Covering Abortion as a Personal Health Care Issue, and Not Just a Political One

For about a year, Becca Andrews, a Mother Jones reporter based in California, diligently worked to build a relationship with Laurie Bertram Roberts, an activist who helps Mississippi women obtain abortions, often shepherding them across state lines for care. The two women regularly spoke on background, and over time, Andrews became well versed in the obstacles to accessing abortion in Mississippi, a state considered one of the most difficult in the nation to legally terminate a pregnancy.

Andrews wanted to document the emotional, physical, and financial toll of seeking an abortion in the South, and her ultimate goal was to do a ride-along with such a patient as she went for the procedure. To accomplish this goal, Andrews needed the activists on the ground to trust her. Roberts, she hoped, could connect her to a woman willing to share her story as it was unfolding. But there were significant ethical issues to consider: As head of the Mississippi Reproductive Freedom Fund, Roberts provided logistical and financial help to women seeking abortions. That put her in a position of power over them at a critical juncture in their lives.

[pq]Andrews’ Mother Jones story is an anomaly in the world of abortion coverage[/pq]

If Roberts asked one of her clients if they were open to speaking to a reporter, they might feel implicit pressure to comply, or wonder if their funding was contingent on their participation, even if Roberts stressed that it was completely optional. Andrews and Roberts were at an impasse.

One day, during another conversation, Andrews offered a potential solution. What if one of Roberts’ clients explicitly asked how they could help spread awareness and support her work? In that case, could Roberts pass along her phone number? The next morning, the reporter got a text: A young Mississippi woman who was about to travel to Arkansas for an abortion was eager to talk. If Andrews could make it to Little Rock the following day, she could follow the woman as she went through the process of obtaining an abortion and traveled back home.

The resulting article, “When Choice is 221 Miles Away: The Nightmare of Getting an Abortion in the South,” was published in September 2019. It follows a recent college graduate, given the pseudonym Kate, and documents her three-month struggle to get an abortion. Ultimately, it took her three separate trips to an abortion clinic 200 miles from her home before she was able to end her pregnancy.

Andrews’ Mother Jones story, which centers the lived experience of a woman trying to terminate an unwanted pregnancy and illustrates the impact of burdensome state regulations on abortion, is an anomaly in the world of abortion coverage. Despite the fact that abortion is common (nearly one in four women in the U.S. opt to have one in their lifetime), overwhelmingly safe, according to a landmark study by the National Academies of Sciences, Engineering, and Medicine (NASEM), and, according to a Pew poll, the majority of the U.S. public believe it should remain legal in all or most cases, abortion is predominantly treated by the media as a political issue, not as an everyday women’s health issue.

The failure to cover abortion through the lens of health care is particularly acute now, in the midst of a historic pandemic. As the coronavirus crisis enveloped the country, officials in 12 states made attempts to limit abortion access, arguing that abortion should not be categorized as an essential health care procedure. Abortion rights are also in jeopardy of being rolled back by an increasingly conservative Supreme Court. Readers deserve honest, thorough coverage of abortion and the role it plays in women’s lives.

Instead, what audiences so often get are superficial political news stories about the latest bill to regulate abortion, without context about the cumulative effect of years of such legislation. Readers are left without signposts to understand what is happening or why it matters. And more often than not, the people most affected by abortion access end up invisible in these stories.

Complicating matters, there is timidity among some media outlets when covering abortion, and a sense that “both sides” of the abortion debate must be given airtime. Editors — wary of the appearance of bias — may require reporters to present opposing viewpoints as equal even if the evidence does not support such framing. This is particularly pernicious in abortion coverage, as anti-abortion activists often offer false information and use misleading terms that can confuse readers if not properly contextualized. The desire for neutrality means news organizations end up amplifying dishonest sources, while those who are most marginalized by the issue remain silent.

“Most media organizations aren’t really covering abortion well,” says Kelly McBride, chair of the Craig Newmark Center for Ethics and Leadership at the Poynter Institute. “It takes a fair amount of knowledge to do any sort of reporting that is insightful. You have to have a pretty evolved interviewing skill set. You have to have your craft down where you can put a story together in a compelling way. That requires some sophisticated editing as well.” 

