Depicting abortion access on American television ... - SAGE Journals

Special Issue: Abortion in Context (Part 1)

Depicting abortion access on American television, 2005–2015

F eminism & Psychology Feminism & Psychology 2017, Vol. 27(1) 56–71 ! The Author(s) 2016 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0959353516681245 journals.sagepub.com/home/fap

Gretchen Sisson and Katrina Kimport University of California, San Francisco

Abstract Despite an increasing number of restrictions on accessing abortion care in the United States, most Americans remain unaware of challenges to obtaining abortion. Theorists of abortion stigma have posited that entertainment media contribute to ongoing lack of knowledge about abortion care. Analyzing all plotlines that aired on American television between 2005 and 2015 in which abortion is considered (n ¼ 89), we examine how access to abortion is portrayed, whether characters are able to surmount barriers, and what documented real-life challenges to access are missing from onscreen representations. We find that 42% show at least one barrier to accessing abortion care, most frequently illegality, cost of the procedure, and social stigma. Almost no barriers—including illegality—are insurmountable, and most are easily overcome for the characters seeking abortion. Some barriers, however, change how abortion is understood by a character such that she opts to continue the pregnancy. This underrepresentation of the difficulty of obtaining abortion care may contribute to public beliefs that abortion restrictions do not pose real challenges for women’s access to abortion. Keywords abortion, media, stigma

Introduction Since 2010, policymakers throughout the United States have enacted over 280 new restrictions on abortion access and provision (Guttmacher Institute, 2015a). These restrictions include waiting periods between counseling and the procedure, ranging from 24 to 48 hours; limitations on the gestational age after which an abortion may occur; restrictions on the use of medication abortion; prohibitions on Medicaid payments for abortion services; and requiring admitting privileges Corresponding author: Gretchen Sisson, Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA. Email: [email protected]

Sisson and Kimport

57

for abortion-providing physicians and/or ambulatory surgical center standards for abortion facilities (Guttmacher Institute, 2015a, 2015b; Jones & Jerman, 2014; Jones & Kooistra, 2011). Additionally, many American women must pay a personally significant amount of money (Roberts, Gould, Kimport, Weitz, & Foster, 2013) and travel increasingly far (Jones & Jerman, 2013; Roberts, Fuentes, Kriz, Williams, & Upadhyay, 2015) to access abortion services. This makes abortion access both legally and logistically challenging for those seeking care. It is not clear, however, that the general public understands the significance of these increasing barriers to abortion access (Bessett, Gerdts, Littman, Kavanaugh, & Norris, 2015; Kavanaugh, Bessett, Littman, & Norris, 2013; White, Potter, Stevenson, Fuentes, & Grossman, 2015). Some of this ignorance may owe to abortion stigma and associated widespread underestimates of the prevalence of abortion (Kumar, Hessini, & Mitchell, 2009), and scholars have postulated that media representations can contest this erasure (Norris et al., 2011). Yet popular culture, including fictional television programming, centrally aims to entertain, not to correct public misperceptions about medical care. Indeed, television representations of all aspects of life, including different areas of medical care, often depart from reality for the sake of a good story. For example, cardiopulmonary resuscitation (CPR) is frequently depicted as safer and more effective than it is in real life (Diem, Lantos, & Tulsky, 1996). Studies of depictions of abortion care find similar mismatches with real life care: abortion is portrayed as more dangerous than it truly is (Sisson & Kimport, 2014), with characters seeking abortion portrayed as younger, whiter, wealthier, and less likely to be parenting than their real-life counterparts (Sisson & Kimport, 2015). Comparing abortion portrayals against reality is limited by the fictional imperative of television shows to attract viewers. There is, nonetheless, value in examining the content of fictional abortion portrayals for their discursive construction of barriers to abortion care. Regardless of their accuracy when compared to real life, entertainment television depictions of medical care, including ease of access, can influence public understandings of topics ranging from beliefs about organ donation (Lapansky, Schuh, Cody, Woodley, & Buffington, 2010; Morgan, Movius, & Cody, 2009), to understandings of cancer diagnoses and treatment (Rosenthal, Buffington, & Cole, 2013), to knowledge about protection from sexually-transmitted illnesses (Whittier, Kennedy, Seeley, St. Lawrence, & Beck, 2005). These depictions can also have real political consequences. For example, Annas (1995) argues that the American television show ER’s portrayal of emergency medicine as easily accessible and affordable mitigated Americans’ sense of urgency around healthcare reform. Similarly, Turow (2010) found that medical shows significantly underrepresented concerns about the cost of care in a way that diminished public awareness and debate. Below we consider how cultural representations of abortion access—and, pointedly, the extent to which barriers to access are presented as surmountable—may contribute to the public perception that abortion is easy to obtain and that restrictions on care are reasonable. We further speculate on the consequences such perceptions might have for viewers’ political understandings of abortion access

