The truth behind a dirty business

MIKE LEIGH’S award-winning film Vera Drake brings sharply into focus the trade of illegal abortionists. It is a trade that has been swept under the carpet and forgotten for nearly 40 years.

The film is brilliant - well written, directed and acted - but surprisingly, its medical accuracy is questionable.

A woman’s right to control her own body is taken for granted now, and younger people can scarcely believe that abortion used to be a crime.

The law encouraged back-street abortionists to flourish, because there have always been women who wanted or needed to end pregnancy.

For rich women this would be a clandestine visit, at great expense, to a secret address, but for poor women it would be a very different story.

Women had too many children - far more than they could house and feed decently - and another baby would be a disaster. Contraception was inadequate. For single women, illegitimate pregnancies meant social and economic catastrophe.

Thousands of women tried some sort of medicinal way of evacuating the uterus. Violent purgatives such as a pint of Epsom Salts were used: gin and ginger; turpentine; raw spirit; aloes or sloes. None of them worked. Some less reputable newspapers advertised "cures for menstrual blockage". These were poisonous and sometimes fatal.

When all failed, desperate women were driven to back-street abortionists like Vera Drake. This is where the film’s medical accuracy becomes questionable, because Vera’s method of procuring an abortion - flushing out the uterus with soap and water - was invariably fatal.

Inflating the uterus with liquid can induce primary obstetric shock, a dramatic fall in blood pressure, heart failure and death. Thousands of women have died instantly from this method of abortion.

Abortionists knew of the danger of the "flushing out" technique, and did not use it routinely.

Does it matter if a historic film, authentic to the smallest detail of post-war London family life, is inaccurate in this respect? I think it does.

The film promotes the idea that abortion is easy - quick, clean, painless and successful. It is not. The film is dangerous because it will be shown worldwide, in countries where abortion is still illegal. If women in these countries see a film which depicts abortion as no more problematic than syringing wax out of an ear, they might try it themselves, with fatal results.

Evacuation of the uterus is not easy, and can only be achieved by surgical operation. The horrors of back-street abortions are beyond imagining and defy description. They were done without anaesthetic, with obsolete or inadequate surgical instruments, with no sterility, on kitchen tables, by medically untrained persons. They were agonising and carried a high risk.

I was a district midwife in London in the 1950s, and my book, Call the Midwife, tells the story of our work, and the people among whom we worked. Illegal abortions were all around us and in my book I describe one that took place in a brothel, where the girl died and her body disappeared.

We, as midwives, were never directly involved, but we often had to clear up the mess after a bungled abortion, especially on gynaecology wards.

Doctors, midwives and hospitals were required to report to the police if they suspected an abortion. But I never heard of this being done. We all knew what the woman had suffered; prosecution would have been too cruel. But by shielding the woman, we were also shielding the abortionist, whom most of us would have wished to see behind bars. It was a dilemma.

The film Vera Drake tries to imply that the heroine was acting on principle, and never took payment. But I doubt if this was ever the case. Abortionists were in it for the money. I never heard of one who was conducting a philanthropic practice.

Ignorance, incompetence and avarice seem to be the folklore memory of abortionists. But I wonder if this is entirely fair. When medical treatment was illegal these women were in demand. They performed a service which was widely used. That they were medically untrained was not their fault; the legislation was at fault.

Fatality of women was high, but it was a great deal higher among women who tried to procure their own abortions, unaided.

I give talks to women’s clubs about my book, and at nearly every meeting at least one woman in the audience will relate a horrifying story of a distant relative who tried a do-it-yourself abortion. Knitting needles, crochet hooks, scissors, paper knives, pickle spoons and other implements have all been pushed into the uterus by desperate women who preferred anything to the continued pregnancy.

Chronic ill-health frequently followed a back-street abortion: continuous pain, infections, anaemia, scar tissue or adhesions, cystitis or nephritis, incontinence, a torn cervix or perforated colon.

I clearly remember a girl of 19 who developed renal failure due to damage to the bladder. Her kidneys actually packed up, but amazingly she survived.

I recall a tragic woman, the mother of five children, who developed a massive sac of pus in the peritoneum. We tried to drain it, without success. I will never forget the five children being brought into the hospital just before their mother died.

In 1967, the Abortion Act was passed, and abortion was no longer illegal. When I was a gynaecology ward sister I was sometimes asked if I approved of it or not. My reply was always that I did not regard it as a moral issue, but as a medical issue. A minority of women will always want an abortion. Therefore, it must be done properly.

• Jennifer Worth was a nurse, midwife, ward sister and night sister from 1953 to 1973. She is author of Call the Midwife, published by Merton Books in 2002. Her next book, Shadows of the Workhouse, is out in February.