Forcing Abortion Patients to Prove ‘Medical Necessity’ Recalls Pre-‘Roe’ Era: Analysis

Plenty of people still got abortions in the United States before Roe v. Wade federally protected abortion rights in 1973. 

According to one estimate by the Saturday Evening Post in 1961, between 750,000 and 2 million abortions were performed each year. Abortions happened in two different circumstances: either in hospitals, where individual women were approved for abortion care based on medical or psychological necessity; or in illegal settings dubbed “back-alley” operations (or “abortion rings”). 

Miscarriages were one indication for abortion care (medically, the procedure for both is the same), as were other life-threatening complications like ectopic pregnancy. Some people could also get approved for an abortion if licensed mental health professionals wrote a letter attesting that continuing the pregnancy would threaten their sanity.  

My new book, Given No Choice: A History of Abortion Rights, traces the evolution of abortion worldwide since antiquity through modern times. In researching that history while chronicling the modern abortion rights movement in my newsletter, Repro Rights Now, I was struck by a sense that the past is seemingly repeating itself. 

The U.S. hasn’t returned to the exact pre-Roe reality since the Dobbs v. Jackson Women’s Health Organization decision deprived people of the constitutional right to abortion care in 2022. But we have seen a resurgence of the murky situation in which people must justify their need for abortion care to doctors or legal professionals. 

When medicine and law collided

During my book research, I had a particularly poignant conversation with Sherri Chessen, who sought an abortion in Arizona in 1962 due to fatal fetal abnormalities. 

Early in pregnancy, Chessen had taken thalidomide, a sedative commonly prescribed for sleeplessness and morning sickness. This drug was later shown to harm the physical development of the fetus, but Chessen didn’t know that until she was 11 weeks pregnant. 

Chessen’s OB-GYN agreed she should get an abortion, and had arranged for the procedure to be done at Good Samaritan Hospital (now Banner – University Medical Center). 

Chessen wanted to warn more people about the danger thalidomide posed to pregnant people, which had only recently become public. So she went to the media. Rather than on the risks of the medication, however, her local paper, the Arizona Republic, focused its article on the abortion itself. 

After the coverage, Chessen received threatening letters from anti-abortion zealots that mentioned harming her children. The Vatican condemned her choice. Media outlets across the country covered her situation, including Life magazine, which published a pictorial spread. 

The hospital committee that had approved Chessen’s abortion rescinded permission. Chessen then went to two psychiatrists to get documentation to show that terminating the pregnancy was in the best interest of her mental health. After a court wouldn’t greenlight the abortion, she flew to Sweden to get the care she needed. 

The obstacles Chessen faced helped galvanize the abortion rights movement, which reached its peak in the late 1960s. Reproductive freedom was one of the central tenets of second-wave feminism. 

While Chessen’s story got more media attention than most, it was by no means abnormal. Women typically had to get permission from hospital committees to get an abortion in medical settings. Poor women and women of color had a harder time persuading hospital committees to approve an abortion, my research shows. 

As Leslie Reagan documents in her foundational book When Abortion Was a Crime, these “therapeutic abortion” committees were designed not simply to evaluate medical need but to regulate and restrict access, narrowing abortion to a small set of defensible, strictly defined indications. 

Physicians had to present formal cases, secure supporting opinions, and submit them to review. Yet many patient requests would never reach the committee at all, as doctors learned over time which cases would likely be rejected and declined to sponsor them.

This system discouraged applicants, Reagan shows: It required repeated examinations, detailed questioning, and, in some hospitals, procedures that patients experienced as intrusive or humiliating. Only a woman who “desperately” needs help would “consent” to such treatment, one New Jersey doctor observed.

Committees also eliminated broader considerations—such as economic hardship or family circumstances—that some physicians had previously taken into account. In practice, that shift mattered most for pregnant people who already had children, whose cases were less likely to be framed in narrowly medical terms and therefore less likely to be approved.

The result was a system that filtered access before a woman ever appeared before a committee. Those who could not secure physician advocacy or meet the increasingly rigid criteria were left outside the hospital system altogether, often turning instead to the more dangerous but more accessible option of an illegal abortion.

Medical exceptions are hard to get

Today, a modern version of this phenomenon is playing out in restrictive states like Idaho and Texas, which essentially don’t allow abortion unless the doctor determines it would be life or health-saving. 

Many doctors are reluctant to make those decisions. They report feeling a great deal of trepidation and confusion around the circumstances that would allow them to legally terminate a pregnancy. Texas recently opened investigations into several doctors whose patients died after life-saving abortion care was delayed, according to ProPublica.

Medical exceptions “have often proven to be unworkable,” concluded KFF Health in a recent report, and “have sometimes prevented doctors from practicing evidence-based medicine.” Since Roe fell, tens or hundreds of thousands of women in abortion-ban states have had to travel out of their home state to get the care they need. 

These laws have been at the center of litigation around abortion access, as women and medical organizations have challenged bans in places like Texas and Idaho. 

