Abortion AF: Introducing Abortion Access Front’s Comedy-based Health Intervention

By Amy E. Alterman

Acknowledgement: For Abortion Access Front, who teach me about agility, dedication, kindness and how to “walk the walk” of feminist activism.

Meeting AAF

June 22^nd, 2018, Columbus, Ohio. It’s my opening night in Abortion Access Front’s traveling comedy show “Abortion AF: The Tour.”[1] No, I am not a performer in the show, but researchers have opening nights too. The members of Abortion Access Front (AAF) describe themselves as a pro-abortion[2] “coven of hilarious badass feminists who use humor and pop culture to expose the haters fighting against reproductive rights.”[3] “Abortion AF: The Tour” is their annual multi-city, stand-up comedy show that celebrates independent abortion providers while strengthening their local community support networks. And here I am, emerging from my clunky, old Subaru, after four days on the road from UCLA—notebook in hand, business cards in pocket, donning a feminist t-shirt—hoping to volunteer with the organization and learn more about how stand-up comics use humor to destigmatize abortion and support abortion clinics.

I sit in the back of the venue, scrawling notes in the low light of the merchandise table next to the other volunteer, Marisa.[4] We are still technically working the “merch” table and need to stay close. Marisa and I bond while conducting our merch-table duties throughout the night—applying golden uterus tattoos to audience members’ hands and biceps, facilitating the postcards Thank Bank project, and dispensing t-shirts that display phrases such as: “Property of No One,” “Abortion AF: The Tour,” and “Lady Parts Justice” with a uterus in a cowboy hat riding an American Eagle (my personal favorite).[5] Furiously writing in dark-room chicken scratch, I try to capture quotes from the comics when I can, while laughing with Marisa at the punch lines.

The lineup is excellent, and the comics are killing! An all-women line-up, they joke about dire political realities for women and people of color.[6] They focus on the impending doom for abortion access, and their various coping mechanisms for surviving the patriarchy. AAF creator and comic Lizz Winstead drops facts about abortion access, such as the realities about mandatory waiting periods and gestational limits.[7] She quips, “What’s next, Ohio? Next thing you know exfoliating will be illegal here!”[8] The audience roars. Although horrified at the current state of affairs, the joke allows me to release the tension of the news, while also laughing at the ridiculousness of the people who propose these regulations in the first place.

Next up is comic Joyelle Johnson. She describes herself as “the protest whisperer” at anti-abortion[9] protests, throwing male anti-abortion activists off their game by saying things like, “I’m sorry for your loss,” after they admit that they voted for Trump.[10] She explains that she responds this way because “no one who voted for Trump has a big dick…it’s very sad for them!”[11] She laughs and the audience joins her. I delight in hearing her insult the hyper masculinity of male Trump voters, while amusing herself (and us).

Then, Beth Stelling, the audience’s home-state performer and headliner, takes the stage. I lean over in anticipation, clutching my notebook and pen when Marisa lightly taps my arm. She begins to excitably whisper in my ear. I turn my body away from Stelling and towards her. She whispers that she had an abortion and has never talked about it until this moment—she never felt like she really could after hearing messages from close family and friends that it was wrong.  She elaborates that seeing so many people, in the same room, who support abortion and can joke about it shocks, comforts, and motivates her to be vocal about her experience.

We refocus on the stage for the second part of the show—the talk-back. The stage transforms to resemble an informal panel set-up with chairs aligned in a half-moon shape towards the audience. Lizz moderates a discussion about abortion access with representatives from the local abortion clinic and other aligned non-profits. To my surprise, not one audience member leaves. In fact, the audience appears just as captivated as they did during the show. Lizz wields their attention to focus on the voices of the local providers.

She asks providers about the challenges they face. They respond discussing the difficulties securing vendors for basic maintenance, the extreme targeted harassment of clinic staff, and the lack of support many of them experience from their own friends and family. I watch the faces of the crowd as they listen—many appear surprised and several seem angry that providers experience multiple and accumulating injustices to provide essential healthcare such as abortion. Lizz then poses the question: “What can we, the audience here, do to support you?”[12] Each panelist provides an answer and gestures to their respective organization’s tables where they collect volunteer emails, accept donations, and disseminate educational materials. NARAL Ohio says they need people at their upcoming advocacy day event.[13] The local clinic needs volunteers to enroll for clinic escorting. And of course, the practical abortion fund, Women Have Options, need donations to support patients accessing abortion, such as procedure, travel, and childcare fees.[14] They all implore the crowd to prioritize abortion when voting. The audience thanks them for their work with exuberant applause. Many give the providers a standing ovation.

