Leslie J Reagan. Journal of Modern European History. Volume 17, Issue 3. June 2019.
Where abortion has been criminalized, repressed by the state, and hard to find, many women—in the past and in the present—have travelled across international borders to find safe, and often legal, abortion providers. Currently, Latin Americans travel to Mexico City for legal abortions; South Koreans travel to Japan, China, Hong Kong, or Vietnam; and, until recently, thousands of Irish women followed a well-known path to Britain for legal abortions. In a landmark election, Ireland voted by a landslide to legalize abortion in May 2018. Some have referred to such travel as ‘abortion tourism’. The ‘tourism’ label, however, obscures the true nature of these trips by associating them with pleasurable holidays filled with sight-seeing in foreign lands. These are trips taken in a rush, since as pregnancy progresses, abortions become harder to obtain and more expensive; furtive, because of laws and social stigma; and for many, financially difficult. They are not vacations. Travelling to find skilled, safe abortion specialists is not a recent phenomenon. The rise of international travel for abortion was produced out of the 19th-century criminalization and repression of abortion in North America, England, and Europe and made possible by the systems of mass transportation that brought people closer to cities and other countries. Periodic public outcry and publicity reveal the transnational information and medical networks that have met the persistent demand for reproductive control. The number of border-crossings has gone up and down; the map of abortion travels changed as laws and their enforcement changed over time.
Women who cross international borders for abortion have left the countries where they live in order to escape the dangers of unsafe abortions and the threat of state persecution and prosecution. Perhaps, they should be thought of not as tourists, but as refugees for reproductive rights. Reproductive rights refugees, as I call them here, do not conform to stereotypical images of refugees—travelling in masses walking on the road, in boats, often in family groups. When historians have considered the history of travel, they have mostly thought of migration for work, fleeing religious oppression, ethnic persecution or war-time suffering, and travel for pleasure. Scholars have recently analysed transnational travel to create peace and memory of the horrors of war. A few have investigated travelling for medical treatments, including abortion, across international borders. Oncologists have brought to light the problem of ‘cancer refugees’, largely rural, poor people who travel far from home to access medical care and become homeless, usually in their own countries in Japan, India, and China. The history of female international travel for abortion belongs in the history and current conversation about refugees and human rights.
For decades, feminists around the world have challenged conventional human rights thinking. More than 25 years ago, an international women’s rights coalition meeting in the Philippines declared, ‘Women’s rights are human rights’. Recognition of women’s rights as human rights requires, Charlotte Bunch observed, a ‘re-vision’ of the definition of human rights and an end to the ‘insidious myth’ that ‘women’s rights […] are trivial or secondary to the concerns of life and death. Nothing’, Bunch asserted, ‘could be further from the truth: sexism kills’. Bunch’s words are succinct and shockingly true. Murderous husbands and boyfriends kill women regularly; gender norms, poverty, and restrictive abortion laws push women into inducing their own abortions or into the hands of unskilled abortionists, with injury, infection, and death too often resulting. In the 21st century, unsafe abortion is a global problem: seven million women are hospitalized each year as a result of unsafe abortions. The global risk of death due to an unsafe abortion is astronomically higher—350 times greater—than the rate associated with legal, induced abortions in the United States. (220 deaths per 100,000 unsafe abortions worldwide: 0.6 deaths per 100,000 procedures in the United States.) The struggle for recognition of women’s rights as refugees has focused on sexual persecution, that is, rape, sexual assault, and forced prostitution. But abortion and lesbian, gay, bisexual, and transgender (LGBT) rights have increasingly been brought to the forefront, signalling an important shift away from focusing solely on sexual victimization to claiming sexual self-determination as an essential component of human rights.
Trains, buses, vans, cars, and airplanes have all carried women who travelled in order to obtain abortions. They would not have been recognizable as ‘refugees’, each one would have tried to blend in, as if she were travelling to visit her family or take a new job. Perhaps, she would pretend to be a tourist. A woman in transit would be highly aware that she crossed borders because she could not obtain a legal and safe abortion in her own country. Uniformed agents at border stations checking passports might ask piercing questions. If found out, she might by detained, arrested, prosecuted. That some states attempted to prevent ‘their’ women from obtaining abortions elsewhere or punished them upon their return starkly reveals those states claim to ownership of the sexuality, reproductive capacity, and bodies of women. These travellers may have carried a bag, but they did not drag all of their worldly belongings with them like the proto-typical refugee, because they expected their exile to be short and to return to home, as do many other refugees. There were hundreds of thousands of such travellers around the world over the decades, but they came one by one, not en masse. If we can drop the expected image of refugees, perhaps we can re-envision the women who cross borders for abortion both today and in the past as refugees. In the face of laws that threaten physical harm and prosecution for abortion, generations of travelling women have asserted a firm, collective vision of their right as women, as human beings, to make their own reproductive decisions and to seek refuge and assistance in other countries.
