Medication Abortion Is the Future, so Why Don’t TV Shows Depict It More?

"This year, what's happening politically right now is just so divorced from the representations of abortion that we're seeing on TV."

Screengrab image of woman on the couch looking over box of abortion medication
In a March episode of A Million Little Things, Maggie self-manages her abortion with pills. ABC/Hulu

Abortion is normal and common, but you wouldn’t know it from watching television. Just ask Steph Herold, a research analyst with Advancing New Standards in Reproductive Health (ANSIRH) who studies onscreen abortion narratives and how they impact viewers’ understanding of abortion care.

The results are mixed. In 2021, Herold and her colleagues at ANSIRH’s Abortion Onscreen project found 47 abortion plotlines on 42 television shows, from The Handmaid’s Tale to This Is Us. While accurate depictions of abortion do exist, according to the annual ANSIRH report out today, they by and large involve white women, who are in the statistical minority of people having abortions in the United States. Abortion portrayals are often fraught with stigma and misinformation about safety, the kind of person who has an abortion, and the reasons someone chooses to have an abortion.

These creative choices matter. The reality is that for a large swath of the population, their understanding of all sorts of different human experiences comes from entertainment, for better or worse. And for many people living and working outside of abortion advocacy and reproductive justice, watching an abortion story on their favorite show might be their only exposure to the issue.

As abortion restrictions tighten nationwide, accurately depicting abortion stories has never been more critical, especially as advocates are turning to the availability of abortion pills—mifepristone and misoprostol—to combat dwindling access.

Rewire News Group spoke with Herold about what this year’s research tells us about how the depiction of abortion is changing, and how far we still have to go before we can turn on our TVs and see abortions that look like the ones people are actually having. The interview has been lightly edited for length and clarity.

Rewire News Group: Why is the way abortion is depicted in television and movies so important?

Steph Herold: There’s so many different kinds of abortion stories to tell, from juggling child care and work, having to travel hundreds of miles to the nearest clinic, and navigating racism and xenophobia and the health-care system. And trying to understand if those realities are portrayed on screen is really important because TV can influence the cultural conversations that we have about abortion, the political conversations, and votes and policy about abortion.

So, it’s crucial for us to really understand what messages are being conveyed out there about abortion safety, about the people who have abortions, about how to support or not support someone who’s had an abortion—and what’s missing, so we can try to understand how the public puts together their understanding of abortion, and if and how TV influences that.

Was there anything about this year that stuck out to you as different from years past?

SH: I think the most important trend to me, that’s been a theme in the past years too, is just a lack of portrayal of barriers to abortion access. When a character wants an abortion, even if there are one or two barriers in her way, they’re easily surmountable. When in reality, we know that the combination of financial barriers, logistical barriers, cultural barriers really makes abortion access excruciatingly difficult. And of course, political barriers, right? And we just don’t see that on television.

And this year, what’s happening politically right now is just so divorced from the representations of abortion that we’re seeing on TV. That only two characters face any barriers at all out of the 47 different plotlines we saw is just really staggering to me.

Are there more portrayals of medication abortion this year?

SH: There are starting to be slightly more depictions of medication abortions. In 2020, we saw two. In 2019, we had three. This year, we had four, so it’s still a pretty small percent of total depictions of abortion on TV, though going up slightly. What’s interesting to me about the ones that we saw this year, three of them had providers who gave very matter-of-fact and accurate instructions for the abortion pill. And that is pretty new.

And in one study that we published this year, we studied a specific episode of Grey’s Anatomy from 2019 that had a mom come in, and she had tried to self-manage her own abortion, and it didn’t work, and they gave her pills in the hospital. And one of the doctors does this very matter-of-fact like, “You take this one pill, and then this happens. And then you take a few more pills, and then this happens.” And we found that the audience watching this—their knowledge about medication abortion went up significantly after this episode. So that was really interesting to us. It made me think like, “OK, having a trusted character like a doctor, even a character on TV may cause people to think like, ‘Oh, this actually is accurate information.’”

What was also interesting, though, is it didn’t cause them to increase their support for abortion in any way. Their support of abortion, whether they were pro-choice, or anti-abortion, or somewhere between, stayed the same. To me, that suggests that these portrayals, the effect of them, is really complicated. It’s not just, see a character have an abortion on TV, all of a sudden you understand abortion, all of a sudden your views change. It really depends on what’s happening in that plotline. And obviously where else you’re learning about abortion in your life, and what else you’re watching on TV. It may be that just seeing one character one time doesn’t really have a big effect. It has to be a couple of characters over time. That’s something we’re still investigating.