58

Feminism & Psychology 27(1)

in the US. Such potential applications are not limited to the US context, as research has shown the presence of inaccurate and stigmatizing media representations in countries with varying levels of contention around the topic of abortion (Evans & O’Brien, 2014; Kirkham, 2013; Kumar et al., 2009; O’Neil, 2013; Purcell, Hilton, & McDaid, 2014). While our analysis focuses on the US, similar questions about the portrayal of abortion access onscreen and through other popular media (e.g. print media) may be found in other countries around the world, with the potential for corresponding influence on their respective audiences. Using content analysis of television portrayals of characters considering abortion broadcast during a ten-year period on American television, this analysis examines the depiction of barriers to abortion care these characters face. We consider how access to abortion is portrayed, whether characters are able to surmount barriers, and what documented real-life challenges to access are missing from onscreen representations. We find that barriers to abortion are only infrequently depicted on television and, when they are, they are presented as obstacles characters can overcome. We suggest that such discursive constructions of abortion access as relatively easy, conveyed through entertainment media, may impact people’s real-life beliefs about abortion and the effect of barriers to access.

Methods We produced a comprehensive list of abortion-related plotlines on American television. Abortion-related plotlines are defined as any story in which a character considers abortion as an outcome for a pregnancy. We identified these plotlines using three online searches: (1) keyword descriptor results for ‘‘abortion’’ in the Internet Movie Database (IMDB.com), a crowd- and industry-sourced online resource; (2) plot descriptor results for ‘‘abortion’’ on IMDB; and (3) the top Google results for the string ‘‘abortion on television.’’ We included all plotlines where a character considers abortion, not only plotlines where the character obtains an abortion. We conducted these searches in December 2012, February 2013, January 2015, and December 2015 to ensure search results were kept current. We also included titles discussed in previously published academic literature. From this comprehensive list, we identified individual plotlines within the shows. See Sisson and Kimport (2014) for further detail. The sample for this analysis includes all television plotlines that were available to American audiences via network television or online channels (e.g. Netflix, Amazon) between January 2005 and December 2015, in order to limit our analysis to those portrayals with the potential to impact the current political environment. This includes programs that first aired in non-US countries (e.g. United Kingdom or Australia) that were later available on American television. A member of the study team viewed all plotlines in their entirety and quantitatively content coded each plotline for: pregnancy outcome (e.g. parenting, adoption, abortion, pregnancy loss), time period in which the story is set (e.g.

Sisson and Kimport

59

19th-century, present, future), urban/rural location (urban, suburban, or rural), US state (when applicable), and geographic region (e.g. East coast, Midwest, non-US country), with an ‘‘Other/Unknown’’ category capturing plotlines where the region is not specified and/or plotlines that take place outside of understood geographic distinctions (e.g. outer space). Finally, we coded any challenges the pregnant character faces in seeking abortion care. We defined challenges broadly to include not just legal regulations (e.g. parental consent requirements), but also practical obstacles (e.g. cost of procedure, lack of transportation) and social barriers (e.g. stigma, lack of support). The study team met weekly to discuss coding questions, and decisions were reached by consensus. After initial coding was complete, a second coder independently coded a 10% sample of the plotlines. We achieved 95% intercoder reliability.

Analysis We computed frequencies for the time period, region, location, and challenges to access variables for all plotlines. All analyses and descriptive statistics were computed in Microsoft Excel.

Results Frequency of abortion plotlines We identified 89 plotlines in which a character considers abortion, that aired on American television between January 2005 and December 2015. In 49 of these plotlines (55%), the character obtains an abortion. In an additional 36 plotlines (40%), the character either rules out abortion as a pregnancy option early in the plotline, changes her mind about getting an abortion after serious consideration, or does not have to make an abortion decision due to pregnancy loss, false pregnancy, or maternal death. For the remaining four plotlines (4%), the characters want an abortion and pursue getting one, but encounter barriers they deem insurmountable and ultimately do not get one.

Geographic settings Most abortion stories are geographically set on the East or West coast of the US, and they are most frequently in urban locations (Table 1). Settings of California, New York, Illinois, and Washington, DC account for over half of plotlines that are set in the contemporary US. Notably, these settings are in some of the regions, locations, and states where abortion access in the US is subject to the fewest legal regulations (Guttmacher Institute, 2015b; Jones & Jerman, 2013). This pattern suggests that the chosen settings for these fictional abortion stories could depict fewer legal barriers to access and, to the extent the programs aim to reflect real life, still be accurate.

60

Feminism & Psychology 27(1) Table 1. Geographic setting of onscreen abortion stories. Plotlines Region East Coast South Midwest West Coast Non-US Country Other/Unknown Urban/rural location Urban Suburban Rural Other/Unknown

26 15 11 18 13 6 52 13 12 12

Frequency of challenges to access Thirty-seven plotlines (42%) show the character facing at least one barrier—legal or social—to accessing abortion care (Table 2). Of the plotlines that show no barrier to the character obtaining care, 42 programs depict characters seeking an abortion but not confronting a barrier, and in the remaining 10, the character considers, but does not actively seek, an abortion.

