Before Roe: The Physicians' Crusade : Throughline Abortion wasn't always controversial. In fact, in colonial America it would have been considered a fairly common practice: a private decision made by women, and aided mostly by midwives. But in the mid-1800s, a small group of physicians set out to change that. Obstetrics was a new field, and they wanted it to be their domain—meaning, the domain of men and medicine. Led by a zealous young doctor named Horatio Storer, they launched a campaign to make abortion illegal in every state, spreading a potent cloud of moral righteousness and racial panic that one historian later called "the physicians' crusade." And so began the century of criminalization.

In the first episode of a two-part series, we're telling the story of that century: how doctors put themselves at the center of legal battles over abortion, first to criminalize — and then to legalize.

Before Roe: The Physicians' Crusade

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RUND ABDELFATAH, HOST:

A note before we get started - this episode contains graphic descriptions of suicide and abortion.

(SOUNDBITE OF WHOOSHING)

UNIDENTIFIED PERSON #1: (Reading) The police were startled by the announcement that the well-known Madame Restell had been found dead earlier this morning in the bathroom of her mansion on Fifth Avenue. She rose in the night and went into the bathroom, where she suicided. The coroner's physician examined the body and found that a deep gash had been cut across the front of the throat, severing the jugular vein.

(SOUNDBITE OF RUNNING WATER)

UNIDENTIFIED PERSON #1: (Reading) The water had been left running in the bathtub, and hence there was but little blood in the water which still filled the tub.

(SOUNDBITE OF BATHTUB KNOB SQUEAKING)

UNIDENTIFIED PERSON #1: (Reading) The body was cold, and it was evident that the woman had been dead for some hours.

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UNIDENTIFIED PERSON #2: Read all about it - morning paper. Read all about it - morning paper.

ABDELFATAH: In the early hours of Wednesday, April 1, 1878, the death of a woman named Madame Restell - known to some as the wickedest woman in New York...

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UNIDENTIFIED PERSON #2: Read all about it.

ABDELFATAH: ...Rocked the country.

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RAMTIN ARABLOUEI, HOST:

The Morning Herald, Wilmington, Del.

UNIDENTIFIED PERSON #3: (Reading) Madame Restell found dead. Madame Restell left a fortune estimated at from 1 million to $1.5 million.

ABDELFATAH: The New York Times.

UNIDENTIFIED PERSON #4: (Reading) Having for nearly 40 years been before the public as a woman who was growing rich by the practice of a nefarious business, she yesterday came to a violent end by cutting her throat ear to ear.

ARABLOUEI: The Cincinnati Daily Star, Cincinnati, Ohio.

UNIDENTIFIED PERSON #5: (Reading) Another story is that Madame Restell was murdered through the instigation of wealthy people who had patronized her in her criminal business.

ABDELFATAH: Clarksville Weekly Chronicle, Clarksville, Tenn.

UNIDENTIFIED PERSON #6: (Reading) Crimes of this wretched woman were not hers alone. They were the crimes of a splendid, profligate society, of which she was simply the paid agent. She has simply done upon herself the vengeance which the law should have inflicted many years ago. Systematic murder was her trade - the murder of the unborn, perpetrated to shield the guilty lusts of the living. We are using language which will be blamed as shocking to society, but society needs to be shocked.

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ABDELFATAH: Madame Restell was one of the key targets of a moral crusade that had swept the country - a crusade that started in the 1800s and led to a century of criminalizing abortion - a century that came to an end in the early 1970s.

(SOUNDBITE OF TV SHOW, "CBS EVENING NEWS WITH WALTER CRONKITE")

WALTER CRONKITE: Good evening. In a landmark ruling, the Supreme Court today legalized abortions. The majority said that the decision to end a pregnancy during the first three months belongs to the woman and her doctor - not the government. Thus, the anti-abortion laws of 46 states were rendered unconstitutional.

ABDELFATAH: Roe vs. Wade.

LESLIE REAGAN: People, I think, still think that abortion was never practiced and was always illegal until the Supreme Court decision in 1973. And they think that the decision created the practice of abortion and expanded it, and that is completely wrong. That is not true. It was legal under common law in the colonial era in what is now the United States. And in the early United States, it was not made criminal in the way that we think of it - from conception on - until late 19th century. And throughout all that time, abortion was practiced by many people and really accepted in a certain way by Americans.

ARABLOUEI: This is historian Leslie Reagan. She's a professor at the University of Illinois Urbana-Champaign and author of the book...

REAGAN: "When Abortion Was A Crime: Women, Medicine And Law In The United States."

ARABLOUEI: In the country's early days, people like Madame Restell were thriving. When she began her practice around the 1830s...

REAGAN: She wasn't hiding her practice at all, but nor was anybody else. She just was much - she was a very good businesswoman, made a lot of money, and was very rich and obvious in New York City.

ARABLOUEI: But by the end of her life, in 1878, Madame Restell was facing criminal prosecution, and some had branded her a monster in human shape. Her name had become synonymous with abortion.

ABDELFATAH: Over the course of a couple decades, the country had moved from thinking of abortion as a personal matter - a common practice that happened everywhere, albeit quietly and in private - to a criminal offense outlawed across the country. The question is, how and why did that change happen?

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ABDELFATAH: A question with higher stakes now than ever if the recent leak of an early draft of the Supreme Court opinion on Roe v. Wade is an indication of what's to come.

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CHRIS HAYES: Politico has obtained what they say is an initial draft majority opinion written by Justice Alito showing the Supreme Court striking down Roe vs. Wade.