Women on the road
In 18th- and early-19th-century North America and England, early abortions were not restricted under Common Law. Women learned from each other and domestic guide books how to use plants in the woods or grown in the family garden to ‘bring on the menses’. The term ‘abortion’ was used for induced miscarriages after quickening, when the woman herself felt foetal movement. At that point, law and religion agreed on the immorality and illegality of abortion. What we now call early abortions were not uncommon. Abortion became more visible in the late 1830s and 1840s as several practitioners, most famously Madame Restelle of New York City, advertised their services to bring back the menses. The earliest travellers for abortion went to the offices of these specialists in cities near their homes. As female abortionists and their patients—largely white, native-born, Protestant, middle-class, married ladies—became visible, both became politically volatile subjects. Regular medical men and the male sporting press attacked Restelle, abortion, and the middle-class ladies who evaded their duties to reproduce—as women and as native-born white citizens of the nation. In the 1860s and 1870s, individual states eliminated the common law acceptance of abortion before quickening. Canada followed a similar history.
By the end of the 19th century, England, Europe, and North America had all passed new laws criminalizing abortion from conception on, but that did not end the practice. Chicago and New York, like London and Paris, were not only world commercial centres but also well-known abortion sites. The 1888 Chicago Times exposé of abortion in Chicago dubbed numerous smaller American cities, including San Francisco, St. Louis, Philadelphia, and Cincinnati, ‘lesser Londons’. Early-20th-century Europeans travelled to Geneva, Constantinople, and Naples for abortions in addition to Paris and London.
Chicago—the national railroad hub—brought cattle, grains, and people from all over the United States and Canada into the city and sent them back out again. Chicago was also a medical centre to which patients travelled for premier specialists. And it was known as an abortion site. For the women travelling by train from Iowa, Michigan, or Wisconsin to Chicago, it took several hours to cross state-lines and might require catching another local train to reach the midwife or doctor who would help her.
In the 1930s, a number of excellent abortion specialists in the United States openly advertised their practices and were well-known to their medical colleagues and local communities. In the 1940s and 1950s, however, police raided these trusted practices around the country; state prosecution of providers shut down clinics that had operated safely and openly for decades. Abortion became increasingly inaccessible and increasingly clandestine. As untrained people entered the business and women induced their own abortions, the danger and injuries increased.
It is no coincidence, then, that as abortion became harder to find and air travel easier, Americans began talking about travelling abroad for abortions. By the 1950s, Tijuana, Mexico, became known as a place to go for abortions in the same way that Americans had turned it into a destination for finding prostitutes during the First World War and saloons during prohibition. Women asked friends, family, co-workers, and doctors for names of abortionists. Public figures known for addressing the taboo topic, like Alan Guttmacher, physician, author, and birth control and abortion law reform advocate, received such letters. For years, Guttmacher had sent patients to Dr Timanus in Baltimore for therapeutic abortions, but after the 1950 police raid and prosecution of Timanus, Guttmacher sent women to Japan and England.
American connections to Japanese physicians who performed abortion grew out of the long-standing relationship between American and Japanese birth controllers. Indeed, Japanese interest in Margaret Sanger had contributed to a significant change in American law in the 1930s. When US authorities seized a box of sample diaphragms sent by a Japanese doctor to Sanger’s birth control clinic, the clinic fought back in court. In the historic decision U.S. v. One Package (1936), the US Appeals Court ruled that importing contraceptives for legitimate medical purposes was legal. In 1948, during the American occupation, Japan liberalized its abortion laws in response to fears of ‘overpopulation’ and anxiety about inadequate food, jobs, and housing. Concern about the effects of radiation exposure on pregnancies surely encouraged American occupying officials to permit legal abortion as well. Japanese used legal abortion in great numbers—half of all Japanese women terminated their first pregnancy—and increasingly used birth control. By the end of the 1950s, Japan’s birth rate had fallen significantly—80% in some areas, 25% overall. Japanese and international observers regularly pointed to ‘overpopulation’ rather than the war itself to explain the starvation and poverty of the immediate post-war years; controlling female reproductive capacity through family planning and legal abortion was the proposed solution. In the 1960s, fear of overpopulation began reversing to fear of under-population.
Foreign observers often found Japan’s general attitude towards abortion remarkable and repugnant. ‘In Japan, there are no compunctions about medical indications’, one medical man reported: ‘a woman merely needs to state that she wants an abortion’. Dr Pommerenke, an assistant professor of obstetrics and gynaecology from Rochester, New York, who had spent several months in Japan, was astonished by the number of physicians licenced to perform abortions. Furthermore, he declared, abortion ‘carries no stigma in Japan where a man can operate perfectly openly’.
