Since the Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision, many have invoked the coat hanger and the public hospital septic abortion ward as portents of life after the fall of Roe. Illinois Governor J. B. Pritzker was one of many pro-choice advocates who made direct reference to Ward 41 at Chicago’s public hospital, Cook County Hospital. But by only paying attention to the horror stories of botched abortions in the pre-Roe era, we miss the other lessons that public hospitals like Cook County can teach us: even during Roe, access to abortion was limited, hard-fought, and dependent on local conditions. 

Public hospitals are key to understanding the brutal consequences of policies that limit people’s access to healthcare, as well as the role that local governments often play in a country with no national healthcare system. In providing care to everyone who came through its doors, the public hospital approximated the right to healthcare. When county, state, and federal lawmakers undermined the right to reproductive care, Chicagoans demanded its reinstatement at Cook County Hospital. 

These struggles and the hospital’s history shed light on the importance of tethering demands for reproductive rights to a more expansive welfare state and healthcare system. They also help us understand the crucial importance of federal action.

The State of Illinois passed its first anti-abortion law in 1827. But making abortion illegal never prevented women from having abortions. In the twentieth century, even before Roe, “abortion was not extraordinary, but ordinary,” according to historian Leslie Reagan. Women with means were often able to access safe abortions in doctors’ or midwives’ offices. Low-income women were more likely to self-induce abortion and, as a result, more likely to suffer complications and end up in the hospital. 

In Chicago, more often than not, that hospital was Cook County. Opened in 1866 to fulfill the county’s legal obligation to finance medical care for the indigent, County (as it was called by many Chicagoans) provided a full spectrum of healthcare to the city’s marginalized people. Communities of color, especially Black Chicagoans, relied disproportionately on County, the city’s only public hospital until the 1990s. Historically barred from the industrial jobs most likely to provide insurance, Black Chicagoans were uninsured at higher rates. Private hospitals also routinely discriminated against Black Chicagoans. Medicaid, created in 1965, left out many people because the program was means-tested and because many private providers did not care for publicly insured patients. Before and after Roe, County provided care, reproductive and otherwise, to Chicagoans who needed it. Public hospitals all over the country played similar roles.