CALIFORNIA STATE UNIVERSITY, NORTHRIDGE

THE IMPACT OF THE SILENT SCREAM AS A HEALTH EDUCATION INTERVENTION

A thesis submitted in partial satisfaction of the requirements for the degree of Master of Public Health by Jacqueline M. Changala

January, 1987 (\ .

The Thesis of Jacqueline M. Changala is approved:

Mary C. ~afker, R.N., M.S.

i i ©1986 Jacqueline M. Changala All Rights Reserved

; ; i ACKNOWLEDGEMENTS

I wish to acknowledge and thank several individuals and organizations that contributed to this research study.

I am grateful to the college instructors who permitted me to enter their classrooms to conduct my research; and to the National Right to Life Committee, Washington, DC; American Portrait Films of Anaheim, California, the production company of The Silent Scream; and The Life Education Center of Santa Ana, California, for their time and expertise. A heartfelt thank you goes to James Fleming, Director of the Computer Center, California State University, Northridge for his countless hours of guidance and programming. I am in deep appreciation to my committee members: to Goteti Krishnamurty, a true educator, for his constant support and direction to "discover"; to Mike Kline for his professional and much-respected advice; and to Mitzi Parker, for her uplifting attitude and encour­ agement.

iv TABLE OF CONTENTS ACKNOWLEDGEMENTS iv LIST OF TABLES vi ABSTRACT . • . . vii CHAPTER

1 INTRODUCTION • . . . . . 1 Background ...... 1 The Abortion Debate •. 1 The Court Decision 2 Abortion Statistics .. 3 Purpose ...... 3 Problem Statement .. 3 Null Hypotheses .... 4 Three Student Groups . 4 Comparison of Three Student Groups 4 Review of the Literature ..... 5 Public Opinion of Abortion 5 Factors Affecting Public Opinion 7 Pro-Life Shift in Public Opinion 9 Pro-Life Education Activities .• 14 The Advent of The Silent Scream . 16 Film Content ...... 19 Reactions to the Film .... . 21 Use of Film in Health Education 23 Limitations . 24

2 METHODOLOGY . . . . . 25 Procedure . • . . . 25 Instrument .... 27 The Research Design 30 Statistical Analysis 30

3 RESULTS AND DISCUSSION 31 Null Hypothesis 1 31 Null Hypothesis 2 .. 31 Null Hypothesis 3 . . 34 Null Hypotheses 4, 5, 6 . 34 Demographic Factors .. 36 Knowledge Item Analysis . 38 Attitude Item Analysis 40 School Attendance and Demographic Factors Affecting Attitude . . . • ...... 45 Conclusion 46 Summary . 50 REFERENCES . . . 54 APPENDIX - Student Survey/Survey Answer Key 58

v LIST OF TABLES

Table Page

1 Subjects - Demographic Information 28

2 Knowledge Scores by School 32 3 Attitude Scores by School . 33 4 Analysis of Variance Between Schools on Knowledge and Attitude ...... 35

5 Knowledge Item Analysis ...... 38 6 Attitude Item Analysis - Likert Scale Scores 41

7 Attitude Item Analysis - Percent of Students Agreeing, Holding No Opinion, Disagreeing on Specific Attitude Items .•. , ..•.... 42

8 School and Demographic Factors Affecting Specific Attitude Items ...... 47

vi ABSTRACT

THE IHPACT OF THE SILENT SCREAM AS A HEALTH EDUCATION INTERVENTION by Jacqueline M. Changala Master of Public Health

Few issues have surpassed abortion in generating controversy and disagreement among men. An analysis of public opinion indicates that there has been a slight shift to the pro-life or anti-abortion stance, the first since the United States Supreme Court legalized abortion on demand in the Roe v. Wade decision of 1973 (Hume, 1985; Sackett, 1985a). In 1985, a film entitled The Silent Scream, which depicts a real-time ultrasound of a 12-week-old fetus being aborted, increased media exposure of the pro-life movement (Thomas, 1985). The film's intent is to educate the general public on the viability of the unborn child and to change its opinion on the morality of legalized abortion on demand, and thus contribute to the repeal of Roe v. Wade. The purpose of this research study is to determine if the viewing of The Silent Scream affects change in the knowledge and attitude of three Orange County college populations: a public junior college and university, and a private Christian college, and if so, will the affected changes differ among these distinct groups.

vii Fifty-one students participated in the research. Before and after viewing the film, the students completed a questionnaire that consisted of 11 knowledge items based upon factual information pre­ sented in The Silent Scream, and 14 attitude items placed on a 5-point Likert scale. The attitude items were similar to questions used by the National Opinion Research Center from 1972-84, the Gallup polls of 1968-77, and the National Fertility Studies to assess public opinion on abortion. The attitude items were placed on a pro-choice/ pro-life scale. The statistical analysis for this study was completed by using the Statistical Package for the Social Sciences (SPSS). Statistical significance was determined by the student t-test and analysis of variance at the level of significance E < .05. The Silent Scream significantly influenced two schools, the junior college and university, in increasing knowledge regarding the unborn child and abortion. The three schools did not significantly differ in pre-test (baseline) or post-test knowledge scores, nor in knowledge gained. In contrast to knowledge, the film seemed to have influenced the students at all three schools to become more pro-life. There was no significant difference between the three schools in the amount of change in attitude. The schools were not comparable when pre-test (baseline) scores in attitude were considered. Age, sex, ethnicity and religion did not affect these results. This study demonstrates that The Silent Scream influenced two public college populations to gain knowledge and three college pop­ ulations to change their attitude regarding the unborn child and

viii abortion. These results, along with findings by Louis Harris and Associates (1985) for the Planned Parenthood Federation of America, Inc. indicate that the film may be a factor in increasing public support for the pro-life cause.

ix CHAPTER 1

INTRODUCTION

Background

The Abortion Debate Few issues have surpassed abortion in generating controversy and disagreement among men. Abortion affects almost every fiber of society as it revolves around the most fundamental issues of sex, religion and the meaning of life (Sackett, 1985a), and has profound implications in politics, medicine, and the social realm. However, as Noonan (1979) suggests, abortion is 11 an issue that once or twice in a century ... arises so devisive in its nature, so far-reaching in its consequences, and so deep in its foundation that it calls every person to take a stand .. ( p. 1). In debates on abortion, the most vocal activists are usually those who are either for abortion on demand or not for abortion at all. Public opinion, in contrast, is somewhere in the middle. The majority of Americans believe that abortion should remain legal in at least some circumstances, but a slim majority oppose legal abortion in most of the circumstances where it takes place today (Sackett, 1985b). In fact, recent trends indicate that there has been a slight shift to the anti-abortion or pro-life stand (Hume, 1985; Sackett, 1985a). This is apparent in both the political world and in medi­ cine, and by the increased media exposure of the pro-life movement

1 2

primarily caused by a film entitled The Silent Scream depicting a real-time ultrasound film of a 12-week-old fetus being aborted (Thomas, 1985). This poses a serious social and legal question that has tremendous health implications.

The Court Decision As many believe that abortion is only legal in the first tri­ mester of a pregnancy (Sackett, 1985a), it is important to briefly note the history of the law and how it reads. On January 22, 1973, the United States Supreme Court struck down all state laws regarding abortion, and legalized abortion on a national scale in the infamous case of Roe v. Wade. The law reads, according to Justice Blackmum who delivered the opinion of the Court, as: a) For the stage prior to approximately the end of the first trimester, the abortion decision and its effectuation must be left to the medical judgment of the pregnant woman's attending physician. b) For the stage subsequent to approximately the end of the first trimester, the state, in promoting its interest in the health of the mother, may, if it chooses, regulate the abortion procedure in ways that are reasonably related to maternal health. c) For the stage subsequent to viability, the state, in pro­ moting its interest in the potentiality of human life, may, if it chooses, regulate, and even proscribe, abortion except where it is necessary, in appropriate medical judgment, for the preservation of the life or health of the mother (Roe v. Wade, 1973, p. 49). In a simplified summary of the Court ruling, during the first three months, abortion is available en demand. In the second three months, the state may only enact laws to protect the health of the mother in terms of who performs the abortion and where it occurs. 3

The state may not enact laws to protect the fetus. In the last three months of a pregnancy, the state may enact a law to forbid a woman to have an abortion that is not found necessary to preserve her "life or health" where health is described in broad terms, i.e., social or psychological well-being (Powell, 1981).

Abortion Statistics According to a Newsweek poll of 1985, from 1973 to 1985, 15 mil­ lion legal abortions were performed in the United States. One-fourth of all pregnancies end in abortion, amounting to 4,000 per day. Ninety percent occur before the thirteenth week while one percent are done after the twentieth week of the pregnancies. In New York, the number of live births equals the number of abortions. Seventy-nine percent of abortions are performed on unmarried women, usually in their twenties, for financial or psychological convenience (Sackett, 1985a). The abortion rate is higher in the United States than in Canada, England, France, Sweden and The Netherlands (Harris, 1985).

Purpose The purpose of this study is to assess the impact of The Silent Scream, a health education intervention designed by the pro-life movement to influence the general public•s knowledge and opinion on abortion. Specifically, this research study will focus on the film•s influence upon three college student populations.

Problem Statement This research study will determine if students attending three different colleges: a public junior college, a public university, 4

and a private Christian college, gain knowledge and change their attitude regarding the unborn child and abortion after viewing The Silent Scream, and if so, will the affected changes differ among these distinct student groups.

Null Hypotheses Three Student Groups 1. There is no difference in the mean a) knowledge and b) atti­ tude regarding the unborn child and abortion among junior college students before and after viewing The Silent Scream. 2. There is no difference in the mean a) knowledge and b) atti­ tude regarding the unborn child and abortion among private Christian college students before and after viewing The Silent Scream. 3. There is no difference in the mean a) knowledge and b) atti­ tude regarding the unborn child and abortion among university students before and after viewing The Silent Scream.

Comparison of Three Student Groups 4. There is no difference in the mean change of a) knowledge and b) attitude regarding the unborn child and abortion among junior college and university students before and after viewing The Silent Scream. 5. There is no difference in the mean change of a) knowledge and b) attitude regarding the unborn child and abortion among univer­ sity and private Christian college students before and after viewing The Silent Scream. 6. There is no difference in the mean change of a) knowledge and b) attitude regarding the unborn child and abortion among junior 5

college and private Christian college students before and after viewing The Silent Scream.

