Abortion Is Healthcare: Lessons From a Public Hospital

Abstract

Abortion Is Healthcare:Lessons From a Public Hospital Amy Zanoni (bio) Since the Supreme Court's Dobbs v. Jackson Women's Health Organization decision, many have invoked the coat hanger and the public hospital septic abortion ward as portents of life after the fall of Roe. Illinois Governor J. B. Pritzker was one of many pro-choice advocates who made direct reference to Ward 41 at Chicago's public hospital, Cook County Hospital. But by only paying attention to the horror stories of botched abortions in the pre-Roe era, we miss the other lessons that public hospitals like Cook County can teach us: even during Roe, access to abortion was limited, hard-fought, and dependent on local conditions. Public hospitals are key to understanding the brutal consequences of policies that limit people's access to healthcare, as well as the role that local governments often play in a country with no national healthcare system. In providing care to everyone who came through its doors, the public hospital approximated the right to healthcare. When county, state, and federal lawmakers undermined the right to reproductive care, Chicagoans demanded its reinstatement at Cook County Hospital. These struggles and the hospital's history shed light on the importance of tethering demands for reproductive rights to a more expansive welfare state and healthcare system. They also help us understand the crucial importance of federal action. Cook County Hospital Before Roe The State of Illinois passed its first anti-abortion law in 1827. But making abortion illegal never prevented women from having abortions. In the twentieth century, even before Roe, "abortion was not extraordinary, but ordinary," according to historian Leslie Reagan. Women with means were often able to access safe abortions in doctors' or midwives' offices. Low-income women were more likely to self-induce abortion and, as a result, more likely to suffer complications and end up in the hospital. [End Page 33] In Chicago, more often than not, that hospital was Cook County. Opened in 1866 to fulfill the county's legal obligation to finance medical care for the indigent, County (as it was called by many Chicagoans) provided a full spectrum of healthcare to the city's marginalized people. Communities of color, especially Black Chicagoans, relied disproportionately on County, the city's only public hospital until the 1990s. Historically barred from the industrial jobs most likely to provide insurance, Black Chicagoans were uninsured at higher rates. Private hospitals also routinely discriminated against Black Chicagoans. Medicaid, created in 1965, left out many people because the program was means-tested and because many private providers did not care for publicly insured patients. Before and after Roe, County provided care, reproductive and otherwise, to Chicagoans who needed it. Public hospitals all over the country played similar roles. In 1934, County admitted 1,159 patients suffering complications related to abortion; in 1949, the number reached 1,683 patients—about thirty-two per week in a city of approximately 3.6 million. By the early 1960s, hospital personnel cared for around 5,000 patients suffering complications from abortions annually. In 1965, one abortion patient was admitted to County for every 4.1 deliveries, compared to 1 in 10.8 at other Chicago hospitals. A twenty-one-year-old woman who underwent an illegal abortion in September 1970 was one such patient. An ambulance first brought her to a private hospital less than two miles from her South Side home. But hospital personnel sent her to County, about five miles to the northwest, claiming they had no obstetric beds available and that she had not previously seen a doctor on staff. (Private hospitals routinely sent uninsured or otherwise "undesirable" patients to County, a practice advocates decried as "patient dumping.") When she arrived at County, she was hemorrhaging and, according to the Chicago Daily Defender, "reacting adversely to poisoning from the dead fetus" left in her uterus. She died soon after. Cook County Hospital After Roe Roe v. Wade made abortion legal in 1973. But it did not guarantee the right to abortion: the absence of a comprehensive healthcare system put the onus on pregnant people to find providers and pay for abortions, as scholars including Dorothy Roberts and...