Conditions in 1955, America were quite the opposite of Japan. In fact, the doctor spoke at a meeting kept secret because its topic was abortion. By the early 1950s, American physicians and women seeking abortions lived within a strict system that required two physicians to agree on the medical necessity of the procedure and hospital review boards that monitored physicians’ decisions to induce therapeutic abortions. ‘Therapeutic abortions’ performed in hospitals were, thus, ‘legal’; all others were ‘illegal’. The process ensured the legality of medical practice within hospitals while simultaneously ensuring anxiety among doctors and patients, stigmatizing the procedure, and deepening inequality in access to physician-induced therapeutic abortions.
Conservatives in Japan came to dislike the country’s reputation for liberal abortion laws and practices and the foreigners who travelled there for abortion. The criminality of abortion elsewhere and its association with illicit female sexuality (and female autonomy) rubbed off and smeared an entire country. Becoming an ‘abortion paradise’ for foreigners dishonoured the nation, according to leading Japanese physicians and politicians. Japanese officials worried that, ‘The nation is gaining a black eye abroad’, according to one American newspaper. Abortion was legal, accessible, safely performed by physicians who practised Western medicine, and relatively inexpensive—for anyone who could afford to travel there. Compared to the hostility of doctors, the threats of police and the reputed dangers of illegal abortionists in the U.S. and elsewhere, those features made Japan an attractive option. At least one Tokyo physician advertised his abortion services to American doctors and hospitals, which surely brought some patients to Tokyo; it also provoked the wrath of Japanese medical leaders and made the national news. Notably, the denounced physician was from a stigmatized group, Korean-Japanese. Although doctors highly recommended Japan, potential patients discovered suspicious officials at the Japanese consulate. When one man tried to get visas for Japan in order for his wife to get a legal abortion as advised, the consulate refused. Sweden’s consulate similarly denied them visas. Americans learned to be more discrete.
Probably the most politically influential instance of a woman travelling for an abortion is that of popular TV personality Sherri Finkbine, who flew to Sweden for an abortion in 1962. While travelling to find an abortion was not unusual, Finkbine did something unheard of: she was the first woman in the United States to voluntarily speak publicly to the media about her need and desire for an abortion. And she became (in)famous for doing so. The entire story of her denied abortion began because Finkbine had tried to warn other mothers about the danger of unknowingly taking thalidomide as she had. Finkbine was a white, married, mother of four who led ‘Romper Room’, an educational television show for young children—as such she was the model of respectable motherhood. She was also pretty and photogenic and wanted to talk to the press about the danger of thalidomide. As a result, Finkbine and her travails and travels became well-known. Finkbine had discovered that the sleeping pill that she had taken months before was thalidomide—and she was pregnant. The teratogenic effects of thalidomide, which caused shortened or missing limbs, missing digits and ears, as well as internal organ malformations in newborn babies, had reached the front page of the newspapers that summer. Her doctor confirmed that she had taken thalidomide and recommended a therapeutic abortion. This was an accepted medical response to known congenital malformations. Sherri and her husband agreed and scheduled an appointment with the hospital, but soon learned that obtaining a legal therapeutic abortion was impossible. Publicity, politics, and a newly provoked discussion of religious values concerning pregnancy and abortion combined to make therapeutic abortion in the United States inaccessible to the Finkbines. Robert Finkbine explained, ‘We’ve been blessed with four healthy children […] we can’t do this to them or to the new baby’. Furthermore, his wife was becoming ‘distraught’ over the delay, he told reporters. She ‘couldn’t go on living’, she told him, ‘if she had to wake up every morning thinking of having a baby without arms and legs’. The photographs of ‘thalidomide babies’ that Finkbine had seen stuck in her mind and in public memory. Commentators did not hesitate at the time to call the babies a variety of mean names ranging from ‘basket cases’ to ‘deformed’ to ‘monsters’.
‘We were forced to go overseas. We chose self-imposed exile’, is how Sherri Finkbine later described the situation. Her doctor suggested Japan, but fearing ‘anti-Japanese demonstrations by Americans who opposed us’, Japan refused to grant a visa.
The Finkbines turned next to Sweden and Swedish journalists who had offered to help. She told reporters, ‘I know we wouldn’t go behind the Iron Curtain and it would be too expensive to go to Japan’. Within only a few weeks of learning about thalidomide’s teratogenic effects and the denial of her scheduled therapeutic abortion, Finkbine had become well-informed about the global status of abortion. She knew where legal abortions might be obtained, but Cold War politics stopped her from going to several countries.