UNIDENTIFIED PERSON #7: In it, he states that we hold that Roe must be overruled.

HAYES: This would be, if true, the most seismic court ruling in 50 years.

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ABDELFATAH: I'm Rund Abdelfatah.

ARABLOUEI: I'm Ramtin Arablouei.

ABDELFATAH: And on this episode of THROUGHLINE from NPR, as the country awaits the official decision on the future of Roe v. Wade, we're looking back at how and why laws outlawing abortion in every state were put on the books in the first place.

ARABLOUEI: Laws which, in some states, could potentially kick back into effect if - and likely when - Roe v. Wade is overturned.

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ABDELFATAH: Coming up - a moral crusade is born.

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EMILY: Hello. This is Emily (ph) from Lompoc, Calif. And you're listening to THROUGHLINE from NPR.

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UNIDENTIFIED ACTOR #1: (As Horatio Storer) Dear Father, I did not sail before half-past 8 last night as the vessel had to wait for a passenger. After we had started, a fog came up and we had to anchor in the narrows. I never was out in such rough weather in my life, on deck nearly all the time, and yet was not so sick as I was the other day.

ARABLOUEI: In 1849, when he was 19 years old, Horatio Storer sailed from Boston to the wilds of Labrador, Canada, on a research expedition alongside a naturalist - an expert in the natural world. They were interested in the process of reproduction, which they hoped to learn more about by studying the embryos of birds and fish.

UNIDENTIFIED ACTOR #1: (As Horatio Storer) Hundreds of fish have strewed on the shore, among which I noticed menhaden, herring, goosefish, smooth and prickly...

ARABLOUEI: It was the early days of embryology, a branch of biology focused on prenatal development of embryos and fetuses. Charles Darwin, a naturalist himself, would soon publish his theory of evolution, drawing a direct line between man and beast.

(SOUNDBITE OF ANIMAL ROARING)

ARABLOUEI: Horatio Storer was fascinated by all of it - embryos, nature, the circle of life. So when he got back home to Boston, he decided to enroll in medical school, following in his father's footsteps, who was a doctor who specialized in obstetrics, a modernizing field of medicine focused around childbirth.

MICHELE GOODWIN: It was a time in which there was the burgeoning professionalization of obstetrics by white men of medicine.

ARABLOUEI: This is Michele Goodwin, professor at the University of California, Irvine, in the areas of law and bioethics. She's written a lot about the legal history of abortion. Her most recent book is "Policing The Womb: Invisible Women And The Criminalization Of Motherhood."

GOODWIN: These are the people who were leading the way in terms of the professionalization of this new thing, obstetrics. And at the same time, they were articulating their insecurities and really a level of high disregard for midwives.

ARABLOUEI: There are different theories on why some doctors began to get interested in childbirth. Some historians believe it was a money grab. If you delivered the baby, the family would call you back for all the falls and fevers that came after that.

ABDELFATAH: Others believe these doctors genuinely thought they could make childbirth safer for women. In the early 1800s, around 500 in every 100,000 births ended in the death of the mother. Today, that number has dropped by 95%. So it was a lot more deadly then. And doctors like Horatio Storer thought they were helping women at a time when women didn't have much of a say. But women didn't necessarily want their help.

UNIDENTIFIED ACTOR #2: (As character) She's almost here. Breathe, breathe...

UNIDENTIFIED ACTOR #3: (As character) Just breathe...

UNIDENTIFIED ACTOR #2: (As character) ...Breathe.

UNIDENTIFIED ACTOR #3: (As character) ...Just breathe. Just breathe. Just breathe.

ABDELFATAH: For tens of thousands of years...

REAGAN: Childbirth and pregnancy was all in the domain of women.

ABDELFATAH: Historian Leslie Reagan again.

REAGAN: Midwives delivered babies and they did it surrounded by her friends, her mother, her sister, potentially her daughters, neighbors. There was a crowd of women involved in the delivery, along with the midwife.

ABDELFATAH: But in the early 1800s, as more doctors...

REAGAN: Male doctors. Doctor equaled male.

ABDELFATAH: ...Entered the delivery room...

REAGAN: Which is in the woman's, you know, in her own home, in her own bedroom or her mother's bedroom.

ABDELFATAH: ...That began to shift a millennia-old dynamic. And as you can imagine, having a man in the room suddenly introduced some awkwardness.

REAGAN: Especially a brand-new doctor. Sometimes they've never seen a childbirth at all.

ABDELFATAH: New doctors like Horatio Storer.

REAGAN: So they could be coming in and they're surrounded by older women who know what's happening. And there are these stories in doctors' diaries of, you know, they'd been taught you need to shave the woman's pubic hair, you know, for sanitation before you deliver the baby. And they pull out that shaver and they're kicked out of the room. They're like, you are out of here. You're not doing this.

UNIDENTIFIED ACTOR #2: (As character) Good.

(SOUNDBITE OF WOMAN SCREAMING, BABY CRYING)

ABDELFATAH: Storer and his fellow specialists in women's health didn't just face skepticism from women in those delivery rooms. Other doctors also looked down on them.

GOODWIN: Because as you think about it, they were entering a profession where nearly 100% of it had been done by women. More than 50% of that had been done by Black women.

ABDELFATAH: Some even referred to the specialty as man-midwifery. It was a time when modern medicine was still in its early days. There were no antibiotics, no pregnancy tests, no ultrasounds. People didn't really go to hospitals. C-sections were rarely done and even more rarely successful.