Legal regulations The most frequently encountered barrier to access characters face (24%) is illegality, meaning that abortion procedures are generally illegal within the context of the story (Table 2). The majority of these plotlines wherein abortion is illegal are set in the past (e.g. Deadwood (2005), set in 19th-century South Dakota, or Boardwalk Empire (2012), set in Prohibition era New Jersey), but in two plotlines set in the future, characters live in places where abortion is against the law (Battlestar Galactica (2006) and Defying Gravity (2009)). It is worth noting that in the majority of these illegal contexts (64%), the characters nonetheless effectively have access to abortion care. Further, all of the remaining eight characters who do consider illegal abortion but ultimately continue the pregnancy are aware of a provider who could perform an abortion, suggesting that illegality does not affect their ability to access care. Indeed, even surmounting the obstacle of illegality is portrayed as relatively easy: For all of these plotlines, little to no work locating abortion care is depicted, suggesting that finding and accessing an illegal provider requires little effort. Six of these characters are depicted visiting or consulting a provider. For example, Edith on Downton Abbey (2014), set in 1920s London, Joan on Mad Men (2010),

Sisson and Kimport

61

Table 2. Challenges to abortion access encountered by US television characters considering abortion, 2005–2015.

Legal regulations Illegality Parental consent requirement Parental notification requirement Mandated script read by physician Waiting period before procedure Logistical challenges Cost of procedure Lack of transportation Difficulty finding a provider Social barriers Social stigma Protestors at clinic Other Preventative physical force Incarceration Any barrier No barriers

Total plotlines

Plotlines resulting in abortion

22 1 1 1 1

14 1 1 1 1

7 1 1

6 0 0

4 2

2a 2

1 2 37 52

0a 1 24 25

a

Barrier prevented access for at least one character.

set in 1960s New York, and Virginia on Masters of Sex (2015), set in 1960s St. Louis, all visit doctors’ offices where abortions are performed, even though the characters choose to continue their pregnancies. The remaining two characters pursuing illegal abortions are aware of providers, but do not pursue abortion due to fears over safety in plotlines that link illegal and unsafe abortion. For example, on Reign (2014), which is set in 16th-century France, one character dramatically halts the abortion that is about to be performed on her friend over worries the procedure will cost her friend her life. In these portrayals, illegality functions as a barrier not by making abortion unavailable, but by making it unsafe or contributing to the perception that it is unsafe. In essence, these characters continue their pregnancies because they believe the available abortion provider to be dangerous—not because they do not know how to access one. The conflation of illegal abortion and unsafe abortion characterizes television depictions of abortion provision more broadly (Sisson & Kimport, 2016), leaving stories of safe, pre-legal abortion providers (Joffe, 1995; Solinger, 1994) and patients (Kaplan, 1995) largely unrepresented. There are a few exceptions to this pattern (i.e. The Knick (2013) and Boardwalk Empire (2012) where there are safe, albeit illegal, providers), however in

62


these plotlines the safe providers are portrayed as the exception and illegal abortion is broadly presented as risky and fatal (Sisson & Kimport, 2016). Television plotlines include depictions of other legal regulations of abortion, but none of these regulations impede access to care. These regulations include a parental consent requirement (Jack and Bobby (2005)), a parental notification requirement (The Good Wife (2014)), a mandated script read by the physician before the procedure, and a mandated waiting period (both on Friday Night Lights (2010)). Generally, these regulations are portrayed as hassles. For example, the Friday Night Lights plotline portrays the mandated script reading as upsetting to Becky, who is getting the abortion, and annoying to her mother, who angrily tells the doctor to stop, but this regulation of care does nothing to prevent Becky from wanting or obtaining an abortion. While the regulations described above are accurate reflections of the laws of the states in which the stories were set at the time they were set (Missouri, Illinois, and Texas, respectively) (Guttmacher Institute, 2015b), other plotlines do not depict regulations that should have applied to the characters. For example, on Cold Case (2008), an American flight attendant secretly accesses abortion in Sweden in 1960. However, while accurately accounting for US law at the time, wherein abortion was largely illegal, this story inaccurately presents Swedish abortion law, which did not allow for abortion without the permission of a doctor or medical board until 1974 (Muzollo, Lindam, & Gottvall, 2010). In this episode, the American flight attendant obtains an abortion quickly while on a layover, with no mention of such an approval process, thereby presenting her work-around for abortion’s illegality in the US as quite simple. This plotline then fails to depict barriers that would have been appropriate to the story and misrepresents the ease of overcoming the barrier of US illegality.

