'It's Incredibly Routine': A Q&A With Andréa Becker
A "cloud of stigma and fear" keeps people from understanding their rights and medical realities around abortion. Medical sociologist Andréa Becker discusses moral panics and reproductive health.
Hey, welcome back to MomLeft! This week I spoke with Andréa Becker, a medical sociologist at the University of California, San Francisco, where she conducts postdoctoral research with the Advancing New Standards in Reproductive Health (ANSIRH) group. She’s an incoming assistant professor at Hunter College, and the author of the forthcoming book UNCHOOSABLE (NYU Press) about hysterectomies.
We talked about her research on abortion, birth control, and the stigmas that shape reproductive care. (This interview has been lightly edited for length and clarity.)
Kelly: You recently tweeted that, as an abortion researcher, you’ve learned that most people don’t actually have a clue what an abortion actually is. In your research, what are some common misconceptions you’ve encountered, and how are people coming to these ideas?
Andréa: There’s widespread misinformation and disinformation about abortion on basically all levels. That includes the legal status of abortion. A lot of people are unaware of their access to abortion in their state. But also in terms of medical risk, there’s a lot of misinformation about how risky or safe abortion is. In that tweet, I was specifically referring to the mechanisms of abortion.
There are two kinds of abortion: procedural and medication abortion. Most people I’ve talked to in my research and in normal life lack basic knowledge about how abortion works. A lot of this is because of the language we use. Most people talk about abortion as surgical abortion versus medical abortion. These are inaccurate. “Surgical abortion,” in particular, really grinds my gears because it gets people thinking about a really intense surgery; particularly men that I’ve interviewed think that abortion is basically a c-section, is how they describe it. Like a cross-body incision. They talk about the cutting of umbilical cord; all these things that don’t actually happen.
Also because the incredibly rare, later abortion methods that are the most gory tend to be the ones that go viral, those are the ones that people often think about when they think about what abortion looks like. The videos are intended to incite fear and disgust and so people might not actually understand what’s happening in an abortion when they’re watching those videos. They’re usually cartoons or very graphic images, created to plant disinformation.
I’ve been thinking about that in the context of efforts, either through the courts or through misinformation, to spread fear about the safety of medication abortion—for instance, saying that mifepristone is dangerous or that telehealth abortion can’t be trusted. How safe and common are those methods actually?
Medication abortion is known to be safer than Tylenol and Viagra. I believe it’s 14 times safer than childbirth, which most people don’t think of as dangerous but is actually incredibly dangerous. Even before Roe fell, a lot of restrictions on abortion were rooted in stigma, rather than in science.
Telehealth abortion is something I’m very passionate about, and something that a lot of my research focuses on, because that is the most convenient way to have an abortion. For folks who are able to access it, in states in which it is legal, they’re able to have their entire abortion from their couch, if they want to. They can talk with a provider on their phone, they can have the pills shipped to their house, they can have the entire abortion from the comfort of their home. Sometimes it even has things like Tylenol and pads included in their kit. This is how it is for people who don’t feel the need to go to a doctor in person. Everyone should be able to have an abortion that’s that convenient, especially for people who live far from a provider. Having to travel for an abortion, having to first get an ultrasound and then do a waiting period—none of those are actually necessary for the safety or efficacy of these medicines. They’re rooted in trying to create an obstacle course for abortion, rather than trying to keep people safe.
We’ve created this cloud of stigma and fear around abortion, so people think it’s a lot more complicated and risky than it actually is. But it’s incredibly routine. If we didn’t have all these abortion myths and all this disinformation around it, it would be as simple as texting and getting a pill delivered.
A lot of your recent work focuses on how abortion and birth control are discussed on social media. You’ve done studies on TikTok coverage of abortion news, you’ve done studies on people making YouTube videos about IUD self-removal. Are those videos meeting an information gap that people are encountering in traditional media?
Definitely. There’s a lot of medical gaslighting when it comes to topics like birth control, particularly when it comes to IUDs. This leads to doctors often minimizing the symptoms that their patients are reporting. We’ve had a lot of coverage of this regarding IUD insertion, which is really important—people telling patients that insertion won’t be that painful, that they’ll be okay with just ibuprofen, which I find ridiculous—but also in terms of symptoms people have with birth control, whether they’re having it inserted, whether they’ve been taking it for a long time. There’s a lot of minimizing of symptoms and telling people that symptoms might be due to diet or weight, rather than the IUD. So this leads a lot of people to go online and get information from laypeople, from peers. On every platform, people are talking about symptoms and looking for information that matches their lived experience.
In the IUD project I worked on, people were motivated to go online because many doctors are hesitant to remove an IUD before it’s “time.” These can last up to 10 years for Paragard IUDs, for instance, so doctors are resistant to removing them. We found that people are posting their own removals online, and based on comments, people would watch the videos and become inspired to take them out, themselves. Most people think IUD self-removal would be highly dangerous, but one of my colleagues did the research on it and found that self-removal can be quite safe. So more doctors (I wrote about this for Insider) are telling patients best practices for pulling their strings, themselves, to create some sort of autonomy. especially for low-income people and women of color who might have more misgivings about an IUD because they can’t remove it themselves. This offers more agency for patients.
