'I could see myself doing something like that': US women's engagement with characters who experience abortion, adoption and surrogacy on Little Fires Everywhere.

Building on existing scholarship examining how audiences interpret reproductive experiences on film and television, we investigate how viewers make meaning of representations of motherhood, abortion, adoption, and surrogacy on the Hulu television miniseries Little Fires Everywhere. We recruited twenty-one participants to watch the series and conducted three virtual focus groups of seven women each. Based on the racial identities of the main characters in the series, we segmented these groups by race: one group each of white women, Black women, and Chinese American women. Focus groups were facilitated by moderators who matched the racial and ethnic backgrounds of each group. We asked participants about their overall reactions to the series, their impressions of various characters, and each reproductive health plotline. Participants expressed both tender and critical reactions to characters who endured motherhood, surrogacy and adoption, yet most participants were overtly critical of Lexie, the character who obtained an abortion. We argue that this is likely because the character of Lexie is written as largely unsympathetic, leaving audiences with little opportunity to form a parasocial relationship with her. We discuss the implications of this for cultural conversations and understandings of abortion more broadly.

After After Tiller: the impact of a documentary film on understandings of third-trimester abortion.

Onscreen pseudo-experiences have been shown to influence public perceptions of contested social issues. However, research has not considered whether such experiences have limits in their influence and/or vary in their impact. Using the case of third-trimester abortion, an issue subject to high amounts of misinformation, low public support and low occurrence in the general population, we investigate how the pseudo-experience of viewing After Tiller, a documentary film showing stories of third-trimester abortion, providers and patients, might serve as a counterpoint to misinformation and myth. We interviewed 49 viewers to assess how viewing the film interacted with viewers' previously held understandings of later abortion. Participants reported that viewing made them feel more knowledgeable about later-abortion patients and providers and increased their support for legal third-trimester abortion access, suggesting the efficacy of this pseudo-experience in changing belief. Nonetheless, respondents' belief systems were not entirely remade and the effects of the film varied, particularly in regards to gatekeeping around the procedure and the reasons why women seek later abortion. Findings show the potential of onscreen pseudo-experiences as a means for social change, but also reveal their limits and varying impacts.

Abortion pills on TV: An exploratory study of the associations between abortion plotline viewership and beliefs regarding in-clinic and self-managed medication abortion.

OBJECTIVES: Entertainment television is an influential source of health information, including about reproductive health. We investigated the association between exposure to television plotlines about medication abortion on audience awareness and beliefs about medication abortion. STUDY DESIGN: We administered a national cross-sectional online survey from December 2021 to January 2022 with a probability-based sample of people assigned female at birth. We asked respondents to select plotlines they had seen from a list of seven that portrayed medication abortion. Among the 3425 people who responded to plotline items, 3340 responded to our outcome measures. Using weighed multivariable analyses, we examined adjusted relationships between exposure to specific types of abortion plotlines and awareness of and beliefs about medication abortion medical safety. RESULTS: We found that audience exposure to medication abortion plotlines in which the medication abortion was obtained from a clinic and portrayed as safe was associated with greater awareness of medication abortion compared to nonexposure (RR: 1.68; 95% CI: 1.17, 2.40). Exposure to plotlines that portrayed MA or self-managed MA as safe was associated with audience beliefs that medication abortion is safe. CONCLUSIONS: This study demonstrates that the content of abortion plotlines and exposure to accurate information may be connected to audience awareness of and beliefs about abortion. IMPLICATIONS: In a climate of misinformation about abortion, audience exposure to medically accurate television plotlines about medication abortion may be an effective way to increase awareness of medication abortion and influence beliefs about medication abortion safety.

Estimating the annual domestic adoption rate and lifetime incidence of infant relinquishment in the United States.

OBJECTIVES: Estimating the rate of infant relinquishment for adoption in the United States (U.S.) can inform understandings of pregnancy decision-making and adoption practice. Yet, private domestic adoptions are not systematically tracked. Most methods of estimating adoptions rely on nonmarital birth rates, despite the changing social context of nonmarital births. This analysis provides updated estimates of the rate of infant relinquishment for private domestic adoption in the United States. STUDY DESIGN: Using data from National Council for Adoption, Centers for Disease Control, and Guttmacher Institute, I compiled annual estimates for the number and rates of births, abortions, and adoptions; calculated annual domestic infant adoption rates among all women and unmarried women of reproductive age; estimated the number of adoptions as a proportion of marital and nonmarital births; and estimated the lifetime incidence of relinquishment for U.S. women. RESULTS: Since 1982, the annual adoption rate per 1000 U.S. women of reproductive age has been between 0.32 and 0.45, decreasing for the last 30 years. The most recent adoption rate translates to a lifetime relinquishment estimate of 0.9% of U.S. women. Based on patterns from 2002 to 2014, I estimate the current number of private domestic adoptions to be approximately 0.5% the annual number of births, or about 18,300 to 20,000 adoptions per year. CONCLUSIONS: Despite finding a higher estimate of private domestic adoptions per year than previous estimates, adoption relinquishment rates remain dramatically lower than birth (and thus parenting) and abortion rates in the U.S. IMPLICATIONS: National and state level information about annual adoptions is needed to inform policies regarding adoption, abortion, and support for families.

