IN the opening years of the 20th century, a woman who found herself in a certain condition and did not want to let nature take its course had to choose between a number of unpalatable options.
If traditional remedies such as a bottle of gin and a hot bath or throwing herself down the stairs didn’t work, she could send away for one of the various brands of “Reliable Female Pills” cryptically advertised on the back pages of newspapers.
If the pills proved in fact to be unreliable, which they almost certainly would, more active measures might be sought.
As writer and filmmaker Shirley Barrett documents in a new anthology of writing about abortion, a range of practitioners advertised termination services to women at the time. One advertisement from 1900 read:
LADIES – Your Troubles at an End by Applying to MADAME ORME, MD, SYDNEY’S ONLY LADY SPECIALIST, for a list of her REMEDIES and genuine testimonials, FAILURE IMPOSSIBLE …
When Madame Orme (real name: Rosaline Brown) appeared at the inquest of one of her patients, a widow with five children, she was asked by the coroner about the meaning of the letters “MD” after her name.
“There is no special significance in the letters MD,” she replied. “They are used for attraction more than anything else.”
Madame Orme was just 20 years old at the time and had started her business aged 17.
One of her competitors in what was clearly a thriving industry was Dr Frederick Marshall, a respected medical man with rooms on Sydney’s Macquarie Street.
Marshall had, he claimed, studied in Edinburgh, Vienna, Berlin, Leipzig, Dresden, Budapest and London, and had spent 3 years as district surgeon at the Sydney Hospital, where he had treated more than 16 000 patients.
He was also, as Barrett has uncovered, implicated in the deaths of at least eight women between 1901 and 1905, women who died from perforation of the uterus, septicaemia or uncontrolled haemorrhage after botched abortions.
Marshall repeatedly found himself in court answering accusations ranging from performing an illegal procedure to murder. In all but one case, he was exonerated.
In the absence of reliable contraception, and with single motherhood putting any respectable woman beyond the pale, abortion was a thriving and highly profitable trade. Its illegal status left it unregulated, with no protection for the desperate women who turned to scoundrels such as Marshall for help.
A century on, things have improved, at least in countries like Australia, though there is no room for complacency.
Around 45% of abortions performed around the world today are deemed unsafe, according to Médecins Sans Frontières (MSF), almost all of them in low income countries. More than 7 million women and girls each year are injured or disabled as a result, and more than 22 000 die.
The world has made significant progress on four of the five main causes of pregnancy-related mortality (severe bleeding, severe infection, blood pressure disorders and obstructed labour), says MSF.
“But unsafe abortion – the only almost completely preventable cause – has been largely forgotten.”
Abortion has long been a political football, with many of its most vocal opponents belonging to the half of the human species who will never be confronted by the dilemma of how to deal with an unwanted pregnancy.
So fraught is this issue in the United States that the country recently forced the removal of any reference to reproductive or sexual health services from a United Nations resolution on sexual violence in war.
The removed phrase did not even mention abortion, but said: “recognizing the importance of providing timely assistance to survivors of sexual violence, urges United Nations entities and donors to provide non-discriminatory and comprehensive health services, in line with Resolution 2106”.
Even in Australia, it is not always easy for women to access safe abortion services.
Laws vary widely around the country, as noted recently in the MJA. The procedure was recently decriminalised in Queensland but remains a crime in New South Wales. Other jurisdictions have various restrictions in place.
Even where abortion is legal, services are not necessarily accessible, as has recently been the case in Tasmania.
Those who seek to restrict women’s access to abortion might do well to consider that their efforts are unlikely to save embryos but may well end up harming the women and girls who find themselves pregnant against their will.
“When a woman or girl is determined to end her pregnancy she will do so, regardless of the safety or legality of the procedure,” says MSF. “Where safe abortion is not available, she will risk her life with an unsafe abortion, often because the prospect of continuing the pregnancy is unbearable.”
Enter Dr Marshall and his ilk.
Jane McCredie is a Sydney-based health and science writer.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.