How abortion changed the world

From a sketchy underground doctor to the American fight against communism, a look at the unlikely forces that helped spread global family planning.

Topics: Abortion,

In the 1950s, before he became notorious, Harvey Karman was a psychology student at UCLA, attending on the GI bill. Writing a paper on the emotional impact of abortion led him into the abortion underground, where he helped a number of desperate coeds find ways to terminate their pregnancies. “It seemed like every guy who got a girlfriend pregnant, everyone who had remotely heard about me, said, ‘This guy knows about abortion,’” he told Ms. magazine in 1975. Often he’d help young women make their way to Mexico to end their pregnancies. Some of them came through the procedures fine, but some came home sick or injured, and Karman would take them to the school’s medical center for treatment. Frustrated with this system, he eventually started performing abortions himself.

Much of Karman’s early history is hazy, but one horrific incident stands out. In 1955, one of the women who sought Karman’s help died of an infection, and he was charged with both murder and abortion. A court rejected his insistence that he was a mere middleman between the woman and a doctor, finding that he himself had tried to induce a miscarriage using a speculum and a nutcracker. Nevertheless, he was convicted only of the lesser charge, and after serving two years in prison, he emerged unfazed to resume the work that had become, for him, a kind of crusade.

A man of the nascent counterculture, Karman dabbled in experimental films and worked with juvenile delinquents and at Head Start, but abortion remained his consuming passion. A sympathetic doctor told him that if he could induce just a small bit of bleeding in a pregnant girl, she could be admitted to the hospital and her abortion could be completed legally, a technique he adopted. In fact, all around the world, in countries where abortion is restricted, that’s often how it’s done. According to Malcolm Potts, an Oxford-educated doctor who is one of the world’s leading authorities on abortion, the “extralegal person is usually trying to produce uterine bleeding that will take the woman to the public hospital where she will be cleaned up.”



However standard, this system struck Karman as crazy, and he started trying to devise something better. Karman “was a very dexterous person,” said Potts, who later became his friend. “He used to make model airplanes when he was young. I once locked myself out of my car, and I’d never seen anybody break into a car as quickly as Harvey did. And he’s pretty good at breaking into the uterus.” As Potts recalled, Karman read the medical literature about abortion in Eastern Europe, where it had been legal since the 1950s. He wanted a method that was as painless as possible, allowing a woman to get up and walk away as soon as it was over. So he started experimenting in his kitchen. Karman cut the end off a large, plastic, handheld syringe, attached some polyethylene tubing to it, and soon came up with the prototype for the manual vacuum aspiration (MVA) syringe, a simple, hand-operated device that today is used all over the developing world. “It’s probably done many millions of abortions since then,” Potts said.

Starting in the 1960s, Karman used his invention to perform illegal abortions out of a rented room next to a dentist’s office in Los Angeles. Charismatic and swaggering, he was remembered by some in the nascent abortion rights movement as a hero, by some as a huckster. He added a Ph.D. to his name, though his degree came from a dubious Swiss diploma mill. Without a doubt, there were abundant reasons to be suspicious of him, but he was no mercenary backroom butcher, and many recall him as more interested in spreading word of his discovery than in profiting from it, giving free demonstrations to interested doctors and health care workers. “I was most impressed … because of the safety for the women and because [the technique] made it possible to bring the price way down. And Harvey never charged a cent for his visits,” one San Diego Planned Parenthood official told Ms.

In 1972, the device came to the attention of Reimert Ravenholt, the head of population affairs at the U.S. Agency for International Development. Ravenholt, a roguish figure gleefully dismissive of political sensitivities, had already decided that poor countries sorely needed abortion equipment that could be run without electricity. USAID was primarily focused on spreading contraception, but government officials knew that birth control was always going to fail for a certain percentage of people, especially in places where access was sporadic and use inconsistent. As a then classified 1974 government report on overpopulation would conclude, “[I]ncreasing numbers of women in the developing world have been resorting to abortion, usually under unsafe and often illegal conditions … [A]bortion, legal and illegal, now has become the most widespread fertility control method in use in the world today.” To Ravenholt it seemed obvious that no comprehensive American program to bring family planning to the world could ignore abortion. Besides, after Roe v. Wade was decided at the beginning of 1973, the issue seemed to be settled. Abortion was legal in America. Why shouldn’t American aid reflect that?

Reimert had USAID contract with the Battelle Corporation to reengineer Karman’s innovation for mass production. It was a modified 50 cc syringe topped with a thin plastic tube, or cannula. When the plunger was pulled, a thumb-operated valve retained the vacuum. The abortionist would insert the cannula through the cervix, then gradually release the valve to suction out the uterus. “This was a very efficient way of terminating early pregnancies,” said Ravenholt.

