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A Women’s Guide to Reproductivehoose Freedom 

1 I may be arrested, I may be tried and thrown into jail, but I never will be silent; I never will acquiesce or submit to authority, nor will I make peace with a system which degrades woman to a mere incubator and which fattens on her innocent victims. I now and here declare war upon this system and shall not rest until the path has been cleared for a free motherhood and a healthy, joyous, and happy childhood. —Em m a Go l d m a n

Aberhardt Question Press is pleased ofof women. Access This includes the family, E to print the second edition of church, capitalism and the state, to Free to Choose. We received mostly name a few. The knowledge we share positive feedback on the first edition and the ways we use it can be seen as and a few thoughtful critiques that tools for unravelling this web of op- are deeply appreciated. pression. Part of our intention in putting this I emphasis the necessity for access pamphlet together is to aid the dis- to abortion and not for legality. The cussion around the issue of abortion reason for this distinction is a mat- access in a anti-state context. It bears ter of control. The state may grant repeating that we should never allow or withdraw a woman’s “right” to laws or governments to dictate the have a legal abortion. The state profoundly personal and life altering may shut down clinics and imprison decisions we make around abortion, abortion providers. Criminalization birth control or bringing a child into has always made getting safe abor- the world. tions more difficult. However, no It is also our intention to better state has ever stopped women from equip ourselves and our comrades having abortions. with the knowledge and tools for It is up to women to make sure we making safe and empowered choices never go back to the bad old days of in our bedrooms and in the world back alley abortions. We should not we live in. I firmly believe that it is allow ourselves, our sisters, moth- ultimately a woman’s decision to ers or friends to end up uneducated, do what she will with her body. It is ill-equipped or desperate. We are re- important to keep in mind that deci- sponsible for our bodies, our choices sions are made within the context of and our lives. the world a woman lives in, her com- I have also included stories where- munity, family and lovers. in women teach themselves safe and There is a complex web of social re- effective ways to end a pregnancy. lationships that create the oppression When we examine our history, we

2 Introduction find examples of women’s groups, who, like Jane and other anonymous groups, were unwilling to wait for abortion to be a legally granted “right.” “Let’s just stop the frustra- tion and humiliation of trying to persuade the powers that be to le- galize abortion. Let’s just take back the technology, the tools, the skills, and whatever else we need...” stated a woman who helped form one such group in the 1970s. It truly is humili- ating to ask the state for control over one’s own body. We need not lobby, we need not beg, nor demand our “rights” to be granted to us. From traditional herbs to end or prevent pregnancy to underground abortion services, women have al- ways defended and exercised our ability to choose. The knowledge exists for women to exercise their reproductive freedoms in safe and empowering ways. The time has come to take it back. This brief introduction is meant to be educational. I hope that it can be a starting point for further exploration and discussion. I encourage people to review the recommended books at o the end of this pamphlet. Let’s sup- port one another, learn from our mistakes and remember our history. love and solidarity, To know our history Esther Eberhardt is to begin to see how to take up struggle again. No t e : The following may be triggering if you have experienced sexual abuse or have ] had a difficult abortion experience.

Introduction 3 Lete c a u s e o f significant’s not a d v a n c e s goshe did have back a positive pregnancy to the bad old days. Bin abortion technology and the test. There was one other finding: widespread availability of legal abor- a small puncture point with a little tion, many people have forgotten bit of bleeding at the entrance of her what life was like when abortion was uterus.... I suspected that either she illegal. Dr. Jerry Hulka, Professor of had tried to abort herself, or some- Obstetrics and Gynecology at the one else had done it to her. When I University of North Carolina School checked on her a little later, I had to of Medicine, describes what he saw press the point of asking her what on an ongoing basis as an intern, a had happened because she had vis- resident, and then as an attending ibly weakened. physician, in hospitals in Pittsburgh “I had to do it,” she said. “I went from 1957 to 1967. “In one hospital, to this lady who put a coat hanger we had a special ward that was al- up in me. She told me not to panic, ways filled with women who had but if there was some real prob- infections and perforations from il- lem, don’t say anything but go to legal abortions,” he says. Dr. Hulka the emergency room. I figured that often assisted Dr. Sam Barr, a senior blood coming out whenever I went physician on the staff, with these to the bathroom was a problem and cases. Dr. Barr ultimately wrote a I got real scared.” book about the need for abortion With luck, I thought, the worst reform, in which he recalled one un- diagnosis would be that this wom- forgettable case: an’s bladder had been perforated. That would not be pleasant, but I’l l n e v e r f o r g e t o n e p a t i e n t ; s h e hopefully there wasn’t any major was 32 years old and the mother systemic problem. I started massive of two children. She was admitted antibiotic treatment immediately, through the emergency room [and] beginning with several transfusions wouldn’t say anything except that to replace the blood she had lost... she thought she ought to get help [but] three hours later I learned I as soon as possible... Her symptoms was wrong.... First, the laboratory were relatively mild. Her pelvis was reported that preliminary studies moderately tender and her uterus indicated an infection with gas gan- was only slightly enlarged, but grene. Then, the nurse on the floor