To be fair, it is hardly surprising that the majority of abortion coverage focuses on politics. In the past few years, state lawmakers have passed an unprecedented wave of anti-abortion legislation, ranging from bans on the procedure to regulations imposing additional obstacles on patients and clinics, such as waiting periods and mandated counseling. According to the Guttmacher Institute, between 2011 and 2019, nearly 500 abortion restrictions were enacted across the country — accounting for more than a third of all restrictions enacted since the Roe v. Wade case in 1973. Recently, abortion has dominated the news due to the nomination of Amy Coney Barrett, a devout Catholic who has expressed hostility to abortion rights, to the Supreme Court.

A recent study commissioned by NARAL Pro-Choice America and conducted by an independent research group examined a random sample of more than 300 abortion-related articles across 10 major news outlets. It found that while 65% of articles quoted a politician, only 13.5% included a quote from a doctor and only 8% featured a real person’s story.

[pq]The failure to cover abortion through the lens of health care is particularly acute now, in the midst of a historic pandemic[/pq]

A 2018 study by Advancing New Standards in Reproductive Health, a research group at the University of California, San Francisco, that examined abortion coverage in The New York Times, The Washington Post, and The Associated Press found similar results: 50% of stories were about electoral politics. References to the fetus as a person were more common than women's own stories of unintended pregnancy and abortion. This is notable as there is a growing movement to afford legal rights to fetuses that are equal to or even supersede the rights of pregnant women. These efforts have led to the arrest of women for actions that could be perceived as endangering the fetus inside them. In 2019, an Alabama woman was charged with manslaughter after an incident in which she was shot while pregnant and her fetus died. The charges were later dropped.

Centering pregnant women’s experiences in stories about abortion poses real difficulties for reporters and editors. It takes patience and perseverance to gain the trust of activists working directly with patients, and to find people willing to talk on the record. Those who have sought abortions may be reluctant to speak openly due to societal pressure, fear, shame, anxiety, and judgment. Speaking out can also result in negative consequences for women, who may face harassment if they use their real names.

Journalists who interview such subjects must ensure they approach the interview and reporting process with care and sensitivity. For Andrews, that meant as soon as she met up with Kate, they had an off-the-record talk at the hotel pool where they had a chance to get comfortable with each other before diving into more emotionally fraught terrain. “I took a while to just hang out with her and get a feel for who she was,” Andrews says. “After a while, I explained what ‘on the record’ means and the broad rules of journalism.”

Kate had already agreed to be in the story, but Andrews wanted to make sure the young woman understood what it would mean to be the main source for a magazine story about a controversial topic, even with her identity hidden. “There’s this complicated layer: She's very young, she's vulnerable, she's in a position where her whole life is sort of hanging by a thread if she couldn't get the health care that she needs,” Andrews says.

Once she had written a draft, Andrews checked in with Kate about the exact details she was including to make sure Kate was comfortable that they could not be used to identify her. It was a balancing act, she says, to include as much specificity as possible to ensure Kate’s account felt real, while not using anything that could jeopardize her privacy.

One of her goals, Andrews says, is to introduce as much complexity into the story as possible. In her opinion, abortion coverage suffers when journalists shy away from contradictions and murky areas. “People get so caught up in the politics and the activism of it … It makes people leery of looking at the whole thing, because they want to adhere to a certain narrative that helps advance the agenda,” she says. “Sometimes I’ll write something and I'll ask myself, ‘Am I sugarcoating a little? Am I, like, trying to make this simpler than it really is?’ It's an important thing for me to be asking myself when I'm writing.”

The subject of regret is a particularly dicey area, she adds: “There are women who have really complicated feelings about their abortions, and that’s really valid.” But those stories are often downplayed by those advocating for abortion rights for fear of giving fuel to the anti-abortion side.

“AKA Jane Roe,” a documentary released in May of 2020 about Norma McCorvey, the “Jane Roe” whose unwanted pregnancy led to the 1973 case that legalized abortion nationwide, offers a cautionary tale about flattening the experience of women seeking abortion. It explores how McCorvey, who switched from being an abortion rights supporter to an outspoken anti-abortion activist, was exploited by those on both sides of the debate, her story used to push a political agenda when it was convenient. (Before she died, she confessed that her anti-abortion switch was a paid act.)

One big obstacle in writing about abortion is that many traditional news organizations require reporters to include “both sides” of the issue, aiming to find balance on controversial topics. This commitment to neutrality can work when both sides present honest information that offer readers needed context. However, a problem arises when misleading or untrue statements about abortion are made and repeated in news reports, often without being fact-checked.