After the talk-back, Marisa leans in with a warm smile and says, “What Abortion Access Front does, it’s really powerful.” She meets my gaze and insists, “I want to be active now” and strolls to the NARAL table to learn more.[15] In this moment, I realize that in witnessing Marisa’s engagement, I am experiencing the crux of what AAF does on their tour. They use comedy as an instigator of fun and a mode of feminist analysis to relax, involve, as well as educate the audience—enabling audience members to open, transform, and reclaim the conversation about abortion with themselves and each other. Then, through the talk-back and tabling portion of the event, they provide audience members with the knowledge and tools to support abortion patients, abortion providers, and their communities.

***

“Abortion AF: The Tour” is not just a comedy show. It’s an intervention, a public health intervention. Abortion Access Front employs a unique methodology of using stand-up comedy for abortion education and community mobilization. Through the format of the show, they challenge abortion stigma, educate about antiabortion activist tactics and abortion policy, convey the precarity of providing abortions in their community, and enable the audience to support their local clinic and pro-choice organizations—right then and there.

The story of my first night meeting AAF demonstrates the power and potential of their work. Drawing from this example, I will now contextualize their groundbreaking work. By describing how they use stand-up comedy and the format of the comedy show to destigmatize abortion and support independent providers, I demonstrate the tour’s potential as an innovative public health intervention. I conclude with the ways AAF ignited my own commitment to reproductive rights and justice—not just as a researcher, but as an activist too.

Stand-up: Busting Abortion Stigma

Abortion stigma is pervasive in the United States and permeates all aspects of the relatively safe procedure. In their systematic review of abortion stigma literature, Hanschmidt et al. clarify that sources of abortion stigma include significant others, medical institutions, community, and society.[16] Researchers highlight that most women who have had abortions report self-judgment and a need for secrecy, as well as fear of social judgment.[17] Ellen M. H. Mitchell, Anurada Kumar, and Leila Hesseni specify that abortion “marks” women who seek to terminate a pregnancy as inferior according to traditional “ideals of womanhood” (i.e., culturally and historically specific notions that vary depending on the person’s unique positionality within society).[18] Additionally, they assert that abortion stigma is a “compound-stigma,” as it builds upon other forms of discrimination and structural injustices, such as sexism, racism, and classism.[19]  Allison Norris et al. expand the causes of abortion stigma to include “attributing personhood to the fetus, legal restrictions, the idea that abortion is dirty or unhealthy, and the use of stigma as a tool for anti-abortion efforts.” [20] Researchers also insist that abortion stigma is pervasive, impacting patients, providers, and their friends and families.[21] Abortion stigma saturates abortion discourse and limits access to services in the United States.[22]

Abortion Access Front uses stand-up comedy to combat abortion stigma. When comics poke fun at the system that stigmatizes them and often come out as having abortions themselves, the opportunity for the audience to (re)frame abortion in a positive way becomes a possibility. In Performing Marginality: Gender, Humor, and Cultural Critique, Communication Studies scholar Joanna Gilbert explains that stand-up comedy specifically can be transgressive because it has the ability to disarm and relax the audience into listening and understanding.[23] She says this happens particularly when comics perform marginalized humor, which includes jokes that poke fun at the process of marginalization based on gender, race, ethnicity, sexuality, etc. She admits that although these events may not immediately change existing power structures, the “inherently subversive power of humor” makes jokes a good place to start.[24] For some audience members, the AAF show is one of the rare occasions they have heard the word “abortion” spoken—multiple times. Additionally, it may be the first time they learn that using language such as pro-abortion (rather than pro-choice) and anti-abortion protestor (rather than pro-life protestor) does important rhetorical and cultural work to destigmatize abortion.

