Abortion Knowledge and Attitudes: KFF Polling and Policy Insights
KFF has a long history of providing insights into national and state-level reproductive health care policy including a series of public opinion polls examining the experiences and attitudes of the general public and the group most likely to be impacted by such policies – women between the ages of 18 and 49. In recent years, many states have passed laws restricting access to abortion and the Trump administration has made a number of changes to federal reproductive health policy, including major changes to the federal Title X family planning program.1 This polling and policy analysis includes new polling data on federal and state reproductive health policy in the U.S. as well as knowledge of abortion and its safety.
- Nearly five decades since the 1973 Supreme Court case Roe v. Wade, a majority of the public do not want to see the Supreme Court overturn its landmark ruling, which established a woman’s constitutional right to abortion. While most Republicans (57%) would like to see Roe overturned, larger majorities of Democrats (91%) and independents (70%) do not want it overturned.
- Most people (67%) think state regulations on abortion providers or women seeking abortions are intended to make access to abortion more difficult as opposed to protecting the health and safety of women (32%). Three-fourths of Democrats (77%) as well as six in ten independents (61%) and Republicans (62%) say these state laws are designed to make it more difficult for women to access abortions. This includes majorities of men (67%), women (67%), and women between the ages of 18 and 49 (66%).
- Few (11%) Americans think abortion should be illegal in all cases but many people also support some state-level abortion restrictions currently at the center of different lawsuits. A majority (69%) of the public support laws requiring abortions to be performed solely by doctors who have hospital admitting privileges, similar to a Louisiana law in question in a case that will be heard at the Supreme Court this term. Majorities of Americans also support laws that would require women to wait 24 hours between meeting with a health care provider and getting an abortion (66%) and doctors to show and describe ultrasound images to women seeking an abortion (57%). But majorities oppose criminalizing doctors who provide abortions (65%) or women who get abortions (74%).
- Six in ten (63%) Americans personally know someone who has ever had an abortion (including themselves). Yet, despite this, there is significant lack of knowledge about abortion. A majority (69%) incorrectly think most abortions occur 8 weeks or later into pregnancy and about one-fifth of adults (21%) and one-third of women between the ages of 18 and 49 (36%) have ever heard of Mifepristone, or a medication abortion.
- Reproductive health issues are not a top issue so far in the 2020 presidential election. Small shares of Democrats (6%), independents (4%), and Republicans (7%) say reproductive health issues such as birth control and abortion are the most important issue for the 2020 presidential candidates to talk about.
Access to Abortion Services and State-Level Restrictions
In the last several years, over 250 abortion clinics have closed across the U.S. and there are currently six states with one abortion clinic remaining: Kentucky, Mississippi, Missouri, North Dakota, South Dakota, and West Virginia. The most recent KFF poll finds about half of Democrats (48%) and one-third of independents (34%) say it has gotten “harder” for women in their community to get abortions during the last three years. On the other side of the aisle, most Republicans (55%) don’t think women’s ability to get abortion services in their community has changed under the Trump administration.
|Box 1: Key Facts about Abortion in the U.S.|
The closure of clinics that offer reproductive health services could affect more than access to abortion and also affect women’s ability to access services including prenatal care and contraception. Most say women’s ability to get prenatal care and family planning services including birth control in their communities is “about right” (63% and 59%, respectively) while about three in ten say it is too difficult for women to access these services and one in ten say it is “too easy.” Yet, the public is divided in their views of women’s ability to access abortions in their communities with similar shares saying it is “too difficult” (35%), and “about right” (36%), and a slightly smaller share saying it is “too easy” (28%).
This divide is largely driven by differences among partisans. A slim majority of Democrats say it is “too difficult” for women in their community to access abortions (52%) while half of Republicans say it is “too easy” for women to get an abortion in their community. Independents are more evenly split with similar shares saying it is “too difficult” (35%) and access is “about right” for women in their community (36%). About three in ten (28%) independents say it is “too easy” for women in their community to get abortion services.
More than four in ten women, 18-49, say it is “too difficult” for women in their community to get abortion services, compared to one-third (34%) who say women’s access is “about right,” and one in five (21%) who say it is “too easy.”
The share who say it is “too difficult” for women in their community to get abortion services has increased 13 percentage points since 2018, up from 22% to 35%. The increase is largely driven by Democrats with half (52%) now saying it is “too difficult” for women in their community to get abortion services (compared to 37% in 2018).
