Carole Joffe, PhD

Carole Joffe, PhD, is a professor of sociology at the University of California, Davis, a researcher of obstetrics and gynecology at the University of California, San Francisco, and a lead faculty member of our Leadership Training Academy. She has published widely on the topic of abortion, including the notable book Doctors of Conscience: The Struggle to Provide Abortion Before and After Roe v. Wade, in 1995.

Any physician who was in an emergency room in a big city routinely saw many women suffering the effects of either a self-induced abortion or a very badly performed abortion at the hands of somebody else. And these doctors had to do cleanup, so it became increasingly clear to them that the abortion policies that we had in this country before Roe v. Wade weren’t working.

They had to go through a very difficult reckoning process, even those who did not take the ultimate step of deciding to provide illegal abortions. For example, helping patients find someone who could give them a safe abortion, offering to work with an illegal abortionist to see his or her patients afterward when the patient returned to her hometown. Any level of involvement put them at some degree of risk.

What unites all of these doctors is the affront of their professional sense of what it means to be a physician.

It was an uncertain legal environment in the pre-Roe era. It wasn’t clear what kind of acts constituted breaking the law, so, for example, if you didn’t do an illegal abortion yourself but made antibiotics available to someone who did, was that breaking the law? No one knew. And even if you weren’t breaking the law, you were establishing your career in a medical profession that was by and large very conservative. To be known as someone who was sympathetic to abortion seekers, to be known as someone who was willing to take a stand on that issue, was to put your career in jeopardy.

Some saw themselves as crusaders. Some were eager to get politically involved and realized early on this was going to be a lifetime commitment for them to change not only the laws, but medical culture around the issue of abortion. Others had no intention to become deeply involved. They were headed elsewhere in medicine. Many were headed toward a career in general medical practice, did not see themselves as particularly political, did not see themselves as particularly heroic.

What unites all of these doctors is the affront of their professional sense of what it means to be a physician. Here they are, trained physicians, who know how to do a certain procedure, prevented by law from doing this procedure. Therefore, their patients, by definition, are going to end up in unsafe hands, or the patient’s own hands, and seriously injure, if not kill themselves.

There were several categories of doctors who did abortions before Roe. There were tremendously inept practitioners. We will never know for sure exactly how many women died or were injured before Roe because we don’t have adequate records. But some scholars estimate as many as 5,000. Some people were only doing it for the money and didn’t do a good job. Some people did it only for the money but apparently did a reasonable job. And some, like these doctors, were doing it because they realized that women were dying, becoming injured. Their patients, their wives, their loved ones were at risk. As physicians, they felt it was untenable if you had such a skill, not to use it to save women’s lives.

A very small number of doctors made the decision to offer illegal abortions to all who sought them. These were people who were very often involved with the Clergy Consultation Service. The Clergy Consultation Service sent people to check them out, found they were medically reliable, and so this small group of people were committed to providing the service to all those who asked. These were people often, although not always, already involved in progressive political movements.

Another slightly larger group of people did not want to be open for business to anyone who came across their door. They felt such a development would flood their practices, so that any other kind of medical practice would become impossible. But they provided illegal abortions for their own patients, for relatives, for friends of friends. For a fairly large network, but not an open-ended one.

Then there were others who provided abortions in hospitals, operating in what we might call a “gray area.” Before Roe v. Wade, the law of the land in this country was not that all abortions were illegal. It was that abortions that were “medically approved” could be performed in U.S. hospitals. What “medically approved” meant varied enormously from state to state, sometimes within the very same state. Those doctors who performed abortions in hospitals under these conditions were operating in a very uncertain legal environment. They didn’t know, for example, when one set of rules or one set of customs would be supplanted by another.

The social, medical environment was such that many American physicians, whatever their predisposition, whatever their degree of political involvement, whatever their own personal religious background, were struck by the phenomenal desperation of their patients, the phenomenal unfairness of the system they saw operative. They saw a system that wasn’t working. They saw women dying for no good reason, and they decided that they had to do something.

Their stories can teach us what it means to be a phenomenally decent and courageous human being and what it means to take risks for others. The major lesson for the medical profession of today is that even those physicians who do not perform abortions should make every effort to support and honor those among them who are willing to do this very necessary service for women.

—Edited transcript from Voices of Choice