ARABLOUEI: Not to mention some considered it improper, even offensive, for a male doctor to perform a pelvic exam, especially as the field of medicine was still trying to establish itself as a bona fide profession, mainly in the United States and Europe. For the most part, up until the 1870s in the U.S...

REAGAN: There were no laws regulating who was a doctor.

ARABLOUEI: Then some states began passing medical licensing laws. More medical schools opened up. And in 1847, a small group of doctors started the American Medical Association - the AMA.

REAGAN: They explicitly do not include women, and African Americans are not part of their medical profession.

UNIDENTIFIED ACTOR #4: (Reading) Chapter 1 - of the duties of physicians to their patients and of the obligations of patients to their physicians.

ARABLOUEI: And they laid out an elaborate code of ethics.

UNIDENTIFIED ACTOR #4: (Reading) Physicians are enabled to exhibit the close connection between hygiene and morals. Physicians, as conservators...

ARABLOUEI: Despite their best efforts, the AMA wasn't having much luck convincing people to take them seriously. The editor of the "Cincinnati Medical Observer" described physicians as a body of jealous, quarrelsome men whose chief delight is in the annoyance and ridicule of each other.

ABDELFATAH: By the time Horatio Storer came along in the 1850s, they were desperate for ideas about how to make their profession more respectable. And Storer set his sights on abortion.

(SOUNDBITE OF MUSIC)

ABDELFATAH: Just as women had overseen childbirth for most of human history, they'd also been on the front lines of ending unwanted pregnancies - of carrying out abortions. But in early America, they wouldn't have been using the term abortion. At the time, it was referred to as restoring the menses - trying to get your period again.

REAGAN: You know, taking herbs, taking teas, riding horses, falling down stairs - trying to get their menses back.

ABDELFATAH: It was considered acceptable for women to restore their menses up until the moment of quickening. When...

REAGAN: When they felt quickening, when they felt movement.

KARISSA HAUGEBERG: Which, for some women, doesn't occur until the fifth month of a pregnancy. So people didn't wrestle with this as a moral or ethical or even a legal question if a woman engaged in that practice before about the fourth or fifth month of pregnancy.

ABDELFATAH: There were no laws in place to prevent abortions before quickening.

HAUGEBERG: And so the conception of when life began really began at the moment of quickening.

ABDELFATAH: By some estimates, in the late 19th century, around 2 million abortions were performed each year, which means the number of abortions per capita was several times higher than it is today. Keep in mind, birth control options were very limited then, so there was less you could do to prevent a pregnancy in the first place.

REAGAN: You know, quickening is recognized, and the law and churches and, you know, the general community understands that this is in women's purview in terms of what's going on with their bodies. They know their bodies.

ABDELFATAH: In other words, it was your call as the woman to say when - or if - you felt movement.

HAUGEBERG: So I think one thing that people misunderstand about the opposition to abortion is that people assume that there's always been a vibrant religious or moral opposition to abortion, and that - in fact, that's actually relatively recent. It's not something rooted in ancient history.

ABDELFATAH: This is Karissa Haugeberg.

HAUGEBERG: I'm an associate professor of history at Tulane University.

ABDELFATAH: And author of the book "Women Against Abortion: Inside The Largest Moral Reform Movement Of The Twentieth Century."

HAUGEBERG: The question is, how does this go from being a personal, private decision, either among women or between couples, to one that the state becomes invested in?

ABDELFATAH: This question brings us back to Madame Restell, the so-called abortionist of Fifth Avenue.

(SOUNDBITE OF FOOTSTEPS)

UNIDENTIFIED PERSON #2: Get your morning paper. Read all about it.

REAGAN: Madame Restell, female physician - office and residence 148 Greenwich Street between Cortland and Liberty, where she can be consulted with the strictest confidence on complaints incidental to the female frame.

ARABLOUEI: Years before Horatio Storer started building up his name in medicine, advertisements for Madame Restell's services filled the papers - $5 for a packet of preventative powder, $1 for female monthly pills. And if those didn't work, she offered surgical abortions - $20 for poor women, $100 for the rich. She called herself a doctor, just like many others in the business did.

REAGAN: Doctor Dow advertised. Dr. Carswell. Sleeping Lucy in Vermont.

ARABLOUEI: They were all creating a persona, a brand like Madame Restell. She arrived in New York City from England in 1831 with her husband and newborn baby. Back then, she went by Ann Trow Sommers. But within months, her husband died of fever, and she was left on her own. Looking around, she saw that the marketplace for helping women prevent and end pregnancies was thriving. So she changed her name to Madame Restell and opened up shop.

(SOUNDBITE OF MUSIC)

ABDELFATAH: The pills sold in this marketplace turned traditional folk remedies that had been around for centuries into commercial products. They didn't always work and sometimes produced harmful side effects. Some women died.

HAUGEBERG: The American health marketplace in general was kind of dangerous. People were routinely sending away for herbal remedies to cure all manner of maladies.

ABDELFATAH: Some states began passing poison control laws.

HAUGEBERG: It was a desire to protect women from ingesting poisons that might harm them.

ABDELFATAH: Madame Restell and others began to be charged under these laws, but the penalties were never too harsh. And though it earned Madame Restell some critics in the papers, she continued to celebrate her abortion business loudly, living a life of luxury.

ARABLOUEI: 1847 The Sunday Dispatch, New York City.

