Resources for Policymakers for Talking About Abortion

Abortion is a part of the full spectrum of reproductive health care. 

Just like contraceptive care and prenatal care, abortion is a normal part of reproductive health care.

That’s right, it’s normal. And should be talked about and treated as such.

There are two different forms of abortion care. 

Medication abortion is available up to 11-weeks of pregnancy and is provided using two different medications called mifepristone and misoprostol.

• The first medicine, mifepristone, stops the hormones from going to the pregnancy and the second medicine, misoprostol, causes cramping and bleeding, which causes the pregnancy to pass and expel. As with a heavy period, bleeding is a normal part of the process.
• Right now, the law requires that a patient consults with a health care provider first before receiving the medication. They can take the first medication (mifepristone) in the clinic or at home at a time of their choosing. The second medication (misoprostol) is taken at home as well.
• Some states also allow medication abortion to be prescribed via telemedicine, which can increase access to this option for people who live in rural areas and others who may have trouble traveling to a clinic.  
• Research shows that patients can safely and effectively self-manage their abortions using medication abortion when given the proper information and guidance.
• Despite medication abortion being highly safe and effective, the FDA and state governments unnecessarily restrict access to medication abortion via a burdensome set of regulations called the Risk Evaluation and Mitigation Strategy (REMS). In December 2021 the FDA permanently lifted regulations that prohibit medication abortion from being sold at pharmacies or delivered by mail, but many state laws still restrict access via these methods and medication abortion continues to be unavailable over the counter.
• It is not possible to “reverse” a medication abortion. “Abortion reversal” is a myth based on misinformation and should be treated as such. For more information, read this Jezebel column by PRH fellow and family medicine physician Dr. Meera Shah. 
• Please note that medication abortion is distinct from emergency contraception, Plan B, or “the morning after pill,” which are contraceptives that can be taken after intercourse to prevent pregnancy.  

Providers of abortion care can also offer a procedural abortion. It’s also sometimes called an aspiration abortion or surgical abortion.

•  A procedural abortion can occur in a clinic setting or in a hospital setting depending on state laws and the unique medical needs or preferences of the individual patient.
• The procedure can involve gently opening and stretching the cervix using medication which can sometimes occur over the course of one to two days depending on the point in pregnancy. After the cervix has been opened, the pregnancy is removed using suction, sometimes assisted by other medical instruments.
• Procedural abortion laws vary widely by state. Some states limit the type of abortions that can be done and the point in pregnancy at which patients can access abortion care varies as a result.

All forms of abortion care are safe and effective. 

A non-partisan, rigorous scientific report from the National Academies of Sciences, Engineering and Medicine (NASEM) affirms that abortion is safe and effective in all forms. In fact, they noted that the biggest threat to quality abortion care is the litany of medically unnecessary regulations that raise costs and delay procedures, ultimately putting health at risk.

Claims that abortion is linked to an increased risk of breast cancer, depression, or future infertility have been thoroughly debunked.

Today there are also safe and effective ways a person can self-manage their abortion. Research shows that when accurate information and support is available, self-managed abortion with medication is safe. The greatest risks today for people self-managing their abortion in this way are legal—the threat of being criminalized and prosecuted— rather than medical. For more information on self-managed abortion, you can visit AbortionOnOurOwnTerms.org. 

There is no other health care that faces as many medically unnecessary restrictions as abortion care. Politics should not interfere with people’s ability to access health care, and that includes when they can access abortion care, where they can access abortion care, what method of abortion care they wish to access, how old they are when they need abortion care, why they need their abortion care, or their ability to pay for their abortion care. All bans are extreme to the person who can’t get the health care they need because of a restriction, whether it’s at six weeks or twenty weeks.

As states work to ban abortion, we know there has never been a “moderate” position on abortion bans. All abortion bans are bad for the people who need abortions. Every pregnancy is unique and every situation is different. The only thing being prevented when banning later abortion is a patient getting the necessary health care they need.

People have many different reasons for seeking an abortion, all of them valid.

