“It’s a sea of red,” says Dr. John Thackery as he cuts into a woman’s uterus. Her clothes, and the bed underneath her, are drenched in blood. The nun assisting him suggests he look at the left side of the uterus first, assuming the patient is right-handed and that a foreign object would have perforated the opposite wall. She is correct, but far too late: The woman’s pulse fades and vanishes beneath the nurse’s fingertips. The operating theater is quiet for but a moment, until Dr. Thackery cuts open the woman’s chest to manually compress her heart—not in the hopes of reviving her, but in an attempt to salvage the situation and experiment on a fresh corpse.
This frantic, failed abortion is not especially gruesome within the wider context of the Cinemax show The Knick, set in a Gilded-Age hospital in New York City. At the Knickerbocker, things are not so gilded: Patients die one after the other; the hospital administrator embezzles money and steals bodies; Thackery, the hero surgeon, is a racist cocaine addict. Bloodiness is not unusual, and medical failure is expected. This single abortion story is noteworthy not because of its gore but because it typifies the way abortion is portrayed in popular culture.
The Knick’s portrayal is just one example that follows a century-old precedent set by the earliest examples of American onscreen abortion stories. The first of such stories was written and directed by Lois Weber. As a female filmmaker, Weber was an anomaly in cinema’s earliest days; she was also a professed admirer of Margaret Sanger’s activism, including her rejection of legal abortion in favor of gaining wider support for birth control. In Weber’s 1916 silent film Where Are My Children?, a district attorney is busy prosecuting a family-planning doctor for obscenity, while his wife secretly obtains repeat abortions and helps her friends to do the same. The attorney and his wife face a lifetime of lonely, bereft childlessness, and ultimately, their maid’s daughter ends up much like the patient in The Knick. Nearly 100 years of onscreen abortions are bookended with dead women.
In reality, abortion is a simple, fast, safe medical procedure. It can be done as an outpatient procedure taking less than an hour, or by taking pills in your own home. Today, the statistical risk of death from abortion in the United States is virtually zero; the risk of major complications is 0.2 percent. Approximately 1.1 million abortions are obtained in the United States each year, and the vast majority lead to no physical injury whatsoever. But onscreen, abortion is a fraught, dangerous, and often deadly plot point. In our research published in the journal Contraception, my colleague Katrina Kimport and I used online sources to identify more than 300 examples of plotlines involving abortion decisions in film and television over the past 100 years. Fourteen percent of plotlines included the death of a woman who considered getting an abortion, whether or not she obtained one. Frequently, these deaths were the result of violence: Characters committed suicide or were killed either while contemplating what to do about their pregnancies or after getting an abortion.
About 5 percent of fictional women, like the character in The Knick, died because of medical complications of the abortion, and about 20 percent of characters face major consequences such as infection, hemorrhage, hysterectomy, depression, and infertility. Of course, we cannot and should not expect the onscreen world to perfectly mirror reality. Screenwriters find drama and humor in rare, extreme, bizarre, or fantastical circumstances. Yet while other medical procedures, such as CPR, are consistently shown as safer and more effective on television, abortion continues to be depicted as unsafe. These manifold stories linking abortion and risk build a social mythology that abortion is dangerous for women, full stop.
Like nearly all cultural constructs of abortion, these depictions have political underpinnings—in many cases, mirroring the gory imagery long cultivated by the anti-abortion movement. Writer Robin Marty has chronicled on Contributoria this visual discourse as a political tactic, beginning with Dr. John Willke’s “Handbook on Abortion,” the 1971 booklet that helped launch the modern anti-choice movement before the procedure was even legal nationwide. Pictures of tiny embryos and dismembered fetuses strewn in pools of blood are ubiquitous. They’re found on posters outside of clinics or papered on the sides of Operation Rescue’s “Truth Truck,” which drove around Albuquerque in 2013 in support of the city’s 20-week abortion ban. Irin Carmon reported for MSNBC on how anti-abortion organizers literally shrugged off concerns that such images were scaring young children. The point, after all, is to terrify—to make abortion look horrifying, disgusting, and inhumane.
The ongoing resemblance between the popular and political culture’s graphic portrayals of abortion is, perhaps, why this visual representation is so troubling to feminists. With research showing how much fictional stories affect viewers’ beliefs and public opinion, it is easy to imagine how these gruesome, dangerous depictions of abortion could affect political ideas. Is it any wonder that abortion restrictions written in the name of improving women’s safety gain political traction? That hospital-admitting privileges for abortion providers might make sense? That ambulatory surgical center requirements for abortion clinics might be seen as necessary? As our popular culture builds and reflects the social myth of abortion as dangerous, such regulations become a resonant way for politicians to restrict abortion access while painting a picture of concern for women and their health.
What, then, would feminist onscreen portrayals of abortion look like?
