Pandemic, evolving abortion laws mirror content shifts

[00:00:00] Host Amber Smith: From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Advertising is everywhere. And for many of us, ads shape what we know and how we feel about medical care and health.

To examine this concept. I'm talking with Rebecca Ortiz. She's an associate professor in advertising at Syracuse University's S.I. Newhouse School of Public Communications.

Welcome to "HealthLink on Air," Dr. Ortiz.

[00:00:27] Rebecca Ortiz, PhD: Thanks so much for having me.

[00:00:29] Host Amber Smith: Your doctoral degree is in mass communication. Your expertise is health advertising, and you specifically have done research on campaigns having to do with sexual health.

Since the world has just experienced a global pandemic, I wanted to ask you whether and how the pandemic has affected sexual health promotion during lockdowns and afterward.

[00:00:52] Rebecca Ortiz, PhD: Yeah, that's a great question. I think while we were in the middle of the pandemic, we were thinking a lot about health related to contracting the virus and thinking about how do we protect ourselves in that situation, but someone's sexual health is also an important factor through all of that.

And what was really interesting, I think, there's a lot of things that happened, but perhaps for brevity, the most interesting thing that really happened was that we saw some public service announcements that came out specifically talking about sexual health and how one's sexual health might be impacted by the virus.

Some of us may have seen some of these. Some of them may have popped up online, because they were quite surprising, but New York City and then Oregon were two places that really did an interesting thing that we hadn't seen before, which came out with advertising and promotional materials specifically about how the virus could or could not be transmitted through sexual interaction. And so it was really interesting to see them talk really openly about sexuality in a way we hadn't seen in prior public service announcements. So there was a lot of questions, I think, among people about, can I transmit this through sex, like, is this a sexually transmitted virus?

And they really wanted to push away some of those concerns, and so they came out with some messaging specifically about that, and how do you protect yourself in terms of skin-to-skin contact? So that was some of the biggest things that we saw in the pandemic around sexual health.

[00:02:14] Host Amber Smith: So, what sorts of ads are included as sexual health advertising?

[00:02:20] Rebecca Ortiz, PhD: Yeah, it's a big umbrella term, and I think it can mean a lot of different things to a lot of different people. But if we break it down, and we really think about, OK, what do each of those words mean? So, health, of course, can be anything related to emotional, physical, even spiritual well-being. And then so we're taking that in terms of anything related to someone's sexual well-being. And depending on who you talk to, that can mean a lot of different things.

We can talk about it in terms of one's sexual identity, we can talk about it in terms of communication between partners, of sexual consent. I think more traditionally, we think about things like contraception, (and) menstrual products sometimes fall under that if we start to think about it in terms of reproductive health, but even things (like) messaging, talking around sexual pleasure and how do we make sure that we are living our best, healthiest sexual lives. So then it's advertising that promotes any of those types of products or any of those types of ideas.

[00:03:15] Host Amber Smith: The Supreme Court overturned Roe v. Wade last year, and some states have quickly moved to restrict or ban abortion. What impact is this having on sexual health advertising?

[00:03:27] Rebecca Ortiz, PhD: This is a really, really big question, and I'll try to answer it in a couple of different ways, and we can go into different paths if we want to.

You can look at it a couple different ways. So, we have seen, especially around the reversal of Roe, that there was some increase in contraceptive advertising -- Plan B (a morning-after pill), for example. We saw an increase in some of the advertising spent around some of those products. I haven't seen recently if that's maintained, but there was a little bit of an increase there.

And then we also have started to see conversations around, well, how do we advertise and promote and talk about abortion services, especially in places where abortion is completely illegal or severely restricted?

And so there's conversations around what does the advertising look like in those spaces and is advertising appearing in places more readily where you can still get abortions? So there were some of that, and we can talk more about that if we want to, but then there's also some conversations around data and how data is being collected to be used for advertising, especially when you have some of these legal restrictions about being able to talk about abortion.

[00:04:35] Host Amber Smith: So, there's a lot of different things. We can go off in any of those different directions. Well, are you seeing abortion providers in blue states advertising their services in red states? Is that happening?

