In the 1980s, researchers at the pharmaceutical company Roussel-Uclaf in Paris, France, helped develop a biological compound called mifepristone. When a woman takes it, mifepristone interferes with the function of hormones involved in pregnancy and it can therefore be used to terminate pregnancies. In 2000, the US Food and Drug Administration approved mifepristone, also called RU 486, as part of a treatment to induce abortions using drugs instead of surgery, a method called medication abortion. Women can receive medication abortions earlier in their pregnancies than surgical abortions, and medication abortions often result in less severe side-effects than their surgical counterparts. In that capacity, mifepristone has increased women’s access to abortions throughout the world.
In 1955, obstetrician Edward Bishop, a physician specializing in childbirth, published the article “Elective Induction of Labor,” in which he proposed the best conditions for pregnant women to elect to induce, or begin, labor. Elective induction of labor requires an obstetrician to administer a drug to help a pregnant woman to start her contractions, and to rupture the fluid-filled sac surrounding the fetus called the amniotic sac. In the early 1950s, Bishop analyzed the results of one thousand elective inductions and discovered that some pregnant women had faster and easier deliveries with induced labor than other pregnant women. In “Elective Induction of Labor,” Bishop describes the characteristics an obstetrician can look for in a pregnant woman to determine if she can safely undergo an elective induction, metrics still used into the twenty-first century to determine whether or not to pursue elective inductions.
Virginia Apgar and colleagues wrote “Evaluation of the Newborn Infant—Second Report” in 1958. This article explained that Apgar’s system for evaluating infants’ condition after birth accurately predicted the health of infants. Apgar had developed the scoring system in 1953 to provide a simple method for determining if an infant needed medical attention after birth. The research team, working at Columbia University College of Physicians and Surgeons in New York City, New York, studied the Apgar scores of over 15,000 infants from Sloane Hospital for Women in New York City, New York, over a period of five years. In “Evaluation of the Newborn Infant—Second Report,” Apgar and colleagues established that Apgar scores correlated with infants’ health directly after birth and indicated when medical personnel should treat the infant.
In 1965, Austin Bradford Hill published the article “The Environment and Disease: Association or Causation?” in the Proceedings of the Royal Society of Medicine. In the article, Hill describes nine criteria to determine if an environmental factor, especially a condition or hazard in a work environment, causes an illness. The article arose from an inaugural presidential address Hill gave at the 1965 meeting of the Section of Occupational Medicine of the Royal Society of Medicine in London, England. The criteria he established in the article became known as the Bradford Hill criteria and the medical community refers to them when determining whether an environmental condition causes an illness. The criteria outlined in “The Environment and Disease: Association or Causation?” help identify the causes of many diseases, including cancers of the reproductive system.
In the 1964 article, “Pelvic Scoring for Elective Induction,” obstetrician Edward Bishop describes his method to determine whether a doctor should induce labor, or artificially start the birthing process, in a pregnant woman. Aside from medical emergencies, a woman can elect to induce labor to choose when she gives birth and have a shorter than normal labor. The 1964 publication followed an earlier article by Bishop, also about elective induction. In both articles, Bishop used data gathered from the obstetrics department of Pennsylvania Hospital in Philadelphia, Pennsylvania, where he worked. In “Pelvic Scoring for Elective Induction,” Bishop introduces a scoring system later known as the Bishop Score, used into the twenty-first century, to determine if a pregnant woman fits the criteria for a safe and successful induction.
In 1952 Virginia Apgar, a physician at the Sloane Women’s Hospital in New York City, New York, created the Apgar score as a method of evaluating newborn infants’ health to determine if they required medical intervention. The score included five separate categories, including heart rate, breathing rate, reaction to stimuli, muscle activity, and color. An infant received a score from zero to two in each category, and those scores added up to the infant’s total score out of ten. An infant with a score of ten was healthy, and those with low scores required medical attention at birth. Apgar originally used the score to determine how infants responded to the pain-relieving drugs given to pregnant women during labor. But it also served to determine when the infant required medical assistance, especially oxygen resuscitation. As of 2016, nearly every hospital in the world uses an updated Apgar score to evaluate the health of newborn infants. The Apgar score has allowed for medical personnel to evaluate an infant directly after birth on an objective scale to determine whether that infant could benefit from possibly life-saving medical intervention.
Virginia Apgar worked as an obstetrical anesthesiologist, administering drugs that reduce women’s pain during childbirth, in the US in the mid-twentieth century. In 1953, Apgar created a scoring system using five easily assessable measurements, including heart rate and breathing rate, to evaluate whether or not infants would benefit from medical attention immediately after birth. Apgar’s system showed that infants who were previously set aside as too sick to survive, despite low Apgar scores, could recover with immediate medical attention. Additionally, Apgar researched the effects of anesthesia used during childbirth and advocated for the prevention and management of birth defects. Apgar’s work led to a decrease in infant mortality rates in the mid-twentieth century, and into the twenty-first century, hospitals around the world still used the Apgar score at one and five minutes after birth.
In the 1989 case Webster v. Reproductive Health Services, the US Supreme Court upheld the constitutionality of a Missouri law regulating abortion care. The Missouri law prohibited the use of public facilities, employees, or funds to provide abortion counseling or services. The law also placed restrictions on physicians who provided abortions. A group of physicians affected by the law challenged the constitutionality of certain sections of it. The US federal district court that first heard the case ruled many of the challenged sections of the law unconstitutional. The Missouri attorney general then appealed the case to an US federal appeals court and eventually to the US Supreme Court in Washington, D.C. In a five to four decision, the US Supreme Court overturned the decisions of the lower federal courts, ruling that it was constitutional to prohibit public funds, facilities, and employees from providing abortion care. In doing so, the Supreme Court upheld a state law that limited women’s access to abortions and established a precedent that states could apply restrictions to abortion care.
In the 1973 court case Doe v. Bolton, the US Supreme Court in Washington, D.C., ruled that a Georgia law regulating abortion was unconstitutional. The Georgia abortion law required women seeking abortions to get approval for the procedure from their personal physician, two consulting physicians, and from a committee at the admitting hospital. Furthermore, under the statutes, only women who had been raped, whose lives were in danger from the pregnancy, or who were carrying fetuses likely to be seriously, permanently malformed were permitted to receive abortions. The US Supreme Court ruled that the Georgia requirements violated the right to privacy implicit in the Fourteenth Amendment to the US Constitution. Decided on the same day as the abortion case Roe v. Wade, Doe v. Bolton expanded women’s access to abortion by striking down laws that restricted the reasons for which women could receive abortions.
In the 2016 case Whole Woman's Health v. Hellerstedt, the US Supreme Court ruled unconstitutional the Texas requirements that abortion providers have admitting privileges at local hospitals and that abortion facilities meet ambulatory surgical center standards. Whole Woman’s Health represented abortion care providers in Texas and brought the case against the commissioner for the Texas Department of State Health Services, John Hellerstedt. In a five to three decision, the US Supreme Court ruled that the requirements of the challenged law, Texas House Bill 2, had forced the majority of abortion care facilities to close. With fewer available facilities, women faced undue burdens of travel time and cost when seeking abortions, restricting their access abortion care. In previous US Supreme Court cases Roe v. Wade (1973) and Planned Parenthood v. Casey (1992), the Court ruled that placing undue burdens on women seeking abortion care was unconstitutional. Upholding those decisions in Whole Woman's Health v. Hellerstedt, the US Supreme Court struck down Texas House Bill 2 and protected women’s access to abortion care.