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Does Knowledge about Abortion Depend on Where People Live?

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University of Cincinnati-Main Campus
Ohio State University-Main Campus

As American politics become increasingly polarized, particular states often lean one way or another. Does the overall political context in a state influence what people learn and know about specific issues? Our research considers this issue for knowledge of sexual and reproductive health issues. Does political context affect the cultural worldviews of residents who are most likely to seek health services like abortion that have become central to ongoing cultural and political battles?

Because the issue of abortion is caught up in political polarization, it provides a useful way to test the hypothesis put forward by legal scholars Cahn and Carbone in their 2010 book, Red Families v. Blue Families, where they argue that the United States is divided into distinct cultures related to family values. If these scholars are right, people living in conservative “red” states versus more liberal “blue” states – that is, states with varying proportions of conservative and liberal voters – may have different exposure to laws and values about abortion and may differ in their sources of information and misinformation. Such differences could lead people to form divergent cultural worldviews and different levels of knowledge about abortion.

Abortion Policies in Red and Blue States

Political differences on abortion frequently play out at the state level. Conservative states are more likely to enact abortion restrictions and have citizens who express support for anti-abortion platforms, while liberal states are more likely to support pro-choice policies. Eight of the nine states that have laws that require physicians to counsel women seeking abortion that it will increase their risk of breast cancer or depression (even though this is not supported by medical evidence) are “red,” as are 19 of the 27 states that require waiting periods before women can obtain an abortion. Most of the 17 states that cover medically-necessary abortion for patients enrolled in Medicaid are liberal blue states, while laws prohibiting or limiting private insurance coverage of abortion are more common in conservative red states.

State policies governing the dissemination of abortion information are similarly skewed. Studies have revealed that inaccurate information is often provided by abstinence-only education programs and Crisis Pregnancy Centers, both of which tend to exaggerate the mental and physical health risks of abortion. Although many states require that sexual education stress abstinence, most of the 15 states that rejected abstinence-only Title V federal funding in 2016 were blue. Meanwhile, red states make up more than half of the 15 states that support Crisis Pregnancy Centers or other anti-abortion agencies via the sale of “Choose Life” car license plates.

But People’s Individual Characteristics Matter More Than Where They Live

To probe the effect of living in more or less conservative states, we administered an online questionnaire to reproductive-age Americans and then analyzed the relationship between their states’ conservativism and their knowledge of abortion laws and health issues. States were categorized as more or less conservative depending on the results of the 2004, 2008, and 2012 presidential elections.

Overall, we found that as states scored more conservative, respondents answered fewer questions about abortion health and laws correctly. But this finding disappeared once we took into account more characteristics of individuals than simply where they live. After we considered individuals’ other characteristics, there was no longer any significant association between their state’s conservatism and their knowledge of abortion matters. Much more important predictors of how much people knew included personal political beliefs, knowing someone who had an abortion, and believing that abortion should be permitted. Our findings seem surprising in some ways, because there are many reasons to suspect that state context could influence people’s knowledge – for example, if sexual education is inadequate or anti-abortion laws and rhetoric are widespread. However, our results showed otherwise.

  • Regardless of their state’s dominant ideology, respondents who had more conservative political beliefs tended to score lower on questions probing their knowledge about abortion health and legal issues.
  • Respondents who knew someone who had an abortion were statistically more likely to score higher on questions about abortion health and legality than respondents who did not know someone who had had an abortion.
  • Respondents who believed that abortion should be permitted were statistically likely to have more accurate knowledge than respondents who believed that abortion should be prohibited.

Better Education is Needed Everywhere

Overall, we discovered low levels of understanding of abortion health issues for most survey respondents, confirming prior studies. Remarkably, 17% of our respondents did not know that abortion before 12 weeks of gestation is legal in the United States. Regardless of their state’s dominant ideology, abortion is clearly a topic about which many reproductive-aged adults are misinformed, even though abortions are quite prevalent. Although state policies may contribute to misinformation about abortion, insufficient knowledge may also be due to inattention to abortion and reproductive health matters even in supposedly more complete education programs offered in liberal states. Political controversies may encourage overall silence on these issues.

The bottom line is that geography does not dictate Americans’ knowledge or worldviews on abortion. Although “red” or “blue” states may differ in their patterns of political mobilization, some people everywhere do have accurate knowledge about abortion – although many do not. Accurate information about abortion laws and health issues needs to be disseminated in all states. 


Read more in Danielle Bessett, Caitlin Gerdts, Lisa L. Littman, Megan L. Kavanaugh, and Alison Norris, “Does State-Level Context Matter for Individuals' Knowledge about Abortion, Legality and Health? Challenging the ‘Red States v. Blue States’ Hypothesis.Culture, Health & Sexuality: An International Journal for Research, Intervention and Care 17, no. 6 (2015): 733-746. The authors thank Jacqueline Mostow and Elizabeth Ghedi-Ehrlich for their assistance on this brief.