What Do Americans Know About Abortion And Other Reproductive Health Topics?

by Danielle Bessett with Megan L. Kavanaugh, Lisa L. Littman, Caitlin Gerdts, and Alison Norris

After the abortion was complete, the young woman on the exam table – let’s call her Maria, though that is not her real name – asked the doctor, “Will I still be able to have kids?” My mouth dropped open in surprise. I had been observing at this clinic all day, and I held Maria’s hand through her procedure. Maria had told me about her two young children, how impossible it was for her to carry this pregnancy to term, how hard it had been to get time off from work for her appointment, how she hoped her fiancé would remember to pick her up at the right time. But throughout all the counseling, preparation, and intimate conversation, she had not expressed these important concerns about her future fertility. Maria appeared relieved when the doctor assured her that the abortion would not affect her chances of becoming pregnant in the future. As Maria was leaving the clinic, I asked her why she hadn’t asked whether the abortion would negatively affect her ability to have children before the procedure when she was clearly worried about the consequences. “I needed it,” Maria said simply, before she walked out to the car and back to her family.

My encounter with Maria helped to shape my interest in knowledge about reproductive health, because I wondered how many other people shared her concerns and were making decisions about women’s health and well-being with partial information or misinformation. Together with my co-authors, I set out to investigate what Americans know about abortion. We carefully reviewed the literature for the scientific consensus on different aspects of abortion and other reproductive health topics, then we created a survey that asked respondents to evaluate statements based on best possible evidence. We administered this survey to 639 randomly selected men and women aged 18–44 via an online survey.

We found that Maria (who was not included in this survey) was not alone in holding misinformation. Of the 14 items about knowledge of abortion, contraception, pregnancy, and birth in the survey, only four were answered correctly by a majority of respondents. Only one question – whether or not abortion until 12 weeks gestation is legal – was answered correctly by more than two-thirds of respondents, and 17% of respondents couldn’t answer it correctly. (Seven percent mistakenly thought that abortion until 12 weeks gestation was illegal, and another 10% didn’t know if it was illegal or not). Surprisingly, women were no better at answering questions about the health risks of abortion than men. In fact, women were less likely than men to know that the health risks of abortion are less than those of giving birth.

What characteristics were associated with higher levels of knowledge? Perhaps not surprisingly, people with higher levels of education gave more correct responses across reproductive health topics in the survey. We found that living in a red or blue state does not determine abortion knowledge when we took individuals’ characteristics (such as abortion beliefs) into account. Blogs reporting this finding got it slightly wrong, as they reported that there were no differences between red and blue states: we did find small but statistically significant differences in abortion knowledge between individuals from more and less conservative states, but these differences disappeared once we accounted for individual factors. Finally, having less restrictive abortion beliefs – believing that abortion should be allowed in at least some circumstances, rather than not at all – was also associated with higher levels of knowledge regarding abortion. This finding is consistent with other research that suggests people who support abortion restrictions not only overestimate the risks of abortion and contraception, but also underestimate the risks of full-term pregnancy and birth. People with anti-abortion perspectives may be more likely to romanticize motherhood and regard it as a natural state for women.

ThinkProgress (here) and other blogs (here, here, and here) have used our results to argue that “a politicized misinformation campaign surrounding abortion specifically” is at the root of this lack of knowledge. Although our research does not speak to the question of how people form their abortion knowledge, we speculate that abortion misinformation plays an important role in distorting public understandings about women’s health. For example, we found that women who had had an abortion were more likely than others to incorrectly assert that abortion increases the risk of breast cancer and serious mental health problems, and crisis pregnancy centers and state-mandated counseling that provide erroneous information may explain why.   But our cultural silences about abortion are also at fault. Poor sexual education, skewed depictions in popular media, and the marginalization of abortion in medical training all stigmatize abortion – making it seem that the procedure is illicit and the women who seek them, bad or immoral – because women’s control over their reproduction (and often over their sexuality, too) challenges traditional gender norms. As Maria’s case exemplifies, misinformation doesn’t necessarily stop women from obtaining abortions, but it can create considerable – and unnecessary – confusion and distress.

Danielle Bessett, PhD, is an assistant professor of sociology at the University of Cincinnati. Additional authors on the paper are Megan Kavanaugh, DrPH, Guttmacher Institute; Lisa Littman, MD, MPH, an adjunct assistant professor of preventative medicine at the Icahn School of Medicine at Mount Sinai Hospital; Caitlin Gerdts, PhD, MHS, an epidemiologist at University of California, San Francisco; and Alison Norris, MD, PhD, assistant professor, College of Public Health, The Ohio State University. To access the first article from this study, click here.