Women who suffered from septic infections after risky attempts at abortions using sharp objects like knitting needles and coat hangers were common sights for doctors who learned medicine in the days before the Roe v. Wade Supreme Court case was decided in 1973, establishing the right to abortion in the United States.
Sarasota OB-GYN Dr. Washington Hill remembers treating women who sought abortion through illegal or dangerous means. He spoke with Health News Florida's Kerry Sheridan about learning medicine at that time, and what a new generation of doctors may need to expect if abortion is outlawed in some states. Here is a transcript of their interview, which has been lightly edited for time and clarity.
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When did you start practicing medicine and can you share some of your experiences from the time before abortion was legal in all states?
I graduated from medical school in 1965 from Temple University in North Philadelphia. Times were very different. There were two things that I remember. One was there was a pathology room. And you would go in and look at the various pathology specimens —might be a brain, heart, whatever. And I remember the specimens were in formaldehyde, and in a gallon jug, and you would take a look at it when you were on pathology. And I clearly remember one of the specimens was a uterus with a fetus inside and a knitting needle and the knitting needle had completely missed the fetus.
And that that made an impression. This was not a surgical specimen. This was a pathological specimen, and probably was a pathological specimen from someone who had tried an unsafe abortion method. And certainly, in those days, knitting needles, anything sharp, clothes hanger, permanganate, those are the type of things that we had seen.
The second thing that impressed me was going to the emergency room at Temple University Hospital and taking care of patients who had an attempt at an abortion. And now they were septic. They were very, very sick; odor is coming out of the vagina, pus, that type of thing, very, very infected. And they needed care. And I think many of us at that time learned how to take care of a septic patient from taking care of patients who had had an unsafe abortion. [We’d administer] antibiotics, empty the uterus, and watch the patient closely. So those were two impressions that I can remember very well."
When you say a lot of us learned that, do you mean medical students learning to be obstetricians or medical students in general?
Medical students in general, because many medical students rotate to the emergency room.
The interesting thing that has happened, is there are not a lot of us who remember that. Whether that's because they don't want to talk about it, or because we're getting older. There just aren't a lot.
When I was at ACOG (the annual meeting of the American College of Obstetricians and Gynecologists, May 6-8 in San Diego), I asked some colleagues, I said, "Do you remember medicine before Roe vs. Wade?’" And they said no.
So there aren't a lot who remember what happened before Roe v. Wade? How could that be? I mean, how old are you? Dr. Hill?
I'm 83. At least my twin brother is 83 (laughs). And, you know, I am a seasoned physician, as my friends tell me.
You were early in your career about 50 years ago, when Roe was decided? What's your memory of that?
I remember that once Roe vs. Wade was decided, that abortion was legal. And this gave women an opportunity to control their body. If they were ready for a pregnancy, I always felt that I would provide them the best care possible. And I believe the record shows I've done that. And if they did not want a pregnancy, I was going to provide them the best care possible. And I've done that in the past. My whole life.
Did you encounter other doctors or medical students who were in your group that were opposed to abortion or who had decided they didn't want to learn that?
Yes. And throughout my life, I have known and respected those who say, I am pro-life and I do not want to learn about abortion or be involved. And the answer to them is, ‘please refer the patient to someone who can take care of them.’ And the same thing in the operating room. And this has always been the case. It would be the case today. If a nurse or an anesthesiologist or someone said, ‘I'm pro-life, and I don't want to be involved in this case,’ then they would not have to be involved in the case.
For sure, there are doctors who are not interested in learning how to perform an abortion. And respectfully, they do not have to. However, you will find instances in your career as an OB-GYN where a woman is having a miscarriage, or unfortunately has had a miscarriage and is now infected. Now they need to evacuate the uterus. And they need to know how to do that. And as a teacher, we teach them how to do that."
You said you went to the ACOG conference recently. And I was wondering what kinds of conversations you had with other OB-GYNs there about this moment that we're entering and what they remember — or don't — about the past?
Well, there was another doctor there. I forgot where he was from. He knew me. I didn't quite remember his name. But we chatted some about OB-GYN before Roe vs. Wade. And he certainly remembered treating patients who were very sick, some of them on occasion dying because of unsafe abortions. But most of the people there clearly were young. Some of them were medical students. Some were residents, some were fellows, some were folks early in practice. And they had no idea of what happened before Roe v. Wade.
I remember I was chatting with a group in the exhibit hall and talking about reproductive rights. And some of them were (standing there with their) mouths wide open. "I had no idea that this kind of thing happened before Roe versus Wade.’" Others had read about it. But most had no idea. And I just encouraged them to keep doing what they were doing, and to advocate as they were doing for complete reproductive rights.
It was very heartwarming to see young people in their 30s. Many of them had, like a one year old cuddling in their arm. So you knew they were young women. And they said they were very much involved, where they came from, advocating for reproductive rights. They also were advocating for diversity, equity, inclusion. So you know, that was very heartwarming to me.
There's a lot of talk about how these conversations should be between a woman and her doctor. You are a doctor. What do people who may not be intimately involved with this not understand about all the different kinds of circumstances that women encounter?
There are so many stories that I have, and so many women who have touched my life. It is clear that women should have control over their body. I just don't have any question about that. And that's why I told you, I take care of high-risk women and do the best I can and take care of women who may say, I'm not ready for this pregnancy. I need a referral. I think that's a woman's right. That's her right, that she should have access to reproductive services. I don't see that as something astonishing. I just see that as the truth.