Review of the Literature Public Opinion of Abortion There is usually a minority of those who are in favor or opposed to abortion in all cases, but a majority of Americans are somewhere in the middle. The Gallup Polls summarize that since 1975, 55% of all Americans believe that abortion should be legal only in some circumstances. Twenty to twenty-five percent believe it should be legal in all cases while 15-20% agree that it should be illegal in all cases (Sackett, 1985b). The National Opinion Research Center (NORC), which has conducted the most comprehensive survey of the abortion issue, states that since 1965, there has always been overwhelming support for abortion in cases of rape, serious defect to the baby, or if the mother's health is seriously endangered by the pregnancy. All three cases have had at least 79% of the population agree to abortion and as high as 92% have agreed in cases where the mother's health is endangered.

However, the NORC states that the above 11 approved 11 abortions are only a small amount of those actually taking place, and in 1983-84, there was a slight disapproval of the majority of abortions that occur under other circumstances (Sackett, 1985b). In 1984, the NORC found that 54% of the respondents believed that an abortion should not be allowed if the family has a low income and cannot afford any more children; 56% believed that it should not be allowed if a pregnant woman is not married and does not want to 6

marry the man, or if she is married and does not want any more chil- dren, which has never been approved by the majority of respondents in all past surveys (Sackett, 1985b). Similar findings have been noted by The Planned Parenthood Federation of America, Inc. (Harris, 1985). William Schneider, polling analyst for American Enterprise Institute and the Los Angeles Times explains why abortion is approved in some circumstances, but not in most, by suggesting that: People draw the line when the pregnancy was, at least to some degree, a deliberate decision. The public is sympathetic to any danger to mother or child. But when the woman has had some control over her condition, the public does not support abortion as a way of getting out of it. Most people do not endorse abor­ tion as a form of birth control (Sackett, 1985b, p. 19). A January 1985 CBS/New York Times poll found that 38% of the respondents want to keep abortion legal as it is now, 45% want abortion to be legal only in cases where the mother•s health is endangered, or in cases of rape or incest, and 13% believe that abortion should not be allowed at all. In general, 58% want more restrictive laws (Sackett, 1985b). According to a mi d-1985 poll entitled 11 Pub 1 i c Attitudes About

Sex Education, Family Planning and Abortion in the United States 11 conducted by Louis Harris and Associates for The Planned Parenthood Federation of America, Inc., 37% of the respondents favor a consti- tutional ban on abortion while 55% oppose it. This differs from 33% who favored a constitutional ban while 58% oppose it in mid-1984. Also, it was found that 50% are in favor of Roe v. Wade as it now reads versus 47% opposing. This differs from 56% who approved the law and the 42% who opposed it in 1985. 7 (l '

Similarly, the Gallup organization in a Newsweek poll of January 19b5 ( 11 America•s Abortion Dilemma,.) found that 58% would support a ban on legalized abortion except in cases of rape or incest and dan­ ger to mother•s health, up from 50% in Fall 1984. One-third of the respondents think that restrictions are necessary due to modern medi­ cine•s ability to keep the fetus alive. As in the past, only 25% support an absolute right to abortion. Even though support exists for changing the law, according to the January 1985 ABC/Washington Post poll, less than half of the respondents agreed that making abortion illegal would substantially decrease the number of abortions, and 73% believed that women will seek and have abortions regardless of the law (Sackett, 1985b). The Newsweek poll states that 87% feel that women will be physically hanned by obtaining illegal abortions ( 11 America•s Abortion Dilemma," 1985) . In conclusion, to only re-emphasize the controversy and indeci­ sion of public opinion, the Newswee~ poll found that 40% of the respondents questioned their own opinion whether for or against legalized abortion, and in terms of morality, 37% sec abortion as immoral, 8% see it as moral, while 50% feel that abortion is not a question of morality at all (Sackett, 1985b).

Factors Affecting Public Opinion In an attempt to understand public opinion on abortion, various research studies have been undertaken to identify the factors that contribute to an individual •s opinion of the issue. 8

The majority of research indicates that the higher the level of education, income and occupational prestige a person has, the more likely he will defend a woman's right to an abortion (Blake, 1971; Combs & Welch, 1982; Ebaugh & Haney, 1980; Legge, 1983; Tedrow & Mahoney, 1979). Sex does not appear to have a significant effect; however, on specific survey items that men and women differ on, men tend to be more liberal (Legge, 1983; Sackett, 1985b). Some research has attributed this finding to the fact that women attend church more often than men and are therefore less approving on some abortion issues. However, the 1980 Election Study of the Survey Research Center of the University of Michigan indicates that women are more liberal, in contrast to the works noted previously (Legge, 1983). Studies indicate that age is not as important as a factor as others; however, the older a person is, the more likely he will be against abortion. A 1978 survey of New Jersey voters showed that people over 50 years of age are two times more likely to be anti­ abortion than 18 to 29 year olds (Legge, 1983). The National Opinion Research Center indicates that race does play a role in public opinion as whites are more pro-abortion than non-whites (Legge, 1983). In 1983, 26% of non-whites believed that abortion should be illegal in all circumstances in contrast to only 15% of whites. Again, this is attributed to church attendance as more non-whites are regular churchgoers. Most research indicates that religion, as measured by church attendance, contributes to less support for abortion (Legge, 1983; Sackett, 1985b; Tedrow & Mahoney, 1979). However, the abortion issue is no longer considered a 9

"Catholic" issue as in the past. There is no significant difference between Catholic and Protestant views, but it has been noted that the "importance" of religion to a person does increase opposition to abortion (Sackett, 1985b). Political party affiliation bears no relationship to one's attitude on abortion, and studies completed on liberal and conserva­ tive political scales are inconsistent (Legge, 1983). Research on marital status, however, does show a slight influ­ ence in that married persons tend to be more anti-abortion as well as does being the parent of children under the age of 6 years. Although extensive research has analyzed factors such as educa­ tion, income, occupational prestige, sex, age, religion, political affiliation, marital status, and parenthood, there are many inconsis­ tencies and, overall, very few predictors to determine public opinion on abortion (Legge, 1983).

Pro-Life Shift in Public Opinion An analysis of current public opinion on abortion reveals that there has been a slight shift to the pro-life or anti-abortion stance (Hume, 1985; Sackett, 1985a). In recent years, a growing and contin­ uing doubt has emerged regarding the abortion law as it reads today. Sentiment to the pro-life movement is apparent in both the political world and in medicine. Similarly, media exposure, which had been partisan to the pro-abortion or pro-choice view for the last 13 years, has been devoting more attention to the pro-life movement (Thomas, 1985). 10

The abortion issue has become a central one in politics. In the 1984 Presidential campaign, Geraldine Ferraro, the Democratic Party vice presidential nominee, was attacked by anti-abortion activists for her pro-choice stand. President Ronald Reagan is very outspoken on his opposition to abortion and has vowed to reverse the law on legalized abortion. In 1985, he was the first president to address the annual Pro-Life March held in Washington, DC every January 22nd, the anniversary of the passage of Roe v. Wade. President Reagan has also appointed several right-to-life advocates to top federal posts ( Hume, 1985) . Supporters of abortion rights on Capitol Hill acknowledge that a decade of protests against them have taken their toll. Senator Bob Packwood, Republican of Oregon, states "more people will vote against me solely on this issue than will vote for me solely on it" (Hume, 1985, p. 11). In 1984, anti-abortionists gained 12 seats in the House; however, there is still too small of a minority to pass a constitutional amendment. Federal funding of most abortions for poor people, government workers and others has been almost totally eliminated, and abortion­ related bills are being pushed in 37 state legislatures (Hume, 1985). Although right-to-life organizations generally denounce the recent rash of abortion clinic bombings, these terrorist actions have garnered a tremendous amount of publicity for the pro-life side. During the 14 months from February 1984 to April 1985, 231 violent acts, ranging from bombs to death threats, have occurred (Hume, 19&5). Thirty such attacks have occurred in the Washington, DC area alone since 1982. President Reagan has stated, "I condemn in the strongest 11

possible terms those individuals who perpetuate these and all such violent 'anarchist activities .. ' ("America's Abortion Dilemma," 1985, p. 22). However, the media exposure is still invaluable. Advances in medical technology have compounded the moral dis­ quiet of the abortion issue. Greater knowledge of when life begins, aided by electronic fetal heart monitoring, fetology, hysteroscopy, and radio immunochemistry, along with neonatal intensive care units and in utero surgery saving the lives of premature babies earlier than ever, contributes to the dilemma of whether the fetus is a per­ son or not. Similarly, sonograms allow parents to see the fetus in graphic detail. Dr. Thomas Murray of the University of Texas Medical School agrees, "Clearly we are at the point where the moral status of the fetus is up for grabs because of technological development" ("America's Abortion Dilemma," 1985, p. 22). Medicine now has the ability to treat the fetus as a second patient. The sixteenth edition of Williams Obstetrics (1980), a standard medical school textbook, states in the preface, "Happily we have entered an era in which the fetus can be rightfully considered and treated as our second patient. Who would have dreamed even a few years ago that we could serve the fetus as physicians?" (Smith, 1985, p. 16). Dr. Murray also states, "When you do things to a child in the womb, you're acknowledging that you're dealing with a patient. It's hard to do that and then turn around and abort a child of the same developmental age" ("America's Abortion Dilemma," 1985, p. 26). Many believe that recent advances in perinatal interventions are altering the biological foundation upon which the Roe v. Wade deci­ sion is based (Blank, 1984). The viability of 28 weeks used in the 12

