Abortion is a reliably contentious topic, and social media abounds with longstanding and ongoing arguments between those who self-identify as “pro-choice” and those who identify as “pro-life.” While both protagonists use information gleaned from supportive sources, government sources, and occasionally sources such as Guttmacher, very few actors in the arguments refer to information gleaned from the appropriate physicians: OB/GYNs. As a result, many arguments are flawed and based on misconceptions and misunderstandings.


 

In early February 2019, we observed several thousand tweets on multiple abortion discussion threads. This article analyzes those tweets, examining how proponents use sources to support or describe their own position, or to undermine or contradict that of their opponents in the argument. We are not focusing on any of the typical perspectives of the abortion debate, and we grant each “side” of the debate their chosen self-identification. Additionally, we are taking no side on the issue. An interesting phenomenon was observed regarding where the two groups go for knowledge, but perhaps more importantly, where the adversaries do NOT go for support of their positions: doctors.

It was noted that both pro-life and -choice arguers used terminology and classification in ways that were self-serving and tautological and used to anticipate argumentative attack but were all but useless to clarify clinical situations and decisions. For example, pro-life arguers frequently used “baby” in a highly ambivalent manner—sometimes referring to neonates, other times to everything from blastocyst to adolescent. This resulted in many arguments being simply about terminology and semantics, yet making forceful medicolegal conclusions.

A key discovery is that vanishingly few of the adversaries on either side of the arguments made points that were even remotely relevant to how clinical decisions are actually being made and showed remarkable lack of insight into clinical decisions. Many accusations, choices of topic, or assumptions related to a lack of understanding of the clinical process, the actual medicolegal considerations used in abortion decisions, or the ways in which clinical decisions are typically made.

Ancient Greeks

Many pro-life protagonists made frequent reference to the Hippocratic oath and the teachings of ancient Greek philosophers, such as Plato and Aristotle. According to the ancient oath, doctors swear “Similarly I will not give to a woman a pessary to cause abortion.” They argued that modern doctors should be making clinical decisions according to the tradition of doing no harm but were confused over what this meant in real terms in clinical decision making. Notably lacking in the arguments were any consideration of triage or relative risk evaluation by the OB/GYN.

Government Data

Although both groups used governmental data to support arguments, they also both expressed doubt that government institutions either collected the right data or that they did so in a trustworthy manner. On the pro-life side was a general animosity toward government and suspicion that the data was untrustworthy, while those on the pro-choice side expressed doubt that government was in fact upholding the accepted law and may be undermining access, and they suspected the data of being manipulated to hide the effects of reduced access to care.

Guttmacher

Pro-life and -choice arguers both used Guttmacher Institute data and reports to support their arguments, even when the arguments had diametrically opposed positions using the same data. Unfortunately, the data often did not adequately encompass the subject of any of the arguments, which were most frequently about the medical or other considerations in abortions after viability. As a result, the arguers frequently made extensive extrapolations and inferences that were not supported by the available data.

OB/GYNs

The biggest feature of the arguments was the almost total lack of consultation with OB/GYNs. Both pro-choice and pro-life arguers made sweeping statements and picked positions that suggested they had little clinical insight or experience, yet had not asked an OB/GYN to clarify. When questioned on this directly, most admitted that they had not asked an OB/GYN to explain. Where clinicians were consulted or cited, these were all to specialties that are far-flung from OB/GYN, such as radiology and dentistry.

Many of the arguments were positioned in ways that had little or no bearing on clinical decision making or the medicolegal criteria involved in abortions. This led to arguments that were obviously frustrating to both the pro-choice and pro-life protagonists but did not enable either to make any progress or reach any kind of mutual understanding. For example, several pro-life arguers posted pages of Tweets making very forceful proclamations that a fetus is human and felt that this was highly germane to clinical decision making. While no physician is likely to disagree about an embryo being human, they may be perplexed over why this was raised as a point. What was unclear to pro-life arguers was how a clinical decision is made in practice and what criteria are actually used. Pro-choice arguers, in turn, made highly forceful arguments about fetal dependency and often focused solely on the mother’s body, which ignores the actual medicolegal and triage deliberations that OB/GYNs must make.

The key questions to which none of the protagonists had suitable information or understanding included:

  • In practice, why are women seeking abortions post-viability?
  • How does the clinician infer viability, and what methods and tests are used to determine this?
  • How are triage decisions made when there is a choice of risk-shifting between fetus and mother?
  • What role does maternal health risk play in post-viability abortion decisions?
  • What are the key factors used in practice to decide if a fetus that is past normal post-viability gestation is terminal?
  • What role does fetal or neonatal palliative care play, what conditions are typically involved, and what care is used?
  • What role does prenatal testing, such as amniocentesis, play?
  • What role do stress and mental health factors play?

 

Path Forward?

Although most OB/GYNs may be highly reticent to speak about abortion on social media, there is an opportunity for OB/GYNs to inform people at an individual level, as well as informing male patients, which may be highly effective in improving public understanding of the clinical processes and issues.

Many of the most foundational misunderstandings could be dealt with, and the discussion reframed in more relevant and accurate ways that help both pro-life and pro-choice protagonists to adjust their positions and opinions to be more productive. Instead of somewhat metaphysical arguments and sophistry, the public debate could shift to the real-world and practical issues encountered in the clinical setting.

While we shouldn’t expect the disagreements between pro-life and pro-choice protagonists to dissolve, more information flowing from OB/GYNs may help to make the adversaries go on the same terrain, and for the public understanding of the real, clinical issues to improve.