# Lentis/Abortion As a Sociotechnical Controversy
## Introduction

Abortion will be explored as an American socio-technical controversy from the 19th century up until present day. Key influential figures leading up to the abortion ban in 1873 will be analyzed; abortion technologies in the 20th century and current controversies will be addressed.

## Technical Background & Abortion Overview
### Menstruation, Fertilization, and Pregnancy

Pregnancy begins with the menstrual cycle, a 28 day process that is divided into the menstrual, follicular, ovulation, and luteal phases. The lining of the uterus is shed during the menstrual stage. During the follicular phase, the uterine lining thickens and the egg matures. Two weeks into the cycle, the egg is released from the ovary during ovulation to be fertilized, surviving for 24 hours; this is the only time when a woman can conceive. Pregnancy requires the buildup of a uterine lining, so “doctors date pregnancy from the first day of a woman's last menstrual period, which is typically 2 weeks before fertilization”.

#### Trimester I (Week 1 to Week 13)

Fertilization begins Week 3 of a pregnancy. The fertilized egg travels towards the uterus, undergoing cell division and implantation. The embryo is formed from the inner layer of the cells. At Week 11, the embryo is considered a fetus and measures 2 inches in length.

#### Trimester II (Week 13 to Week 27) & III (Week 27 to Week 40)

By 24 weeks of pregnancy, a fetus can survive outside of pregnancy with the help of a neonatal unit.
The fetus’ skeleton, neural network, and senses continue developing through the last trimester. A baby is considered full term by the end of Week 36 but most women give birth between 38 and 42 weeks.

### Abortion in the Modern Era

As of 2015, 65.4% of abortions were performed at or before Week 8 of pregnancy, 91.1% were performed at or before 13 weeks of pregnancy and 98.7% of abortions were performed before Week 21.

## Abortion in the 19th Century
### Early Abortion

Up until the late 19th century, abortion prior to quickening was considered legal. Quickening is when pregnant women are able to feel and/or perceive fetal movements, usually around the 13 to 25 week mark during pregnancy. It was largely believed that the fetus was not alive until quickening was felt, thus making it acceptable to terminate a pregnancy up until this point. Leading up to and around the 19th century, abortions were commonly performed with abortifacients, or drugs which cause an abortion. Advertisements in newspapers would advertise these drugs, oftentimes by the name "female monthly pills." Madame Restell was a leading figure whose advertisements to women were often found in newspapers. One such advertisement read:
   Female monthly pills prepared by Madame Costello...the very best medicine that ladies laboring under a suppression of their natural illness can take, and they very seldom fail to relieve when taken according to the directions.

### Dr. Horatio Storer

Dr. Horatio Storer was a Boston Surgeon who started practicing medicine in 1855. He was a strong leader in the 'physicians crusade against abortion,' and an individual with prominent anti-feminist sentiments. In his book Why Not? A Book for Every Woman, published in 1868, he declared abortions to be "proof of actual insanity" and that women's influence to do so came from the extravagance of living, fashion, or lust. It was commonly believed in the 19th century that physical and psychological problems were rooted in a woman's womb. Storer stated: "Woman's mind is prone to depression, and, indeed, to temporary actual derangement, under the stimulus of uterine excitation." Storer was influential among the physician profession, and declared: "Physicians have now arrived at the unanimous opinion, that the [fetus] if alive from the very moment of conception." Despite many women believing that a child was not alive prior to quickening, Storer stated quickening was merely a sensation, and one that some women never felt. Thus, he concluded, it could not be an indication of the existence of a child during pregnancy.

### American Medical Association (AMA)

Established in 1847, the American Medical Association (AMA) was an organization of medical professions that in its early years largely condemned abortion. In May 1857, a Committee was appointed by the American Medical Association in order to investigate criminal abortion, of which Dr. Horatio Storer was made Chairman. In the Report on Criminal Abortion submitted by the Committee, it stated that guilt of criminal abortion was acknowledged by medical men everywhere and proceeded to conclude: "As a profession we are unanimous in our condemnation of the crime." It was advised by the Committee that all physicians express abhorrence to the crime of abortion. Later in 1860, in the Address of Henry Miller, M.D., President of the Association, Miller stated that the resolutions from the Report on Criminal Abortion would be brought before Congress in order for laws punishing abortion to be revised and further legal action be provided.