Who are the women who relinquish infants for adoption? Domestic adoption and contemporary birth motherhood in the United States.

INTRODUCTION: The social context of pregnancy decision-making has changed in recent decades in the United States (US), but little research has examined how these changes manifest in the context of infant adoption. METHODS: To create an updated profile of US birth mothers, this analysis uses demographic data collected and aggregated from six adoption agencies, with information on 8658 private adoptions that occurred between 2011 and 2020. RESULTS: Based on this sample, birth mothers today are older and more racially and ethnically diverse than counterparts in previous generations; a majority have other had children and a substantial proportion were parenting other children at the time of relinquishment. They report living on low incomes and, when considered with other measures (e.g., employment, health insurance, homelessness), seem to lack the economic resources that would give them meaningful power over the options available to themselves and their children. Most birth mothers contact agencies late in their pregnancies or after delivery, at a point when abortion care is likely inaccessible or unavailable. An important minority of birth mothers will relinquish more than one infant for adoption over the course of their reproductive lives. CONCLUSION: Given the underlying shift in the demographic profile of women who relinquish infants, it is likely that the underlying circumstances that lead to adoption have also diverged. More research is needed into how women make decisions about adoption; such research carries implications for how best to support women's decision-making and ensure access to needed services throughout pregnancy and beyond.

Prime-time abortion on Grey's Anatomy: What do US viewers learn from fictional portrayals of abortion on television?

CONTEXT: Entertainment television can impact viewers' knowledge, attitudes, and reproductive health behaviors, yet little research has examined the impact of scripted abortion plotlines on viewers' abortion knowledge or social supportiveness for those having abortions. We examined the impact of an abortion storyline from Grey's Anatomy on US-based viewers. METHOD: We conducted an online survey of likely Grey's Anatomy viewers prior to the episode's airing, assessing abortion ideology, knowledge, and support. After airing, we resurveyed respondents (including both those who had and had not viewed the target episode). We tested three hypotheses: episode exposure would (1) improve abortion knowledge and (2) increase support for medication abortion and decrease support for self-induced abortion, and (3) the effects on knowledge and supportive intention would be moderated by state support for abortion. We used independent samples t tests to examine hypotheses 1 and 2 and PROCESS macro to test the moderated effects (hypothesis 3). RESULTS: The results of the pretest/posttest analysis indicated that exposure to the episode significantly improved medication abortion knowledge. Increases in medication abortion knowledge were tied to explicit educational dialogue and did not translate into an increase in general abortion knowledge or social supportiveness. Notably, abortion-related state policy significantly moderated the influence of exposure for respondents in states with policies favorable to abortion access. CONCLUSIONS: These findings suggest that entertainment television can contribute to meaningful increases in viewers' knowledge about abortion, but that the potential for impact of entertainment-education is closely linked to episode content and moderated by state-level abortion policy.

Abortion Providers on Politically Engaging Patients.

BACKGROUND: For decades, abortion providers have lamented the lack of patients' voices in the abortion rights movement. Given the millions of women who have received abortions, the absence of this large constituency, providers assert, has been politically costly. Underlying this disappointment is a parallel question that reflects a philosophical divide among abortion providers: are attempts to politically engage abortion patients a desired or appropriate element of care? METHODS: We interviewed providers from 14 abortion clinics, representing a range of approaches to care, patient volume, and geographic locations. We transcribed and analyzed the interviews to identify themes related to whether, why, and how providers worked to politically engage their patients. RESULTS: We found that many respondents limited or avoided political engagement with patients, believing that such efforts interfered with patient care or comfort, were not a priority given limited time, and were not something in which patients were interested. Many participants were unclear as to what political work they could pursue as nonprofit facilities. In contrast, other providers believe political outreach helped patients to more fully understand their care experiences, could influence future patients' access to care, and was an important part of the way they cared for patients. CONCLUSIONS: These varying approaches reflect divergent ways of and reasons for engaging abortion patients politically. Future research should consider if the act of obtaining an abortion could be understood as low-level engagement with the abortion rights movement, particularly as abortion access is increasingly limited and patients might be considered potential activists.

