Medical Examiner

25,000 Illegal Abortions, One Doctor on the Run

Before abortion was legal, people in the northeast could travel to New York City to go to Dr. Nathan Rappaport, one of the most notorious illegal abortionists of the era.

Nathan Rappaport, talking into a newsperson's microphone outside of an abortion rally.
Nathan Rappaport, talking to the press. Photo by Bettmann Archive/Getty Images.

In 1966, a writer for the Village Voice sat down with Nathan Rappaport in an out-of-the-way hotel on Manhattan’s Upper West Side. The divorced, disgraced, and debarred physician was ready to come out of the shadows: He was an illegal abortionist and had been for more than 35 years and 25,000 procedures. By that point, he realized that he was going to continue, despite the risks: “I tried to quit after I got out of prison the first time and just to do something related to medicine,” Rappaport told the alt-weekly. “But, with my license revoked and my jail record, I couldn’t get a job anywhere in the world.”

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At the time, in most states, the situation on the ground was tense. Legal hospital abortions—or “therapeutic abortions”—were offered only in the narrowest circumstances, typically when the pregnant person’s health was threatened or when two psychiatrists would (or could be paid to) testify that being forced to carry a pregnancy to term might drive the woman in question to suicide. That meant only about 8,000 of the estimated 200,000 to 1 million total abortions performed in the U.S. each year were done legally. The rest were a hodge-podge of home remedies, “quacks and butchers,” and the occasional skilled surgeon willing to risk it all. Each year, hundreds of women died as a result of botched abortions.

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And each year, hundreds of women went to Dr. Rappaport. He had long believed abortion should be legal—a perspective he shared in the 1962 book The Abortionist, published by Doubleday under the pseudonym Dr. X. But Rappaport wasn’t just an advocate for women; he hadn’t gotten where he was on principle alone. His practice had started in dire financial straits, and his legal situation forced him to keep going. He made the best of things and helped a lot of women throughout his career. But as described in the third episode of this season of Slow Burn, going to his apartment for an abortion could also be a frightening experience: “Filled with old wives’ tales and horror stories, many feared they were about to die,” Rappaport said. “Those who went through with it often were so terrified no amount of assurance I could give them during the preliminary interview did any good.”

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While most abortionists remained anonymous, by the late 1960s Rappaport became one well-known and enduring example of the unregulated, underground providers who women were forced to trust in the years before Roe v. Wade made abortion legal nationwide. He was joining women at rallies for abortion and taking interviews with local and national outlets. His impassioned speeches helped earn him the title of “America’s most loquacious abortionist,” which the reporter Susan Brownmiller would bestow on him in 1969. In some ways, he was an outspoken advocate for the procedure that came to define his life. But in another light, he was an opportunist who took advantage of a bad situation.

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Little is known about Rappaport’s life outside of his practice—and, even then, the pieces can be hard to fit together as anecdotes, dates, and other details changed over decades of retelling. He was born in 1900, possibly in Russia, but grew up in New York City. He attended City College for his undergraduate degree and medical school at the University of Arkansas. Shortly after graduating in 1926, Rappaport hung his shingle in Jackson Heights, Queens, near where his parents lived. His abortion practice was born of a dual necessity: During the Great Depression, “more and more women asked me for abortions because they could not afford to feed another mouth,” he said. “The collections from my practice had dwindled to almost nothing. There was pressure from my family to take the abortion money.” At the time, he charged $25 for the service—in a period when the average annual income for a family was just $1,368 a year and more than 18 percent of Americans were out of work entirely.

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Rappaport moved frequently—Census records, newspaper accounts, and other documents place him in Philadelphia, Washington, D.C., Miami, and Chicago—but he spent most of his time at his New York City practice. For women who were in their first trimester, he relied on a method called dilation and curettage, or D&C, which involved dilating the uterus and scraping out fetal tissue with a small rake. Each procedure took between 5 minutes and an hour, depending on the amount of tissue that had to be removed. Later in a pregnancy, he used a method of injecting the amniotic sac containing the fetus with a saline solution, which poisoned the fetus and then caused delivery within about a day. While Rappaport tried to do no more than five abortions a day, he said his record was 27 in one day. Still, Rappaport had to turn about 10 percent of the women who approached him away, for lack of time.