#### Hippocratic Oath

The Hippocratic Oath, taken by all new physicians entering the medical field, establishes the professional conduct for medical personnel to uphold when practicing medicine. In particular, the oath requires physicians to swear to do no harm and thus can be attributed to the beliefs by many physicians at the time believing abortion to be ethically immoral and going directly against this sworn oath.

### Comstock Act of 1873

A Statute passed by the Forty Second Congress, Session III on March 3, 1873, titled as An Act for the Suppression of Trade in, and Circulation of, obscene Literature and Articles of immoral Use, banned the possession of articles which could be used to either prevent conception or cause an abortion. The consequence of doing so included imprisonment for hard labor and a fine of up to two thousand dollars. This Statute later became known as the Comstock Act of 1873.

## Abortion in the 20th Century
### Vacuum Aspiration

Vacuum aspiration abortions were first investigated in 1957 in China and were developed throughout the 1970s. By the late 1970s, vacuum aspiration had become the most common first-trimester method and it is still used today. During vacuum aspiration, the cervical canal is dilated and a small tube is placed inside to suck the tissue out of the uterus. Vacuum aspiration has an extremely low complication rate and a lower risk of death than carrying a pregnancy to term, with the risk decreasing the earlier an abortion is performed. This proved to be a key factor in the Roe v. Wade (1973) decision: “Because early induced abortion was much safer than a continued pregnancy, the Court recognized the right of a woman and her physician to choose to terminate a pregnancy during the first trimester”. Increasing safety of abortions resulting from new technologies led to an increase in abortions between 1973 and the 1980s. This pattern is consistent with Jevon’s Paradox and was one of the supporting points of abortion opponents who were concerned that safer, faster, and cheaper procedures would result in abortions becoming routine and frequent. Note that abortions did level out in the 1980s around 1.5 million per year.

### Medication Abortion

In 1982, the French company Roussel Uclaf announced that mifepristone (RU-486) could abort a pregnancy. Mifepristone causes the zygote to detach from the uterine lining. This medication is followed up with misoprostol, which induces contractions to get rid of the tissues. Once it was approved for use in France, American feminist groups like the Feminist Majority Foundation tried and failed to bring the drug to the U.S. Political pressure from oppositional groups was strong; in 1989, the FDA banned the importation of mifepristone. The AMA announced their support of mifepristone on the grounds that it was less invasive but still as effective than surgical abortions. The tide turned with the Clinton administration, which succeeded in overturning the ban. The FDA issued a tentative approval for the drug in 1996; however, it was not approved for public use until 2000. More recently, oppositional groups like Americans United for Life have tried to push for stricter medical supervision during medication abortions, arguing that they are dangerous.

## Abortion in the 21st Century
### Modern Day Abortion Debates
#### Fetal Pain

Fetal pain has been a social issue since 1984 when the National Right to Life Committee (NRLC) produced The Silent Scream, a film depicting a first-trimester abortion where the fetus is seen opening its mouth as though it were in pain. There is significant debate whether a fetus can feel pain associated with abortion, particularly regarding late-term abortion methods. Determining if a fetus can feel pain is challenging since pain involves physical, psychological, and emotional responses. Therefore, researchers must take developmental and neurological factors from the fetus into consideration. The American Medical Association has denied a fetus can feel pain at 20 weeks while many conflicting studies have been published on the issue. Various members of the United States legislature have proposed the Unborn Child Safety Awareness Act since 2004 and as recently as 2013. This bill mandates abortion providers to give information to abortion-seeking women about the possibility of their fetus to feel pain. The state of Utah also passed the “Administration of Anesthetic or Analgesic to an Unborn Child” law which mandates that a fetus be anesthetized prior to abortion with few exceptions. These laws have primarily been presented by Republican congressmen and women as the Republican party has opposed abortions since Roe v. Wade.

#### Late-Term Abortions

A fetus is considered viable between 24 and 28 weeks as defined in the opinion of the court in Roe v. Wade. As of 2019, 43 states have bans on abortion at some point during pregnancy, including 20 at viability and one at the beginning of the third trimester (25 weeks). Reasons for late-term abortions are most commonly due to the risk of death of the fetus or the mother due to abnormalities only detectable at later stages of pregnancy. The American College of Obstetricians and Gynecologists (ACOG) places importance on a physician-patient relationship and believes political interference disrupts this.