For example, abortion opponents often claim that abortion hurts women. A new book, “The Turnaway Study: Ten Years, a Thousand Women, and the Consequences of Having — or Being Denied — an Abortion” by Diana Greene Foster debunks this and should be cited by journalists who include quotes about the supposed negative consequences of abortion. Her study found, for example, that women who have abortions are no more likely to suffer from depression than women who do not, disproving a common anti-abortion talking point.

A 2017 study conducted by researchers in California of  journalists recruited from listservs for progressive or feminist reporters who have reported on abortion found that many struggled with how to responsibly include information from sources who were repeating inaccurate information. Study participants noted that the desire to be seen as unbiased and include context from both sides had, in some cases, led to the incorporation of misinformation into their coverage.

As a reporter covering abortion at HuffPost, I struggled with this issue in a profile I wrote of a young anti-abortion pastor in Texas. I pitched the story because I believe there is news value in understanding the current anti-abortion movement and its central players. My story, “The Traveling Salesman Bringing Abortion Bans To A Texas Town Near You,” which came out in March of 2020, followed Mark Lee Dickson as he lobbied a small town to pass an unconstitutional bill banning abortion. I wanted to explore Dickson’s history and personal motivations, but I was also cognizant not to further amplify dishonest information.

At one point, he showed me a plastic toy fetus that he claimed was anatomically correct. He used the prop to convince people that abortion of a fetus that size was immoral. Before including this and a photo of the toy in my story, I checked with an ob-gyn, sending her a link to where the model was sold online with its dimensions. She replied that it was oversimplified, exaggerated in size, with its large facial features made to appear more adult. Fact-checking allowed me to use the details offered by my source without spreading misinformation.

I also strived to show the real-world impact of his efforts to erode abortion access. I went to the town where he was trying to outlaw abortion and spoke to a handful of women who were angry and scared. They were worried that he had sowed more confusion in an area already extremely hostile to abortion, and that women who wanted to seek abortions might not because they would be unclear of their rights and fearful of prosecution.

Striking the balance between including both sides without spreading false information was a major challenge for filmmaker Neha Shastry, who made “Restricting Abortion Access,” a short documentary for CNN, in 2018. The segment centers on Anuj Khattar, a doctor based in Washington state who travels to Oklahoma once a month to provide abortions at a clinic called Trust Women. In many parts of the country, abortions are provided by doctors like Khattar, who travel to areas without abortion providers so that access does not completely disappear.

It took her a few years to get a news organization interested in the story, she says, and some outlets turned it down because the topic was too polarizing. In the meantime, she collected research and developed an ongoing relationship with the founder of Trust Women, Julie Burkhart, a longtime abortion rights activist who worked with the late Dr. George Tiller before he was killed by an anti-abortion extremist. By the time CNN expressed interest in the story, Shastry had built a strong foundation with Burkhart, who trusted her enough to allow her to bring in a camera crew for a week of shooting.

That access paid off: Her documentary provides a rarely seen glimpse of the day-to-day work of an abortion doctor as he interacts with women in a clinic. Khattar, the traveling physician, is shown counseling patients, some of whom are scared and misinformed about the procedure they are about to have.

“I’m not sure how the procedure works … do you rip it apart?” asks one patient, whose face is not shown. Khattar says no and explains the medical procedure slowly, asking if she has any more questions. When he hands her the ultrasound photo, she is crying. “I know it can be really emotional,” he says. “There's a lot of conflicting emotions that can come up. Sadness and anger and happiness can all happen at the same time. It’s okay to have all those emotions.”

The film humanizes abortion providers, who are often caricatured by anti-abortion groups as evil, money-hungry doctors, and shows the toll of doing the work. Khattar tells Shastry he is nervous about the documentary, as it will likely open him up to more harassment.

When Shastry initially envisioned the film, she was not planning to include an abortion opponent voice, but editors at CNN suggested it as a way to bring balance. “The personal challenge for me in trying to find someone to fill the anti-abortion voice … was really trying to find someone who wasn’t lying,” she says.

As the piece centered on a doctor who supports abortion rights, she decided to find an anti-abortion leader from the medical community to best address his claims. She settled on Christina Francis, a practicing ob-gyn, and chair of the board of the American Association of Pro-life Obstetricians and Gynecologists (AAPLOG).