Overall, about half of the public says women’s ability in their community to get abortion services has “stayed about the same” in the past three years but there are differences across partisans. About half of Democrats (48%) say it has gotten “harder” in the past three years for women in their community to get abortion services while 55% of Republicans say women’s access to abortions in their community has “stayed about the same.” About half (47%) of independents say access has “stayed about the same” but a larger share (34%) say access has gotten “harder” rather than “easier” (18%).
State Actions Legislating Abortion Services
Over the past couple of years, many state legislatures have passed laws restricting women’s access to abortions within each state. These include a wide variety of restrictions that range from gestational age bans, prohibiting abortions for specific reasons, barring certain methods of abortion, and regulations on abortion providers.
|Box 2: State Regulations on Abortion|
|States vary in the degree to which they regulate abortion services, including the following.
Time Limits: The Supreme Court’s decision in Roe v. Wade allows states to restrict access to abortion after “viability,” often presumed around 24 weeks gestation. However, many states seek earlier gestational limits on abortion. This includes Alabama that has banned abortion altogether and six states with “so-called” heartbeat bans, which ban abortions after there is detectable cardiac activity, around 6 weeks into a pregnancy. All of these bans are currently blocked by court action.
Waiting Periods: Twenty-seven states require waiting periods between abortion counseling and obtaining an abortion, necessitating at least two trips to the clinic. Waiting periods vary by state, from 18 to 72 hours.
Ultrasounds: About half of states (26) have various requirements surrounding pre-abortion ultrasounds. For example, 3 states require the abortion provider shows and describes ultrasound images to the patient before an abortion, while 14 states mandate the patient is given information on how to access ultrasound services.
Penalties for Abortion Providers: An array of legal and financial penalties can be imposed on providers for violating state abortion laws including jail sentences (20 states) for abortions performed after a certain time period in the pregnancy.
Admitting Privileges: Hospital admitting privileges for abortion providers, which means that the provider could admit a patient to a hospital to get tests and treatment, are required in two states and in 8 states this law is enjoined. This means that in event of an emergent complication from an abortion, the physician can admit the patient to a hospital and continue management of their care. In practice, however, when complications from abortion arise, albeit rarely, patients typically present to emergency departments (<1% of the time) that are required by law to evaluate and treat all patients.
Insurance Coverage: The Hyde Amendment restricts federal funding for abortion, except in cases of life endangerment, rape and incest. This affects Medicaid, Medicare, and other federally funded programs. While some states prohibit coverage of abortion services in private insurance plans, some states have enacted laws that require plans to cover abortions.
Overall, twice as many think recent state actions are generally designed to make it more difficult for women to access abortion (67%) rather than protect the health and safety of women (32%). Three-fourths of Democrats (77%) as well as six in ten independents (61%) and Republicans (62%) say these state laws are designed to make it more difficult for women to access abortions. This includes majorities of men (67%), women (67%), and women between the ages of 18 and 49 (66%).
The public overwhelmingly thinks that decisions about abortions should be made by women in consultation with their doctors (79%) rather than having lawmakers decide when abortions should be available and under what conditions (20%). This includes majorities of Democrats (94%), independents (79%), and Republicans (59%), as well as eight in ten women (82%) and women of reproductive age (83%), and three-fourths of men (76%).
A majority of the public say they would like to see their state “pass laws to protect women’s access to abortions” (61%) while four in ten (38%) say they would like to see their state “pass laws to make it more difficult for women to get an abortion.” Attitudes towards state actions are largely partisan with two-thirds of Republicans saying they want their state to pass laws to make it more difficult to get an abortion while a majority of Democrats (85%) and independents (59%) say they want their state to pass laws to protect women’s abortion access. Seven in ten (69%) women between the ages of 18 and 49 want their state to pass laws to protect women’s access to abortions.
However, there is support for some state-level restrictions on women seeking abortions as well as abortion providers. Roughly seven in ten support state laws that would require abortions to only be performed by doctors who have hospital admitting privileges (69%), and a similar share (66%) support laws requiring women to wait 24 hours between meeting with a health care provider and getting an abortion. A smaller majority supports laws requiring doctors to show and describe ultrasound images to women seeking an abortion (57%). The public is divided on laws prohibiting abortions once a fetal heartbeat is detected, which is usually around 6 weeks (49% support, 50% oppose). Majorities oppose making it a crime for either doctors who perform abortions (65%) or women who get abortions (74%).