4 Let’s Not Go Back to the Bad Old Days Let’s not go back tosaid that the the patient lookedbad just aw- oldunnecessary days.deaths again.” The ful she wasn’t bleeding much but nameless woman in the above sto- she had a lot of difficulty breathing. ry left two children, perhaps quite I ran to the floor and found her slip- young ones, who had to face life ping rapidly into heart failure. The without the love and protection of professor who headed our program their mother. We will never know came in to assist, but everything how her children fared in life, but that 20 skilled people could contrib- we do know that losing a mother is ute did not help. The gangrene bac- perhaps the most devastating psy- teria were destroying her red blood chological event children can face, cells. That vital fluid was turning and putting them at a severe disad- into little more than red water1 Her vantage growing up. heart couldn’t handle it and her body was dying.... The last thing I Ho l l y , w h o is n o w in h e r e a r l y remember her saying to me was, “I seventies, and raised three children know you tried. Figure some way to of her own, lost her mother to a tell my kids. They won’t understand self-induced abortion in 1922. at all. Tell them for me somehow. I When my older sister was seven, don’t want them to think me bad.” I was five, and my baby sister was She lost consciousness and then, a two, we lived with our parents in little bit later, just before dawn, she one big room in Pittsburgh. When died. our mother, who was 28 years old at the time, got pregnant for the Dr. Hu l k a w a s o n e o f t h e d o c t o r s fourth time, there simply wasn’t who tried to help this woman. He room for another child, so our vividly remembers her pain and her dad went to the drugstore and got death, and says that similar cases some medicine. I don’t know what occurred on a daily basis because of it was, but she took it. Later, she repressive abortion laws. “Women started hemorrhaging so he took and doctors have forgotten about her to the hospital. She lived for a these deaths,” he says. “Unless few days, but one night, Dad came something is done quickly to stem home and was crying and said that the tide of regressive legislation, our mother was dead. I remember we are going to start seeing such seeing her laid out in the living

Let’s Not Go Back to the Bad Old Days 5 room of my aunt’s house. We just in smaller communities, yet how couldn’t understand why it had common abortion was: happened. In the months after her death, our father drank heavily and It w a s a n o p e n s e c r e t w h o d i d had a hard time holding down a job. abortions in town. There was even There was no money, so he sent us a doctor who had his own hospital to an orphanage. The building was where he did abortions, but the laws on the top of a high hill, and every were very threatening, and we were day for seven years, my sisters and at risk if we even referred patients to I looked down the hill, waiting for him. In any event, the results weren’t Dad to come visit us. He came, but necessarily good. At the time, the only about every six months. favored method of abortion was inserting a catheter; a thin rubber Du r i n g t h e 1960s, Dr. Al e x Br i c k l e r , tube, into the uterus to precipitate a an African-American gynecologist miscarriage. That was almost a for- in Tallahassee, Florida, took care mal invitation to an infection, and I of numerous young women at the treated many. I particularly remem- student health service at Florida ber several young undergraduates A&M University, which was at the who came in with massive infections. time Florida’s only public univer- These young women, 18 or 19 years sity for African-American students. old, were poised on the threshold Dr. Brickler remembers how dif- of life. They had everything ahead ficult those times were for doctors of them — their lives, their careers,

6 Let’s Not Go Back to the Bad Old Days Let’s Not Go Back to the Bad Old Days their families, but we simply couldn’t four times during the 1950s and save them. 1960s, and was finally convicted and sent to prison when she was 70 years In t h e d a y s be f o r e a b o r t i o n w a s old and ill with cancer. In her auto- legal, many doctors undertook enor- biography, They Weep On My Door- mous personal and professional risks step, Dr. Barnett, reviews her gutsy, to do abortions. Dr. Ruth Barnett, a unconventional career and provides Portland, Oregon, naturopath, was a revealing glimpse into the lives of one of them. Barnett learned to do underground abortionists and the abortions while she was secretary plight of the women they served. for a female gynecologist in Port- After her second arrest in the early land, and later, as a receptionist for 1950s, she stood in her clinic, which Dr. George Watts, a prominent gy- was about to be closed, and remi- necologist who also did abortions nisced about one particular patient. in Portland. “Soon I was interview- “She was only 15, slightly built, ing patients, preparing them for blue-eyed, blond and innocent, with surgery, sterilizing the instruments immature breasts poking small and keeping them in order... After a rounded points into her sweater. She time, [Dr. Watts] began instructing seemed numb as I questioned her. me in the painstaking details of his She said she had been raped. ‘Who technique.” Dr. Watts encouraged raped you?’ I asked. ‘My father. He Barnett to go to chiropractic school was drunk.’ ‘When?’ ‘Maybe seven in order to become licensed, which months ago.’ Examination cor- she did, and later he lent her money roborated her statement. She had to buy a rival practice down the hall been pregnant too long. When I said from his own office. that an abortion would be impos- Dr. Watts moved to Los Angeles sible, she asked, almost tonelessly, and became a partner in an ambi- ‘What can I do?’ ‘Nothing,’ I said. tious chain of clinics that not only ‘You’ll have to have the child.’ ‘My did abortions but trained other doc- own father’s baby?’ I could only tors to do them as well. The chain nod. My throat was too choked for spread all over the West Coast, but speech. She arose, went to the door; since the profits were technically stood there a moment, turned to- illegal, eventually its partners ran ward me as though she were going afoul of the Internal Revenue Ser- to say something further. But she vice. All of the clinics were bust- said nothing. She was weeping. She ed, and Barnett, now Dr. Barnett shook her head once and left. The watched in horror as her benefac- next morning the police fished her tor, and other doctors and nurses he body from the Willamette River.” worked with, were tried and sent to Dr. Barnett’s career spanned al- San Quentin Penitentiary. most 50 years, from 1918 until her Dr. Barnett herself was arrested final conviction and imprisonment

