The XX Factor

Does Looking at the Ultrasound Before an Abortion Change Women’s Minds?

Anti-abortion advocates continue to promote the idea that when a woman glimpses her little bean during a sonogram, her maternal instinct awakens.

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The journal Obstetrics & Gynecology published an important study this month: the deepest inquiry yet into whether viewing ultrasound images can influence a woman’s decision to have an abortion. True, anti-choicers have lately shifted tactics from concern for the fetus to feigned concern for women’s health. But they’ve succeeded in getting mandatory ultrasound laws on the books in 10 states, and many continue to promote the idea that, when a woman glimpses her little bean during a sonogram, her maternal instinct awakens and prompts her to carry the pregnancy to term.

Where did this notion come from? In 1983, two doctors wrote an editorial noting that the grainy photos hastened fetal bonding for a pair of female patients who wanted to give birth. They speculated that the same bonding might happen even to women who didn’t want to give birth. Over three decades of conservative telephone (and a few dubious studies funded by abortion crisis centers), this wisp of conjecture permutated: By 2013, pundits like Rachel Campos-Duffy were claiming that more than 90 percent of women change their mind about abortion after viewing an ultrasound.

Seven states now mandate that women seeking abortion get an ultrasound first and require doctors offer the women a chance to see the images; three states require the doctors to show and describe the ultrasound. But despite the conservative push for these laws, smaller studies out of Texas, Canada, and South Africa imply that sonogram viewings do not impact women’s decisions to end or continue their pregnancies.

This latest study is much larger. Researchers analyzed 15,575 medical records from an urban abortion care provider in Los Angeles. Each patient seeking an abortion was asked how she felt about her choice: Those who made “clear and confident” replies were rated as having “high decision certainty,” while those who seemed sad, angry, or ambivalent were said to show “medium” or “low” decision certainty. (Only 7.4 percent of the women fell into the latter categories.) Patients underwent ultrasounds as part of the standard procedure, and 42.5 percent of them opted to see the images. Of those, 98.4 percent terminated their pregnancies; 99 percent of the women who did not look at the photographs ended their pregnancies. But here’s the thing: The women who viewed the sonograms and then backed out were all part of that 7.4 percent of women with low or medium decision certainty. Women who knew abortion was the right decision for them continued with the procedure whether they were shown the images or not.

The main takeaway here is definitely that 98.4 percent of the women who saw their ultrasounds went on to get an abortion anyway. And for the 1.6 percent who decided not to go through with it, other factors, such as gestational age, were more salient in swaying them. (“It is the information the ultrasound scan renders … rather than the image that influences women’s decision-making,” the researchers write.) Also, it is clear that once you’ve resolved to terminate, gazing at the bean won’t change that: Exactly none of the women with high decision certainty were dissuaded by their sonograms.

Yet viewing the ultrasound images did influence some of the wavering women to stick with their pregnancies. Even though the number is very small, this is important to acknowledge. It means not only that forcing or pressuring women to look at their fetus will probably prevent a sliver of abortions—which is relevant for those who oppose and want to reduce abortions—but also that some women do respond to these pictures. I don’t buy the patronizing notion that patients seeking abortion “know not what they do”—that they have some false idea about the contents of their uteruses to be toppled by an “adorable,” “precious” or “lifelike” sonogram. I also doubt all women even have the maternal instinct right-wingers hope these images will fan to life. But I do trust that unsure women who voluntarily look at ultrasounds and then decide against abortion are acting as rationally as the ones who decide to go through with it. We all make choices along a variety of axes: the financial axis; the relationship-status axis; the personal goals and dreams axis; the ethical axis; and, yes, the emotional axis. Expecting women to ignore any one scrap of data (as if they are not capable of weighing it, carefully, alongside the others) is underestimating women.

Of course, few pro-choicers would dream of denying a woman considering abortion the opportunity to peruse her ultrasound, if she wanted to. And given that only 42.5 percent of the women in the study actually wanted to, it is 100 percent clear that sonogram-viewing shouldn’t be mandatory. The researchers warn of the slight drop in abortions among women who saw their sonograms that, “these results cannot be generalized to women’s experience of ultrasound viewing in settings where it is required.” What is for sure is that “patient satisfaction and health outcomes … are enhanced when patients feel control over decisions related to their care.” Which means forcing a woman to stare at her fetus before terminating it remains very much in violation of that new conservative gold standard, “women’s health.”