Access : inside the abortion underground and the sixty-year battle for reproductive freedom / Rebecca Grant.

Enhanced descriptions from Syndetics:

From the award-winning author of Birth , a journey into the underground activist networks that have been working to protect women's autonomy over their bodies amidst legal, political, religious, and cultural oppression over the past sixty years.

In this definitive, eye-opening history, award-winning author Rebecca Grant charts the reproductive freedom movement from the days before Roe through the seismic impact of Dobbs . The stories in Access span four continents, tracing strategies across generations and borders. Grant centers those activists who have been engaged in direct action to help people get the abortions they need. Their efforts involve no small measure of daring-do, spy craft, sea adventures, close calls, undercover operations, smuggling, sequins, legal dramas, victories, defeats, and above all, a deeply held conviction that all the risks are worth it for the cause.

In Access , we meet a cast of brave, bold, and unforgettable women: the founders of the Jane Collective, a group of anonymous providers working clandestinely between Chicago apartments to perform abortions in the pre- Roe years ; the originators and leaders of the abortion fund movement; Verónica Cruz Sánchez, a Mexican activist who works to support self-managed abortion with pills and fights to free women targeted by the criminalization of abortion; and Rebecca Gomperts, a Dutch doctor who realizes that there is one place abortion bans cannot reach: international waters.

Post- Dobbs , activist groups have once again stepped up and put themselves on the line to resist. Building on the work of their feminist forebearers and international allies, they are charting new pathways for access in the face of unprecedented acts to subjugate and control half of America's population. Working above ground, underground, and in legal gray areas, they've helped people travel across state lines for care, established telehealth practices, and formed community networks to distribute pills for free to people who needed them.

Drawing on expert research and investigative reporting, told with deep compassion and humanity by a journalist who has spent her career on the frontlines of the fight, Access celebrates the bravery, ingenuity, and determination of women across decades who have fought for a fundamental human right--and serves as an inspiring rallying cry for the work that lies ahead.