And I think that certainly, the data shows that most individuals in this country agree with me. Now, there are some who do not. I respect their opinion. There are some in Sarasota who do not. I respect their opinion, I just disagree with it, and I will work hard to help women find the necessary services that they need.
Do you think that students need to be learning things that you learned before Roe about how to treat women who may be coming in due to complications of attempting to have abortions on their own or illegally, if this does become illegal?
I think that we are going to have to teach medical students and residents, that when a woman comes in, and may have had an attempt at a unsafe abortion, what to look for. Another way to put it is when a woman comes in and has an infection and is pregnant, to ask that question, ‘Was there an attempt at an unsafe abortion?’ You know, there's, there's a tact to doing that. But we will have to go back and start asking those questions.
I think there certainly will be ways for women to have an abortion. Women around the world who have an unwanted pregnancy find a way to terminate that pregnancy. Now, that's a fact. And I've been around the world. So we will have to recognize that fact, and then deal with it. And I think that's something that we have not had to deal with in the past.
The other thing that's important to remember is that women of color, Black women, Brown women, poor women, they're the ones who are going to have difficulty going out of state to have a termination, even with the help of funds that are being donated to agencies who are helping solve the problem. But still women of color need to get that information. That's one of the very important things, where can I go? What do I do now? Where do I get the funds, etc.
And making sure that they don't go to places that practice unsafe abortions. They're going to creep up. You're going to hear about them in your lifetime, the doctor so-and-so or nurse so-and-so or Mr. so-and-so who was doing unsafe abortions in their house or home or facility. So we need to get that information out about the importance of — if you're going to terminate a pregnancy, then let's talk about the safest way that you can get it done.
It's so interesting to hear you talk about it. I was born the year that Roe was decided. And what would you tell people -- how do we prepare for this moment, if Roe is overturned? I mean, how do we prepare for the years ahead?
I think we, those of us who knew the practice before Roe v. Wade, have to speak up and say, ‘This is what the situation was.’ We're sharing with you the truth. We're sharing with you our experience, that women will find a way to end a pregnancy if that is their desire, either because of timing or abnormality or whatever, they will find a way. And these are the problems that occurred, that women got sick and some of them died. And we have to find a way now to make sure that every woman, every woman has the opportunity to access complete reproductive services. And complete reproductive services includes abortion, which is health care.
As you mentioned, it can be difficult and seem possibly insurmountable for people with fewer means, people of color, and these are the women who are going to be most affected by this.
And that's why an important part of this is marketing. Marketing to those who least know about it, just like we did with the (coronavirus) vaccination, we had to market it to the Black and Brown people, we had to share with them the importance of getting vaccinated. We now have to do something similar. We have to market to them, OK? This is the situation now. These are your options. This is how you can access the funds, etc. So that marketing piece will be very important, especially the piece of making sure that you don't go to someone who is not qualified, and where you would be having an unsafe abortion and putting your life at risk. So that will be very important. And there are funds available to do that.
I wonder if we have to re-experience some of the trauma that people went through at that time in order to get back to a position where it's a protected right.
I don't think we'll get back to the trauma. I'm hanging on that word. Because you can now have a medical abortion, you can get pills, and if early enough, you will be able to have a medical abortion. So that eliminates the trauma of the case I told you where somebody tried to knit a needle on the fetus that looked like it was 16 weeks, or whatever. So hopefully, we won't have that. However, as you know, there are efforts to even keep the pills from being sent from one state to another state. And I just think that that's horrible. That shouldn't happen. But there are efforts as you know, to keep practitioners in one state from sending those pills to someone in another state.
Is there anything that I didn't ask you that you want me to know? Or wanted to tell me about?
I hope we do not go back to the days when I was in medical school. I will add one other thing. And that is, as you probably know, I spent two years in Africa, teaching medical students, as I always say, anyone who would sit still long enough, as part of the Clinton (Health Access Initiative) program for global health, and it was clear that those countries where abortion was legal had lower maternal mortality rates than those countries where it was illegal.
And that's because those where it was illegal found a way. But unfortunately, they found a way that ended up with maternal morbidity and mortality. And I think we have to learn from that. And that is that women will find a way to terminate their pregnancy it can be either safely or unsafely, but they're going to find a way. And many of those women are Black or Brown, they live in rural areas. They don't live in the city. They don't have access, they may not have the funds, etc. But they will find a way. And unfortunately, we're going to end up with women being sick, unable to conceive in the future, and some of them will die.
Where did you work in Africa? What countries were you in?
In Rwanda, abortion was legal. But there were some countries where it was not, and the medicine used to induce normal labor could also be used to perform abortion. And I can remember going to some countries to labor and delivery and saying, ‘Where is your medicine for hemorrhage?’ And one of the medicines for hemorrhage can also be used for abortion. And I can remember them saying, ‘Oh, I gotta find it.’ So why is it so hard to find? Well, because it disappears and is used for illegal abortion. So they had to keep it under lock and key, which is, I guess, a good thing. But then in the middle of the night, when you needed to save a woman's life, because she was hemorrhaging. No one could find the key, or where it was hidden.
Wow, that's incredible. You are saying that this is part of human nature. That women, they do find a way.
They're going to find a way, because the time is not right, or for the children, or an abnormality… I've thought about it, talked about it, prayed about it, and decided, I'm not ready for this deformed or disabled child. That's a woman's right. She says that, then we have to find a way for her to safely and legally have a termination.
Well, thank you so much, Dr. Washington Hill, for your willingness to share your memories and your perspective. So valuable. Thank you.
Thank you, Kerry, for the opportunity.
