Women and Reproduction in the United States during the 19th Century
Summary and Keywords
Throughout the 19th century, American women experienced vast changes regarding possibilities for childbirth and for enhancing or restricting fertility control. At the beginning of the century, issues involving reproduction were discussed primarily in domestic, private settings among women’s networks that included family members, neighbors, or midwives. In the face of massive social and economic changes due to industrialization, urbanization, and immigration, many working-class women became separated from these traditional networks and knowledge and found themselves reliant upon emerging medical systems for care and advice during pregnancy and childbirth. At the same time, upper-class women sought out men in the emerging profession of obstetrics to deliver their babies in hopes of beating the frightening odds against maternal and infant health and even survival. Nineteenth-century reproduction was altered drastically with the printing and commercial boom of the middle of the century. Families could now access contraception and abortion methods and information, which was available earlier in the century albeit in a more private and limited manner, through newspapers, popular books, stores, and from door-to-door salesmen. As fertility control entered these public spaces, many policy makers became concerned about the impacts of such practices on the character and future of the nation. By the 1880s, contraception and abortion came under legal restrictions, just as women and their partners gained access to safer and more effective products than ever before. When the 19th century closed, legislatures and the medical profession raised obstacles that hindered the ability of most women to limit the size of their families as the national fertility rate reached an all-time low. Clearly, American families eagerly seized opportunities to exercise control over their reproductive destinies and their lives.
In 1871, Alice Kirk Grierson sat down to write a letter to her husband, Ben. At 43 years old, Grierson had been married for seventeen years and had six living children. She wrote to her husband from her parents’ home in Ohio, while Ben Grierson and the children remained at home in Fort Sill, in Indian Territory. Grierson tried to convey to her husband why she would not be returning home as soon as he had hoped: “Both of us will know one thing, which will inevitably occur, if the good Lord permits us to meet again, and are both well aware of the possible consequences which may follow.” Grierson feared another pregnancy. Further in the letter she admitted that she was not comfortable with the one method of pregnancy prevention they had tried—withdrawal, or what Grierson referred to as an incomplete act of “union”—because it did not align with her religious beliefs. She also refused to consider what she called “the national crime of abortion.” Having endured at least seven pregnancies and the recent death of a three-month-old daughter, Grierson did not want to be pregnant again. But in 1871, she could think of no other preventative than to take an extended trip, placing many states between her and her husband.1 By the end of the 19th century, American women showed increased interest in controlling their reproduction, but many had few, if any safe, effective, or legal means to do so. Unlike their mothers and grandmothers, women like Alice Grierson began to seek ways to curtail their fertility, but they faced opposition to do so by politicians, laws, and doctors. The 19th century was an era of both reproductive revolution and reproductive restriction.
Families in a New Republic, 1800–1830
At the dawn of the 19th century, most American families were large and gained most of their economic stability from work done in or close to the home. More than 90 percent of Americans lived in rural areas, and almost three-quarters of the workers in the country were involved in agriculture, which meant that all family members joined in the labor.2 On average, women typically married for the first time around the age of 20, gave birth 7 times, and faced the very real possibility of dying or losing an infant in childbirth.3
In the new nation, politicians, writers, and philosophers began to promote the idea of “republican motherhood.” This emerging ideal strengthened existing gender roles by tightly linking womanhood with birthing and caring for children while also creating a role for women as political players in the future of the country. Through bearing, rearing, and educating children, the republican mother took responsibility for ensuring the next generation of productive citizens, while preserving and cultivating virtues foundational to the new republic.4 Young girls were raised to think that their national duty was to marry, give birth to many children, and educate their offspring in the values of the new nation.
Of course, only a select few, mainly white women of the “better classes,” could fulfill the dictates of republican motherhood. Most American families relied on the income earned or labor performed by women and children. In the households of large farm families, women’s work included bearing and raising children, but also outdoor manual labor, domestic manufacturing, housework, and supervising the education and work of children. In this largely agricultural nation, children also functioned as economic assets. Labor carried out by children, sometimes the very young, ensured a family could work large parcels of land and secure it for future generations.
To be sure, cultural commentators did not include enslaved women or other women of color in this portrait of republican motherhood. While early slave owners favored male Africans for their labor, by 1800, an estimated 450,000 women lived in slavery in the United States. Plantation owners, slave traders, and lawmakers valued these women not only for their production in the fields but also for their ability to reproduce future laborers. Especially after Congress outlawed the overseas slave trade in 1807, enslaved women’s bodies became crucial for sustaining the southern agricultural industry and fueling a large portion of the US economy.5 Unlike white women, whose value to the nation derived from their social relations as wives and mothers, enslaved women were valued for the economic profit derived from their reproductive capacities. As a result, enslaved women were denied the right to legal marriage or choose their own sexual partners; instead, they were raped by white owners or forced to “breed” with other slaves, and they were denied the opportunity to mother their own children given the heavy demands white owners made on their bodies and their time. Land-owning whites, and the male physicians they hired, treated female slaves as manufacturers of property, and their childbearing capacity as a commodity for generating profit. “Republican motherhood” did not account for slavery—nor did it include slave women.6
