Health care providers who perform abortions routinely use ultrasound scans to confirm their patients’ pregnancies, check for multiple gestations, and determine the stage of the pregnancies. But it is far from standard – and not at all medically necessary – for women about to have abortions to view their ultrasounds. Ultrasound viewing by patients has no clinical purpose: it does not affect the woman’s condition or the decisions health providers make. Nevertheless, ultrasound viewing has become central to the hotly contested politics of abortion.

Believing that viewing ultrasounds will change minds, opponents of abortion – spearheaded by the advocacy group Americans United for Life – have pushed for state laws to require such viewing. So far, eighteen states require that women be offered the opportunity to view their pre-abortion ultrasound images, and five states actually go so far as to legally require women to view their ultrasound images before obtaining an abortion (although the women are permitted to avert their eyes). In two of the five states that have passed such mandatory viewing laws, courts have permanently enjoined the laws, keeping them from going into effect.

States that allow/require ultrasounds before abortion (vocative):7

As the debates continue to rage, both sides assume that what matters for an abortion patient is the content of the ultrasound image. Abortion opponents believe the image will demonstrate to the woman that she is carrying a baby – a revelation they think will make her want to continue her pregnancy. Ironically, supporters of abortion rights also argue that seeing the image of the fetus will make a difference. They say this experience will be emotionally distressing and make abortions more difficult. Paradoxically, such arguments from rights advocates reinforce assumptions that fetuses are persons and perpetuate stigma about abortion procedures.

Does viewing change women’s minds – or cause trauma?

What is missing from all of this is research on a crucial question: How do women planning abortions actually react to voluntary or coerced viewing of ultrasounds? As it turns out, seeing the ultrasound images as such does little to change women’s minds about abortion. What matters is how women scheduled for abortions already feel. Viewing an ultrasound can matter for women who are not fully certain about their plans to have an abortion.

My colleagues and I analyzed medical records from over 15,000 abortion visits during 2011 to a large, urban abortion provider. This provider has a policy of offering every patient the voluntary opportunity to view her ultrasound image. In her intake paperwork, the patient can check a box saying she wants to view; then, when she’s in the ultrasound room, the technician provides her with the opportunity to see the image. Over 42% of incoming abortion patients chose to view their ultrasound images, and the substantial majority (99%) of all 15,000 pregnancies ended in abortion.

Our research team looked at whether viewing the ultrasound image was associated with deciding to continue with the pregnancy instead of proceeding with the abortion. We took into account factors such as the age, race, and poverty level of the women involved, as well as how far along their pregnancies were, the presence of multiple fetuses, and how certain women said they were about their abortion decision.

As it became clear that certainty mattered, we looked more closely. Among women who were highly certain, viewing their ultrasound did not change minds. However, among the small fraction (7.4%) of women who were not very certain or only moderately certain, viewing slightly increased the odds that they would forego their planned abortion and continue with their pregnancy. Nonetheless, this effect was very small and most did proceed to abortion.

Our findings make sense, because some women who are unsure about their abortion decision may seek experiences such as ultrasound viewing to help them make a final choice. Nevertheless, many previous studies have documented that women’s reasons for abortion are complex and unlikely to be negated simply by viewing an ultrasound image. Our study analyzed a situation where viewing ultrasounds was voluntary, but there is no reason to think that mandatory viewing would change more minds. Forcing women to view their ultrasounds could, however, affect patient satisfaction and sense of autonomy.

Apart from whether minds are changed, many people imagine that viewing an ultrasound for an unwanted pregnancy is distressing; and in interviews with 26 staff members at an abortion facility that offers pre-abortion ultrasounds, my colleague and I discovered that many staffers believed viewing the image caused relief for women early in their pregnancies but was traumatic for those at later stages.

However, when my colleagues and I asked 212 women throughout the United States about their reactions to viewing pre-abortion ultrasounds, we found no evidence that viewing was broadly distressing or that emotions depended on the gestational stage. All interviewees said their minds were not changed about proceeding with abortions. Just over one in five reported that viewing provoked negative reactions of guilt, depression, or sadness; one in ten reported positive feelings such as happiness; and the largest group, just over a third, said they felt “fine,” “okay,” or even “nothing.” This common response that viewing did not matter was a surprise given the intensity surrounding political debates.