The Turnaway Study has found that people seek abortion care for a wide range of reasons, including finances, timing, issues with a partner, and the need to care for their other children. Research has also found that the overwhelming majority of people who seek abortions are confident about their decision, meaning that abortion should not be portrayed as an inherently difficult, complicated or tragic choice. In addition, while some may choose to self-manage an abortion because of restrictions or barriers that make accessing care at a clinic impossible, for others, self-managing an abortion is an affirmative choice and personal preference. All abortion stories should be presented as equally valid and treated with compassion.

Lack of insurance coverage is a major barrier to abortion care.  

Abortion care is health care. It should be covered no matter your source of insurance. Unfortunately this is not the case due to restrictions like the Hyde Amendment that restrict publicly funded insurance coverage of abortion care through programs like Medicaid, Tricare, Indian Health Services, federal employees, and for people receiving care in federally funded detention centers and carceral centers.

Federal laws are not the only ones dictating abortion coverage. States level restrictions cause additional barriers when it comes to abortion care being covered by insurance.

Texas, Idaho, Oklahoma, and a growing list of other states aiming to ban abortion are currently facing devastating restrictions on access to abortion care, essentially making all abortion care impossible to access for folks in the state. In addition to the “Say This, Not That” section above, here is some general messaging guidance when discussing these dangerous bills and laws:

• Do NOT compare to “Handmaid’s Tale.”
• When discussing patients traveling out of state to receive care, do NOT use phrases related to “underground railroad” to conflate this to the efforts in rejecting and ending slavery.
• Do NOT use xenophobic, Islamophobic language like “Texas Taliban.”
• DO speak to providers, storytellers, clinic admin, and abortion funds in impacted states.
• DO guide calls to action to supporting local abortion funds and independent providers, directly.

When someone decides to end a pregnancy, whether they go to a health care provider or manage their own abortion, they should be able to do so safely and with dignity—and without fear of arrest, jail or investigation. Self-managing one’s abortion with pills is a safe way to end a pregnancy. Nobody should have to fear going to jail for ending a pregnancy. 

Don’t equate self-managed abortion with illegal or unsafe abortion. That language is stigmatizing and can lead to further targeting and criminalization of people who self-manage their abortion as well as those who experience pregnancy loss. 

Don’t solely talk about self-managed abortion as tragic, desperate, or an option of last resort. There are many valid reasons a person may self-manage their abortion. For some people, it is due to inability to access clinic-based care, for others it is a choice grounded in agency, autonomy, and self-care. 

Don’t use coat hanger or knitting needle imagery. Thanks to the abortion pill, self-managed abortion today looks very different than it has in the past and when people have access to information, resources and support, self-managed abortion is safe. Symbols like the coat hanger create the false impression that abortion is unsafe and in need of regulation which can lead to surveillance and criminalization. As an image it was once powerful, but today it is outdated and could be harmful. 

Do name that the real risk of self-managed abortion care is legal, not medical. Use gavel imagery or other imagery depicting that criminalization is the real harm that people face. 

Do emphasize that state-based legislation aiming to criminalize pregnant people, no matter their decision to continue or end a pregnancy, is rooted in the anti-abortion sentiments of controlling and punishing people’s bodies, families, and lives. 

There are many reasons why someone may need an abortion later in pregnancy, all of them valid:

• Restrictive and unnecessary laws enacted by politicians to limit abortion including bans, arbitrary waiting periods, medically unnecessary regulations, increase financial and logistical barriers to accessing abortion. 
  • These laws often force people seeking abortion to travel long distances to get care, which often requires taking time off from work, arranging transportation and paying for childcare. 
  • As a result, pregnant people navigating logistical and financial barriers are forced to delay receiving the care they need. 
  • Medicaid only covers abortion care in 16 states. This increases the amount of money that a person may need to save or raise for their care in 34 states and DC.