Fortunately for the Finkbines, the Swedish newspaper Expressen was very interested in her and willing to help arrange their flights and a meeting with the Swedish medical board about an abortion. In return, Expressen received up-close and personal photos and accounts written by Sherri and Bob Finkbine. As Lena Lennerhed has shown, Sweden treated the Finkbines as celebrities, photographing and following them everywhere. From the moment Finkbine’s personal story first broke, she had become part of US daily and international news.
The intense publicity brought more Americans and Europeans to Sweden in search of safe, legal, medical abortions. Abortions were not easily obtained in Sweden, however. Indeed, Swedish women who applied for abortions were often rejected. Some Swedish women went to Poland for the procedure instead in order to escape the numerous interviews (or interrogations) prescribed by the Swedish system or after being rejected by Sweden’s medical board. Underlining the limits of Sweden’s apparent liberalism, the Swedish state tracked women who went abroad to prosecute them for illegal abortions. Finkbine had avoided going behind the Iron Curtain, but many Europeans knew this was a safe place for abortions. When the Soviet Union re-legalized abortion in 1955, East Central European countries followed. Poland made abortion legal upon women’s application and available at no cost from state health centres in 1959 (a more restricted solution was already issued in 1956). Yugoslavia legalized abortion in 1960; East Germany allowed for indication-based abortion in 1965 (and for selective abortion in 1972). By the mid-1960s, airlines reportedly ran ‘abortion excursions’ from Scandinavia and France to ‘iron curtain abortionists’.
Sending women to foreign lands
Going across an ocean for an abortion was extremely far and expensive. Few Americans could undertake such a trip even if trusted doctors considered Sweden or Japan the best. Instead, where they went depended on where they lived and, most importantly, their income and the money they could quickly gather. Those living on the East Coast went to Puerto Rico; flights between New York and San Juan were so frequent that women could make a quick trip and be back home on the same or the next day. On the island, they could find practitioners with small, well-equipped hospitals. In 1964, the president of the Puerto Rican medical society estimated that every year, 10,000 women came from the mainland for abortions. Americans living in the south-west crossed the border into Mexico. Abortion was not legal in either Puerto Rico or Mexico, but local authorities mostly overlooked these physician-run clinics which served well-to-do Americans.
A handful of women in California made the earliest medical-legal effort to reform the state’s abortion laws a women’s rights issue. Demand for abortion had grown with the German measles epidemic (1961-1964) and the associated fear of the birth of ‘deformed’ babies. In 1966, when state authorities threatened to revoke medical licences and prosecute physicians who performed therapeutic abortions for German measles, abortion rights activist Patricia Maginnis took to San Francisco street corners to pass out fliers listing the names of abortion ‘specialists’ and advertising do-it-yourself abortion classes. Maginnis had hoped that a test case would develop out of her blatant law-breaking. While no such case emerged, she and her group, the Association for the Repeal of Abortion Laws (ARAL), produced what became known as ‘the List’, which they distributed in the San Francisco Bay Area and nationally. The list guided women to abortion specialists in Mexico, Sweden, Japan, and Canada, all of whom ARAL had vetted, and relayed information about fees, travel tips, what to expect from the specialist, and how to prepare for surgery, manage taxi-drivers, money, and police. Finally, ARAL asked everyone who used the list to help monitor the specialists by returning frank evaluations.
ARAL sent women to Mexican specialists located in Nogales and Agua Prieta across from the Arizona border, Ciudad Juarez across from El Paso, Texas, Mexicali south of Los Angeles and to Mexico City and Mazatlan. The list explicitly told them to avoid Tijuana, where women had gone for abortions for decades, and where authorities conducted frequent police raids. Women sent detailed reports back in order to help and protect other women. Almost all spoke of the humane and kind treatment they received. Four years after the first leaflet was produced, over 12,000 women had travelled outside the United States to obtain abortions with the list’s help. Most had gone to Mexico. Many Americans benefitted from their country’s border with the global south. The benefits of the border extended well beyond the western border states of California, Arizona, New Mexico, and Texas. Women calculated their risks, the costs of travel, and flew from all over, from Oklahoma, New York, and Minnesota to obtain safe and inexpensive abortions in Mexico. Feminists at the University of Texas also connected women to abortion providers in Mexico. In 1968, they began advertising their abortion service and their phone numbers. When women called, Judy Smith borrowed a truck and drove them across the border to practitioners in Mexico.
