In 1964, women began requesting abortions at Atlanta's Grady Memorial Hospital—despite the fact that abortion had been illegal in the state since the 1870s.

But the pregnant women had—or believed they had—what some called the "three-day measles": rubella. A rash would blossom on their faces, travel down the body and then disappear.

Except when it didn't.

And by 1964, the virus also known as "German measles" was blazing its infectious path throughout the nation and influenced state efforts—in Georgia and beyond—to reform "criminal abortion" laws that had banned pregnancy termination since the last century. Because for pregnant women, the impact of rubella was anything but fleeting. The mother-to-be could bounce back from the virus with no ill effects, but the fetus she carried could have birth defects that ranged from deafness and developmental delays. Or, as one study suggested, it could be born with microcephaly, a disorder in which infants have abnormally small heads and a host of chronic health conditions.

Now, 50 years later, clusters of microcephaly have popped up in Latin American countries—this time believed to have been caused by mosquito-borne Zika virus. In El Salvador, government officials unhelpfully suggested that women abstain from sex for years after possible infection, advice that fails to take into account high rates of sexual violence, male responsibility, lack of contraceptive access, and the simple fact that abstinence-based approaches tend to fail.

And let's not forget lack of abortion: El Salvador totally bans abortion and keeps its promise of punishment; on suspicion of abortion, it incarcerates women who appear to be miscarrying. Brazil, which also has high numbers of Zika-affected babies, also severely restricts abortion, as do many countries around Central and South America and sub-Saharan Africa.

Different national contexts and health care systems aside, the U.S. "Great Rubella Outbreak" of 1964 could help inform abortion activism or reform elsewhere in the Western Hemisphere. But it also serves as an important cautionary tale about who gets left behind when there's momentum to change a law without broader social change.

In Georgia, those passed by were Black women—whose experiences became a key but often-forgotten part of the fight for abortion reform.

In 1964, rubella coursed through the nation. Schools closed at the sight of spotty-faced and potentially infected students. In January, the U.S. Department of Health, Education and Welfare was on high alert, mapping the disease in the mid-Atlantic. By February, the epidemic had reached further south. By March, Kentucky had a 60-percent jump in cases, Maryland's numbers doubled, and Atlanta physicians issued vague reports of seeing similar rashes at higher rates.

It had been known since the 1940s that rubella could cause congenital birth defects. And there was not yet a rubella vaccine. It would take until 1971 for the vaccine to become available and still longer for the MMR (measles, mumps, rubella) combo to become required for a standard immunization. In the absence of a vaccine, fear escalated.

The prospect of "rubella babies" moved some hospitals to provide abortions—but not in any meaningful numbers.

Only sixty-four women had abortions at Atlanta's Grady Hospital in 1964 due to suspected rubella infection. Only two of those women were Black.

The inaccessibility of legal abortion for Black women meant that they bore more than their share of rubella-affected children. A 1968 Emory University study found that of the 55 children with confirmed rubella-related health issues, 27 were African-American. Though there were far fewer Black women in Georgia than White, equal numbers of Black women had babies with rubella defects in the hospital.

"Few Negro women presented themselves to physicians during the epidemic for therapeutic abortion consideration, while rubella deformities were rare in the upper social classes, from which most of the abortions came," an Atlanta Constitution article summarizing the study.

Abortion access was limited for everyone, but Black women's difficulty ending pregnancies was compounded by their race and overall poor health-care access.

They could appeal to a hospital and hope that they'd find a sympathetic doctor willing to do "the operation." But Black women still struggled for equal access to hospitals in general in 1964, the year that the Civil Rights Act passed and began the push for desegregation in public facilities, including health care institutions. Georgia's Cave Spring School for the Deaf, which would educate rubella children, housed and fed Black and White children on different campuses. Grady Hospital—the one that performed abortions on those 64 women in 1964—still had segregated wings for Blacks and Whites.

So, without access to the best care at hospitals that catered to Whites, they'd have to journey to "colored" physicians known for safe but illegal abortions in secret, physicians like Dr. Joseph Griffin (who operated the state's largest Black hospital near the Florida border and even performed abortions on White women in secret). Or there were other options: sometimes the community midwife, the quack who had a profitable abortion side hustle, or self-induced abortion by any dangerous means necessary—knitting needles, mustard baths, a push down stairs, reeds, quinine tablets or fingernails.

Though Black women in Atlanta had poor odds of getting an abortion and higher risk of having a "rubella baby," there was no consensus about what that meant. Many Georgians knew that rubella would afflict both races, but still understood rubella in racial and class terms. When a Black New York couple sued a hospital for assuring them that rubella would not harm their baby (but later delivered a severely disabled daughter who would require a lifetime of care), one witness declared that he had never seen a Negro with rubella.