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It was lucrative work, which proved difficult to reconcile in public accounts of his career. (Was he a feminist, a hustler, or both?) By the 1940s, Rappaport was charging between $300 and $600 for his services, which was significantly more than his peer, Robert Spencer (better known as Dr. S) in Ashland, Pennsylvania, who never charged more than $100. But it was much less, Rappaport maintained, than other providers in midtown Manhattan who catered to upscale clients. Either way, Rappaport saw himself as a crusader for the poor: At times, he operated on a sliding scale, charging an industrialist $10,000 for an abortion for his teenage son’s girlfriend to compensate for the abortions he performed for poor women at what he believed was a reasonable rate. Women “wake up crying for joy after it’s over, so happy to be free,” he told the Chicago Daily News in 1969. “That’s how I get my kicks, I guess. You know, an abortionist has his satisfaction, too.”

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All told, Rappaport was pulling in more than $200,000 a year—or $2.5 million in today’s dollars. In some accounts, he seemed to brag about the money, and at other times he rationalized it: “There are many expenses and legal fees,” he told Newsday in 1969, reportedly “with a touch of embarrassment.” And there were legal fees. Between 1949 and 1968, Rappaport spent nine years in jail for his illegal abortion practice. His trials were often the subject of media scrutiny. In one salacious story, the New York Daily News described a raid on Rappaport’s office, part of a larger sting operation involving “a woman sleuth.” More than a decade later, The Miami News observed him at another trial, this time for illegally practicing abortion in Florida, sitting behind the defense table and “chewing gum with machine-gun rapidity.”

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There were less-than-legal fees, too. Bribing cops, judges, and other criminals was commonplace; a $10,000 pay-off was just part of doing business. If an abortionist resisted the rules of the street, the consequences could be swift and serious. When gangsters in New York caught wind of his practice, they asked for money in return for their silence. Rappaport refused to pay, so they called the police—resulting in his 1950 jailing and the loss of his medical license. “When he was arrested again, in Florida, the police, always glad to be of service, gave his instruments to another abortionist who was paying off at a higher rate,” the Village Voice reported.

But no amount of money could get Rappaport what he wanted most—hospital privileges. “Complications may arise in any surgery,” he told the Daily News, “but in a hospital you’re prepared. You have immediate access to blood banks, drugs and special equipment… Outside the hospital the abortionist is alone in a hostile world.” In 1968, Rappaport had been jailed and charged with manslaughter in connection with the death of a 20-year-old woman who had reportedly fallen into a coma and later died from a salt infusion that had entered her bloodstream after her abortion. (Rappaport denied all wrong-doing, and said that none of his patients had ever died as a result of an abortion.)

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In the twilight years of his career, Rappaport began to see some evidence of change he had so long desired. The New York Medical Society further expanded its legislative recommendations for the legalization of abortion to include women who are “incapable of caring” for their children and pregnant unmarried women 16 and under. In 1967, California expanded its reasons for legal abortion to include rape, incest, and the physical or mental health or the mother or child. New York State was considering something of the same, and ultimately succeeded in 1970, despite the Catholic Church’s objections. While abortion remained mostly illegal, arrests of providers and referrers in Rappaport’s neck of the woods went down—not that the threat of jail time had ever deterred him. “I believe in civil disobedience of laws which cannot be respected,” Rappaport told Newsday in 1969.

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Ultimately, in 1973, in Roe v. Wade, the Supreme Court of the United States decided in a 7-2 decision that a woman’s “right to privacy” guaranteed her a right to abortion under the 14th Amendment. Rappaport is not quoted on the decision, but he must have been overjoyed.

The public record on Rappaport trailed off. Eventually, he retired to Dade County, Florida, where he died in 1978. Right up until the end, he thought of himself as a doctor, even though he’d been operating without a license for almost half of his career. “I felt then, as I do now, that the needs of my patients in their pursuit of happiness and love was of primary importance to me, their physician, and that the wonder of conception, its regulation, postponement, or interruption is wholly a medical problem,” he had told the Village Voice. “It is not the sphere of influence or interpretation of the moralists, religionists, faddists, legalists, or anybody else.”

Listen to the episode of Slow Burn that features Dr. Rappaport here:

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