[00:04:47] Rebecca Ortiz, PhD: What you have is tricky. So when you talk about advertising abortion services, there are a couple of different limitations.

So first, I'll answer your question to say, no, I haven't seen that exactly. However, there's been some reports, and we've seen some increases in these centers that are trying to convince people not to get abortions, and then they sort of sell themselves as abortion centers. We've seen some increases in the advertising there, and there's been some concerns about those advertisers being allowed and being misinformation around some of these. So they're sometimes are called crisis pregnancy centers is what we'll see. But what we're really talking about is: Are we seeing increases in abortion services in general? And what you have to remember is that abortion is still a generally taboo topic. And so, even if it's legal somewhere, there might still be some restrictions in places who aren't willing to carry that type of messaging. And so, even though places might want to be advertising their services, they're limited where those messages can appear.

So, Google, for example, has gotten a lot of backlash from some activists around allowing crisis pregnancy centers to advertise in their spaces and selling themselves as something that they're not. So, it's a big question.

And abortion services have perhaps increased a little bit in some of their promotion, but they can't always do it in a direct way that we think about when we think about selling something like advertisements for menstrual products or things like that.

[00:06:13] Host Amber Smith: Are you seeing ad campaigns, post-Roe, are you seeing those aimed at women or men or both?

[00:06:21] Rebecca Ortiz, PhD: I don't think I have the exact answer to that, but I can say generally that, of course, abortion services, when we start to talk about that, or any sort of contraceptive products and things, often are more advertised towards women. What we are seeing is some increase in discussion around how men can be part of these conversations.

And so there have been some advertisers who have tried to include some of that messaging in their advertising. Whether it's actually aimed at women or men, it's not entirely clear.

[00:06:51] Host Amber Smith: Do you think that contraceptive makers are going to be boosting their advertising now that we're in a post-Roe landscape?

[00:06:59] Rebecca Ortiz, PhD: Yes, and we have seen that some of them have again. I don't know, in terms of the most up-to-date numbers, but right post-Roe, we did see some increases, and I think, yes, I think advertisers are always looking not only for the right message, but the right place and time to put their messaging. And so right now, with such a landscape of concern about how do I control my own family planning, it's an opportune time to do that type of advertising. So, yes, I think we'll continue to see increases in that.

[00:07:30] Host Amber Smith: There's a new over-the-counter birth control pill that's projected to come out after the first of the year. Have you seen any ads for that yet?

[00:07:39] Rebecca Ortiz, PhD: No, I haven't. Not to say that they don't exist, but I would be surprised if they do, because usually there are restrictions about being able to advertise products until they've gone through a full regulation period. I don't know exactly where all of that is, but I would be surprised to see them officially being advertised. But there might be advertisements around people kind of talking about it from a cause issue. So I haven't seen anything where the manufacturers themselves are directly advertising.

[00:08:05] Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking to Rebecca Ortiz from Syracuse University's S.I. Newhouse School of Public Communications, and we're talking about public health advertising.

You were involved in research on how menstrual products are advertised in the United States in a paper that was published in the journal Health Care for Women International. What can you tell us about it?

[00:08:31] Rebecca Ortiz, PhD: Well, in a very quick nutshell, we won't get too into the nitty-gritty of the research, we looked at advertising from a 10-year span. So, a couple years ago, and then 10 years prior to that, looking to see what were sort of the general trends and themes among those ads that were advertising menstrual products like tampons and pads, some things like that, and to see, like, what were some of the themes, what were some of the trends, and then what were some of the responses by potential audience members as to how they interpreted those themes and trends?

[00:09:03] Host Amber Smith: Have you noticed that the ads have evolved over the years? Have you seen changes in menstrual advertising?