By way of jokes and stories on the stand-up stage, AAF comics demonstrate how humor can help start (and shift) a conversation about abortion. For instance, the specific joke work AAF comics engage in not only educates audiences about abortion, but also identifies the problematic power dynamics between legislators, providers, and patients. For example, when Lizz Winstead makes fun of Ohio legislators for recent gestational ban bills, she teaches the audience about the anti-abortion legislation in their own state. Simultaneously, she mocks legislators who seek to control reproduction and identifies their faulty logic by comparing the fusion of egg and sperm cells with dead skin cells.

Talk-back: Supporting Indie Providers

AAF focuses on supporting independent clinics because in the United States, abortion access hinges on the ability of independent providers (i.e., anyone employed by an independent clinic) to keep their doors open and serve patients; yet, they don’t have much support.[25] The term “independent abortion clinic” usually connotes any clinic that is not Planned Parenthood, a hospital, or an individual doctor’s office. Such clinics provide the majority of abortions in the US (58 percent), often without the institutional and funding support that their colleagues at larger national health centers and hospitals receive.[26] AAF centers these providers and seeks to connect them to potential supporters.

In their recent book Obstacle Course, The Everyday Struggle to Get an Abortion in America, David S. Cohen and Carole Joffe explain that abortion access barriers exist and are perpetuated primarily due to pervasive “abortion exceptionalism.” [27] They define abortion exceptionalism as “the idea that abortion is treated uniquely compared to other medical procedures that are comparable to abortion in complexity and safety.”[28] They show that the multiple unnecessary barriers to abortion, often disguised as for the “safety” or “wellbeing of the mother,” are not about the health of the pregnant person at all, but stem from the politicization of abortion.[29] These barriers create unique and unnecessary obstacles for providers and patients, and compound other problems patients may experience.

In the United States, independent abortion providers are profoundly impacted by external stressors including Targeted Regulation of Abortion Providers laws (TRAP laws),[30] anti-abortion harassment and violence, funding and business challenges, insurance limitations, and stigma.[31] As a result, in the past five years, clinics have closed at a rapid and troubling pace, with five states in the South and Midwest (Mississippi, North Dakota, West Virginia, Missouri, South Dakota) left with only one remaining clinic .[32] The clinics left in Mississippi, North Dakota, and West Virginia are all independent clinics. Despite the fact that independent abortion clinics require community support in order to remain in operation, there are few, if any, health interventions specifically designed to increase abortion access by focusing on increasing community support at the clinic-provider level.

“Abortion AF: The Tour” is one of the few organizations that focuses on the clinic-provider level, and they are the only performing arts organization. Their unique comedy tour format can be categorized into three parts: (1) clinic service day, (2) protests and counter protests, and (3) comedy show. Attracting anywhere from 100-400 people (depending on the venue), the comedy shows act as the locus of the intervention, spotlighting the clinics and their needs, thereby connecting the clinic to the community, as well as connecting community members to one another.

Because of the low-profile independent clinics often maintain due to safety concerns,[33] they have few, if any, opportunities to reach out to their communities. Not only do many providers feel that they cannot be open about their work due to anti-abortion harassment, but some providers report reluctance to disclose their jobs to their own family members and friends for fear of negative repercussions. Furthermore, many clinics have limited capacity and simply do not have enough time and/or money for community outreach and communication. Abortion Care Network, the non-profit independent clinic support organization, insists that clinics need the support of their communities to survive and thrive.[34] Abortion access depends on it.

But is it a health intervention? Educate & Activate.

Still in its relative infancy, arts-based health interventions reveal the possibilities for engaging, funny, and collaborative theater-based interventions that confront fear with comedy and use storytelling to humanize stigma. For example, Cockrill et al. launched an arts-based, storytelling intervention to reduce abortion stigma and found that exposure to first-person abortion stories may reduce stigma toward women who have abortions.[35] Additionally, Arts Activism Scholars David Gere and Robert Gordon, implemented a theatre-based health education intervention, which demonstrated that storytelling and humor work as effective apparatuses to spark honest and educational conversations about stigmatized topics.[36]

Like these examples, AAF also uses comedy to start conversations, debunk myths, share personal narratives, and work towards destigmatizing abortion. Additionally, they use their comedy and the talk-back to center abortion providers and educate about abortion access. Through the talk-back and tabling, they activate potential supporters—right then and there—to assist independent providers. Ultimately, these strategies effectively contribute to expanding abortion access—and it’s fun!