Abortion on American television: An update on recent portrayals, 2015-2019.

OBJECTIVE: To compare differences in televised abortion depictions from two time periods: 2005 to 2014, as examined in previous studies, and more recent depictions from 2015 to 2019. STUDY DESIGN: Using a database of television abortion plotlines, we analyzed recent portrayals for character demographics, barriers, genre, and safety, calculated proportions, and compared to prior findings. RESULTS: While recent portrayals shift towards reflecting some demographics of U.S. abortion patients, people of color, low-income people, and parents remain under-portrayed. Compared to prior depictions, recent plotlines are more likely to inaccurately depict abortion as easier to access than it is for the majority of U.S. abortion patients. However, recent depictions are also less likely to depict exaggerated and inaccurate medical complications of abortion. Abortion plotlines are increasingly appearing on comedies. CONCLUSION: Despite progress, there remain important ways television could improve abortion depictions. IMPLICATIONS: Content creators should continue to consider diversity, nuance, and medical and demographic accuracy in depicting abortion.

Hangers, Potions, and Pills: Abortion Procedures on American Television, 2008 to 2018.

BACKGROUND: Television portrayals of medical procedures may contribute to patient anxieties and cultural myths. We explored how television depicts abortion procedures, focusing on what these portrayals communicate about abortion access and safety. METHODS: Researchers identified all abortion procedure plotlines on American television from 2008 to 2018 through Internet searches. We viewed plotlines and coded for type of abortion, health outcome, and whether the abortion occurred on or off screen. We used inductive content analysis to identify themes. FINDINGS: We identified 96 television plotlines between 2008 and 2018 in which a character obtains or discloses an abortion. Of these, 39 plotlines (40%) depict some aspect of the abortion procedure. Twenty-three of the 39 abortion portrayals (59%) depict a surgical abortion procedure, of which about one-half were legal abortions and one-half were illegal. Only 7 of the 39 procedure plotlines (18%) portray medication abortions. Five of these plotlines depict illegal abortions; only two depict legal abortions. Four plotlines depict attempted abortions by supernatural means or ingestion of a toxic liquid. CONCLUSION: The majority of abortions on television are surgical, contrasting with the reality of abortion practice in which one-third of U.S. abortions are by medication. Portrayals of surgical abortion often reinforce the misperception that abortion is a surgical intervention requiring hospitalization. The few portrayals of medication abortion also perpetuate inaccuracies, including that it is easily accessible, uncommon, and dangerous. Portrayals of illegal abortions are overrepresented. This misinformation may seed unnecessary fear for patients before an abortion, and may create confusion among the public about abortion access and safety.

"I was close to death!": abortion and medical risk on American television, 2005-2016.

OBJECTIVES: To examine the portrayal of complications and long-term health consequences associated with abortion on television, recognizing the impact that fictional stories can have on public beliefs about abortion's safety. STUDY DESIGN: Using a systematic online search, we identified all instances of abortion on US television from 2005 to 2016. We qualitatively coded these plotlines to identify any occurrences of complications, interventions or long-term health consequences associated with abortion care, with 95% intercoder reliability. We calculated the frequencies and rates of these occurrences in Microsoft Excel. RESULTS: Our search identified 80 abortion plot lines. A percentage of 37.5 of characters who obtained an abortion experienced complications, interventions and/or negative health consequences. This rate contrasts with the 2.1% of real patients who experience complications or require intervention as a result of their abortions. Most onscreen complications were major events (e.g., hemorrhage), as opposed to real women, whose complications are mostly minor. Major medical interventions (e.g., hysterectomy) were similarly overportrayed, while the most commonly used interventions for real patients (e.g., medication) were not depicted at all. Finally, 22.5% of characters faced a long-term adverse health consequence, including mental illness, infertility or death. The onscreen abortion mortality rate was 5%, about 7000 times the actual mortality rate. CONCLUSIONS: Overall, television dramatically exaggerates the risk associated with abortion procedures, overportraying medical complications - particularly major and life-threatening complications - and long-term adverse health consequences. This pattern of misrepresentation may be partially attributable to the occurrence of stories about illegal abortions or abortions taking place outside of modern medical contexts. IMPLICATIONS: Onscreen abortion portrayals may contribute to inaccurate beliefs about abortion's risk that are common among the public, broadly, and abortion patients, specifically. Abortion advocates and providers will be more equipped to respond misinformation if they understand how and to what extent our popular culture portrays abortion as unsafe.

"The stakes are so high": interviews with progressive journalists reporting on abortion.

