Keywords

Introduction

Popular culture representations of abortion both reflect and reinforce powerful narratives about reproductive health and womanhood. Critical evaluation of how traditional media—such as film, television, and print—have depicted abortion illustrates the ways in which cultural representation can reinforce negative social myths of abortion. This includes the myth that abortion is rare and dangerous (Sisson & Kimport, 2014), as well as contributes to the overall stigma surrounding abortion (Purcell, Hilton, & McDaid, 2014). Additionally, these traditional forms of media often reinforce hegemonic perspectives , with minimal representations of poor women or women of color who are more likely to experience undesired pregnancy and abortion. Since the introduction of Facebook in 2004, social networking has emerged as an important form of communication and a transformative popular culture medium. The impact of social media on public opinion and framing of pregnancy and abortion is yet to be elucidated. However, given their popularity and participatory nature, social media platforms—like Twitter and Facebook—have been evaluated as tools for public health research (Altshuler, Gerns Storey, & Prager, 2015) and in targeted sexual health education interventions (Veale et al., 2015; Yonker, Zan, Scirica, Jethwani, & Kinane, 2015). By engaging diverse populations and allowing people to share personal experiences, promote news, and exchange opinions, social media has the potential to become a platform for abortion activism (Stevenson, 2014) that can be used to cultivate an empowering, positive abortion counter-narrative.

This chapter critically evaluates key media representations of abortion in traditional and social media over the past 10 years. From this analysis, a theoretical framework for understanding how social media has transformed cultural representations of abortion to create a counter-narrative to traditional media conceptualizations will be generated. Case studies of how abortion has been considered in social media will be used to provide examples of how social media has been used to normalize abortion, galvanize political action, and increase women’s ability to seek safer abortion care. Ultimately we conclude that, through their participatory nature, social media platforms have the potential to challenge traditional media representations of abortion and can serve as empowering platforms for political and feminist pro-choice activism. Combining backgrounds in popular culture and gender studies, public health, and provision of family planning services we aim to consider the unique intersection of media and reproductive health.

Abortion Stigma —The Impact on Public Health

While the medical experience of abortion is defined by safety, the social experience of abortion is defined by silence, shame, and stigma. Abortion stigma is an increasingly used framework for understanding how women experience abortion. With a recognized impact on provision of care, abortion stigma impacts both providers (Harris, Debbink, Martin, & Hassinger, 2011; Joffe, 2014) and patients in significant ways (Harris, 2012; Hessini, 2014). Individual-level abortion stigma is multifaceted, with factors that include fear of social judgment, isolation, and negative social consequences (Cockrill, Upadhyay, Turan, & Greene Foster, 2013; Hanschmidt, Linde, Hilbert, Riedel-Heller, & Kersting, 2016). An important component of abortion stigma relates to the feelings of deviance experienced by women who choose to end a pregnancy vis-à-vis the deeply rooted cultural values and social pressures surrounding motherhood.

Abortion is a common reproductive experience in the United States, with one in three American women undergoing abortion at some point in their lives (Jones & Kavanaugh, 2011). Yet abortion is concealable and, owing to the power of stigma and the resulting silence, abortion is conceptualized as rare or exceptional. Abortion stigma shapes how women experience abortion, and impacts health outcomes after abortion. In particular, abortion stigma contributes to morbidity when women seek abortion outside of traditional medical contexts or delay care for complications.

Worldwide, unsafe abortion accounts for 13% of all maternal deaths with an estimated 47,000 women dying each year (Ahman & Shah, 2011). The primary burden of deaths attributed to unsafe abortion occur in settings where abortion is illegal; therefore, access to legal and safe abortion care is a key component to decreasing abortion-related mortality. Abortion stigma contributes to the public health burden of unsafe abortion. Globally, the impact of abortion stigma on abortion morbidity occurs in settings where abortion is legal and illegal. For example, in Ghana, where abortion is legal but utilization of safe services is limited by cultural acceptability of abortion, dangerous clandestine procedures or self-abortion practices persist (Payne et al., 2013). Meanwhile, in the United States, fear of disclosure of abortion has been connected to complications and failure to seek appropriate care (Harris, 2012).

