There's a Better Way to Talk About Abortion

For decades, conservative politicians and activists have dictated the rhetoric around abortion, and for that reason many of the words we use to talk about the procedure are medically inaccurate, emotionally charged, and suffused with stigma. And that includes even the most basic terms we use to describe the debate over abortion rights: The anti-abortion camp has long described itself as “pro-life” instead, monopolizing a powerful word that advocates say clouds their real intention—to ban abortion. The word “choice,” some say, is an imprecise one as well, creating the impression that one’s ability to get an abortion is simply a matter of choosing to do so, when in fact there are many systematic obstacles in the way that keep people from accessing the procedure.

Other terms are not just imprecise, but flat out incorrect. “Late-term abortion” isn’t a medical term, for example; and embryos don’t have “heartbeats” at six weeks, despite the dozens of bills named for this supposed phenomenon.

This language has not only influenced how we talk about abortion on an everyday basis, but has shaped legislation and policy that affects people’s access to the procedure, and, in some cases, prevented people from seeking the type of abortion care they would prefer to have. In a recent study on self-managed abortion, researchers found that some people chose to end their pregnancies on their own—in private—rather than get an abortion in a clinic “to avoid the stigma or shame of having an abortion.”

Most people don’t intend to harm people seeking abortions when they use medically incorrect terms; often it’s the case that they simply lack crucial knowledge about the procedure that would help them talk about it in a more sensitive way. (A new Kaiser Family Foundation poll found that nearly 70 percent of Americans don’t know how far along in pregnancy most abortions occur.)

Reproductive health experts say that changing the way we talk about abortion can begin to change the realities of the people who need abortions.

“The language that we use in this conversation defines the terms of the debate and defines whether people can access care in a supportive and affirming environment,” said Elisabeth Smith, the chief counsel of state policy and advocacy at the Center for Reproductive Rights. “When we use language that’s stigmatizing, we are simply dividing people and creating additional hurdles or barriers for [patients].”

Here’s how to begin undoing some of the stigma, according to providers, advocates, and people who have received abortion care themselves:

Transgender and nonbinary people experience increased barriers to getting healthcare, and are more likely to face discrimination from providers when they can access it. And when it comes to abortion care, people can unwittingly exacerbate those barriers by implying that it’s only cisgender women who need the procedure.

“It’s not only women who can get pregnant, which means it’s not only women who seek access to care,” Smith said. “Leaving trans men or nonbinary people out of the conversation means that when they try to access care it’s that much more stigmatizing and that much more difficult to access.”

What might otherwise be called a “six-week” abortion ban has instead become widely known as “heartbeat” legislation, thanks to conservative lawmakers who have used the false claim that six-week embryos have “heartbeats” in order to ban abortion before many people even know they’re pregnant. (Even after a functioning heart does form, a fetus isn’t considered viable until around 24 weeks.)

“There’s no heart [at that stage], there’s only a collection of cardiac cells that pulse,” Smith explained. That pulse—which anti-abortion activists insist is the sound of a “heartbeat”—isn’t actually audible, Smith continued: “The sonogram machine is what makes the pulse,” she said.

Over the last year, President Donald Trump and other anti-choice politicians have leaned heavily on the term “late-term abortion,” using it to bolster the false claim that providers perform abortions just before patients' due dates. “Democrats are … pushing extreme late-term abortion,” Trump said at a 2019 rally, after telling his supporters that fetuses can be “ripped from the mother’s womb moments before birth.”

Not only is this a misleading portrayal of the procedure, and a misrepresentation of the stage at which the overwhelming majority of abortions occur—88 percent are in the first trimester—but the term itself is non-medical and inaccurate, according to experts.

"The term 'late-term abortion' was largely created by anti-choice individuals and groups as a way to create more emotion around the process of abortion and make people feel empathy for the fetus," Anuj Khattar, an abortion provider based in Washington and a fellow at Physicians for Reproductive Health, told VICE last year. "It's not a medical term used by the medical community.”

This inflammatory language can mean that people who need later abortions (usually because of undetected fetal abnormalities or risks to their life) may find themselves experiencing stigma in already difficult circumstances.

"I kept telling my husband, 'Please don't think I'm a horrible person,’” said Dana Weinstein, a woman in Washington, D.C., who needed an abortion after she learned at 29 weeks that her fetus was missing large parts of its brain. "Of course he didn't—but it was so frustrating that I had this stigma in my face when I was in this devastating situation."