Most free American women in the first decades of the 19th century began their reproductive lives upon marriage, in their late teens or early twenties. Determining a first pregnancy may have been a difficult enterprise for many. While 19th-century women typically relied upon bodily symptoms that still, to this day, signify a possible pregnancy—the cessation of menstruation, breast tenderness, nausea, fatigue—these signs held much less certainty then. Illnesses and malnutrition could cause nausea and amenorrhea, and most medical men of the early 19th century informed their patients that a missed period was a sign of illness, not of pregnancy. For many women, pregnancy became certain only after quickening, or when the woman first felt fetal movement. As James Ewell, popular health writer and prominent physician, claimed in his 1822 health guide, “though we can conclude, that she who is regular is not pregnant, we cannot infer, that she who is obstructed is conceived.”7 Women and healers agreed that regular menstruation signified health while “obstructed” menstruation signified ill health that could prevent a woman from conceiving or bearing children. As a result, domestic health guides and recipe books of the era often included teas, tonics, and other herbal concoctions meant to restore a woman’s menses. These emmenagogues, made from locally foraged or cultivated botanicals, were passed along from mother to daughter or through other women’s networks.8
Early 19th-century women often discussed maternal mortality, sometimes detailing wills or instructions for the care of their other children late in pregnancy in case they should not survive the experience of birth. Although estimates of maternal mortality rates, around 0.5 percent of births, are not as high as we might suspect given the lack of antibiotics and antisepsis, evidence from women’s writings suggests that parturient women faced childbirth with trepidation.9 Dangers from childbirth, including infections, hemorrhage, eclampsia (usually termed toxemias at the time) threatened all birthing women, leading some to prepare for death and a few to seek out alternatives to traditional midwifery.10
The majority of women, enslaved and free, white and non-white, gave birth throughout most of the 19th century with female midwives and other women in attendance. Male physicians who assisted with birth (known in Europe at the time as male midwives or accoucheurs), had gained some authority and medical power in convincing the upper classes that their specialized training in universities better prepared them for the dangers of childbirth. Still, until the 20th century, men remained in the minority among birth attendants. In the United States, few universities had begun to train men in obstetrics (only a handful of American universities had even established medical programs by 1830), and trained doctors charged much more money than the average American family could afford to spend on something that might happen every two years. The majority of male physicians in the United States at the time trained through apprenticeship, but even these practitioners argued that their training was superior to female midwives. Most babies delivered by physicians in the first half of the 19th century were born to upper-class urban families who valued university education and believed it equipped men with special knowledge that could save birthing women and newborns.11
Male physicians brought more than education to childbirth; they also brought opium and forceps. A tool that may have been developed as early as the 16th century by the Chamberlens, a highly esteemed and old medical family in England, forceps were used by male physicians to help pull a child out of a woman’s vaginal canal during prolonged or difficult labor. Female midwives eschewed forceps, relying instead on traditional practices such as moving the infant manually or relaxing the birthing mother with herbal remedies. Similarly, male physicians were quick to offer opium for pain relief, while midwives relied more often on herbal painkillers or relaxing positions and activities.12 Despite the medical revolution underway, during the first third of the 19th century most American women continued to give birth at home surrounded by female relatives or neighbors who not only helped with the birth, but also cooked, cleaned, and tended to the mother’s other children. Because of the predominantly rural lifestyle, most Americans started their families in close proximity to their extended families, including female relatives who could provide ample aid during childbirth.
While early 19th century rhetoric might have informed American women of their duty to have children, evidence shows that many attempted to restrict their fertility in some way. Recipes for tansy tea and pennyroyal tonics, circulated among women in private conversations or printed recipe books and published by physicians in domestic health guides, not only worked as emmenagogues (medicines to restore blocked menses) but could also be put work as contraceptives or abortifacients. Such preparations held a respected place in domestic and professional medicine as doctors perceived the value of these medicines for patients who might not otherwise survive pregnancy and childbirth. Women also relied upon gentler methods for ending a pregnancy such as steam, hot baths, and exercise.13 Legal codes in the 18th and early 19th century did not attempt to regulate pregnancy before quickening, and most laws outlawing abortion after quickening tended to target dishonest practitioners and not individual women who sought to end a pregnancy.14 Couples interested in limiting their family size could also obtain commercial contraceptives, such as condoms made from animal skins or intestines. These, however, had to be imported from Europe, were prohibitively expensive for most Americans, and probably not available outside of the larger urban areas.15
Commercializing Reproduction, 1830–1860
During the second third of the century, the United States experienced unprecedented social and demographic changes that came with immigration, industrialization, and urbanization. The nation’s population quadrupled between 1800 and 1850 (from about 5 million to over 23 million) and more than 15 percent of that population lived in cities. Cities themselves had exploded. In 1830, only one American city, New York, was home to 100,000 citizens or more. By 1850, six cities in the east, south, and Midwest had populations over 100,000 and New York City’s population exceeded 500,000. Immigration rates rose sharply, from 60,000 immigrants each year in 1800, to almost 2 million immigrants annually by 1850. These economic and social changes also altered American families’ access to traditional reproductive knowledge and interest in large families, leading many women and couples to search for new reproductive control measures and childbirth options. By the middle of the century, fertility rates had dropped but maternal and infant mortality remained virtually the same, still a frightening reality.16
As the American economy began to rely upon specialized services and products, families became less self-sufficient. By the middle of the century, fewer families produced all their needed goods at home or on the farm, and more families sent workers (many men, but women and children too) out of the home. For working-class families, children could still contribute to the family economy, but they also required increased resources that were hard to come by in crowded urban tenements. Pregnancy, childbirth, and infant care also prevented women workers from earning the necessary income to keep a family fed. For middle-class families, many parents began devoting more time and resources to individual children whose level of education and refinement became a symbol for the family’s status and a potential source for future economic stability. Industrialization and urbanization gave rise to a new American family that saw a need for fewer children. As a result, the fertility rate fell from 7 children per family in 1800 to 5.42 in 1850.