UNIDENTIFIED PERSON #8: (Reading) Madame Restell is showy enough for a princess. She likes fine carriages, handsome horses and expensive living. Her pew is one of the pleasantest in a very fashionable church. She has fortified herself too strongly ever to be overthrown.

ARABLOUEI: At that point, no one - least of all Madame Restell herself - believed her reign would ever end.

(SOUNDBITE OF MUSIC)

ABDELFATAH: But those poison control laws were just the start of a moral tide that was sweeping the country.

UNIDENTIFIED ACTOR #1: (As Horatio Storer) It has been said that misery loves companionship. This is nowhere more manifest than in the histories of criminal abortion.

ABDELFATAH: And it would lay the foundation for a campaign to make abortion not only immoral but illegal, a campaign that would eventually take down Madame Restell and the entire abortion marketplace, a campaign led by Horatio Storer.

UNIDENTIFIED ACTOR #1: (As Horatio Storer) If we have proved the existence of fetal life before quickening has taken place or can take place, we are compelled to believe unjustifiable abortion always a crime.

ARABLOUEI: Coming up, Horatio Storer launches the physicians crusade against abortion.

(SOUNDBITE OF MUSIC)

TOBIAS DWYER: Hi, this is Tobias Dwyer (ph) from Ann Arbor, Mich. And you're listening to THROUGHLINE from NPR.

UNIDENTIFIED PERSON #9: Part 2 - A Century of Criminalization.

UNIDENTIFIED ACTOR #1: (As Horatio Storer) The moral guilt of criminal abortion depends entirely upon the real and essential nature of the act. It is the intentional destruction of a child within its parent. And physicians have now agreed from actual and various proof that the child is alive from the moment of conception.

ABDELFATAH: In 1860, governors of every single state in the U.S. received this letter from the recently established American Medical Association.

UNIDENTIFIED ACTOR #1: (As Horatio Storer) The evil to society of this crime is evident from the fact that it's instances in this country are now to be counted by hundreds of thousands.

ABDELFATAH: But there was really only one guy holding the pen.

HAUGEBERG: Horatio Storer.

ABDELFATAH: Karissa Haugeberg, again, who studied the formation of the anti-abortion movement.

HAUGEBERG: Basically, he ghost-wrote a letter from the president of the AMA - so it looked like it was coming from the president, but Storer was actually the one who wrote it - saying that the AMA opposes abortion. And he used the language of morality.

UNIDENTIFIED ACTOR #1: (As Horatio Storer) In reality, there is a little difference between the immorality by which a man forsakes his home for an occasional visit to a house of prostitution that he may preserve his wife from the chance of pregnancy, and the immorality by which that wife brings herself willfully to destroy the living fruit of her womb.

ABDELFATAH: The letter was pivotal to what historians call the physician's crusade against abortion. And Storer was making a few key arguments for why abortion should be illegal across the country. First, he introduced a new idea...

UNIDENTIFIED ACTOR #1: (As Horatio Storer) The child is alive from the moment of conception.

ABDELFATAH: ...That life began at conception. Remember, up till now, people generally agreed that life began when a woman could actually feel life move inside her at quickening. But that wasn't enough for Storer. He campaigned on a moral argument that also tapped into the racial fears of the moment, fears that would eventually inspire a pseudoscientific field of, quote, "racial improvement and planned breeding of the population."

GOODWIN: American eugenics.

ABDELFATAH: These racial fears would inspire forced sterilization programs to decrease certain populations, whereas Storer's anti-abortion campaign was trying to increase other populations by focusing on...

HAUGEBERG: Protestant white women.

ABDELFATAH: Because elite Protestant white women were often the ones going to people like Madame Restell. And people like Horatio Storer were realizing that that had consequences.

HAUGEBERG: The birth rate for Protestant white women had been declining over the course of the 19th century, so he had fears of what were commonly - what was commonly referred to as race suicide, that the Anglo stock wasn't going to replenish itself fast enough to keep up with the swells of new immigrants to the United States.

REAGAN: And who is going to have power and populate this country and populate the Great Plains and the Great West? Well, it is going to be Chinese migrants, it's going to be African Americans, newly freed people and Catholics. They are not the ones using abortion. It's our, you know, Yankee women who are using abortion, trying to get into medical school, trying to do politics when they should be at home having babies and taking care of them.

GOODWIN: They began to say, we need white women to use their loins because they're concerned about the Blackening and the browning of what is now - what, at that point, became the United States. And this real concern that, when Black people become free, what will this mean for white people? And white women become a key to that.

ABDELFATAH: So part of Storer's thinking was that criminalizing abortion would help rebalance the scales of who was being born into this country. But there was more to his strategy. He saw this as a way to finally knock out the competition - midwives and people like Madame Restell.

HAUGEBERG: And so if the AMA could wrest control over the marketplace of abortion, it would be lucrative to this growing cadre of university-educated mostly male physicians who were beginning to specialize in things like obstetrics and gynecology.

ARABLOUEI: So midwives were slandered in this campaign.

GOODWIN: Described as unsanitary, unclean, as immoral.

ARABLOUEI: And as clueless as the mothers themselves.

REAGAN: Saying, women do not know - they don't know when they quicken - and really makes fun of women's own sensations and knowledges and says, you know, some of them quicken at one month, some of them never quicken at all and then they have a baby.

UNIDENTIFIED ACTOR #1: (As Horatio Storer) They may very constantly be recognized by the physician in cases where no sensation is felt by the mother.

REAGAN: So there's this scoffing at women's knowledge saying, this is a sin, this is murder, you're killing children.

