Abortion Has Always Been More Than Health Care

The week before the 2024 election, a gut-wrenching advertisement created by a progressive campaign fund went viral. A young woman lays curled up on her living room floor, sobbing. Her frantic partner is on the phone, begging a doctor to tell him what to do. An authoritative male voice answers: “She needs an abortion or she’s going to die from the pregnancy.” An older white man wearing a red tie suddenly appears and says: “Sorry, that’s not happening. I’m your Republican Congressman. Now that we’re in charge, we banned abortion.” The ad exhorts viewers to “Save her life.” The woman never speaks.

The ad seized on a series of horrifying, real life stories of pregnant women left to bleed out in parking lots, drive to multiple states to outrun sepsis, and die in a hospital surrounded by medical professionals. These women experienced medical emergencies and needed abortions, which state bans prohibited. In response, advocates, commentators, and legislators shamed states for preventing doctors from doing their jobs, using the near-constant refrain that “abortion is health care.”

Abortion is health care in the broad sense of the term, and certainly in the instances described above. The World Health Organization defines health “as a state of complete physical, mental and social well-being,” and abortion promotes all of these. The underlying message, however, isn’t just that abortion promotes health, but that health care is politically neutral, and that it’s grounded in medical expertise and objective professional judgment.

But in fact, many feminists working towards abortion rights in the 1960s and '70s would have viewed this framing with suspicion—if not vehement disagreement. The movement to reform criminal abortion laws coincided with increased skepticism toward the medical profession by the Patients’ Rights and Women’s Health movements, which challenged what they saw as paternalistic, patriarchal, and profit-driven physicians. Although some activists believed that organized medicine could be reformed through government regulation and patient education, others thought medicine itself was a lost cause because of the hierarchy that placed “expert” doctors above patients.

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The Women’s Health Movement was just one part of the broader second-wave feminist movement that began in the 1960s. These feminists rejected traditional gender roles, demanded equality in the workplace, and fought to extend control over reproduction made possible by recent technological advances such as “the Pill.” This included fighting to legalize abortion.

Many feminists rejected the idea that the medical profession should have any say in abortion. The Redstockings, a radical feminist group in New York, interrupted a 1969 hearing about proposed reforms to the state’s criminal abortion law, at which 14 men (mostly doctors and lawyers) and just one woman (a nun) were scheduled to speak. Members of the Redstockings shouted, “Alright, now let’s hear from some real experts—the women.”

That same year, women rather than doctors challenged a criminal abortion statute’s constitutionality for the first time in the case Abramowicz v. Lefkowitz. Drawing on the idea that a woman’s lived experience was expertise, the lawyers in Abramowicz called women to share their abortion stories as witnesses at trial as an alternative to medical “expert” testimony.

Professional medical groups also supported abortion law reform, but their approach departed dramatically from that of feminists. Although some physicians believed abortion was a woman’s right, many simply wanted to shield their professional domain from government interference. Some doctors wanted to perform abortions that they deemed necessary but feared that legalizing abortion would give their female patients too much power. At a medical conference in 1970, Alan Guttmacher, Planned Parenthood president and namesake of the Guttmacher Institute, worried that abortion reform would force doctors to “rubber stamp” women’s decisions. Another physician expressed concern about doctors losing their respected role in society because “[l]egal abortion makes the patient truly the physician: she makes the diagnosis and establishes the therapy.”

A 1970 American Medical Association resolution urged lawmakers to allow abortions for economic and social reasons, but only if the final decision was made by three physicians “according to their sound clinical judgment.” The resolution emphasized that abortion should not be provided on “mere acquiescence to the patient’s demand” — a clear rebuttal to feminists’ call for “abortion on demand and without apology.”

Read More: How Doctors Came to Play a Key Role in the Abortion Debate

As physicians debated threats to their authority, feminists worked to move reproductive care out of exam rooms. In 1971, Carol Downer, founder of the radical Self-Help wing of the Women’s Health Movement, pioneered the “self-exam,” which allowed women to complete their own pelvic exams using a mirror and speculum. Downer’s colleague Lorraine Rothman developed the “Del-Em” device (short for “dirty little machine”) to “extract” one’s period before it started. Although menstrual extraction would end an early pregnancy, it also allowed women “to enjoy the convenience and comfort of a five minute as opposed to a five day menstrual period” and facilitated direct control over their bodies. This practice avoided the fraught legal and medical debates surrounding abortion altogether. As one woman wrote of her menstrual extraction group, “We simply are not concerned enough with the question of a possible fertilized egg to include it in our thinking.”

Sidestepping the legal and medical questions around reproduction did not mean that feminists saw the practice of menstrual extraction as apolitical. To the contrary, these feminists saw creating alternatives to organized medicine as inexorably tied to their political power. In 1972, radical members of the Women’s Health Movement compared a gathering in Iowa City to the 1848 Women’s Rights Convention organized by Elizabeth Cady Stanton in Seneca Falls, which introduced the Declaration of Sentiments. One feminist wrote that women learning about their own bodies “is POLITICAL. Just as it is POLITICAL that today almost all gynecologists are male! Thus the message of gynecological Self Help is POLITICAL in the extreme.”

In January 1973, the Supreme Court struck down state abortion bans in Roe v. Wade, holding that women had a constitutional right to abortion. Although Roe invoked women’s rights, it also bolstered physicians’ authority. Justice Blackmun, who counseled the Mayo Clinic as a lawyer, wrote that “the abortion decision in all its aspects is inherently, and primarily, a medical decision.” After Roe struck down criminal abortion laws, the supply of legal abortions expanded, but many feminists remained deeply skeptical of the patriarchal structure of medicine. Writer Dorothy Tennov published an article in 1972 predicting the limits of legal abortion. “Abortions may become plentiful,” she wrote, “but good medical care and respectful treatment of patients are very scarce indeed, and patients know it.”

To protect women seeking abortions after Roe, Women’s Health Movement activists crowdsourced information about doctors, published “How to Pick Your Abortion Clinic” guides, and confiscated medical supplies from unscrupulous providers. They also founded “woman-controlled” clinics. Although they hired physicians to perform legal abortions, they banned the traditional white lab coat and often insisted on calling doctors by their first names.

Read More: Why Abortion and Trans Rights Activists Have Found Common Cause

This vision of reproductive freedom was not limited to clinic-based abortion care provided by medical professionals, and certainly not limited by Roe’s idea that a “responsible physician” should make decisions about abortion. Nonetheless, since Roe, relying on doctors as representatives of the abortion rights movement has become commonplace. Doctors appear as surrogates of their patients in political debates and have served as plaintiffs in nearly every abortion case before the Supreme Court in the past half century.

Before Roe was overturned, a crisis in clinical abortion access led many women to self-manage their abortions. As the likelihood of nationwide restrictions on abortion grows, so too will the number of women turning to self-managed abortion using options such as AidAccess, which safely provide abortion pills without a prescription or medical supervision.

But like feminists in the 1960s and '70s, those calling for the return of Roe should widen their vision of abortion rights beyond the clinic. Deferring to expertise and professional judgment is rhetorically powerful, but it primes us to think about abortion rights as a matter of medical judgment instead of equality and autonomy. Abortion promotes health, but as many feminist activists have long argued, abortion should not be legal or accessible just because it is health care.

Christen Hammock Jones is a PhD student in legal history at the University of Pennsylvania and former reproductive rights litigator.

Made by History takes readers beyond the headlines with articles written and edited by professional historians. Learn more about Made by History at TIME here. Opinions expressed do not necessarily reflect the views of TIME editors.