A Love Letter

Filled with accumulating anxiety since November 6^th, 2016, when president #45 was elected, I’ve been consumed with a foreboding and powerless sense that everything I care about is rapidly disintegrating before my eyes. Since meeting AAF, that feeling has dissipated. Even on that first night from unstacking chairs to writing postcards for abortion providers to laughing with my whole body, I felt like I was working for something that I cared about. I felt like a part of a community. And in the two years of fieldwork that followed, I observed them ushering in joy, laughter, and a willingness to stand up loudly for abortion rights. I saw them physically and emotionally labor around-the-clock. I felt like I could see—quite literally—how AAF lightened the load for providers. My experiences with them ignited a new purpose for me—to be active as an abortion researcher and as an abortion activist.

 

Amy Elizabeth Alterman (MPH) is a PhD Candidate in Culture and Performance. Working at the nexus of performance studies, gender studies, anthropology, and public health, she applies feminist and performance theory to current sexual and reproductive health problems. Based on 2 years of ethnographic research, her dissertation analyzes the obstacles, resiliencies, and support networks associated with independent abortion clinics in the United States—spotlighting the Abortion Access Front comedy show as an arts-based public health intervention. Her work has been published in Contraception, The Journal of Adolescent Health, and others. Alterman is the recipient of the CSW 2019-2020 Jean Stone Dissertation Fellowship.

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[1] “Abortion AF: The Tour” is the name of Abortion Access Front’s annual comedy tour which has occurred in similar formats since 2017 (excluding 2020 due to COVID-19 travel restrictions). Technically, this experience is taken from my fieldnotes from June 2018. At that time the tour was called “Lady Part’s Justice League’s Vagical Mystery Tour.” In 2019, the organization formerly known as Lady Parts Justice League changed its name to “Abortion Access Front.” Read more about their name change here: https://www.aafront.org/lady-parts-justice-league-name-change/. Read more about their annual tour here: https://www.aafront.org/the-abortion-af-tour/.

[2] Abortion Access Front (AAF) does not use “pro-choice” language but identifies as “abortion activists” or “pro-abortion.” For both of these reasons, I avoid using choice-based language unless I am specifically referring to organizations that, unlike AAF, explicitly identify as “pro-choice.” Many organizations that advocate for abortion identify as “pro-choice.” Rosalind Petchesky and other reproductive justice advocates have problematized this term because it implies that some women, in fact, have a choice. In fact, regardless of abortion’s legal status, many women do not have the choice to receive one due to many factors, including geographic location and cost. Additionally, “choice” language tends to de-emphasize abortion, perpetuating abortion silencing and stigma.

[3] Abortion Access Front, “Abortion Access Front,” accessed December 17, 2020, https://www.aafront.org.

[4] “Marisa” is a pseudonym. I received oral permission to use her name. However, including her full name is not necessary.

[5] AAF’s “Thank Bank” project asks people to write thank-you postcards for independent abortion providers. Once collected, AAF sends the cards to providers across the country, throughout the year. The front of the postcard features a feminist illustration designed by AAF. AAF facilitates their Thank Bank project at almost every event they organize. So far, they have sent 6,534 postcards (and counting). Abortion Access Front, “Abortion Access Front Thank Bank,” accessed December 17, 2020, https://www.aafront.org/thank-bank/.

Additionally, the shirts originally said “Vagical Mystery Tour” instead of “AAF: The Tour.” I have changed the writing on the shirt here to avoid confusion.

[6] My use of the term “women” as an individual or small-group descriptor connotes people who identify as women. When I use women in reference to public health studies, it means people who were born with uteruses, whether they identify as women or not (as this is how their data is collected). When I refer to women in the context of the feminist movement and activism in general, I am referring to people who identify as women and people with uteruses (who may or may not identify as women). Notably, AAF specifies that they are a trans and Gender Non-Conforming (GNC) or Gender Non-binary inclusive organization on their website. When Lizz speaks about abortion restrictions, she describes them as specifically concerning the bodies of “women and people with uteruses.”

