Reproductive Health Care Coverage
What Should Health Care Plans Cover?
There is nearly unanimous agreement (92%) among Americans that most health insurance plans should cover testing and screening for sexually transmitted infections (STIs), such as HIV. There is also broad agreement that most health insurance plans should cover prescription birth control (85%) and infertility treatments (72%). Americans are more divided over whether erectile dysfunction medications, such as Viagra, should be covered: 50% are in support while 47% are opposed. About four in ten (43%) Americans say abortion services should be covered under most health care plans. A majority (53%) say these services should not be covered.
Women are generally more inclined than men to say that all of these health services should be covered by most insurance plans, even erectile dysfunction medications, although the gender gap varies by service type. More than nine in ten women (94%) and men (91%) say STI screening and testing should be covered by health insurance plans. A similar number of women say that health insurance should cover prescription birth control, while men are somewhat less likely to say this should be covered (91% vs. 79%). More than three-quarters (77%) of women and roughly two-thirds (68%) of men say infertility treatments ought to be covered by most health insurance plans. A majority (53%) of women say erectile dysfunction medications should be covered in health insurance plans while fewer than half (46%) of men agree. But there is some variation on this question among men of different ages. Middle-aged men (age 50-64) are more likely than young men (age 18-29) to say erectile dysfunction medications ought to be covered by insurance (54% vs. 43%).
Coverage for Abortion Services
Americans are sharply divided over whether health care plans should generally cover abortion services. There are critical fault lines along age, race and ethnicity, religion, and party affiliation, although notably not gender.
Fewer than half of women (45%) and men (42%) say abortion services should be covered by most health insurance plans. A majority of women (51%) and men (55%) say these services should not be covered.
A majority (52%) of young adults say abortion services should be covered by most health care plans. Only 42% of seniors (age 65 or older) say abortion services should be covered.
Black Americans are far more likely than white and Hispanic Americans to believe that abortion services should be covered by most health care insurance plans. Nearly six in ten (59%) black Americans say abortion services should be covered, while only about four in ten white (41%) and Hispanic (40%) Americans agree. There are no significant attitude differences by gender among black, white, and Hispanic Americans.
Religious affiliation is also a major dividing line on this issue. Just one in five (20%) white evangelical Protestants say abortion services should be covered in most health insurance plans. In contrast, more than four in ten Catholics (42%) and white mainline Protestants (46%) say abortion services should be covered. Majorities of black Protestants (56%) and religiously unaffiliated Americans (57%) say abortion services should be covered by most health insurance plans.
Partisan differences are extreme. Two-thirds (67%) of Democrats say abortion services should be covered in most health insurance plans, compared to only 21% of Republicans. More than three-quarters (76%) of Republicans say abortion services should not be covered. Political independents closely track the views of the public overall.
Government Health Insurance Programs: Contraception and Abortion
Americans overwhelmingly believe that government health insurance programs for low-income women, like Medicaid, should cover the cost of prescription contraception. Eighty-three percent of the public say prescription contraception should be included in programs like Medicaid. Only 15% say it should not.
There is widespread agreement on this issue. Even partisans largely agree. Three-quarters (75%) of Republicans and 93% of Democrats say that government health insurance programs for low-income women should cover prescription contraception.
Americans are more divided on whether these types of programs should cover abortion services. Nearly half (46%) of the public says that government health insurance programs for low-income women, like Medicaid, should cover abortion services, while more than half (51%) say they should not. Americans are divided on this question by education and party affiliation, and to a lesser degree by race and ethnicity, but there are not substantial divisions by gender.
Men and women have nearly identical views on the issue. Fewer than half of men (45%) and women (47%) say government health insurance programs should cover abortion services.
Racial and ethnic differences are modest. A majority (52%) of black Americans and fewer than half of Hispanic (47%) and white (43%) Americans say abortion services should be covered under government health insurance for low-income women.