Another result of the social and economic changes at midcentury was the entrance of contraceptives and contraception information into public discussions and commercial trades. What had previously been a subject of private conversations, perhaps between couples or between a woman and her female relatives, became a topic addressed in books and public lectures. The two most widely read of these works, Robert Dale Owen’s Moral Physiology (1831) and Charles Knowlton’s The Fruits of Philosophy (1832), informed readers about the contraceptive power of methods such as withdrawal and douching with spermicides. Between 1830 and 1860 itinerant lecturers traveled throughout the country, speaking to large and small audiences of women and men on subjects dealing with physiology and marital relations, including contraceptive methods.17
The popularity of such books and public talks inspired entrepreneurs to produce a plethora of contraceptive goods. One of the more popular methods espoused by health commentators was douching, which could be used as part of a general health regimen, as a post-coital contraceptive, or as an abortion technique. By the middle of the century drug companies began offering up their own douching preparations while manufacturers sought patents for a variety of douching syringes and bulbs. After Charles Goodyear invented a process for vulcanizing rubber in 1839, the contraceptive market expanded even more. Imported skin condoms could cost as much as $1 each in 1830, when the yearly wage of a common laborer was about $50.18 Thanks to vulcanized rubber, the cost of condoms dropped to between twenty-five cents and fifty cents each, even as they became more effective and durable.19 Vulcanized rubber was also put to use in diaphragms, cervical caps, douching bulbs, and “male caps” (shields that only covered the tip of the penis).20
By the 1850s, Americans encountered this wide range of contraceptive devices and preparations in a variety of locations. While continuing to rely on women’s networks for reproductive advice, many also gained information from newspaper advertisements for products such as douching preparations; mail-order catalogs offered diaphragms and vaginal sponges; pharmacies carried drugs and injections meant to kill sperm in the vaginal canal; dry-goods stores sold douching syringes and bulbs; and door-to-door salesmen who represented rubber vendors or drug-supply houses informed countless Americans of their options for limiting their family’s size.21 Combined with the popular health literature informing couples about the benefits of withdrawal or the rhythm method, these emerging public discussions of contraception provided real options for most Americans and brought greater legitimacy to the practice. While most of these methods would not be considered very effective based on contemporary standards, rubber condoms and diaphragms were much safer, more effective, and more accessible than any method available in the earlier decades of the 19th century, and probably seemed revolutionary to many Americans at the time.
Mid-century women also had greater access to abortion services and products. Advertisements in newspapers, on broadsides, and in pamphlets circulated on city streets and arrived by direct mail; they announced an assortment of pills, solutions, and oils, as well as practitioners who could help with an unwanted pregnancy.22 According to contemporary observers, women utilized all of them. Numerous physicians at the time wrote about the increase in abortions in the middle decades of the 19th century throughout the country. One Michigan doctor asserted that, by the 1870s, abortion had become so frequent that it was “rare to find a married woman who pass[ed] through the childbearing period, who has not had one or more.”23
Elite physicians worried less about the increase in the number of abortions, per se, than about the character of women who sought abortions. Prior to 1840, most politicians and physicians believed abortion was utilized most by young, unmarried women, desperate and succumbing to the wiles of wicked quacks. By the 1850s, as physicians began seeing more women for reproductive matters, they discovered that many white, native-born, Protestant, middle- and upper-class married women used the products and services of abortionists. Many of these professional and powerful men viewed this very group of women as representing the source of the nation’s best mothers and children. However, as abortion became more widespread and mainstream, many different groups became convinced that the practice did not just endanger women and reduce the number of children they produced, it also jeopardized the nation.24
To be sure, southern doctors hired by wealthy slave-owners had different concerns about the practices of abortion and contraception. Many slave owners and their physicians sought to increase, not reduce, an enslaved women’s fertility, because, by law, a slave woman’s children expanded the slaveholder’s property, and thus contributed to future profits. Slaveholders and their physicians feared, perhaps with good reason, that slaves used secret herbal concoctions to prevent or end pregnancy. Enslaved women also yearned for and cherished their own children. Many undoubtedly sought to prevent or end pregnancy as a form of resistance against captivity, but others sought to control their fertility as a means of fulfilling their own personal or cultural beliefs about the proper and healthy spacing of children and pregnancies. In the face of owners who wanted as many slave children produced as possible, enslaved women enacted their own will and determined, as effectively as they could, their own reproductive destinies.25
Medicalizing Reproduction, 1840–1880
As workers and poor families from Europe and rural America flocked to new urban areas, they often became separated from extended family, ethnic communities, and traditional knowledge about health, illness, and birth. At the same time, regular male physicians, who were growing in number by midcentury, began an active campaign to drive midwives out of business and gain a medical monopoly over pregnancy and birth. By 1880, doctors had successfully taken advantage of the changing economic and demographic environment to take over delivery of nearly half of all American infants.26
An emerging narrative within the culture of the new urban middle class suggested that women were fragile and needed to be protected even from the natural process of childbirth. The modern industrialized world was fashioned as a highly masculine one that posed threats to women’s bodies and minds. In addition, by 1850, America included a range of new foreign bodies, not only of European immigrants flooding in; with westward expansion through trading routes and railroad construction, the country included thousands of Hispanics and Chinese and millions of Native Americans. White, native-born, middle and upper class groups sought to reinforce ethnic and racial hierarchies by distinguishing themselves from “primitive” bodies; they did so, in part, by emphasizing the relatively delicate nature of white women’s bodies.27
