For nearly four centuries, the frequency of abortion in America has depended on how citizens and residents answered five questions:

Anatomy: Is the being in the womb human?

Bible: Is Scripture’s teaching on the sacredness of human life binding on us?

Community: What kind of advice and support do vulnerable women receive from boyfriends or husbands, parents or friends, employers, or anyone to whom a woman might look for emotional and financial help?

Danger to women: What is the likelihood of an abortion ending with not just one victim but two?

Enforcement: In what informal and formal ways do those with influence and resources protect the most vulnerable?

How do we answer these questions today? One article does not provide enough space to spin out each of these threads historically (if you want to read more, Leah Savas and I have done that in our book, The Story of Abortion in America). But some changes are evident: Americans now have more awareness than ever before of what unborn children look like, and less knowledge of what the Bible teaches. The influence of community and the possibility of enforcement have fluctuated over the years. The danger to women has sharply declined. Let’s unpack these changes one by one.

‘A’ Is for Anatomy

The most popular seventeenth-century guide to pregnancy and fetal anatomy, The Midwives Book, echoed ancient and medieval contentions that unborn children have “first the life of a Plant, then of a Beast, and lastly of a Man.” But in 1839 Dr. Hugh Hodge, brother of theologian Charles Hodge, spoke of the unborn child’s continuous development from conception.

Other doctors conveyed Hodge’s teaching to their patients, who without seeing an unborn child were proceeding on faith. A breakthrough in popular understanding came at the 1939 World’s Fair in New York City, where more than two million people waited in line to view twenty-four sculptures that showed human development in the womb. The next mass education came in 1965 when a Life magazine cover showed Lennart Nilsson’s photograph of an unborn child floating within an amniotic sac. This issue was Life’s all-time fastest seller at checkout counters. And now, 3D and 4D ultrasound lets a woman see not a baby but her baby.

‘B’ Is for Bible

In an era of frequent Bible reading that lasted until early in the twentieth century, it was hard to miss God’s creative involvement in human life from its beginning. Colonists read in the Psalms, Job, Isaiah, Jeremiah, Luke, Galatians, and other books, not only that we are made in God’s image, but that he “knitted me together in my mother’s womb” (Psalm 139:13).

Bible readers and hearers also imbibed sensational detail about what evildoers do to unborn children. When an Israelite town did not surrender to an evil king, “he ripped open all the women in it who were pregnant” (2 Kings 15:16). Hosea prophesied that “Samaria shall bear her guilt . . . their pregnant women [shall be] ripped open” (Hosea 13:16). The Ammonites were guilty because “they have ripped open pregnant women in Gilead, that they might enlarge their border” (Amos 1:13).

Volumes other than the Bible, like The Midwives Book, featured the sacred and secular overlapping seamlessly. Jane Sharp quoted from or alluded to the Bible at least thirty times. She twice referred to Psalm 139’s “knitted me together,” but also noted Genesis 1, 2, 3, 4, 17, 29, and 30, as well as other passages from Exodus, Leviticus, Deuteronomy, 1 and 2 Samuel, 1 Chronicles, Psalms 113 and 127, Matthew, John, Acts, and Hebrews. Sharp frequently referred to “the law of God,” “the laws of God,” and “the blessings of God.”

Pastors in early America cited the Bible in speaking out against abortion. In 1869 the General Assembly of the Presbyterian Church in the United States of America declared that it viewed “the destruction by parents of their own offspring before birth with abhorrence.” But in 1908 Dr. Walter Dorsett at an American Medical Association convention complained that “Few sermons are preached from the pulpit for fear of shocking the delicate feelings of a fashionably dressed congregation.”

Some pastors were bold, but avoiding any mention of abortion was common in churches during the twentieth century and into the twenty-first. WORLD surveyed pastors in the 1990s and the 2010s. While some such as John Piper spoke out, I could accurately headline the articles “Silence of the Shepherds” I and II. The A and B trends — more anatomical knowledge, less Bible knowledge — pretty much canceled each other out.

‘C’ Is for Community

In early America, as the delightfully named book Sex in Middlesex (the Massachusetts county I grew up in) showed, community pressure on young men meant that pregnant, unmarried women could generally count on marriage before going into labor. If young men hesitated, old men intervened. They rarely needed shotguns, but every father had one.

The growth of large cities beginning in the 1830s broke down community protection and left more women and children at risk. Pastor Isaac Ferris in the Mercer St. Presbyterian Church spoke to three hundred young New Yorkers in 1852 and said an apprentice or clerk a generation earlier lived with his employer’s family, “but now it is sadly altered. The lad is left on the wide world — he is surrounded by the mercenary and the callous.” Self-indulgence with no supervision left young men in a moral maelstrom.

Ferris jump-started the YMCA movement as a way to form new communities, and YWCAs soon followed. Unmarried women surprised by pregnancy often went to homes away from home. Some had non-euphemistic names like the Erring Women’s Refuge. Starting in the 1970s crisis pregnancy centers tried to create supportive communities. Many pastors, even if they did not speak about abortion, prodded their congregations to support compassionate alternatives to abortion.