Roe v. Wade decision is slowly being stripped down ( 11 America•s Abor­ tion Dilemma, 11 1985). The court has been criticized because it failed to recognize or understand the extent to which technological advances can alter biological fact (Blank, 1984). As the law now reads, the fetus is not viable at 28 weeks; however, today, with artificial aid, a 28-week-old fetus can survive. Fletcher (1979), a proponent of abortion, states that using viability as an indicator for legal abortion might eliminate the right to choose as viability may even be stretched to four weeks by modern technology. What was somewhat of a philosophical decision has become one of fact where a moral issue has a scientific component (Thomas, 1985). Where does this leave the status of the U.S. Supreme Court? Prior to June 17, 19&6, of the nine Justices, six still supported Roe v. Wade; however, five are over 75 years of age and may not outlive President Reagan•s second term. Of the six, two have stated that an early retirement is possible. One of the supporters, Justice Lewis F. Powell, believes however that the doctrine needs to be re-evaluated due to recent technological advances. The three opposing Justices were Sandra Day o•connor, William H. Rehnquist and Byron R. White

11 ( America•s Abortion Dilemma, 1985). Then on June 17, 1986, Chief Justice Warren Burger, a supporter of Roe v. Wade, retired to chair the Commission on the Bicentennial of the United States Constitution. President Reagan nominated William H. Rehnquist, an auortion critic, to the Chief Justice posi­ tion, and Judge Antonio Scalia of the Court of Appeals for the Dis­ trict of Columbia to fill the vacancy created by Burger•s departure. Following Senate confirmation, both Rehnquist and Scalia were sworn 13 (l '

in as Chief Justice and Associate Justice respectively on September 26, 1986. Although Justice Scalia has not delivered a written opin­ ion on abortion, he is described as a judicial conservative. One can only speculate on his stand towards abortion, although one must consider President Reagan's vow to reverse Roe v. Wade. As noted previously, various factors in politics, medicine and the media have contributed to the shift towards the pro-life senti­ ment. However, other factors have also played a role. Many people are just now realizing that the law allows abortion past the first trimester (Sackett, 1985a) even though most individuals believe that abortion should be legal or illegal no matter when it is performed. Also, people who view it as a right of a woman are uneasy about how much that right has been exercised (Hume, 1985). Representative Henry Waxman, Democrat of California and an abortion rights leader in

Congress comments, 11 People are genuinely troubled by the large number of abortions taking place, and by the convenience of them. There is a serious backlash against feminist leaders who are perceived as callously indifferent to the moral issue .. (Hume, 1985, p. 1). Another major factor is that abortion rights activists are not arguing as loud as anti-abortionists. According to Faye Wattleton,

President of Planned Parenthood Federation of America, 11 We aren't going to argue whether they believe abortion is right or wrong, but whether women have the right to choose that for themselves (Hume, 1985, p. 1). It seems difficult to stir up fervor for people's rights to have a choice. 14 il .

Pro-Life Education Activities Another factor that the pro-life movement would like to suggest has played a role in this shift to the pro-life sentiment is the role of pro-life education activities. The following is a brief history of these activities according to the National Right to Life Committee Public Relations Department (Dan Donehey, Director of Public Rela­ tions, National Right to Life Committee, February 6, 1986). In 1973, four states printed individual newsletters that were mailed to large community mailing lists. These newsletters were mimeographed legal size drafts of pro-life information and educa­ tional material. However, it was soon realized that the pro-life movement needed a voice in Washington, DC. Hence, the National Right to Life Committee was formalized and began its own newsletter, cen­ tralizing and organizing what the individual states had been doing on their own small scale to promote pro-life education and a ban on legalized abortions. In the early 1970s, educational tools were developed on a small scale basis by local community pro-life groups. Most of these tools were pamphlets and similar literature. In 1971, J. C. Wilke, MD authored Handbook on'Abortion (Hayes Publishing Company, 1971), a text describing abortion and abortion procedures, and soon started touring the United States on what some would call a "whistle stop train ride." Dr. Wilke then created what proved to be a better educational tool than his book because of its visual impact, a slide show entitled Abortion, How It Is. Profes­ sionals in various hospitals took photographs of abortions and sent 15

them to Dr. Wilke. He then utilized these photographs for the slide show. Because of the positive response to this audio-visual tool, 16 mm films were soon made to promote the pro-life movement. Films such as A Sign of Life by New Liberty and produced by Donald Smith, and A Matter of Choice portraying a saline abortion were made available. The only drawback to the use of film as an educational tool was the cost. Most films cost $1,000 each and rental fees are $50. The National Right to Life Committee, which has 2,000 local organizations in the 50 states, helps to organize the rental of these films. Efforts to make less expensive videotapes are currently in effect. In 1980, Bernard Nathanson MD released Aborting America (Double­ day, 1979). Even though this book exposed the National Association for the Repeal of Abortion Laws' (now known as National Abortion Rights Action League [NARAL]) tactics and why Dr. Nathanson, once an abortion advocate and leader of the NARAL, switched sides on the issue and began to denounce abortions, the text did not garner a great amount of media attention as an educational or advocacy tool for the pro-life movement. Throughout 1980-85, films and pamphlets of an improved quality continued to be the principal pro-life education tools. The films included Assignment: Life (1980), which presents the problem of un­ wanted pregnancies, abortion alternatives, and suction and saline abortions; A Matter of Choice, a shortened version of Assignment: Life, and Conceived in Liberty (1984) depictin9 the pro-life movement. Then in January 1985, The Silent Scream made its debut. This film turned the abortion controversy around. The NARAL is now on the 16

defensive for the first time in many years. The issue has changed from one dealing with women and their rights to the rights of the fetus. As the topic of this thesis, this film will be discussed in more detail forthcoming. The pro-life movement has also entered the radio and television media. The National Right To Life Committee produces a 5-minute radio show entitled 11 Pro-Li fe Perspective., with host Dr. Wilke, President of the National Right to Life Committee. In less than a year of production, the show is aired on 200 radio stations, 20% being secular radio stations. Similarly, local pro-life groups are doing their own television programs.

The Advent of The Silent Scream The National Right to Life Committee states that The Silent Scream is one of the best education tools the pro-life movement has offered and has been most instrumental in turning the abortion issue around as, for the first time in years, the NARAL is on the defensive. The Silent Scream, a 28-minute, 16 mm film, was produced by American Portrait Films in Anaheim, California and released in Janu­ ary 1985. The executive producer is Donald Smith. The Silent Scream is a health education intervention to educate the general public on the viability of the unborn child and to change its opinion on the morality of legalized abortion on demand. The ultimate goal of the pro-life movement is, of course, to repeal the Roe v. Wade decision. Clips of the film have been shown on all three major television networks (ABC, NBC and CBS) and more comprehensive coverage has been given on the commentary/talk shows of Phil Donahue, 20/20, Nightline 17

with Ted Koppel, CBS Morning News, Good Morning America and Hour Magazine. The Silent Scream has also appeared in such written media as the New York Times, Washington Post, The Washington Times, Los Angeles Times, Time magazine, Newsweek and U.S. News and World Report. The Silent Scream is narrated by Bernard Nathanson MD, a practi­ cing obstetrician and gynecologist. The credibility of Dr. Nathanson has undeniably added to the impact of the film as he was the co­ founder of the influential National Abortion Rights Action League (NARAL), the group which helped to legalize abortion first in New York in 1970 and then on a national level in 1973. Dr. Nathanson's involvement in the pro-choice movement resulted from the continual hypocrisy he saw in the medical field when he had to treat victims of dangerous illegal abortions or self-inflicted abortions. Additionally, women would fake miscarriages to allow for legal abortions in hospitals. Angered by what was happening, Dr.

Nathanson decided to take a stand for safe and lega~ abortions, and hence his involvement in NARAL. After the New York law passed, Dr. Nathanson inspected abortion clinics for NARAL endorsement, and in 1971, he became the administra­ tor of New York's most active abortion clinic, The Center for Repro­ ductive and Sexual Health (CRASH), where he presided over 60,000 abortions. He also continued as the Medical Director for the NARAL. In 1973, the year Roe v. Wade passed, Dr. Nathanson withdrew from his association with the NARAL due to political infighting and sheer exhaustion. He also left CRASH, although he still advocated legal abortions. He accepted the directorship of the obstetrics and gynecology department at vJomen • s Hospital in New York. It was the 18

four years he spent at this hospital that initiated his philosophical shift on abortion. Advancements in fetology and fetal development aided by the electronic fetal heart monitoring apparatus, fetoscopes, hysteroscopy and radio immunochemistry caused Dr. Nathanson to re­ evaluate 11 What v1as being killed in an abortion,. (Smith, 1985, p. 88). In 1974, Dr. Nathanson wrote an article entitled ,.Deeper Into

Abortion 11 which appeared in the New England Journal of Medicine (November 28, 1974). In this article, he tried to explain his own experience with CRASH and the abortion movement. Dr. Nathanson remarks, 11 my own mechanism of denial failed and I began to have very serious doubts as to what we were doing here,. (Mehren & Cuniberti, 1985, p. 2). Continuing in his private practice in New York City, Dr. Nathan­ son published Aborting America in 1979 (Doubleday), ,.making a major step in aligning himself with the pro-life movement,. (Smith, 1985, p. 89). Speaking engagements, seminars and another text, The Abortion Papers (Frederick Fell Publishing, 1983) exploring the abortion mentality followed. As Dr. Nathanson began to become more of a pro­ life advocate, he continually emphasized that his stance was based upon moral and medical considerations, not religious. In fact, he is an avowed atheist. In 1984, Dr. Nathanson was able to obtain an ultrasound video­ tape of an elective suction abortion and realized how important it could be as a visual aid for his lectures and speaking engagements. It was also in 1984 that American Portrait Films persuaded him to use the videotape as the basis of an important film, The Silent Scream. 19