Excerpt provided by Syndetics

Chapter One: San Francisco, California, 1966 One SAN FRANCISCO, CALIFORNIA, 1966 At the stroke of 9 a.m. on Friday, July 29, 1966, Patricia Theresa Maginnis approached the Federal Building, a stately Renaissance Revival structure in San Francisco's Civic Center, holding a box of leaflets. It was a cool and overcast morning and a gaggle of reporters had already amassed outside, waiting for the small figure with the big box to arrive. Described by The New York Times as a slender and intense spinster "with the eyes of a zealot," Maginnis was striking as she marched into the crowd with a mane of tousled hair that framed her angular face. Once inside the scrum, she began passing out yellow leaflets to the journalists and passersby that advertised "Classes in Abortion" and listed female anatomy, sterile technique, after-abortion care, methods of abortions, dangers involved, police questioning, and foreign abortion specialists as topics she would cover over the course of four Wednesday-evening sessions. The leaflets also included a list of addresses and prices for doctors who provided abortions in other countries and described in detail, complete with diagrams, two methods for self-inducing abortion. "I am attempting to show women an alternative to knitting needles, coat hangers, and household cleaning agents," Maginnis proclaimed to the bystanders, urging those around her to take the papers and pass them on. At a time when abortion was swathed in taboo, stigma, and shame, Maginnis was making the argument that anyone who wanted one should be able to get one without having to navigate legal, political, or medical barriers, on demand, without apology or justification, for free. In distributing the leaflets, she wasn't just doing something radical--she was doing something potentially illegal, and she knew it. Section 276 of the California Penal Code stated that helping a woman have an abortion, or soliciting her to have one, was punishable by up to five years in prison. The law had largely been unchanged in California since 1850, and Maginnis believed that changing it required a test case. But in order to do that, she needed to be charged and go to court. She planned to leaflet until the authorities got sick of her, arrested her, or gave in and repealed the law. She'd already been at it for six weeks, handing out leaflets to anyone who would take one on the streets of San Francisco and keeping the police abreast of her activities. Law enforcement, however, was wary of the attention that arresting her would bring and frustrated her ambitions by leaving her alone. When they still had not arrived at the Federal Building by 10:30 a.m. on the twenty-ninth, Gary Bentley, a member of a Channel 7 camera crew that was filming a piece about Maginnis, grew impatient and took matters into his own hands. After ensuring the camera was trained on him, Bentley announced he was placing Maginnis under citizen's arrest for violating Section 188 of the Municipal Police Code, a local ordinance that prohibited advertising abortion and lewd literature. "What do you think of that?" he asked Maginnis. "Excuse me, please," she said, dismissing him as she rushed after another woman to hand her a leaflet. At last, a policeman arrived on the scene to take Maginnis into custody (emphasizing while doing so that it was Bentley, not him, who was making the arrest) and drove away with her in his car. Soon thereafter, Section 188 was found unconstitutional, and the case was thrown out, but to Maginnis, the victory felt insufficient. Her aims were higher--total repeal of the state's abortion laws. "A decade before Roe , with her ungainly activism, her proclivity for wearing clothes she'd found on the street, and her righteous, unquenchable rage, Maginnis helped to fundamentally reshape the abortion debate into the terms we're still using today," journalist Lili Loofbourow wrote in a profile years later. "She was the first to take a passionate, public stance arguing that the medical stranglehold over women's reproductive lives was corrosive." At the time Maginnis took her stand, abortion had been illegal in the US for nearly a century. Every state in the country had criminal abortion laws with exceptions only offered for procedures necessary to save or preserve the life of the mother. These were known as "therapeutic abortions," although there was not a clear definition or universal agreement on what qualified as "necessary." What one hospital considered permissible under the law, another might not, and to get approval for the procedure, patients had to go before hospital committees composed entirely of men and plead their case. It was a terrifying, alienating, and humiliating hurdle to overcome, not to mention a high one, as women had to bare their most vulnerable, intimate selves in supplication to physicians who had the power to determine their fates. In practice, few women qualified for therapeutic abortions, and those who didn't had to resort to other measures. Women with the most resources could travel to places where abortion was legal, while the rest had to seek out underground providers or figure out a way to end the pregnancy themselves. In the best-case scenario, and only for those who could afford it, there were physicians who would quietly and capably perform the procedure as a clandestine part of their medical practice. Until a surge in prosecutions of abortion providers during the 1940s and '50s, many physicians had operated for decades in what was essentially open secrecy, and although their numbers dwindled after the crackdowns, there was still a cluster of such doctors in every state by the mid-1960s. Many had gotten into the work after treating people who became grievously ill from botched abortions, feeling they couldn't stand by and do nothing. There were also skilled midwives, like the so-called Mrs. Vineyards, who practiced in the St. Louis area for some thirty years, providing proficient, albeit expensive, abortion care. On the other end of the spectrum were inept and callous providers who took advantage of a desperate and vulnerable clientele, practicing in unsanitary conditions, treating clients badly, and inflicting serious, sometimes permanent damage. For women who couldn't afford a provider of any stripe, didn't know where to find one, or were too afraid or unable to visit one, there was a long and seemingly ever-growing list of methods they tried to induce an abortion themselves: Lysol douche, glycerin douche, powdered kitchen mustard douche, hydrogen peroxide douche, potassium permanganate corrosive tablets, intrauterine installation of kerosene and vinegar, paintbrushes, curtain rods, slippery elm sticks, garden hoses, glass cocktail stirrers, ear syringes, telephone wire, copper wire, coat hangers, nut picks, pencils, cotton swabs, clothespins, knitting needles, rubber catheters, chopsticks, bicycle pumps, gramophone needles, castor oil by mouth, and turpentine. During this period, there were so many women suffering from abortion complications that hospitals had dedicated wards called Infected OB to treat them. The consequences of unsafe abortions were ghastly, ubiquitous, and becoming impossible to ignore, and in 1961, after hearing the story of a woman forced to carry a child conceived in an assault, a freshman California assemblyman named John Knox introduced a bill that would broaden exceptions to California's abortion law. At the time, around 30 percent of the state's population identified as Catholic, and politicians, afraid of backlash from a powerful voting constituency, kept the proposal from even reaching the floor of either chamber. When a young Patricia Maginnis, still five years away from her leafletting campaign, read a newspaper article about the bill and its failure, she