A new group of male physicians calling themselves obstetricians tapped into this anxiety and argued that, during childbirth, white women needed medical assistance provided by a specialist. As these doctors argued, while Native American women might be able to give birth outside, without aid, and return to manual labor soon after, “civilized” women needed as much help as possible.28 Many women agreed with this characterization and began seeking out male physicians to attend their births. It helped that physicians could offer drugs, and by the 1850s, these included inhaled anesthetics such as ether and chloroform. Of course, this new type of birth, still at home but with a professional obstetrician in attendance, with forceps and ether at the ready, provided an option only to those who could afford it.29 It must be noted, however, that the historical evidence does not support physicians’ claims that this new way of childbirth was any safer than those attended by midwives who wielded no instruments other than their hands and offered no drugs aside from herbs. In fact, physician-assisted deliveries may have resulted in more fatalities.30
But the middle and upper classes were not alone in seeking out professional medical aid for childbirth in the second half of the 19th century. For working-class poor and immigrant women who were separated from their female relatives by hundreds of miles, or even an ocean, turning to trusted experienced women for pregnancy advice and childbirth aid ceased to be an option. Many of these women relied instead upon unfamiliar midwives, male physicians, dispensaries, or charitable hospitals. In manufacturing towns and cities across America, male physicians began attending immigrant women in childbirth, simply because these women had no other options. In addition, many charity-minded citizens organized hospitals to provide care for these women. For example, in 1862, Dr. Maria Zakrzewska established the New England Hospital for Women and Children in Boston to accomplish two goals: first, to provide training for the few women who managed to graduate from medical school but lacked opportunities for clinical training afterward; second, to provide a safe and comfortable birthing environment for women short on money and family. Zakrzewska argued that her hospital would provide a place “where a woman—not a pauper, but of narrow means—[could] receive the comfort and care so necessary at the period of childbirth, if she is not so fortunate as to possess a good home and friends.”31
Most urban areas had multiple hospitals like the New England Hospital for Women and Children, where working-class women could give birth for a low price or for free. Doctors valued these hospitals as well, for they offered excellent opportunities for training and experimentation. Young physicians and medical students could observe a live birth and test various aids, such as forceps or anesthetics. For women at these hospitals, the experience could be uncomfortable (strange men looking up their skirts), painful (lacking birthing experience, many physicians over-used tools and conducted unnecessary internal exams and manipulations), or even deadly (safe dosages of ether and chloroform were difficult to determine with certainty, and the use of tools increased the chance of internal tears and subsequent hemorrhage or infection).32
As late as 1900, this medicalization of childbirth was primarily an urban trend. Sixty percent of Americans still lived in rural areas, leaving a majority of families to continue to rely on local midwives and other traditional healers. Regular physicians, most of them white and wealthy, had little interest in assisting with the births of families of color or those who could not pay. Midwives attended most births among African Americans, Native Americans, Asian Americans, and Mexican Americans well into the 20th century.33
While the American South lagged behind the north in numbers of medical colleges and hospitals, the antebellum south did provide a unique opportunity for doctors who hoped to gain obstetric and gynecological experience through the bodies of enslaved women. In the 1840s, South Carolina physician J. Marion Sims, generally considered the “father of gynecology,” experimented on numerous enslaved women, using them as human guinea pigs. For example, Sims attempted to find an effective treatment for vesicovaginal fistulae (tears between the vaginal canal and the rectum and/or the urinary tract, usually a result of a difficult birth), by carrying out a number of experimental surgeries on 14 enslaved women from nearby plantations. He operated without anesthesia on the women, practicing under the prominent assumption among many medical practitioners of the time that African-American women felt less pain than more “civilized” white women. Performing as many as 30 surgeries on one woman, Sims shared his results widely, and many white elites (both southern and northern) hailed him as a savior of women. Like many physicians of the time, Sims created reproductive medicine for white women by practicing on the bodies of women of color.34
Regulating Reproduction, 1870–1900
If the middle of the 19th century saw reproductive control enter public discussions through advertising, commercial goods, popular literature, and public lectures, the last third of the century is perhaps better known for triggering a backlash. While urbanization, industrialization, and immigration continued to increase at a dramatic pace, women strove to control the size of their families but soon faced fierce opposition. As urban centers became overcrowded with diverse populations and American women began seeking out new opportunities in education, activism, and political power, professionalizing physicians and many politicians began to see the legal regulation of fertility control as an immediate necessity.
At the same time, many politicians and other public officials became concerned with the nature of the immigrants streaming to American shores. In 1850, boats arriving in east-coast cities contained mostly Anglo-Saxons and northern Europeans; but, by the end of the century, the majority of immigrants came from southern and eastern Europe. In contrast to earlier groups, these immigrants spoke dramatically different languages, practiced exotic customs and religions, and looked physically different from what many in positions of power deemed proper for Americans.35 As a result, lawmakers began seeking out methods for reducing these immigrant streams. In the late-19th century, new attention to federal demographics, through tools like the census, revealed a sharp decline in fertility rates of white, Protestant, native-born women, but higher rates among immigrants and the recently freed African Americans. As abortion and contraceptive rates among married, white, Protestant women continued to rise, many in positions of power began to view fertility control as a threat to the character of America.
Regular physicians who trained in universities and were affiliated with professional organizations such as the American Medical Association began gaining power in the latter decades of the 19th century. For much of the century, regular doctors battled midwives, homeopaths, eclectics, and a variety of alternative practitioners for business. But as the germ theory of disease began to show real promise in medical therapeutics beginning in the 1880s, many Americans soon saw professional medicine as the answer to most health problems, including childbirth. Male physicians continued to deliver babies of wealthy patients in their own homes and infants of the growing working-class poor in hospitals. By 1900, doctors delivered nearly 50 percent of all infants and continued to expand their authority in all reproductive matters.