Notably, there are profound differences by education level among white Americans. A majority (54%) of whites with a four-year college degree, compared to only 37% of whites without a four-year college degree, say government health insurance for low-income women should cover abortion services. The education gap is slightly larger among white women than white men. Nearly six in ten (59%) white women with a four-year college education, compared to only 39% of white women without a four-year college education, say such programs should cover abortion services. Half (50%) of white men with a four-year college degree say these programs should cover abortion services, compared to 35% of white men without the same degree.
Partisan differences again loom large. Two-thirds (67%) of Democrats, but only one-quarter (25%) of Republicans, say government health insurance programs, like Medicaid, should include coverage for abortion services.
The Legality of Abortion
Stability of Attitudes About the Legality of Abortion
A majority (54%) of Americans say abortion should be legal in all or most cases, while about four in ten (43%) say it should be illegal in all or most cases. There has been little change in public views on abortion legality over the last decade. In 2008, 57% of Americans said abortion should be legal in all or most cases, while 36% said it should be illegal in all or most cases.1
There are particularly notable divisions on the legality of abortion by religious affiliation. With the exception of white evangelical Protestants majorities of every other major religious group believe that abortion should be legal in all or most cases. About one-third (32%) of white evangelical Protestants say that abortion should be legal in all or most cases, compared to about two-thirds (66%) who believe that it should be illegal in most or all cases; notably, even among white evangelical Protestants, only 19% say abortion should be illegal in all cases. In contrast, majorities of Catholics (52%), white mainline Protestants (55%), and black Protestants (60%) say abortion should be legal in all or most cases, as do nearly three-quarters (74%) of religiously unaffiliated Americans.
While a majority of Democrats (71%) and political independents (56%) believe abortion should be legal in all or most cases, only about one in three (34%) Republicans say the same. More than six in ten Republicans say that abortion should be illegal in most (42%) or all (20%) cases. While there are no major gender differences between Democrats and political independents, Republican women (39%) are more likely to believe abortion should be legal in all or most cases than Republican men (30%).
Consistent with the stability in opinion on abortion, most Americans say their own views have not changed on the issue in recent years. More than three-quarters (76%) of the public say their views on the issue of abortion have not changed over the last five years. Those who have reported a shift in their attitudes about abortion are about as likely to say their views have become more supportive (12%) as they are to say their views have become more opposed (11%).
There are few gender differences, but greater variations by race and ethnicity and age. Hispanic Americans are more likely to say their views have changed on abortion than black or white Americans. More than one in three (35%) Hispanics say their views on abortion have changed over the last five years, compared to one-quarter (25%) of black Americans and fewer than one in five (19%) white Americans. Although Hispanic Americans exhibit greater movement in their personal views on abortion, like the public overall they are about equally as likely to say their views have become more supportive (19%) as more opposed (16%). Black Americans are more likely to say their views have become more supportive (16%) than opposed (9%) while white Americans are about equally likely to have become more supportive as more opposed (9% vs. 10%).
The pattern among young Americans, however, is unique. Approximately one-third of young Americans say their views on abortion have changed in recent years, and nearly three times as many say their views have become more supportive of abortion rather than more opposed to abortion (25% vs. 9%). Conversely, seniors are twice as likely to say their views have become more opposed than more supportive (12% vs. 6%).
Personal Beliefs and Attitudes About the Legality of Abortion
While a majority of Americans say abortion should be legal in at least most cases, a majority (54%) also agree that “abortion goes against my personal beliefs.” More than four in ten (44%) Americans disagree, saying abortion does not conflict with their personal beliefs.
There is a complex relationship between attitudes about the legality of abortion and personal beliefs about abortion. More than one-third (34%) of Americans who say abortion is at odds with their personal beliefs nonetheless believe it should be legal in most or all cases. Notably, only 19% of those who are personally opposed to abortion say it should be illegal in all cases.