Let’s Not Go Back to the Bad Old Days Let’s Not Go Back to the Bad Old Days 7 in 1966. During that time she per- deed take place on the kitchen table. formed more than 40,000 abortions, During the night I began having not only for the women of Portland severe pelvic pains, but was too em- and its environs, but for women barrassed to call my own gynecolo- from San Francisco, Seattle, Boi- gist. He was very thorough and also se, Salt Lake City, and other West very conservative, and I thought he Coast towns. In addition, she notes, might ask too many questions, so I “A great many cases came from a went to a doctor recommended by prominent Catholic gynecologist a friend. He said that I must have who would tell women who insisted had a ‘puncture,’ and would have on an abortion to ‘go to the Broad- to have a hysterectomy. During the way Building and ask for Dr. Ruth.’” surgery, he also removed part of my bowel, saying later that it had been De a t h w a s n ’t t h e o n l y c o n s e q u e n c e damaged as well. My recovery from of poorly done illegal abortions. Uter- the surgery took a long time, and af- ine infections frequently resulted in terward I developed chronic pelvic lifelong pain or infertility, as it did pain. I complained so much that my for Janice, a Boston schoolteacher, doctor finally did an exploratory op- whose life was dramatically changed eration and found that I had ‘adhe- one night on her kitchen table: sions,’ [a sort of fibrous, internal scar “In the early 1950s, we already had tissue] around my bowel as a result three children, and I was planning of the first surgery. A second surgery to go back to teaching so we could removed part of my small intestine, build an addition to our home. When leaving me with chronic digestive I found out I was pregnant, my hus- difficulties and a very limited diet. band and I were both very upset Up until the night of my abortion because, if I didn’t go back to work I was a healthy person. Afterward, I we wouldn’t have the money for the became a medical case — always construction. I didn’t know what to in pain, always in the hospital for do, but a friend of my husband’s said something.” that he knew someone who could Janice’s case never made head- ‘take care of things.’ I had heard sto- lines, yet her life was profoundly ries about ‘kitchen table’ abortions changed, both by her abortion and and initially refused, but after a by her hysterectomy, which may or week of arguments, I agreed to have may not have been necessary by to- an abortion. On Friday night, after day’s medical standards. But she was the children had been put to bed, a lucky. She got medical help, and did woman who my husband’s friend not bleed to death, as many women said was a nurse came to the house. did, in their bathrooms, in shabby I drank a lot of sherry beforehand hotel rooms, or in hospitals, where and don’t remember much about even the best of medical help often the abortion, except that it did in- came too late.

8 Let’s Not Go Back to the Bad Old Days Theh e U.S. a bAbortiono r t i o n r e f o r m m o v e - “We Handbook were working all the time, Tment was fueled by the work of traveling and lecturing,” Lana remem- a number of highly visible activists bers. “But it was like pushing on fog. who published pamphlets, organized Just when you thought you had made demonstrations, established abor- some progress, things just collapsed tion referral services, taught classes before your eyes.” Pat and Rowena on abortion, and worked through taught classes about abortion in the the courts to normalize and legalize San Francisco Bay area, and openly abortion. The work of these activists courted arrests. To their dismay, they was supported by a legion of unsung found that the police were reluctant to heroes: doctors who risked their li- make arrests, because they didn’t want censes to provide women with safe to provide opportunities to challenge procedures; therapists, social work- existing laws. Feeling very frustrated, ers, and clergy who risked their Pat began writing down information livelihoods making reliable referrals; from the classes on self-abortion and the friends, family members, and and showed it to Lana. occasionally strangers who support- “I thought it was too technical,” says ed women through days of pain, fear, Lana. “It assumed a lot of information and uncertainty that all too often on the part of the reader. I thought it followed surreptitious abortions. should be more practical.” Lana took But waiting for the courts to re- over the book, hammering it out on spond was like waiting for Samuel her portable typewriter every night. Beckett’s eternally truant Godot. “I tried to keep it light, while tears were He was always anticipated, but no running down my face,” Lana says. one seemed to know the precise “I was so angry at all the authority men hour of his arrival. So, while activ- had, and they were not using it in our ists pressed ahead on various fronts best interests.” She finished a draft in six in the late 1960s, a few women weeks and took it to two gynecologists working at the grassroots level de- who said, “Get that book in print!” Lana cided to take things into their own quickly found a publisher who “came hands. Lana Clarke Phelan, a Long to the house with a contract and didn’t Beach, California, housewife, Pat leave any of his money behind when Maginnis, a medical technician he left with the contract signed.” But from San Francisco, and Rowena money didn’t matter to Lana as much Gurner, a Bay Area activist, who as getting the book in print. And The became known as “the Army of Abortion Handbook3, published in 1969, Three,” were among the most reso- quickly became an underground clas- lute of these activists. sic. Lana estimates that it went through

The Abortion Handbook 9 five printings, selling over 50,000 cop- sels women to give their doctors ies. “Once I even saw copies of it on a “a large piece of your mind for his newsstand in Penn Station in New York gross neglect of your health, and City, so I knew it had gotten around,” his sworn medical duty, in forcing she remarks. you into underground or self-abor- The Abortion Handbook is surely tion paths.” The Abortion Handbook one of the most creative, irrever- speaks directly to women, exhort- ent, and subversive documents of ing them to take control of their American feminism. In a voice that lives before they lose them. Sadly, is at the same time empathetic, the bulk of the information it con- militant, and provocative, it coun- tains is all too relevant today.