One helpful tool in this expanding power and expertise was doctors’ continuing campaign to convince families that midwives were uneducated, inept, and dangerous. Beginning in the 1860s, some elite physicians began to consider laws against abortion a strategy for driving midwives out of business and gaining a professional monopoly for themselves. Spearheaded by Horatio Storer, a former Harvard obstetrician, a small group of elite east-coast physicians lobbied state legislators to pass laws banning abortion at any time during pregnancy, sweeping aside centuries-old definitions that linked abortion to ending a pregnancy after, but not before, quickening. For many supporters of Storer, a helpful bonus of outlawing abortion was that it could reverse the decreasing birth rates of white middle and upper class women. Speaking before a group of Maryland physicians, Georgetown obstetrician Joseph Tabor Johnson attempted to garner support for abortion laws by describing lawmakers across the country who had been “so alarmed in the decrease of the American element of their population,” and offering up the criminalization of abortion as a solution to that fearful decrease.36 Additionally, many male politicians viewed women who obtained abortions as examples of a frightening trend: the rise of independent, educated females. As one physician remarked in 1859, women who aborted pregnancies were “strong-minded,” an undesirable trait in a woman at the time.37 In the second half of the 19th century, as women began seeking out higher education, entering the workforce in increased numbers, and agitating for political power, many men in power fought back in a variety of ways, often stressing Victorian commitments to female fragility, domesticity, and dependence. According to many politicians, outlawing abortion and tamping down on independent decisions made by worrisome “strong-minded” women could only benefit the future of the country. These men were stunningly successful. By the 1880s, even though popular opinion opposed laws against abortion, every state in the union had passed them.38
American women soon faced similar obstacles in their efforts to access contraception. By 1900, almost 40 percent of Americans lived in cities, and along with the increasing images and texts dealing with reproduction, many urban dwellers also noticed an increase in material dealing with sex.39 As urban centers expanded and the commercialization of sex boomed, many moral reformers sought to outlaw items, expressions, and performances that they considered obscene. One reformer, Anthony Comstock, targeted contraception. Horrified by the increasingly public nature and commercial exploitation of sex, Comstock formed the New York Society for the Suppression of Vice and, in 1873, authored a federal anti-obscenity bill. The bill outlawed sending obscene materials through the US mail, including any “article of an immoral nature, or any drug or medicine, or any article whatever for the prevention of conception.” In the next few years, 24 states passed mini-Comstock laws outlawing the sale, distribution, and even use of contraceptives.40
By the late 1870s, abortion and contraception had been driven underground. While many women with the money and the connections could obtain abortions or contraceptive information from their family doctors, most had to rely on black market sources for contraceptive devices and potions of dubious safety and effectiveness. Major retailers like Sears, Roebuck & Co. skirted the law through clever marketing; they continued to advertise douching syringes, vaginal inserts, and male caps, but sold them not as contraceptives but as products for the prevention or treatment of disease or for general health concerns. Thus, the most obvious shift for many contraceptive vendors after Comstock was in the language they used to describe their wares. Goods previously marketed for use as birth control became products for the “protection” or “safety” of the health of “married women.”41
As educated physicians saw the success of their professionalization efforts through the regulation of abortion and in the increased number of women coming to them for aid in childbirth, many looked to another reproductive concern of the time as a potential for increased income and professional authority: miscarriage. By the 1880s, doctors began informing women that miscarriage rates were frighteningly high (some physicians quoting the statistic that 90% of women would have at least one), and they were the most qualified practitioners to help a woman survive the experience and even to prevent the next one.42 While offering up little in the way of successful treatments or preventative for pregnancy loss, physicians were able to appeal to women in cases of prolonged miscarriage, retained placentas, and miscarriages that resulted in more serious infections.
In addition to growing their businesses and patient bases, physicians also discovered they could gain one more thing through helping women in cases of miscarriage: valuable scientific specimens. In an age of growing faith in the role of anatomy and physiology in understanding disease and health, many American physicians sought to obtain bodies for training and research but came up against legal and social restrictions to their access of adult cadavers.43 Fetal tissues that resulted from miscarriages became valuable tools for physicians, both in their ability to reveal the “truth” of the human body, but also in their portability and social acceptability. Many women handed over the material results of miscarriage to their attending doctors, perhaps finding some comfort in thinking of their miscarriage in terms of a specimen rather than a lost child, particularly if they welcomed a miscarriage in the face of no discernable method for curbing their fertility.44
By the close of the 19th century, American women had developed an entirely new relationship to reproduction compared to what their mothers or grandmothers had. In the early 1800s, fertility control was shrouded in mystery and myth. Women gave birth in their homes surrounded by trusted female attendants, and most women raised their children in rural areas alongside a community of people very similar to themselves. By the end of the 1800s, women were much more likely to know about multiple methods for preventing pregnancy, yet often unable to obtain them easily or legally, and many urban women gave birth assisted by a professional doctor. The social, economic, geographic, and demographic changes in 19th-century America transformed the act of giving birth (or preventing pregnancy) from a woman-controlled private endeavor, to a public, medical, and legal matter. While this shift may have provided some comfort for women who believed these changes could help them survive birth or would benefit the future of the country, it also pushed women further away from their own bodies by removing their options and their voices from modern reproduction.
Discussion of the Literature
During the past forty years, the historiography of women and reproduction has mirrored contemporary anxieties, political movements, and reproductive controversies surrounding gender, race, and sexuality. In the field’s early years, the 1970s, multiple scholars set out to chronicle the legal and medical histories of abortion and reproduction. Inspired by recent Supreme Court rulings—especially Eisenstadt v. Baird (1972) and Roe v. Wade (1973)—against laws that hindered women’s access to birth control and abortion, historians became interested in understanding when and why these practices were outlawed in the 19th century. However, from the very beginning, historians seemed conflicted about how to tell this story. Some male scholars viewed the 19th-century movement as a decision based on medical and legal forces, unfortunate for women but not surprising given Victorian ideals regarding sexual and racial purity of the time.45 A few female scholars, however, sought to tell this history as one of men’s encroaching control over women’s bodies, echoing feminist struggles of the 1970s.46 The gender divide among authors had a noticeable impact on the framework of the histories produced. Female historians, very few in number at the time and battling discriminations in their own working environments (such as offices with no women’s restrooms), viewed the history of abortion and contraception as a story of women’s freedom and power, often depicting women as victims of powerful white men.
By the late 1980s and through the 1990s, scholars expanded the purview of historical scholarship to include other reproductive issues, including childbirth, the social role of motherhood, and the role of women’s voices and women’s power in the medicalization efforts of the 19th century.47 Some scholars also endeavored to move beyond the woman-victim/doctor-villain model of earlier studies by examining the medicalization of reproduction as a woman-led movement. Historians fiercely debated these narratives, questioning whether interpretations that depicted women as responsible for their own subjugation advanced feminist goals.48
However, a decade later, historians of color began critiquing the scholarship, claiming that white scholarship had investigated only the viewpoint of white, mostly east-coast, middle- and upper-class women.49 Like the contemporaneous struggles within the women’s health movement over issues of race and health, historians of reproduction searched for the voices of underrepresented women. In the process, they discussed the utility and meaning of various sources for documenting the views and experiences of poor women and women of color. To the surprise of many 20th-century male historians, feminist scholars found women’s voices in the archive, among personal papers, and even in published materials. However, these early viewpoints still mostly belonged to white elites, leading some historians to conclude that the voices of women of color or poor women had not been documented.