Why is it so critical for medication abortion specifically to be depicted in a normative and accurate way in the current landscape, where it is increasingly the only way that many can access abortion?

SH: I think part of what’s troubling is that the only depictions we’ve had where a character has ordered abortion pills online, they are very few and far between. We just had one that we found this year, which was a Law & Order: SVU episode, where a character’s foster father orders abortion pills online and gives them to her, coerces her to take them. And she ends up in the hospital. So it just has this very dangerous connotation to it, and this undercurrent of coercion. And that is unfortunately the only representation we found of someone ordering abortion pills online.

And in years past there have been … I think there was one Chicago Med episode, either last year or the year before, where a teenager ordered abortion pills online, and they didn’t work completely. So we just don’t have a lot of media or really any media representations of the reality that you can order abortion pills online.

It is almost always safe. You can do it in a supported way, and especially given the post-Roe world that we’re moving towards, it’ll be really increasingly important for television to showcase these different ways that people have safe and loving abortions, and right now we just don’t have that.

Can you talk about the few depictions that you mentioned that were accurate, where it wasn’t through the mail, but it was in a doctor’s office. What stuck out to you?

SH: What I liked seeing was one piece in the portrayal in the show A Million Little Things, where the character, Maggie, she gets the abortion pill. She’s sitting on the couch. We actually see her put the pills in her cheek. I don’t think that we’ve seen that before on TV, and that can be a weird thing about taking those pills. Because usually you swallow a pill. You don’t put it in your cheek. I thought it was really important too that we see the character do that. And she’s sitting on the couch. She has her pillow. She has a blanket. It’s just like, “Oh, she’s having an abortion at home.” She looks really tense, and really cozy. She’s not in any emotional anguish, and her best friend tries to support her. And then, later on in the episode, the guy that she had sex with flies across the Atlantic from the U.K. to come and support her. So I thought that was really nice.

It wasn’t this clinical portrayal that we all often see of a surgical abortion, where the character is in scrubs, and there’s a lot of medical equipment and a lot of beeping, and a lot of providers in the room, many more than there would be in real life. In this one, she’s in this intimate, cozy, comfortable environment, surrounded by people who are there to support her. I thought that was really lovely.

If you could create your ideal storyline about medication abortion, what would that be? What would that look like?

SH: What strikes me about a lot of the depictions, it’s usually one character alone, even if there are other people supporting her. It would be great to see lots of different types of characters having medication abortions or any kind of abortions, really. A character who’s a mom, characters who are in their 20s. We usually see teenagers having abortions on TV. That’s the most common. It’s just to show that this is an experience that lots of people have, showing that it’s people of color, showing gender diverse folks having abortions.

And I think what’s really missing from TV, like we talked about, is showing safe self-managed abortions. Having someone go through, “OK, why are they having a self-managed abortion? Maybe we have one character have one because that’s just what they want.” They want it to be private and at home, and they want to avoid going to a clinic. And maybe for another character, it’s because the clinic is too far away. There’s a parental consent law that they can’t get around, or they don’t want to go through the mandatory waiting period, or there’s a six-week ban like there was in Texas. Really showcasing how barriers affect people’s lives, and that medication abortion is one way that people can get around that and still have a safe abortion. So showing them Googling, this frantic Googling like a lot of people do, where they find the safe information, how they’re supported by providers through telemedicine, and waiting for that in the mail.

I think there could be a lot of good drama and story around that—getting the pills, and taking them at home, being together. These two different characters having abortions together, or supporting each other through that. I would watch that.

Is there any character that you feel right now is particularly poised to have that conversation, or a TV show that would be really great to see an abortion story in?

SH: Good question. I don’t know. I’m really curious how the entertainment industry will respond to this particular crisis moment. And I’m guessing we’ll see many more abortion plotlines depicting barriers and abortion illegality next year as a response to this.

But I don’t know. I think any show could have abortion on it, right? Because abortion is about sex, and love, and sometimes religion, and the law, and relationships, and conflict. So I think it could really be incorporated anywhere. Parenting, obviously, and race and class. It’s just like, there are so many big issues that undergird abortion, and I feel it could be incorporated in any kind of storyline, comedy or drama.