10 The Abortion Handbook “This is Jane From Women’s Liberation” n e o f t h e m o s t w i d e l y k n o w n decided that the system they had in- Oexamples of women taking herited needed improvement. things into their own hands was “We got the calls, then turned the Jane, the now legendary group of women’s names over to abortion- women that took over an abortion ists, and didn’t have any contact again referral service in Chicago, turned until after the procedure. They came it into a booming abortion busi- back alive. That’s about all we knew,” ness, and ultimately, learned to do Leslie recalls. “They waited on street the abortions themselves. corners to be picked up then were From 1964 until 1968, Heather blindfolded. It must have been so Booth, one of the scary. From the be- founders of the Chi- o ginning, we tried cago women’s libera- to make the experi- tion movement, and ence different. We some of her friends, explained what it ran an ad hoc abor- Menstrual extraction is was going to be like, tion referral service how it was going to out of Heather’s dor- a practice maintained by a feel, what the basic mitory room at the small cadre of women who m.o. was.” Leslie re- University of Chica- members receiving go. One day, Heather believe in the importance counseling calls at called some women of self-empowerment. her home. “When together, talked about ] you said, ‘This is the politics of abortion, Jane from Women’s trained them to coun- Liberation,’ you could sel, handed over her contact sheets, hear an audible sigh of relief.” and left. “I was ready to move on,” The first thing that needed im- she says. provement was the price: The abor- “That was the real beginning of tions were expensive — from $600 Jane,” says a woman we’ll call Leslie, to $1,000 ­— and that was out of the a long-time member of the group. reach of many poor women. So the Right away, the women in the group group decided to attempt to gain

This Is Jane From Women’s Liberation 11 o We realized that if he could do abortions and wasn’t a doctor, then we could learn to do] them ourselves. some control over the price by cut- by assisting — up to and including ting a deal with one of their doctors. dilation — and then doing more, as The deal worked. In return for vol- each of us became more comfort- ume, he lowered the price to about able with the procedure. $500. Then, in late 1970, at the end “Doing the abortions ourselves of the second year of the Service had enormous advantages,” Leslie (as Jane was also called), the group continues. “We dropped the price to found out that the man, like many $100 or whatever the woman could others who did illegal abortions, pay. The average was about $40.” was not a doctor. The revelation By this time the group was doing created an enormous philosophi- 20 to 30 abortions a day, three days cal crisis among the group. Some a week, and continued to use the women felt betrayed. Others left. standard D&C procedure they had Others felt liberated. learned from their abortionist for “That was when we realized that women who were up to 14 weeks if he could do abortions and wasn’t from their last menstrual periods. a doctor, then we could learn to do “We always had to be on our toes. them ourselves,” Leslie says. Still, Anything could happen-and it did,” nothing happened for a while. Fi- Leslie confesses. “Often we impro- nally, one of the women in the vised. For example, hemorrhages group pressured the abortionist to could often be dealt with on the share his skills. spot by applying ice or giving ergot- “He was reluctant at first,” Leslie rate (a drug used to help the uterus recalls, “but then he agreed. A few contract).” When emergencies oc- other women learned from him, curred, they drove the woman to and by the fall of 1971, we were do- the hospital emergency ward. ing all of the abortions ourselves. “We took women to the door, but Mostly we learned in stages, first it was too dangerous to the group

12 This Is Jane From Women’s Liberation for anyone to go in with them, so up and down the street, looking in we just helped them get their sto- vain for the address. She was sur- ries straight and told them to call us prised when a police car pulled up when they got home. ‘Act dumb,’ beside her, and the policeman point- we told them. ‘That’s what doctors ed out the entrance on a side street expect from women.’” nearby.” Jane had a policy of never turn- The bust occurred in May 1972. A ing away any woman who wanted relative of a woman who was sched- to terminate her pregnancy, as uled for an abortion didn’t feel com- long as the counselors felt that she fortable with the arrangements and wouldn’t be too upset by the pro- called the police. “Two homicide cedure. But like doctors of that era, detectives came in looking for ‘the they didn’t have the technology to money and the man,’” Leslie re- do late second trimester abortions. members. “‘He just jumped out the “If women were too far along, we window,’ somebody said. That was just induced a miscarriage by break- a great joke, since we were in a high ing the waters,” Leslie recalls. After- rise.” In all, seven women were ar- ward, women whose miscarriages rested. Some members dropped had been induced went home and out in fear, but two weeks later, waited, an ordeal which, Leslie notes, Jane was back in business. In the “often took incredible bravery.” She meantime, the group got women remembers one teenager who called appointments at clinics they knew in every half hour while her father of in New York and Washington. slept in the next room, asking in a “We called in all the feminist chips whisper, “What do I do now?” in town and collected plane fare for Considering the volume of busi- those who couldn’t afford it,” Les- ness that passed through the Ser- lie says. “Women were going to get vice, it is astonishing that the bust their abortions no matter what.” didn’t come sooner. Jane operated until April of “In the early days, a number of our 1973, three months after the Roe clients were policemen’s wives, girl- v. Wade decision, by which time friends, or daughters,” Leslie says. several legal clinics had opened in “After a while, we began to feel sort Chicago. Afterward, some of the of protected.” One treasured anec- group stayed together and with dote about the hands-off attitude of other women founded the Emma the police describes an incident that Goldman Women’s Health Center, took place in the predominantly named after the famous anarchist white Lincoln Park neighborhood: who was one of the earliest advo- “The entrance to the building where cates of birth control in the United the abortions were being done was States. The Emma Goldman op- on a side street, and a young Afri- erated until the mid-1980s on the can-American woman was walking north side of Chicago.

This Is Jane From Women’s Liberation 13 MenstrualA No t e To T hExtraction e Re a d e r All home health-care procedures, including menstrual extraction, can, under some circumstances, carry certain risks, even if performed correctly. The information in this pamphlet is intend- ed to be for the education of the reader, but does not constitute an adequate set of instructions. Indeed, the central message of the chapters on menstrual extraction is that women without specialized medical backgrounds can learn to perform it. But their training must involve working with a group over a period of time, learning directly about women’s reproductive anatomy and function; it must include self-education, utilizing medical texts and journals; it must include independent research into abortion availability in the immediate area and beyond; it must include locating medical personnel to provide consultation and assistance; it must involve a group of women who are committed to in-depth discussion of the struggle for women’s reproductive freedom and periodic reassessment of the group’s goals; and it must include, if at all possible, personal observation of clinical abortion, to become adequately acquainted with the differences and similarities between menstrual extraction and clinical procedures. Benefit : risk assessments will vary, situation by situation. The authors have attempted to explain which risks, although statistically low, might possibly be encountered by a group or an individual, and which other risks are quite rare, but can be very serious when they do occur. The reader must then evaluate the risks and the benefits, depending on the situation in which she finds herself, in order to make an informed decision.

