Abstract
Context
Abortion restrictions diminish access and perpetuate hostility toward abortion seekers. Support for restrictions is high, but at the same time, understanding of restrictions is low. We evaluated the effectiveness of a video intervention designed to increase knowledge of abortion restrictions in Arkansas and evaluated whether hearing a person’s abortion experience changed their support for restrictions.
Methods
Using a pre-test, post-test, and follow-up design, we randomly assigned a convenience sample of Arkansas residents (N = 369) to view one of two video conditions, either information on abortion legislation only or information followed by an abortion testimonial, in 2018. We compared knowledge of abortion restrictions (KAR) and support for abortion restrictions (SAR) across time with repeated-measures analyses of variance and McNemar’s tests.
Results
Knowledge increased over time for both groups and was higher among testimonial-watching participants. The 20-week abortion ban, counseling on “abortion pill reversal,” and 48-hour waiting period yielded the largest knowledge gains for both groups. Support decreased slightly over time but did not differ by video condition.
Conclusions
Combined information and testimonial videos were effective in increasing awareness of Arkansas abortion restrictions, potentially because of repeated information or emotional connections, making the information more memorable. Endorsement of restrictions remained high in the sample.
Policy Implications
Participants in this sample did not seem to interpret abortion restrictions as burdensome, even after being given information in the video, and ended up simultaneously supporting choice to have an abortion and the policies that restrict access.
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Notes
It is important to acknowledge that people who seek abortions may vary in gender identity (e.g., non-binary, trans, men) and may not necessarily identify as women. However, women comprise the majority of study samples in abortion research. We use the term “women” more often as that reflects the wording of our survey items and video actors but may interchange women and people throughout this paper.
Participants in the information + testimonial condition comprised four sub-groups, each viewing a slightly different version of the testimonial. For the purposes of this study, they were combined into one group. There were no differences between the four testimonial groups on baseline KAR and SAR scores.
The unbalanced sample sizes between groups were due to missing data.
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Acknowledgements
This research was supported by a Trainee research grant (SFPRF11-T3) from the Society of Family Planning, the Health, Human Performance and Recreation Department Graduate Student Research Grant of the University of Arkansas, and the Public Health Graduate Student Research Grant of the University of Arkansas.
Funding
This research was supported by a Trainee research grant (SFPRF11-T3) from the Society of Family Planning, the Health, Human Performance and Recreation Department Graduate Student Research Grant of the University of Arkansas, and the Public Health Graduate Student Research Grant of the University of Arkansas.
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Mary Hunt. The first draft of the manuscript was written by Mary Hunt and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Appendix Script
Appendix Script
Informational Portion (Delivered by the news anchor, “Michelle”):
“Hello, my name is Michelle. I am an educator at the [institution of data collection] in the public policy program with a focus on reproductive health laws. Today I am going to talk about laws that restrict abortion in Arkansas
Abortion, which is when a pregnancy is ended so that it does not result in the birth of a child, has been legal in all 50 US states for over 40 years
There are a few types of abortion- the most common two are Medication, which is a combination of pills that can only be taken up to 10 weeks of pregnancy and Aspiration, which involves a procedure using gentle suction, 92% of which take place before 13 weeks of pregnancy
Even though abortion is legal in all 50 states, in recent years, states have passed many laws to restrict abortion. In the last 7 years, states passed 338 new abortion restrictions. Arkansas is in top three states with the newest laws restricting abortion access
To get an abortion in Arkansas, there are several rules that patients and doctors must follow:
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If you’re under 18, you have to get permission from a parent. Research shows it delays the procedure or teens may travel to states without these laws to get an abortion.
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You have to go in for a required counseling session and then wait 48 h before you can get an abortion, which means going into a clinic twice and increasing costs associated with travel and lodging.
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Sometimes, doctors use telemedicine to provide care for people who live far away from a clinic. This is a way to meet with a doctor over video conference so you don’t have to travel to see the doctor in person. But in Arkansas, doctors aren’t allowed to use telemedicine to provide the abortion pill, which means they must meet the doctor in person and…
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During the counseling session, doctors are required to tell patients that it is possible for a medication abortion to be reversed after the first dose of pills, which is not backed up with medical evidence.
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So in order to get an abortion, you must go to the facility at least twice and the abortion has to be performed by a licensed doctor, which means if you usually go to a health professional like a nurse practitioner, you have to go to a different place.