UNIDENTIFIED ACTOR #1: (As Horatio Storer) By the moral law, the willful killing of a human being at any stage of its existence is murder.

REAGAN: And the general public and women don't get it. They don't know that. And we need to change the laws.

ABDELFATAH: So to help people get it, Storer wrote articles, books, reports, speeches all to make his views on abortion and women clear. In one lecture called "The Origins Of Insanity In Women," he advocated for ovariectomies for women who, quote, "have become habitually thievish..."

UNIDENTIFIED ACTOR #1: (As Horatio Storer) Profane or obscene, despondent or self-indulgent, shrewish or fatuous.

ABDELFATAH: The solution, as he saw it...

UNIDENTIFIED ACTOR #1: (As Horatio Storer) Remove the cause.

ABDELFATAH: A woman's reproductive organs.

HAUGEBERG: He was really hostile to women.

ABDELFATAH: And that hostility was starting to gain traction. A few years into the campaign, some states began to pass laws outlawing or restricting abortion. Perhaps the harshest was in Connecticut in 1860. The law got rid of the quickening rule and made abortion a crime for which the abortionist and the woman getting the abortion could be fined and jailed. And over the next few decades, most states across the country would adopt similar laws, thanks in part to another campaign that was going on at the same time that was getting even more attention. It was led by a Union Army Civil War veteran named...

HAUGEBERG: Anthony Comstock, who's well known for leading the anti-birth control crusade of the 19th century.

ABDELFATAH: Anthony Comstock was a descendant of some of the earliest Puritans in New England. He took that ancestry to heart and went on to work with the Young Men's Christian Association, the YMCA, in New York City and founded the New York Society for the Suppression of Vice. And he dedicated his life to exactly that - suppressing vice.

ARABLOUEI: In 1873, Comstock began lobbying Congress to pass anti-obscenity laws. There had been a rise of prostitution and new forms of birth control, like diaphragms and rubber condoms, all of which triggered a powerful backlash, a backlash that culminated in the Comstock Law.

GOODWIN: The criminalization of sending materials through the mail that could be seen as obscene.

UNIDENTIFIED ACTOR #5: (As Anthony Comstock) That no obscene, lewd or lascivious book, pamphlet, picture, paper, print or other publication of an indecent character or any article or thing designed or intended for the prevention of conception or procuring of abortion, nor any article or thing intended or adapted...

ARABLOUEI: The law made it illegal to mail sex toys, pornography, contraception, abortion drugs or even information about contraception and abortion.

GOODWIN: Including some medical books that had pictures of anatomy - right? - is just how deep it went.

ARABLOUEI: But here's the thing - Comstock conflated birth control with abortion. He saw no difference between the two, which meant that abortion was wrapped up into this new law, making it a federal offense to send or order material about abortion by mail with punishment of up to $5,000 in fines, which is over $110,000 today, and up to 10 years in prison. The law was the first of its kind in the Western world.

ABDELFATAH: Between Comstock's laws and Horatio Storer's crusade, by 1880, every single state had a law outlawing abortion on the books. These laws launched a century of criminalization.

REAGAN: So in the terms of the way the laws are written, there is always an exception written into the laws that allow for medical professionals - for doctors to perform abortions if they, in their medical judgment, believe it is necessary to save a woman's life or to save her health. This is clearly written from the perspective of a specific group of the medical profession, and they're really claiming abortion as theirs. It is the procedure that doctors can perform if they believe it is medically necessary, and that medically necessary is not defined in the law. But it does mean that they can kind of control this and also say, you know, other people - midwives, you know, Madame Restell, immigrants - you know, bad people are doing this procedure and it's immoral, and now it's illegal.

ABDELFATAH: Unless it's done by us, doctors.

(SOUNDBITE OF MUSIC)

ARABLOUEI: In the end, Horatio Storer and the AMA's campaign against abortion, aided by Anthony Comstock's anti-contraception campaign, was a success. And although not all doctors agreed with or followed the new laws, midwives and entrepreneurs like Madame Restell were still sidelined as male gynecologists and obstetricians took over. But they didn't just lose business, they were in danger now that their very livelihoods were illegal. Things were especially dire for Madame Restell since she had been so public and bold about her services. Her clientele were mainly upper class white women, the women Storer believed should be having more kids. All eyes were on her as these laws took hold. And Comstock made it his mission to end her.

(SOUNDBITE OF BELL)

ABDELFATAH: In 1878, he rang her doorbell on East 52nd Street, pretending that he was a married man seeking an abortion for his wife, who already had too many children and wasn't in good enough health to birth another. She sold him some pills, and he was on his way. But the next day, Comstock returned with a police officer who arrested Restell. As always, Restell went to the press.

UNIDENTIFIED ACTOR #6: (As Madame Restell) He's in this nasty detective business. There are a number of little doctors who are in the same business behind him. They think, if they can get me in trouble and out of the way, they can make a fortune. If the public are determined to push this matter, they will have a good laugh when they learn the nature of the terrible items of the preventative prescriptions. Of course, if there's a trial, it will all come out.

ARABLOUEI: But there was never a trial. Restell became distressed. She paced around her house, asking her servants why she was persecuted time and time again. And on the morning of the day she was supposed to appear in court, one of her chambermaids walked into her bathroom to find her dead in her bathtub. She had slit her own throat.

ABDELFATAH: When Comstock found out, he took out his file on her and wrote, quote, "a bloody ending to a bloody life."