decided to draw up a petition of her own. She wasn't just going to let the issue, a matter of life and death, a matter of freedom, wither on the vine. Maginnis had developed a taste for rebellion and righteous outrage over gender inequality from a young age. She was born on June 9, 1928, in Ithaca, New York, while her father, Ernest, was studying to be a veterinarian at Cornell University. After his graduation, the family moved to Okarche, Oklahoma, where Maginnis was raised during the Great Depression. Her parents were Catholic and did not believe in using birth control, and her mother, a schoolteacher, gave birth to seven children, despite warnings from doctors about the harmful effects that so many pregnancies had on her health. Maginnis grew up watching her plagued by constant pain. During World War II, processions of soldiers traveled by the family's house, which was near a highway, and when she was fourteen, Maginnis turned a pink satin bedspread into a halter top and dashed outside to wave at a passing convoy. She didn't have time to change back into normal clothes before she got caught, and in response, her parents promptly dispatched her to a convent school forty miles away. After high school, Maginnis ventured off into the world on her own, moving around and trying out various professional pursuits, including a stint as a nude artist's model and a job in a lab at the Bureau of Mines in the northern part of Oklahoma. After traveling to the Netherlands to visit a boyfriend she'd been writing to for years, she joined the Women's Army Corps and trained as a surgical technician. She was posted to Fort Bragg, North Carolina, where she got in trouble for taking a walk with a Black soldier and was sent off to Panama. At her new post, Maginnis had hoped for an assignment with a surgical team, but since she was a woman, she was placed on a pediatrics and maternity ward in the army hospital. Every day, she was surrounded by patients who were suffering from complications from unsafe abortions or who had been forced to give birth, sometimes to babies with severe health needs or who would die within hours or days. The experience was traumatizing, not just for the patients, but for Maginnis as well. In a 1966 interview with the San Francisco Examiner , she recalled one situation when "a woman pregnant by another man and expecting her husband's return tried to abort herself [and] was hospitalized. The poor thing, who received no sympathy or understanding, became so distraught, a wire cage was placed over her bed. She was held captive like an animal. I still shudder at the memory." After her two years in Panama, Maginnis returned to the United States and attended college at San Jose State on the GI Bill. During that time, she became pregnant, despite using contraceptive methods like a diaphragm and foam, and, like many of her peers, traveled to Mexico to have an abortion. Abortion was not legal in Mexico, but it was not too difficult to find providers practicing in towns along the border. While Maginnis was relieved to have accessed the care (and survived to tell the tale), the entire ordeal angered her. She resented being forced to travel outside the country for treatment she thought should be available everywhere, and certainly shouldn't require a passport. About five years later, in 1959, she conceived again, and instead of returning to Mexico, she self-induced an abortion by repeatedly dilating her cervix with her fingers over the course of multiple months. This caused severe complications, and while being treated at the hospital, she received a visit from the homicide squad. She openly admitted to giving herself an abortion and volunteered to demonstrate how she had done it if brought to court, but they declined to pursue charges. These experiences cemented her interest in fighting for abortion rights, then a marginal cause that was just starting to gain some traction. In 1955, the first-ever national conference on abortion legalization had been held by the Planned Parenthood Federation of America in Newburgh, New York, in response to a wave of media coverage documenting the harms of unsafe abortion, and after the event, physicians started to become more vocal about calling for reforms that would grant them greater latitude to provide abortion care to their patients. Maginnis also supported the liberalization of abortion laws, but she was frustrated by discussions that prioritized the judgments of doctors over those of women and skeptical of laws that only allowed abortions in some cases, like a life-threatening illness or rape, but not in others, or which only allowed abortion when certain conditions were met. In 1961, the same year Knox first introduced the reform bill in California, Maginnis graduated from college. She was thirty-three years old and took a job working nights as a medical technologist so her days were free to canvass in support of abortion rights. Rather than advocate for reform measures that would expand exceptions to abortion bans, which still required approval from a hospital committee, Maginnis believed it was better to do away with the approval process altogether. She was not interested in incremental change and didn't think anyone should have authority over the decision other than the woman herself. There weren't any other organizations out there spreading that message, so in 1962, she founded the Citizens Committee for Humane Abortion Laws, to advocate for the total repeal of abortion restrictions. Later, she would change the name to the Society for Humane Abortion (SHA). Maginnis was joined on her mission by two other women, and collectively, they would become known as the "Army of Three." Rowena Gurner was petite and dark-haired, born to a Jewish family in New York, but ended up in San Francisco after riding a three-speed bicycle all the way from New York (and garnering a mention in Sports Illustrated ). She herself had once traveled to Puerto Rico to have an abortion and learned about SHA while attending a naturist meeting. Instantly, she felt connected to its mission. The third member of the trio was Lana Phelan. Born to a poor family in South Florida, she had left school in eighth grade to take a job at a drugstore, gotten married as a young teenager, and had her first baby soon after. It was a traumatic pregnancy and delivery, and her doctor warned that future attempts to have children might be fatal, but gave her no advice on how to prevent getting pregnant. Three months later, with an ailing infant and hardly recovered from childbirth, Phelan conceived again. Unwilling to risk her life for another child it would be a struggle to support, she learned from her coworker at a Walgreens in Tampa that there was a woman who lived in a shack in nearby Ybor City who performed abortions for $50. That was more than three weeks' wages. Phelan scrimped and saved for months and pawned her valuables, but still did not have enough; a customer had to offer to lend her the final few dollars before she could afford the appointment. With the payment in hand, Phelan took the streetcar to Ybor City and walked the rest of the way to the woman's home, which was scruffy and small but clean. In the back room, there was a gurney with white sheets. The provider was kind. She inserted slippery elm bark into Phelan's cervix, which absorbs water and expands, dilating the cervix and triggering contractions. "Now, go home, and in a few days, this will start you up," the provider said, when it was done. "Don't come back here, and don't tell anybody I did this." Three days later, Phelan was running a serious fever. She white-knuckled her way through a family dinner, but started miscarrying in the bathroom at her sister-in-law's house. Bleeding, panicked, and unsure of what to do next, she stuffed her underwear