‘D’ Is for Danger

Until the 1830s abortion was often fatal for the mother as well as the child. Ingesting an abortifacient was playing Russian roulette: Place a bullet in a revolver, spin the cylinder, point the muzzle at your head, pull the trigger. Letting an abortionist invade a uterus was the equivalent of two bullets in the cylinder. Only utter desperation, or unrelenting pressure from an unloving lover, would lead a woman to accept a one-third risk of death.

At that time surgical abortion hadn’t changed much in two millennia. Around the year AD 200, the theologian Tertullian described how an abortionist inserted into the uterus “an annular blade, by means of which the limbs within the womb are dissected,” along with a blunt gripper “wherewith the entire fetus is extracted by a violent delivery.”

The surgical trauma was bad enough, but then infection arrived. Abortion became a little less dangerous for mothers when specialists with steady hands and extensive experience began doing more abortions than neighborhood hacks. In the late nineteenth century, knowledge of antisepsis spread: Cleanliness in abortion was not next to godliness, but the Maryland Court of Appeals in 1901 recognized the difference antiseptic procedure made when it declared, with some tunnel vision, that “death is not now the usual . . . consequence of an abortion.”

As use of antibiotics spread after World War II, the concerns about personal danger that had kept some women from obtaining abortions dropped steadily. New York City went from 144 abortion deaths in 1921 to 15 in 1951. The number kept declining: Although abortion propagandists in the 1960s claimed “thousands” of women were dying in abortions, Planned Parenthood medical director Mary Calderone acknowledged in 1960 that for women, “Abortion is no longer a dangerous procedure.”

‘E’ Is for Enforcement

In the late nineteenth century newspapers regularly reported that abortion was arousing “intense feeling.” The Wisconsin State Journal reported an arrest “on the charge of seduction and abortion made by the parents of a girl 14 years old. . . . The arrest causes intense feeling.” But with all the intensity, it was still hard to lock up abortionists.

In 1904, Dr. Rudolph Holmes successfully urged the Chicago Medical Society to create a Committee on Criminal Abortion. Holmes became chairman and pushed his colleagues to try “influencing the daily press to discontinue criminal advertisements.” Abortion was illegal in Illinois and every other state, but the Chicago Tribune and other newspapers still ran thinly veiled ads for it. Holmes visited editors who dropped the ads, particularly when postal authorities issued a stop order against mail delivery of publications sustaining abortion.

By 1910, though, Holmes was despairing. He noted in a medical journal that abortionists, denied newspaper advertising space, printed business cards and distributed them through brothels and rooming-house landlords. He said Chicago abortionists had their own legal department, with witnesses on tap and ready to swear that “the young woman had an operation elsewhere and the doctor was merely performing a life-saving operation.” He said the coroner’s office investigated not more than one percent of abortion deaths in Chicago: “The persons who perform the operations find it easy to cover up their tracks, and it is difficult to get witnesses to testify in cases of this kind.”

Doctors in other cities shared Holmes’s pessimism about enforcement. In 1912 Dr. M.S. Iseman offered an acidic city-by-city tour of how laws were not working at street level. During five years in Washington, D.C., thousands of abortions led to “only nine indictments for abortion and three convictions — not enough to do more than to slow down slightly the traffic to abort.” In New York City, abortion was rampant but “in some years not a single indictment follows. . . . It is difficult to say which is the stronger attraction for the lady visitors to the metropolis — the horseshow, the opera, or the gynecologist.” In Atlanta, “After years of suspended animation, the police made a solitary arrest for the crime of abortion.”

The Heart-Changer

Moving forward a century to a time when more people call themselves pro-choice than pro-life, we should be aware of the limitations of enforcement in red states, particularly in their blue cities. It’s hard for me to believe that a jury of twelve randomly chosen people in my city would ever imprison an abortionist. With danger to the mother no longer a deterrent, and wherever enforcement is unlikely, the ABCs — anatomy, Bible, community — are the bulwarks for life against death.

That realization is especially important now that American society suffers from structural abortionism. The frequent corporate response to Dobbs — paying travel costs to legal-abortion states for employees in pro-life states — shows abortion’s economic role. Many organizations structure their workforce on the assumption that young female employees will always be available to show up in the office for full-time work. Corporate and government offices, instead of pretending that differences between men and women of childbearing age don’t exist, should and could be more creative in promoting shared jobs, flextime, on-site infant care including feeding times, work from home, and other pro-life scheduling.

Beyond economics, we should also recognize that an underlying cause for many abortions, like much of homelessness, is the catastrophic loss of relationships. Churches can and should be gospel-formed communities that communicate to unhappily pregnant women: There’s room here for you.

Pro-lifers in deep blue states may despair, but in one respect they may have an advantage. To be successful, laws restricting abortion need to pedal in tandem with lives devoted to expanding compassion. In red states the temptation will be to put politics in the front seat. In states where protective laws are so dead-on-arrival that millions of babies are likely to be dead pre-arrival, changed hearts are the only hope — and the gospel is a heart-changer.