14 Menstrual Extraction In 1970, Carol Downer, a house- The Development of wife and mother of six young chil- Menstrual Extraction dren, was working on the abortion committee of the Los Angeles chap- MENSTRUAL EXTRACTION (ME) ter of the National Organization for was developed as a technique to Women (NOW). “One woman in help women maintain control over the group was working in an illegal their menstrual cycles, and hence, abortion clinic in Santa Monica,” over their reproductive lives. On or Carol recalls. “She had figured out about the day that a woman expects that abortion wasn’t as difficult as it her menstrual period, the contents was made out to be, and suggested of the uterus are gently suctioned that we do abortions ourselves.” out, lightening and greatly shorten- One day Carol went to the clinic ing the expected period. If an egg with that woman and the woman’s has been fertilized within the pre- daughter, who was going to have ceding weeks, it will be suctioned an IUD inserted. Suddenly Carol out as well. Dealing as it does with found herself in the procedure normal bodily functions, ME is not room, where the younger woman a medical treatment — but a home was already on the examination health-care technique, similar in table with a speculum in place. “I many ways to self-catheterization, got a glimpse of her cervix and was at-home bladder instillations, and completely bowled over,” Carol re- other health-maintenance routines. members. “It was such a shock to The tabloids and the electronic see how simple and accessible our media have labeled menstrual ex- anatomy is. At that moment, ev- traction “self-abortion” or “do-it- erything clicked for me. I had read yourself abortion,” but these terms The Abortion Handbook, and realized are misleading. First of all, due to that if women just had some basic the location of the uterus, it is virtu- information about their bodies, ally impossible for a woman to do they could take care of themselves ME on herself. To do the procedure and wouldn’t have to depend on safely and correctly, a woman needs back alley abortionists. “ the help of one or more women who Carol and a small group of activ- are trained and experienced in ME. ists organized an event billed as a In this sense, it is no more appropri- “Self-Help Clinic” at Everywoman’s ate to label ME “self-abortion” than Bookstore in Venice Beach on April 7, it is to call home birth “self-birth.” 1971. “To us, ‘self-help’ meant taking Lorraine Rothman, one of the devel- control of our bodies and our health opers of ME. explains that the name care,” she says. menstrual extraction was chosen Lorraine Rothman, a public school “because it is a very literal descrip- teacher in Orange County, just tion of the process.” south of Los Angeles, and herself

Menstrual Extraction 15 the mother of four, recalls the first cessible a woman’s cervix (the neck Self-Help Clinic meeting vividly. “I of the uterus that protrudes into the had read an article in Everywoman’s vagina) was. “After that, the discus- Newspaper that made it sound like sion took a different turn,” Lorraine women in L.A. were doing abor- remembers. “We talked about tak- tions. I thought, ‘Of course. What ing charge of our own health care.” did women do before they had doc- One woman had brought a can- tors? It can’t be that hard. Let’s just nula and a large plastic syringe stop the frustration and humiliation (minus the needle) from Karman’s of trying to persuade the powers abortion clinic and showed it to the that be to legalize abortion. Let’s group. Lorraine immediately felt just take back the technology, the that the device had two obvious tools, the skills, and whatever else weaknesses. “For one thing, there we need.’” was no mechanism to prevent air In the weeks before the first Self- from being accidentally pumped Help Clinic, Carol and a few other back into the uterus — which was women from the group had visited one of the big scary things about an underground abortion clinic run illegal abortion,” she says. “For an- by Harvey Karman in Santa Monica. other, the uterine contents passed Karman, who the group later found directly through the cannula into out was not a medical doctor, was the syringe. If the syringe got full, one of the most active proponents the cannula would have to be re- of a new, non-traumatic suction moved, so that the syringe could be abortion technique that made use emptied. This was clumsy to han- of a flexible plastic cannula (a thin dle and caused additional discom- tube about the size of a soda straw fort for the woman. I thought there that can be inserted into the uterus) must be a better way.” and a hand-held syringe used to cre- Lorraine took the apparatus ate suction and to collect the uterine home and spent the next week contents. Proponents of this tech- haunting hardware stores, grocery nique generally eschewed the use stores, chemistry labs and aquari- of a curette, a razor-sharp, spoon- um shops. She brought her version like instrument used for D&Cs. At of the device to the next Self-Help the first Self-Help Clinic meeting, Clinic meeting. This modified de- about 30 women sat in a circle on vice consisted of a cannula and a the floor. When Carol’s turn came large (50 or 60cc) syringe for pump- to speak, she said she had some- ing suction, but Lorraine’s version thing special she wanted to share had two tubes, one leading from with the group. She climbed up on the cannula into a collection jar, a desk, inserted a plastic speculum and the other leading from the sy- into her vagina, and demonstrated ringe into the jar. When pumped, to the amazed onlookers how ac- the syringe created a vacuum inside

