We’re a screen-soaked culture, and that means that what we see on TV and in movies often serves as a framework to look at the world around us. That’s certainly true for abortion. It’s still rare to see an abortion depicted, and even more rare to see it in a situation that matches the circumstances of most abortions in America; research has found that the most common abortion patient is a low-income, unmarried young mother, without a college degree, who is seeking her first abortion. The majority of abortion patients in America are non-white.

Yet that’s not the average depiction. And this affects not just what people think about abortion, but how viewers treat people who seek abortions, as well as how they think about public policy.

Steph Herold is an analyst with the Abortion Onscreen initiative at UC San Francisco’s Advancing New Standards in Reproductive Health research group. She’s been speaking with people from across the job spectrum in Hollywood — writers, showrunners, directors, and many more — about their experiences depicting abortion onscreen. Herold spoke by phone about her findings, the truth about Hollywood’s leanings on abortion, and why it matters that its depiction more closely matches reality.

Our conversation has been edited for clarity.

You’ve talked to a lot of people who work in the industry — tell me about your findings.

My colleagues and I study how abortion is portrayed on TV and film. We do a lot of thinking about popular culture and abortion, and what these portrayals tell us about how Americans understand abortion, what messages we receive, where we receive them from, what impact these portrayals have on our beliefs, on our attitudes, on the way that we think about abortion.

There’s this general sense that there aren’t depictions of abortion on television and film, but really that’s not true. Hollywood has always found ways to depict abortion — ways that reflect the politics of the time, going back to the early 20th-century silent films to today’s TV streaming dramas, and movies, and comedies. What’s been problematic is not the absence, but about how abortion has been portrayed.

That’s where a lot of our research comes in. Abortion is one of the safest outpatient procedures in the US. Less than a quarter of 1 percent of abortions result in any kind of major complication. If you compare that to a similar outpatient procedure, like a tonsillectomy, that has a 9 percent complication rate. Abortion’s extremely safe. On TV, about 18 percent of abortions result in some major complication, or result in the person being infertile, or even dying sometimes. It’s more than 70 times the actual complication rate. That really suggests that abortion is dangerous or risky, in ways that it isn’t in reality.

A lot of people hear that and say, “Well, we don’t expect TV to be an exact representation of reality.” Which of course is true. But because abortion is so stigmatized, and such a polarizing issue in our society, people don’t have that common reference point, where they see something on TV and can recognize it’s an exaggerated depiction.

If someone gets in a car accident on TV, you don’t think, “Wow, everyone gets in car accidents.” People have the experience of driving and know how it could be safe. But they don’t have the same thing with abortion, a common reference point.

You’d have to imagine one reason for this is that an ordinary outpatient procedure with no complications doesn’t inherently make for great television. Are there any other reasons, like ideological ones?

We really wanted to understand why all these different kinds of problematic tropes kept emerging. We found that most of the TV characters who get abortions are white, young, wealthy, and not parenting. Compare that to actual abortion patients, who tend to be women of color, parenting, and struggling to make ends meet. We wanted to investigate why showrunners, producers, and writers keep telling this story about a certain patient.

[The typical onscreen patient] also often has a surgical abortion, not a medication abortion, when now we know that the majority of abortions in the US are medication abortions.

We did 46 in-depth interviews with showrunners, producers, writers, executive producers, and story editors who’ve all been involved in writing or producing plots about abortion over the last 20 years or so. We asked, “What motivated you to include abortion in your story?” We were trying to get behind some of it — is this for drama, or is there some political reason? What barriers did you face in getting abortion from the page to the screen? What did you hope the audience would take away?

Their answers were really fascinating. Part of what we found is that, at least among the people that we talked to, there was this real desire to counter the stigmatizing narratives that we’ve found in our research. A lot of the writers we talked to have the sense that abortion is often portrayed as a tragedy, as a decision that’s made out of desperation. They have this sense that they wanted to write something new, where abortion is just a certain routine medical procedure.

Some people really wanted to represent more characters of color. One person even pointed out that where you see abortion stories, they’re about a pretty rich white girl getting pregnant. I was like, “Oh, okay, so people are really noticing these things that we’re finding, too.” They talked about having to argue in their writers’ rooms and with their producers, about finding alternative sources for drama and conflict, taking the emotion out of the medical procedure itself, and putting the emotion on getting access to the abortion, or figuring out who to tell about the abortion.

Some also talked about abortion as a plot device — not wanting to do an abortion plot line for political reasons, per se, but using it as a way to bring characters closer together, or to cause conflict between characters, or to showcase something about a relationship or a marriage.

People kept talking about a particular challenge between men and women. That’s what I often heard about [happening] in writers’ rooms, or between women writers and male showrunners. One person said, “Once a male showrunner decides the direction of an abortion plot line, it’s hard to get him to change his mind, even if he had the details about the abortion wrong.” Another said, “You can hire as many women as you want, but if the people in power don’t listen to them, it doesn’t matter.”

There was a sense that male colleagues would tamper with an abortion plot line or would make it more dramatic for the sake of drama. They felt they had to explain over and over why it’s important to have a normal, simple abortion portrayed on TV, saying, “Okay, yes, we can put the drama somewhere else. We can have the conflict be somewhere else.”