Given these potentially dangerous outcomes, there is a growing interest in finding ways to counteract the impact of abortion stigma. In the conceptual model of abortion stigma created by Cockrill and Nack, women experience negative personal and social consequences related to abortion including internalized, felt, and enacted stigma. Further, because abortion is a concealable social experience, women employ behavioral strategies to cope with internalized abortion stigma (Cockrill & Nack, 2013). Informed by this conceptual model, Cockrill et al. (2013) developed a valid and reliable scale to measure individual-level abortion stigma with four factors that include worries about judgment, isolation, self-judgment, and social condemnation.

Role of Popular Culture in Reinforcing/Creating Narratives About Women, Women’s Bodies , and Sexuality

Although gains have been made in portrayals of women in the media as complex, multifaceted individuals, more often than not, the virgin/whore dichotomy of womanhood is still perpetuated through the mainstream media today. Archetypes of women as innocent, virtuous, and nurturing caregivers are contrasted by their over-sexualized, deviant, and/or villainous counterparts. Younger women, in particular, are sexualized through the media, while older women are more often than not seen as matronly, if they are seen at all. With our national consumption of media across platforms at an all-time high, the consequences of these portrayals affect women in a number of ways. A 2015 report by Common Sense Media (2015) finds that Americans aged 13–18 years consume over 9 h of media per day. The effects of the oversexualization of women in the media on young women are well documented, with eating disorders, low self-esteem, and depression the most common mental health problems associated with this phenomenon (Abramson & Valene, 1991; Durkin & Paxton, 2002; Harrison, 2000; Hofschire & Greenberg, 2001; Mills, Polivy, Herman, & Tiggemann, 2002; Stice, Schupak-Neuberg, Shaw, & Stein, 1994; Thomsen, Weber, & Brown, 2002; Ward, 2002). Feminist scholars have argued that the increased sexualization and objectification of women in the media are a backlash against gains in equality such as Title IX and Roe v. Wade, and work as a checkmate against women’s empowerment in social and professional domains (Douglas, 2010; Faludi, 1991; Wolf, 1991). This impact is especially seen in young women, who are engaging with media more intensely than women of other age groups.

The hypersexualization of women in the media and culture’s obsession with women’s appearance intensified as other cultural regulatory myths about women’s worth—most often associated with their nurturing abilities as wives and mothers—lost traction after the advances of the women’s liberation movement and the second wave of feminism. Pregnancy, in particular, has seen a shift in its representation in the media, with the tabloid “bump watches” of today a far cry from when CBS deemed the term “pregnant” taboo when dealing with Lucille Ball’s on-screen and real-life pregnancies. The growth in choices today of how and when women become mothers (if they make this choice at all) has led to an increased scrutiny as to the correct path to motherhood. The result is that those “lone, working, teen, mature, lesbian or feminist mothers who do not fit the idealised image of the white, heterosexual, self-sacrificing, middle-class, ‘good’ mother or perform in line with the ideology of intensive mothering, tend to be judged, ranked and found wanting within and beyond the media environment” (Feasey, 2012, 2).

Social norms and stigma have been found to play significant roles in reproductive health behavior and pregnancy decision making among women. Formative research using focus groups with low-income women in the United States demonstrated that women recognize and identify community expectations of avoiding pregnancy outside of a monogamous relationship. Further, women in this study felt that in the setting of unplanned pregnancy, continuation of the pregnancy is viewed more positively than abortion or adoption (Smith et al., 2016). Women with unplanned pregnancy are stigmatized regardless of their pregnancy decision making, and this pressure may limit women’s ability to make the best decisions about a pregnancy. Additionally, the framework of “planning a pregnancy” or pregnancy intention used when discussing public health imperatives to improve obstetric outcomes and decrease abortion does not reflect how women frame pregnancy decision making (Borrero et al., 2015).

Traditional Media Conceptualizations of Abortion: What We Know

Critical evaluation of popular culture portrayals of abortion in movies and television reveals how cultural stories about abortion help create and reinforce social myths and impact public perception about abortion. Unpacking the complicated relationships between popular culture representations and public opinion can enhance our understanding of how abortion is considered, framed, and conceptualized in media texts. A 2014 analysis of abortion-related plots in American film and television from 1916 to 2013 found variations in abortion storylines over time, suggesting an interplay between media representations, cultural attitudes, and abortion policy. Further, this study found a high proportion of plotlines featuring death as the outcome for women considering abortion, reinforcing the social myth that abortion is dangerous and deadly (Sisson & Kimport, 2014).