There are few gender differences on this question, but there are significant differences of opinion by race and ethnicity, age, and religious affiliation. A majority of white (56%) and Hispanic (56%) Americans agree that abortion goes against their personal beliefs, while black Americans are more divided. Fewer than half (48%) of black Americans say abortion goes against their personal beliefs, while half (50%) say abortion does not violate their personal beliefs. Notably, there is a considerable gender gap among Hispanics. More than six in ten (62%) Hispanic women say abortion goes against their personal beliefs, compared to fewer than half (49%) of Hispanic men.
Young people are far less likely than older Americans to say abortion is at odds with their personal beliefs. Fewer than half (44%) of young people say abortion goes against their personal beliefs, compared to 60% of seniors.
The interplay between personal beliefs and support for the legality of abortion remains complex among religious groups. On the one hand, majorities of white evangelical Protestants (78%), Catholics (59%), black Protestants (56%), and white mainline Protestants (54%) say abortion goes against their personal beliefs. By contrast, only 29% of religiously unaffiliated Americans say abortion goes against their personal beliefs, and nearly seven in ten (69%) say it does not.
But personal beliefs about abortion, even among religious groups, do not directly correspond with support for the legality of abortion. While a majority of religious groups say abortion goes against their personal beliefs, majorities of nearly every major religious group nonetheless support the legality of abortion in all or most cases. White evangelical Protestants are the only major religious group in which a majority opposes the legality of abortion in all or most cases.
Is the Abortion Issue Complicated or Simple?
For most Americans, abortion is a complex issue. More than six in ten (62%) Americans see abortion as a complicated issue, while about one-third (36%) say it is simple and straightforward.
Women (66%) are more likely than men (59%) to say abortion is a complicated issue. And young Americans are more inclined than seniors to believe the issue is complicated (65% vs. 55%). There are also divisions along racial and ethnic lines. Hispanic Americans (75%) are substantially more likely than black (61%) or white (60%) Americans to say abortion is a complicated issue.
There is also considerable partisan disagreement. More than two-thirds (68%) of Democrats see abortion as a complicated issue, compared to 52% of Republicans. Nearly half (47%) of Republicans, compared to only 30% of Democrats, say the issue is simple and straightforward.
Americans who say abortion should be either legal in all cases or illegal in all cases are more likely to say the issue is simple and straightforward than those who hold more qualified attitudes. Approximately half of those who believe abortion should be legal in all cases as well as those believe abortion should be illegal in all cases see the issue of abortion as simple and straightforward (49% and 47%, respectively). By contrast, only 25% of those who say abortion should be legal in most cases and 35% of those who say abortion should be illegal in most cases believe the issue of abortion is simple.
The Importance of Abortion as a Voting Issue
Few Americans say abortion is a litmus test in their vote for candidates for major offices, but most say it’s at least one among many important factors. Eighteen percent of Americans say they would only vote for a candidate who shares their views on abortion. About half (47%) say they would consider a candidate’s position on the issue as one of many important factors. Fewer than one-third (31%) say abortion is not a major issue in how they decide to vote.
Women are significantly more likely than men to prioritize a candidate’s position on abortion when making voting decisions. Nearly one in four (24%) women say they would only vote for a candidate who shares their views on the issue, while close to half (46%) say it would be one among many important factors and roughly one in four (26%) say abortion is not a major issue for them when voting. Significantly fewer men (13%) say they would only vote for a candidate who shares their views on abortion, while nearly half (48%) say it is one among many important factors that would impact their decision making and 36% say it’s not a major issue when deciding how to vote.
Democrats and Republicans are slightly more likely than independents likely to prioritize the issue of abortion when making voting decisions. Twenty-two percent of Democrats and an identical number (22%) of Republicans, compared to only 15% of independents, say they would only support a candidate who shares their views on the issue. However, there are divisions by gender within the parties. Republican women (30%) are twice as likely as Republican men (15%) to say they would only support a candidate whose views on abortion align with their own. Democratic women (26%) are also more likely than Democratic men (15%) to say they would not support a candidate with a different view from their own on abortion.