(SOUNDBITE OF WATER DRIPPING)

ARABLOUEI: As for Horatio Storer, he co-founded the Gynecological Society of Boston, which focused on diseases that affected women and reproductive health and came to be known as a pioneer in the field of OB-GYN, obstetrics and gynecology.

GOODWIN: When we think about this, is there any wonder why, for so long, medicine looked white and male in the United States? What explains that? It's certainly not because women aren't intellectually curious about medicine. It's not because women don't know how to read books. It is because the American Medical Association, through the tools of all of this time very specifically - very specifically - made sure that women would be cut out.

ABDELFATAH: Coming up, abortions go underground.

(SOUNDBITE OF MUSIC)

SVEN CORSO: Hi. My name is Sven Corso (ph). I'm a teacher from Tampa, Fla. And this is THROUGHLINE from NPR.

UNIDENTIFIED PERSON #10: Part 3 - Into the Shadows.

JOAN LESTER: I still remember the sound.

(SOUNDBITE OF MUSIC)

ABDELFATAH: When Joan Lester was 19 years old, she found herself in a dark room with a doctor whose name she didn't know.

LESTER: I don't even know if he was a gynecologist.

ABDELFATAH: Alone, at midnight, getting an illegal abortion. What happened next was really common and really graphic.

LESTER: So he told me to lie down on the table. You know, take my pants off first. I lay down on this table. He inserted a curette, which is basically a razor, and began to scrape the inside of my uterus to scrape out the fetus. And I still remember the sound in addition to the pain. I don't think he gave me any painkillers. And so I began to moan. And then I think I screamed. He clamped his hand over my mouth. He said, shut up. And that's mostly all I remember about it.

ABDELFATAH: At the end of the procedure, the doctor gave her a couple of towels.

LESTER: Blood was just coming down my legs, and I remember soaking through the one or two towels that I had. It hurt like hell. I was probably crying.

ABDELFATAH: A few weeks later, Joan was still in a lot of pain, so she went to the closest hospital looking for answers, looking for help.

LESTER: I got to the hospital emergency room, and there was a doctor there who was the admitting doctor.

ABDELFATAH: She told him she'd had an abortion.

LESTER: And there I am, writhing in pain.

ABDELFATAH: When suddenly, his whole demeanor changed.

LESTER: Then he said, you're an abomination. This is God's punishment to you for your sin, for what you've done. And you're never going to have children. Your tubes are going to be sealed up because you have this huge pelvic inflammatory infection. And he was just screaming at me.

ABDELFATAH: Joan was admitted into the hospital and put on antibiotics. If she'd waited, she might have gone into septic shock - when an infection causes your blood pressure to drop to life-threatening levels. Over the next week, she began to recover.

LESTER: And I have to say that this was probably not one of the most extreme examples of what happen to women. There are just all kind of horror stories because we were just completely vulnerable because we had done something illegal. And, you know, we basically had no rights.

ABDELFATAH: For decades after Horatio Storer and the AMA got those laws on the books in every state, women continued to quietly seek out abortions in the private practices of doctors who disagreed with or simply worked outside of the laws, which there were plenty of. Those doctors rarely faced criminal charges unless a woman died. It wasn't until the middle of the 20th century that the horror stories of botched illegal abortions, like Joan Lester's, began skyrocketing, a byproduct of a changing world.

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UNIDENTIFIED PERSON #11: The hospitals, designed to serve thousands at a time, are equipped with the most modern devices and specialists and expert technicians.

REAGAN: By World War II, everybody is in the hospital.

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UNIDENTIFIED PERSON #12: John Rogers Jr. (ph), white, 6 lbs.

UNIDENTIFIED PERSON #13: Mother's name Clara (ph).

REAGAN: Ninety, 95% of the entire population goes to hospital to deliver babies.

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UNIDENTIFIED PERSON #14: That's exactly the reverse of the figures when John Sr. (ph) was born.

ARABLOUEI: There had been a revolution in medicine. Things like X-rays, antibiotics and sterile surgeries made hospitals important like never before. Childbirth and abortions were theoretically safer than ever.

REAGAN: And so abortion, too, is increasingly going to be done in the hospital. And this really changes things.

ARABLOUEI: Many OB-GYN doctors moved into hospitals where they had a lot more oversight. And hospital administrators...

HAUGEBERG: ...Who are worried about violating state laws and getting sued...

ARABLOUEI: ...Formed abortion review committees...

REAGAN: ...That would review whether an abortion was medically justifiable or not.

ARABLOUEI: And they made it really hard for a woman's abortion request to get approved.

HAUGEBERG: Women are subject to multiple exams, usually by both psychiatrists, obstetricians, and then often three other physicians. This is an era when many women don't have health insurance, certainly when there aren't federal programs to help women pay for these services.

ARABLOUEI: Certified OB-GYN doctors who would have done abortions before were terrified of getting caught now, especially because this shift in medicine collided with another massive change.

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UNIDENTIFIED PERSON #15: Babies all over the map.

HAUGEBERG: After World War II, we had the baby boom. And there was enormous pressure put on American women to have children.

ABDELFATAH: During the Second World War, women had staff jobs in factories and other parts of society as the men went off to battle. When the men came back...

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UNIDENTIFIED PERSON #16: You like to cook, don't you, Tess?

UNIDENTIFIED PERSON #17: Well, it's accomplishing something.

ABDELFATAH: Women were pressured to return into the home and to have children.

LESTER: Get married, have children, and live with a white picket fence.

