Image courtesy of Luna Aguilar.
On June 22, 2022, the United States Supreme Court overruled Roe v. Wade, which provided constitutional protection for the right to abortion for nearly half a century. Two months after the decision was overturned, over twenty million women in the United States lost access to elective abortions in their home states.
The New York Times published a piece sharing the stories of people who got abortions before Roe stating that an important part of advocating for abortion is learning from the experiences of Americans who have had unsafe abortions before the court decision. On Twitter, Representative Alexandria Ocasio-Cortez trended for sharing her personal sexual assault story during an abortion rally. In the video, she told the crowd that she was glad to know she at least had a choice if she did end up being pregnant because of readily accessible abortion care in New York City.
In 2017, Abigail Cutler SPH ’19, a doctor and clinical instructor in the Department of Obstetrics and Gynecology at Yale School of Medicine, noticed the increased prevalence of abortion storytelling in social media campaigns. Many of these campaigns’ messages were to normalize abortions and denounce the stigma associated with it so that those who had or were seeking care felt like they were not alone in their experience.
These campaigns inspired Cutler to examine whether forms of public storytelling—in which storytellers don’t necessarily know their audience—could decrease community-level abortion stigma or the stigma people feel towards others who seek or have abortions. This stigma commonly manifests as discrimination against people who have abortions and as structural barriers against abortion care.
Evidence from years of polling research shows clearly that the public tends to be most supportive of abortions involving rape, incest, threats to maternal life, and fetal anomalies—none of which reflect the most common reasons people seek an abortion.
“We know these stories are already effective for warming public opinion,” Cutler said. However, she endeavored to know whether “non-exceptional” stories—stories centered on the most common circumstances for seeking abortion—would impact the hearts and minds of the public.
Formation of the Study
To test this, Cutler’s team conducted a randomized trial on a large, nationally representative set of US adults selected using the Ipsos Knowledge Panel. They showed the subjects three videos of people sharing their abortion experiences. They then measured community-level stigma immediately after showing the videos and then in a three-month follow-up.
The authors developed a conceptual model to measure community-level abortion stigma and its facets. This model measures stigma through three scales: one primary scale measuring judgment (Community Abortion Attitudes Scale), one measuring how the context of an abortion affects opinion (Reproductive Experiences and Events Scale), and one measuring expectations of silence and secrecy surrounding abortion experiences (Community Level Abortion Stigma Scale).
The crucial part of this experiment was the selection of the three videos of people telling their experiences, which would be shown to the audience. Cutler recognized that, as a cis white woman leading a research team of white women, the group needed to be mindful of how their biases could adversely affect their study design. They formed an advisory board with racially and ethnically diverse members with professional or personal backgrounds in abortion stigma and storytelling, including several non-profit abortion organizations.
The essential qualities welcomed an intersectional analysis and would include speaking to the common reasons for seeking abortions, the ease or boundaries faced with healthcare, and whether the speaker told their story in a fluid and thoughtful manner. They sought to curate videos that would give the viewer a different perspective on abortions. “We wanted to make the watcher look at abortion in a different way, in a way not highlighted every day in the media,” Cutler said.
After developing a scoring matrix for the videos based on these essential qualities, the advisory board members selected three final videos to showcase various abortion stories. One video talked about a parent who had multiple abortions before. Another video was about a woman who spoke about the barriers to obtaining an abortion in Texas and who traveled to California for the procedure. The final video was on a Latina woman who attempted to acquire birth control through the military and was facing difficulties doing so. Before she got deployed, she became pregnant. She spoke about how she made the decision to get an abortion in the context of her family and her values.
“People don’t make these decisions in a vacuum, they don’t make it by themselves,” Cutler emphasized. These videos were chosen because they reflected the intersectionality and politicized nature of the abortion conversation through real, lived experiences of the most common demographics that seek an abortion.
Reflecting on the Results
The results of the study showed that intervention exposures to these three videos both immediately after watching and three months later showed no association with decreased stigma by the judgment scale (CAAS) or the silence and secrecy scale (CLASS). This means that exposure to these three different abortion stories did not lower community-level stigma. Although there was a decrease in stigma in the context scale (REES) immediately after watching the videos, it was not significant after a three-month follow-up.
This study approached the question of non-intimate storytelling and community-level stigma from a neutral standpoint, meaning that stories were not chosen because of their potential to elicit a response but to represent non-exceptional abortion stories. Furthermore, lack of an effect could mean that intervention exposure could be dose-dependent and that a single exposure to storytelling would not be enough for a long-term change in community-level stigma but rather should be more frequent and prolonged. For instance, a social media campaign, such as #ShoutYourAbortion, could prolong exposure to abortion stories over the period of time that it is trending. Furthermore, newspapers such as The New York Times creating a section called Abortion News could also keep the abortion conversation present in the public’s mind.
“I think it’s important to acknowledge the limitations of this study,” Cutler said, “I don’t think a takeaway from the findings of this study is that abortion storytelling does not have the power to change hearts and minds. It was one study, and it was conducted several years ago. The legal landscape is really different now.” She mentioned that repeating this study, especially now post-Dobbs, would be interesting to see.
Cutler emphasized that the results of this study do not mean that abortion storytelling isn’t important for other reasons. It is essential to recognize that the purpose of abortion storytelling is not just to change public opinion. People who decide to disclose their abortion experiences to the general public do so for various reasons, such as to feel empowered and take the reigns over an experience that ought to be discussed more.
“Abortion storytelling can also help other people who have abortions who happen to see that story to feel less alone,” Cutler said. “And that is arguably equally, if not more important, than changing public opinion.”
Cutler, A. S., Lundsberg, L. S., White, M. A., Stanwood, N. L., & Gariepy, A. M. (2022). The Impact of First-Person Abortion Stories on Community-Level Abortion Stigma: A Randomized Trial. Women’s health issues : official publication of the Jacobs Institute of Women’s Health, S1049-3867(22)00059-7. Advance online publication. https://doi.org/10.1016/j.whi.2022.06.006
Cutler, A. S., Lundsberg, L. S., White, M. A., Stanwood, N. L., & Gariepy, A. M. (2021). Characterizing community-level abortion stigma in the United States. Contraception, 104(3), 305–313. https://doi.org/10.1016/j.contraception.2021.03.021