Notably, there are only modest variations between religious groups on this question. Even among white evangelical Protestants, fewer than one-quarter (24%) say they would only vote for a candidate who shares their views on abortion, compared to 51% who say they would consider a candidate’s position as one among many important factors and 21% who say they do not see abortion as a major issue in their decision to support a candidate.
Most Americans agree that lawmakers are spending too much time on the issue of abortion at the expense of other important issues. Seven in ten (70%) Americans say lawmakers are devoting too much attention to the issue of abortion, while about one in four (27%) disagree.
The consensus on this question spans the political divide. Nearly three-quarters (74%) of Democrats and close to two-thirds (64%) of Republicans say lawmakers are spending too much time on the abortion issue at the expense of other important issues. Political independents mirror the views of the public overall.
Access to Abortion Services
The Availability of Abortion Services in Local Communities
A majority (55%) of Americans, including identical percentages of men and women, say that at least some health care professionals in their community should provide legal abortions, compared to 41% who disagree. There are stark differences of opinion on this question by age, race and ethnicity, region, religion, and party.
There is a substantial generation gap on whether abortion should be widely available. Nearly seven in ten (69%) young people say some health care professionals should provide legal abortions in their community, a view shared by fewer than half (46%) of seniors (age 65 or older).
A majority of black (62%) and white (56%) Americans say there should be a least some health care professionals in their community who provide legal abortions. However, Hispanic Americans are divided on this question (47% agree, while 52% disagree).
There are significant geographic splits on this issue. Regionally, Americans living in the Northeast (65%) and the West (59%) are significantly more likely than those living in the Midwest (52%) or the South (50%) to support having at least some health care professionals in their communities who provide abortions. In addition, those living in metro areas are more supportive than those living in non-metro areas of having at least some health care professionals in their local communities who provide abortion services (59% vs. 38%, respectively).
There are also large divides between partisans. While a majority of Democrats (71%) and political independents (58%) are say there should be at least some health care professionals in their community who provide legal abortions, less than four in ten (36%) Republicans say the same. These are no notable gender differences between co-partisans.
Once again, white evangelical Protestants are a notable outlier. Majorities of all other major religious groups — including Catholics (52%), black Protestants (59%), white mainline Protestants (62%), and religiously unaffiliated Americans (74%) — say there should be at least some health care professionals in their communities who provide legal abortions. In contrast, less than one-third (31%) of white evangelical Protestants say at least some health care professionals in their community should provide legal abortions, while 63% disagree.
Perceptions of the Availability of Abortion Services in Local Communities
Americans are divided in their perceptions of how difficult it is to obtain an abortion in their local community, and significant numbers report they are unsure about the answer or express no opinion. Close to half of Americans say obtaining an abortion in their community is not too difficult (24%) or not at all difficult (22%). Fewer than four in ten say it is somewhat difficult (22%) or very difficult (16%). Sixteen percent of Americans say they are not sure or did not provide an opinion.
Women are somewhat more likely than men to say abortion access is at least somewhat difficult. More than four in ten women (41%), compared to about one-third of men (34%), say getting an abortion in their community is somewhat or very difficult.
Perspectives diverge more sharply by age. Nearly half (49%) of young people say abortions are at least somewhat difficult to obtain, while only about one-third (35%) of seniors say the same. Notably, seniors (26%) are far more likely than young people (7%) to say they are not sure how difficult it would be to get an abortion in their community.
Hispanic Americans are more likely than other racial and ethnic groups to say abortion access is difficult in their local community. Half (50%) of Hispanic Americans report that abortions are at least somewhat difficult to obtain in their community, compared to about four in ten white Americans (37%) and roughly three in ten (32%) black Americans.
Democrats are far more likely than Republicans to say abortion is difficult to access in their community. Close to half (45%) of Democrats say getting an abortion is at least somewhat difficult, compared to only 28% of Republicans. Most Republicans (56%) believe that getting an abortion in their community is not too difficult.
Attitudes About How Difficult It Should Be to Get an Abortion
Four in ten (40%) say getting an abortion should either not be too difficult or not difficult at all, compared to 46% who say getting an abortion should be either somewhat difficult or very difficult. Just twelve percent of the public say abortion services should not be available at all.