Fi 1m Content The Silent Scream begins with an explanation of ultrasound techniques, the various stages of fetal development, and abortion procedures followed by a real-time ultrasound film of a 12-week-old fetus being aborted by the suction method. The ultrasound technique gives a graphic detailing of the suction abortion via high frequency sound waves bouncing off the fetus to produce an image. Dr. Nathanson narrates that "as the suction tip •.. moves toward the child, the child will rear away from it and undergo much more violent, much more agitated movements" (Smith, 1985, p. 22). He adds, "For the first time, we are going to watch a child being torn apart, dismembered, disarticulated, crushed and destroyed by the unfeeling steel instruments of the abortionist" (Smith, 1985, p. 14). As the abortionist seeks the child's body with the suction tip, Dr. Nathanson says, " ... we see the child's mouth wide open in a silent scream ... This is the silent scream of a child threatened immi­ nently with extinction" (Smith, 1985, p. 24). Arguments among the scientific community range from the accuracy of the scientific data to the generalization that the fetus is "silently screaming" in pain. Dr. Hart Peterson, Acting Chairman of Pediatric Neurology at New York Hospital at Cornell Medical Center states, "The notion that a 12-week fetus screams in discomfort is erroneous. If you take out an earthworm and poke it with a stick, it responds too" (Kleiman, 1985, p. 8). Dr. Edwin C. Meyer, Chairman of the department of pediatric neurology at the Medical College of Virginia in Richmond says, "To make a statement that the fetus feels pain is a totally ridiculous 20 Q •

statement. Pain implies cognition. There is no brain to receive the information 11 (Kleiman, 1985, p. 8). In response, Dr. Nathanson replies, 11 Pain is a reflex. It is not an intellectual exercise (Kleiman, 1985, p. 8). Regarding the muscular movement, leading pediatric neurologists and neuroembryologists agree that the fetus moves, but these movements are reflexive (Kleiman, 1985, p. 8). Dr. Pasko Rakic, Chainnan of Neuroanatomy at the Yale University School of Medicine indicates that a fetus• nervous system lacks the synapses that would pennit it to scream (Kleiman, 1985, p. 8). Even though the abortion is depicted graphically, the prevailing medical opinion among those who favor abortion is that the narration is misleading regarding the issue of pain. However, there are some who do not discount the narration. Ronan o•Rahilly, fetal develop­ ment specialist at the University of California at Davis says, 11 It•s a rather highly emotional account, of course, but I would not want to say it•s incorrect ... I certainly think that the fetus could feel some pain. The nervous system is quite well developed by then .. (Marcus, 1985, p. 9). In general, these scientific arguments are so controversial a consensus may never be reached. In response to recent arguments gen­ erated by an editorial in the California Physician, February 1986 edition, Allen W. Matthies, Jr. MD explained, 11 The Silent Scream was reviewed by several knowledgeable physicians who made every effort to be objective. It is to be expected that there will be controversy on such an emotional issue 11 (p. 43). 21 ~ '

Reactions to the Film "It is perhaps the most dramatic development in the abortion issue since the Supreme Court decided abortions were legal •.• " states the Baltimore Sun News Service (Smith, 1985, p. 37), and so fitting is this generalization regarding the mixed reactions to the film The Silent Scream. The film received an enthusiastic endorsement from President Ronald Reagan in January 1985, stating "This film pro vi des chi 11 i ng documentation of the horror of abortion. It•s been said that if every member of Congress could see this film, they would move quickly to end the tragedy of abortion and I pray that they wi 11" ( Cl endi nen, 1985, p. 15). Videocassettes have been sent to every member of the U.S. Congress and Supreme Court. At a press conference for the film, Faith Ryan Whittlesey, Assistant to President Reagan commented that the film, "is a powerful testament for the pro-life position" and "it would forever alter the terms of the debate on the abortion issue (Houston, 1985, p. 6). Senator James R. Butcher, Republican from Indiana states, I sincerely believe that if people view the film with open minds, it cannot help but have a positive impact in their attitude toward abortion. If they•re pro-abortion, they cannot walk away without some serious second thoughts. If they•re neutral, they would have to say 11 This makes sense.~~ If we err, let•s err on the side of life (Smith, 1985, p. 36).

1 Ron Fitzsimmons, lobbyist for NARAL comments, 11 lt S really quite moving. I can see how it would affect people. If we let it go with­

11 out rebutting it, it could possibly do some damage (t~alone, 1985, p. 6). Judith Goldsmith, then president of the National Organization for Women (NOW) in February 1985, protests the film by stating, 22

"There is a person when a fetus has been born. I wi 11 give greater rights to a living, breathing woman than a microscopic egg. A woman can feel pain. A fetus cannot" (Malone, 1985, p. 6). Nanette Falkenburg, president of NARAL, says "The other side (pro-choice) is now on the defensive. I think we're in for some hard times" (Tanner, 1985, p. 1). In 1985, public awareness and opinion on The Silent Scream were assessed by the Planned Parenthood Federation of America. In this study, it was found that 42% of the public had seen, heard or read about the film with awareness rising to 60% of the public with some college education or a bachelor's degree. Fourteen percent of people over 18 years of age stated they had seen this film, implying that 20 million Americans have seen The Silent Scream since its release. Of those viewing the film, 45% said it made them more opposed to abortion (6% of the general public); 48% stated it did not alter their views, and 5% stated that the film made them more pro-abortion (Harris, 1985, p. 59). In February 1985, Dr. Allan Rosenfield, Chairman of the Board of Planned Parenthood Federation of America said The Silent Scream is the most powerful thing the right-to-life movement has put out to date. We need to come up with something that focuses on the woman. That part of the story, from the perspective of the woman, needs to get the same type of visibility The Silent Scream has received (Marcus, 1985, p. 9). In January 1986, Planned Parenthood premiered Personal Decisions, re-focusing attention on the woman. Likewise, Dr. Nathanson and American Portrait Films plan a sequel to The Silent Scream entitled Silent Scream II where a survivor of a late-term abortion tells her story. 23

Use of Film in Health Education Various studies have been completed on the use of film in edu­ cation and specifically, health education. A survey of the research indicates that film is a very good medium to present information (Mercer, 1981). Audio-visual programs, especially those depicted on television, can present information in a non-threatening manner due to the viewer's familiarity with the medium (Cassileth, 1982), and hence health education information can also be presented in a like manner. Audio-visual programs are available on many disease topics such a cancer (Cassileth, 1982) and health-related issues such as breast self-examination, birth control and mental health (Domino, 1983; Herold, 1978, 1980; Monahan, 1975). Herold (1978, 1980) found that for health education films to be effective in changing attitudes, the topic must be related to issues held by the audience. Also, the narrator must be a credible source and real circumstances, not fictional ones, must be portrayed. In his studies on responses to a birth control film, Herold (1980) found that attitude reinforcement can often occur instead of attitude change. Monahan (1975) found in her studies on teaching breast self­ examination to university women, that knowledge and skills achieved are equal regardless if the subject viewed a film or listened to a lecture followed by practice on a model. Cassileth (1982) indicates that audio-visual cancer programs increased knowledge and reduced anxiety for patients and their fam­ ilies. In more general terms, Pflieger (1959) found that in health 24

education courses, there is no significant difference in achievement scores between viewing a film and face-to-face instruction using a pre-post test design. The use of film has demonstrated to be an effective teaching methodology in health education; however, more extensive work needs to be completed to understand how people learn from film (Mercer, 1981). Although the cost of making a film is substantial, it ensures that information is uniformly presented and becomes more cost­ effective as it is repeated.

Limitations Probable limitations foreseen for this study include: 1. The students may have previously seen the film prior to test­ ing. This may affect the pre-test scoring on knowlege and attitude. 2. The students' knowledge and attitude may be affected by the great amount of publicity surrounding the film prior to their viewing it. 3. The appropriateness of items chosen to be on the question­ naire and their validity may not be indicative of knowledge and attitude. 4. The researcher is six months pregnant while completing the student testing. It is assumed that the presence of a pregnant woman will not affect a change in knowledge or attitude among the subjects. 5. Students from the first school tested may discuss the research with students attending the later schools tested; however, the students will be asked not to discuss what occurred during the research testing procedure until a given date. CHAPTER 2

METHODOLOGY

Procedure Personnel at three Orange County college campuses, a public junior college, a public university, and a private Christian college, were contacted in January 1986 regarding a possible showing of the film The Silent Scream. Each school agreed to allow the researcher to show the film to certain health-related classes. Dates were scheduled for the month of April 1986. The junior college stated it had approximately 30 students in a general health education course available for the study. Likewise, the private Christian college indicated 20 students enrolled in an upper division physical education theory class could participate. The university stated that 35 students who were peer health coun­ selors at the student health center would be able to participate. The personnel at each school were asked not to mention the specifics of the research study to the students. Instead, the stu­ dents were told that a guest speaker would be attending class. On the day of testing, the researcher was introduced by the personnel at each respective school. The researcher then gave the following instructions to each individual student group. Good morning. As your instructor stated, my name is Jackie Changala, and I am a graduate student at California State University, Northridge. I am here today to conduct some research for my thesis.

25 26

I'd like to thank you now for your time and cooperation. I'd like to begin the testing procedure and ask that you refrain from speaking to any of your fellow classmates until the testing procedure is over as I shall indicate. I am going to distribute two sets of papers and a #2 pencil to each of you. One set of papers will be facing up, and one will be facing down. Please do not turn over the set of papers facing down. Now, please look at the set of papers facing up. You will find a survey and an answer sheet. Please do not write on the survey. Please do not write your name on the answer sheet. Read the instructions on the survey carefully and answer accordingly on your answer sheet with the #2 pencil beginning with Space #1. All of your answers wi 11 be given anonymously. Now I am going to collect the survey and answer sheet. I'd like to remind you not to speak to your neighbor. Now I would like all of you to view this film. At this time, the film The Silent Scream was shown to the students. Then the researcher continued with the following instructions: Now, please turn over the remaining set of papers in front of you. Again, please do not write on the survey nor put your name on the answer sheet. Read the directions on the survey and answer accordingly on your answer sheet with the #2 pencil beginning with Space #1. Now I am going to collect the survey, answer sheet and #2 pencils. The testing procedure is now complete. After the testing, the instructors at the three schools led a discussion on the film. Each pre- and post-test answer sheet was marked with the follow­ ing identification: Junior College Pre-test JC PR-# Post-test JC PO-# 27 Q •

Private Christian College Pre-test PCC PR-# Post-test PCC PO-# University Pre-test Univ. PR-# Post-test Univ. PO-# where# = 1, 2, 3, etc. for student identification. The actual number of students tested was much lower due to attrition during the semester. The actual count was: 1) Junior college - 18 students 2) Private Christian College 10 students 3) University - 23 students totaling 51 students actually tested. Demographic information on the students is indicated in Table 1 for each specific school and for the total combined population of 51 students.