In the late 1990s and early 2000s, some scholars challenged these conclusions. Looking beyond well-used sources—like popular magazines, family letters, and census records—historians began to understand how race, class, and ethnicity shaped women’s reproductive choices, decisions, and freedoms. In the last fifteen years, more and more studies have analyzed histories of contraception, abortion, and birth among enslaved, minority, and immigrant women.50 By focusing on previously neglected populations, scholars have uncovered new topics in the history of reproduction, such as reproduction under slavery, national ideals of motherhood based on class and race, and the circulation of fertility information and techniques between various racial and ethnic groups, while deepening our understanding of fertility control and childbirth to include issues and anxieties beyond those of white, middle-class, east-coast women.51
More recently, historians have begun to ponder what, or perhaps who, should be included in a history of reproduction beyond a more diverse population of female historical actors. Directed by recent efforts to prioritize the fetus in the abortion debate, liberal historians have long steered clear of placing unborn children at the center of their studies. While most feminist historians remain committed to prioritizing a woman’s experience in the history of reproduction, some have begun to include pregnancy and the fetus involved as important aspects of the history.52 Like early work on fertility control, some studies debate the merits and pitfalls of paying attention to the health and interests of the fetus over the health and interests of the pregnant woman.
For decades, historians generally believed that first-hand accounts regarding reproductive issues (assumed to be controversial and intensely private) were difficult, if not impossible, to find in archives. Multiple scholars have put that assumption to rest, illustrating the power of close readings of women’s letters, diaries, and other personal writings. Scattered in archives across the country (in state historical societies as well as archives focused on women’s history such as the Sophia Smith Collection at Smith College, the Sallie Bingham Center at Duke University, and the Schlesinger Archives in Women’s History at Radcliffe College), these collections remain under-examined by historians of reproduction. Scholars interested in pursuing this arduous but rewarding path can begin with digital databases of published personal writings, such as “North American Women’s Letters and Diaries.”53
While these collections and databases primarily present the views of white, English-speaking middle and upper-class women, historians have recently explored a variety of methods for accessing the viewpoints of women of color, and poor or immigrant women. Some archives, such as the Social Welfare History Archives at the University of Minnesota offer up writings of immigrant women. Another method used to some success is utilizing oral histories, such as the Library of Congress WPA interviews with former slaves and Native Americans.54 Clelia Mosher’s survey of sexual habits of American women, conducted from 1892 to 1920, offers historians a view into the reproductive interests of and restrictions upon individual women who lived in the latter half of the 19th century.55
More easily accessible viewpoints on 19th-century reproduction are published records by physicians. It was common for doctors to record individual cases in careful detail and publish them in medical journals such as American Journal of Obstetrics. Such publications not only provide insight into physicians’ medical beliefs and interests, but can also offer insight into the perspectives of the women involved, why they called on doctors and what they believed was happening with their bodies and their reproductive capacity.56 Hospital records also provide glimpses into health care practices on the ground, allowing historians to access a range of reproductive topics and examine the often-complicated gender and racial dynamics at play.57 Domestic health guides, a prolific genre throughout the 19th century, can be helpful in understanding the treatments and techniques available to women at the time, as well as in analyzing social constructions of motherhood, womanhood, and reproduction.58
Many historians have adeptly utilized popular women’s magazines and advertisements to better understand the regulation of reproduction, expectations of American mothers, and how women’s health concerns fit within a larger scope of the commodification of medicine.59 Governmental records, such as the census, collated by race, class, and geography, reveal reproductive patterns and insight into reproductive practices. Finally, court cases and state and federal legislation allow historians to understand the legal issues surrounding reproduction and to gain an understanding of social anxieties present at the time.
Beisel, Nicola. Imperiled Innocents: Anthony Comstock and Family Reproduction in Victorian America. Princeton, NJ: Princeton University Press, 1997.Find this resource:
Briggs, Laura. “‘Overcivilization’ and the ‘Savage’ Woman in Late Nineteenth-Century Obstetrics and Gynecology.” American Quarterly 52, no. 2 (2000): 246–273.Find this resource:
Brodie, Janet Farrell. Contraception and Abortion in Nineteenth-Century America. Ithaca, NY: Cornell University Press, 1994.Find this resource:
Gordon, Linda. “Voluntary Motherhood: The Beginnings of Feminist Birth Control Ideas in the United States.” Feminist Studies 1, no. 3/4 (1973): 5–22.Find this resource:
Leavitt, Judith Walzer. Brought to Bed: Childbearing in America, 1750–1950. New York: Oxford University Press, 1986.Find this resource:
Lewis, Jan. “Mother’s Love: The Construction of an Emotion in Nineteenth-Century America.” In Social History and Issues in Consciousness: Some Interdisciplinary Connections. Edited by Andrew E. Barnes and Peter N. Stearns, 209–229. New York: New York University Press, 1989.Find this resource:
Jennifer L. Morgan, Laboring Women: Reproduction and Gender in New World Slavery. Philadelphia: University of Pennsylvania Press, 2004.Find this resource:
Reagan, Leslie. When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867–1973. Berkeley: University of California Press, 1997.Find this resource:
Schwartz, Marie Jenkins. Birthing a Slave: Motherhood and Medicine in the Antebellum South. Cambridge, MA: Harvard University Press, 2006.Find this resource:
Smith-Rosenberg, Carroll, and Charles Rosenberg. “The Female Animal: Medical and Biological Views of Woman and Her Role in Nineteenth-Century America.” The Journal of American History 60, no. 2 (1973): 332–356.Find this resource:
Solinger, Rickie. “Racializing the Nation.” In Pregnancy and Power: A Short History of Reproductive Politics in America, 27–62. New York: New York University Press, 2007.Find this resource:
Stowe, Steven M. “Obstetrics and the Work of Doctoring in the Mid-Nineteenth-Century American South.” Bulletin of the History of Medicine 64, no. 4 (1990): 540–566.Find this resource:
Wood, Janice. “Prescription for a Periodical: Medicine, Sex, and Obscenity in the Nineteenth Century, As Told in ‘Dr. Foote’s Healthy Monthly’.” American Periodicals 18, no. 1 (2008): 26–44.Find this resource:
(1.) Alice Kirk Grierson, The Colonel’s Lady on the Western Frontier: The Correspondence of Alice Kirk Grierson (Lincoln: University of Nebraska Press, 1989), 58–60.