Much of the documentary centers on the impact of what abortion rights groups call “targeted regulation of abortion providers,” or TRAP laws, which are often onerous requirements imposed on abortion providers and women's health centers. While abortion opponents say such measures are needed to protect women’s health, abortion rights groups say TRAP laws are an underhanded way to shut down abortion clinics.

These alternative belief systems were on display when Shastry interviewed Francis. In the film, Francis explains her belief that abortion is bad for women and is dangerous. When Shastry pointed to studies showing that abortion is a safe procedure, Francis says that the data has been cherrypicked. To buttress her claims, Shastry says, Francis sent her a handful of studies, but when she reviewed them, she found that they didn’t meet medical and scientific standards. Basic fact-checking made it hard to include Francis’ statements without countering them as part of the documentary, she says.

In the end, she kept in many of Francis’ claims but followed them up immediately with the facts. Looking back, Shastry still feels conflicted about the final product.

“I'm proud that we have both sides of the debate showcased, and we have on camera someone who is a well-known pro-life advocate spreading misinformation,” she says. “But at the same time, knowing that it was a requirement by the network to include this voice doesn't sit well with me, that abortion is too ‘divisive’ to sit on its own in a news story is disappointing to me, and that it’s seemingly more valuable to include the lies in order to showcase the experiences of the clinic and the workers in it.”

One of her takeaways from the project was how fraught it is to report on abortion. “We are now living in a moment where, I hope, newsrooms and networks are taking an honest look at themselves and how certain issues are covered,” Shastry says. “This isn't quite the moment where people may be reflecting on how abortion is covered, but I think the ethical standards are the same as when examining how we cover race — what voices do we amplify, and at what cost? Why is it that those who are marginalized by an issue cannot stand alone in a story?”

[pq]The best reporting on abortion attempts to be as honest as possible, avoiding euphemisms or loaded language[/pq]

Even the specific language used in articles on abortion is deeply contentious. From the beginning of the abortion debate, both sides have branded themselves using politically charged terms like “pro-life,” which suggests that those who support abortion rights must be against life, or “pro-choice,” which obscures the medical procedure at hand.

For this story, I used the terms “anti-abortion” activists and “abortion opponents” interchangeably; both are accurate depictions of their goals. For their adversaries, I used “abortion rights” activists and “reproductive rights” groups, which summarizes their position.

Recently, abortion opponents began dubbing early abortion bans as “fetal heartbeat bills,” which prohibit abortion once an ultrasound can detect electrical activity in cells that will control the heart once it develops. That electrical activity can occur as early as two weeks after a missed period. Reproductive rights groups urged news organizations not to use the term “heartbeat bill,” arguing that it is a misnomer as the fetus does not yet have a heart at six weeks’ gestation. A number of media organizations have issued new guidelines on what terminology to use when covering abortion to ensure that they avoid medically inaccurate, misleading language.

Last year, Alison Mitchell, who helps guide daily news coverage at The New York Times, noticed a shift in messaging by those working for and against abortion rights, and a slew of unfamiliar, politically charged terms. She asked a reporter to look into it for an article. The resulting piece by Amy Harmon, “‘Fetal Heartbeat’ vs. ‘Forced Pregnancy’: The Language Wars of the Abortion Debate,” tracks the evolving language of abortion used by abortion opponents and supporters, and how such messaging might impact public perception.

Language has a powerful effect in shaping the narrative, she adds. “Abortion, like many hard-fought political movements, is about hearts and minds,” Mitchell says. “Both sides are trying to shape the way people view it.”

The best reporting on abortion attempts to be as honest as possible, avoiding euphemisms or loaded language, she says: “It is a very, very emotional issue on both sides. I think part of the way you get into the subtleties of it is by talking to people who chose to have an abortion, talking to people who chose not to have an abortion, and have them think about how it affected their lives.”

This is the crucial challenge that reporters must live up to now. It is not enough to merely repeat the details of abortion bills and expect readers to understand what is at stake. Reporters should work to find the people most affected by abortion restrictions and speak to them. They should seek out and interview doctors with expertise in abortion. They should contextualize abortion as health care, not simply political fodder. Those voices are out there. It is up to reporters and editors to put the work in to find them.