Our research questions the wisdom of state laws that force women scheduled to have abortions to view their ultrasounds prior to the procedure. Fewer than half of abortion patients want to view their ultrasounds, and there is no clinical benefit. More to the point, abortion providers already offer patients the opportunity to view their ultrasounds – and never turn down women’s requests to look at these images. When women already feel uncertain about proceeding with an abortion, viewing the image of the fetus may make a difference. But for the vast majority whose minds are made up, viewing does not matter – and trying to force this to happen in every case merely adds costs and indignities to the abortion process.

Originally posted at Scholars Strategy NetworkRead more at: 

Katrina Kimport, PhD is an assistant professor in the Department of Obstetrics, Gynecology and Reproductive Sciences and a research sociologist with the Advancing New Standards in Reproductive Health program at the University of California, San Francisco.

Flashback Friday.

The term “fetal alcohol syndrome” (FAS) refers to a group of problems that include mental retardation,  growth problems, abnormal facial features, and other birth defects.  The disorder affects children whose mothers drank large amounts of alcohol during pregnancy.


Well, not exactly.

It turns out that only about 5% of alcoholic women give birth to babies who are later diagnosed with FAS. This means that many mothers drink excessively, and many more drink somewhat (at least 16 percent of mothers drink during pregnancy), and yet many, many children born to these women show no diagnosable signs of FAS. Twin studies, further, have shown that sometimes one fraternal twin is diagnosed with FAS, but the other twin, who shared the same uterine environment, is fine.

So, drinking during pregnancy does not appear to be a sufficient cause of FAS, even if it is a necessary cause (by definition?). In her book, Conceiving Risk, Bearing Responsibility, sociologist and public health scholar Elizabeth M. Armstrong explains that FAS is not just related to alcohol intake, but is “highly correlated with smoking, poverty, malnutrition, high parity [i.e., having lots of children], and advanced maternal age” (p. 6). Further, there appears to be a genetic component. Some fetuses may be more vulnerable than others due to different ways that bodies breakdown ethanol, a characteristic that may be inherited. (This may also explain why one fraternal twin is affected, but not the other.)

To sum, drinking alcohol during pregnancy appears to contribute to FAS, but it by no means causes FAS.

And yet… almost all public health campaigns, whether sponsored by states, social movement organizations, public health institutes, or the associations of alcohol purveyors tell pregnant women not to drink alcohol during, before, or after pregnancy… at all… or else.

The Centers for Disease Control (U.S.):

The National Organization on Fetal Alcohol Syndrome:

Best Start, Ontario’s Maternal Newborn and Early Child Development Resource Centre:

Nova Scotia Liquor Commission:

These campaigns all target women and explain to them that they should not drink any alcohol at all if they are trying to conceive, during pregnancy, during the period in which they are breastfeeding and, in some cases, if they are not trying to conceive but are using only somewhat effective birth control.

So, the strategy to reduce FAS is reduced to the targeting of women’s behavior.

But “women” do not cause FAS. Neither does alcohol. This strategy replaces addressing all of the other problems that correlate with the appearance of FAS — poverty, stress, and other kinds of social deprivation — in favor of policing women. FAS, in fact, is partly the result of individual behavior, partly the result of social inequality, and partly genetic, but our entire eradication strategy focuses on individual behavior. It places the blame and responsibility solely on women.

And, since women’s choices are not highly correlated with the appearance of FAS, the strategy fails. Very few women actually drink at the levels correlated with FAS. If we did not have a no-drinking-during-pregnancy campaign and pregnant women continued drinking at the rates at which they drank before being pregnant, we would not see a massive rise in FAS. Only the heaviest drinking women put their fetus at risk and they, unfortunately, are the least likely to respond to the no-drinking campaign (largely due to addiction).