Logistical challenges While only some characters face legal regulations that restrict access to abortion care, many characters (some of whom must also address legal regulations) encounter logistical challenges that make obtaining care more difficult. Cost is the most frequently represented logistical challenge to accessing care, although it is depicted in only seven plotlines. This contrasts with the experiences of many women, both historically and contemporarily, for whom financial hardship is both a reason to pursue an abortion (Biggs, Gould, & Foster, 2013; Finer, Frohwirth, Dauphinee, Susheela, & Moore, 2005), and a challenge in obtaining one (Dennis, Manski, & Blanchard, 2012; Donovan, 1995; Fried, 1998; Henshaw, Joyce, Dennis, Finer, & Blanchard, 2009; Solinger, 2005). The challenge inherent in affording abortion has been documented back to Victorian England (Knight, 1977) and continues today. Forty two percent of US women getting abortions (42%) live below the federal poverty level (Jones, Finer, & Singh, 2010) and pay out-of-pocket for abortion care (Jones & Kooistra, 2011). For many women in need of abortion services today, this means paying up to one-third of their personal monthly income to cover the cost of the procedure (Roberts et al., 2013). Despite this real-world pattern, and although

Sisson and Kimport

63

cost is mentioned as a challenge in seven plotlines, only two plotlines detail efforts to overcome this challenge. On Shameless (2012), set in contemporary Chicago, Mandy’s friends host a fundraiser at a bar to help her raise the money, and on Call the Midwife (2015), set in post-war England, Nora sells her curtains to raise money to pay the illegal provider. Both of these characters are able to get their abortions, and the challenge of cost is easily overcome when they draw on the resources immediately at hand. In fact, the only character for whom cost is a challenge who does not get an abortion is Gabi on Days of Our Lives (2012), who is still able to raise funds and go to her appointment, only to change her mind once there and decide to parent. For no character is cost an insurmountable barrier. It is also worth noting that cost in these onscreen plotlines relates exclusively to the cost of the actual medical procedure; there is no discussion of other costs that real-life women often face, such as childcare, lost work time, or travel expenses, that might also be related to accessing abortion. The only other logistical barriers depicted are difficulty locating a provider and lack of transportation to get to the provider. Both of these barriers are portrayed on The Secret Life of the American Teenager (2008). However, these barriers are centrally about Amy’s perception of her options rather than objectively true in the show’s setting. There is a provider in her town, but, due to her youth and lack of knowledge, Amy is unaware of this. Ultimately, Amy overcomes these obstacles and is able to both locate and get to the clinic—where she changes her mind and decides to parent. Consistent with other onscreen portrayals of barriers to abortion care, the challenges to access are easily overcome and not what stop characters from getting abortions. In real life, difficulty locating a provider and getting to a provider are not so easily overcome. Recent data show that US women travel a mean of 30 miles to access abortion care (Jones & Jerman, 2013) and research suggests that this distance will increase as certain restrictions are enacted (Roberts et al., 2015).

Social barriers There are four plotlines where abortion stigma, a social process through which negative attributes are ascribed to women who obtain abortions (Kumar et al., 2009), creates a barrier to abortion access. In real life, stigma can impede access in a number of ways. Most women desire to keep their abortions a secret (Kumar et al., 2009; Norris et al., 2011), so all appointments, payments, transportation, etc., must be arranged covertly, creating additional challenges. For example, some women seek to conceal their need for abortion by paying out-of-pocket, rather than billing available insurance (Jones et al., 2010), which reaffirms the cost barriers previously discussed, even for women with private health insurance. Stigma also contributes to ideas that abortion is unhealthy and risky, making some women fearful of pursuing it, even if they want or need an abortion (Norris et al., 2011). Finally, stigma is also used as a political tool to erode public support for abortion access, thus contributing to legal restrictions that act as barriers (Norris et al., 2011).

64


The four characters who encounter stigma as a barrier want an abortion, but face a social environment that is hostile and/or opposed to that decision. On The Good Wife (2013), in a different plotline than described earlier, concerns over abortion stigma lead Anna, an Olympic athlete, to seek an abortion in secret, so as to avoid losing endorsement deals. This secrecy makes it more difficult for her to access care, but she does ultimately access medication to end her pregnancy. In contrast, on two separate plotlines on The Secret Life of the American Teenager (2008 and 2010), Amy and Adrian both consider getting abortions, even though that option is nearly uniformly presented as unthinkable by other characters on the show. In both of these plotlines, the lack of social support for their abortion decisions creates a barrier to access for these young women, as they view accessing abortion as socially unacceptable and discrediting. While it is difficult to draw direct parallels to real women’s experiences around these socially enacted (rather than legally enacted) challenges, previous literature does provide some insight. Research shows that, when faced with a pregnancy decision, most young women do tell their parents and partners, and that they are susceptible to external pressure to either end or continue their pregnancies (Henshaw & Kost, 1992; Ralph, Gould, Baker, & Foster, 2014). Thus, the portrayal of abortion stigma and social pressure to avoid abortion could reflect some of the complexity that women face around considering abortion, and depict ways that such social barriers make the experience of seeking care more difficult. In two plotlines, anti-abortion advocates approach characters outside of the abortion clinic, trying to persuade them to continue their pregnancies. These fictional advocates are portrayed as generally innocuous and as having no effect on characters’ ability to access abortion or their abortion decision. However, in real life, anti-abortion advocates sometimes engage in aggressive tactics toward clinic clients and can cause emotional trauma, although there is no evidence they regularly change women’s minds (Foster, Kimport, Gould, Roberts, & Weitz, 2013).

