In his draft decision that would overturn Roe v. Wade, Justice Samuel A. Alito Jr. repeatedly emphasizes that the Constitution did not explicitly provide the right to abortion.

No, it did not. Nor did it provide for any other medical care specifically, much less intimate care related to sex and reproduction. But Alito makes a profound mistake in assuming that this means people did not regard fertility management as an elemental and presumed part of women’s familial and social roles.

At the time the Constitution was drafted, abortion was something women were supposed to take care of, away from the public sphere, as abortion had to do with sex, and with women’s “secret” and “shameful” parts. Most medical care was provided by the family matriarch, and abortions were often managed for women by women, in the home. Women were supposed to deal privately with the fact that they were vulnerable to rape and that their bodies bore the brunt of procreating the species. Everyone understood that a good wife would do what she could to preserve her health and long-term fertility, to “be fruitful and multiply” — including ending a pregnancy.

Women have long been given responsibility for procreation without official authority to manage it. Male theologians often considered abortion a sin, especially after “quickening,” the moment when the pregnant woman felt fetal movement and ensoulment was believed to take place. Abortion was connected to the general sense that women's bodies were of Eve: fallen, sinful and shameful in and of themselves.

But physicians generally acknowledged the necessity of abortion for protecting women’s lives and fertility. Herbal medicines to restore the menses were part of married women’s self-care, used to enhance long-term fertility by spacing births. Explicit “abortifacients” were part of standard lists of pharmaceutical herbs because miscarriages happened all the time and could be deadly if incomplete.

Even as the practices were widespread, it is unclear how effective — or safe — herbal abortifacients were. The milder ones might have made a difference around the edges. Those that worked effectively early in pregnancy were essentially poisons, and a woman had to poison herself enough to convince her body to reject the pregnancy without accidentally killing herself. In later pregnancy, drugs that caused uterine contractions could cause abortion, but dosages were not standard and uterine ruptures have long been known to lead to death.

Before the 19th century, civil society regarded abortion as a private medical matter for married women, and a problem in need of occasional discipline when it was a sign of extramarital sex.