In November 1964, 9 years before the right to an abortion was codified by Roe v. Wade, I was an intern in a busy, urban emergency room, when our team heard about a call for a “home delivery”. In the parlance of the hospital, I knew what that meant: probably a low-income Black teenager, fearful of hospitals, was delivering a baby at home, and something had gone wrong. Interns with experience delivering newborns had the option of attending home births when these calls occurred. It was my turn to respond. This would be my first encounter, a memory as vivid today as it was fifty-eight years ago.
1960s Home Birth
A hospital vehicle urgently transported a medical assistant, a hospital security guard, and me to the patient’s home. A few curious bystanders dressed in tattered clothing observed our arrival to the neighborhood of decaying tenements. Climbing broken steps to the second floor, I pondered how many residents were injured doing so. How could our government officials allow a landlord to keep a building in this level of disrepair?
When we knocked, a frightened Black woman in her late 30s opened the door. The woman’s visage suggested years of hardship – the grandmother. She greeted us, frantically gesturing toward her daughter on an old, tattered couch. A young 16-year-old girl lay in an expanding pool of her own blood. Her 2-year-old son crying next to her head, her newborn wriggling between her legs. After quickly checking her vital signs, we placed an IV, cut the umbilical cord, and delivered the placenta. I was relieved when the bleeding subsided, both baby and mother alive. Given the blood loss and birthing conditions, I recommended she return with us to for a 24 hour hospital observation. The family declined.
Five lives changed that day. The patient, at age 16, now a mother of two, had another unwanted child which she was ill equipped to care for. If she returned to school (if she had attended school since her first child’s birth), the grandmother would have to care for the children during the day and continue working more years at night to provide for the family. If the teen finished high school, the opportunity to get a higher level of education was improbable. For this growing family, future years of hardship were a near certainty. This child would probably not experience much maternal bonding given the circumstances. The older sibling would be impacted as well. This was not the image of the deliveries I’d witnessed of white women in the hospital. As for me, I could no longer deny the existence of racial disparity in healthcare.
1960s Disparities in Abortion Access
My emergency room experience also included caring for young women, often Black, who used coat hangers, glass bottles, and sharpened sticks to try and end their pregnancies. Genital mutilation, sepsis, and death were common. The latter racial inequity became abundantly clear a year later in my surgical training. My gynecology elective gave me exposure to a significant number of young white girls in their late teens who were being admitted for D and Cs (dilation and curettages, a procedure to remove tissue from the uterus). The histories were primarily uniform, abnormal bleeding intervals. None admitted to being pregnant. The abortions were performed under ideal conditions – sterile, dignified, by trained hands with appropriate tools. These young white women resumed their lives – they returned to school and avoided being spirited away to secretly give birth. Pre-Roe racial disparity in abortion and birthing care was rampant. When the Supreme Court overturns Roe as anticipated, we will return to these dangerous, disparate times. Welcome to the 1960s.
Impact on Rape Survivors
We watch the atrocities in in Ukraine with horror, our sensibilities disrupted by scenes of dead bodies lying in the streets some beheaded, others dismembered. The images of dead children are a testimony to the cruelty that “humans” are capable of inflicting upon one another. These scenes have led to supportive action. I wonder if I had permission to take pictures of aggravated rape survivors I cared for, their faces battered, eyes swollen shut, fingers broken, abrasions on their wrists where their hands had been bound and their genitalia mutilated and been able to share such, if in their infinite wisdom inhumane “legislators” would still require continuation of an unwanted pregnancy. I wonder if they would make those abused women relive that horror when they looked at the offspring of that intrusion every day. I question if they have any concern for the fact that these victims have a significantly increased rates of suicide. Even after years of therapy (if a victim has access), lives have been permanently scarred. Do legislators and justices care they are contributing to that? Welcome to the 1960s.
Demand Bodily Autonomy Today
Mississippi’s Gestational Age Act makes no exception for an abortion following rape or incest. Texas SB8 Texas Heartbeat Act weaponized citizens to report anyone aiding in the abortion process. Physicians are threatened with prison.
More than fifty percent of our citizens are now on the precipice of having their personal autonomy and rights abrogated by the Supreme Court and legislators. A member of this Supreme Court, Clarence Thomas, has fragrantly violating the Court’s ethics and should be barred from voting on cases. Welcome to 2022, and echoes of the sixties.
Until 3 years ago, I was a center right Republican. Now I am a centrist Independent. This is the United States of America and we citizens have rights and responsibilities. Before the final Supreme Court vote is formally announced, we must peacefully demonstrate to protect Roe v. Wade. We must contact our legislators and demand action to do the same. Despite efforts to make voting more difficult for millions of Americans, in November we must vote and demand every person’s right to bodily autonomy, privacy, and dignity.
Marshall Strome, MD, MS, FACS is a Professor of Bioethics and Humanism at University of Arizona College of Medicine-Phoenix, Adjunct Professor Department of Otolaryngology at Vanderbilt University, Co-Founder Aero-Di-Namics, and Professor and Chairman Emeritus Cleveland Clinic Head and Neck Institute.