If there was a risk in putting an illegal abortionist to work, albeit indirectly, for the U.S. government, it seems not to have occurred to Ravenholt. “I knew what we needed, and Harvey had done something along that line, so what the hell?” he said. Through the U.S. government’s General Services Administration, he ordered a thousand “menstrual regulation kits” that included a syringe, a dozen cannula, a speculum and a plastic basin, and he supplied them to doctors all over the world. The feedback was positive, so he ordered ten thousand more. His staffers would bring suitcases full of them when they went on trips abroad. The technology has since been introduced in over one hundred countries.

It’s hard to believe now, after years in which the United States has exported its antiabortion movement all over the globe, that the American government was once responsible for bringing safe abortion to great swaths of the developing world. Hard to believe, too, that support for distributing contraceptives to remote corners of the planet was once a solidly bipartisan undertaking. As George H. W. Bush wrote in 1973, “Success in the population field, under United Nations leadership, may, in turn, determine whether we can resolve successfully the other great questions of peace, prosperity, and individual rights that face the world.” (As a congressman, Bush earned the nickname “Rubbers” for his enthusiastic interest in family planning.)

Today abortion is broadly legal in the vast majority of the developed world and in Asian countries, including China and India; more than 60 percent of people live in countries with liberal abortion laws. Another 14 percent or so live in nations like Colombia and Ghana that allow abortion under certain circumstances. But in many poor countries, including large parts of Africa and Latin America and parts of Asia and the Middle East, abortion is either banned entirely or allowed only to save a woman’s life.

Twenty-six percent of the world’s women and men live under such laws, which are largely the relics of colonial constitutions promulgated by European countries that have since abandoned such restrictions for themselves.

Given that so many abortion bans are artifacts of colonialism, it is particularly ironic when the contemporary global antiabortion movement accuses reproductive rights activists of neoimperialism. Yet it’s also true that realpolitik-driven fears of swelling third world population, more than humanitarianism, drove early efforts by the United States to bring family planning to poor countries. America’s international commitment to birth control was intended to fight communism, not to liberate women. If it did the latter, that was at best a bonus. Eventually, the national security rationale would give way to a focus on women’s rights, leaving birth control programs far more politically vulnerable to right-wing attacks, since nothing but women’s lives was at stake.

The vicissitudes of the United States’ policies on birth control and abortion have always had at least as much impact abroad as they do domestically. Americans don’t pay much attention to what goes on beyond their borders, giving those working on issues of sexual health abroad a freer hand than at home, whether that means blanketing neighborhoods in other countries with packets of pills or channeling money to abstinence-promoting, condom-excoriating missionaries. American officials have introduced safe abortion into foreign countries, and they’ve interfered to make abortion more perilous. The United States pushed to create the United Nations Population Fund, the world’s premier agency promoting reproductive health, in 1969. Decades later, the United States government tried to destroy it.

By then it was in some ways too late: The family planning infrastructure that America did so much to build had taken on a life and a legitimacy of its own. At the same time, the forces of cultural globalization — undermining sexual taboos and celebrating individual rights above community attachments — continue to be associated with Americanization. Thus a country like Nicaragua can pass abortion legislation that mirrors the position of the party then in power in the United States and still spin it as a blow against Northern imperialism.

The global spread of family planning has vastly changed the world. Even as the planet’s population increased nearly fourfold in the twentieth century, from 1.6 billion to 6.1 billion people, fertility rates have declined sharply in most countries, and smaller families have become the norm. “In the 1950s, women in less developed regions had an average of six children,” wrote UN demographer Joseph Chamie. “[T]oday’s average is closer to three. By mid-century, the global fertility average is anticipated to be close to replacement levels of around two children per couple.” There are many reasons women are having fewer children, but many studies show that a substantial part of the decrease is due to increased access to contraception, now used by more than half the couples in the world.

In some countries effective family planning programs have been a great boon to development. Falling birthrates, which for a time increase the percentage of working adults to dependent children in a society, create a window where a greater share of the population is productive. Demographers call this the “demographic dividend,” and it can be a major spur to development. Harvard economists David Bloom, David Canning, and Jaypee Sevilla have argued that the demographic dividend created by East Asia’s postwar embrace of family planning “was essential to East Asia’s extraordinary economic achievements, accounting for as much as one-third of its ‘economic miracle.’” (The Philippines, conversely, is the only big East Asian country to eschew family planning, and the only one whose economy never took off.)

Perhaps most important, the global family planning movement has — often inadvertently, and in the face of great internal resistance — given rise to a new vision of universal women’s rights that has changed both international law and individual lives. At the 1994 International Conference on Population and Development in Cairo, more than 180 countries adopted a program of action proclaiming, “Advancing gender equality and equity and the empowerment of women, and the elimination of all kinds of violence against women, and ensuring women’s ability to control their own fertility, are cornerstones of population and development-related programs. … The full and equal participation of women in civil, cultural, economic, political and social life, at the national, regional and international levels, and the eradication of all forms of discrimination on grounds of sex, are priority objectives of the international community.”