(2.) Steven Mintz and Susan Kellogg, Domestic Revolutions: A Social History of American Family Life (New York: The Free Press, 1988), 43–65; and Dorothy S. Brady, Output, Employment, and Productivity in the United States after 1800 (New York: National Bureau of Economic Research, 1966), 118.
(4.) While many historians have discussed republican motherhood, Linda K. Kerber is often named as the originator of the phrase. See Kerber, Women of the Republic: Intellect & Ideology in Revolutionary America (Chapel Hill: University of North Carolina Press, 1980).
(5.) Deborah Gray White, Ar’n’t I a Woman? Female Slaves in the Plantation South (New York: W. W. North, 1985), 62–90.
(6.) Marie Jenkins Schwartz, Birthing a Slave: Motherhood and Medicine in the Antebellum South (Cambridge, MA: Harvard University Press, 2006); and Ricking Solinger, Pregnancy and Power: A Short History of Reproductive Politics in America (New York: New York University Press, 2007), 27–62.
(7.) James Ewell, The Medical Companion: Or Family Physician (Washington, 1827), 516.
(8.) Janet Farrell Brodie, “Menstrual Interventions in the Nineteenth-Century United States,” in Regulating Menstruation: Beliefs, Practices, Interpretations, eds. Etienne Van De Walle and Elisha P. Renne (Chicago: University of Chicago Press, 2001), 39–63.
(9.) Jacqueline H. Wolf, Deliver Me from Pain: Anesthesia and Birth in America (Baltimore: Johns Hopkins University Press, 2009), 15–16; and Judith Walzer Leavitt, “Under the Shadow of Maternity: American Women’s Responses to Death and Debility Fears in Nineteenth-Century Childbirth,” Feminist Studies 12, no. 1 (1986): 129–154.
(10.) Irvine Loudon, Death in Childbirth: An International Study of Maternal Care and Maternal Mortality, 1800–1950 (Oxford: Clarendon Press, 1992), 49–106.
(12.) Leavitt, Brought to Bed, 114–141.
(13.) Susan E. Klepp, “Colds, Worms, and Hysteria: Menstrual Regulation in Eighteenth-Century America,” in Regulating Menstruation, 22–38.
(14.) James Mohr, Abortion in America: The Origins and Evolutions of National Policy, 1800–1900 (New York: Oxford University Press, 1978), 20–45.
(15.) Linda Gordon, The Moral Property of Women: A History of Birth Control Politics in America (Urbana: University of Illinois Press, 2007), 32.
(16.) U. S. Bureau of the Census, Historical Statistics of the United States, Colonial Times to 1970 (Washington, DC, 1975); and Haines, “Fertility and Mortality in the United States.”
(18.) U. S. Department of Labor, History of Wages in the United States from Colonial Times to 1928 (Washington, DC: Government Printing Office, 1934), 136–139.
(19.) Gordon, The Moral Property of Women, 32.
(20.) Vern L. Bullough, “A Brief Note on Rubber Technology and Contraception: The Diaphragm and the Condom,” Technology and Culture 22, no. 1 (1981): 104–111; and Andrea Tone, Devices and Desires: A History of Contraceptives in America (New York: Hill and Wang, 2001), 14.
(21.) Brodie, Contraception and Abortion in Nineteenth-Century America, 87–135; and Tone, Devices and Desires, 47–66.
(22.) Brodie, Contraception and Abortion in Nineteenth-Century America, 224–231.
(23.) Mohr, Abortion in America, 90.
(24.) Mohr, Abortion in America, 86–118
(25.) Schwartz, Birthing a Slave; Sharla M. Fett, Working Cures: Healing, Health, and Power on Southern Slave Plantations (Chapel Hill: University of North Carolina Press, 2002); Darlene Clark Hine, “Female Slave Resistance: The Economics of Sex,” Western Journal of Black Studies 3, no. 2 (1979); 123–127; and White, Ar’n’t I a Woman?
(26.) Leavitt, Brought to Bed, 12.
(27.) Wolf, Deliver Me From Pain, 13–17.
(28.) Miriam Rich, “The Curse of the Civilised Woman: Race, Gender, and the Pain of Childbirth in Nineteenth-Century American Medicine,” Gender and History 28, no. 1 (April 2016): 57–76.
(29.) Leavitt, Brought to Bed, 64–86.
(30.) Laurel Thatcher Ulrich, “‘The Living Mother of a Living Child’: Midwifery and Mortality in Post-Revolutionary New England,” The William and Mary Quarterly 46 (1989): 27–48; and Charles King, “The New York Maternal Mortality Study: A Conflict of Professionalization,” Bulletin of the History of Medicine 65 (1991): 476–502.
(31.) Annual Report of the New England Hospital for Women and Children For the Year Ending November 10, 1864, New England Hospital Records, Box 2, folder 1, Sophia Smith Collection, Smith College, Northampton, MA. For more on Zakrzewska and her hospital, see Arlene Tuchman, Science Has No Sex: The Life of Marie Zakrzewska, M. D. (Chapel Hill: University of North Carolina Press, 2006).
(32.) Leavitt, Brought to Bed, 171–195.