Attitudes about how difficult it should be to get an abortion are strongly correlated with attitudes about the legality of abortion. Among those who think abortion should be illegal in all or most cases, 63% think it should be somewhat or very difficult to obtain, and 23% say it should not be available at all. Only about one in ten (12%) say it should be not too difficult or not difficult at all to obtain.
In contrast, among those who think abortion should be legal in all or most cases, more than six in ten (63%) say it should be not too difficult or not difficult at all to obtain an abortion, compared to one-third (33%) of who say it should be at least somewhat difficult.
Will Abortion Become Illegal in the U.S.?
Most Americans do not believe abortion will become completely illegal in the U.S. in their lifetime. Six in ten (60%) Americans say it is not too likely or not at all likely that no woman will be able to obtain a legal abortion in the U.S. in their lifetime. About four in ten (38%) say this is at least somewhat likely to occur.
Americans differ modestly by gender and party affiliation, but substantially by race and ethnicity. Women (43%) are somewhat more likely than men (34%) to say it is at least somewhat likely that abortion could become completely illegal in their lifetime.
Fewer than half of Democrats (43%) and Republicans (33%) say abortion becoming illegal in the U.S. is even somewhat likely. A majority of Democrats (54%) and more than six in ten (63%) Republicans say this outcome is not too likely or not at all likely.
Hispanic Americans are more likely than members of other racial and ethnic groups to say they believe abortion is likely to become illegal in the U.S. during their lifetime. Nearly six in ten (58%) Hispanics say it is at least somewhat likely that this could occur. Close to half (46%) of black Americans also agree that abortion is at least somewhat likely to become illegal. Fewer than one-third (32%) of white Americans believe this scenario is likely.
Sexuality Education
Teaching Abstinence vs. Safer Sex Practices
Americans generally believe that sexuality education that focuses on teaching about contraception and safer sexual practices is a more effective way to reduce both sexually-transmitted infections (STIs) and unintended pregnancies among young people, as opposed to sexuality education that emphasizes abstinence. Two-thirds (67%) of Americans say emphasizing safer sexual practices is more effective than abstinence at reducing unintended pregnancies. Fewer than one-quarter (24%) say focusing on abstinence is more effective. Similarly, 69% of Americans say that emphasizing safer sexual practices and contraception in sexuality education is a better way to reduce the spread of STIs than emphasizing abstinence.
There is broad agreement across subgroups that sex education emphasizing safer sex is preferable to one focusing on abstinence, both in terms of preventing STIs and preventing unintended pregnancies. While a majority of Republicans see safe sex education as more effective than abstinence at reducing the number of unintended pregnancies (55%) and STIs (57%) among young people, they are less likely to hold this view than political independents (71% and 69%, respectively) and Democrats (77% and 80%, respectively).
White evangelical Protestants stand out as one of the few groups making a distinction between these two outcomes. While a majority (52%) of white evangelical Protestants say sexuality education focused on abstinence is the most effective way to prevent unintended pregnancies, only 40% say the same about preventing STIs.
Same-Sex Relationships in Sexuality Education
Americans generally support the idea that sexuality education classes should include discussions of same-sex relationships. Nearly six in ten (59%) Americans agree that sexuality education should address same-sex relationships, while 38% disagree.
Women (64%) are more likely than men (55%) to favor discussing same-sex relationships in sexuality education classes than men.
Young people are more likely than seniors to say same-sex relationships should be covered in sexuality education courses (74% vs. 55%), although there is support for discussion of same-sex relationships in this context across all age groups.
There is more greater disagreement on this topic by political affiliation. More than seven in ten (71%) Democrats say sexuality education classes should include discussions of same-sex relationships, but only 38% of Republicans. Notably, Republican women (44%) are more likely to support including this topic than are Republican men (34%). There is no gender gap among Democrats.