Although Maginnis expected that travel to Japan would be too expensive for anyone to go there, a few women did use the list to go to Japan. Since ARAL’s list reached people far from ARAL’s home in California, for some, Japan was closer than Mexico. ‘There are well over 5,000 physicians in Japan specially licenced to do abortions’, the list explained. ‘A large percentage of the population speaks English [and] there are numerous excellent hospital[s] in Japan. We suggest that you go to Japan (Tokyo) and ‘shop around’ for a physician’. The leaflet told women what they should expect to pay and who to avoid because of ‘outrageous fees’. Japanese women paid $10-$50; ARAL thought $50-$100 ‘would be fair’. Additional notes warned that officials might refuse visas if they knew that abortion was the purpose of a trip. One woman living in Guam went to Japan after contacting Maginnis. Another from Milwaukee sent in a detailed evaluation of the ‘kindly’ and ‘very skilled’ doctor whom she saw in Tokyo. She advised others to plan on 2 weeks to get their passports, the ‘yellow booklet’ certifying their small pox vaccination, and a visa.
Reflecting the intense public awareness of Finkbine, Sweden appeared on ARAL’s list, but ARAL made clear that securing approval for an abortion in Sweden was unlikely. ‘All women who wish to have abortions must have their cases passed by a committee at the hospital’, the list explained. Furthermore, ‘almost all applicants for abortion in Sweden are turned down. […] Swedish women generally go to Poland for abortions’. ARAL advised doing the same: go to Poland, Hungary, or other Eastern European countries where abortion was available ‘upon request. Excellent care’. One man, who thanked Maginnis for helping him and his wife find the doctor she saw in Mexico, shared some useful information with her. Friends in Czechoslovakia had reported ‘that legal abortions are available for $150.00 to foreigners, with not much hassle’. He signed his name, ‘gratefully’.
In 1967, a year after Maginnis openly passed out the names of abortion specialists in Mexico, England, and Japan, a group of ministers and rabbis in New York City announced the formation of the Clergymen’s Consultation Service on Abortion (CCS) to help women obtain abortions. Begun by Baptist pastor Howard Moody, CCS grew out of personal familiarity with the need for abortion and awareness of the difficulty and potential danger of illegal abortion—especially for poor women and anyone who lacked medical connections. CCS quickly expanded into a national network that helped hundreds of thousands of women obtain safe abortions. Women seeking abortions met for face-to-face counselling with the clergyman (or one of a handful of female clergy among the 1500 or so in CCS from 1967 to 1973) and then, after medical confirmation of pregnancy, received referrals for either legal therapeutic abortions in local hospitals or to doctors outside of the country, in Puerto Rico, England, Japan, and sometimes Mexico. A Canadian chapter sent women to Los Angeles; a Japanese chapter helped Americans who travelled to Tokyo for late abortions.
Re-routing: England, 1968
When England passed its Abortion Act in 1967, European and trans-Atlantic abortion travel patterns shifted. British women no longer had to travel out of the country and go ‘behind the iron curtain’. Other Western Europeans could also avoid communist countries. As soon as the new law went into effect, experts awaited tens of thousands of ‘foreign girls’ to flood the city of London seeking abortions. Indeed, in the first weeks of the new law, many general practitioners within the National Health Service (NHS) doubted that the NHS could provide the now-legal procedure to the number of British women who would seek it. Fortunately, in the eyes of these NHS doctors, private services arose to meet the need of British citizens (and foreigners). The 1967 Act permitted abortions if two physicians found that pregnancy threatened the life, physical or mental health of the woman, would harm her family, or if there was risk of foetal abnormalities.
Two years later, anxiety focused on Americans. ‘Pregnant American girls’, the London Sunday Times reported, ‘now substantially outnumber’ German and other European ‘girls’. Due to this increase in ‘traffic’, the Secretary of Social Services warned that he would ‘impose much tougher controls on private nursing homes and clinics. […] because of the risk that the rush of girls from America may eventually lead to ‘package tour’ flights to London’. Some clinics, authorities suspected, ‘provide[d] […] ‘conveyor belt’ services for overseas girls’.
The language used here is revealing. The anxiety was less about a threat to patients’ health, than about the idea of hundreds of women travelling to obtain a legal medical procedure that they could not receive at home. First, using the term ‘traffic’ to describe women travelling across international borders immediately placed them in the tainted and illegal category of the commercial ‘trafficking’ of women and children for sexual exploitation. It also simultaneously made them into victims requiring the protection of British authorities and criminalized them as prostitutes. Second, what was it about Americans? American girls? Perhaps, it suggested ‘women’s lib’? Or hippies? Their pregnancies—the evidence of sexuality of American ‘girls’—apparently made them undesirable people and their quest an unwanted American cultural invasion. The term risk referred to the number of female travellers arriving, not their health. Neither the newspapers nor the authorities said exactly what concerned them about Americans versus Germans. The ‘rush’, the newspaper said, would be ‘curbed’. Observers suspected that foreigners received abortions ‘instantly on demand’.