with toilet paper and told the family she had to leave. It was dark and raining as she made her way back to Ybor City. When the shack finally appeared out of the gloom, it was like "the light of heaven." She knocked on the front door, and when it opened, the provider looked at her. "I told you not to come back," she said. Phelan responded that she had no choice. Unable to turn her away, the woman cleaned her up, stemmed the bleeding, and then swept her into a hug. "Honey," she asked, "did you think it was so easy to be a woman?" Phelan continued on with her life, and years later, in 1964, she and her husband were visiting San Francisco on another dark and rainy night. She spotted a bedraggled figure handing out newsletters on a street corner outside a medical conference. Phelan took one and read the headline: "Repeal Repressive Abortion Laws." "My God, the only person there with a dab of sense was standing outside there in the rain," Phelan told her husband. When she'd read through all the materials later that night, Phelan called the phone number and asked if she could help. Maginnis was on the other end of the call and welcomed her to the team. Each member of the Army of Three had a distinct skill set and her own strengths to contribute. Maginnis was the radical and the visionary; Phelan was a poised and excellent spokesperson, with a signature necklace of pearls; and Gurner was adept at strategy, marketing, and organization--she once gave Maginnis $20 to buy a new dress, concerned that her fondness for shabby clothing was less than helpful to the cause. (Phelan did her part as well, reminding Maginnis to brush her hair.) The three of them shouted about abortion from the rooftops, frankly sharing details of their own experiences and explaining how these had shaped their views on the subject. The tenor of their message--unapologetic, provocative, outraged, irreverent, and forthright--about the importance of safe abortion and the need to repeal all criminal abortion laws and eliminate obstacles to the procedure was something new in American politics, as was the level of visibility at which they shared it. The Society for Humane Abortion, Lili Loofbourow suggested, was "arguably the very first American organization to advocate a pro-choice position that centered the woman, instead of the legal dilemmas of the physician--specifically, her right to privacy and choice." In championing this perspective, the Army of Three was facing off against entrenched societal beliefs about the supposed harms and immorality of abortion and the supposed malevolence of abortion providers. It was a formidable barricade to overcome, but in 1966, a legal fight erupted in San Francisco that the activists seized as a foothold for advancing their cause. That May, the State Board of Medical Examiners had brought charges against nine San Francisco obstetricians for performing abortions that they said violated the law. The abortions in question had been performed on women whose pregnancies involved a high risk of fetal anomalies, which wasn't considered a legal exception within California's abortion law, but two health crises in the early 1960s--thalidomide and a measles outbreak--had expanded public support for abortion in a wider range of circumstances, and the doctors had felt justified in their decision to proceed. Thalidomide was a sedative synthesized in 1954 that had been prescribed to pregnant women in Europe to help with sleeping and nausea until scientists discovered that it caused severe birth defects in what has been described as the "largest man-made medical disaster in history." The FDA had never approved the drug due to concerns about safety, but American women, including a doe-eyed children's television host named Sherri Finkbine, were sometimes able to obtain the medication in Europe, unaware of the risks. In 1962, Finkbine was pregnant with her fifth child when her husband returned from a trip to Europe with a supply of the drug, which he said would help her sleep, and Finkbine took about three dozen doses in the early days of her pregnancy. When she was nine weeks pregnant, she read a news article about reports starting to emerge overseas about a drug that was causing babies to be born with phocomelia, a medical term that translates to "seal limbs," and asked her doctor if she should be concerned about the contents of the pills she had taken. He wired to London for more information and then asked Finkbine to come into his office. He suggested that, given the gruesome pictures he'd seen of the effects of the drug, she should consider ending her pregnancy. Finkbine lived in Arizona, which only allowed abortion if the mother's life was in danger, so her doctor diagnosed her as a potential suicide (a common workaround), and she scheduled a legal abortion at a nearby hospital. The procedure would likely have proceeded without causing a stir, but a few days before her appointment, Finkbine called a local newspaper, the Arizona Republic , to warn people about the harmful side effects of thalidomide. She was concerned about other families, and particularly local Air National Guardsmen who had been posted to Europe and might have come home with stashes for their wives. The next day, the Republic ran the headline "Pill Causing Deformed Infants May Cost Woman Her Baby Here" and the lawyers at the hospital got cold feet from the publicity. A media firestorm ensued, and Finkbine was informed that her abortion had been canceled. Finkbine, a woman of means, decided that if she couldn't have an abortion in the US, she would travel abroad. She considered going to Japan, which denied her a visa, but then found a facility in Sweden that was willing to treat her. Once there, she spent two weeks waiting for the Royal Swedish Medical Board to approve a therapeutic abortion at a hospital in Stockholm, dogged at every turn by reporters who were relaying the details of her journey to all of America. After the procedure, the doctors in Sweden confirmed to Finkbine that the fetus had been missing limbs and would not have survived after birth. Finkbine believed she had made the right choice for herself and her family, but her decision was not without consequences. When she returned to the United States, she lost her job as host of the TV show Romper Room , having been deemed unfit to interact with children. Her family was bombarded with death threats and FBI agents had to walk her children to school because people were calling her home and threatening to cut off their arms and legs. In a Gallup poll about her decision--the first poll on abortion in the organization's history--32 percent of respondents said they thought she made the wrong decision, but 52 percent of Americans thought it was the right thing to do. In a way they perhaps hadn't been before, people were encouraged to consider the subject of abortion with greater nuance and complexity, and for a two-month period in 1962 abortion was widely discussed across the country by "polite society." In sharing what she had gone through, and being honest about the physical and emotional harms she had endured, Finkbine evoked sympathy not just for herself, but for all women in a similar position, and helped shift public opinion in a way that became pivotal in the evolution of the abortion debate. And then there was the 1963 outbreak of German measles, also known as rubella. The disease could lead to serious birth defects if contracted by pregnant people, and although fetal anomalies were not technically an exception to the California law, hospitals had routinely provided abortions to people who contracted it--of the fifty-six abortions performed at UCSF in 1965, forty-six were for rubella. (As the hospital's chief of gynecology Alan Margolis put it, "Anybody who had a possibility of having a