Other challenges to accessing abortion Two final barriers to abortion portrayed onscreen are physical force and incarceration. Physical force is used in Masters of Horror (2007): Angelique, who is pregnant with a demon, is kidnapped by her father and brothers to prevent her from having an abortion; they also murder the abortion providers. This does prevent her from having the abortion she wants. In a more realistic challenge to access, Orange is the New Black (2013) and Jessica Jones (2015) depict characters who are incarcerated when they seek abortion care. In the former plotline, Daya wants to keep her pregnancy a secret, and thus cannot request access to abortion services (although it is unclear whether she would be permitted an abortion even if she went through proper channels). She attempts to end the pregnancy by drinking a tea provided by a fellow inmate. When that fails, she decides to parent. While it is difficult to know whether Daya truly wanted an abortion, the plotline is structured such that when the abortion fails,

Sisson and Kimport

65

she is relieved. Parenting is portrayed as her true first choice: her abortion was an attempt to conceal the pregnancy, and she is ultimately pleased when it does not work. In the latter plotline, Hope knows that the prison will not provide an abortion in a timely manner, and has Jessica smuggle medication to her that will end her pregnancy, marking incarceration as something that increases the difficulty of obtaining an abortion but does not make it impossible. The challenges Daya and Hope face are not unrealistic. Although real incarcerated women maintain their right to abortion, they face many barriers, including not only the cost of the procedure, but the costs of transportation and security—expenses that must often be paid out-of-pocket and are required in advance of the procedure. There are also bureaucratic delays to obtaining abortion care, and a sometimes unacceptable loss of privacy (Sufrin, Kolbi-Molinas, & Roth, 2015).

Discussion We find that just over 40% of television abortion plotlines in the last 10 years portray barriers to abortion access. Pointedly, however, these challenges only rarely prevent characters from obtaining abortions. Even illegality, perhaps the most definitive of barriers, does not prevent any character from knowing how and where to access abortion. Across these depictions, obstacles to abortion access are shown as easily overcome, with just a small amount of determination, effort, and sacrifice by the pregnant character. In other words, barriers neither definitively nor meaningfully preclude access to abortion, though they might work persuasively to change how characters understand their decision to pursue abortion care. Barriers on television do not function simply to impede or prevent access, but are also depicted as changing how characters weighed their abortion decision. There are a handful of shows where the character surmounts various legal obstacles to abortion care only to decide to continue the pregnancy. In these cases, the challenges present in the plotline, while not preventing access per se, change the way abortion is understood by the character in such a way that makes it a less good option. For example, some characters considering illegal abortion opt not to get one because they fear it is unsafe. Similarly, other characters face abortion stigma and social pressures to avoid abortion in a way that prevents them from fully considering abortion as an appropriate option for them. In still other cases, the experience of surmounting the barriers offers the character time for reflection that causes her to decide she truly wants to parent. In all of these cases, the line between what creates a definitive barrier to access and what creates enough of a challenge to make abortion seem unacceptable is thin. This is, perhaps, a very realistic way to consider how challenges to access impact women’s reproductive decision-making. In the aggregate, these depictions communicate that abortion is relatively easy to access. There are surely many narrative reasons for presenting barriers that can be overcome (plot tension and then resolution) or failing to present any barriers. Related to the latter, most abortion stories in our sample are set in urban locations and in states in which there are comparatively few restrictions to access. In many

66


cases, the plotline’s setting—including both geographic location and, for some, the facility in which it is set (e.g. the hospitals on ER, Grey’s Anatomy)—is established well prior to the inclusion of an abortion story, and the lack of legal restrictions is an accurate reflection of that setting’s current legal environment around abortion access. Thus, this pattern of where plotlines are set might account for the fact that relatively few legal regulations of abortion care are depicted. The same conclusion might be drawn from the fact that most abortion plotlines on television are on medical dramas (Sisson & Kimport, 2016). In this genre, the plotline is already located within the healthcare setting; any character seeking an abortion has thus already achieved some level of access. The demographics of the characters considering abortion may also inform the lack of depiction of barriers. In aggregate, characters seeking abortions on television are of higher socioeconomic status than their real-life counterparts (Sisson & Kimport, 2015). This pattern not only reflects a larger invisibility and misrepresentation of working-class and poor people in the media (Bullock, Wyche, & Williams, 2001; Clawson & Trice, 2000), it leaves the abortion stories of poor women in the contemporary US—with their specific and daunting challenges to access (Dennis, Manski, & Blanchard, 2015; Guttmacher Institute, 2016; Ipas & Ibis Reproductive Health, 2015; Texas Policy Evaluation Project, 2015)—largely untold. Those real-life women are more likely to encounter difficulty paying for abortion and logistical challenges getting to a provider (Roberts et al., 2013). This finding stands in contrast to earlier work on the depiction of abortion on television by Press and Cole (1999). They found that characters accessing abortion in the early 1990s were most typically poor or working class. In these earlier plotlines, characters’ lack of resources is narratively presented as an appropriate reason for their abortion decision. Furthermore, Press and Cole found that this classed presentation impacted how viewers of various socioeconomic backgrounds came to understand reproductive choice and constraint, with working-class viewers much more critical of how their onscreen counterparts’ abortion stories are constructed, as the choices characters made did not ring true to the viewers’ lived experiences. Our research finds that, in the past 20 years, this presentation has shifted; television characters pursuing abortion are of higher socioeconomic status than their predecessors (Press & Cole, 1999). Indeed, they are, on average, of higher socioeconomic status than real American women who pursue abortion care (Sisson & Kimport, 2015). We are cautious, however, about interpreting this apparent change as we do not know whether it is unique to plotlines about abortion or characterizes a broader trend across television programs. That said, the dominance of higher socioeconomic status among characters seeking abortion might account for the minimal number of logistical barriers to access we find over the past 11 years on US television, as challenges such as cost and transportation are easier to navigate for characters with greater socioeconomic means. As Press and Cole found that the classing of television’s abortion stories has considerable impact on how viewers understand abortion and choice broadly, we might expect that this new pattern already has had different impacts on public understandings of abortion access.