One of your most recent publications was a study you did on attitudes of people who were exposed to accurate abortion storylines on TV. What did you find in participants from that study?
This study was more exploratory in nature, due to its design. What we were trying to figure out was whether exposure to medically accurate plotlines—which are very rare—impacted the knowledge and attitudes people had about abortion. We found that it increases knowledge about abortion, as well as willingness to support a friend in seeking an abortion, but it didn’t impact the stigmatizing attitude that people had regarding abortion. In contrast to these three abortion plot lines we selected, most TV shows are inaccurate on various levels. They tend to overemphasize medical risk. They tend to misrepresent patient demographics, and they typically don’t show the barriers to getting abortions. The procedure, itself, is also often misrepresented on TV.
It’s interesting that the study participants indicated greater willingness to help a friend obtain an abortion, but they didn’t lose their overall stigma about abortion. There’s this dynamic where so many people have abortions, and are willing to make carve-outs for themselves or their friends, but the stigma still persists.
Definitely. Most people in the U.S. think abortion should be legal. For those that are against abortion, research shows that they’re supportive of abortion for themselves or their daughters. A big problem is that we talk about abortion as this abstract, political thing, rather than a routine health procedure that is incredibly common. I think when people speak about their attitudes on abortion, they’re thinking in these abstract ways, rather than thinking that “these are individual people who need healthcare.” When they think about their friends, their daughters, their sisters, they think about it in more concrete ways and are willing to be more supportive.
Most people who have abortions are already parents. You’ve done research on how women use their status as mothers to destigmatize abortion, or to make it sound more conventionally acceptable. Do those narratives help dispel stigma? Is there a risk that those narratives help reinforce gender roles?
We generally think of abortion as antithetical to motherhood, when in reality, as you point out, most people who have abortions already have children and already know what it takes to raise a child. They understand the impact of having an additional child. I was analyzing the stories of women in Tennessee, which continues to be one of the most restrictive states toward abortion. (It was legal at the time I conducted the study, but now Tennessee’s ban begins the first day of pregnancy. It’s a pretty extreme ban.) What I found is that the way most people talked about abortion was as an extension of their motherhood ideals: either to spare an unborn baby from an imperfect life, or to protect current children from losing the mom’s time or resources to an additional child. So abortion is recast as this selfless act, an altruistic act that one does for their children or their unborn children, which runs counter to a lot of the ways abortion stigma is framed as selfish, as not caring about children and families. I’m not sure how much it breaks stigma. I don’t have numbers about that. But I do think it can be a powerful way of reframing abortion especially in very conservative states where people really value motherhood and traditional gender ideologies. If they can think of abortion as something protective of children and families, they might be able to reframe attitudes about abortion.
Even if you look at the original Roe v. Wade decision, they consistently refer to the people having abortions as “mothers.” It’s a pet peeve of mine when people refer to pregnant people as “mothers,” especially if they’re having an abortion to prevent becoming a mother. That conflation of “woman” and “mother” is grating to me. But it’s interesting that in the original decision, they refer to women as such. It’s part of that conflation, which is problematic, but it also allows more empathy if people think of them as mothers in some way.
You’re writing a book about hysterectomies! It’s a topic I know almost nothing about. Can you give me the pitch?
Hysterectomy is the most common gynecological procedure worldwide. It’s the most common second to c-sections in the U.S. Between one-in-three and one-in-five people who are born with a uterus will have a hysterectomy. Despite this, there’s very little conversation about hysterectomy. There’s very little research outside medical journals. Before me, there’s only been one sociologist to study hysterectomy. The basis is that hysterectomy can be very beneficial to a lot of people, particularly if they have a chronic illness, or if they’re trans or nonbinary. But access to hysterectomy is really complicated across the country due to a lot of the ideologies we’ve been talking about: the conflation of “woman” and “mother,” the idea that all people with a uterus will eventually want to be pregnant. So the idea that wanting to remove it runs counter to these ideas and makes doctors very hesitant to approve an “elective” hysterectomy even if it would be really beneficial to the patient. I interviewed 100 people who either want or have had a hysterectomy, to capture these lived experiences with having a hysterectomy and why they would want to choose one; what it means when someone isn’t able to choose one.
It’s so interesting that this procedure, which affects cis women and trans and nonbinary folks, is so under-discussed in this narrative about not allowing gender-affirming care. But this stuff is so much more common, for such a broader spectrum of people, than is ever acknowledged.
That’s the case for both abortion and hysterectomy. Elements of healthcare that limit fertility have moral panics around them, but they’re really common for a wide spectrum of health concerns. We didn’t talk about it with abortion, but with hysterectomy, it’s not just for trans people but also for people with endometriosis or adenomyosis or “unexplained menstrual bleeding,” “unexplained pelvic pain.” We know so little about chronic conditions that affect these organs and how to treat them, that often hysterectomy is the best solution for a lot of people.
With abortion, a lot of the medicines and tools have wide uses beyond just terminating a pregnancy. It could be for the management of these illnesses, it can be used to investigate what’s going on in the uterus, to treat fibroids, that sort of thing. They’re really central to gynecological care, despite being caught in the crosshairs of all these different political battles.