The Abortion Act made abortions available through the NHS, which is how most British residents obtained abortions without a fee. Foreigners rarely received an abortion through the NHS; almost all paid for the procedure at a private practice or ‘nursing home’ (a small private establishment specializing in abortion). Opponents of the private practices worried that they charged foreign women extravagant fees for abortions. Accusing abortion providers of exploiting patients and profit-making was an old method of smearing the ethics of any physician who helped patients by making a referral or terminating a pregnancy. In some cases, business-men established referral services and paid NHS doctors twice what they typically received for performing terminations. They then, for a fee, referred women to these clinics. Notably, the much-maligned doctors subjected to media attention, state investigations, and prosecution for abortion under the British Act were all foreign-born themselves—one was German, one Persian, and another Indian. Underscoring suspicion of foreigners, Scotland Yard also trailed foreign ‘girls’ back to their own homes where they interrogated them about their abortions and their doctors (who were suspected of providing abortions beyond the limits of the Act).
It was never primarily Americans who came to England for abortions, however. Europeans, and especially Germans, travelled to London by the thousands for abortion. Those thousands did not go unnoticed in Germany. German police and prosecutors investigated, undoubtedly with help from undercover British detectives who visited Germany to question the ‘girls’ who had gone to London for abortions. In 1971, one ‘mother of five’ and her former husband were both fined for violating German law by obtaining an abortion in London. After German feminist-celebrities collectively spoke-out against the law and announced their own illegal abortions, two movie stars were prosecuted. This event led to the reform of German abortion law.
When abortion-seeking women arrived in London, some had names and addresses from friends who had gone before or appointments with doctors or nursing homes. Others asked for referrals upon arrival. British doctors, clinics, and advisory services—like the World Wide Pregnancy Advice Bureau—had sent letters and pamphlets abroad to guide such women. Glossy coverage of England’s new law in Stern, the popular German magazine, advertised the new law and led travelling women to specific practitioners. Feminist and abortion law reform groups in Finland, Canada, Sweden, and the United States relayed information to women in their own countries.
Although the law had changed, many still understood requests for abortion information through the lens of illegal abortion. The words used to describe the changes taking place as Britain legalized abortion, the people seeking abortions, and those who helped them continued to sound shady and criminal. Asking for abortion referrals—and the accompanying complaints that taxi-drivers ‘steered’ women to disreputable practitioners or stole patients for ‘kickbacks’—was no different than what occurred when women sought abortions in cities and countries where the procedure was illegal. Using language familiar to stories about the criminal underworld or prostitution stigmatized abortion, the providers, and taxi-drivers. As one union officer for cab-drivers grumbled, it was a ‘slur on the whole of the cab trade’. The union threatened to revoke the licence of any driver who took a commission for bringing women to abortion clinics. In response to the reported ‘hijacking’ of customers by taxi-drivers at airports and train stations, volunteers began staffing information desks at Heathrow Airport and Victoria Station in London to help women who asked about abortions.
Newspapers and politicians who created a worrisome portrait of foreigners and doctors exploiting the new Abortion Act did not seek the perspectives of ‘foreign girls’. A rare letter written in 1969 tells how one young woman found herself far from home giving American travellers checks to a London doctor. The story begins with the search for information on the East Coast and ends with warnings to teenagers and gratitude to the San Francisco leader of the abortion law repeal effort, Patricia Maginnis. A ‘frantic’ mother had been searching for abortion information for her daughter, who would soon graduate from high school. She, her husband, and ‘the boy’s’ parents read ‘the List’ that Maginnis sent, but were ‘very apprehensive’ about sending their daughter to Mexico or Puerto Rico because of ‘the language barrier’. She also met with a minister from Clergy Consultation Services who informed them that her daughter’s pregnancy at 12 to 14 weeks was too far along to go to a local physician. ‘We had only one alternative and that was London, England. Well, you can imagine how we felt’, the mother’s sigh of resignation rang through her letter. The parents ‘immediately’ got ‘shots and passports’ for the young couple who left for London with an appointment. A car picked them up at the airport and drove them to ‘the doctor’s office for a real quick exam and to collect the money’. The doctor, her daughter told her, ‘pulled her Travelers checks out of her hand to see how much she had with her. When she mentioned to him that [the minister] had said $350, he seemed very annoyed, but accepted the $350’. She was told to arrive at the Nursing Home at 3pm; late in the evening, she received two shots, stayed overnight, and was told to return the next day for a check-up. What type of ‘shots’ her daughter received or how the doctor performed the procedure is unclear, but she was presumably given an anaesthesia and the abortion performed in the evening. They came home, ‘tired, but happy that the mess is over with’.
