Ancient Abortion: Lessons in Medical Ethics


“Thirteenth century depiction of an herbalist preparing pennyroyal, a traditional herbal abortifacient,” (7: p. 56)


In October 2020, thousands of Polish protesters objected newly introduced, exceedingly strict abortion laws, and actively continue to do so in the first weeks of 2021 (1). Clearly, the discussion on the moral and legal status of abortion persists. Although abortion laws have been growing more liberal globally, the trajectory towards pro-choice legislation has been anything but linear (2). In fact, from Ancient Mesopotamia to Tudor England, ideologies surrounding termination procedures have run the gamut. In exploring this diversity, I believe history can provide valuable insight into the complexity and importance of this conversation in modern context.


The history of abortive procedures and remedies is impressively long. The first indications of the use of abortifacients come from Ancient China, where folklore suggests their use nearly 5000 years ago (3,4). Furthermore, abortion has been linked to Ancient Egyptian civilization through a well-known medical manuscript, Ebers Papyrus. It outlines methods for terminating pregnancy using mixtures of honey and dates, and has been said to include credible information from 3000 B.C. (4). Essentially, abortion has been around nearly as long as pregnancy.


Much is known about the Greco-Roman perspective on abortion. Most of us are somewhat familiar with the Hippocratic Oath, which applies to all practicing physicians. It claims that a medical doctor cannot “… give a suppository to cause an abortion” (5). However, a closer analysis reveals that Hippocrates himself is perhaps not the original author of parts of the Oath, or that translations with Pythagorean influence warped the original anti-poison intention of the statement (3). It is even said that Hippocrates himself provided instructions for abortion despite his reservations against potentially harmful herbal remedies (6). The pioneering Roman gynaecologist, Soranus, made similar claims about women’s safety. However, he belonged to a society where abortion anxieties remained high due to the patriarchical structure of Rome, which held that abortion gave women an uncomfortable level of familial agency (7). We’ll find this is a common theme. Finally, it wasn’t just Greco-Roman doctors who spoke on abortion so neutrally. The famed Greek writers Aristophanes, Procopius, and Ovid included references to abortive methods and herbs in their works, revealing a certain level of public knowledge and acceptance (7).


Another historical perspective comes from the Ancient Persians. In this society, abortion was strictly prohibited under Zoroastrianism, the prevalent religion in the Middle East pre-dating Islam. Their belief was that abortion was akin to “cutting out the roots of life and the most important blessing of God,” and harsh punishments were administered to any who attempted or assisted an abortion. However, the Persians took strong preventative measures against it, both prepartum and postpartum (3). A guardian was to offer aid to the family, and if any individual partially responsible for the pregnancy, like the father, was absent for the birth, the persons immediately closest to the mother would be called upon to assist. Postpartum, it was established that if the father was absent during delivery, the individual who was present would be responsible for care of the mother and child for the following 7 years. If at any point after fertilisation the mother or foetus was endangered, the guardian would be punished as if they had essentially facilitated abortion (3). In addition, mothers working in government were offered maternal leave, food allowances, and opportunities for the father to take on additional work. Men and women were allowed to work independently and were generally viewed as equals (3).


Interlaced with much of the later history of abortion is Christianity. Recalling the Greco-Roman period, it has been suggested that translations of the Hippocratic Oath were diluted in the medieval period to satisfy ecclesiastical authority (5). This brings us to Tudor England, where Catholic and Anglican teachings both held abortion as morally repugnant. This progression was clearly steeped not only in religious dogma but also in male hegemony (7). Much of this mistrust of women was demonstrated throughout the 15th century “Witch Craze,” which painted women with knowledge of herbs (including abortifacients) as suspicious and conniving. Despite this, midwives and herbalists like the famous Jane Sharpe continued to share knowledge of abortive substances in their published works with what history interprets as half-hearted attempts to discourage their use amid fear of persecution (7). Tudor women seemed to have exercised more control over their fertility than authorities may have assumed, sharing information about abortive practices amongst themselves to suppress evidence of promiscuity and avoid potentially fatal outcomes of unsanitary hospital births (7).


The past 7,000 years of medicine and ideology surrounding abortion have been a whirlwind. However, one thing is clear: it is here to stay. Regardless of the level of legal restriction, rates of abortion today remain consistent in nearly every country. The difference is only made in how many of these are safe procedures, with only 25% in legislatively restrictive countries being considered safe compared to 90% in more liberal regions (2). For those invested in Hippocrates’ word on the issue, I may suggest taking a renewed focus on patient well-being. I make no comment on the validity of any of these cultures’ views on abortion. But what do we want our chapter of history to look like? Which of these echoes of the past do you want your culture to resonate with? I hope the shadows of history can cast some shades of gray on the black and white views that divide too many of us.


References

  1. Mortensen, A. Poland puts new restrictions on abortion into effect. CNN [Online]. 2021 Jan 28 [cited 12th Feb 2021]. Available from: https://www.cnn.com/2021/01/28/europe/poland-abortion-restrictions-law-intl-hnk/index.html

  2. Abortion Law: Global Comparisons. [Online] Council on Foreign Relations. Available from: https://www.cfr.org/article/abortion-law-global-comparisons [Accessed: 11th February 2021]

  3. Yarmohammadi H, Zargaran A, Vatanpour A, Abedini E, Adhami S. An investigation into the ancient abortion laws: comparing ancient Persia with ancient Greece and Rome. Acta medico-historica adriatica: AMHA. 2013;11(2): 291–298. Available from: https://pubmed.ncbi.nlm.nih.gov/24304111/

  4. Head, T. When Did Abortion Begin?. [Online] ThoughtCo. Available from: https://www.thoughtco.com/when-did-abortion-begin-721090 [Accessed: 11th February 2021]

  5. Smith L. Abortion in the classical world. Journal of Family Planning and Reproductive Health Care. [Online] British Medical Journal Publishing Group; 2012;38(2): 125–126. Available from: doi:10.1136/jfprhc-2012-100313

  6. Fox P. How Abortion Was Handled in the Ancient and Premodern World. [Online] ThoughtCo. Available from: https://www.thoughtco.com/abortion-in-the-premodern-world-3528230 [Accessed: 11th February 2021]

  7. Gradwohl A. Herbal abortifacients and their classical heritage in Tudor England. Penn History Review. 2013;20(1):3.

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