• Disinformation about abortion from politicians trying to ban abortion and from ‘fake clinics’ can deceive people and cause additional delays before they are able to access abortion care.
• Later recognition of pregnancy can happen to anyone who can become pregnant and can happen for many different reasons including absent pregnancy symptoms, contraceptive use, absent or irregular periods, and more. Learn more about later discovery of pregnancy at WhoNotWhen.

• In other cases, people may receive new medical information that leads them to make the difficult decision to end a wanted pregnancy. 

Most abortions beyond 20 weeks of pregnancy are between 20 and 24 weeks of pregnancy.

People who have later abortions are experts in the care they need, how restrictions impact their ability to get that care, and how we should talk about later care.

• Use this extremely helpful resource from our friends at Who Not When to learn more.

The SisterSong Women of Color Reproductive Justice Collective (SisterSong) defines reproductive justice as “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” Reproductive justice centers the needs of marginalized people, particularly women of color, who have historically been overlooked by the traditional reproductive rights movement. Reproductive justice also goes beyond a focus on abortion rights, and includes a wide range of issues including maternal health, sexual autonomy, environmental justice, and freedom from state violence. Including the reproductive justice perspective in reporting is an important part of providing a comprehensive, inclusive view of these issues.

While many doctors affiliated with Physicians for Reproductive Health use the reproductive justice framework to guide and inform their work, we are not a reproductive justice organization. Other organizations to engage when reporting on reproductive justice issues include:

1. SisterSong
2. National Latina Institute for Reproductive Justice
3. URGE: Unite for Reproductive & Gender Equity
4. In Our Own Voice: National Black Women’s Reproductive Justice Agenda
5. Black Women’s Health Imperative

Additionally, there are many local and regional reproductive justice organizations that legislators and staffers should seek out when discussing issues impacting communities in a state or specific geographic area.

Young people face unique barriers to accessing abortion, particularly in states that require parental consent or notification for abortion care. Parental involvement laws can put young people seeking abortion care at risk of abuse. Some states allow young people who are unable to get parental consent to secure a judicial bypass, in which a judge authorizes the abortion. However, many young people do not have access to transportation and other resources to navigate the court system and secure a bypass. Parental involvement laws unnecessarily delay abortion care and are not supported by medical experts like the Society for Adolescent Health and Medicine or the American Academy of Pediatrics. Young people are also more likely to face stigma about their decision to seek abortions, particularly from family members, which can create both logistical and emotional barriers to accessing care.

The Mabel Wadsworth Center offers helpful resources for coverage of abortion that is inclusive of LGBTQ voices. Some key points to consider include:

Refer to ‘people’ not only ‘women’: The right to decide if, when, or how to have children is a human right, not just a woman’s right. Not every story about abortion or parenting needs to focus on LGBTQ people exclusively, but every story should use gender-inclusive language that acknowledges that a diverse range of people seek reproductive health care.

Use people’s correct pronouns: Transgender people may use he, she, they or other words as pronouns. Just as you would never misquote a witness, it’s important not to misrepresent any person by using the wrong name or pronoun to refer to them. It’s common to use a singular they–the Associated Press Stylebook now recognizes that they/them can be used as a singular pronoun–and you can always use a person’s name again to help clarify.

Don’t make assumptions about transgender people’s reproductive choices: A person’s gender identity or sexual orientation doesn’t have anything to do with what body parts a person has or whether they can or want to get pregnant. Anyone who can get pregnant needs access to quality, comprehensive reproductive health care, including abortion care and prenatal and postpartum resources so that they can make their own choices about if, when or how to become parents.

Quote representative sources: When identifying witnesses or constituents to have conversations with, it’s important to consider who can speak to the topic at hand from lived experience or direct expertise. Hearings about transgender people accessing reproductive health care should center the voices of impacted transgender people and provide perspectives from physicians and other health care providers who offer gender-affirming care, rather than quoting speculation or opinions about transgender people from politicians or others.