Instrument The pre- and post-test questionnaires used in this study were identical except for various demographic items asked for on either the pre- or post-test and for the addition of one phrase prefacing two post-test knowledge items. This will be discussed further in more detail. The knowledge section of the questionnaire consisted of 11 items. Seven were of a true or false nature while four were of multiple- choice construction. Two of the multiple-choice items on the post- test were prefaced by "According to the film The Silent Scream,." This statement was not on the pre-test as the researcher did not want Table 1 Subjects - Demographic Information Junior Private------All Schools College Christian College University Combined N == 18 N == 10 N == 23 N == 51 Sex Male 5 6 13 24 Female 13 4 10 27 Age -17-18 years 6 0 1 7 19-20 years 8 2 8 18 21-22 years 3 2 14 19 23 years & older 1 6 0 7 Religion Catholic 6 0 4 10 Protestant 2 0 5 7 Non-denominational Christian 8 8 4 20 Other 2 2 10 2 Ethnicity White 13 10 14 37 Non-white 5 0 9 14 Country of Birth USA 16 8 16 40 Other 2 2 7 11

Note: Variations in category names between questionnaire and table are apparent as some questionnaire categories contained an insignificant number of subjects to permit statistical analysis.

N 00 29

film. The knowledge items were based upon factual information pre­ sented in the film. The attitude section was comprised of 14 items placed on a 5- point Likert scale. Six of the questions were similar to ones used by the National Opinion Research Center from 1972-84, the Gallup polls of 1968-77, and the National Fertility Studies to assess public opinion on abortion. The other eight items dealt with the morality

1 of abortion and women S rights, and specific issues discussed in the film. The attitude responses were then placed on a pro-choice/pro­ life scale. Demographic information was asked for on both questionnaires. The pre-test asked for age, sex, marital status, ethnicity and coun­ try of birth, while the post-test asked for religion. After the data was collected, several response categories were collapsed to broader ones due to little or no responses on specific items. Age was col­ lapsed to four categories, combining the last two age groups, and ethnicity was generalized to white/non-white. Marital status was not statistically analyzed as there were 49 single students and only 2 married students, and religion was collapsed to four categories. Don Tanner, Director of Distribution at American Portrait Films, producer of The Silent Scream, approved the questionnaire items as being representative of the film 1 S intent. Also, the questionnaire was pre-tested by student groups similar to the subjects scheduled for the actual testing. The questionnaire and correct answers as presented in The Silent Scream are presented in the Appendix. 30

The Research Design The research design is as follows:

X llk 1 and lla1 X llk 2 and lla2 X llk3 and lla3 where R1 = junior college students R2 = private Christian college students R3 = university students X = The Silent Scream 01-6 = observations

ll kl -3 = mean change in knowledge

ll al-3 = mean change in attitude

Statistical Analysis The statistical analysis for this study was completed by using the Statistical Package for the Social Sciences (SPSS). Statistical significance was determined by the student t-test and analysis of variance where the level of significance was E < .05. Chapter 3

RESULTS AND DISCUSSION

The results of this study are first presented in reference to each null hypothesis followed by more specific analysis and discus­ sion of demographic factors and individual knowledge and attitude items.

Null Hypothesis 1 There is no difference in the mean a) knowledge and b) attitude regarding the unborn child and abortion among junior college students before and after viewing The Silent Scream. In analyzing the junior college student group, the above hypothesis is rejected. The students scored a mean difference of +2.1 out of 11 knowledge questions on the post-test (E < .05). Similarly, attitudes became more pro-life resulting in a mean difference of +5.6 on the 5-point Likert scale (E < .05) (see Tables 2 and 3).

Null Hypothesis 2 There is no difference in the mean a) knowledge and b) attitude regarding the unborn child and abortion among private Christian college students before and after viewing The Silent Scream. Part (a) of the above hypothesis is not rejected as the analysis of the private Christian college students reveals that the mean differ­ ence in knowledge of +1.2 out of 11 items is not significant

(E < .05). However, part (b) is rejected as the mean difference in attitude of +3.7 is significant (E < .05), resulting in the group becoming more pro-life (see Tables 2 and 3).

31 Table 2 Knowledge Scores by School

Pre-Test Scores Post-Test Scores Difference in Scores Mean Standard Mean Standard Mean Standard School N Error Error Error t-val ue

Junior College 18 8.0 0.5 10.1 0.2 2.1 0.5 4.1

Private Christian Call ege 10 8.7 0.6 9.9 0.3 1.2 0.7 1.7

University 23 8.3 0.4 10.3 0.2 2.0 0.4 5.0

All three schools combined 51 8.3 0.3 10.2 0.1 1.9 0.3 6.5

w N Table 3 Attitude Scores by School

Pre-Test Scores Post-Test Scores Difference in Scores Mean Standard Mean Standard Mean Standard School N Error Error Error t-value

Junior Co11 ege 18 40.7 2.9 46.2 3.2 5.6 1.3 4.2

Private Christi an College 10 52.0 3.7 55.7 3.4 3.7 1.5 2.4

University 23 36.5 2.7 40.0 2.8 3.4 1.0 3.5

All three schools combined 51 41.1 1.9 45.4 2.0 4.2 0.7 6.0

w w 34

Null Hypothesis 3 There is no difference in the mean a) knowledge and b) attitude regarding the unborn child and abortion among university students before and after viewing The Silent Scream. An analysis of the university student group indicates that the above hypothesis is rejected. The mean difference in knowledge of +2.0 out

of 11 items is significant (~ < .05) as well as the mean difference

in attitude of +3.4 (~ < .05). This group also became more pro-life (see Tables 2 and 3).

Null Hypotheses 4, 5, 6 4) There is no difference in the mean change of a) knowledge and b) attitude regarding the unborn child and abortion among junior college and university students before and after viewing The Silent Scream. 5) There is no difference in the mean change of a) knowledge and b) attitude regarding the unborn child and abortion among university and private Christian college students before and after viewing The Silent Scream.

6) There is no differ~nce in the mean change of a) knowledge and b) attitude regarding the unborn child and abortion among junior college and private Christian college students before and after viewing The Silent Scream. Analysis of variance between the three student groups, as indicated in Table 4, reveals that there is no significant difference between any matched pairs of schools on knowledge (F ratio= 0.7 where

~ < .05) or beliefs (F ratio= 1.1 where~< .05). Therefore, the above three null hypotheses are accepted. Therefore, The Silent Scream significantly influenced two schools, the public junior college and university, in increasing knowledge regarding the unborn child and abortion. The private Christian school did not show a statistically significant mean difference in knowledge; however, there was a slight increase. 35

Table 4 Analysis of Variance Between Schools on Knowledge and Attitude

F Ratio Knowledge Pre-test 0.4 Post-test 0.6 Difference in post-test minus pre-test scores 0.7

Attitude Pre-test 5.4 Post-test 5.2 Difference in post-test minus pre-test scores 1.1 36

It is interesting to note that this school had the highest pre-test knowledge score and the lowest post-test knowledge score; however, analysis of variance indicates that there was no significant differ­ ence between the pre-test and post-test scores between the three schools on knowledge. Also, analysis of variance indicates that there was not a statistically significant difference between the three schools on knowledge gained. In contrast to knowledge, The Silent Scream seemed to have influenced the students at all three schools to become more pro-life. Analysis of variance also indicated there was no significant differ­ ence between the three schools in the amount of change occurring before and after viewing the film. However, the schools were not comparable when pre-test (baseline) attitude scores were considered. These findings are similar to the ones published by The Planned Parenthood Federation of America, Inc. in 1985 in that both study groups became more pro-life. Their findings state that of those viewing the film, 45% became more pro-life, 48% did not change their views, and 5% became more in favor of abortion (Harris, 1985, p. 9).

Demographic Factors Age did not have a significant effect on pre-test scores on knowledge or attitude; however, this is not surprising since 86% of the respondents fell into the 17-22 year old category, and the design of this study did not permit a thorough analysis of how age affects knowledge and attitude regarding abortion as past studies on public opinion have demonstrated (Legge, 1983). Also, age did not affect 37

the mean difference in knowledge or attitude before and after viewing The Silent Scream. Similarly, sex did not affect the pre-test scores for knowledge or attitude as indicated by Legge (1983) and Sackett (1985b). Like­ wise, sex did not affect the mean difference in knowledge and atti­ tude caused by viewing the film among the students. In contrast to studies on race by the NORC (Legge, 1983), this study found no significant difference between whites and non-whites on pre-test scores of attitude. Also, there was no significant dif­ ference in pre-test knowledge scores of white and non-whites, nor did race affect the mean difference in knowledge and beliefs of students before and after viewing The Silent Scream. Country of birth did not significantly affect the pre-test scores of knowledge and attitude, or the mean difference in knowledge and attitude of students before and after the health education inter­ vention. Marital status was not analyzed as a factor in determining knowledge and attitude as 96% of the students were single, and only 4% were married. Religion did not significantly affect the pre-test scores on attitude. Past studies (Legge, 1983; Sackett, 1985b) have shown that one•s perceived 11 importance 11 of religion contributes to less support for abortion; however, this thesis study did not collect data relating to 11 importance, 11 but rather the students were asked to select a reli­ gious category that best described themselves. Similar to research completed by Sackett (1985b), there was also no significant difference between Catholics and Protestants. In addi- 38

tion, there was no significant difference between pre-test scores on knowledge by religion or the mean differences in knowledge and atti- tude among students before and after viewing the film.

Knowledge Item Analysis There was no significant difference on any one knowledge item either on the pre- or post-test by school. Table 5 indicates the percentage of students that correctly answered each knowledge item on the pre- and post-test questionnaires.