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In Arkansas, if you are 20 weeks pregnant or later, you cannot get an abortion unless your life is endangered or were a victim of rape or incest.
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The safest and most common procedure for abortion after 20 weeks, called dilation and extraction, is not allowed in Arkansas. You may have heard people call this a “partial birth” abortion but that is not a medical term or an actual procedure.
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If you are approved to get an abortion after 20 weeks in Arkansas, doctors are required to give you information about pain the fetus might feel in a counseling session. Other states require doctors to talk about the link between abortion and breast cancer or negative mental health outcomes. None of this information is evidenced by medical research.
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Lastly, Medicaid (state insurance for low-income people) will not cover abortion in Arkansas unless your life is endangered or were a victim of rape or incest. This limits reproductive options for women who are poor.
Because of these restrictions, many places that offered abortion services have closed. Now there are only 4 clinics in 2 cities in the state that can offer abortion services to the 1 million women that live in Arkansas.”
Testimonial Portion (Introduced by the news anchor, “Michelle” and delivered by “Mia”):
Introduction: “States have passed these laws with the reasoning they are making it safer for women. But these laws don’t actually improve safety, they only make it harder for women who seek an abortion to get one, which can delay getting care, and cost more time and money
The largest group of women who get abortions in the US are in their 20’s and low-income like Mia, who is here to tell us a personal story about her experience with these Arkansas laws.”
Rape Condition | Consensual Condition |
|---|---|
“Last year, I was raped. I was coming out of work and someone attacked me the parking lot. I didn’t know the guy and I didn’t tell anyone about it for a long time | “Last year, I became pregnant. I didn’t really know the guy and I didn’t tell anyone about it for a long time |
By the time I found out I was pregnant, I was about 8 weeks along. You count from the first day of your last period so by the time you find out you’ve missed a period, you’re already 4–5 weeks pregnant. I rarely get my period on time so I didn’t even know I was pregnant until I took a test around 8 weeks | By the time I found out I was pregnant, I was about 8 weeks along. You count from the first day of your last period so by the time you find out you’ve missed a period, you’re already 4–5 weeks pregnant. I rarely get my period on time so I didn’t even know I was pregnant until I took a test around 8 weeks |
I live paycheck to paycheck. I can barely make rent and groceries. I knew I didn’t have the money to support a baby as well | I live paycheck to paycheck. I can barely make rent and groceries. I knew I didn’t have the money to support a baby as well |
I also knew I definitely did not want to have the baby of the person who raped me | |
My insurance wouldn’t cover me because I didn’t report the rape. I didn’t want people to know | My insurance wouldn’t cover it |
It was about $500. I had to use all the money in my bank account. By the time I got the money together and asked about an appointment, I was almost 9 weeks pregnant. I live in the middle of nowhere so the closest clinic is 3 h away. I had to take off work, and ask a friend for money for the bus ride to the doctor | It was about $500. I had to use all the money in my bank account. By the time I got the money together and asked about an appointment, I was almost 9 weeks pregnant. I live in the middle of nowhere so the closest clinic is 3 h away. I had to take off work, and ask a friend for money for the bus ride to the doctor |
But then they make you wait 48 h to get it done which means I had to take two more days off work. I had nothing left to even get a hotel so I slept in the bus station | But then they make you wait 48 h to get it done which means I had to take two more days off work. I had nothing left to even get a hotel so I slept in the bus station |
I was sure of my decision and just wanted to get this taken care of as soon as possible, in the safest way possible. But these laws made everything go so much slower and so much more expensive because I had to take time from work and stay extra days | I was sure of my decision and just wanted to get this taken care of as soon as possible, in the safest way possible. But these laws made everything go so much slower and so much more expensive because I had to take time from work and stay extra days |
I don’t regret the abortion. I felt relieved. I just wanted to put the rape behind me.” | I don’t regret the abortion. I felt relieved. It wasn’t the right time.” |
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Hunt, M.E., Jozkowski, K.N., Cleland, K. et al. Examining the Effect of a Randomized Media Intervention on Knowledge and Support of Abortion Restrictions: A Case Study in the South. Sex Res Soc Policy 19, 870–885 (2022). https://doi.org/10.1007/s13178-021-00624-4
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DOI: https://doi.org/10.1007/s13178-021-00624-4