(33.) For stories of such midwives, see, for example, see Margaret Charles Smith, Listen to Me Good: The Story of an Alabama Midwife (Columbus: Ohio State University Press, 1996); and Susan Lynn Smith, Japanese American Midwives: Culture, Community, and Health Politics, 1880–1950 (Urbana: University of Illinois Press, 2005).
(34.) Deirdre Cooper Owens, Medical Bondage: Race, Gender, and the Origins of American Gynecology (Athens: University of Georgia Press, 2017), 15–41; and Deborah Kuhn McGregor, From Midwives to Medicine: The Birth of American Gynecology (New Brunswick, NJ: Rutgers University Press, 1998), 33–68.
(35.) Campbell J. Gibson and Emily Lennon, “Historical Census Statistics on the Foreign-Born Population of the United States: 1850–1990.” Population Division Working Paper No. 29 (US Census Bureau, Washington, DC, 1999).
(36.) Joseph Tabor Johnson, “Abortion and Its Effects,” Transactions of the Medical and Chirugical Faculty of the State of Maryland (1889): 159–172, and quote on p. 162.
(37.) Quoted in Mohr, Abortion in America, 105.
(38.) Mohr, Abortion in America, 147–199.
(39.) Tone, Devices and Desires, 10.
(40.) Tone, Devices and Desires, 3–24.
(41.) Tone, Devices and Desires, 47–90.
(42.) See, for example, Henry P. Newman, “Remarks on the Treatment of Inevitable Abortion,” Journal of the American Medical Association 29, no. 22 (1897): 1085–1086.
(43.) Michael Sappol, A Traffic of Dead Bodies: Anatomy and Embodied Social Identity in Nineteenth-Century America (Princeton, NJ: Princeton University Press, 2002).
(44.) Shannon K. Withycombe, “From Women’s Expectations to Scientific Specimens: The Fate of Miscarriage Materials in Nineteenth-Century America,” Social History of Medicine 28, no. 2 (2015): 245–262.
(45.) See, for example. Mohr, Abortion in America; and James Reed, From Private Vice to Public Virtue: The Birth Control Movement and American Society Since 1830 (New York: Basic Books, 1978).
(46.) Linda Gordon, Woman’s Body, Woman’s Right: A Social History of Birth Control in America (New York: Grossman, 1976); Barbara Ehrenreich and Deirdre English, Withces, Midwives, and Nurses: A History of Women Healers (New York: The Feminist Press, 1973); and Ehrenreich and English, For Her Own Good: 150 Years of the Experts’ Advice to Women (New York: Anchor Books, 1978).
(47.) Leavitt, Brought to Bed; Richard W. Wertz and Dorothy C. Wertz, Lying-In: A History of Childbirth in America (New Haven: CT: Yale University Press, 1989); Molly Ladd-Taylor, Mother-Work: Women, Child Welfare, and the State, 1890–1930 (Urbana: University of Illinois Press, 1994); Janet L. Golden, A Social History of Wet Nursing in America: From Breast to Bottle (New York: Cambridge University Press, 1996); Julia Grant, Raising Baby by the Book (New Haven, CT: Yale University Press, 1998); Sally G. McMillen, Motherhood in the Old South: Pregnancy, Childbirth, and Infant Rearing (Baton Rouge: Louisiana State University Press, 1990); and Charlotte Borst, Catching Babies: The Professionalization of Chidlbirth, 1870–1920 (Cambridge: Harvard University Press, 1995).
(48.) The most widely discussed and debated interpretation at the time was Leavitt’s Brought to Bed, which seemed to conflict with Ehrenrich and English’s claims of female victimhood. For examples of both sides of the debate, see Judy Barrett Litoff’s review of Brought to Bed in American Historical Review 93 (1988): 221–222; and Molly Ladd-Taylor’s review in The Journal of Interdisciplinary History 19 (1988): 353–354.
(49.) For example, see Dorothy E. Roberts, Killing the Black Body: Race, Reproduction, and the Meaning of Liberty (New York: Pantheon Books, 1997); and Rickie Solinger, Wake Up Little Susie: Single Pregnancy and Race before Roe v. Wade (New York: Routledge, 1992).
(50.) For example, see Jennifer L. Morgan, Laboring Women: Reproduction and Gender in New World Slavery (Philadelphia: University of Pennsylvania Press, 2004); and Owens, Medical Bondage; and Schwartz, Birthing a Slave.
(51.) See, for example, Tone, Devices and Desires; Leslie Reagan, When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867–1973 (Berkeley: University of California Press, 1997); and Jacqueline Wolf, Deliver Me From Pain: Anesthesia and Birth in America (Baltimore: Johns Hopkins University Press, 2009).
(52.) See, for example, Lynn M. Morgan, Icons of Life: A Cultural History of Human Embryos (Berkeley: University of California Press, 2009); Sara Dubow, Ourselves Unborn: A History of the Fetus in Modern America (New York: Oxford University Press, 2011); and Shannon K. Withycombe, “From Women’s Expectations to Scientific Specimens: The Fate of Miscarriage Materials in Nineteenth-Century America,” Social History of Medicine 28, no. 2 (2015): 245–262.
(53.) Many university libraries hold a subscription to this collection.
(54.) While the collection is titled “Born in Slavery,” William J. Bauer Jr. has recently demonstrated the utility of the collection for accessing Native experiences as well in California through Native Eyes: Reclaiming History (Seattle: University of Washington Press, 2016).
(55.) Clelia Duel Mosher, The Mosher Survey: Sexual Attitudes of 45 Victorian Women (New York: Arno Press, 1980).
(56.) Many of these journals are digitally available through Google Books, although the database is difficult to browse and it is best for searching a particular title or author. To find articles by subject, it is easier to use the Index-Catalogue of the Library of the Surgeon General’s Office, the NIH National Library of Medicine, which can be accessed digitally.
(58.) Many are available through Google Books.