OBJECTIVES: Because news frames can influence public and policy agendas, proponents of abortion access should be concerned with how this issue is covered in the news. While previous research has examined the content of news on abortion, this analysis explores the process of newsmaking on abortion, examining how journalists understand their role in and experience of covering abortion. STUDY DESIGN: We recruited journalists with experience reporting on abortion through listservs for progressive and feminist reporters. Thirty-one participants, with experiences at 75 diverse media outlets, completed in-depth, open-ended interviews. We used grounded theory to code interview transcripts in Dedoose to identity emergent themes. RESULTS: Journalists described many challenges that applied to reporting generally, but that they perceived to be more difficult around abortion: grappling with the meaning of "neutrality" on this issue, finding new angles for articles, and handling editors with varying knowledge of abortion. Over one-third (n=13) of participants mentioned feeling that the stakes were higher around abortion: this urgency and polarization left journalists frustrated by efforts to find new sources or angles on abortion stories. Finally, over 80% (n=28) of participants reported experiencing anti-abortion harassment as a result of their abortion work. CONCLUSIONS: The difficulties journalists described when reporting on abortion were often rooted in abortion stigma and the political polarization around the issue. This pattern was true even for reporters who worked to counter abortion stigma through their reporting. IMPLICATIONS: Advocates interested in accurate, destigmatizing news frames might work pro-actively to educate editors and increase reporters' access to providers, patients, and advocates.

Adoption Decision Making among Women Seeking Abortion.

BACKGROUND: Little is known about how adoption factors into pregnancy decision making, particularly when abortion is unavailable. METHODS: We used data from the Turnaway Study, a longitudinal study of 956 women seeking abortion, including 231 women denied abortions owing to gestational limits. Through semiannual quantitative interviews, we assessed the frequency with which women denied abortion consider and choose adoption, and, among adoption participants, decision satisfaction. We compared differences in the demographic profiles of parenting and adoption participants using mixed effects regression models. We conducted in-depth interviews with 31 women who received or were denied wanted abortions, including 2 adoption participants, focused on understanding pregnancy decision making and feelings about their choice. Interviews were coded using inductive and deductive methods. RESULTS: Most women who received abortions were aware of but uninterested in adoption. A minority of women denied abortions (n = 231; 14%) were considering adoption at 1 week after denial. Of participants who gave birth (n = 161), most (91%) chose parenting. Parenting participants (n = 146) did not differ from adoption participants (n = 15) on measures of age, race, or poverty status, although adoption participants were somewhat less likely to be employed (20% vs. 43%; p = .1), and somewhat more likely to have completed high school (87% vs. 74%; p = .08). Although satisfaction with their decision was high among adoption participants, in-depth interviews revealed mixed emotions. CONCLUSIONS: Among women motivated to avoid parenthood, as evidenced by abortion seeking, adoption is considered or chosen infrequently. Political promotion of adoption as an alternative to abortion is likely not grounded in the reality of women's decision making.

Doctors and Witches, Conscience and Violence: Abortion Provision on American Television.

CONTEXT: Popular entertainment may reflect and produce-as well as potentially contest-stigma regarding abortion provision. Knowledge of how providers are portrayed on-screen is needed to improve understanding of how depictions may contribute to the stigmatization of real providers. METHODS: All abortion provision plotlines on American television from 2005 to 2014 were identified through Internet searches. Plotlines were assessed in their entirety and coded for genre, abortion provision space, provider characteristics, method and efficacy of provision, and occurrence of violence. Inductive content analysis was used to identify themes in how these features were depicted. RESULTS: Fifty-two plotlines involving abortion provision were identified on 40 television shows; a large majority of plotlines appeared in dramas, particularly in the subgenre of medical dramas. Medical spaces were depicted as normal and safe for abortion provision, and nonmedical spaces were often portrayed as remote and unsafe. Legal abortion care using medical methods was depicted as effective and safe, and legal providers were presented as compassionate, while providers operating outside of medical and legal authority were depicted as ineffective, dangerous and uncaring. Fictional providers were largely motivated by the belief that abortion provision is a necessary and moral service. Plotlines linked abortion provision to violence. CONCLUSIONS: The differing ways in which legal and illegal abortion are portrayed reveal potential consequences regarding real-world abortion provision, and suggest that representations situated in medical contexts may work to legitimate and destigmatize such provision.

Facts and fictions: Characters seeking abortion on American television, 2005-2014.