In these lawsuits, testimony from doctors and patients with risky pregnancies say restrictive laws have imperiled their lives and health because doctors couldn’t provide abortion care even when doing so would be legal. Doctors argue that abortion bans have limited their medical choices in emergency situations, with sometimes dangerous consequences. 

I worry that the fear of imprisonment among medical doctors has actually put patients in a worse spot in some ways than they were before Roe became the law of the land. 

Ms. Magazine keeps a running tally of how many women have died in wake of the abortion bans implemented after Dobbs. As of January 2026, the number is at 12; the majority are Black women. 

The figure is “likely an undercount, with more cases still unnamed or not yet public,” Ms. Magazine says.

My book ends with one of those women. Porsha Ngumezi, a 35-year-old mother of two, suffered complications during a miscarriage at 11 weeks’ gestation. Doctors in Texas did not provide a D&C, or dilation and curettage, a common treatment for an incomplete miscarriage in the first trimester. In this procedure, a provider removes the remaining fetal tissue from the uterus. 

Instead, the hospital gave Ngumezi a pill that usually serves to clear the tissue medically. 

Ngumezi’s condition worsened, and her heart ultimately stopped. She died on June 11, 2023, leaving behind her husband and children.

Before Roe, doctors routinely performed abortions in situations where the patient’s health and life were at risk, at least for white women with access to a sympathetic doctor. Now, the sentences for violating state abortion bans are so draconian—Texas calls for 99 years in prison—that doctors aren’t providing the care patients need. 

The underground abortion market

For a long time in the U.S., midwives were involved in abortion care—which was legal until the point of “quickening,” or fetal movement. In the 19th century, a push by the American Medical Association cast abortion in a largely negative light, leading to its criminalization. 

After that point, but before Roe, pregnant people who needed abortion care had fewer safe, reliable options, according to a 1935 report compiled by a leading authority of the era, Frederick Taussig. 

In cities like New York and Los Angeles, an underground abortion market took shape in the 1950s and 1960s, operating in the shadows but widely known to those who needed it. A three-part Saturday Evening Post investigation that ran in 1961 showed readers how this system worked.

Throughout pre-Roe history, women found their way to abortion clinics through word of mouth, euphemistic referrals and coded advertisements for “pills” for “married ladies” and doctors who promised to “restore the menses.” Informal networks of people involved in helping women arrange a procedure, like taxi drivers. 

“Abortionists,” as they were called at the time, were often trained physicians working quietly outside the law. 

Some early abortion providers felt a moral obligation to help women. Curtis Boyd—one of the relatively few doctors who performed abortions in the third trimester in the last 50 years—did so illegally because he felt morally compelled to (his Albuquerque clinic was later burned to the ground). 

In Ashland, Pa., Dr. Robert Spencer performed 30,000 abortions between 1920 and 1969, according to documents I obtained from the law office that represented him. His clinic was clean and sanitary.  

That was not the case for every abortion provider. Some were not medical professionals, and some were in it for the money. (There will always be people who want or need to terminate a pregnancy, and these patients paid out of pocket.)

These “mechanics,” as they were sometimes called, had little training and even less oversight. The conditions varied, but the risks were always there. Medical instruments like curettes were not always sterile. Anesthesia, when used, was not always properly administered. 

Pregnant people could leave with perforated uteruses or an infection, as the Saturday Evening Post reported. I spoke to one woman who hemorrhaged badly and developed anemia following an unsafe abortion in Youngstown, Ohio. 

Prices for abortion care before Roe fluctuated depending on what a woman could pay, and desperation was often part of the transaction. The 1961 Saturday Evening Post investigation revealed that some surgeons might charge $75 to $125. Others might demand between $400 and $2,000—roughly $4,000 to $21,000 in today’s dollars. 

The people who performed abortions and those who assisted them took precautions to not get caught, according to my interviews. As shown in the 2022 documentary, “The Janes,” patients often wore blindfolds during transport so that if they were interrogated by police after a procedure went awry, they couldn’t identify the site of the abortion. 

When a procedure went wrong, my past reporting found, some patients might be taken to a hospital by a relative or friend. Prosecutors often relied on the women’s deathbed confessions to start their investigations. As advances in medical hygiene and techniques allowed more patients to survive botched procedures, they sometimes testified against their “abortionist.” 

As documented in my book, in the early 20th century, abortion was often treated as a crime that harmed the pregnant person, who was seen as a victim of negligent and wanton care. Patients weren’t typically prosecuted. But that could vary by race and class, according to some scholars. 

Nor was abortion heavily penalized for providers who broke the law; the prison sentences I found in old law books are three to five years. 

The far more severe penalties codified in today’s abortion bans reflect a shift in how effective anti-abortion messaging from a small but loud segment of the population has been in reshaping reproductive care. These new sentences are the culmination of 50 years of reframing abortion as “murder.”

The tragic stories that I’ve recounted here show why abortion is health care that should be safe, legal and accessible to all who want one. It makes no sense, in the 21st century, where doctors hesitate to perform abortions and of pregnant people dying needless, preventable deaths.

The post Forcing Abortion Patients to Prove ‘Medical Necessity’ Recalls Pre-‘Roe’ Era: Analysis appeared first on Rewire News Group.