Originally posted in 2010 and developed into a two-page essay for Contexts magazine.

Lisa Wade is a professor at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. Find her on TwitterFacebook, and Instagram.

A new article reports the findings from a longitudinal study that followed 667 women who had early- and later-term abortions for three years after their procedure. Dr. Corinne Rocca and her colleagues asked women if they felt that the abortion was the “right decision” at one week and approximately every six months thereafter.

This is your image of the week:


Percent of women reporting that abortion was the right decision over three years:


Over 99% of the women said that the abortion was the right decision at every time point. The line that looks like the upper barrier of the graph? That’s the data.

Overall, measures of negative emotions were relatively low — an average score of under 4 on a 16-point scale at one week and declining to about 2 at three years — and were higher for women who had a more difficult time deciding whether to get an abortion or who subsequently had planned pregnancies. Whether the abortion occurred in the first trimester or near the legal limit did not correlate with emotional response.

In contrast, women reported twice as many positive emotions at one week. Over time, positive feelings about the abortion declined along with negative ones, suggesting that the experience became less emotionally charged overall with distance from the procedure.

Lisa Wade is a professor at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. Find her on TwitterFacebook, and Instagram.

At the New York Times, Ross Douthat has called out liberals who think, and declare, that churches today are more focused on “culture war” issues like abortion and homosexuality than on poverty.

Ridiculous, says Douthat. Religious organizations spend only “a few hundred million dollars” on pro-life causes and “traditional marriage” but tens of billions on charities, schools, and hospitals. Douthat and his sources, though, lump all spending together rather than separating domestic U.S. budgets from those going to the developing world.  But even in the U.S. and other wealthy countries, abortion and gay marriage are largely legislative and legal matters. Building schools and hospitals and then keeping them running – that takes real money.

Why then do liberals get this impression about the priorities of religious organizations? Douthat blames the media. He doesn’t do a full O’Reilly and accuse the media (liberal, it goes without saying) and others of ganging up in a war on religion, but that’s the subtext.

Anyone who tells you that America’s pastors are obsessed with homosexuality or abortion only hears them through a media filter. You can attend Masses or megachurches for months without having those issues intrude.

Actually, the media do not report on the sermons and homilies of local clergy at all, whether they are urging their flocks to live good lives, become wealthy, help the needy, or oppose gay marriage. Nor is there a data base of these Sunday texts, so we don’t know precisely how much American chuchgoers are hearing about any of these topics. Only a handful of clergy get media coverage, and that coverage focuses on their pronouncements about controversial issues.  As Douthat says, liberals are probably reacting to “religious leaders who make opposition to abortion more of a political priority than publicly-funded antipoverty efforts.”

Of his own Catholic church, Douthat adds, “You can bore yourself to tears reading denominational statements and bishops’ documents (true long before Pope Francis) with a similar result.” Maybe he has done this reading, and maybe he does think that his Church does not let “those issues intrude.” Or as he puts it, “The belief that organized religion is organized around culture war is largely a conceit of the irreligious.”

But here, thanks to the centralized and hierarchical structure of the Church, we can get data that might reveal what the Church is worried about. As Douthat implies, the previous pope (Benedict XVI, the former Joseph Ratzinger), was more concerned about culture-war issues than is the current pope.

How concerned? I went to Lexis-Nexis. I figured that papal pronouncements on these issues would be issued in masses, in official statements, and in addresses.  For each of those three terms, I searched for “Pope Benedict” with four “culture-war” terms (Abortion, Homosexuality, Condom, and Birth control) and Poverty.

3 2 2 (1)
Abortion was the big winner.  Poverty was referred to in more articles than were the other individual culture-war terms.  But if those terms are combined into a single bar, its clear that poverty as a papal concern is dwarfed by the attention to these other issues. The graph below shows the data for “mass.”

This is not the best data. It might reflect the concerns of the press more than those of the Church. Also, some of those Lexis-Nexis articles are not direct hits. They might reference an “address” or “statement” by someone else. But there’s no reason to think that these off-target citations are skewed towards Abortion and away from Poverty.So it’s completely understandable that liberals, and perhaps non-liberals as well, have the impression that Big Religion has a big concern with matters of sex and reproduction.Cross-posted at Montclair SocioBlog and Pacific Standard.

