The Oldest Question

The question of what to do about pregnancy – when it is wanted, when it is not, when it is dangerous, when it is the result of violence – is as old as civilization itself. No society in recorded history has avoided grappling with it. None has arrived at an answer that satisfied everyone. To understand the contemporary American debate, we must first understand that we are not the first people to stand in this particular storm.

In the ancient world, abortion and infanticide were practiced openly. The Greeks regarded termination as household management. Aristotle recommended abortion before “sensation and life” as population control. Plato treated reproductive decisions as civic planning. The Hippocratic Oath’s prohibition on abortifacients – often cited as ancient medical opposition – likely reflected a minority Pythagorean view. Most Greek physicians provided the procedures without moral reservation.

Roman law was similarly pragmatic. The fetus was not a person but a part of the mother’s body – pars viscerum matris. Soranus of Ephesus, the foremost gynecologist of the Roman world, wrote detailed instructions for both contraception and abortion, treating both as legitimate medicine. When Roman law eventually imposed restrictions, they protected not the unborn but the husband’s right to offspring and the state’s interest in population.

Early Christianity introduced a fundamentally different framework. The Didache, perhaps from the late first century, explicitly prohibited abortion: “You shall not murder a child by abortion nor kill that which is born.” Yet even within Christianity, significant debate persisted about when the soul entered the body. Saint Augustine condemned abortion but distinguished between early and late procedures, arguing that destroying an “unformed” fetus was not homicide because the soul had not yet arrived. Thomas Aquinas adopted a similar position in the thirteenth century, drawing on Aristotelian biology to place ensoulment at forty days for males and eighty or ninety days for females. It was not until 1869 that Pope Pius IX eliminated the distinction entirely, declaring all abortion from conception subject to excommunication. The modern Catholic position, while rooted in ancient convictions, achieved its current doctrinal form relatively recently.

English common law built its framework around “quickening” – the moment the mother first felt movement, typically between sixteen and twenty weeks. Before quickening, abortion was generally not criminal. After quickening, it was a misdemeanor, rarely prosecuted and more rarely resulting in conviction. This framework governed the English-speaking world for centuries and was the legal backdrop of the American colonies.

In early America, abortion before quickening was legal in every state. Women used herbal abortifacients; newspapers advertised practitioners who could “restore” menstrual regularity. The earliest American abortion statutes, in the 1820s and 1830s, targeted practitioners who administered dangerous poisons rather than the women who sought them, reflecting concern for maternal safety rather than fetal rights.

The great transformation came in the mid-to-late nineteenth century, driven not primarily by religion but by the professionalization of medicine. The American Medical Association, founded in 1847, launched a campaign against abortion motivated by a volatile mixture: alarm at dangerous unregulated practices, professional rivalry with midwives and homeopaths, nativist anxiety about declining birth rates among white Protestant women, and an emerging understanding that fetal development was continuous rather than marked by a threshold at quickening. Dr. Horatio Storer, who led the campaign, warned explicitly that the failure of “native” American women to reproduce would lead to the nation being overrun by immigrants’ children. By 1900, every state had criminalized abortion at all stages, with narrow exceptions for the mother’s life.

The Comstock Act of 1873 added a federal dimension, criminalizing the distribution of “obscene” materials including contraceptive devices and abortion information. The effect was to drive both contraception and abortion underground for decades.

Margaret Sanger began her crusade for birth control in the 1910s after witnessing the devastating consequences of uncontrolled fertility among poor women in New York’s immigrant neighborhoods. Her legacy is deeply contested – tireless advocate for women’s autonomy, founder of what became Planned Parenthood, but also a eugenicist who spoke to Ku Klux Klan women’s groups and whose racial views were entangled with the eugenic thinking of her era. Her story illustrates a recurring theme: the cause of women’s autonomy has often been intertwined with less noble agendas, and the same policy can be championed for reasons ranging from the liberatory to the coercive.

The reform movement that led to Roe v. Wade emerged in the 1950s and 1960s from a convergence of forces: the thalidomide crisis, which confronted the public with women forced to carry severely deformed fetuses to term; the women’s liberation movement; a growing medical consensus that therapeutic abortion was being hampered by outdated laws; and high-profile cases dramatizing the human costs of criminalization. Between 1967 and 1970, roughly a third of states reformed their laws, and four – New York, Washington, Hawaii, and Alaska – repealed their bans entirely.

Roe v. Wade, decided January 22, 1973, by a 7-2 majority, established a trimester framework rooted in viability. First trimester: the decision belonged to the woman and her physician. Second trimester: the state could regulate for maternal health. Third trimester: the state could prohibit abortion except to preserve the mother’s life or health. The decision located the right in constitutional privacy, grounded in the Fourteenth Amendment’s Due Process Clause.

Roe was both landmark and lightning rod. Legal scholars across the spectrum questioned its reasoning. Religious leaders condemned it. A nascent pro-life movement mobilized with an energy that would reshape American politics for half a century. The decision did not settle the debate; it intensified it, nationalizing a question that had been working through state legislatures and framing it in terms that left little room for incremental compromise.

Planned Parenthood v. Casey (1992) preserved Roe’s essential holding but replaced the trimester framework with an “undue burden” standard. The decades between Casey and Dobbs saw a steady erosion of access in many states through targeted restrictions on providers, gestational limits, mandatory ultrasounds, and waiting periods – while access expanded in others. By 2022, a woman’s experience of abortion in America was largely determined by her ZIP code.

Dobbs v. Jackson Women’s Health Organization, decided June 24, 2022, overturned both Roe and Casey. Justice Alito’s majority opinion argued that Roe was “egregiously wrong from the start.” The decision triggered a cascade of state action: trigger bans took immediate effect in several states; others moved to enshrine protections. The post-Dobbs landscape is a patchwork more unequal than at any point since before Roe.

What this history reveals is not a simple story of progress or decline but an enduring human struggle with questions that do not yield easy answers. When does developing life acquire moral standing? What are the limits of autonomy when another potential life is at stake? What role should the state play in the most intimate decisions a person can make? These questions have been asked in every era, every civilization, and never answered to everyone’s satisfaction. The people who answered them differently across the centuries were not, for the most part, monsters or saints. They were people operating within different moral frameworks, different understandings of biology, different conceptions of individual and community. Humility about the difficulty of these questions is the beginning of wisdom.

It is precisely because history offers no settled answers that the voices of the present matter – and why they disagree with such ferocity.