deformed baby could have an abortion, it was just that simple.") The practice was routine and uncontroversial, so when an obstetrician named John Paul Shively was charged by the California State Board of Medical Examiners in May 1966 for performing the procedure, and threatened with the loss of his medical license, the first of nine physicians that summer, it precipitated a public outcry. More than 200 physicians across the country, including 128 deans of medical schools and every medical school dean in California, filed an amicus curiae brief in the state's supreme court to defend the "San Francisco Nine." They were considered victims of a "political-religious vendetta." Seeing how the threats that thalidomide and rubella posed to maternal and fetal health had created an environment in which prominent physicians felt compelled to vocally advocate for abortion to be treated as a medical procedure--a decision between a woman and her doctor, an act of health and compassion--Maginnis, Gurner, and Phelan sensed an opportunity. In the "back alley" clinics, in the US as well as abroad, the conditions could be horrific, dangerous, and unsanitary. Patients were sometimes blindfolded, treated with dirty instruments, and sexually assaulted, and because abortion was illegal, they had little ability to protect themselves or opportunities for recourse. For years, the activists had been contacted by people looking for trustworthy abortion providers, and through word of mouth, they had managed to gather "a few names of people in Tijuana" who provided adequate abortion care. When someone reached out for help, the trio responded by writing down the contact information on a piece of paper, placing it in an envelope with no return address, and mailing it to the requester from a postbox in another town. At first, this was all done in secret, but when the Board of Medical Examiners scheduled a meeting in June 1966 to discuss the case of the nine doctors, Maginnis decided it was time to thrust the information out of the shadows. I The morning of the meeting, Maginnis arrived at the UCSF campus at 8 a.m. in an overcoat and pumps, lugging a box of leaflets that asked: "ARE YOU PREGNANT? IS YOURS A WANTED PREGNANCY? IF NOT, WHY NOT SEE AN ABORTION SPECIALIST?" Inside was the contact information for ten abortion providers in Mexico, one in Japan, and one in Sweden, and two methods for self-inducing abortion--the first draft of what would become known as "the List of Abortion Specialists," or more simply, "the List." In interviews with reporters at UCSF that day, Maginnis declared that abortion laws requiring a committee's authorization were discriminatory. While "respectable" women with money and contacts could gain their approval, she explained, everyone else was typically left behind. Her focus was not on what was or wasn't legal. It was on what was, or wasn't, accessible and to whom, and on presenting some options. At the outset of the campaign, the goal had been to distribute a thousand leaflets, but when Maginnis wasn't immediately hauled off in handcuffs, she set a more ambitious threshold of fifty thousand in the weeks leading up to the July hearing. Word spread, and before long, the Society for Humane Abortion was receiving seventy-five phone calls a week and a torrent of letters from people requesting copies of the List. The group was happy to share the information but still believed that the key to real change was through education. They were just three women in California with limited resources, and while sharing phone numbers for abortion providers was meaningful on an individual basis, they aspired to build a real political movement where people were aware of abortion as an issue, knew how to access it despite criminal abortion laws, and shared that knowledge as a means of movement-building and resistance. They started holding classes in private homes, motel rooms, church basements, and union halls, with audiences ranging from fifteen to one hundred fifty people. The workshops lasted for hours and covered a wide range of information: the specifics of abortion laws, how to calculate gestational age, how to make an appointment with a specialist from the List, what happened during the procedure, and how to respond to police questioning. Though the Society was the first prominent activist group to promote the idea that women could do abortions for themselves, and teach them how to do it, they emphasized that those methods should be viewed as a last resort. Based in part on her own experiences, Maginnis strongly advised against self-inducing an abortion, but figured if someone was going to do it, then she wanted them to be smart about it, and offered instructions and kits with materials for sterilizing bathrooms and hands. She became a dynamic teacher, known to use an intrauterine device (IUD) as a pointer and showcase anal bacteria cultures and infected blood samples to emphasize the risks of unsafe abortion. The workshops became well known in the city and police were often in attendance--Maginnis extended the invitations herself--but the SFPD made clear it had no plans to arrest her unless she got involved in the physical act of performing an abortion. Until then, she was only exercising her right to free speech. By the end of 1966, SHA had taught twenty-five classes across the Bay Area and was invited to lead more throughout California, as well as in Ohio, New Mexico, and Washington, D.C. However, despite amassing two thousand names on their mailing list, the organization was still running on a shoestring budget, operating out of Maginnis's $90-per-month San Francisco apartment and funded by a combination of donations and her salary as a lab technician. As the group's activities grew in scale and scope, Maginnis realized she needed to keep their legally risky work, like the List, separate from their political advocacy activities so one wouldn't compromise the other. In response, she created an additional organization called the Association to Repeal Abortion Laws (ARAL) to focus on legal strategy. Under this structure, the List evolved into an annotated catalogue of vetted abortion providers--as many as sixty at any given time--in Mexico, Canada, Japan, Sweden, and elsewhere. Most abortion seekers traveled to border towns in Mexico, like Tijuana and Ciudad Juárez, and in Mexico City there was a clinic so popular with Americans it was known as La Casa de las Gringas . To create the directory, the Army of Three identified specialists through referrals, and went to great lengths to ensure they were safe and reliable, sorting out the trained and ethical professionals from the predators who put lives at risk. In order to be included, candidates had to follow a twenty-point outline of minimum requirements, which encompassed physical and emotional comfort and safety. Clinics were expected to be clean, with operating rooms disinfected and equipment sterilized; the specialist was required to "scrub his hands" and clinic staff to be able to speak English in order to explain what was happening and ensure that all patients were treated with respect. The agreement relied on mutual trust--if the List directed patients to a specialist and didn't turn him (it was usually, but not always, a him) in to the police, then the specialists promised to abide by its standards. Maginnis also used her leverage to negotiate on cost. The price of an illegal abortion in Mexico was steep, ranging from $150 to $700 (about $1,400 to $6,400 in today's dollars) and had to be paid in cash. The List not only served to ensure fees were consistent, but also advocated for specialists to provide refunds if an abortion was incomplete. Once accepted, each specialist was given an entry on the List with information about their background and clinic, reviews, and a code