OBJECTIVES: We aim to describe how women who seek abortions are portrayed on television, recognizing that onscreen fictional stories can shape the public's beliefs. STUDY DESIGN: Drawing on a comprehensive online search, we identified all fictional representations of abortion decision making on U.S. television from 2005 through 2014. Characters who considered abortion in these plotlines were quantitatively content coded for their demographic details and reasons for abortion, with 95% intercoder reliability. RESULTS: Seventy-eight plotlines were identified, including 40 plotlines (51%) wherein a character obtained an abortion. Characters who considered abortion were mostly white, young, in committed relationships and not parenting. Comparing all abortion-considering characters to the subset of abortion-obtaining characters, the higher rates of abortion were found for characters who were white, of lower socioeconomic status and not in committed relationships. Compared to statistics on real women, characters who obtained abortions were disproportionately white, young, wealthy and not parenting. Compared to reports on real women's reasons for abortion, immaturity or interference with future opportunities was overrepresented; financial hardship or pregnancy mistiming was underrepresented. CONCLUSIONS: Taken in aggregate, televised abortion stories misrepresent the demographics of women obtaining abortion and their reasons for doing so, overrepresenting younger white women and underrepresenting women of color, poor women and mothers. Overrepresented reasons were more often self-focused rather than other-focused, contributing to a perception that abortion is a want rather than a need. Findings hint at the politics of onscreen abortions, suggesting that it is easier to portray with peripheral characters and among some demographics (e.g., teens). IMPLICATIONS: Onscreen representations may influence public understandings, contributing to the production of abortion stigma and judgments about appropriate restrictions on abortion care. Understanding the particular shape of inaccuracies around abortion portrayals can enable advocates and healthcare practitioners to identify and respond to popular misperceptions.

"Choosing Life": Birth Mothers on Abortion and Reproductive Choice.

PURPOSE: As the least-chosen option when faced with an unplanned pregnancy, adoption remains largely unexamined as a reproductive choice. Although the anti-abortion movement promotes adoption as its preferred alternative to abortion, little is known of birth mothers' pregnancy decision making and whether adoption was chosen in lieu of abortion. METHODS: I conducted in-depth interviews with 40 women who had placed infants for adoption from 1962 to 2009. Participants were asked about all aspects of their adoption experiences, including their pregnancy decision making and thoughts on abortion. Interview transcripts were analyzed using grounded theory to find unifying themes speaking to reproductive choice. RESULTS: Participants' stories revealed widely varying ideas about abortion. Many were opposed to abortion, but a greater number supported abortion as a reproductive choice, although one they did not choose for themselves. Birth mothers were most often choosing between adoption and parenting, not adoption and abortion. Most participants would have preferred to parent, but did not because of external variables. Mixed experiences with adoption also influenced participants' long-term ideas about reproductive choice. CONCLUSION: Findings suggest that the anti-abortion framing of adoption as a preferable alternative to abortion is inconsistent with birth mothers' pregnancy decision-making experiences and their feelings about adoption. Reducing social barriers to both abortion and parenting will ensure that adoption is situated as a true reproductive choice.

Telling stories about abortion: abortion-related plots in American film and television, 1916-2013.

OBJECTIVES: Popular discourse on abortion in film and television assumes that abortions are under- and misrepresented. Research indicates that such representations influence public perception of abortion care and may play a role in the production of social myths around abortion, with consequences for women's experience of abortion. To date, abortion plotlines in American film and television have not been systematically tracked and analyzed. STUDY DESIGN: A comprehensive online search was conducted to identify all representations of pregnancy decision making and abortion in American film and television through January 2013. Search results were coded for year, pregnancy decision and mortality outcome. RESULTS: A total of 310 plotlines were identified, with an overall upward trend over time in the number of representations of abortion decision making. Of these plotlines, 173 (55.8%) resulted in abortion, 80 (25.8%) in parenting, 13 (4.2%) in adoption and 21 (6.7%) in pregnancy loss, and 16 (5.1%) were unresolved. A total of 13.5% (n=42) of stories ended with the death of the woman who considered an abortion, whether or not she obtained one. CONCLUSIONS: Abortion-related plotlines occur more frequently than popular discourse assumes. Year-to-year variation in frequency suggests an interactive relationship between media representations, cultural attitudes and policies around abortion regulation, consistent with cultural theory of the relationship between media products and social beliefs. Patterns of outcomes and rates of mortality are not representative of real experience and may contribute to social myths around abortion. The narrative linking of pregnancy termination with mortality is of particular note, supporting the social myth associating abortion with death. IMPLICATIONS: This analysis empirically describes the number of abortion-related plotlines in American film and television. It contributes to the systematic evaluation of the portrayal of abortion in popular culture and provides abortion care professionals and advocates with an initial accurate window into cultural stories being told about abortion.