16 Menstrual Extraction the jar, and the contents of the uter- had heard about Dr. Franz Koomey, us were sucked into the jar, instead the doctor in Washington state who of into the syringe. An automatic had led the fight to legalize abortion two-way bypass valve, which Lor- there and who used paramedics in raine located in a scientific mail or- his clinics. “I mentioned Koomey to der catalog, prevents air from being Lorraine one evening, and she just pumped back into the uterus.3 She said, ‘Let’s go!’” Without so much as dubbed the device “Del-Em.” doing the laundry, the two took off “We were on that device like ducks the next morning in the Rothman on a June bug,” Carol remembers. family station wagon for the Pacific “Word about this new technique got Northwest. “I just told my husband around very quickly. We were learn- that 1 would need the car for a cou- ing to estimate the size of a pregnant ple of weeks. I was afraid if I asked and non-pregnant uterus, and got a he might say no.” Lorraine remem- lot of practice. But for women who bers with a laugh. were in fact pregnant, we were get- Carol and Lorraine worked in ting too many incomplete abortions Koomey’s clinic for several days and we wanted to know more.” Carol observing abortions. “Dr. Koomey

IPAS kit

DEL-EM

The DEL-EM and a kit used for menstrual regulation in developing countries, made by the International Projects Assistance Service (IPAS). The major difference is that the DEL-EM collects the uterine contents in a jar, while it goes directly into the syringe in the IPAS kit. Both kits have a two-way bypass valve to prevent air from entering the uterus. For information, write to IPAS at 300 Market St., Suite 200, Chapel Hill, NC, 27516 or call 800-334-8446.

Menstrual Extraction 17 had a well deserved reputation as ME marathon with plastic specu- an activist, but we were shocked lums in little brown bags, and the that he still used curettes and large, Self-Help group acquired a national stiff cannulas which required that mailing list. From the list, Carol the cervix be dilated a lot before and Lorraine put together a na- they could be inserted.” Carol says. tional tour. Traveling by bus and “Women were given no anesthet- selling speculums transported in ic, and, consequently, had a lot of boxes marked “toys,” they hit 23 cit- pain.” (Unanesthetized procedures ies in six weeks, spreading the word were a prominent hallmark of ille- about self-examination, menstrual gal abortions, because women were extraction and self-empowerment. usually required to leave the prem- Lolly Hirsch, a housewife and ises quickly, and to do so, they had mother of five from Stamford, Con- to be mobile.) necticut, was one of the women who One day, Koomey invited Carol attended a menstrual extraction and Lorraine to do procedures un- demonstration at the Santa Monica der his supervision. They found the NOW conference. Lolly and her D&C procedure without anesthetic daughter Jeanne immediately saw excessively brutal. “At the end of the implications of menstrual ex- the day, we had a lot of experience, traction. “The self-empowerment but we were more convinced than aspects were just so phenomenal,” ever that the suction procedure was Jeanne observes. “My mother and I, the way to go.” Lorraine says. and later, my sisters, were definitely Menstrual extraction made its committed.” In the next 10 years, public debut at the National Orga- Lolly and Jeanne started a number nization for Women conference in of self-help groups in the Stamford Santa Monica in August, 1971. The area, got on the college lecture cir- conference organizers thought that cuit, and began publishing a news- the concept was too shocking and letter, wryly entitled The Monthly refused to grant the group exhibit Extract: An Irregular Periodical. space. Undeterred, the West Coast “Ultimately, several women we Sisters, as they were now known, met on the tour migrated to Los put up leaflets announcing demon- Angeles, and joined the struggle,” strations of the procedure in their Carol Downer recalls. “They all hotel room. shared our vision of wanting to “Women flocked in,” Lorraine change women’s lives, and they had reports. “The first day we packed the will and the wits to do it.” The in twenty or more at a time for group, which had lost some origi- demonstrations. The next day they nal members and gained some new were lined up in the hallway. We ones, founded the Women’s Abor- did demonstrations all day until we tion Referral Service with the high- were exhausted.” Women left the ly appropriate acronym of WARS.

18 Menstrual Extraction They made an arrangement with still learned the technique and a a doctor who worked at a hospi- small number of them, perhaps tal where a staff psychiatrist rub- as many as a thousand at any one berstamped “applications” WARS time, maintained their skills, “just brought in and the abortions were in case.” done quite openly. After Roe v. Wade legalized abor- Then, suddenly, on January 22, tion, providers sprung up nation- 1973, after more than two years wide, and by the mid-1970s, about of internal rancor, indecision, and 75% of U.S. counties had an identi- equivocation, the United States Su- fiable abortion provider. Because of preme Court announced its deci- the widespread availability of abor- sion in the case of Roe v. Wade. tion, doctors assumed that there “That abruptly changed every- was no longer any need for women thing,” Carol says. “We borrowed to be concerned about taking care some money, hired a doctor, and of themselves, and were sometimes opened a clinic.” In March of critical of the continuing interest 1973, WARS became the Women’s in menstrual extraction, especially Choice Clinic of the Los Angeles since there were no studies on its Feminist Women’s Health Center. safety and effectiveness. In July, Lorraine opened a sister To counter this criticism, Carol clinic in Santa Ana, near her home and Lorraine contacted various re- in Orange County. Other Feminist search organizations in search of Women’s Health Centers opened in funding for a study. The one ex- the next two or three years in Chi- pression of interest came from Dr. co and San Diego, California, Port- Christopher Tietze, the preeminent land, Oregon, Tallahassee, Florida, expert on abortion and contracep- and Atlanta, and later, Yakima, tion at the Population Council, a so- Washington, ultimately forming cial policy organization funded by the Federation of Feminist Wom- the Rockefeller family. “Dr. Tietze en’s Health Centers. was quite intrigued by ME and our For the time being, which right experience with it, and encouraged then seemed like forever, Carol, us to submit a proposal,” Carol re- Lorraine, and their cohorts focused calls. “We did submit one, but the their attention on managing legal Foundation declined to fund it on abortion clinics and working on a the grounds that it did not fund broad range of reproductive health ‘direct services.’” Menstrual extrac- concerns — safe second trimester tion became a practice maintained abortions, woman-centered child- by a small cadre of women who birth, the cervical cap, and many worked tirelessly for legal abortion, others — at the local, state, and na- but who continued to believe in tional levels. Menstrual extraction the enduring importance of self- went on the back burner. Women empowerment.