It’s important to understand that, while on a cultural level the dangerous abortions onscreen seem to express anti-abortion sentiment, when viewed individually, a good case could be made for just the opposite. (While there is a subset of filmography and television programming produced specifically to promote an anti-abortion worldview—the films October Baby and Bella are likely the most well known—these representations rarely gain traction with mainstream audiences.) Shonda Rhimes (Grey’s Anatomy, Scandal) and Lena Dunham (Girls) have both publicly spoken of their support for Planned Parenthood; the writers of Friday Night Lights consulted with Whole Woman’s Health, a Texas abortion provider to ensure they accurately reflected Texas law at the time. Additionally, many of the unsafe abortions onscreen are set at historical moments when abortion may have been more dangerous, and their portrayal as such might build a case supporting safe and legal abortion. The slow spreading of blood across the back of April’s dress in Revolutionary Road; the shivering, pale face of Penny in Dirty Dancing—these dangerous abortions can be understood as progressive (even feminist) because they support the idea that illegal abortion is harmful.
Most onscreen representations of modern-day abortions lauded by feminists avoid the physical experience of the procedure entirely. As viewers, we might see the prologue and epilogue to the abortion, while never following the character to the clinic for the procedure (Friday Night Lights). Frequently, we get as far as the waiting room, only to pick up with the character on the drive home (Parenthood). Rarely, we might enter an operating room (which is, to say the least, not what most clinics look like) only to have the screen fade to black before the abortion begins (Grey’s Anatomy, which has certainly never shied away from showing a medical procedure of any other stripe). In the case of Obvious Child, the story is sanitized through lightheartedness and humor; in Girls, through after-the-fact flippancy. This is not a criticism of these stories: They are careful, nuanced, and well written. They focus on the woman making the decision and not the clinical procedure itself. But they are also—often explicitly—calibrated responses to the goriness of political anti-abortion imagery. Such responses are necessary, and they deserve to be viewed and enjoyed by feminists.
However, we should also recognize that the reality of abortion—even safe, straightforward abortion—can be messier than that. To explore this, it’s important to consider what contemporary abortion actually looks like. There is a long preamble of decision-making, appointment planning, and, for more and more women, fundraising, traveling, forced ultrasound viewing, and mandatory waiting. But when it comes to the actual procedure, studies show that most patients are satisfied with their care. In the 2001 Guttmacher Institute report “Choice of and Satisfaction with Methods of Medical and Surgical Abortion among U.S. Clinic Patients,” an estimated 82 percent to upward of 93 percent of patients are satisfied with their care. In a way, this is easy to understand: While most medical experiences involve prolonged diagnosis, treatment, and recovery, abortion is a relatively easy and quick solution to what is often experienced as a very large problem.
However, while the vast majority of women report being satisfied with their abortion care, women who are less satisfied reported that they experienced more pain and bleeding than they expected. Particularly for women who chose medication abortion (which is induced by taking pills, either in a physician’s office or at home) over surgical abortion, the amount and duration of bleeding was surprising. This does not mean these patients regret the abortion or even that they’d choose a different method. It does mean that tens of thousands of American women each year experience abortion in a more uncomfortable, bloodier way than they anticipate, and that this physical experience of the abortion negatively affects their perceptions of their care.
It seems, then, that the cumulative cultural effect of anti-abortion imagery has made it difficult for popular culture to acknowledge the physical, or even clinical, experience of contemporary abortion in a feminist way. We are left with this tension: Abortion is safe, but we cannot dismiss it as a bodily experience. How do we understand and represent the corporeal experience of abortion (which involves blood, and often pain, to be sure) without ceding ground to the violent, gruesome, and gory ideas promoted by anti-abortion propaganda? Is this—should this—even be a goal of popular culture?
Perhaps not. For nearly every abortion story shown onscreen, even those that seem truly out of the ordinary, there is a viewer with whom that story will resonate as similar to their own. It is a tall order to expect popular culture to reflect a range of logistical, emotional, and physical experiences around abortion in a thoughtful way. If an abortion is too bloody, it becomes scary; but if an experience is too simplified, it elides the work involved in obtaining and undergoing an abortion. This double-edged sword is particularly unwieldy. Content creators shouldn’t try to navigate this balance in each story they want to tell, because whatever good-faith story they do tell will likely reflect someone’s reality.
As much as we hold media up as an influencer of public opinion, it is also a reflection of popular belief. If liberal, pro-choice depictions of abortion seem to avoid any messiness—particularly any physical messiness—that might be a reflection of an underlying discomfort among supporters of abortion access. The anti-abortion side’s use of bloody imagery has so overwhelmed the visual culture of abortion that it seems difficult to imagine a real, feminist way of acknowledging the bodily experience of abortion care. Some parts of the reproductive justice movement have actively worked to recognize this (the full-spectrum doula movement is the most direct example), but a public, feminist, radical framework for reclaiming this aspect of abortion has yet to take shape.
Abortion is bloody. It can be uncomfortable, even painful. (That it is both less bloody and less painful than childbirth might be beside the point.) But blood does not inherently equate with the violence and danger that the anti-abortion movement wants it to. Abortion is safe and necessary; we know that. And as long as we know that, we cannot shy away from the physical reality of care—especially if the temptation to step back is a yielding of ground to those who would distort that reality for fearmongering. Abortion rights activists must accept and grapple with all complexities of patient experiences in order to reclaim these visual representations. And we must remember that onscreen abortions may take lives, but real abortions can save and preserve them.