The abortion storytelling organization We Testify provides detailed background on the intersection between abortion access and disability justice. As their resource explains, discussions of the unique barriers that disabled people face in accessing reproductive health care should:

• Provide historical context about the reproductive coercion that disabled people have experienced in the U.S.: As many as 70,000 disabled people, people of color, and women were forcibly sterilized in the 20th century as a result of eugenicist ideologies. 
• Recognize that disabled people continue to experience reproductive coercion and a lack of autonomy due to restrictive policies: Even today, whether or not disabled people can consent to abortion (or contraception, pregnancy, or adoption) can still be determined by a judge since no laws currently protect that right for disabled people.

Not portray abortions that happen because of a fetal disability or anomaly as ‘better’ than other abortions: The idea that abortion is more acceptable in cases where the fetus would not develop in an able-bodied way is rooted in ableism—the mistreatment, prejudice, and discrimination towards disabled people and disabilities. This tactic allows those who want to ban abortion to push legislation that further restricts abortion on the basis of that specific medical necessity, while also banning abortions in most cases and only allowing it in the most dire circumstances.

Speeches, hearings and other communications about abortion should draw from a range of relevant and credible perspectives. This includes the voices of both people who have had abortions, who can share their firsthand experiences, and subject matter experts, who can provide fact-based insights on the reality of abortion and abortion access. Depending on your goals, important voices to incorporate may include storytellers. 

Storytellers: As often as possible, conversations about abortion should include the perspective of someone who has had an abortion. Based on the specific topic of the story, storytellers should reflect the diversity of those who seek abortion by race, gender identity, age, socioeconomic background, reason for seeking an abortion, or other relevant factors. The organization We Testify, which focuses on elevating abortion storytellers and their perspectives, can offer storytellers with a wide range of diverse backgrounds and abortion experiences.

1. 1. Example: When holding a hearing on state-level Medicaid coverage of abortion, it is highly appropriate to include the perspective of a person whose abortion was covered by Medicaid (or a low-income individual in a state without Medicaid coverage of abortion who struggled to access care as a result).
   2. Example: Floor remarks about abortion later in pregnancy should lift up multiple perspectives from people who received later abortions, whether because of medical complications, barriers to accessing care, or other factors. 

Abortion providers are excellent sources for discussing their work providing abortions, the importance of ensuring access to comprehensive reproductive health care for all people, and how restrictive abortion laws harm patients by making it more difficult for providers to offer them appropriate, necessary and compassionate care.  

1. 1. Note: Abortion providers are not all doctors. Many states allow nurse practitioners, certified nurse-midwives, and physician assistants to provide abortion care in addition to physicians. It is safe and appropriate to include abortion care in the scope of practice for these professions. 
   2. Note: When discussing health care professionals who provide abortions, “abortion provider” or “physician/nurse/physician assistant who provides abortion” are the preferred terms. This language helps reinforce the fact that every health care provider who offers abortion care is also trained to provide other kinds of health care.  The terms “abortion doctor” or “abortionist” should never be used; they are medically inaccurate and often used to stigmatize abortion providers and mislead people about their work. Physicians should always have their professional title “Doctor” used. 

People who own, operate or work at abortion clinics, both health care providers and non-medical clinic staff, can offer valuable perspective on the need to protect abortion access and the current barriers and challenges to offering compassionate abortion care. Independent abortion providers care for the majority of people seeking abortion care in the United States, and the Abortion Care Network (ACN), a national association for independent, community-based clinics, can both offer connections to providers in specific states and speak to the experiences of independent providers more generally.

Major medical organizations such as the American Medical Association and the American College of Obstetricians and Gynecologists (ACOG) have issued statements in support of protecting and expanding abortion access and opposing harmful restrictions on abortion care. Including the perspectives of health care professionals and major institutions that are not directly associated with abortion can help demonstrate the broad medical consensus that abortion is an important part of comprehensive reproductive health care and must be protected.

Both academic and non-academic researchers who focus on studying reproductive health issues can provide valuable, fact-based information that helps illustrate the reality of abortion and abortion access in the United States. Institutions like the Guttmacher Institute, Advancing New Standards in Reproductive Health (ANSIRH), and Ibis Reproductive Health are staffed by research and policy experts who can share a wide range of research and expertise on abortion policy, abortion care and other reproductive health related issues.