Sisson and Kimport

67

For instance, such portrayals might both reflect and perpetuate low levels of knowledge about abortion restrictions in not only the general public (Bessett et al., 2015; Kavanaugh et al., 2013; White et al., 2015), but also among abortion patients (Cockrill & Weitz, 2010) and low-income women and immigrant women most likely to be impacted by these regulations (Lara, Holt, Pena, & Grossman, 2015). This lack of knowledge persists, even as abortion remains very common, with over one million procedures performed in the US annually (Jones & Jerman, 2014), and as the number of restrictions on abortion care dramatically increases – with access rendered even more precarious by the results of the November 2016 election. However, these television portrayals do more than fail to correct this lack of knowledge. To the extent that the general public builds their opinions and beliefs about abortion from onscreen depictions, as has been shown regarding other health services (Lapansky et al., 2010; Morgan et al., 2009; Rosenthal et al., 2013; Whittier et al., 2005), we might imagine that viewers would not consider limits to abortion access to be problematic. They may, further, not be concerned about expressing social or moral judgment about women who seek and/or obtain abortions, unaware of the effects of abortion stigma on women’s confidence, self-esteem, and emotional stability (Kavanaugh et al., 2013; Kimport, 2012; Norris et al., 2011; Rocca, Kimport, Gould, & Foster, 2013). These speculations on audience impact, however, are limited to the US context. Further research might explore how popular culture and entertainment television portray abortion—including access—in other countries and world regions. In different political environments with varying degrees of access to abortion, legal restriction of abortion, stigmatization of abortion, and media consumption, both the onscreen content and posited audience impact could differ greatly. Abortion stigma is theorized to contribute to a public ignorance of the realities of abortion access (Kumar et al., 2009) and entertainment media is posited to both exacerbate and contest abortion stigma (Norris et al., 2011; Sisson & Kimport, 2014, 2015, 2016), with a likely greater effect when abortion stigma is high and abortion is highly concealed. Thus, we hypothesize that the degree of abortion stigma may be a particularly significant predictor of: firstly, variation in the onscreen depiction of abortion access; and, secondly, the extent to which these depictions affect viewers’ impressions of the ease of obtaining abortion care. Future research should examine this hypothesis through case studies of other media environments as well as comparison studies. Another limitation of this research, and a potential limitation on the speculated audience impact, is that many plotlines were not set in contemporary, US locations. These plotlines were set in the past, in non-US countries, and/or in other spaces (e.g. outer space). The extent to which such settings are differently understood by US audiences as relevant to contemporary abortion care and policy is an area for future research. Because television can both reflect and perpetuate cultural beliefs, examining how depictions vary in different cultural contexts, and which contexts are understood as most relevant to different audiences, remains an important, open question. Finally, although it is often empirically difficult to examine what is missing from a dataset, we close by suggesting that the barriers currently underrepresented or missing from onscreen abortion plotlines might offer rich narrative opportunities.

68


While content creators have often relied on inaccurately depicted medical risk to heighten the dramatic implications of an abortion plotline (Sisson & Kimport, 2014, 2016), women’s real life experiences trying to access abortion care offer dramatic opportunities that have remained largely unmined onscreen. For example, creators could find narrative potential in raising money for an abortion, taking a road trip to a clinic, or sitting through a mandated waiting period. All have the potential to be stressful, humorous, or dramatic for characters. This represents not only a creative opportunity for television creators, but a possible way to round out the onscreen presentation of the ever-increasing barriers to abortion access. Acknowledgements The authors wish to thank Brenly Rowland and Aliza Gordon for their research assistance on this project.

Declaration of conflicting interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The David and Lucile Packard Foundation provided funding for this analysis.