In the first six months of 2019, seven states passed some version of an abortion ban: Georgia, Kentucky, Louisiana, Mississippi, and Ohio passed legislation banning abortion at six weeks, while Missouri banned the procedure at eight weeks, and Alabama passed a near-total ban on abortion. All of these laws were—and are—unconstitutional under Roe v. Wade which says states can't restrict abortion before a fetus is viable outside the womb. None went into effect right away. Yet at the time, some news outlets ran headlines like “Abortions after six weeks will be illegal under Georgia law,” or failed to mention the inevitable legal challenges the laws would face until readers got several paragraphs in.

Abortion providers have said that circulating this misinformation harms their patients by confusing them about the care they can legally access.

“People are saying, ‘I don’t know if I can make an appointment,’” Calla Hales, the director of a clinic network that oversees two locations in Georgia, told VICE last year amid the spate of bans. “We’re explaining to them, ‘No, abortion isn’t illegal. This ban doesn’t go into effect until 2020, and honestly, it may never get there.’”

Advocates say there’s a way to emphasize the severity of abortion bans, without circulating information that can harm patients: Instead, people who want to share news about new anti-abortion legislation—and those who are writing the news itself—can use words like “could” and “would” instead of “will,” to emphasize that the law is not yet in effect, and stress the law's unconstitutionality.

Medication abortion is an early-abortion procedure that involves taking the drugs mifepristone and misoprostol, which have been proven to be overwhelmingly safe and effective for ending a first-trimester pregnancy. When patients can access medication abortion in a clinic, they receive the medication from a licensed provider, and take the first drug in person and the second drug at home to pass the pregnancy. The Food and Drug Administration continues to require patients to receive the medication in the provider's office as part of its longstanding restrictions on mifepristone, which much of the medical community has deemed unnecessary.

But in an effort to portray the procedure as risky or illicit, abortion foes sometimes refer to medication abortion as “chemical abortion" instead.

“It’s a very deliberate choice on their part: People think of chemicals as causing harm, or something caustic,” said Elisa Wells, the cofounder of Plan C, a site that rates online abortion-pill sellers for those who can’t access medication abortion in a clinic.

“Medication is something approved and deemed to be safe,” she said.

Self-managed abortion in 2020 doesn’t involve a coat hanger or receiving care from an unlicensed provider. It's the same method as medication abortion, except instead of getting the medications in a clinic, patients usually buy the pills online. And research has shown that the abortion drugs mifepristone and misoprostol remain safe and effective even when administered without medical supervision.

Some people choose self-managed abortion because they don’t have access to in-clinic care, while others prefer it because of the privacy, comfort, and convenience it can offer. Either way, advocates say it shouldn’t be characterized as dangerous or rudimentary so as to avoid stigmatizing the people who choose to self-manage.

“When people use that term ‘back-alley’ it evokes a time when doing your own abortion could be very dangerous,” Wells said.

“That’s not at all the case now with self-managed abortion,” she continued. “We want to get away from the image of the coat hanger and help people associate self-managed abortion with pills and safety.”

Last week, New York City-based abortion provider Zoey Thill was explaining an early abortion procedure to a patient when she was faced with a revealing question: “What do you cut with?” Thill had shown the patient the tools she would use, but the patient was confused why there were no sharp instruments Thill could use to make an incision.

As Thill went on to explain, performing an abortion doesn’t involve any incisions or “cutting” of any kind. But she understands why some patients might think so: What Thill refers to as a “procedural abortion” is what most people likely consider a “surgical” abortion. And the term “surgical” can give both patients and lawmakers a misleading idea about what an abortion entails, Thill said: In reality, most abortion procedures involve dilating the cervix, inserting a thin tube into the uterus, and then connecting it to a plastic, syringe-like device known as a vacuum aspirator to extract the pregnancy.

“It’s a very simple in-office procedure that sometimes can last just two or three minutes,” she told VICE. But the term “surgical” can “elevate the perception of the severity of the procedure, which could make patients feel more anxious about it.”

Referring to abortion as surgery can also lend credence to regulations on providers and clinics, like the medically unnecessary and unconstitutional Louisiana law the Supreme Court will take up in March, requiring abortion providers to have hospital admitting privileges. “Rhetoric that associates abortion with danger can serve as their justification,” Thill said.

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