number: Specialist No. 26, for instance, was a Tokyo doctor described as "a stocky, kind-faced man with very sure hands"; No. 30 was noted as a specialist in later abortions whose father had reportedly been an abortion provider in Ciudad Juárez starting in the 1940s; No. 39 operated a clean Mexicali clinic two blocks from the US border and was described as "a middle-aged Spaniard with an anxious demeanor." The providers were given handwritten cards signed by Maginnis, and when patients arrived, they were instructed to ask to see the card, which signified that the provider was qualified and approved. The List was constantly updated as new information came in about clinics that moved or closed and new specialists who cropped up, and SHA members visited as many of the providers as they could to observe their practice in person. As the document was formalized, a system of checks and balances developed, effectively creating what Reagan (the historian, not the president) referred to as "the first open (and illegal) abortion referral service in the United States," an "underground feminist health agency." The most important tool for ensuring the List was accurate, trustworthy, and up-to-date was the women who used it. When someone received a copy of the List, the materials included a feedback form, which asked questions about cleanliness, the condition of the office, if the medical instruments were sterilized, the procedure itself, how many staff members were there, any medications or IVs used, and how the patient was treated. These helped to confirm standards and incentivize good behavior--a doctor in Nogales, No. 49, for example, was praised in evaluations as "understanding" and "very kind," someone who treated patients "very tenderly" and "very sympathetically"--and also sometimes to provide specific insight into hurdles patients might encounter with a specialist. "We have received more than 15 letters from women who went to her; all praising her highly," Maginnis noted of doctor No. 35. "Do not believe taxi drivers who say her office is dirty and that women die there. She refuses to pay them graft. We visited her office. It is immaculate," while the List added that No. 43 in Juárez "may act as if he doesn't speak or understand English. Don't believe it." In the event of negative reports, specialists would be removed from the List. After multiple women complained about specialist No. 53 in the border town of Agua Prieta, with reports about both botched abortions and rape, his listing was scratched. "Words will not describe how horrified we feel," Gurner wrote to the provider after receiving letters about his behavior. "We shall have to warn people who contact us about your unprofessional conduct," she added, before demanding that he refund a patient's $300 fee. In addition to the annotated catalogue, the List included detailed instructions for how to navigate the international journeys from start to finish: tips for moving through customs; details about the procedure; instructions for payment; and guidelines for preparation, such as not eating eight hours beforehand, trimming pubic hair, and packing a toothbrush. It suggested obtaining a Spanish-English dictionary, an oral fever thermometer, sanitary napkins, walking shoes, and a map. Women were instructed to look like tourists--carrying as little luggage as possible, buying souvenirs, and looking neat, alert, and healthy, and wearing makeup--to protect themselves from arrest. All of this had to be done, on both sides of the border, in absolute secrecy. In traveling to Mexico, abortion seekers were following in a long tradition of Americans crossing the border to access services that were illegal or difficult to obtain in the US, or cheaper in Mexico--divorces, sex workers, haircuts and clothing, car repairs, and pharmaceuticals, to name a few. American women, including Maginnis herself, had traveled there for abortions since the 1940s, when the suppression of abortion in the US caused the number of providers on the other side of the border to grow. Although abortion was also illegal in Mexico, enforcement could be minimal, and American women who were caught were unlikely, or at least less likely, to face full legal consequences. In one case, a Tijuana doctor was arrested in the middle of performing the procedure on an American woman, but the police let him complete the procedure before arresting them both. The patient then paid $1,200 in bail and left Mexico. "Although not all patients could have afforded such an arrest, in this case, the financial advantage that the U.S. woman had by virtue of crossing from an affluent First World nation into a poor Third World nation protected her," said Reagan. "Furthermore, the border itself served as protection. Once she recrossed it, Mexican police could not easily pursue her." Before long, the List had helped to formalize an abortion corridor between the US and Mexico. Tens of thousands of American women traveled south, where there were many skilled and reliable providers, but some US activists and doctors deployed the "back-alley butcher myth" in reference to Mexican abortion providers to advance their own advocacy for legal abortion in the US. According to scholar Lina-Maria Murillo, "Racializing Mexico as an inherently dangerous place and Mexican providers as innately dangerous people" led states like California to liberalize their abortion laws "to protect US women from potential butchery in Mexico." Meanwhile, on the other side of the border, newspapers in Mexico criticized the waves of North American women who traveled to la frontera for abortions, casting them as "irresponsible foreign women." In response, Maginnis wrote a letter to the editor of El Fronterizo , a local newspaper in Ciudad Juárez, calling out the American Medical Association as the culprit for its hypocritical "hands-off" policies, and arguing that their "grave lack of social responsibility" had led women to seek abortions out of the country. She also laid out her frustration with media coverage portraying abortion providers as "seedy, pushy Mexican outlaws" and US medical professionals as "innocent lambs." In her view, it was US medical professionals who had abdicated their own responsibilities to American women, and who were therefore complicit in the harms they were warning about. "The establishment institutions of organized law, medicine, and religion have dispossessed abortion-seeking women," Maginnis wrote, "yet they are talented opportunists at dumping the United States' dirty wash into the lap of Mexico." By the late 1960s, the situation at large had prompted a shift in public sentiment, with calls for abortion reform from all corners of American society growing louder. In addition to doctors, lawyers, and feminist activists, even clergy members began agitating for change. On May 22, 1967, the front page of The New York Times announced the establishment of the Clergy Consultation Service on Abortion, or CCS. A group of twenty-one clergymen--nineteen ministers and two rabbis--listed by name promised to provide women with confidential counseling and referrals. Helmed by Reverend Howard R. Moody, a minister at Judson Memorial Baptist Church in New York City, the CCS soon built up a roster of underground abortion providers around the country and in Mexico where they could refer women who came their way, believing that as clergy, they had a measure of protection from prosecution. The work had begun a couple years prior when the progressive ministers and rabbis had started meeting in New York City to discuss issues of social justice. A recent attempt to reform abortion laws in New York State had failed, and like Maginnis, the clergy members were frustrated with the glacial pace of change, especially when faced with the realities of unsafe