Table 5 Knowledge Item Analysis

Pre-test % of Students Post-test % of Students Item Answering Correctly Answering Correctly

1 68.6 98.0 2 84.3 80.0 3 64.7 92.2 4 84.3 90.2 5 78.4 98.0 6 62.7 84.0 7 90.2 100.0 8 78.4 90.2 9 86.0 98.0 10 82.0 90.2 11 54.0 100.0

Item 1, which dealt with fetal development, and Item 3, which stated that advances in science indicate that the unborn child is a distinct human being had the second and third highest gains in knowl­ edge on the post-test. This indicates that the film achieved its goal of communicating to the viewer that an aborted fetus is not always a microscopic egg as is often quoted by pro-abortionists (Maline, 1985). 39 (1 •

It is interesting to note that a higher percentage of students correctly answered Item 2 on the pre-test which tests the students on the definition of fetology than on the post-test. This may have occurred due to the film's manner of presentation of the definition. A large majority of students knew that Roe v. Wade legali2ed abortion on demand; however, this does not indicate if the students knew the specifics of the law (i.e., when it is legal in a pregnancy to abort the fetus). It would have been interesting to test this, but unfortunately the film did not address this issue, and instead speaks only of the law in general and portrays a 12-week-old fetus being aborted. On the pre-test, 78.6% of the students were aware that the abortion industry qualifies to be on the Fortune 500 list of largest industries in the world, rising to 98% of the students answering this item correctly on the post-test. Item 6 stating "the unborn child is not aware of the abortion procedure as it occurs" had the second lowest percentage of correct answers on the pre-test with 62.7%; however, 84% answered "true" on the post-test. Items 7 and 11 questioned the students on the suction method procedure of abortion. It is interesting to note that 6% of the students thought that pain medication was administered to the fetus prior to an abortion. A majority, however, realized prior to view­ ing the film that the fetus is not always removed in one piece. As indicated by Item 8, most of the students understood ultra­ sound techniques prior to viewing the film. 40 (l •

Item 9 indicates some surprising results. Prior to viewing the film, 86% of the students believed that women have not been educated about abortion procedures, and 82% felt that both the mother and the unborn child are the victims in an abortion, both in agreement with the film's intent. Post-test scores were, accordingly, just slightly higher.

Attitude Item Analysis In general, the students' attitude became more pro-life as all the attitude item scores became more pro-life after viewing The Silent Scream as depicted in Table 6. An (*) indicates those items that had statistically significant mean differences. Table 7 shows the percentage of students who either agreed or

11 strongly agreed (category= "agree ), held no opinion; or either dis­ agreed or strongly disagreed (category= 11 disagree") with the item before and after viewing the film. Item 12 which reads, "Abortion should remain legal in cases where the mother's health is in danger" received an increase in pro­ life sentiment; however, it was not statistically significant. The percentage of students that agreed with this statement was 90.2% on the pre-test and 84.4% on the post-test. In prior studies on public opinion regarding abortion by the National Opinion Research Center (NORC), this item has always received 79-92% approval (Sackett,

1985b). The pre- and post-test scores for Item 13, "Abortion should remain legal in cases where the family does not have enough money to support another child," indicate a significant shift to the pro-life Table 6

Attitude lte~ Anallsls - Likert Scale Scores Difference Move to Meen Score In Hun Standerd Pro-life I tel Pre-te5t---ro5t-li5t Scores Error Sentl~~ent t-velue I+ or -1

12. Abortion should r~eln legel In cases where the MOther's health Is In danger. 1.5 1.7 0.2 0.8 + 1.4

13. Abortion should r~aln legal In cases where the faMily does not have enough •oney to support another child. 3.1 3.5 0.4 0.1 + 3.1* 14. Abortion Is •urder. 3.2 3.6 0.4 0.1 + 2.8*

15. A ~n should be able to have an abortion If there Is a strong chance of- serious defect to the baby. 2.3 2.5 0.2 0.1 + 1.7 16. A ~n should have the sole right to dete~lne the fate of her unborn child. 2.6 2.8 0.2 0.1 + 1.5

17. A ~n should be able to have an abortion If she bec.-e pregnant as a result of rape or Incest. 1.7 2.3 0.5 0.1 + 5.0* 18. New technological advances In the study of the unborn child Indicate that the United States Supreae Court should re-eKIMine the Issue of legalized abortion on demand. 3.4 3.6 0.2 0.1 + 2.7

}g. A WDM~n should be allowed to have an abortion If she Is not •arrled and does not want to ..rry the father of the unborn child. 3.1 3.4 0.3 0.1 + 3.5* 20. Abortion Is not an appropriate answer to unwanted pregnancies. 3.8 4.0 0.2 0.1 + 1.7 21. A wa.an should be able to have an abortion If she Is ..rrled and does not want to have any •ore children. 3.3 3.5 0.2 0.2 + 1.3* 22. The unborn child and MOther have equal rights to life. 3.3 3.6 0.3 0.1 + 2.5 • 23. The unborn child Is capable of feeling pain. 3.7 3.g 0.2 o.z + 1.5 24. The Issue of a wa.an's right to choose and to have an abortion Is •ore l•portant than the "1.-orallty/.arallty• of abortion. 2.8 3.1 0.3 0.1 + 1.8 25. Any wa.an considering an abortion should view the filM entitled The Silent Screa• prior to consenting to having an abortion. 3.0 3.5 0.5 0.1 + 5.o•

• significant t-values Note: Pre-test and post-test •ean scores range frOM 1-5 where: 5 • strongly agree with pro-life sentl•ent; 4 • agree with pro-life sentl.ent; 3 • no opinion; 2 • disagree with pro-life sentl~~~ent; 1 • strongly disagree with pro-life sentl.ent·.

...... ~ Table 7 Attitude lte111 Analysis- Percent of Students Agreeing, Holding No Opinion, Disagre~i_n~~ecH_lc-Attitu_de lte111s

~~derrts I of Students Pre-test Post-test 12. Abortion should renain legal in cases where the Agree 90.2 84.4 mother's health is in danger. No Opinion 7.8 7.8 Disagree .2 7.8 13. Abortion should remain legal In cases where the family Agree-----~~ Z7 .4 does not have enough money to support another child. No Opinion 17.6 15.7 Disagree 47.1 56.8 14. Abortion Is murder. J.gree- ----sr.o 54. 9 No Opinion 9.8 17.6 Disagree 39.2 27.4 15. A woman should be able to have an abortion if there 7\gr-ee- 64.8 56.8 Is a strong chance of serious defect to the baby. No Opinion 13.7 23.5 Disagree 21.6. 19.6 16. A woman should have the sole right to determine 7\gree 55.0 43.1 the fate of her unborn child. No Opinion 9.8 19.6 Disagree 35.3 37.3 17. A woman should be able to have an abortion If she J.gree- --12.s--~--~ became pregnant as a result of rape or Incest. No Opinion 23.5 27.5 Disagree 3.9 15.6 18. New technological advances In the study of the unborn Agree ----~9.()--~-~----w.lJ child indicate that the US Supreme Court should No Opinion 27.5 17.6 re-e~amlne the Issue of legalized abortion on demand. Disagree 23.5 21.6 1g. A woman should be allowed to have an abortion If Agree- -~-II"J.l 27."5 she Is not married and does not want to marry the No Opinion 9.8 19.6 father of the unborn child. Disagree 47.1 52.9 Agree-- - -60.7-- -~~-m.o 20. Abortion Is not an appropriate answer to unwanted No Opinion 15.7 15.7 pregnancies. Disagree 23.5 13.7 ~~e 33.3 29.4 21. A woman should be able to have an abortion If she No Opinion 15.7 13.7 Is married and does not want to have any more children. Disagree 51.0 56.9 ~ree 48.0 64.0 22. The unborn child and mother have equal rights to 11fe. No Opinion 20.0 12.0 Disagree 32.0 24.0 ~ree-~-----w.o 12 .o 23. The unborn child 1s capable of feeling pain. No Opinion 28.0 12.0 Disagree 12.0 16.0 24. The Issue of a woman's right to choose and to have Agree -- n.2------n~ an abortion is more Important than the "immorality/ No Opinion 19.6 27.5 morality" of abortion. Disagree 37.3 39.2 25. Any won~n considering an abortion should view the film J;gYee----.n.-.4 58."& entitled The Silent Scream prior to consenting to No Opinion 39.2 11.8 __h_a_~ an---abortion. Disagree 29.4 29.4

..j:::o, N 43

sentiment. On the pre-test, 35.2% of the students agreed with the statement compared with 27.4% on the post-test. In contrast, the NORC found that in 1984, 54% of the general public agreed with this statement (Sackett, 1985b). The statement "Abortion is murder" in Item 14 also received scores that reflect a statistically significant shift to the pro-life stance on the Likert scale. Attitudes toward Item 15, "A woman should be able to have an abortion if there is a strong chance of serious defect to the baby," did not significantly change after the intervention; however, there was a slight increase to the pro-life sentiment. The NORC states that this item has always had at least 79% approval from the general public (Sackett, 1985b). This research study shows that 64.8% of the students agreed on the pre-test, decreasing to 56.8% on the post-test. "A woman should have the sole right to detennine the fate of her unborn child" on Item 16 showed a shift to the pro-life stance although it was not statistically significant. Scores on Item 17, "A woman should be able to have an abortion if she becomes pregnant as a result of rape or incest," had the highest mean difference on the Likert scale, resulting in the largest shift to the pro-life stance. Similarly, 72.5% of the students agreed with the statement on the post-test. The NORC reports that this item has always received at least 79% of the general public's approval (Sackett, 1985b). There was a significant shift to the pro-life sentiment regard­ ing Item 18, "New technological advances in the study of the unborn child indicate that the United States Supreme Court should re-examine 44

the issue of legalized abortion on demand." On the pre-test, 49% of the students agreed, increasing to 60.8% on the post-test. Also, the Newsweek poll of January 1985 ("America•s Abortion Dilemma, 1985) states that 33% of its respondents felt restrictions should be placed in the law due to modern medicine•s ability to keep the fetus alive. This is an important gain as this item reflects the ultimate goal of the pro-life movement to re-examine the law on abortion and eventually to repeal it. The NORC reports that in 1984, 56% of the general public agreed with Item 19, "A woman should be allowed to have an abortion if she is not married and does not want to marry the father of the unborn child" (Sackett, 1985b). This study showed a significant mean difference on the Likert scale before and after viewing the film, resulting in a shift to the pro-life sentiment. Also, 43.1% of the students agreed with the statement on the pre-test, decreasing to 27.5% on the post-test. The scores on Item 20, "Abortion is not an appropriate answer to unwanted pregnancies," showed a shift, although statistically insig­ nificant, to the pro-life stance. Similarly, the scores on Item 21, "A woman should be able to have an abortion if she is married and does not want to have any more children" did not show a statistically significant shift. The NORC states that in 1984, 56% of the general public agreed with this item; however, this thesis research shows that 33.3% of the students agreed on the pre-test with 29.4% on the post-test. Item 22, "The unborn child and mother have equal rights to life," scores showed a statistically significant pro-life shift on the Likert 45

scale. Also, on the pre-test, 48% agreed with the item, increasing to 64% on the post-test. "The unborn child is capable of feeling pain" stated in Item 23 had scores that showed a pro-life shift although it was not statis­ tically significant. On the pre-test, 60% of the students agreed with this item, increasing to 72% on the post-test. Item 24, "The issue of a woman's right to choose and to have an abortion is more important than the 'immorality /morality' of abortion" scores again showed a pro-life shift, although it was statistically insignificant. Finally, scores on Item 25, "Any woman considering an abortion should view the film entitled The Silent Scream prior to consenting to having an abortion" showed a significant pro-life shift on the Likert scale. Also, on the pre-test, 31.4% of the students agreed, 39.2% had no opinion and 29.4% disagreed, while on the post-test, 58.5% agreed, 11.8% had no opinion and 27.4% disagreed. Hence, it appears that the increase in those agreeing came from the group that had no opinion prior to the film as the number of students disagreeing prior to the film remained the same after viewing the film.