A similar analysis evaluated portrayals of women who seek abortions on American television from 2005 to 2014. This study found that televised stories of women seeking abortion were more likely to feature white women and less likely to feature women of color, women who are already mothers, and/or poor women (Sisson & Kimport, 2016b). Evaluation of the reasons women chose abortion in these storylines found an overrepresentation of what are perceived as immature or self-focused rationales (i.e., interference with future opportunities) as opposed to other focused rationales (i.e., impact on other children and financial constraints). The inaccuracy of depictions of the demographics of women who seek abortion is problematic because it perpetuates the myth that abortion is a selfish choice as opposed to a carefully considered need. It also perpetuates the myth that motherhood is the ultimate achievement for women, and to make any other choice is a deviance from “natural” womanhood. When popular media includes accurate representations of women’s experience with abortion, social myths are challenged, and often these truer representations are marginalized and/or seen as abnormal. For example, despite positive reviews and numerous independent film nominations and awards, the 2014 film Obvious Child only earned slightly over $3 million in box office receipts. Writing for Entertainment Weekly, Emily Blake speculated that the film’s lack of mainstream recognition was due to its label as an “abortion comedy” (Blake, 2015).

In addition to fictionalized depictions of abortion, several documentary films in the last decade have explored abortion. Documentary films often explore controversial issues and can serve as important vehicles for drawing public attention to a particular issue, changing the narrative, or galvanizing political change , such as Bowling for Columbine, which explored gun control in 2002, and An Inconvenient Truth, which explored climate change in 2006. Abortion-related documentaries in the past decade include 12th And Delaware (2010), After Tiller (2013), Vessel (2014), and Trapped (2016) among others. Of these, After Tiller is the most well known, in part due to its 2015 News and Documentary Emmy award after it aired on PBS. Starting with the assassination of Dr. George Tiller in his church in 2009, the film provides a complex counterpart to the misinformation and myth that surrounds late-abortion care in the United States. Critical evaluation with audiences revealed that this film was somewhat effective in changing beliefs about abortion (Sisson & Kimport, 2016a). The film’s focus on the four remaining doctors that openly perform late-term abortions in the United States, however, suggests that narrative depictions of abortion and abortion providers may have more efficacy with respect to social change than narratives that solely focus on women who chose abortion.

Role of Social Media in Garnering Political Support Normalizing the Abortion Experience

A review of mainstream popular culture representations of abortion suggests that these narratives have contributed to the silence and shame surrounding abortion. Abortion has largely been framed as a moral issue, as opposed to a medical, financial, or women’s health issue. In this context, the nuances and complexity of abortion for individuals and society at large are overtaken by a binary conceptualization of abortion as right versus wrong, moral versus immoral, and rhetorically signaled by the simplistic and erroneous “pro-life” and “pro-choice” labels. Studies evaluating private discourse about abortion have shown that person-to-person conversations about abortion allow for a more balanced conversation where women can explore their own thoughts about abortion and disclose personal experiences (Herold, Kimport, & Cockrill, 2015). Building off these personal conversations, successful social media campaigns in the past years have capitalized on moments when abortion was in the national media spotlight and sought to galvanize political support to challenge antiabortion legislation, garner support for abortion providers, protect access to care, and create cultural change to destigmatize abortion through the online sharing of abortion narratives. This “hashtag activism” has become an important tool of social media at large, and particularly for the pro-choice movement.

#StandwithPP

In 2015, an antiabortion organization called the Center for Medical Progress (CMP) released deceptively edited, undercover videos alleging abortion providers and Planned Parenthood profit from the sale of donated fetal tissue. These videos received widespread media coverage, leading to state-level and congressional investigations, as well as attempts to cut federal family planning funding for Planned Parenthood. The objectives of CMP to expose illegal activity on the part of Planned Parenthood and abortion providers were not met—in fact, none of these investigations found any wrongdoing on the part of Planned Parenthood. Instead, investigation of the CMP videos ultimately led to criminal indictment and felony charges for some of the CMP members involved in making the videos (Fernandez, 2016).