Her daughter observed the doctor and the environment closely. Others, she found, paid double what she did and only ‘American girls’ received two shots and stayed overnight; ‘girls from other countries were woke[n]-up and told to leave’ to free up the rooms. The clinic was ‘clean, but the Dr. was rough & very business-like’. The doctor also instructed the Americans to tell the ministers who have given them his name, ‘how nice he was!’ Echoing British newspapers, her daughter called it a ‘regular assembly-line’ and guessed the doctors made $5000-$6000 per day. Maginnis shared this information about the price—and that the doctor accepted less than he demanded—his manner, and the procedure with other women through the list. The entire project had cost almost $2000 for a family that, the mother noted, ‘was by no means wealthy, as we both work and the boy’s parents gave us no help financially’. (For a rough comparison, in 2017 dollars, the total costs added up to over $13,000.) She promised a future donation to help ‘Pat’ change the laws once they recovered from this financial hit.
This mother’s letter shows how a daughter’s unplanned pregnancy became the object of anxiety, rushing, and financial stress. Parents suddenly searched for information, took their daughter to doctors and ministers, and then sent her on a nearly week-long trip for an abortion abroad. Her letter tells, too, what she told daughter and boyfriend upon their return. ‘Everyone makes mistakes and we are all entitled to one mistake, but don’t make the same mistake [a] second time’, she warned them, ‘if you do that the picnic will be all yours and you will have to go through with it’. Pre-marital pregnancy threatened gender norms of childbearing within marriage and future class standing, particularly for white middle-class families.
‘Planeloads’ of American (and Canadian) ‘girls’ no more
After 1970, when several states in the United States repealed their century-old criminal abortion laws, North Americans abruptly became a tiny minority among those seeking abortions in Britain. Almost 2000 Americans and Canadians had obtained abortions in England in 1969; by 1971, they added up to just over 250—a drop of nearly 90%. 1971 data showed that North Americans made up less than 1% of the total, compared to over 13,000 Germans and nearly 12,000 French women. Travellers came from all over the continent: Belgium, Switzerland, Holland, Spain, Italy, Austria, Denmark, Sweden, and Norway, as well as Northern Ireland, the Irish Republic, and as far away as South Africa and Australia. While the number of North Americans travelling to Britain for abortions fell, the total number of non-resident patients expanded. The British Society of Conservative Lawyers insisted that ‘speedy abortions’ for foreigners must end. They wanted residency requirements, 48-hour waiting periods, and a limited number of providers.
Despite the headlines in London newspapers and the cries of anti-abortion politicians in Parliament, the number of ‘girls’, like the number of Americans, had always been exaggerated. Data collected across the country for 1968-1971 showed that more than half of the abortion patients, resident and non-resident alike, were 25 years of age or above. Not ‘girls’. The biggest age-group, for both residents and non-residents, was the 20- to 24-year-old group. Again, not ‘girls’. Less than 15% of the non-resident abortion patients were between 16 and 19 years of age. (This was also true for resident patients in this age group in 1968-1970, with a slight rise in 1970-1971.) But referring to women making decisions about pregnancy, childbearing, motherhood, and family as children, as ‘girls’, suggested that they were unable to make decisions, needed parental (paternal) guidance, and lacked the legal right or ability to make medical decisions, to act or travel on their own. Using ‘girl’ may have drawn upon sentiments that travelling ‘girls’ deserved protection from danger or the age-old spectre of the out-of-control, sexually-active run-away who disobeyed her parents and needed to be monitored and either sent home or to juvenile hall. The term did not suggest that patients were adults who commanded respect and had rights in the world. It infantilized them.
A change in plans, 1970s
When New York legalized abortion in 1970, Canadian and American women swiftly changed their travel plans to get to New York rather than London, Mexico, or Puerto Rico. Tens of thousands of Americans travelled across state-lines to find new legal abortion clinics in New York. In the law’s first 2 years, the majority of abortion patients—over 65%—were from out of state. New York experienced some of the same issues that arose in England when abortion was legalized there, including taxi-drivers who ‘kidnap[ped]’ patients to take them to other clinics. A Calgary group helped Canadians from the middle of the country cross the international border to reach providers in New York as well as Washington, California, and England. When Canada had liberalized its law in 1969, it had institutionalized the system of therapeutic abortion committees and permitted abortions for limited medical indications only. Thus, the Calgary Birth Control Association (CBCA) (a name designed to hide their abortion referrals from federal funding agencies) worked with other abortion rights activists to identify providers, make appointments, and ensure their comfort during travel. When the state of Washington liberalized its law in 1970, Canadian women on the west coast could easily travel to Seattle and back in a day. Those on the east coast went to New York and several thousand did so annually. Travelling from the middle of Canada was more arduous. The CBCA, Beth Palmer has found, encouraged the most affluent women to take the expensive trips and tried to ‘save’ spots that might be obtained through friendly local therapeutic abortion committees for low-income women.