Abortion Access Front, “Abortion Access Front About Us,” accessed December 17, 2020, https://www.aafront.org/about-us.

[7] For more information on mandatory waiting periods, see “Waiting Periods for Abortion,” Guttmacher Institute, accessed December 17, 2020, https://www.guttmacher.org/evidence-you-can-use/waiting-periods-abortion.

[8] Alterman, fieldnote, June 2018.

[9] Instead of “anti-choice,” I adopt AAF’s language and use “antiabortion.” They also use “antis” instead of “pro-life” because they do not believe that antiabortion activists are, in fact, “pro-life.” They assert that they are antiabortion (and usually anti-woman).

[10] Alterman, fieldnotes, June 2018.

[11] Alterman, fieldnotes, June 2018.

[12] Alterman, fieldnotes, June 2018.

[13] To learn more about this organization, see: NARAL Ohio, “About Pro-choice Ohio,” accessed December 17, 2020, https://prochoiceohio.org/.

[14] To learn more about this organization, see: Women Have Options, “Making Reproductive Rights a Reality,” December 17, 2020, http://www.womenhaveoptions.org/.

[15] Alterman, fieldnotes, June 2018.

[16] Hanschmidt, Franz, Katja Linde, Anja Hilbert, Steffi G. Riedel-Heller, and Anette Kersting, “Abortion Stigma: A Systematic Review,” Perspectives in Sexual and Reproductive Health 48, no. 4 (2016): 169-77, accessed December 17 2020, https://doi.org/10.1363/48e8516.

[17] Hanschmidt et al., “Abortion Stigma,” 170.

[18] Kumar, Hessini, and Ellen M.H. Mitchell, “Conceptualising Abortion Stigma,” Culture Health Sexuality 11, no. 6 (2009): 625–39, accessed December 17, 2020, https://doi.org/10.1080/13691050902842741.

[19] Kumar and Mitchell, “Conceptualising Abortion Stigma,” 634.

[20] Norris, Alison, Danielle Bessett, Julia R. Steinberg, Megan L. Kavanaugh, Silvia De Zordo, and Davida Becker, “Abortion Stigma: A Reconceptualization of Constituents, Causes, and Consequences,” Women’s Health Issues 21, no. 3 (2011): S49-54, accessed December 17, 2020, https://doi.org/10.1016/j.whi.2011.02.010.

[21] Norris and Becker, “Abortion Stigma.”

[22] For a discussion of the many ways in which abortion stigma negatively impacts abortion access see: Cohen, David S., and Carole Joffe, Obstacle Course: The Everyday Struggle to Get an Abortion in America (Oakland, California: University of California Press, 2020); Ostrach, B., and M Cheyney, “Navigating Social and Institutional Obstacles: Low-Income Women Seeking Abortion,” Qual Health Res 24, no. 7 (2014): 1006–17, https://doi.org/10.1177/1049732314540218; Autorino, Tommaso, Francesco Mattioli, and Letizia Mencarini, “The Impact of Gynecologists’ Conscientious Objection on Abortion Access,” Social Science Research 87 (2020): 102403, https://doi.org/10.1016/j.ssresearch.2020.102403; Coast, E, A H Norris, A M Moore, and E Freeman, “Trajectories of Women’s Abortion-Related Care: A Conceptual Framework,” Soc Sci Med 200 (2018): 199–210, https://doi.org/10.1016/j.socscimed.2018.01.035.

[23] Gilbert, Joanne R., “Performing Marginality: Comedy, Identity, and Cultural Critique,” Text and Performance Quarterly 17, no. 4 (1997): 317–30, https://doi.org/10.1080/10462939709366196.

[24] Gilbert, “Performing Marginality,” 167. For more on how stand-up performances do the explicit work of feminist politics through joke material and delivery, see: Auslander, Philip. “Brought to You by Fem-Rage: Stand-up Comedy and the Politics of Gender,” in Acting Out: Feminist Performances, ed. Lynda Hart and Peggy Phelan (Ann Arbor: University of Michigan Press, 19); Lockyer, Sharon, “From Toothpick Legs to Dropping Vaginas: Joan Rivers ’ Stand-Up,” Comedy Studies 2, no. 2 (2014): 113–23, https://doi.org/10.1386/cost.2.2.113; Merrill, Lisa, “Feminist Humor: Rebellious and Self-affirming,” Women’s Studies 15, no. 1–3 (1988): 271–80, https://doi.org/10.1080/00497878.1988.9978732.