The rubella virus. Image courtesy CDC.
The rubella virus. Image courtesy CDC.

It's unclear how seriously the Emory researchers took Black women's overrepresentation among the mothers of rubella babies. But around the same time, activists and doctors began pushing the idea of changing the law.

The Georgia legislature voted in 1968 to make a limited reform of its abortion law. Now a woman could have an abortion if she jumped through a punishing series of hoops. Her abortion would have to be for verifiable health reasons, or because the pregnancy was a result of rape, or because fetus was likely to be malformed.

But she'd also have to be a Georgia resident. She would have to apply to a hospital abortion committee, which could approve or refuse her request. An additional two doctors outside that committee would have to agree with the attending physician. And the hospital itself would have to be accredited.

So Georgia remained inhospitable to women seeking therapeutic abortions. From the years 1968 to 1970, the state's health-care facilities reported only 939 abortions performed for health reasons. That's compared to nearby North Carolina, which partly reformed its abortion policy in 1967 and had performed more than 680 in 1970 alone. Maryland had performed 7,700 abortions in 1969 and 1970. Only six of Georgia's almost 150 counties had facilities that performed more than 10 legal abortions.

Georgia's legal change was both reformist and restrictive. Under the pressure of the law, an estimated 20,000 women still underwent illegal abortions annually in the state. It was an experience that nurse Mary Long bore witness to in Grady's emergency ward, where she saw women "come in lifeless… almost near death."

And dying from an illegal abortion, or suffering serious injury from one, was overwhelmingly an experience of Black women. Between 1950 and 1969, medical researchers documented 205 nonhospital abortion deaths. One hundred forty-three were Black. Between 1964 (the year of the rubella epidemic) to 1969, 88 percent of such deaths were Black, according to a study by physician Roger Rochat and others.

A stark disparity—one that meant the road to abortion reform was paved with Black women's bodies, though their individual stories rarely rose to public attention. When the state coalition for hospital abortion reform began looking for a plaintiff to challenge the abortion law, they settled on an unidentified White woman who was denied an abortion: Mary Doe, later revealed to be Sandra Cano. Doe was 22 years old, the mother of three children and 9 weeks pregnant when her husband abandoned her. With no income and a history of mental health issues, Doe said her health and poverty would not allow her to take care of another child. Her case became Doe v. Bolton, which tried to expand the definition of an abortion for health reasons; it was decided the same day in 1973 as Roe v. Wade, which then trumped all state laws.

But even if the unseen "face" of Doe v. Bolton was a White Georgia woman, Black women were on the forefront of legal change. Nurse Mary Long, who worked for decades at Grady, was among the plaintiffs who argued in Doe that Georgia's law was patently unconstitutional; she would later become the first Black woman president of the Georgia Nurses Association. And when Georgia attempted to reform its abortion law yet again in 1970, one of its co-sponsors was Grace Hamilton, the first Black woman in the state legislature. Her effort to allow abortion in the first trimester met with opposition: Anti-abortion leaflets describing "Three Ways to Kill a Baby" were distributed in the statehouse. But the 1968 law, Hamilton contended, left women with few choices but to search out a "butcher" or bear an unwanted child.

It's the same kind of "non-choice" that women in Brazil and elsewhere are considering today if they're pregnant and have the Zika virus.

And truth be told: Many women in the United States are not faring much better. There are waiting periods; biased counseling, which forces abortion-seeking women to listen to misinformation about how abortion can cause breast cancer; laws that regulate abortion clinics out of business by dictating the size of closets and doorways; and so many clinic closures that finding an abortion provider can require a temporary migration to another county or state. In Texas, since a law shut down many of the state's abortion providers, some of the remaining clinics are seeing women who arrive for services with stalks of parsley inside them or who ask about how they can start their own abortions.

In this country where abortion is theoretically legal yet frequently inaccessible, restrictions are now the norm, not the exception. And so maybe the takeaway is not how Zika-affected countries should look toward our example, but how little distance there is betwixt and between our ostensibly progressive abortion law and those across Latin America. It's a distance that a mosquito can cross.

Cynthia R. Greenlee is a historian, editor, and writer based in North Carolina. She’s co-editor of the forthcoming anthology, “The Echoing Ida Collection,” of black women and nonbinary writers on reproductive and social justice. She’s also the winner of a 2020 James Beard Foundation Award for excellence in food writing.