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The religious history of Caesarean surgery and what it means for the abortion battle

How colonial powers used Caesareans to define the boundaries of unborn life


This Women’s History Month marks a sobering historical landmark: According to the Guttmacher Institute, 2021 was “the worst legislative year ever for U.S. abortion rights,” and Roe v. Wade could be overturned at any time.

Efforts to restrict abortion often fixate on slippery questions about when life begins and what constitutes fetal personhood. Catholic authorities arguably led the charge from the mid-18th century to the present, as a long line of popes and their subordinates made the protection of unborn life a cornerstone of the church’s philosophy.

But this was not always the case. In fact, the Catholic Church’s positions on fetal life have changed throughout history. It was actually not until 1869 that Pope Pius IX (1792-1878) removed the long-held distinction between “animated” and “unanimated” fetuses and then declared that abortion merited excommunication. Previously, influential thinkers had accepted the long-standing Aristotelian idea that the unborn first had a plantlike soul, then, by mid-pregnancy, a sentient soul and only after birth did they have a rational human soul.

The Caesarean operation also played a role in shaping these claims about unborn life. Despite their lack of medical training, priests became surgeons during the 18th century. They performed hundreds of Caesarean surgeries as a way to advance the religious notion that the unborn were ensouled early in pregnancy. Pre-modern surgery, colonial violence and theological mandates, therefore, are all at the heart of the fetal personhood debate.

After 1749 and until the end of Spanish colonial rule, authorities throughout the Americas required Catholic priests to perform Caesarean operations on dead and dying women. The Caesarean operation was exceedingly rare at the time, as reliable pain control did not exist, and as antibiotics would not be developed for another century, meaning infection was almost impossible to control. Before this time, surgery was only performed as a last resort when the child could not be born without intervention and the mother’s life was already lost.

Yet, by the 18th century, priests did not primarily aim to save the bodies of unborn babies. Rather, they sought to save their souls. They did so by baptizing the products of conception they extracted via Caesarean surgery. Theological mandates now superseded medical necessity: to save unborn souls, authorities had to argue that the unborn were individuals who had their own souls that needed saving. This quest to baptize the unborn altered the historical trajectory of Caesarean surgery, transforming a rare pre-modern surgery into a commonplace modern one.

King Charles IV wrote in 1804 that he considered all unborn products of conception to be ensouled, even if they were “as small as one grain of barley.” His mandate meant priests performed surgery to extract unborn products of any size, no matter how small. That same year, Charles IV also said priests must not allow the burial of any woman in their parishes unless they first ascertained whether she was pregnant — even if the pregnancy was in its very early stages. If a priest had already buried a woman and then he heard that she had been pregnant, the priest was obligated to dig up her body and cut open her womb. In short, women’s dead bodies became objects of theological scrutiny, and the discovery of a conception outside of marriage could bring shame onto their families even after her death.

Historians say priests performed hundreds of Caesarean operations between 1750 and 1850, from southern Argentina to modern-day California, with one of the earliest operations on an enslaved woman in Peru. Eight states in the U.S. southwest were then part of the Spanish empire, and the operation was particularly common there.

Battles over political control partially explained this pattern. Communities in the Southwest were particularly rebellious in the late 18th century because Indigenous nations fought off the encroachments of multiple colonial powers, including French, American and Spanish troops. Indigenous warriors raided missions frequently, stealing horses, guns and food. In this context, some priests viewed surgery as means with which to threaten Indigenous women and force them to comply with Christian mandates. Moreover, the priests focused on the unborn because they believed that their mothers were already lost to demonic forces such as shamanism and witchcraft. Women’s bodies became more dispensable in the struggle to evangelize the next generation.

Sometimes surgeries became a tit-for-tat war strategy: During the Túpac Amaru rebellion of 1780-1782 in Peru, some Indigenous rebels allegedly excised infants from the wombs of colonizers. Some theologians responded in kind, proposing that the best response was forcible Caesarean surgery against the Indigenous, even if it entailed substantial violence. They pointed to examples of violent Caesareans during warfare in ancient Rome, slipping from an emphasis on evangelization to an emphasis on attacking the womb as a war strategy.

During the late 18th and 19th centuries, theologians increasingly sought to monitor and control women’s sexual behavior. Priests often tried to find out which women in their parishes were pregnant so that they could plan to operate in case they struggled to give birth. Pinpointing the moment of death was impossible in the 18th century, and priests sometimes began to operate before the woman’s death. In other cases, priests used the threat of surgery to warn women that the operation was a potential consequence of becoming pregnant outside of marriage. As historian José Rigau Pérez has shown, family members often opposed Caesarean surgery, decrying desecration of the dead. Authorities urged the arrest of families who resisted, charging them with the crime of homicide against an unborn life.

Not every religious Caesarean operation was coercive, and not every priest targeted rebellious women for surgery. Yet, it is notable that the history of the Caesarean is embedded within a colonial and religious context imbued with social violence. Indigenous and African-descended people in the Americas suffered warfare, forced labor and a caste system that stratified people by color and heritage.

The fight over the souls of the unborn cannot be separated from this context, because Caesarean surgery was not only meant to save women and children from dying during childbirth: rather, it was primarily to show that colonial powers had a right to define the boundaries of unborn life and prioritize spiritual personhood at all costs. This is important because this conflict remains at the heart of modern debates about fetal personhood, and it reminds us that such arguments are rooted in the historical weaponization of women’s reproduction to advance political, religious and economic agendas.