’s self-sovereignty. Others believed that, while one or both of these techniques were interesting and important, they were not the zenith of women’s empowerment. In spite of the contentious nature of self-help, the movement created a space and a process for a grand feminist experiment in women’s healthcare provision. What began in the back room of a local bookstore as a small-scale attempt at controlling abortion soon blossomed into a national movement with interests well beyond abortion.

Women Seek Control of Abortion before Roe v. Wade

Until around 1880, abortions were legal in the United States until “quickening,” the time when a woman could first feel the fetus moving. In general, abortions were the purview of midwives or homeopaths, not professionally trained physicians. In the mid-1800s, out of a “desire to win professional power, control medical practice, and restrict their competitors,” the fledgling American Medical Association began pushing to make abortion illegal. When abortions became illegal in the 1880s, women continued to find them illegally, especially from midwives and sympathetic doctors or by traveling to places where abortion was legal. In fact, women were so successful at finding abortions during the time when it was criminalized in the United States that there were no significant differences between the numbers of abortions performed before and after Roe.¹

In the midcentury United States, doctors, lawyers, clergy, and women’s groups advocated for the repeal of abortion restrictions. Those who saw the horrors of botched abortions advocated for legal reform. Lawyers brought suits to help women and doctors on the hook for obtaining and providing abortions. Hundreds of clergy members and feminist groups set up underground referral networks to help women find ways to terminate their pregnancies.

While some feminist groups focused on legislation and referrals, others, such as the California-based “Army of Three,” also shared information about abortion techniques with ordinary women. The Army of Three (Patricia Maginnis, Lana Clarke Phelan, and Rowena Gurner) is most famous for advocating the complete repeal of abortion laws in the United States beginning in 1959. They argued that decisions about abortion should be left to women, not to politicians and doctors. They also created a list of referrals to men and women willing to provide abortions, mostly in Mexico, and handed out thousands of copies.

The Army of Three was the first well-known activist group to flaunt the fact that women could do abortions for themselves if necessary. They began holding classes in which they helped women write letters to politicians asking for the repeal of abortion laws, discussed obtaining an illegal abortion, and learned about sterile procedures and how to use the “digital method,” in which a woman inserted her finger into the opening of her uterus until she aborted. They even created and sold $2 “abortion kits” containing everything a woman would need to sterilize her bathroom and hands before using the digital method. The Army of Three warned that do-it-yourself methods were dangerous and could cost a woman a lot of money in medical procedures. They encouraged such methods only as a last resort.

Maginnis, Phelan, and Gurner advertised their classes and made sure that local police knew about them; they hoped that an arrest might lead to a court case in which they could fight for the repeal of abortion laws. In 1969, Phelan and Maginnis also published The Abortion Handbook for Responsible Women. In addition to information about where to get an illegal abortion, they included very detailed information on how a woman could fake a hemorrhage in order to convince a hospital that she needed an abortion. The little book sold over 50,000 copies. The three women were arrested in San Mateo County, California, for holding classes and selling the kits.²

Meanwhile, in Chicago, another group of women demonstrated a different way that women could take control of abortion. The Abortion Counseling Service of Women’s Liberation, usually called the Jane Collective or simply Jane, was a group of women who began making abortion referrals to underground providers starting in 1969. Their goal was to help women find safe and affordable abortions. The Janes soon grew frustrated at the cost of abortions and the quality of care many of the local underground providers offered. They also learned that the man they sent most of their referrals to was not actually a licensed physician. Several members began to wonder if they too could learn to provide abortions and soon discovered that the procedure was quite simple. From 1968 to 1972, the Janes provided over 11,000 abortions to women in the Chicago area.³

Jane strove to provide “feminist” abortions by encouraging women to learn about their own bodies as part of their procedures. When a woman came to them for an abortion, she also left with copies of Our Bodies, Ourselves, The Birth Control Handbook, and The VD Handbook so that she could arm herself with as much knowledge about her body as possible. The Janes believed that they were acting to help their “sisters” and saw the women receiving abortions as “partners in the crime of demanding the freedom to control our own bodies and our own childbearing.”⁴ They did not teach women to perform abortions for themselves but did sometimes recruit members from among women who had used their services. Unlike the Army of Three, publicity was not their goal.