[25] Abortion Care Network, “Communities Need Clinics: The Essential Role of Independent Abortion Clinics in the United States,” 2020. https://abortioncarenetwork.org/wp-content/uploads/2020/12/CommunitiesNeedClinics-2020.pdf.

[26] Abortion Care Network, “Communities Need Clinics,” 2.

[27] Cohen, David S., and Carole Joffe, Obstacle Course: The Everyday Struggle to Get an Abortion in America (Oakland, California: University of California Press, 2020).

[28] Cohen and Joffe, Obstacle Course, 8.

[29] Cohen and Joffe, Obstacle Course, 9.

[30] Targeted Regulation of Abortion Providers (or “TRAP laws”) are laws which attempt to restrict abortion by unnecessarily regulating physicians (i.e., requiring hospital admitting privileges and OBGYN certification) and abortion facilities (i.e., requiring structural standards comparable to surgical centers, transfer agreement with nearby hospital, and other specific and unnecessary facility requirements). For an up-to-date (as of December 2020) table of current TRAP laws in the United States, see “Targeted Regulation of Abortion Providers,” Guttmacher Institute, last modified December 1, 2020, https://www.guttmacher.org/state-policy/explore/targeted-regulation-abortion-providers.

[31] Joffe, Carole, “Abortion Providers and the New Regulatory Regime: The Impact of Extreme Reproductive Governance on Abortion Care in the United States,” Revue de Recherche En Civilisation Américaine, no. 8 (2018); Cohen and Joffe, Obstacle Course, 2020; Abortion Care Network, “Communities Need Clinics,” 2020; Summit, Aleza K., Ian Lague, Miranda Dettmann, and Marji Gold, “Barriers to and Enablers of Abortion Provision for Family Physicians Trained in Abortion During Residency,” Perspectives on Sexual and Reproductive Health 52, no. 3 (2020): 151–59, https://doi.org/10.1363/psrh.12154.

[32] Since 2021, the overall number of independent clinics has decreased 34 percent. In 2019 alone, 27 independent clinics have shuttered. Furthermore, 76 percent of the 41 independent clinics that have closed over the past two years provided abortion care after the first trimester. These closures have disproportionately affected abortion availability after the first trimester, ultimately diminishing meaningful abortion access. Abortion Care Network, “Communities Need Clinics,” 4, 8, and 9.

[33] Jacobson, Mireille, and Heather Royer, “Aftershocks: The Impact of Clinic Violence on Abortion Services,” American Economic Journal: Applied Economics 3, no. 1 2011): 189–223, https://doi.org/10.1257/app.3.1.189; National Abortion Federation, “2018 Violence and Disruption Statistics,” n.d.; Russo, J A, K L Schumacher, and M D Creinin, “Antiabortion Violence in the United States,” Contraception 86, no. 5 (2012): 562–66, https://doi.org/10.1016/j.contraception.2012.02.011.; Feminist Majority Foundation, “2018 National Clinic Violence Survey,” 2019, https://www.feminist.org/anti-abortion-violence/images/2018-national-clinic-violence-survey.pdf; Cohen, David S., and Krysten Connon, Living in the Crosshairs: The Untold Stories of Anti-Abortion Terrorism (New York: Oxford University Press, 2015).

[34] Abortion Care Network, “Communities Need Clinics: The Essential Role of Independent Abortion Clinics in the United States,” 2020. https://abortioncarenetwork.org/wp-content/uploads/2020/12/CommunitiesNeedClinics-2020.pdf.

[35] Cockrill, K, and A Biggs, “Can Stories Reduce Abortion Stigma? Findings from a Longitudinal Cohort Study,” Cult Health Sex 20, no. 3 (2018): 335–50, https://doi.org/10.1080/13691058.2017.1346202.

[36] Gordon, Robert, and David Gere, “Sex Squad: Engaging Humour to Reinvigorate Sexual Health Education,” Sex Education 16, no. 3 (2016): 324–36, https://doi.org/10.1080/14681811.2015.1120193.