ABDELFATAH: And abortion was at odds with this. City officials motivated by the social messaging of the time and looking for ways to boost their public profile in the face of growing racial tensions and accusations of corruption...

HAUGEBERG: ...Begin enforcing these laws that have been on the books.

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REAGAN: They start to go after people who've been practicing for 10, 20 years, and they raid them.

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HAUGEBERG: So we see an explosion of the illegal marketplace for abortion in the 1940s and 1950s.

LESTER: You're thrown underground and into the shadows.

HAUGEBERG: As the illegal marketplace flourishes, a whole host of people fill that vacuum.

ABDELFATAH: Some doctors risked losing their license to practice, risked going to jail, and continued providing abortions to women in secret. But...

HAUGEBERG: The vast majority of women sought to self-abort.

LESTER: I heard of people throwing themselves down stairs or drinking Clorox or, you know, various kinds of poisons.

GOODWIN: There were women who died in motel rooms sitting on towel - on top of clumps of towels, people coming home and finding daughters dead in bathtubs, bleeding out, coming home and finding wives on the top of dining room tables having used hangers and things like that.

CAROLE JOFFE: Many women of all social classes, many women of color were getting abortions. The real story here is the difference in outcomes.

ARABLOUEI: If you had the means, which usually meant you were an upper middle class white woman, you could pay off someone with a little more training to do the abortion.

JOFFE: You know, it was African-American women who were most likely to end up in the clutches of the so-called back alley butchers.

ARABLOUEI: This is Carole Joffe.

JOFFE: I'm a professor at the University of California San Francisco. My most recent book is called "Obstacle Course: The Everyday Struggle To Get An Abortion In America."

ARABLOUEI: It's hard to pinpoint exactly how many illegal abortions were being carried out in this period. Estimates range from 200,000 to 1.2 million per year. There was a cone of silence around it. Many women were too afraid to talk about their experiences, fearing both legal and social consequences.

JOFFE: We have to remember what it was like in the 1950s and the 1960s and the shame that was brought about by being a single mother. Women were not supposed to have babies out of wedlock, they were not supposed to divorce their husbands if they experienced domestic violence. I mean, it was legal to rape your wife. So in the United States, we're talking about a time in which states' laws protected men who raped their wives.

ABDELFATAH: More and more women like Joan Lester were showing up in emergency rooms with infections and injuries caused by botched abortions.

LESTER: Five, 10, 20 a day, hundreds coming in on the weekends.

ABDELFATAH: Doctors and medical students were scrambling to help them all.

LESTER: And they're holding their hands while they bleed and die. And this just this is - for many people is intolerable.

ABDELFATAH: Abortions, if done in sterile conditions by a trained professional, were rarely deadly at this point. But the illegal marketplace was creating an epidemic.

LESTER: So that drives a lot of doctors to support the decriminalization because they personally know what the results are and they see it as a public health problem.

ARABLOUEI: Doctors teamed up with like-minded lawyers and set out to reform abortion laws at the state level.

LESTER: And the hope is, you know, these doctors will be able to perform more of the abortions that they think are necessary.

ARABLOUEI: In cases where women had been raped or the mental or physical health of the fetus was at risk. A group of doctors had been responsible for getting laws against abortion rights on the books. And now doctors were on the other side of the fight, pushing to get those same laws off the books. More than a dozen states passed reform laws in the late 1960s and early '70s. And four states legalized abortion outright - New York, Alaska, Washington and Hawaii.

HAUGEBERG: Almost immediately, as states revised their laws, anti-abortion activists began to mobilize. And most of them were Catholic. So they were really the only, you know, stalwart opponents to abortion.

ARABLOUEI: On and off for centuries, the Catholic Church had declared all abortion murder. And in the 1960s, a movement began to form around that idea.

ABDELFATAH: At this time, as the movement is emerging, would they have been self-identifying as anti-abortion or pro-life?

HAUGEBERG: They would've used the language - the descriptor pro-life. Catholics who were coming out of anti-war activism, civil rights activism, anti-nuclear proliferation activism - they believed that life should be protected from conception to death. So they opposed the death penalty, they supported a more generous welfare state to enable women to be able to support families.

ARABLOUEI: They saw all of this as a part of a broader movement to protect life at all stages - a, quote, "pro-life movement."

ABDELFATAH: But outside of this Catholic opposition, the pushback to these reform laws was minimal. Mainline Protestant institutions even came out in support of expanding access to abortion, seeing firsthand the toll of illegal abortions on women in their congregations.

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UNIDENTIFIED REPORTER #1: A new movement for women's liberation is launched. And once again, protesters take to the street to support their demands for total freedom economically, politically, socially.

ABDELFATAH: In the 1960s, the women's liberation movement began to advocate for what one organization called, quote, "true equal partnership with men."

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UNIDENTIFIED PROTESTER: Equal rights to have a job, to have respect, to not be viewed as a piece of meat. We just want what men have had all these years.

REAGAN: Those of us like myself who were involved were just living and breathing, you know, liberation, liberation, liberation.

ABDELFATAH: But pretty soon, the mostly white, mostly middle class leaders of the movement shifted their focus.

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UNIDENTIFIED REPORTER #2: What is it you're pioneering? What are you wanting to say?

UNIDENTIFIED PERSON #18: The sexual revolution. I feel we're going into the, you know, beginning of an emotional revolution.

ABDELFATAH: They wanted to get rid of the shame and silence that had surrounded women's bodies and sexuality for so long.

