Even the meaning of the word 'abortion' is up for debate

For all that abortion is talked about in hospitals, courts, legislatures and the media, it turns out the public doesn't really agree on what the word means, a new survey finds.

The study by the Guttmacher Institute, a group that supports abortion rights, questioned people about a series of situations showing various circumstances in a pregnancy. Researchers asked: Is this an abortion? Yes, no or maybe?

"Our biggest takeaway is that people do not hold a shared standard definition of what is and isn't an abortion," says lead author Alicia VandeVusse. "We found that there's a lot of nuance and ambiguity in how people are thinking about these issues and understanding these issues."

Guttmacher did in depth interviews with 60 people and an online survey with 2,000 more people.

Not a single scenario, which they dubbed "vignettes," garnered complete agreement. One scenario had the phrase "had a surgical abortion." Still, "67% of respondents said, yes, that's an abortion, and 8% said maybe, but 25% said no," VandeVusse says.

To give you an idea of the scenarios people were thinking through, here is one of the vignettes posed in the study:

"Person G is 12 weeks pregnant. When they have their first ultrasound, there is no cardiac activity, and their doctor recommends having the fetus removed. Person G has a surgical procedure to remove the fetus."

"We consider that miscarriage intervention," says VandeVusse. The 2,000 people who took the survey weren't so sure. Two thirds of them agreed it was not an abortion, a third said it was.

Other scenarios described things like people taking emergency contraception, or getting abortion pills through the mail, or having a procedural abortion after discovering a fetal anomaly.

"Intention definitely played a very strong role in sort of how our respondents thought through the different scenarios," VandeVusse says. For instance, "when people were talking about taking emergency contraception the day after intercourse, we had folks who were saying, 'Well, you know, they wanted to end their pregnancy, so it's an abortion,' even if they're not pregnant."

She says many respondents seemed unsure about how pregnancy works and how complications can unfold.

"We don't speak openly about a lot of reproductive experiences, particularly abortion, but also miscarriage," says VandeVusse. "These are both stigmatized and very personal experiences."

This isn't just an academic discussion – what counts as an abortion has huge implications for abortion restrictions and how reproductive care changes in states with those laws.

"I think it's really important research," says Ushma Upadhyay, professor and public health scientist at the University of California San Francisco, who was not involved in the study. "It sheds light on how important these terms are and how important it is for the public to have better knowledge about these issues that are constantly in our media, constantly being discussed in policy – and policymakers are making these decisions and probably have very similar misunderstandings and lack of understanding."

Upadhyay thinks clear terms and definitions can help. She recently published a statement on abortion nomenclature in the journal Contraception, which was endorsed by the American College of Obstetricians and Gynecologists or ACOG.

Meanwhile, the American Association of Pro-Life Obstetricians and Gynecologists recently came out with its own glossary of terms, suggesting, for example, that people don't say abortion at all, and instead say "intentional feticide." The organization says the word abortion "is a vague term with a multitude of definitions depending on the context in which it is being used."

One key point about the Guttmacher study on the public's varying views of what counts as an abortion: The research was conducted in 2020, before the Supreme Court overturned Roe v. Wade. It's possible that in the time since the legal and political picture changed so dramatically, the public understands more about reproductive health now.