While this campaign to reveal illegal activity backfired, the objective of vilifying abortion providers and invoking a narrative that connected abortion provision with monetary gain and immoral activity was successful. In the midst of widespread news coverage of this controversy, social media became an important vehicle for the pro-choice movement to create a counter-narrative. Drawing on a powerful social media presence, Planned Parenthood declared September 29th “Pink Out Day” and offered free STI screening at their clinics across the United States. “Pink Out Day” highlighted the fact that the vast majority of reproductive health services provided by Planned Parenthood are not abortion care, and the campaign elicited widespread community support for the agency. Further, the #StandwithPP campaign on Facebook and Twitter created a way for people to show support for abortion access and Planned Parenthood. Reflecting on the hashtag #StandWithWendy that supported the 11-h filibuster of a restrictive Texas abortion law by Wendy Davis, the #StandwithPP drew on this imagery of standing up for abortion access and rights.

The #StandwithPP campaign allowed Facebook members to create a filter for their Facebook profile picture that included a pale pink background and text box frame that said #StandwithPP. By changing their Facebook or Twitter profile picture, people could show their support for Planned Parenthood. This media campaign drew the support of politicians and celebrities and brought attention to the attempts to restrict government funding for Planned Parenthood.

#ShoutYourAbortion

Other campaigns on social media have focused on affecting cultural change through direct de-stigmatization of the abortion narrative. In September of 2015, the #ShoutYourAbortion campaign was launched with the objective of normalizing abortion as a common reproductive experience. With one in three American women having an abortion by the age of 45, this campaign challenged the silence and shame that characterize abortion in popular discourse.

By creating #ShoutYourAbortion, reproductive rights activists Amelia Bonow, Kimberly Morrison, and Lindy West sought to end the silence and shame around abortion by providing spaces for women to share their personal stories of how access to safe and legal abortion has impacted their lives (Lewin, 2015). Ms. Bonow publically shared her own abortion story on social media and created the hashtag #ShoutYourAbortion. With #ShoutYourAbortion, a novel way of engaging the public in the narrative of abortion was created, allowing real women to share their non-sensationalized stories of abortion. This campaign is noteworthy in that it stands in contrast to much of the prior focus of reproductive rights activists, which tend to center on the legal challenges to abortion (as was the goal of the #StandwithPP campaign).

With the #ShoutYourAbortion campaign, women began sharing their abortion stories online—reflecting on the situation surrounding the pregnancy, the difficult considerations they weighed in making the decision, and the way that access to abortion has changed the trajectory of their lives. Using this hashtag, women mention their other children, discuss abusive or damaged relationships , and share stores of isolation and loneliness as they relate to the abortion experience. The collection of honest, raw stories from women across the world via #ShoutYourAbortion has created a platform for women’s voices within the abortion narrative. As stated on the movement’s webpage, “The era of compulsory silence is ending. Abortion is normal. Our stories are ours to tell. This is not a debate. #ShoutYourAbortion.” This media campaign is ongoing with women continuing to share their stories and experiences every day.

#NotoriousRBG

Among the best examples of the ability of social media to galvanize political activism in young people is the rise of Ruth Bader Ginsburg as a feminist cultural icon. Justice Ginsburg was the second woman to be appointed to the Supreme Court and has served as an Associate Justice since 1993. She is viewed as a defender of progressive principles and her dissenting decisions (Toobin, 2013) in cases like Burwell v. Hobby Lobby have helped her to be recognized as a liberal voice and advocate for women’s rights within the court (Ohlheiser, 2014). Artwork of Justice Ginsburg with a crown and her trademark lace collar over her Supreme Court robe trend on the “Notorious R.B.G” Tumblr which contrasts the 80-year-old lawyer sharply with the rapper her nickname parodies (Totenberg, 2015). Through social media, Justice Ginsburg’s decisions on family planning issues in the Supreme Court have disseminated, making her a hero and advocate for the reproductive rights movement.

The regulation of abortion at the state level is an ever-evolving process and many states introduce several reproductive health and abortion laws each year. For instance, in 2011, legislators introduced more than 1100 abortion-related provisions with 135 of these eventually enacted (Guttmacher Institute, 2012). These laws have significant impact on provision of abortion, access to care, and public health.

The passage of an omnibus abortion bill in Texas in 2012 led to closure of over half abortion clinics in the state of Texas, and became a case study of the public health impact of restricting abortion access (Grossman, Baum, et al., 2014; Grossman, White, Hopkins, & Potter, 2014). Challenge of the constitutionality of law occurred, eventually taken to the level of the Supreme Court in the case Whole Women’s Health v. Hellerstedt. As the Supreme Court considered the first abortion case in years, the extent that states can legislate abortion policy that ultimately restricts access was questioned.