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UNIDENTIFIED PERSON #18: It's - we don't just take our clothes off and say, look. I am nude, you know. We are - it's all very natural.

ABDELFATAH: Abortion became a top priority for the movement, and they encouraged women to speak out about their illegal abortion stories.

REAGAN: And it was pretty shocking. It was shocking to me. I think it was shocking to everybody how widespread this was. Respected professionals and mothers - oh, my God, they had an abortion? It really changed the conversation.

JOFFE: What's so interesting is that so much of the feminist movement of that time in general was very focused on health and was very antidoctor. There was a tremendous critique of gynecology. You know, the image of a woman in the stirrups became sort of this emblem of female passivity and male power.

ABDELFATAH: And suddenly they found themselves on the same side as these doctors - forced to work with them, whether they liked it or not.

JOFFE: I have referred to them as, quote, "uneasy allies."

ABDELFATAH: Who didn't always see eye to eye.

JOFFE: It was a clash of style.

ABDELFATAH: Feminists wanted sweeping change. Some called for repeal of all laws restricting abortion. They were saying, we don't need to be told when it's appropriate to have an abortion - by a doctor or anyone else. It should be a private, personal decision.

ARABLOUEI: But some people who supported abortion rights worried that framing the issue within the context of the feminist movement and pushing a national agenda might create a backlash.

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HAUGEBERG: So for the women who opposed abortion beginning in the late 1960s, they understood the sexual revolution as a threat - a threat to the family, something that might cause men and women not to get married and have children in the orderly way that they should. They believed that they were suddenly being criticized as being stupid or being dupes for having that lifestyle.

ARABLOUEI: And there was a fear that abortion was just the beginning of the end of that lifestyle.

HAUGEBERG: That this is part of a moral decline wrought by the sexual revolution.

ARABLOUEI: Some of these women began joining the pro-life movement, a movement that was still in its infancy - a movement that was poised to enter a new era.

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UNIDENTIFIED PERSON #19: Today, we find it the center of a gathering storm, as women and men argue the question of abortion - the right to life or the woman's right to choose.

ABDELFATAH: In 1970, while all this was happening, a small group of lawyers took on a case in Texas. The plaintiff - a woman named Norma McCorvey, who was listed as Jane Roe in court records to protect her identity. The defendant - Henry Wade, the district attorney of Dallas County, Texas, where Jane Roe lived. The issue - Jane Roe was pregnant with her third child and wanted an abortion on the grounds that it should always be a woman's right to choose. Under Texas law, abortions were only allowed when necessary to save a woman's life.

ARABLOUEI: By 1973, the case had made its way to the Supreme Court. Jane Roe had already had her child, but the stakes were much higher by then. If the court sided with Jane Roe, abortion would become legal nationwide.

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CRONKITE: Good evening. In a landmark ruling, the Supreme Court today legalized abortions. The majority in...

GOODWIN: Roe v. Wade was a 7-to-2 opinion. Five of those seven justices who struck down laws criminalizing abortion were Republican-appointed.

ARABLOUEI: The court ruled that the state could not regulate abortion in the first trimester at all. Only in the third trimester, once the fetus could live outside the womb, could states ban abortion entirely.

ABDELFATAH: And the court stopped short of giving women total control over the decision - quote, "the attending physician, in consultation with this patient, is free to determine without regulation by the state that, in his medical judgment, the patient's pregnancy should be terminated." Doctors remained a central part of the decision and at the heart of the issue. Still, this was a huge, sweeping change, and abortion was now legal in all 50 states.

JOFFE: And everybody thought the problem's done. It wasn't.

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JOFFE: So what happened right after Roe?

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ABDELFATAH: What happened after Roe? That's what we'll find out in part two, coming soon.

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ARABLOUEI: That's it for this week's show. I'm Ramtin Arablouei.

ABDELFATAH: I'm Rund Abdelfatah, and you've been listening to THROUGHLINE from NPR.

ARABLOUEI: This episode was produced by me.

ABDELFATAH: And me and...

LAWRENCE WU, BYLINE: Lawrence Wu.

LAINE KAPLAN-LEVENSON, BYLINE: Laine Kaplan-Levenson.

JULIE CAINE, BYLINE: Julie Caine.

VICTOR YVELLEZ, BYLINE: Victor Yvellez.

ANYA STEINBERG, BYLINE: Anya Steinberg.

YOLANDA SANGWENI, BYLINE: Yolanda Sangweni.

CASEY MINER, BYLINE: Casey Miner.

ARABLOUEI: Fact-checking for this episode was done by Kevin Volkl.

ABDELFATAH: Thank you to Turner Ross, Blaize Adler-Ivanbrook, Lawrence Wu, Julie Caine, Benjamin Swift, Owen Perry, Sam Clague (ph), Shaheer Khan, Eric Lu (ph) and Berrigan Hoff (ph) for their voiceover work. And a special thanks to Deb George for her editing support.

ARABLOUEI: Thanks to Sarah McCammon, Tamar Charney and Anya Grundmann.

ABDELFATAH: This episode was mixed by Josh Newell. Music for this episode was composed by Ramtin and his band, Drop Electric, which includes...

ANYA MIZANI: Anya Mizani.

NAVID MARVI: Navid Marvi.

SHO FUJIWARA: Sho Fujiwara.

ARABLOUEI: And finally, if you have an idea or like something you heard on the show, please write us at throughline@npr.org or hit us up on Twitter @ThroughlineNPR.

ABDELFATAH: Thanks for listening.

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