With one important exception, Americans of different religious backgrounds largely support including discussions of same-sex relationships in sexuality education classes. A majority of black Protestants (54%), white mainline Protestants (62%), Catholics (64%), and religiously unaffiliated Americans (74%) say this topic ought to be discussed. Fewer than four in ten (39%) white evangelical Protestants agree. Six in ten (60%) white evangelical Protestants say same-sex relationships should not be discussed in sexuality education classes.
The Problem of Sexual Harassment
By more than a two-to-one margin, Americans say that real experiences of sexual harassment or assault that are not reported or believed are a bigger problem in the U.S. than false accusations made about sexual harassment or assault (65% vs. 26%).
There is a gender divide on this question. More than seven in ten (72%) women, compared to 57% of men, say real experiences of sexual harassment or assault that are not reported or believed are a bigger problem than false accusations. Nearly one-third (32%) of men say false accusations made about sexual harassment or assault are more pressing.
Younger Americans are somewhat more likely than seniors to say that unreported or unbelieved sexual harassment or assault is the bigger problem in the U.S. (69% vs. 57%). Older men in particular are less concerned about the issue. Only about half (51%) of senior men say sexual harassment or assault that is not reported or believed is a bigger concern in the U.S. than false accusations, compared to 61% of senior women.
Partisan differences are also notable. Nearly eight in ten (78%) Democrats, compared to about two-thirds of political independents (65%) and only about half (52%) of Republicans, say unreported or unbelieved experiences of sexual harassment or assault are a bigger problem in the U.S. than false accusations.
There are also significant gender gaps within the parties. Women who identify as Democratic (84%), independent (72%), and Republican (58%) are more likely than their male co-partisans (69%, 59%, and 47%, respectively) to say unreported or unbelieved sexual harassment or assault experiences are a bigger problem that false accusations.
Majorities of each major racial and ethnic group say unreported or unbelieved experiences of sexual harassment or assault are a bigger problem in the U.S. than false accusations, but black Americans (74%) are somewhat more likely than either Hispanic (66%) or white (63%) Americans to say this is the case. Once again, there is notable gender divide. Hispanic (75%) and white (69%) women are more likely than their male counterparts (55% and 57%, respectively) to say unreported or unbelieved sexual harassment or assault experiences are a more important concern. Black women (81%) are also likelier to express this sentiment than black Americans overall.2
Sexual Harassment: Just a Misunderstanding?
Most Americans reject the notion that sexual harassment claims are “just the result of misunderstandings between women and men.” Nearly seven in ten (69%) Americans disagree that sexual harassment claims are the result of misunderstandings between men and women, compared to roughly one-quarter (27%) who agree.
There are modest gender differences on this question. More than seven in ten (73%) women and nearly two-thirds (66%) of men reject the idea that sexual harassment claims are primarily due to misunderstandings.
Younger Americans are more likely than seniors to disagree that sexual harassment claims are just the result of misunderstandings between men and women. More than three quarters (76%) of young people, compared to more than six in ten (64%) of seniors, reject the idea that sexual harassment claims are primarily due to misunderstandings. There are also clear divides by gender among younger and older Americans on this question. Young (82%) and senior (66%) women are more likely than young (71%) and senior (60%) men to say that sexual harassment claims are not the result of misunderstandings.
Democrats (79%) are more likely than independents (69%) or Republicans (60%) to reject the idea that sexual harassment claims are primarily due to misunderstandings between men and women. There are notable divides by gender even among different political groups as well. Women who identify as Democrats (82%) and Republicans (65%) are more likely than Democratic (76%) or Republican (54%) men to say that sexual harassment claims not primarily due to misunderstandings between men women.
End Notes
1 Pew Research Center for the People & the Press Mid-October 2008 Political Survey.
2 The survey did not have a large enough sample size to break out black men separately.
Recommended Citation
Jones, Robert P., Carolyn Davis, Daniel Cox, and Rob Griffin. “Young People Set to Impact the Debate on Women’s Health Issues.” PRRI. 2018.