Harvey Karman Develops the Flexible Cannula

As feminist groups worked to give women control over abortions, a University of California student named Harvey Karman began exploring technology that would make abortions safer and simpler. Karman became interested in abortion technology in the 1950s while conducting research on the emotional aspects of therapeutic abortion. After learning about one UCLA student who committed suicide when she could not obtain an abortion and a second who died of a botched abortion, he began working to help women find illegal abortions in Mexico. While doing this work, Karman encountered many women who were unable to afford to travel to Mexico and others who were suffering because of the poor care they received there. He decided to learn how to perform abortions himself and began offering them illegally. One acquaintance, Dr. Phillip Darney, chief of gynecology and obstetrics at San Francisco General Hospital, said that Karman’s goal was to “make it possible for women to safely do their own abortions using the simplest possible equipment.”⁵

By the time Karman began learning to do abortions, many abortion providers around the country were already familiar with a variety of suction methods. Suction abortions were an alternative to the more common dilation and curettage (D&C) method, in which a provider dilated a woman’s cervix and then scraped out the contents of her uterus with a spoon-like instrument. Suction abortion had become popular in Russia and China in the early twentieth century and then began slowly spreading to the United States. However, it was Karman’s reliance on the “Karman cannula” that launched suction abortion into the U.S. mainstream and made it possible for laypersons (including feminist self-help activists) to begin experimenting with the procedure. Karman claimed that he developed this device while serving a prison sentence for providing an illegal abortion in California in the 1960s. Earlier cannulas were either made of solid metal, which meant that they were more likely to puncture the lining of a woman’s uterus, or were so large that providers had to dilate a woman’s cervix before using them, which typically required a local anesthetic. These earlier versions of the cannula were not disposable and had to be sterilized between each use. The cannula Karman used was thin, flexible, and disposable, which eliminated many of the risks and challenges of suction abortion. Self-help activists experimenting with menstrual extraction in the early 1970s would rely heavily on this technology.⁶

After his release, Karman continued experimenting with the flexible cannula, and with the help of medical writer and women’s health activist Merle Goldberg, he developed a method of early suction abortion. Using a vacuum syringe and the flexible cannula, one could manually extract the contents of the uterus during the first few weeks after a missed period. The procedure was so fast compared to other contemporary methods of abortion that some began to call it the “lunch-hour abortion.” Other names included uterine aspiration, manual vacuum aspiration, menstrual induction, and, most commonly, menstrual regulation.⁷ A few of his physician friends gave him fetal tissue that they had removed while performing abortions. Karman practiced suctioning the tissue through cannulas of different sizes and soon discovered that he could aspirate fetal tissue up to twelve weeks of development with his small cannula. Convinced that this technology was going to revolutionize abortion procedures around the world, Karman even created a television commercial advertising free suction abortions. He was arrested again, and after his release from prison, Karman began to refer to himself as a doctor (he held a bachelor’s degree in theater and a master’s in psychology), a habit that would later cause great friction between him and the self-help community. Nonetheless, the medical community began using the “Karman cannula” regularly to provide suction abortions.⁸

Consciousness-Raising as a Precursor to Self-Help

Recalling a feminist meeting at the Cleveland Women’s Liberation Center, health activist and author Barbara Ehrenreich wrote, “I remember the relief in the room when a group of women … discovered that every one of us had been told, at one time or another, that her uterus was undersized, misshapen, or misplaced. How could every woman’s body be somehow abnormal and pathological?”⁹ What Ehrenreich described was not atypical; in newly formed feminist groups beginning in the 1960s, women took turns discussing their personal experiences with healthcare, abortion, domestic violence, childbearing, sex, and motherhood. Hearing the similarities in each other’s stories validated the women’s experiences and helped the group understand that their personal problems were often the result of systemic oppression. Especially popular among young, middle-class, White women, this practice became known as consciousness-raising (CR). One participant said that CR was “a safe place for women to come together and talk about what was true for them.”¹⁰ Dialoguing about their previous health experiences became particularly popular in CR groups; many women shared their frustration with the typical gynecological exam in which a doctor focused on examining a woman’s body and had little interest in hearing a patient’s thoughts about her health.¹¹ In many cases, discovering that other women had had the same experiences and feelings created a bond of sisterhood and empowered women to take action to remedy their situations. Many were fed up with state control over abortion and birth control and with male-dominated medicine in general. Though they frequently discussed the specific complaints that were the result of having female bodies, many feminist CR groups began celebrating their bodies, exalting the wonders of the female reproductive system. Having a vagina, a cervix, a uterus, and breasts, as well as a body that could carry, birth, and nourish babies, was special, worthy of honoring. It even meant that some CR participants felt that they belonged to a kind of exclusive club. Though ...