In 1973, the US Supreme Court found all state criminal abortion laws and the hospital therapeutic abortion system unconstitutional. Legal abortions became more accessible, largely through stand-alone clinics that offered less-expensive out-patient procedures. In Canada, however, abortions were still not readily available. As a result, after Roe v. Wade, Canadians continued to flow across the border for legal abortions, but now into more states. In the United States, many cities were determined to keep abortion illegal and unavailable despite the Supreme Court rulings: in 1973, a quarter of all American women had been forced to travel out of state for now-legal abortions. By 1980, only 6% travelled out of state for the procedure. Travel of Americans across multiple states and international borders ceased as legal abortion became more available at home—at least for a while.
The 21st century: crossing borders still
Today, Americans are not travelling by the thousands to other countries in search of abortions; many cross internal borders, however, to locate providers. Abortion is a constitutional right in the United States, but that right has been limited by Congressional actions, state legislation, and Court opinions since 1973. And the availability of abortion is highly circumscribed by income, insurance coverage, and, most importantly, residency. Depending on which state a woman lives in, she may be able to find a clinic easily and her private insurance or, very rarely, even state health insurance for low-income residents (Medicaid) might pay for the procedure (e.g. California, Illinois, or New York). If she lives in the South or Midwest, in Alabama, Mississippi, or North Dakota, for example, there may be only one or two providers in the entire state. Many states have passed laws intended to close clinics through new regulations and unnecessary building standards. Although court injunctions stopped some of these laws, they nonetheless succeeded in closing some clinics permanently. The lack of providers has also created something entirely new: doctors who fly across state-lines to provide abortions. These doctors work to ensure that this basic health service—used by at least one quarter of American women today—is available to women living in underserved regions.
Where abortion is highly restricted or illegal, those who can figure out where to go, find the money, make travel arrangements, and organize time off work, child care, and other responsibilities, travel to cities and states where safe abortions are available. As in the United States, disparities in state laws produce female refugees within their own countries who travel hundreds of miles to obtain safe and legal abortions. Since Mexico City decriminalized abortion in 2007 and some Mexican states passed harsher laws in response, women from elsewhere in Mexico journey to Mexico City for safe abortions. Canadian women, too, cover long distances from rural and predominantly Catholic provinces to reach abortion providers. Hundreds of Australians annually travel from one state to another for late-term abortions because of stark differences in state abortion laws. A few Australian patients with money fly to Britain, India, and the United States. South Koreans travel overseas for abortions as well.
Conclusion
Travelling, crossing international borders—fleeing their own state or country—in order to obtain a safe abortion reveals the uneven conditions of abortion legalization globally as well as inequality in their home countries in both the past and the present. If women could obtain the safe abortions they needed for their own health, their family’s future, and their own lives, then they would not be so determined to find the money and the means to travel long distances to foreign lands. If their own countries listened to their beliefs, respected their bodily integrity and autonomy in decision-making, and had health care systems that provided a procedure used by a large proportion of women, then one sex would not be compelled to flee or choose ‘self-imposed exile’ (in Sherri Finkbine’s words) in order to protect their own physical autonomy and safety.
Although well-to-do women could afford the expense of travel, many struggled to fund their trips, and many more could never travel beyond their own neighbourhoods. Even Finkbine, the epitome of the white, middle-class, married woman could not pay for her own travel or abortion in another country. Most of the Irish women ‘in flight’ from their home country, Ann Rossiter showed, could barely scrape together the money to get to London. Many women seeking abortions around the world never travelled for abortions at all, but instead, took steps to induce their own abortions. Some were injured and landed in hospitals. Some faced prosecution; some died. The global data on unsafe abortion—which is highest in the global South and sub-Saharan Africa—and the comparative affluence of many abortion travellers expose the economic inequality built into world’s existing health care system. The death rate for (unsafe) abortions is 800 times greater in Sub-Saharan Africa than for legal abortions in the United States.
The anxious and often hostile reactions to women travelling and arriving in foreign cities seeking abortions might be seen as betraying a typical response to foreign refugees. The hyper-exaggerated stories of British newspapers, politicians and conservative forces about the coming ‘invasion’ of ‘foreign girls’, the demands that the police put a stop to this ‘invasion’, that countries change relatively liberal laws and authorities investigate abortion travellers sound much like present-day responses to Syrian, African, and Central American refugees.
Like the more readily recognized refugees, who flee war and political, religious, and sexual persecution, women who determine that an abortion is necessary have a long history of fleeing their own countries to find assistance terminating their pregnancies in safe, and hopefully humane, environments.