Jay Livingston is the chair of the Sociology Department at Montclair State University. You can follow him at Montclair SocioBlog or on Twitter.

This week the New York Times published an interactive that illustrates the likelihood of pregnancy despite contraceptive use. Risk is divvied up by method, for perfect and typical use, and added up over ten years. The results are a little terrifying (click to see larger or go here to explore):


Somewhere around half of all pregnancies are unintended.  This is why. It’s hard enough to use contraceptives perfectly but, even when we do, the risk of failure is very real.

Male condoms are the safer sex favorite. But, even when used perfectly, almost one in five women will get pregnant over a ten year period. With typical use, more than four out of five. Withdrawal, one primary foil against which male condoms are usually recommended, is only slightly less effective at preventing pregnancy, as typically used.

The favorite of Americans — The Pill, as well as some other hormonal methods — is more effective than the condom, but not nearly as much as we think it is. Under ideal conditions, only three in 100 will get pregnant over ten years; in reality, almost two-thirds — 61 in 100 — will end up pregnant.

Only the most human-error resistant methods — the IUD, hormonal implants, and sterilization — near 100% effectiveness. These are permanent or semi-permanent and not real options for a large proportion of sexually active Americans during at least some parts of their lives.

Discussions of the right to an abortion and the ease with which they can be attained needs to be had with this information at the forefront of the discussion. Unintended pregnancies happen all the time to everyone.

Cross-posted at Pacific Standard.

Lisa Wade is a professor at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. Find her on TwitterFacebook, and Instagram.

Flashback Friday.

New York Times article broke the story that a preference for boy children is leading to an unlikely preponderance of boy babies among Chinese-Americans and, to a lesser but still notable extent, Korean- and Indian-Americans.


Explaining the trend, Roberts writes:

In those families, if the first child was a girl, it was more likely that a second child would be a boy, according to recent studies of census data. If the first two children were girls, it was even more likely that a third child would be male.

Demographers say the statistical deviation among Asian-American families is significant, and they believe it reflects not only a preference for male children, but a growing tendency for these families to embrace sex-selection techniques, like in vitro fertilization and sperm sorting, or abortion.

The article explains the preference for boy children as cultural, as if Chinese, Indian, and Korean cultures, alone, expressed a desire to have at least one boy child.  Since white and black American births do not show an unlikely disproportion of boy children, the implication is that a preference for boys is not a cultural trait of the U.S.

Actually, it is.

In 1997 a Gallup poll found that 35% of people preferred a boy and 23% preferred a girl (the remainder had no preference). In 2007 another Gallup poll found that 37% of people preferred a boy, while 28% preferred a girl.

I bring up this data not to trivialize the preference for boys that we see in the U.S. and around the world, but to call into question the easy assumption that the data presented by the New York Times represents something uniquely “Asian.”

Instead of emphasizing the difference between “them” and “us,” it might be interesting to try to think why, given our similarities, we only see such a striking disproportionality in some groups.

Some of the explanation for this might be cultural (e.g., it might be more socially acceptable to take measures to ensure a boy-child among some groups), but some might also be institutional. Only economically privileged groups have the money to take advantage of sex selection technology (or even abortion, as that can be costly, too). Sex selection, the article explains, costs upwards of $15,000 or more. Perhaps not coincidentally, Chinese, Korean, and Indian Asians are among the more economically privileged minority groups in the U.S.

Instead of demonizing Asian people, and without suggesting that all groups have the same level of preference for boys, I propose a more interesting conversation: What enables some groups to act on a preference for boys, and not others?

Originally posted in 2009.

Lisa Wade is a professor at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. Find her on TwitterFacebook, and Instagram.

We recently got the news that Apple and Facebook were going to offer women egg freezing as a fringe benefit of employment.  The internet exploded with concerns that the practice discouraged women from becoming mothers at a “natural” age, either by offering an alternative or by sending a not-so-subtle message that childbearing would hurt their careers.