#### Fetal Heartbeats

In 2019, six states passed “heartbeat bills,” those being Georgia, Kentucky, Louisiana, Missouri, Mississippi and Ohio. A heartbeat bill prevents abortions after six to eight weeks of pregnancy, the typical timepoint at which an embryonic heartbeat can first be detected. The heartbeat at six weeks is "a little flutter in the area that will become the future heart of the baby," said Dr. Saima Aftab, medical director of the Fetal Care Center at Nicklaus Children's Hospital. These states based their bills after a model bill drafted by Faith2Action founder and president Janet Porter. Faith2Action is a religious non-profit whose mission is to “win the cultural war for life, liberty, and the family”. Many groups and individuals have vocalized their opposition to these bills. The American Civil Liberties Union (ACLU) and Planned Parenthood, the largest provider of reproductive health services in the U.S., have filed lawsuits in each state to block the laws from being enacted. They have been successful in each case. Their defense rests on the claim that “women have a categorical right to a pre-viability abortion” as established in Roe v. Wade. Planned Parenthood also implemented an Abortion Care Finder tool on the homepage of their website to alleviate the confusion surrounding the effects of the bills and their blockage.

## Conclusion

Throughout the past three centuries, each technological advancement in abortion has inflamed American abortion opponents, giving rise to new controversies. Safer abortion methods have pushed the debate away from medical hazards and further into the realm of religion and philosophy. Accordingly, the role of religion in abortion controversies remains open to investigation as well as other abortion technologies, a more detailed analysis of Roe v. Wade, and related court decisions.