While majorities of Democrats (56%), independents (72%), and Republicans (82%) support requiring abortions to only be performed by doctors who have hospital admitting privileges, there are partisan differences in support for other state-level actions.
A majority of Republicans support many of the state-level restrictions including a 24 hour waiting period (86%), requiring doctors to show and describe ultrasound images (83%), prohibiting abortions once there is cardiac activity (70%), and making it a crime for doctors to perform abortions that would result in fines or prison time (58%); all of these are opposed by a majority of Democrats.
|Table 1: Support For Laws Restricting Access To Abortion Services Divided Across Partisans|
|Percent who support each of the following laws:||Democrats||Independents||Republicans|
|Requiring women to wait 24 hours between meeting with a health care provider and getting an abortion||50%||70%||86%|
|Requiring abortions to only be performed by doctors who have hospital admitting privileges||56||72||82|
|Requiring doctors to show and describe ultrasound images to women seeking an abortion||34||61||83|
|Making it a crime for doctors to perform abortions that would result in either fines or prison time||14||34||58|
|Making it a crime for a woman to get an abortion that would result in either fines or prison time||10||23||49|
|Prohibiting abortions once cardiac activity, known as fetal heartbeat, is detected||32||49||70|
Attitudes Towards State Laws Are malleable
The poll finds that the public can be swayed on many of these state actions with some changing their opinions after hearing counter-arguments. For example, though about half the public initially supports laws prohibiting abortions once cardiac activity is detected, a majority (60%) say they would now oppose such laws after supporters hear that fetal activity is usually detected around six weeks into pregnancy and before many women know they are pregnant. Overall support for fetal heartbeat laws decrease to 38% after hearing counter-argument.
Seven in ten (69%) originally support laws requiring abortions to only be performed by doctors who have hospital admitting privileges,2 but after supporters hear the argument that complications from abortions are rare and women who need treatment would be able to receive it, regardless of whether the abortion provider has admitting privileges, support drops to about half (52%).
The public is also somewhat supportive of laws requiring private health insurance plans to cover the cost of abortions (53%), a policy that has been enacted in six states. This is supported by a majority of Democrats (76%), about half of independents (52%), and one-fourth of Republicans (26%).
While a small majority of the public initially support such laws, the divided is divided after hearing that this would force employers who may have moral or religious objections to pay for abortions with 52% now opposing these requirements and 47% still supporting.
National Attitudes toward Abortions Five Decades Since Roe v. Wade
It has been nearly five decades since the U.S. Supreme Court issued their landmark ruling on Roe v. Wade establishing a woman’s constitutional right to abortion services. There have been many cases since the Roe decision over the legality of abortion, and the Supreme Court is hearing another case in March 2020, June Medical Services v. Gee. This case is nearly identical to the 2016 Supreme Court case, Whole Woman’s Health v. Hellerstedt, in which the Court ruled that state requirements for physicians who provide abortions to hold hospital admitting privileges place undue burdens on women seeking abortion services and consequently violate their Constitutional rights. The Court also ruled that such requirements do not provide any medical benefits to women. Since the 2016 decision, the composition of the Supreme Court has changed, and some think the Court may overrule its recent precedent established in 2016 and Roe v. Wade could be overturned by a future case.
KFF polling has consistently found that a majority of the public do not want to see Roe v. Wade overturned and the latest KFF poll is no different. Seven in ten (69%) Americans say they do not want to see the Supreme Court overturn Roe v. Wade while 29% of adults say they would like to see the case overturned. Nearly six in ten (57%) Republicans want to see the law overturned while the vast majority of Democrats (91%) and seven in ten independents do not want the Supreme Court to overturn its decision.
In Roe v. Wade, the Supreme Court ruled that a woman’s right to choose to have an abortion falls within their right to privacy before the fetus is viable outside the womb (typically around 24 weeks). Therefore, while states may not ban abortions before fetal viability, states may ban abortions later in pregnancy as long as the laws allow for exceptions for maternal health. A majority of the public (57%) are aware that the Roe v. Wade decision means there are still some cases in which abortion is illegal while four in ten (42%) incorrectly believe the Roe v. Wade decision means that abortion is legal in all cases. Most Democrats (58%) and independents (60%), as well as half of Republicans, are aware that there are still some cases in which abortion is illegal.