I wasn’t so sure.

First of all, it didn’t seem to me that these women were likely to delay their childbearing till, say, after retirement. So what did it matter to these companies if they had kids at 33 or 43?  If anything, an employee taken out of commission at 43 would be even a greater loss, since they’d accumulated more expertise and pulled a higher salary during maternity leave.

Second of all, the discussion seemed to assume that every 30-something female employee was in a happy and stable marriage to a man. The possibility that some women were 30-something and single — that freezing their eggs had nothing to do with their jobs and everything to do with a dearth of marriageable men — didn’t seem to enter into the equation. To me, that seemed like quite the oversight.

So, I was grateful when sociologists Tristan Bridges and Melody Boyd intervened in this debate. They found actual real data on why women choose “oocyte cryopreservation” and the big answer is not related to their job. As my never-married, 40-year-old self suspected, it was “lack of partner” 88% of the time.


Bridges and Boyd are working on an article re-thinking what it means for women to enter a market full of “unmarriageable men.” In the past, it was mostly working class and poor women who didn’t marry, in part because so few men of their own social status had stable enough employment to contribute to a household. Today women of other class backgrounds are also forgoing marriage, but it isn’t because the men around them don’t make money.

“Men who might be capable of financially providing,” they write, “are not necessarily all women want out of a relationship today.” Women of all classes increasingly want equality, but research shows that many men agree in principle, but fall back on traditional roles in practice.

Freezing one’s eggs is a feminist issue, but not the one that so captivated us a couple weeks ago. It seems to me that Apple and Facebook are simply offering this option as part of a benefits arms race. From that point of view, it’s about class and the widening gap between the rich and everyone else. When women choose this option, though, it’s likely because the gender revolution has stalled. Women have changed; men aren’t keeping up.  In the meantime, ladies aren’t settling, even if they’re holding out hope.

Cross-posted at Gender & Society and Pacific Standard.

Lisa Wade is a professor at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. Find her on TwitterFacebook, and Instagram.

Flashback Friday.

You have likely seen photographs of fetus’ that seem to float in a dark womb.  The first of these were taken by Swedish photographer Lennart Nilsson. One of his photographs graced the cover of Life magazine in April of 1965.

Nilsson’s images forever changed the way that people think about pregnancy, mothers, and fetuses.  Before Nilsson, the visual of a fetus independent from a mother was not widespread. His pictures made it possible for people to visualize the contents of a woman’s womb independently of her body.  Suddenly, the fetus came to life.  It was no longer just something inside of a woman, no longer even in relationship to a woman; it was an individual with a face, a sex, a desire to suck its thumb.

Once the fetus could be individualized, the idea that a woman and her fetus could have contrasting interests was easier to imagine. In many countries even today, the idea that helping pregnant women is helping fetuses and helping fetuses means helping pregnant women is still the dominant way of thinking about pregnancy. Pro-choice and other fetus-defenders, such as those who want it to be illegal to smoke during pregnancy, used these images to disentangle the interests of the woman and the fetus. The vulnerability of Nilsson’s subjects, free-floating in space, made it easier to portray fetuses as in danger.

There is power in visualization and its technological advance and these images were a boon to the pro-life cause. Ironically, it was abortion that made these images possible. Nilsson posed the fetuses to look alive, and gives no indication otherwise, but they are actually photographs of aborted fetuses.

Although claiming to show the living fetus, Nilsson actually photographed abortus material obtained from women who terminated their pregnancies under the liberal Swedish law. Working with dead embryos allowed Nilsson to experiment with lighting, background and positions, such as placing the thumb into the fetus’ mouth.

— Quote from the University of Cambridge’s history of the science of fetal development

Liberal abortion rights laws resulted in a product that was used to mobilize anti-abortion sentiment.  Today it is par for the course to have been exposed to images like this. And the rest is history.

Originally posted in 2009.

Lisa Wade is a professor at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. Find her on TwitterFacebook, and Instagram.