This was a remarkable statement (and to some social conservatives an appalling one). Like most UN declarations it remains more a goal than a reality. Given the persistence of sexual oppression and even terror in much of the world, the half a million women who die due to pregnancy complications each year, the millions more who have their genitals cut in the name of purity, and the plague of illegal abortion that fills hospital wards from Nicaragua to Nigeria, the Cairo program of action can today seem like empty verbiage. But just as peacekeeping remains a crucial endeavor despite the endurance of war, and human rights law matters despite constant violations, the global commitment to reproductive rights represents an important attempt to unite humankind against an ageless scourge: the wholesale devaluation of women.

There have been setbacks and backlashes, some caused by right-wing forces in the United States, others by related movements in countries such as Nicaragua. In all likelihood there will be more, since fundamentalism and feminism are both spurred by the upheavals of globalization. Still, slowly, in frustrating fits and starts, a relatively new international ideal of women’s rights as human rights is altering laws and societies in subtle but systematic ways, forcing changes to discriminatory inheritance laws and patterns of education, draconian abortion bans, child marriages, and other sources of female misery. The attempt to liberate half the world’s people from the intertwined tyrannies of culture and biology is one of the least heralded but most ambitious global initiatives in history.

Michelle Goldberg is a frequent contributor to Salon and the author of "Kingdom Coming: The Rise of Christian Nationalism" (WW Norton).

More Related Stories

Featured Slide Shows

  • Share on Twitter
  • Share on Facebook
  • 1 of 11
  • Close
  • Fullscreen
  • Thumbnails

    Ten spectacular graphic novels from 2014

    Beautiful Darkness by Fabien Vehlmann & Kerascoët
    Kerascoët's lovely, delicate pen-and-watercolor art -- all intricate botanicals, big eyes and flowing hair -- gives this fairy story a deceptively pretty finish. You find out quickly, however, that these are the heartless and heedless fairies of folk legend, not the sentimental sprites beloved by the Victorians and Disney fans. A host of tiny hominid creatures must learn to survive in the forest after fleeing their former home -- a little girl who lies dead in the woods. The main character, Aurora, tries to organize the group into a community, but most of her cohort is too capricious, lazy and selfish to participate for long. There's no real moral to this story, which is refreshing in itself, beyond the perpetual lessons that life is hard and you have to be careful whom you trust. Never has ugly truth been given a prettier face.

    Ten spectacular graphic novels from 2014

    Climate Changed: A Personal Journey Through the Science by Philippe Squarzoni
    Squarzoni is a French cartoonist who makes nonfiction graphic novels about contemporary issues and politics. While finishing up a book about France under Jacques Chirac, he realized that when it came to environmental policy, he didn't know what he was talking about. "Climate Changed" is the result of his efforts to understand what has been happening to the planet, a striking combination of memoir and data that ruminates on a notoriously elusive, difficult and even imponderable subject. Panels of talking heads dispensing information (or Squarzoni discussing the issues with his partner) are juxtaposed with detailed and meticulous yet lyrical scenes from the author's childhood, the countryside where he takes a holiday and a visit to New York. He uses his own unreachable past as a way to grasp the imminent transformation of the Earth. The result is both enlightening and unexpectedly moving.

    Ten spectacular graphic novels from 2014

    Here by Richard McGuire
    A six-page version of this innovative work by a regular contributor to the New Yorker first appeared in RAW magazine 25 years ago. Each two-page spread depicts a single place, sometimes occupied by a corner of a room, over the course of 4 billion years. The oldest image is a blur of pink and purple gases; others depict hazmat-suited explorers from 300 years in the future. Inset images show the changing decor and inhabitants of the house throughout its existence: family photos, quarrels, kids in Halloween costumes, a woman reading a book, a cat walking across the floor. The cumulative effect is serene and ravishing, an intimation of the immensity of time and the wonder embodied in the humblest things.

    Ten spectacular graphic novels from 2014

    Kill My Mother by Jules Feiffer
    The legendary Pulitzer Prize-winning cartoonist delivers his debut graphic novel at 85, a deliriously over-the-top blend of classic movie noir and melodrama that roams from chiaroscuro Bay City to Hollywood to a USO gig in the Pacific theater of World War II. There's a burnt-out drunk of a private eye, but the story is soon commandeered by a multigenerational collection of ferocious women, including a mysterious chanteuse who never speaks, a radio comedy writer who makes a childhood friend the butt of a hit series and a ruthless dame intent on making her whiny coward of a husband into a star. There are disguises, musical numbers and plenty of gunfights, but the drawing is the main attraction. Nobody convey's bodies in motion more thrillingly than Feiffer, whether they're dancing, running or duking it out. The kid has promise.