If Roe v. Wade was overturned by the Supreme Court, some states have laws that would make abortion illegal immediately. About four in ten (38%) of those living in states with such laws3 are aware that if Roe v. Wade was overturned, abortion would no longer be legal in their state. One-third (35%) of those living in states without such laws are aware that abortion would continue to be legal if the case was overturned.
The Public Holds Complex Views toward Abortion Policy
This poll also delved deeper into the public’s attitudes around abortion services beyond whether they simply want to see Roe v. Wade overturned. Overall, a majority of the public (59%) including majorities of men (56%), women (62%), women between the ages of 18 and 49 (66%), Democrats (84%), and independents (57%) say they are “pro-choice” on the issue of abortion. Two-thirds of Republicans (68%) and conservatives (68%), and seven in ten white evangelicals (72%) identify as “pro-life.”
About one-fourth of the public (27%) and 32% of women between the ages of 18 and 49 say abortion should be “legal in all cases” compared to one in ten (11% of total, and 8% of women between the ages of 18 and 49) who say abortion should be “illegal in all cases.”
Not all those who identify as “pro-life” want to overturn Roe v Wade.
Four in ten U.S. adults identify as “pro-life” on the issue of abortion but this group does not have unanimous views on the legality of abortion services. While the majority of pro-life adults say they want to see the Supreme Court overturn Roe v. Wade, three in ten pro-life adults say they do not want to see the Supreme Court overturn Roe v. Wade (by comparison the vast majority (96%) of “pro-choice” adults don’t want Roe v. Wade overturned). These individuals also are divided on whether abortion should be legal or illegal. About one-fourth (23%) say abortion should be “illegal in all cases” compared to few (3%) who say abortion should be “legal in all cases.” A majority of pro-life individuals think abortion should be legal if the patient’s life is endangered (64%) or in cases of rape or incest (60%).
When should Abortion Be Legal or Illegal?
A majority of the public say abortion should be legal if the patient’s life is endangered (82%), in cases of rape or incest (80%), if the fetus is not expected to survive (75%), or if the fetus is expected to have serious birth defects (71%). A smaller majority say abortion should be legal for women who do not wish to be pregnant (55%).
A majority of women ages 18-49 say abortion should be legal in all of these situations. Large majorities say abortion should be legal if the patient’s life is endangered (87%), in cases of rape or incest (83%), if the fetus is not expected to survive (79%), or if the fetus is expected to have serious birth defects (77%). Six in ten (62%) women of reproductive age say abortion should be legal for women who do not wish to be pregnant.
Reproductive Health Care Issues in 2020 Election
Despite the ongoing court cases and pending state actions regarding reproductive health care, these issues are not resonating with voters as top issues in the upcoming presidential election. While health care ranks among the top issues that Americans want to hear the 2020 presidential candidates talk about during the election year, smaller shares say reproductive health care is the most important issue for the candidates to discuss. About one in five (21%) say health care is “the most important issue” for 2020 presidential candidates to talk about, which is similar to the share who say the same about the economy and jobs (18%). Slightly smaller shares say climate change (15%) and immigration (13%) are the most important issues for the 2020 candidates to discuss. Yet, all of these issues rank higher among the public than equal pay or fair employment practices (6%), reproductive health issues including birth control and abortion (6%), and child care issues such as maternity or paternity leave and universal pre-K (4%).
Health care is the top issue that Democrats want to hear the 2020 presidential candidates talk about with one-third saying it is “the most important issue,” while the economy and immigration rank as the top issues for Republicans (21% and 20%, respectively). Independents are more split with similar shares saying the economy and jobs (16%), health care (15%), and climate change (15%) are the most important issues for the 2020 presidential candidates to talk about. Reproductive health care issues rank low across partisans with small shares of Democrats (6%), independents (4%), and Republicans (7%) saying it is the “most important issue” for candidates to talk about.
Knowledge of Abortion Services
The KFF poll also goes beyond the current abortion policy debates and examines what Americans know about abortion services and finds there are significant knowledge gaps on the prevalence and the overall safety of abortions.
|Box 3: Key Facts about Abortion in the U.S.|
Six in ten (63%) Americans – including 69% of all women and 71% of women between the ages of 18 and 49 – say that they personally know someone, including themselves, who has ever had an abortion. Yet, many do not know when most abortions occur. A majority (69%) incorrectly think most abortions occur 8 weeks or more into a pregnancy and few (11%) are aware that less than 5% of abortions occur more than 20 weeks into a pregnancy.