References Annas, G. (1995). Sex, money, and bioethics. Hastings Center Report, 25(5), 40–44. Bessett, D., Gerdts, C., Littman, L., Kavanaugh, M., & Norris, A. (2015). Does state-level context matter for individuals’ knowledge about abortion, legality and health? Challenging the ‘red states v. blue states’ hypothesis. Culture, Health & Sexuality, 17, 733–746. Biggs, A., Gould, H., & Foster, D. (2013). Understanding why women seek abortions in the US. BMC Women’s Health, 13(29). Bullock, H., Wyche, K., & Williams, W. (2001). Media images of the poor. Journal of Social Issues, 57, 229–246. Clawson, R., & Trice, R. (2000). Poverty as we know it: Media portrayals of the poor. The Public Opinion Quarterly, 64, 53–64. Cockrill, K., & Weitz, T. (2010). Abortion patients’ perceptions of abortion regulation. Women’s Health Issues, 20, 12–19. Dennis, A., Manski, R., & Blanchard, K. (2012). Looking back at the Hyde Amendment and looking forward to restoring public funding: A research and policy report. Washington, DC: Center for Women Policy Studies. Dennis, A., Manski, R., & Blanchard, K. (2015). A qualitative exploration of low-income women’s experiences accessing abortion in Massachusetts. Women’s Health Issues, 25, 463–469. Diem, S., Lantos, J., & Tulsky, J. (1996). Cardiopulmonary resuscitation on television. New England Journal of Medicine, 334, 1578–1582. Donovan, P. (1995). The politics of blame: Family planning, abortion, and the poor. New York: Alan Guttmacher Institute.

Sisson and Kimport

69

Evans, B., & O’Brien, E. (2014). The Cairns abortion trial: Language, deviance, and the ‘spoiled identity’. Journal of Sociology, 51, 755–768. Finer, L., Frohwirth, L., Dauphinee, L., Susheela, S., & Moore, A. (2005). Reasons US women have abortions: Quantitative and qualitative perspectives. Perspectives on Sexual and Reproductive Health, 37, 110–118. Foster, D., Kimport, K., Gould, H., Roberts, S., & Weitz, T. (2013). Effect of abortion protesters on women’s emotional response to abortion. Contraception, 87, 81–87. Fried, M. (1998). Abortion in the United States – Legal but inaccessible. In R. Solinger (Ed.), Abortion wars: A half century of struggle, 1950–2000 (pp. 208–226). Berkeley: University of California Press. Guttmacher Institute (2015a) Laws affecting reproductive health and rights: State trends at midyear, 2015. New York: Guttmacher Institute. Guttmacher Institute (2015b) State policies in brief: An overview of abortion laws. New York: Guttmacher Institute. Guttmacher Institute (2016) State funding of abortion under Medicaid. New York: Guttmacher Institute. Henshaw, S., Joyce, T., Dennis, A., Finer, L., & Blanchard, K. (2009). Restrictions on Medicaid funding for abortions: A literature review. New York: Guttmacher Institute. Henshaw, S., & Kost, K. (1992). Parental involvement in minors’ abortion. Family Planning Perspectives, 24, 196–207. Ipas & Ibis Reproductive Health (2015) U.S. funding for abortion: How the Helms and Hyde amendments harm women and providers. Chapel Hill: Ipas. Joffe, C. (1995). Doctors of conscience. Boston: Beacon Press. Jones, R., Finer, L., & Singh, S. (2010). Characteristics of US abortion patients, 2008. New York: Guttmacher Institute. Jones, R., & Jerman, J. (2013). How far did US women travel for abortion services in 2008? Journal of Women’s Health, 22, 706–713. Jones, R., & Jerman, J. (2014). Abortion incidence and service availability in the United States, 2011. Perspectives on Sexual and Reproductive Health, 46, 3–14. Jones, R., & Kooistra, K. (2011). Abortion incidence and access to services in the United States, 2008. Perspectives on Sexual and Reproductive Health, 43, 41–50. Kaplan, L. (1995). The story of Jane: The legendary underground feminist abortion service. Chicago: University of Chicago Press. Kavanaugh, M., Bessett, D., Littman, L., & Norris, A. (2013). Connecting knowledge about abortion and sexual reproductive health to belief about abortion restrictions: Findings from an online survey. Women’s Health Issues, 23, 239–247. Kimport, K. (2012). (Mis)understanding abortion regret. Symbolic Interaction, 35, 105–122. Kirkham, J. (2013). Constructions of childhood, victimhood and abortion in Romania: The ‘Little-Girl Mother’. The Anthropology of East Europe Review, 31, 93–109. Knight, P. (1977). Women and abortion in Victorian and Edwardian England. History Workshop, 4, 57–68. Kumar, A., Hessini, L., & Mitchell, E. (2009). Conceptualising abortion stigma. Culture, Health & Sexuality, 11, 625–639. Lapansky, C., Schuh, J., Cody, M., Woodley, P., & Buffington, S. (2010). Evaluating the ‘‘Baby Jack’’ storyline on ‘‘The Bold and the Beautiful’’: Making a case for bone marrow donations. Cases in Public Health Communication & Marketing, 4, 8–27.