Ultimately, the court overturned HB2, a historical decision that protects access to abortion vis-à-vis state regulation of abortion. In the wake of the decision, #NotoriousRBG trended again, including memes of Justice Ginsburg, including quotes from her concurring decision (Krantz, 2016). While Justice Ginsburg did not write the majority decision, in many ways she remained the voice for the reproductive rights movement and was celebrated along with the decision. Among the many examples of how social media has been engaged in the fight to protect reproductive choice, the #NotoriousRBG illustrates how these new forms of media can transform advocacy through the creation of cultural icons.

Role of Social Media in Making Abortion Safer: Accessing Medical Abortion Outside of the Traditional Health System

In contexts where abortion is illegal or practical access is constrained, the ability for women to access information and recourses for self-induced medical abortion outside of traditional health systems fits within a harm-reduction model of care (Briozzo et al., 2006; Erdman, 2012; Hyman, Blanchard, Coeytaux, Grossman, & Teixeira, 2013). For instance, in Latin America where abortion is legally restricted, the use of misoprostol for self-induced abortion is linked with a decrease in maternal mortality related to unsafe abortion (Dzuba, Winikoff, & Pena, 2013). And, as data to support the expansion of women’s roles in self-management of many components of medical abortion grows, an understanding of women’s preference for independent use of misoprostol for medical abortion is also evolving.

Studies have shown that the media is an important source of information about safe abortion practices, and that quality of information relates to risk for unsafe abortion. An unmatched case-control study in Sri Lanka evaluated the determinants of decision making in the setting of unplanned pregnancy. Comparing controls who were admitted to the hospital for delivery of an unintended pregnancy to cases admitted to the same hospital for complications of unsafe abortion, risk for unsafe abortion was associated with unreliable sources of information and poor knowledge in addition to limited access to affordable abortion care (Arambepola & Rajapaksa, 2014).

When women do not have access to safe abortion, they turn to unsafe abortion practices. Thus, providing accessible, evidence-based information on how to obtain safe medical abortion outside traditional health systems is an important public health imperative. Use of social media to achieve this goal is an evolving way of delivering public health information.

In an effort to improve the quality of available information about medical abortion on the Internet, Ibis Reproductive Health and the Office of Population Research at Princeton University created a multilingual website called www.medicationabortion.com (Foster et al., 2006). A 2014 study of user e-mails submitted to this website confirms that there is significant demand for online informational resources about medical abortion—both in regions where abortion is legal and illegal (Foster, Wynn, & Trussell, 2014).

Women on Web is another nonprofit project that aims to support women in obtaining safe abortion where legal abortion is not accessible. The website provides informational resources, uses an online or telemedicine consultation service with a physician to determine eligibility, and provides mifepristone and misoprostol via mail for use in medical abortion where these services are not available (Gomperts, Jelinska, Davies, Gemzell-Danielsson, & Kleiverda, 2008). When women do not have access to safe abortion services, they undergo unsafe, dangerous procedures with high morbidity and mortality. Providing medical abortion in this way allows safe abortion practices to be possible in settings where legal abortion is not available. Finding ways to support women who seek abortion in regions of the world where these services are not available is an important strategy to decrease mortality related to unsafe abortion.

Conclusion

Scholarship that critically evaluates the content and messaging of popular culture representations of pregnancy, motherhood, and abortion demonstrates the disconnect between popular culture, representation, and reality of experience as it relates to abortion. As traditional media platforms are still primarily male dominated in content and creation, the participatory nature of social media is one avenue transmitting real narratives of abortion. By including the voices and perspectives of women themselves, abortion stigma can decrease. Through their participatory nature, social media platforms have the potential to challenge traditional media representations of abortion and can serve as an empowering platform for political and feminist pro-choice activism.

Discussion Questions

  1. 1.

    What do you think is the cause of abortion stigma? What are the most effective ways for doctors, public health officials, and ordinary citizens to combat this stigma?

  2. 2.

    How do race, class, and age affect representations of abortion in the media?

  3. 3.

    What are the advantages of using social media for activism? What are the disadvantages?

  4. 4.

    In which ways does social media activism correspond to the intersections of feminist theory and praxis?