School Attendance and Demographic Factors Affecting Attitude There were no significant differences between schools on the mean difference caused by viewing the film on any attitude item except for Items 17 and 23 (see Table 8). Item 17 reads, "A woman should be able to have an abortion if she became pregnant as a result of rape or incest." Although the attitude scores for all three schools became more pro-life, the 46 0 •

university student group showed the least amount of change and the private Christian college group showed the greatest change(£< .05). Also, there was a significant difference in mean differences by school on Item 23, "The unborn child is capable of feeling pain ... The private Christian college student group showed no mean difference while the university student group became more negative in disagreeing more with the item on the post-test. The junior college student group showed the highest mean difference before and after viewing the film. The only demographic factors that affected the mean difference before and after viewing the film were ethnicity on Item 24 and country of birth on Item 25 (see Table 8). Non-whites became more pro-life on Item 24 which reads, "The issue of a woman's right to choose and to have an abortion is more important than the • immorality /mora 1 i ty • of abortion" The non-whites became more opposed to the item as it reads than did whites. Also, students whose country of birth is not the United States agreed more than students born in the U.S. with Item 25, "Any woman considering an abortion should view the film entitled The Silent Scream prior to consenting to having an abortion.

Conclusion In conclusion, the two public colleges, the junior college and the university, significantly gained knowledge after viewing The Silent Scream. All three schools, including the private Christian college, changed their attitude, becoming more pro-life as measured by a 5-point Likert scale before and after viewing the film. Hence, Table 8 School and Demographic Factors Affecting Specific Attitude Items StatTSti cal Mean Standard Significance Item Difference Error Used

17. A woman should be able to School have an abortion if she Junior college 0.7 0.2 F ratio = 3.2 became pregnant as a Private Christian college 0.9 0.3 result of rape or incest. University 0.3 0.1

23. The unborn child is capable School of feeling pain. Junior call ege 0.8 0.2 F ratio = 3.5 Private Christian college 0.0 0.3 University -0.1 0.3

24. The issue of a woman's right Ethnicity to choose and to have an White 0.03 0.1 t value = 2.8 abortion is more important Non-white 0.9 0.3 than the 11 immorality/ morality 11 of abortion.

25. Any woman considering an Country of Birth abortion should view the USA 0.4 0.2 t value = 2.2 film entitled The Silent Non-USA 1.1 0.3 Scream prior to consent1ng to having an abortion.

+::> -.....,J 48

the first and third null hypotheses and part (b) of the second null hypothesis are rejected. There was also no significant difference between any set of matched pairs of schools in the mean difference of knowledge or attitude scores before and after the health education intervention. Hence null hypotheses 4, 5 and 6 are accepted. Knowledge baseline scores did not significantly differ between schools; however, atti­ tude baseline scores did. Similar to school attendance, various demographic factors did not significantly affect the results. Age, sex, country of birth and ethnicity did not influence the knowledge and attitude baseline scores prior to viewing the film nor the mean changes after viewing the film. Religion also, surprisingly, did not significantly affect the baseline or mean difference scores on knowledge and attitude. These results agree with the work of past studies on predictors of public opinion of abortion (Blake, 1971; Combs & Welch, 1982; Ebaugh & Haney, 1980; Legge, 1983; Tedrow & Mahoney, 1979). In addition, there were no significant differences in baseline or mean changes among schools on specific knowledge items. The greatest mean differences occurred on those items concerning fetal development and the premise that the unborn child is a separate human being from the mother. In general, the students had prior knowledge of the information and data presented in the film as the mean pre­ test (baseline) score of the three schools combined was +8.3 out of 11 items. Significant changes occurred on specific attitude items resulting in less support for abortion in cases of rape, incest and financial 49

difficulties, and in cases where the mother is not married and does not want to marry the father of the unborn child. Also, the attitude scores on the Likert scale before and after the students viewed the film showed that the students agreed more with the statement "Abortion is murder .. after viewing the film. Similarly, after viewing the film, the students became more in agreement with the statement reading that advances in medical technology indicate that the United States Supreme Court re-examine the current law on legalized abortion on demand. Most importantly, the highest mean difference in the shift to the pro-life stance occurred on the item "Any woman considering an abor­ tion should view the film entitled The Silent Scream prior to con­ senting to having an abortion ... Hence the students became more supportive of the film's content as an important factor to consider in the decision to have an abortion. It is also important to note that one of the college instructors who permitted his students to participate in this research commented that he had previously allowed pro-life speakers to give a short pre­ sentation that included The Silent Scream to his classes as he felt it was important for his students to see both sides of the issue. However, he did not respect nor admire the pro-life speaker's intro­ duction to the film as he closed with "Remember, abortion is murder ... The students, the instructor felt, became defensive and were not willing to view the film with an open mind. In contrast, he felt that presenting the film in an objective fashion as was done in this study with no biased introduction created a more conducive atmos­ phere for the film viewing and intent. In the future, pro-life educators may want to curtail their zeal and emotional speeches to 50

reach more people with what appears to be a beneficial education tool such as The Silent Scream. Although this study only tested the film The Silent Scream on college students and not a target group representative of the general public, there is strong indication, along with the study completed by Louis Harris and Associates for The Planned Parenthood Federation of America, Inc. (1985), that the film is causing people to gain knowl­ edge and analyze their attitudes toward the unborn child and abortion resulting in more support for the pro-life cause. Replications of this study, along with those utilizing other methodological proce­ dures, are needed for further confirmation. Although substantial medical controversy exists regarding The Silent Scream, it is diffi­ cult to deny that the film has been an effective health education tool for the pro-life cause among this study group. However, the continued success of the film at large depends upon medical science's ability to either validate or refute the film's content and the wil­ lingness of the American people to listen.

Summary The Silent Scream was produced by American Portrait Films to educate the general public on the viability of the unborn child and to change its opinion on the morality of legalized abortion on demand to contribute to the repeal of the Roe v. Wade decision. The film presents various stages of fetal development, and abortion procedures followed by a real-time ultrasound of a 12-week-old fetus being aborted by the suction method. 51

This study was designed to determine if the viewing of the film affected a change in knowledge and attitude toward the unborn child and abortion among three college student populations. Fifty-one students participated in the research: 18 public junior college students, 10 private Christian college students and 23 public university students. Prior to the test date, the students had been instructed that a guest speaker would be attending class. At the beginning of the testing period, the students completed a pre-test questionnaire which consisted of 11 knowledge items based upon factual information presented in the film and 14 attitude items placed on a 5-point Likert scale. The attitude items were similar to questions used by the National Opinion Research Center from 1972-84, the Gallup polls of 1968-77, and the National Fertility Studies to assess public opinion on abortion. The attitude items were placed on a pro-choice/pro-life scale. The students viewed The Silent Scream and then completed a post-test questionnaire similar to the pre-test. Demographic information collected on the questionnaires included age, sex, ethnicity, marital status, country of birth and religion. The questionnaire was reviewed by American Portrait Films to ensure that the questionnaire items were representative of the film's intent. The questionnaire was also pre-tested by student groups similar to the subjects who participated in the research. The statistical analysis for the study was completed by using the Statistical Package for the Social Sciences (SPSS). Statistical significance was determined by the student t-test and analysis of variance at the level of significance~< .05. 52

The two public schools, the junior college and the university, significantly gained knowledge regarding the unborn child and abor­ tion after viewing The Silent Scream. The mean differences in knowledge scores were +2.1 and +2.0 respectively. The private Christian college students gained +1.2 in knowledge; however, this was not statistically significant. Analysis of variance indicates that there were no significant differences between the three schools on pre-test (baseline) or post-test scores, nor on knowledge gained (F ratio= 0.7). In contrast to knowledge, the film affected a change in attitude in all three schools as the three student populations became more pro-life. The junior college had the largest mean difference on the attitude scale, followed by the private Christian college and the university. There was no significant difference between the three schools in the amount of change or shift to the pro-life stance (F ratio = 1.1); however, there were significant differences in the pre-test (baseline) and post-test attitude scores between the schools. These findings are similar to those of Louis Harris and Asso­ ciates (1985) for The Planned Parenthood Federation of America, Inc. in that both study groups became more pro-life. This research study found that the demographic factors of age, sex, ethnicity and country of birth did not affect the pre-test (base­ line) or mean difference knowledge and attitude scores after viewing the film. Religion also did not affect the baseline or mean differ­ ence scores in knowledge and attitude similar to the findings of past studies (Blake, 1971; Combs & Welch, 1982; Ebaugh & Haney, 1980; Legge, 1983; Tedrow & Mahoney, 1979). 53 Q •

There were no significant differences in baseline or mean differ­ ence scores among the three schools on specific knowledge items. The greatest mean differences occurred on the items concerning fetal development and the premise that the unborn child is a separate human being. Significant changes occurred on specific attitude items resulting in less support for abortion in cases of rape, incest and financial difficulties, and when the mother is not married and does not want to marry the father of the unborn child. After viewing The Silent Scream, the students agreed more with the statement, "Abortion is murder." They were also in more agreement that advances in medical technology should dictate the United States Supreme Court to re­ examine the Roe v. Wade decision. The students also became more supportive of the statement, "Any woman considering an abortion should view the film entitled The Silent Scream prior to consenting to having an abortion." The results of this study indicate that The Silent Scream was an effective health education intervention among these three college populations. The students gained knowledge regarding and changed their attitude towards the unborn child and abortion. Replications of this study and those involving different methodological procedures are needed to assess the impact of the film on other target groups. The continued success of the film among the general public depends upon the medical validation of the film•s content and the fluctuation of public opinion. REFERENCES

America 1 S abortion dilemma. (1985, January 14). Newsweek, pp. 20-29. Andrusko, D. (1986, June 26). Rehnquist chosen to replace Burger as Chief Justice; Scalia elevated to High Court. National Right to

Life News, p. 1. Andrusko, D. (1986, September 25). Rehnquisition ends, Senate confirms Rehnquist and Scalia. National Right to Life News, pp.