## References

* ↑ Watson, S. (2018, August 17). Stages of the Menstrual Cycle. Retrieved November 11, 2019, from https://www.healthline.com/health/womens-health/stages-of-menstrual-cycle.
* 1 2 Artal-Mittelmark, R. (2019, August). Stages of Development of the Fetus. Retrieved November 8, 2019, from https://www.merckmanuals.com/home/women-s-health-issues/normal-pregnancy/stages-of-development-of-the-fetus.
* 1 2 Pregnancy week by week. (2017, July 12). Retrieved November 14, 2019, from https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-care/art-20045302.
* 1 2 Fetal development week by week. (2018, July). Retrieved November 11, 2019, from https://www.babycentre.co.uk/pregnancy-week-by-week.
* ↑ Jatlaoui, T. C., Boutot, M. E., Mandel, M. G., Whiteman, M. K., Ti, A., Petersen, E., & Pazol, K. (2018). Abortion Surveillance - United States, 2015. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, 67(13). Retrieved from https://www.cdc.gov/mmwr/volumes/67/ss/pdfs/ss6713a1-H.pdf
* ↑ National Abortion Federation. (n.d.). History of Abortion. https://prochoice.org/education-and-advocacy/about-abortion/history-of-abortion/
* ↑ American Pregnancy Association. (n.d.). First Fetal Movement: Quickening. https://americanpregnancy.org/while-pregnant/first-fetal-movement/
* ↑ Abbott, K. (2012). Madame Restell: The Abortionist of Fifth Avenue. Smithsonian Magazine. https://www.smithsonianmag.com/history/madame-restell-the-abortionist-of-fifth-avenue-145109198/
* ↑ Multiple Classified Advertisements. (1841). [Advertisement for Female Monthly Pills]. The New York Herald, 268.
* ↑ Aron, N. R. (2017). The father of American gynecology fought to criminalize abortion in the 1850s. https://timeline.com/horatio-storer-criminal-abortion-c433606491da
* 1 2 Storer, H. R. (1868). Why Not? A Book for Every Woman. Boston: Lee and Shepard.
* ↑ Storer, H.R. (1859). Contributions to Obstetric Jurisprudence: Criminal Abortion. North-American Medico-Chirurgical Review, 3, 64-72. https://horatiostorer.net/
* ↑ American Medical Association. (n.d.). AMA History. https://www.ama-assn.org/about/ama-history/ama-history
* 1 2 Miller, H. (1860). Address of Henry Miller, M.D., President of the Association. Transactions of the American Medical Association, 13, 55-76. https://horatiostorer.net/ama-vs-abortion/
* ↑ American Medical Association. (1859). Report on Criminal Abortion. Transactions of the American Medical Association, 12, 75-78. https://horatiostorer.net/ama-vs-abortion/
* ↑ Hajar R. (2017). The Physician's Oath: Historical Perspectives. Heart views : the official journal of the Gulf Heart Association, 18(4), 154–159. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755201/
* ↑ Act of March 3, 1873, ch. 258, 1 Stat. 598. https://memory.loc.gov/cgi-bin/ampage?collId=llsl&fileName=017/llsl017.db&recNum=639
* ↑ The Editors of Encyclopaedia Britannica (2019). Comstock Act. https://www.britannica.com/event/Comstock-Act
* ↑ Coombes, R. (2008). Obstetricians seek recognition for Chinese pioneers of safe abortion. TheBMJ, 336, 1332–1333. doi: 10.1136/bmj.39608.391030.DB
* 1 2 Meckstroth, K., & Paul, M. (n.d.). First-trimester aspiration abortion. Retrieved from http://prochoice.org/wp-content/uploads/TextbookCh10.pdf.
* ↑ Vacuum Aspiration for Abortion. (2018, September 5). Retrieved from https://www.mottchildren.org/health-library/tw1078.
* ↑ Cates, W., Grimes, D. A., & Schulz, K. F. (2003). The Public Health Impact of Legal Abortion: 30 Years Later. Perspectives on Sexual and Reproductive Health, 35(1), 25–28. doi: https://doi.org/10.1363/3502503
* 1 2 Schoen J. (2013). Living through some giant change: the establishment of abortion services. American journal of public health, 103(3), 416–425. doi:10.2105/AJPH.2012.301173
* ↑ Callahan, D. (1986). How Technology is Reframing the Abortion Debate. The Hastings Center Report, 16(1), 33–42. Retrieved from https://www.jstor.org/stable/3562468
* 1 2 Fraser, L. (2009). The Abortion Pill's Grim Progress. Mother Jones. Retrieved from https://www.motherjones.com/politics/1999/01/abortion-pills-grim-progress/
* ↑ Brief History of the Abortion Pill in the U.S. (2000, September 28). Retrieved from https://www.webmd.com/women/news/20000928/brief-history-of-abortion-pill-in-us#1.
* ↑ Little, B. (2017, June 23). The Science Behind the "Abortion Pill". Retrieved from https://www.smithsonianmag.com/health-medicine/science-behind-abortion-pill-180963762/.
* ↑ Lubbe, Rachel. (2012, Jan 27). The Silent Scream (Full Length). Retrieved from https://www.youtube.com/watch?v=gON-8PP6zgQ
* ↑ Lee, S. J., Ralston, H. J. P., Drey, E. A., Partridge, J. C., & Rosen, M. A. (2005). Fetal Pain. Jama, 294(8), 947. doi: 10.1001/jama.294.8.947
* ↑ Unborn Child Pain Awareness Act of 2004, S.2466, 108th Cong. (2004).
* ↑ Unborn Child Pain Awareness Act of 2013, S.356, 113th Cong. (2013).
* ↑ Administration of Anesthetic or Analgesic to An Unborn Child, Utah. Utah Code § 76-7-308.5.
* ↑ Karrer, R. N. (2012, February 2). The Pro-Life Movement and Its First Years under Roe. Retrieved from https://muse.jhu.edu/article/465870.
* ↑ Roe v. Wade, 410 U.S. 113 (1973).
* ↑ State Bans on Abortion Throughout Pregnancy. (2019, December 3). Retrieved from https://www.guttmacher.org/state-policy/explore/state-policies-later-abortions.
* ↑ American College of Obstetricians and Gynecologists. (2019, February). Facts are Important: Abortion Care Later in Pregnancy is Important to Women’s Health. Retrieved from https://www.acog.org/About-ACOG/ACOG-Departments/Government-Relations-and-Outreach/Facts-are-Important-Abortion-Care-Later-in-Pregnancy-is-Important-to-Womens-Health?IsMobileSet=false.
* ↑ Rettner, R. (2019, May 17). Is a 'Fetal Heartbeat' Really a Heartbeat at 6 Weeks? Retrieved from https://www.livescience.com/65501-fetal-heartbeat-at-6-weeks-explained.html.
* ↑ Faith2Action. (n.d.). Model Bill. Retrieved from http://www.f2a.org/.
* ↑ Faith2Action. (n.d.). About Us. Retrieved from http://www.f2a.org/.
* ↑ ACLU and Planned Parenthood File Lawsuit Challenging Ohio's Near Total Abortion Ban. (2019, May 15). Retrieved from https://www.aclu.org/press-releases/aclu-and-planned-parenthood-file-lawsuit-challenging-ohios-near-total-abortion-ban.
* ↑ Planned Parenthood. (n.d.). Where to Get an Abortion: Find Abortion Services Near You. Retrieved from https://www.plannedparenthood.org/abortion-access.