This article examines the politics of abortion during Mexico’s cultural revolution of the 1930s. Although abortion remained illicit and criminalized during this era, many women gained access to the medical termination of pregnancy due to the expansion of reproductive health care. Women’s popular demands for reproductive health care altered the landscape of abortion services in the nation. The article argues that although doctors were attentive to women’s concerns about the structural factors that constrained their reproductive choices, their practices were still guided by a patriarchal emphasis on state control over reproduction, in which male authorities made paternalistic decisions about which women should have access to abortion, and in which contexts. This was a top-down approach to reproductive governance, based on an ethos of state control instead of individual or familial autonomy.