This Is Jane From Women’s Liberation 19 When Birth Control Fails the pages of The Abortion Handbook for information on self-help tech- In early 1977, when the Allende regime niques. After working all day in was overthrown in Chile, a group of the clinic, Suzann stayed up nights prominent women’s health activists, drawing and writing explanatory which included feminist author Bar- text. When it was finished, with bara Ehrenreich, Sally Guttmacher, a illustrations was staple-bound in well-known women’s health advocate an easily reproducible format and and professor of Health Education at transmitted to the women at WIC, New York University, and the late who then forwarded it to their con- Bobbye Ortiz, a long-time Associate tacts in Chile. Editor of The Monthly Review, formed “This book was deliberately very Action for Women In Chile (WIC) bare bones,” Suzann recalls. “It was out of concern for the conditions in intended only for women who were prisons for women political prison- committed self-helpers. And yet at ers. This group began working with the same time, we wanted to pre- a Chilean group that had asked for in- serve this information for women formation on abortion. The Chilean who had no other options open to women were particularly interested them.” in finding self-help techniques that Over the years, and in various might be useful for women political formats, this information has made prisoners who were raped in prison. its way to women throughout the Ehrenreich passed their request on world in Chile, Mexico, Nicaragua, to Carol Downer and her coworkers. most European countries, Austra- “We were aware of the drastic mea- lia, New Zealand, Japan and Iran. sures that women sometimes resort In 1979, the copy was typeset and to in order to control their lives. We published by Speculum Press as also knew that with sufficient infor- When Birth Control Fails. The book mation, women had safely and suc- quickly became an underground cessfully aborted themselves,” says classic, and enjoyed a brief revival Suzann Gage, a health worker in the after the Webster decision in 1989, Los Angeles clinic and illustrator of but is now out of print. the Center’s books on women’s health care. “I was inspired to put that infor- Other Uses For mation in visual form so it could be understood by any woman, regard- Menstrual Extraction less of what language she spoke.” The early proponents of menstrual Suzann spoke with women who extraction gained valuable infor- had done menstrual extraction, and mation about their own bodies and with others who were familiar with menstrual cycles, information that herbs and other techniques of preg- was otherwise only available, if it ex- nancy termination. She also mined isted at all, in abstruse medical texts.

20 Menstrual Extraction They found that they could shorten when I had ovulated. Because of the and significantly diminish a normal variability of my cycle, I spent a lot heavy period, which could be a boon of time in suspense, wondering if to female athletes, travelers, camp- my period was ever going to come. ers, revolutionaries ­— any woman After I began doing menstrual ex- to whom a long or heavy period traction, if my period didn’t come might pose a substantial inconve- by day 35, I would called my self- nience. They also found that when help group and have an extraction. employed on a regular basis, men- Once it turned out that I was preg- strual extraction could be used as nant, but the extraction still felt so birth control, similar to an IUD, to normal — as normal as getting my prevent the implantation of a fertil- period when I wanted it. ized egg about two weeks after fer- tilization. In short, they found that Me n s t r u a l e x t r a c t i o n c l e a r l y h a s being able to safely extract the con- a variety of uses, and consequently, tents of the uterus provided a mea- has significant implications for wom- sure of reproductive control that few en’s health. The next section reveals women had even dreamed of. how this simple technique has been Val, a massage therapist, com- adapted on a global scale to save the bined menstrual extraction with fer- lives of many women. tility awareness for several years. Fertility awareness employs the Menstrual Regulation observation of cervical secretions, In the Developing World basal body temperature, and a host of bodily signs to pinpoint ovula- At the same time that menstrual tion. Knowing the precise time of extraction was developing in Cali- ovulation can be useful in avoid- fornia, international family plan- ing pregnancy, by abstaining from ning activists began using a nearly intercourse until about 24 hours identical method of fertility control after ovulation. Fertility awareness in developing countries. The tech- can also be useful in enhancing nique has had a variety of names: the chances of getting pregnant, “minisuction,” “menstrual induc- by identifying the fertile time and tion,” and “menstrual aspiration.” coordinating it with intercourse or However, the term most widely donor insemination. My periods used today is menstrual regulation were always somewhat irregular, (MR). Like menstrual extraction, coming anywhere from 27 to 35 the procedure is often done with- days. Fertility awareness gave me out a laboratory test to confirm much more information about and pregnancy. MR can also be used for control over my cycle than I ever teaching women about their anato- dreamed possible, but there were my and fertility, diagnosing uterine still times when I just couldn’t tell cancer, menstrual disorders, and

