Media coverage of abortion care in the United States is—to be blunt—abysmal. Too much news coverage and analysis of abortion is devoid of fact, and instead relies on the faulty premise that the abortion debate involves two sides arguing in good faith, when in reality one side is rooted in evidence and clinical experience and the other in flat-out lies and ideology.
Much of what passes for conservative commentary in outlets like the New York Times, the Atlantic, the Washington Post, and numerous other mainstream publications fails to engage any facts at all. This is particularly astounding given the mountains of data and analysis both domestically and internationally, on the medical, clinical, and public health imperatives of access to abortion care, the morbidity and mortality associated with denying abortion care, and the copious research on how crucial access to abortion is to improving the health of women and children and to reducing poverty. Likewise, on cable news, you will hear even the most intelligent and otherwise-informed hosts use language to describe abortion care that is just flat-out wrong. And very little of this coverage engages actual humans who’ve chosen abortion.
I’ve spent a lot of time wondering why this is. Is it laziness? Are media outlets afraid of being targeted as “unfair” if they don’t succumb to the relentless right-wing pressure to parrot their propaganda? Is it “pressure from the top” to mollify corporate executives? Is it the effects of virulent campaigns to stigmatize abortion endlessly cultivated by the anti-choice movement, and intended to embed indelible shame into our collective psyche?
I don’t know. And, in the end, it doesn’t matter. What does matter is that journalism and journalists are—by definition—supposed to report facts and base their arguments on facts. Reputable newspapers and TV news outlets (omitting by definition Fox News, Breitbart, and the like) are supposed to care about facts and evidence to help inform the public. And they continue to fail miserably.
Here are six facts any responsible reporter should know about abortion:
Sex. Abortion. Parenthood. Power.
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1. Every major medical association here and abroad supports unfettered access to abortion care. Being “pro-choice” is a medical and public health imperative based on science and medicine. It is not an “ideology,” unless doctors and researchers who advocate for health care in any area of medicine or public health are ideologues. The American Congress of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics, the American Medical Association, the World Health Organization (WHO) and the International Federation of Gynaecology and Obstetrics, among others in numerous regions and countries support access to abortion care.
In a 2014 opinion, for example, the American College of Obstetricians and Gynecologists stated:
Safe, legal abortion is a necessary component of women’s health care. The American College of Obstetricians and Gynecologists supports the availability of high-quality reproductive health services for all women and is committed to improving access to abortion. Access to abortion is threatened by state and federal government restrictions, limitations on public funding for abortion services and training, stigma, violence against abortion providers, and a dearth of abortion providers. Legislative restrictions fundamentally interfere with the patient-provider relationship and decrease access to abortion for all women, and particularly for low-income women and those living long distances from health care providers. The American College of Obstetricians and Gynecologists calls for advocacy to oppose and overturn restrictions, improve access, and mainstream abortion as an integral component of women’s health care.
2. The vast majority of abortions in this country take place in the first trimester. Approximately 90 percent of all abortions in the United States occur in the first trimester or 12 weeks of pregnancy. According to the Guttmacher Institute, two thirds occur at 8 weeks or earlier. About 10 percent take place between 13 and 22 weeks, and 1.3 percent take place after 21 weeks of gestation. The irony is that the flood of laws and policies restricting early abortion care mean that more people are forced into delays that increase the number of later abortions. The consequence of this, and the ultimate goal of the anti-choice movement, has been to literally force people either to get the later abortions about which anti-choicers complain incessantly, or to carry unwanted pregnancies to term. As the multi-year Turnaway study shows, the denial of abortion care and resulting forced gestation and birth has lifelong implications for the people who are denied abortion.
3. Abortions are safe and complications are rare. Findings from a 2018 National Academies of Sciences, Engineering and Medicine report echoed decades of research in finding that abortions provided in the United States are safe. The report looked at data for the four major methods used for abortions—medication, aspiration, dilation and evacuation, and induction—and examined women’s care from before they had the procedure through their follow-up care.
“I would say the main takeaway is that abortions that are provided in the United States are safe and effective,” Ned Calonge, the co-chair of the committee that wrote the study and an associate professor of family medicine and epidemiology at the University of Colorado and CEO of The Colorado Trust, told NPR.
In fact, as my colleague Laura Huss wrote in January: “Each year the U.S. Centers for Disease Control and Prevention (CDC) releases statistics about abortion in almost all 50 states, and the data clearly shows that complications from abortion are minimal. Of the 652,639 abortions reported to the CDC for 2014, the last year for which data is currently available, only six women were reported to have died from medical complications related to abortion. This government data paints the same picture as reputable studies and reports from the country’s leading medical and health organizations.”
4. Limiting access to abortion makes complications more likely and endangers patients. The National Academies report, again echoing decades of domestic and international research and conclusions drawn by every relevant major medical association, underscores that state laws and regulations can interfere with safe abortions. “Abortion-specific regulations in many states create barriers to safe and effective care,” the report says.
Laws and policies that restrict abortion mean that more people who need them will have to spend more time and money to access an abortion, frequently turning what might have been an early abortion into a later abortion.