There are no significant differences among men, women, and women between the ages of 18 and 49 with majorities across groups providing incorrect answers. In addition, only about one-fifth of adults (21%) and one-third of women between the ages of 18 and 49 (36%) have ever heard of Mifepristone, or a medication abortion.
|Box 4: Emergency Contraception vs. Medication Abortion|
|Emergency contraception and medication abortion are distinct treatments, used for different reasons. Emergency contraception is used to prevent pregnancy before it has occurred, while a medication abortion terminates a pregnancy after it has already occurred. Emergency contraception does not cause an abortion.|
|Emergency Contraception||Medication Abortion|
|Purpose||To prevent pregnancy after unprotected sex||To terminate an existing pregnancy|
|Medications Used||Multiple options: Levonogestrel (Plan B), Ulipristal Acetate (Ella) or copper IUD||Most commonly: mifepristone (RU486, Mifeprex) followed by misoprostol (Cytotec)|
|How It Works||Prevents fertilization of the egg by the sperm
Levonogestrel and Ulipristal Acetate: delays or prevents ovulation (release of the egg from the ovary)
Copper IUD: makes sperm less likely to fertilize the egg
|Causes uterus to expel existing pregnancy
Mifepristone: blocks progesterone, a hormone critical for continuing a pregnancy
Misoprostol: causes uterine contractions to expel the pregnancy
|Timing||FDA approved for use within 72 hours after intercourse for Levonogestrel and within 120 hours for Ulipristal Acetate and the copper IUD||FDA approved for use up to 10 weeks gestational age|
Emergency ContraceptiVE PILLS
Most Americans – including the vast majority of women (95%) have heard of emergency contraceptive pills, sometimes called morning after pills or “Plan B.” In fact, the share of women who are aware of emergency contraceptives has increased slightly, up from 84% in 2003, shortly after it was approved by the FDA. Yet, there are still some knowledge gaps surrounding the effects of these pills. While most are aware that emergency contraceptive pills are not the same as the abortion pill (58%) and that they are used to prevent pregnancy after unprotected sex (85%); a substantial share (62%) incorrectly think that emergency contraceptive pills can end a pregnancy in its early stages while about three in ten (29%) are aware that emergency contraceptives cannot end a pregnancy.
Overall, women and men are equally knowledgeable about emergency contraceptives, but women between the ages of 18 and 49 are the most knowledgeable group. Larger shares of women 18-49 than older women (50 and older) know that emergency contraceptives are used to prevent pregnancy (95% and 77%, respectively) and are not the same as the abortion pill (73% and 46%, respectively). Still, less than half of women between the ages of 18 and 49 are aware that emergency contraceptives cannot end a pregnancy in its early stages (44%).
|Table 2: Awareness of emergency contraceptive pills differs by age among women|
|Percent who are aware of the following:||Women, 18-49||Women, 50 and older|
|Emergency contraceptive pills are used to prevent pregnancy after unprotected sex||95%||77%|
|Emergency contraceptives are not the same as the abortion pill||73||46|
|Emergency contraceptives cannot end a pregnancy in its early stages||44||17|
Do Americans Think Abortions Are Safe?
The majority (83%) of adults say abortions performed in a medical setting are either “very safe” (47%) or “somewhat safe” (36%),while one in six (16%) say abortions are either “somewhat unsafe” (8%) or “very unsafe” (7%). While majorities across partisans say abortions are safe, Democrats overwhelmingly hold this opinion with two-thirds of Democrats saying abortions are “very safe.” Majorities of men, women, and women 18-49 all say abortions are at least somewhat safe.
There is still some confusion on how safe abortions are in comparison to other medical procedures. Small shares are aware that abortions are safer than giving birth (26%), getting your appendix removed (23%) and getting your tonsils removed (13%).
|Box 5: Abortion Safety|
|Obtaining an abortion is generally very safe in the U.S. Less than 1% of abortions result in subsequent emergency room treatment due to complications, which makes abortions safer than many other common procedures, such as wisdom tooth removal (7%), tonsil removal (8-9%), appendix removal (13%), and childbirth (29%).|
Most Americans are aware of the truth behind many common myths surround abortions. Majorities say it is “false” that a women who has gotten an abortion has a higher chance of getting breast cancer (86%) or will have a harder time getting pregnant (72%).