    Ten spectacular graphic novels from 2014

    The Motherless Oven by Rob Davis
    This is a weird one, but in the nervy surreal way that word-playful novels like "A Clockwork Orange" or "Ulysses" are weird. The main character, a teenage schoolboy named Scarper Lee, lives in a world where it rains knives and people make their own parents, contraptions that can be anything from a tiny figurine stashable in a pocket to biomorphic boiler-like entities that seem to have escaped from Dr. Seuss' nightmares. Their homes are crammed with gadgets they call gods and instead of TV they watch a hulu-hoop-size wheel of repeating images that changes with the day of the week. They also know their own "death day," and Scarper's is coming up fast. Maybe that's why he runs off with the new girl at school, a real troublemaker, and the obscurely dysfunctional Castro, whose mother is a cageful of talking parakeets. A solid towline of teenage angst holds this manically inventive vision together, and proves that some graphic novels can rival the text-only kind at their own game.

    Ten spectacular graphic novels from 2014

    NOBROW 9: It's Oh So Quiet
    For each issue, the anthology magazine put out by this adventurous U.K.-based publisher of independent graphic design, illustration and comics gives 45 artists a four-color palette and a theme. In the ninth issue, the theme is silence, and the results are magnificent and full of surprises. The comics, each told in images only, range from atmospheric to trippy to jokey to melancholy to epic to creepy. But the two-page illustrations are even more powerful, even if it's not always easy to see how they pertain to the overall concept of silence. Well, except perhaps for the fact that so many of them left me utterly dumbstruck with visual delight.

    Ten spectacular graphic novels from 2014

    Over Easy by Mimi Pond
    When Pond was a broke art student in the 1970s, she took a job at a neighborhood breakfast spot in Oakland, a place with good food, splendid coffee and an endlessly entertaining crew of short-order cooks, waitresses, dishwashers and regular customers. This graphic memoir, influenced by the work of Pond's friend, Alison Bechdel, captures the funky ethos of the time, when hippies, punks and disco aficionados mingled in a Bay Area at the height of its eccentricity. The staff of the Imperial Cafe were forever swapping wisecracks and hopping in and out of each other's beds, which makes them more or less like every restaurant team in history. There's an intoxicating esprit de corps to a well-run everyday joint like the Imperial Cafe, and never has the delight in being part of it been more winningly portrayed.

    Ten spectacular graphic novels from 2014

    The Shadow Hero by Gene Luen Yang and Sonny Liew
    You don't have to be a superhero fan to be utterly charmed by Yang and Liew's revival of a little-known character created in the 1940s by the cartoonist Chu Hing. This version of the Green Turtle, however, is rich in characterization, comedy and luscious period detail from the Chinatown of "San Incendio" (a ringer for San Francisco). Hank, son of a mild-mannered grocer, would like to follow in his father's footsteps, but his restless mother (the book's best character and drawn with masterful nuance by Liew) has other ideas after her thrilling encounter with a superhero. Yang's story effortlessly folds pathos into humor without stooping to either slapstick or cheap "darkness." This is that rare tribute that far surpasses the thing it celebrates.

    Ten spectacular graphic novels from 2014

    Shoplifter by Michael Cho
    Corinna Park, former English major, works, unhappily, in a Toronto advertising agency. When the dissatisfaction of the past five years begins to oppress her, she lets off steam by pilfering magazines from a local convenience store. Cho's moody character study is as much about city life as it is about Corinna. He depicts her falling asleep in front of the TV in her condo, brooding on the subway, roaming the crowded streets after a budding romance goes awry. Like a great short story, this is a simple tale of a young woman figuring out how to get her life back, but if feels as if it contains so much of contemporary existence -- its comforts, its loneliness, its self-deceptions -- suspended in wintery amber.

    Ten spectacular graphic novels from 2014

    Through the Woods by Emily Carroll
    This collection of archetypal horror, fairy and ghost stories, all about young girls, comes lushly decked in Carroll's inky black, snowy white and blood-scarlet art. A young bride hears her predecessor's bones singing from under the floorboards, two friends make the mistake of pretending to summon the spirits of the dead, a family of orphaned siblings disappears one by one into the winter nights. Carroll's color-saturated images can be jagged, ornate and gruesome, but she also knows how to chill with absence, shadows and a single staring eye. Literary readers who cherish the work of Kelly Link or the late Angela Carter's collection, "The Bloody Chamber," will adore the violent beauty on these pages.

  • Recent Slide Shows

Comments

0 Comments

Comment Preview

Your name will appear as username ( settings | log out )

You may use these HTML tags and attributes: <a href=""> <b> <em> <strong> <i> <blockquote>