ACOG calls for the elimination of virtually all current abortion restrictions “to ensure the availability of safe, legal, and accessible abortion services free from harmful legal or financial restrictions,” including elimination of the Hyde Amendment and other federal and state restrictions on public and private insurance coverage of abortion, as well as ceasing to propose and repealing legislation that creates barriers to abortion access and interferes with the patient-provider relationship and the practice of medicine.
5. Efforts to ban later abortions are based on outright lies. For example, supporters of 20-week abortion bans (and many other such laws) include groups like Americans United for Life and the National Right to Life Committee (both of which have drafted model legislation for these bans), as well as others such as the Susan B. Anthony List. Each of these groups has used falsehoods and unfounded claims, such as “fetal pain,” to pass legislation that threatens access to critical reproductive health care. Medical evidence and clinical experience, not to mention public health data are, again, why ACOG, AAP, and the AMA oppose such bans.
6. Later abortions are safe, medically necessary procedures. Dilation and evacuation (D and E) abortions are the most common second-trimester abortions, and, again according to the facts, are safe. And as Huss wrote in January, “Despite this, the anti-choice movement has deployed political and linguistic attacks to try and ban all second-trimester abortions. The movement has invented non-medical terms like “partial birth abortions” and “dismemberment abortions,” and has been successful in getting these terms used in legislation and the media.”
Now, the anti-choice movement is deploying charges of “infanticide” to smear state-level efforts to ensure access to abortion care.
There are many reasons people might need a later abortion. As Ibis Reproductive Health notes: “Not knowing about and/or having access to services; personal, financial, and other circumstances; and structural and legal issues like state bans on insurance coverage” may contribute to delays in obtaining abortion care. People may find out they are pregnant later than the first trimester; they may need time to decide what to do about an unintended pregnancy; they may have difficulty accessing care due to trouble finding or traveling to a provider; they may need time to raise money to pay for the procedure or make travel arrangements to a provider in a distant location. “These factors often cause a chain reaction” according to Ibis,”in which delay leads to increased barriers, because as the pregnancy progresses, the costs of the abortion procedure increase while the availability of services decreases.”
Additionally, some individuals seek abortions in the second trimester or later after developing a serious health problem or learning about a genetic or health condition in the developing fetus, as many of these conditions cannot be accurately diagnosed until later in pregnancy. Abortions performed due to maternal and/or fetal indicators are a small percentage of the abortions done later in pregnancy.
The recent furor raised over comments made by Virginia Gov. Ralph Northam about what would happen to a non-viable infant after delivery–you keep the baby comfortable—and the poor reporting on this episode show how quick the anti-choice movement is to make outrageous claims, and how little the media understands later abortion.
A person seeking abortion in the first trimester should have a choice either of medication abortion or surgical abortion. For an abortion between 14 to 28 weeks’ gestation, a physician would most likely employ either dilation and extraction (“D and X”) or dilation and evacuation (“D and E”), depending on the medical situation. In both these later cases, the pregnancy is terminated before the fetus is removed from the uterus.
However, too many reporters too often confuse second-trimester procedures with third-trimester procedures. Third-trimester abortions are exceedingly rare, and, as I have written previously, it’s not clear what people mean when they talk about “abortion” in the third trimester. Depending on the health situation of the pregnant person and whether the fetus is viable, a doctor might induce labor, such as in the tragic case of Rose, or perform a cesarean section, whichever ensures the best outcome for the patient(s).
Is the induction of labor to deliver a fetus that died in utero an “abortion?” We would normally call that a stillbirth. Is it an “abortion” to perform a cesarean section when a fetus or pregnant person is in distress later in pregnancy? Most people would call that what it is, a c-section. The terminology is almost irrelevant to the core goal, which is to ensure the best health outcomes for the patient(s) involved. In any case, lumping all of these together to stigmatize abortion care is deeply inaccurate.
As Dr. Diane Horvath-Cosper has noted: “Inflammatory statements demonstrate the callous misrepresentation of medical realities and complex situations faced by both patients and their physicians.”
Recently, Democrats have taken heat for supporting legislation that would expand access to care to everyone who needs it. What they are really doing is supporting expanded access to essential health care based on a wealth of data and evidence. Isn’t that what politicians should do? Isn’t that what good policy should rest on?
In a poignant letter, patients who have undergone a later abortion state: “We are not monsters. We are your family, your neighbors, someone you love. We are you, just in different circumstances. Due to ignorance, many of us may not have supported later abortion access before facing a crisis ourselves, accepting restrictions on healthcare we never imagined needing. Now we recognize that our laws may not be able to draw neat lines around each of our stories, allowing these procedures in certain, hyper-specific circumstances and not in others, because we know people will be left outside those lines. As people privileged enough to speak up, that is unacceptable to us.”
Bad reporting on abortion is irresponsible. Just like climate denialists and perpetrators of the myth of “voter fraud,” the anti-choice movement depends on the constant recitation of its own lies by the media to promote bad policies the public otherwise does not support or to hinder investments in access to needed health care.
As I’ve written before: “No matter how strong the backlash from the small but loud contingent of people within the anti-choice movement, it is the media’s job to report fairly and responsibly. Making the claims of anti-choice ‘supporters’ of abortion bans equivalent to the consensus of the medical and public health community not only abrogates the public trust, it puts all of us in danger.”
Reporters: You need to do better.