This Is Jane From Women’s Liberation 21 infertility, and for completing self- Because of the lack of qualified train- induced or incomplete abortions. ers, and the demand for MR services, One distinctive difference be- trainees sometimes begin doing un- tween the practices of menstrual supervised procedures without much regulation and menstrual extrac- hands-on instruction, but this is not tion is in the equipment used. The recommended. Del-EM used in menstrual extrac- In developing countries where tion is individually assembled (you health education and contraception can make this yourself), while the are not widely available, women who kit used in menstrual regulation fear they may be pregnant often seek is commercially to induce miscar- produced and mar- riages with sticks, 4 o keted . With this wires or other in- kit, the uterine con- struments, by drink- tents are suctioned ing toxic substances, directly through When used properly, or by douching with the cannula into a harmful concoctions. syringe, while with these techniques are In Nicaragua, for ex- the Del-Em, the safer than childbirth. ample, women com- contents are suc- ] monly use wire from tioned through the telephone cables to cannula and a plas- induce miscarriages. tic tube about two feet long into a Others resort to poorly trained abor- collection jar. tionists who often use stiff, unster- Early on, it became clear to medical ile instruments. As a result, at least professionals and family planning ex- 200,000 women die each year,5 and perts that paramedics and lay people many more are left infertile or with with even minimal education could lifelong health problems. In addition, learn to use hand-generated suction hundreds of thousands of children devices safely and effectively. Today, are left motherless or with a mother training in most countries typically who may be too ill or disabled to pro- lasts from one to three weeks, occa- vide for them adequately. sionally longer, and is done on both Many doctors who do menstrual a formal basis, including classroom regulation may use anesthesia, but in lectures, demonstrations, and super- some clinics, the only anesthesia that vised practice; and on an informal is used is the comforting hand and basis, often consisting of demonstra- soothing voice of a counselor. Zarina, tions only. Trainees may observe a counselor at a women’s clinic in from 10 to 20 procedures before be- Bangladesh, reports that most of the ginning hands on training, and then women who seek MR have already do up to 20 procedures under supervi- endured childbirth; most say the dis- sion before doing them on their own. comfort from the procedure is quite

22 Menstrual Extraction tolerable, even without anesthesia. In care techniques are profoundly practice, menstrual regulation is per- relevant. Women may consciously formed up to eight to 10 weeks from choose to use menstrual extraction the last period, but in many countries, or to take herbs for fertility control the procedure is also done up to 12 for a variety of reasons. When used weeks from the last menstrual peri- properly, these techniques are far od. There are no reliable statistics on safer than childbirth, and can put an the rate of incomplete procedures in end to the makeshift methods that Bangladesh or other countries where desperate women have often used to MR is in use, but the rate of incom- prevent unwanted pregnancies. pletes appears to be low, according to Zarina because “most women in these countries usually don’t come in No t e s until they are eight to ten weeks from (1) Today, this problem would probably be their last period, when it is easier to recognized as disseminated intravascular co- determine, by examining the tissue, agulation (DIC), in which the blood loses its whether or not an implantation has ability to clot. For more information on this been missed.” Menstrual regulation is rare but serious complication read A Book of practiced throughout Latin America, Women’s Choices pages 233-234. Asia, in many African countries, and (2) If air is accidentally pumped into the uter- on a limited basis in the Middle East. us, it will probably pass through the egg tubes In every setting in which this tech- into the abdominal cavity, causing gas-like nique has become accessible, the discomfort or pain. If any air accidentally enters the blood stream this can result in a complication rate for self-induced fatal air embolism. and poorly done abortions has been (3) L.C. Phelan and P.T. Maginnis, The dramatically reduced. In Indonesia, Abortion Handbook (North Hollywood, for example, one study found that CA; Contact Books, 1969). the rate of septic abortion was 80% (4) This device is manufactured by Internation- higher in areas in which menstrual al Projects Assistance Service (IPAS), P.O. Box regulation (in this case, suction cu- 100, Carrboro, NC 27510, (800) 334-8446 rettage) was not available, but that (5) R. Barnett, as told to D. Baker, They where MR was available, wards for- Weep on my Doorstep, Beaverton, OR; merly reserved for cases of septic Halo Publishers, 1969 p. 74 6 abortion were no longer necessary. (6) F.A. Moeloek, et al., “The Relation Be- Clearly, if menstrual regulation were tween Menstrual Regulation service and the employed more widely, the health Incidence of Septic Abortions in Indonesia,” of many women — and the lives of p.2 Available from the International Wom- many others — would be saved. en’s Health Coalition, 24 East 21st Street New York, NY 10010. I n a n e r a t h a t is h o s t i l e t o reproductive freedom, menstrual extraction and other home health-

This Is Jane From Women’s Liberation 23 For More Information A Book of Women’s Choices Chronicles the history of menstrual extraction, the currently accepted standard of ME practice, and accounts of actual ME procedures, including detailed information on how they are performed. This book also discusses abortion in general and RU-486. This book is out of print but can be obtained from used bookstores or websites. A New View of a Woman’s Body This is an excellent resource for women’s health and has a very in-depth section on ME. Published by the Fed- eration of Feminist Women’s Health Centers. This book is widely available. The Story of Jane Written by Laura Kaplan, a long-time member of the Service, the legendary underground abortion service, available from University of Chicago Press.

“Women have always been healers. They were unlicensed doctors and anatomists of western history. They were abortionists, nurses and counselors. They were pharmacists cultivating herbs and exchanging the secrets of their uses. They were midwives, travelling from home to home and village to village. For centu- ries, women were doctors without degrees, barred from books and lectures. Learning from each other, and passing on experience from neighbor to neighbor and mother to daughter. They were called wise women by the people, witches or charlatans by the authorities. Medicine is part of our heritage as women, our history, our birthright. To know our history is to begin to see how to take up the struggle again.” —Barbara Ehreneich and Deirdre English, Witches, Midwives and Nurses, a pamphlet published in 1973

Pr i n t e d & Pu b l i s h e d b y Ebe r h a r d t Pr e s s 833 SE Ma i n St., Bo x #418, Po r t l a n d , Or e g o n 97214 w w w .Ebe r h a r d t Pr e s s .o r g 24 Copyrighted excerpts are reprinted for educational purposes only. @nti-copyright. Please reprint and distribute freely (see website for .pdf)