Class and racial disparities in Hollywood had something to do with this too, I’m sure.

It has a lot to do with it. Class, race, and gender all play a really big role in which stories get written, which stories get approved, and what eventually makes it to the screen. From what I heard, it sounds like you have to have a really supportive showrunner who then is willing to go to bat for this plot line and for these characters and stories with the networks, with the executives who may be a little more fearful about any blowback from audiences or from advertisers.

It seems like the people who want to write these stories tend to be people who’ve had personal experiences with abortion, or have friends who do, or the writers that are just getting started, who want to share these different stories than we’ve seen on TV before. That of course tends to be the writers of color, the writers coming from different types of class backgrounds, the women in the room. It’s all of these issues coming to a head.

Have there been trends in how abortion is portrayed over time?

Good question. I talked to writers who have been working in the industry for over 20 years. The majority of people we talked to had an average of about 10 years of being in Hollywood. Some people have been working for even longer, since the ’80s and from the ’90s. Those folks said to me, “It was impossible. There was no way you were going to get an abortion plot line on TV.” The best that you could do would be to have a character consider it. Then that character would either change their mind, or have a miscarriage on the way to the clinic. If you had a character even talk about it, that was huge. Networks were just not interested at all. Showrunners would say, “Okay, this character needs to suffer a little bit more after she has her abortion.” It seems like that has changed quite a bit.

Now, people say networks are more supportive, although it seems like there’s a certain kind of story that they’re willing to tell and risks that they’re willing to take. A character who has an abortion seems okay. An entire series about abortion, not okay. It’s still risk-averse — doing what someone has already done, maybe with a slight twist, instead of taking a risk on a bigger, bolder kind of show.

One person said they had a really big producer on board for their series that was all about abortion, focused on an abortion clinic and its staff. They had a couple of big-name actors and producers on board, and they took it from network to network. No one wanted to touch it. They asked why, and got the same feedback that the writing was great. The setup that they had was great. But the topic — they would never touch that topic. They would never have a show that focused entirely on abortion, that it was too sad, that it was a downer, that it was a bummer. There was this sense that audiences would never tune in for something like that.

To me, that really conveys this fundamental misunderstanding of American attitudes about abortion, a misunderstanding on the part of networks and executives. The majority of people have some experience with abortion, whether it’s having one themselves, or holding someone’s hand having an abortion, driving them to the clinic. Most people are supportive of abortion, and want to see these kinds of stories told on TV.

Studio and network executives in general, I find, don’t really have a great idea of who’s actually in the audience and what their experiences are! And this is a strange assertion when a show like Law and Order: SVU, which is literally about victims of assault, is a huge hit.

Then again, I also find that most people consider Hollywood to be this liberal, progressive paradise, and the reality is that the only real ideology in Hollywood is money.

Exactly. Right. I’m curious, because now that the Supreme Court has overturned Roe v. Wade, I know that there are show writers, and producers, and folks in all kinds of roles who really feel called to tell bigger and bolder stories right now. The question is if networks will give them the resources to do it, and if they will be willing to take on whatever risk they think it is to their business, to advertisers and audiences. Can they give them the same resources that they would give other shows? Can we see billboards about them? Can we see commercials about them?

I think you said it: At the end of the day, these networks are businesses. From what I understand, anyway, it’s mostly about: is this going to sell, or is this going to turn people off?

And I know a lot of the streaming networks also have other things that they sell. You can imagine Amazon, Disney, Apple: Are people going to protest at Apple stores? Will they not buy their diapers on Amazon anymore? Will they not go to Disney parks?

Are there films and TV shows that have managed to break through these institutional barriers?

One that comes to mind is HBO’s Unpregnant, which is very similar on paper to the film Never Rarely Sometimes Always, in which a young white girl from a rural town needs to travel to get her abortion. The movies themselves couldn’t be more different. Never Rarely Sometimes Always is very solemn, almost a horror movie. Unpregnant is a hilarious buddy comedy with lots of hijinks. The director Rachel Lee Goldenberg has talked in interviews about wanting to see her own abortion experience represented on screen.

In another movie, Saint Frances, the producer and writer talked about having a medication abortion and wanting to see that portrayed on screen. That is also a funny, but very poignant movie where there’s a medication abortion. And Obvious Child comes to mind — really the first rom-com in which a character had an abortion. It was also poignant, funny, and touching. Grandma is also a road trip abortion story.

A lot of times, what we’re seeing is a white character who wants an abortion, and ultimately, she’s able to get it. In all of the movies I mentioned, the characters talk about money and they have to travel, so barriers are being portrayed more than they have been in the past. A trend we’ve seen over the last decade is that barriers to abortion are often underportrayed, compared to reality. But some movies and shows are starting to portray the barriers that real people face.

What do you think will turn the tide?

Mostly it’s if people watch the abortion content. It shows that there is an audience for this, that there are people who want to watch these types of stories, that get excited about these types of stories. A lot of writers do scroll on Twitter and other social media to see the reaction to a TV episode.

If you see an abortion plot line that you really liked, talk about it publicly. Say what you liked about it. Tag the writers or tag the producers, so they can see what you’re saying. For the people in charge, seeing that there is no blowback is good, but also seeing that there is actually excitement and enthusiasm would go a long way, too.