1' 12. Blake, J. (1971). Abortion and public opinion: The 1960-1970 decade. Science, 171, 540-49. Blank, R. H. (1984). Judicial decision making and biological fact: Roe v. Wade and the unresolved question of fetal viability.

Western Political Quarterly,~. 584-602.

Cassileth, B. R., Heiberger, R. M., ~1arch, V., & Sutton-Smith, K. (1982). Effect of audio-visual cancer programs on patients and

families. Journal of Medical Education,~. 54-9. Clendinen, D. (1985, January 23). President praises foes of abortion. The New York Times, Part A, pp. 1, 15. Combs, M.A. & Welch, S. (1982). Blacks, whites and attitudes toward abortion. Public Opinion Quarterly, 46, 510-520. Cuniberti, B., & Mehren, E. (1985, August 8). Abortion film stirs friend, foe. Los Angeles Times, Section I, pp. 26, 27.

Domino, G. (1983). Impact of the film One Flew Over the Cuck00 1 S Nest. Psychological Reports, 53, 179-82.

54 55

Ebaugh, H. R. F., & Haney, C. (1980). Shifts in abortion attitudes: 1972-1978. Journal of Marriage and the Family, 42, 491-99. Fletcher, J. c. (1981). The fetus as a patient: Ethical issues. Journal of The American Medical Association, 246(7), 772-73. Harris, L. & Associates Inc. (1985). Public attitudes about sex education, family planning, and abortion in the United States (Study No. 854005). New York: Author. Herold, E. S. (1978, May). The production and use of an attitudinal film in birth control education. The Journal of School Health, 307-310. Herold, E. S., & Thomas, R. E. (1980, February). Sexual experience and responses to a birth control film. The Journal of School Health, 66-68. Houston, P. (1985, February 13). White House showcases abortion film. Los Angeles Times, Section I, p. 6. Hume, E. (1985, April 15). Anti-abortionists gain as the furor spreads and uneasiness grows. The Wall Street Journal, Part

1, p. 1. Jones, E. F. (1985). Teenage pregnancy in developed countries: Determinants and policy implications. Family Planning Perspec­ tives, .!2_, 53. Kleiman, D. (1985, January 25). Debate on abortion focuses on graphic film. The New York Times, p. 88. Legge, J. S. Jr. (1983). The determinants of attitude toward abortion in the American electorate. Western Political Quarterly,

~. 478-90. 56

Malone, J. (1985). Graphic film raises intensity levels of US abortion controversy. Christian Science Monitor, IL, 6. Marcus, R. (1985, February 9). Silent Scream: Loud impact. Washington Post, Vol. 108, p. A1, 9. Mehren, E., & Cuniberti, B. (1985, August 8). He's the force behind The Silent Scream film. Los Angeles Times, part V, pp. 1-3. Mercer, J. (1981). The informational film. Champaign, IL: Stipes Publishing Company. Monahan, J. A. (1975). The relative effectiveness of film and simulated model on the acquisition of the breast self-examination skill by university women. Unpublished master's thesis, University of Florida. Noonan, J. (1979). A private choice: Abortion in America in the seventies. New York: The Free Press. Pfliger, E. F. (1967). The television teaching project report for the year 1959-60, Detroit; Detroit Public Schools. In C. Reid (Ed.), Research in instructional television and film (p. 147). Washington, DC: U.S. Dept. of Health, Education and Welfare. Reid, C. (Ed). (1967). Research in instructional television and film. Washington, DC: U.S. Dept. of Health, Education and Welfare. Roe v. Wade. (1973, January 22). Syllabus of Justice Blackmum delivering the opinion of the Court. In Powell, J. (1981). The silent holocaust (pp. 11-12). Allen, TX: Argus Communi­ cations. Sackett, V. A. (1985a, April/May). Between pro-life and pro-choice. Public Opinion, 53-55. 57

Sackett, V. A. (1985b). Split verdict: What Americans think about

abortion. Policy Review,~. 18-19. Silent scream's other side. (1986, February). California Physician, 43. Smith, D., & Tanner, D. (1985) The silent scream. Anaheim, CA: American Portrait Films Books. Tanner, D., Balsiger, D. W., & Dawson, s. (1985). The silent scream film demonstrates fetal pain. News Release, American Portrait Films, pp. 1-2.

Tedrow, L. M., & Mahoney, E. R. (1979). Trends in attitudes tm1ard abortion: 1972-1976. Public Opinion Quarterly, 43, 181-89. Thomas, C. (1985, February 17). Silent no more. The Los Angeles Times, part IV, p. 5. APPENDIX

Student Survey

Survey Answer Key

58 59

CALIFORNIA STATE UNIVERSITY, NORTHRIDGE Graduate Research Student Survey

Please read each item on this survey carefully and answer it. Follow the directions at the beginning of each section. Part I For the following questions, please indicate if the statements are True or False by marking A for True orB for False on your answer sheet. 1. At twelve weeks, the unborn child in the uterus is fully formed and has a heart rate. 2. Fetology is the study of women who have had abortions. 3. New technological advances in medicine indicate that the unborn child is a distinct human being separate from the mother. 4. The Roe v. Wade decision of 1973 legalized abortions on demand in the United States. 5. The abortion industry qualifies to be on the Fortune 500 list of largest industries in the world. 6. The unborn child is not aware of the abortion procedure as it occurs. 7. In the suction method of abortion, the suction apparatus always removes the child 1 S body in one piece.

Part II For the following multiple-choice questions, please select the one best answer. 8. The ultrasound device a) is rarely utilized to examine the unborn child in the uterus. b) emits light waves which cast a shadow of the unborn child 1 s body onto a screen. c) emits high frequency sound waves that echo off the unborn child 1 S body which give an image of the child. d) emits x-rays that bounce off the unborn child 1 s body which give an image of the child. 60

Part II - Multiple-choice Questions (Continued) 9. Which of the following is a correct statement? a) In the past, women have been properly informed of the abortion procedures. b) Women do not have to give consent prior to having an abortion. c) In the past, women have not been educated about the abor­ tion procedures. d) Women, in general, are very knowledgeable in fetal development. 10. Which of the following is a correct statement? a) There are no victims in an abortion. b) The unborn child is the victim in an abortion. c) Both the mother and the unborn child are the victims in an abortion. 11. During the suction method of abortion, a) polyp forceps are sometimes used to crush the head of the unborn child. b) the suction apparatus does not come in direct contact wi th the unborn chi 1 d 1 s body. c) pain medication is administered to the unborn child.

Part III The following questions ask you about your opinions regarding the unborn child and abortion. On your answer sheet, please mark the letter that most closely describes your feelings about the statement where: A = Strongly agree with statement B = Agree ~ith statement C = No opinion D = Disagree with statement E = Strongly disagree with statement

12. Abortion should remain legal in cases where the mother 1 S health is in danger. 13. Abortion should remain legal in cases where the family does not have enough money to support another child. 14. Abortion is murder. 15. A woman should be able to have an abortion if there is a strong chance of serious defect to the baby. 61

Part III - Attitude Questions (continued) Please continue to answer the following questions by marking the letter that most closely describes your feelings about the statement where: A = Strongly agree with statement B = Agree with statement C = No opinion 0 = Disagree with statement E = Strongly disagree with statement 16. A woman should have the sole right to determine the fate of her unborn child. 17. A woman should be able to have an abortion if she became preg­ nant as a result of rape or incest. 18. New technological advances in the study of the unborn child indicate that the United States Supreme Court should re-examine the issue of legalized abortion on demand. 19. A woman should be allowed to have an abortion if she is not married and does not want to marry the father of the unborn chi 1 d. 20. Abortion is not an appropriate answer to unwanted pregnancies. 21. A woman should be able to have an abortion if she is married and does not want to have any more children. 22. The unborn child and mother have equal rights to life. 23. The unborn child is capable of feeling pain. 24. The issue of a woman•s right to choose and to have an abortion is more important than the 11 immorality/morality 11 of abortion. 25. Any woman considering an abortion should view the film entitled The Silent Scream prior to consenting to having an abortion.

Part IV - Pre-test Please answer the following questions about yourself. 26. What is your age? 27. What is your sex? a) 17-18 years old a) Ma 1e b) 19-20 years old b) Female c) 21-22 years old d) 23-24 years old e) 25 years or older 62

28. What is your marital status? 29. What is your ethnicity? a) married a) Caucasian b) single b) Hispanic c) divorced c) Asian d) separated d) Black e) widowed e) other 30. What is your country of birth? a) United States b) other

Thank you very much for your time and cooperation.

Part IV - Post-test Please answer the following question about yourself. 26. How would you best describe yourself? a) Roman Catholic b) Protestant c) Christian/non-denominational d) Jewish or t~ormon e) other 63

SURVEY ANSWER KEY ACCORDING TO FACTS AND INFORMATION PRESENTED IN THE SILENT SCREAM

Knowledge Items 1. True 2. False 3. True 4. True 5. True 6. False 7. False 8. c 9. c 10. c 11. A Attitude Items -Likert scale The following answers represent the most extreme pro-life position. 12. strongly disagree 19. strongly disagree 13. strongly disagree 20. strongly agree 14. strongly agree 21. strongly disagree 15. strongly disagree 22. strongly agree 16. strongly disagree 23. strongly agree 17. strongly disagree 24. strongly disagree 18. strongly agree 25. strongly agree