70


Lara, D., Holt, K., Pena, M., & Grossman, D. (2015). Knowledge of abortion laws and services among low-income women in three United States cities. Journal of Immigrant Minority Health, 17, 1811–1818. Morgan, S., Movius, L., & Cody, M. (2009). The power of narratives: The effect of organ donation entertainment television storylines on the attitudes, knowledge, and behaviors of donors and non-donors. Journal of Communication, 59, 135–151. Muzollo, T., Lindam, A., & Gottvall, K. (2010). Aborter 2009 (Induced abortions 2009). Stockholm: Sveriges Officiella Statistik. Norris, A., Bessett, D., Steinberg, J., Kavanaugh, M., De Zordo, S., & Becker, D. (2011). Abortion stigma: A reconceptualization of constituents, causes, and consequences. Women’s Health Issues, 21, S49–S54. O’Neil, M. (2013). Selfish, vengeful, and full of spite: The representations of women who have abortions on Turkish television. Feminist Media Studies, 13, 810–818. Press, A., & Cole, E. (1999). Speaking of abortion: Television and authority in the lives of women. Chicago: University of Chicago Press. Purcell, C., Hilton, S., & McDaid, L. (2014). The stigmatisation of abortion: A qualitative analysis of print media in Great Britain in 2010. Culture, Health & Sexuality, 16, 1141–1155. Ralph, L., Gould, H., Baker, A., & Foster, D. (2014). The role of parents and partners in minors’ decisions to have an abortion and anticipated coping after abortion. Journal of Adolescent Health, 54, 428–434. Roberts, S., Fuentes, L., Kriz, R., Williams, V., & Upadhyay, U. (2015). Implications for women of Louisiana’s law requiring abortion providers to have hospital admitting privileges. Contraception, 91, 368–372. Roberts, S., Gould, H., Kimport, K., Weitz, T., & Foster, D. (2013). Out-of-pocket costs and insurance coverage for abortion in the United States. Women’s Health Issues, 24, 211–218. Rocca, C., Kimport, K., Gould, H., & Foster, D. (2013). Women’s emotions one week after receiving or being denied an abortion in the United States. Perspectives on Sexual and Reproductive Health, 45, 122–131. Rosenthal, E., Buffington, S. C., & Cole, G. (2013). Covering cancer: Examining the incidence and impact of prime time television cancer storylines. Paper presented at the National Conference on Health Communications, Marketing, & Media, Atlanta, GA. Sisson, G., & Kimport, K. (2014). Telling stories about abortion: Abortion-related plots in American film and television, 1916–2013. Contraception, 89, 413–418. Sisson, G., & Kimport, K. (2015). Facts and fictions: Characters seeking abortion on American television, 2005–2014. Contraception, 446–451. Sisson, G., & Kimport, K. (2016). Doctors and witches, conscience and violence: Abortion provision on American Television, 2005–2014. Perspectives in Sexual and Reproductive Health. Epub ahead of print. DOI 10.1363/psrh.1367. Solinger, R. (1994). The abortionist: A woman against the law. New York: Free Press. Solinger, R. (2005). Pregnancy and power: A short history of reproductive politics in America. New York: New York University Press. Sufrin, C., Kolbi-Molinas, A., & Roth, R. (2015). Reproductive justice, health disparities and incarcerated women. Perspectives on Sexual and Reproductive Health, 47, 213–219. Texas Policy Evaluation Project (2015) Texas women’s experiences attempting self-induced abortion in the face of dwindling options. Austin, TX: University of Texas and Ibis Reproductive Health.

Sisson and Kimport

71

Turow, J. (2010). Playing doctor: Television, storytelling, and medical power. Ann Arbor: The University of Michigan Press. White, K., Potter, J., Stevenson, A., Fuentes, L., & Grossman, D. (2015). Women’s knowledge of and support for abortion restrictions in Texas: Findings from a statewide representative survey. Perspectives on Sexual and Reproductive Health, 48. Epub ahead of print. DOI 10.1363/48e8716. Whittier, D., Kennedy, M., Seeley, S., St. Lawrence, J., & Beck, V. (2005). Embedding health messages into entertainment television: Effect on gay men’s response to a syphilis outbreak. Journal of Health Communication, 10, 251–259.

Author Biographies Gretchen Sisson, PhD, is a Research Sociologist at Advancing New Standards in Reproductive Health (ANSIRH) in the Department of Obstetrics, Gynecology, and Reproductive Health at the University of California, San Francisco. Through ANSIRH’s Abortion Onscreen project, Dr. Sisson has examined how abortion and reproductive decision-making are portrayed in popular culture, with particular analyses around onscreen pregnancy outcomes, abortion mortality rates, patient demographics, and provider depictions. This work has been published in Contraception and Perspectives on Sexual and Reproductive Health. Katrina Kimport, PhD, is an Assistant Professor in the Department of Obstetrics, Gynecology & Reproductive Science and a research sociologist in the Advancing New Standards in Reproductive Health (ANSIRH) program at the University of California, San Francisco. Her research focuses on gender, sexuality, and social movements. Dr. Kimport’s work has been published in the American Sociological Review, Gender & Society, Journal of Health and Social Behavior, and Symbolic Interaction. She is the author of Queering Marriage: Challenging Family Formation in the United States (2014, Rutgers University Press).