abortion. Over time, the CCS grew to include some two thousand members in thirty-eight states, and although exact numbers are hard to pin down, some estimates claim they aided as many as five hundred thousand women between 1967 and 1973. The operation was impressive, but Maginnis, with her usual barbed flair, was suspicious of the enterprise. She felt the idea that a woman had to be counseled by a usually male religious leader in order to receive information about abortion was patronizing, and drew a cartoon to that effect--a woman lying facedown on the floor clutching a $500 bill in front of a panel of three men. Below, the text read: "Please may I have a U.S. Supreme-Court-Approved, politician-sanctioned, psychiatrist-rubber-stramped, clergy-counseled, residency-investigated, committee-inspected, therapeuticked, U.S. Health-Dept-statistized, contraceptive-failure, religious-sect-guilt-surmounted, abortion." She never wavered in her conviction that access to abortion should not be gatekept, and along with the direct service the List provided, she continued to campaign for the total repeal of abortion laws. Then in 1967, she finally got the arrest she'd been looking for. In February, a San Mateo district attorney vowed that if SHA held a class within his jurisdiction, he would enforce the law. Maginnis and Gurner responded by scheduling a one-night class on Monday, February 20, and inviting the police. Two plainclothesmen showed up. The session opened, as it usually did, with an explanation of abortion laws, followed by the distribution of a "do-it-yourself" kit, which included a hairnet, hairbrush, cotton, gauze, syringe, and thermometer. At that point, the fuzz had left, but they quickly returned with cops in uniform. A "bust in the grand style" ensued, according to the underground newspaper the Berkeley Barb ; the police took pictures, confiscated evidence, and wrote down the names of audience members. Maginnis and Gurner faced five to seven years in state prison and were ultimately convicted of violating Section 601 of the California Business and Professions Code. II Undaunted, they let it be known that they were looking for a space in Berkeley that could hold fifty people for Thursday-night abortion classes--they were not going to stop, especially not when they could feel change rumbling beneath their feet. More and more Americans were starting to view laws that forced people to put their lives at risk to end pregnancies, and that prevented doctors from helping them, as immoral, rather than abortion itself. Reforms were being proposed in almost every state. In April 1967, Colorado became the first state to decriminalize abortion in cases of rape, incest, fetal abnormalities, or in which pregnancy would present a severe threat to the physical or mental health of the mother. Two months later, a similar reform came to California when Governor Ronald Reagan signed the Therapeutic Abortion Act into law, which made abortion legal in California in cases where a woman's physical or mental health would be "gravely impaired" by carrying a pregnancy. Maginnis, however, was unimpressed. The law included a twenty-week limit and still required medical committees to weigh in, as well as a district attorney in cases that involved rape or incest, and while it was a sign that the dominos of criminal abortion laws were starting to fall, she referred to it as an "unbelievable piece of legislative slop" and pledged to teach women how to fake conditions that would qualify them for the committee's approval. Alongside legislative change, a challenge to California's criminal abortion laws was also making its way through the court system. A few months before the Therapeutic Abortion Act passed, a prominent OB/GYN named Dr. Leon Belous had been convicted of conspiracy to commit abortion. In 1966, Belous had been speaking out against California's abortion ban as a guest on a television show and a young woman named Cheryl Bryant saw the segment. Bryant was pregnant and wanted an abortion, so her boyfriend, Clifton Palmer, contacted the TV station to ask for Belous's phone number and then called him begging for help. Belous was adamant that he did not perform abortions, but Palmer pleaded and said if Belous did not help them, they would go to Tijuana to find a provider there. Belous was alarmed by the ultimatum. He had visited facilities in Tijuana himself, and part of his belief in abortion reform stemmed from concerns about the conditions he'd witnessed there. Worried for Bryant's safety, he gave the couple the phone number for a physician named Karl Lairtus in East Hollywood. (Belous had met Lairtus in Tijuana, where he practiced before moving to California, and been impressed by his "outstanding" work.) Bryant paid the $500 fee and her procedure went smoothly, but as she was recovering, the police arrived to arrest Lairtus after receiving a tip that he was providing illegal abortions out of his apartment. During their search, the police found a notebook that contained a list of physicians' names, including Belous's, and subsequently arrested him under Section 274 of the Penal Code, which made it a crime to provide or assist in providing an abortion. Belous, penalized with a $5,000 fine and two years of probation, appealed his conviction with the support of the American Civil Liberties Union (ACLU). In 1969, the California Supreme Court heard the case, The People v. Belous , and ruled that the language in the penal code was too vague to allow his conviction to stand, and so vague as to be unconstitutional. Aside from exonerating Belous, it meant that the abortion ban he had so publicly criticized was now void, but ironically, the decision would have had a more dramatic impact had California not passed the Therapeutic Abortion Act two years before, which had replaced the law under which Belous had been convicted. Still, The People v. Belous marked the first time in American history that a court opinion had recognized a patient's constitutional right to abortion on the grounds of privacy. Up until that point, most abortion reform and repeal efforts had been focused on changing state laws; after Belous , advocates began considering strategies that involved the federal courts. Maginnis, Phelan, and Gurner followed these political and legal developments, but their focus remained on how to deliver practical guidance and support to women on a day-to-day, person-to-person basis. In 1969, after years of distributing the List and giving presentations around the country, the group published The Abortion Handbook , a 192-page manual that Phelan had composed feverishly on her typewriter over the course of six weeks. The book included chapter titles like "Mrs. No-Money Goes to the Hospital for Clean-Up," as well as thirty pages on how to feign psychoses or manic depression to qualify under the therapeutic abortion laws. Their hope was that the handbook could reach far more people than the in-person seminars, and even the referral service, ever could. During its years of operation, the List helped an estimated twelve thousand women access abortion and jump-started a dialogue about a topic shrouded in taboo, eroding abortion stigma and pioneering a form of "activist lawbreaking" that challenged not only abortion bans, but also the values of a society that allowed them to exist in the first place. By the late 1960s, those values were teetering on the precipice of dramatic upheaval. I . Most of the doctors were found guilty of performing or helping to perform illegal abortions and punished "lightly" with one-year probations. II . The conviction was overturned in 1973. Excerpted from Access: Inside the Abortion Underground and the Sixty-Year Battle for Reproductive Freedom by Rebecca Grant All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.