Abortion funds are an essential part of the landscape of abortion access in the United States. These funds work with individuals who may lack the financial resources to access abortion, helping them with the costs of the care itself, child care, transportation and the numerous other financial and logistical barriers many people have to consider when seeking an abortion. Abortion funds exist in all 50 states, and the National Network of Abortion Funds convenes and supports many of these funds. Abortion fund leaders and staff can provide a first-person perspective on the reality and challenges of abortion access in their geographic area.

In addition to abortion funds, there are a wide range of activists focused on reproductive rights at the state and local level. Including perspectives from independent state-based advocacy organizations such as Avow (TX) or Cobalt (CO), a local NARAL affiliate  or another local advocate voice can offer important insight on the reality of abortion access in that location. 

Many people who have abortions reported having a religious affiliation, according to the Guttmacher Institute, and many religious denominations are strongly or overwhelmingly supportive of protecting abortion access. Centering anti-abortion religious voices as the primary or sole faith perspective in stories about abortion obscures this reality. Including the perspectives of faith leaders who support reproductive rights, such as members of the National Council of Jewish Women’s ‘Rabbis for Repro’ initiative, can help present a more accurate, holistic view of perspectives on abortion among both clergy and laypeople. Other organizations to listen to are Interfaith Voices for Reproductive Justice, Catholics for Choice, and the Religious Action Center. There are also state based faith organizations like Faith Choice Ohio.

The reproductive justice perspective should be included as often as possible to ensure conversations about abortion that center and reflect the priorities of marginalized and oppressed communities, particularly women of color. See the Reproductive Justice section above for more information and suggested reproductive justice voices.

Given the highly politicized nature of many conversations about abortion in the U.S., policymakers – whether deliberately or inadvertently – often elevate commentary from political leaders and other anti-abortion activists who use misinformation and stigma to advance false narratives about abortion. It is crucial to minimize the spread of these misleading claims by only amplifying perspectives from such groups and individuals when absolutely necessary and with appropriate factual context. Examples of perspectives that require such caution include the following subsections.

Anti-abortion organizations that claim to represent medical professionals like the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) should not be presented as an equal counterweight to groups like the AMA or ACOG. AAPLOG and similar organizations represent a tiny fraction of the overall medical community and frequently rely on unverified or debunked research and other misleading claims to advance their agenda. Similarly, “research” from groups like the anti-abortion Charlotte Lozier Institute should be assessed carefully and critically. In general, these groups should not be considered reliable, credible perspectives on reproductive health and abortion in general.

While providing the perspectives of lawmakers opposed to abortion can be relevant in media coverage of debates around abortion legislation, anti-abortion lawmakers should not be presented uncritically as an “opposing view” to abortion providers or others advocating for access to abortion. When it is necessary to include such a politician’s voice, any quotes should be supplemented by research and context that assess their statements and note any inaccuracies.

As noted above, faith communities in the U.S. hold a wide range of views about abortion, with majorities of many denominations strongly supportive of abortion access. When an anti-abortion religious leader or organization makes statements related to abortion they should be viewed as speaking only on behalf of themselves or their congregation and not offered as the perspective of “religious leaders” or “the faith community.” Anti-abortion religious leaders should also not be positioned as an equivalent, opposing perspective to abortion providers or other medical experts. In virtually all circumstances, remarks from such faith leaders should be placed alongside a religious voice supportive of reproductive rights in order to provide a fuller range of views.

A wide range of other anti-abortion activist organizations, such as Susan B. Anthony List and March for Life, rely on misinformation and stigma to advance their ideological agenda. While the views of these groups may sometimes be relevant to understanding political battles around abortion, it is important to avoid a false equivalence between their perspectives and those of medical experts relying on science and research to offer factual insights about reproductive health. In general, any statements made by these groups should be fully contextualized and rigorously fact-checked to prevent the spread of false narratives.