Reviews provided by Syndetics

Publishers Weekly Review

A ship in international waters that offers abortions to anyone, underground pill smuggling networks, and global lists of secretive abortion providers are some of the inventive means by which activists thwart abortion restrictions in this defiant history from journalist Grant (Birth). After a brief look back at a mid-19th-century foremother to these efforts--Madame Restell, the "wickedest woman in New York," who sold "Female Monthly Pills" before abortion's criminalization--Grant homes in on the last 60 years of such illicit activism. She begins just before Roe, with groups like the "Army of Three," who compiled "the first open (and illegal) abortion referral service" in the U.S., and ends with Roe's overturning. Notwithstanding the U.S.-centric framing, the book's scope is international, covering battles for abortion access in Ireland, Poland, Brazil, and the "abortion corridor between the U.S. and Mexico"--an illicit connection that has become more important post-Roe as "older white women," the "least likely to attract scrutiny from customs agents," collaborate with Mexican feminist groups to ferry abortion pills into America. Grant's roving, keenly reported account also looks at how the internet revolutionized possibilities for remote treatment as pioneering websites like Women on Web guided people through the abortion consultation process and at how in recent years women's deaths and imprisonment due to lack of abortion access have galvanized mass protests that successfully demanded change. With an inspiring focus on ordinary people who risk their livelihoods, freedom, and safety to help others, this rivets. (June)

Booklist Review

Freelance journalist Grant (Birth, 2024) documents the decades-long fight for abortion access and reproductive justice in this clear and compelling blend of history and journalism. Focusing primarily on the past 60 years in the U.S., with valuable context from similar struggles in Ireland, Mexico, Poland, and elsewhere, Grant details the abortion landscape from pre-Roe to post-Dobbs. She centers the stories of activists and abortion providers who have been "engaged in direct action to help people get the abortions they need," from the infamous Madame Restell to the Jane Collective, Women on Waves, Las Libres, the TEA Fund, and many more. Her interest lies firmly in the above- and underground efforts to provide access to abortion rather than the slower, less reliable march towards enshrining reproductive rights in law. In the process, she reveals the common thread tying together generations of activists across borders, cultures, and beliefs, "a deeply held conviction that all the risks are worth it for the cause." Those seeking a well-researched, galvanizing narrative about abortion access should look no further than this engrossing account.

Kirkus Book Review

A richly detailed account of the long struggle for women's right to choose. Health journalist Grant notes that every state in the U.S. had enacted criminal abortion laws by 1880, and "for the next one hundred years, abortion in America remained…underground, secret, stigmatized, and dangerous." From the moment thatRoe v. Wade was passed in 1973, anti-abortion activists organized to overturn it, helped along by politicians in gerrymandered districts who used "majorities and supermajorities to pass abortion restrictions at an alarming pace and volume." On the other side, Grant writes, activist groups have long organized to protect choice. In the wake ofDobbs, the battle for access to abortion has heated up--often illegally, in the case of states such as Texas that have banned the importation of abortion pills or travel to other states to obtain the medical procedure. Grant profiles activists at various stages of the battle, from first-generation feminists who linked access to abortion to the struggle for women's liberation generally to modern-day advocates who, among other strategies, have internationalized the ability to obtain pills for "self-managed abortion," creating a sort of "underground for the post-Dobbs world." The battle is multifaceted and requires the commitment of a range of activists and allies--who, Grant allows, are sometimes given to fighting among themselves--especially as certain states enact more restrictive laws even to the point of bans. On which note, Grant writes, "Abortion bans have never and will never stop people from ending pregnancies; what they do is force people to resort to unsafe methods to end them." Her narrative makes clear that the battle for access continues apace to advance the cause for choice against "the notion that a government can dictate if, when, or how its citizens manage pregnancy." A capable history that foresees a hard fight yet to come in the war for reproductive freedom. Copyright (c) Kirkus Reviews, used with permission.