[00:09:10] Rebecca Ortiz, PhD: Yeah, you really have. I think, like we always say with any sort of issue that has been previously taboo and still continues to have some stigma and shame around it, there's room to grow. But within the last decade, you've seen a real shift in acknowledgement of the shame and stigma that has often been attached to menstruation and also trying to create more inclusivity within the advertising and showing different body types, race, gender, to ensure that you're reaching audiences with this message more appropriately and trying to reduce some of the stigma and shame that we saw on previous advertisements.

So, menstrual product advertising used to really focus on the shame around menstruation. And I'd say those advertisements still do, but in a sort of trying-to-counter-that way. So we're seeing a lot of shift in that.

[00:10:00] Host Amber Smith: Regarding the shame in menstrual product ads, do you see similar shame in ads for erectile dysfunction drugs?

[00:10:08] Rebecca Ortiz, PhD: So, this is the thing that a lot of people compare, is we're talking about sort of men's health versus women's health. And how do these two things get portrayed in advertising? Is there equality and respect for these two different areas of people's health?

I would say what's interesting about erectile dysfunction ads is not so much the message, though that is interesting, but it's where it's allowed to exist.

So, let me first start with the message. So, yes, I think you do see acknowledgement of some shame or some confusion that men might be experiencing when they experience this problem or issue. There's acknowledgement in the advertisement, so I think both menstrual product advertising and erectile dysfunction advertising are both engaging in messages around acknowledging some of the shame.

But what I think is perhaps more interesting when you start to compare these two different categories is where they're allowed to live. When we're advertising, we don't just think about what does the message say? We think about where is it going to appear. So where is the media that people are going to be exposed to this message?

And last year there was a really interesting investigative report out of theCenter for Intimacy Justice that looked at advertisements for health care products for women, not just menstrual products, but things around sexual health, and looked to see how often were they rejected by Meta, so, Meta being Facebook and Instagram, how often were they rejected, not allowed to be on the platform, versus advertisements for erectile dysfunction.

Now, there's a lot of factors that play into whether an advertisement is allowed to air, if you will, or be published in those spaces. But there seem to be, and I think they had some good evidence to suggest, that they're much more likely to sensor, not allow and moderate women's sexual health ads, than these erectile dysfunction ads. And some of the argument is well, you can't really talk about sex directly. And some of these women's health ads, try to talk about sex directly, which is why you'll often see advertising that is related to sexual health using innuendos. Or, like, the little peach symbol or the eggplant symbol or things like that, because the ads can get flagged as being sort of pornographic if you don't have some of those more innuendos. But if you look at the ads side by side, you see it's perhaps not just that the women's sexual health ads were using more explicit language. There seems to be another undertone there. So, I know Meta changed some of their policies, and it still remains to be seen whether that has fixed some of the problems. But it does appear that when we're talking about men's health, in example of erectile dysfunction, those ads are more allowed to exist.

So, they're more likely to not get flagged and censored than some of the women's health ads.

[00:12:54] Host Amber Smith: So, the ad standards that you mentioned, are these created to protect kids or keep things G-rated? Is that what that's about?

[00:13:02] Rebecca Ortiz, PhD: That's the argument, and I would say for some people that is the case. I mean, that is exactly why they feel the need to restrict or sensor or moderate this type of advertising, is they're trying to reduce pornography on the site, as they would say.

But where it becomes problematic to be thinking about that is to assume that children, and we can talk about different age ranges needing different things, but children not needing to get sexual health information as well. So, as they're developing, as they're starting to experience menstruation, or experiencing sexual desire, all these types of things, it's also important that they get the right information.

So, it's this very sensitive dance that happens between how much information can we allow without it stepping into a place where we feel this is inappropriate for children? And I think a lot of people have a lot of different opinions about what exactly that is. And so the media platform ultimately gets to decide, as long as it doesn't actually enter into legal restrictions.

[00:14:03] Host Amber Smith: You mentioned racial and gender and body type inclusivity in menstrual product ads. Is that unique to the menstrual product ads, or are you seeing that inclusivity in other sectors as well?

[00:14:17] Rebecca Ortiz, PhD: Yeah, definitely seeing it not just in menstrual product advertising. I think it's very welcomed, and I was excited to start to see that appearing more in menstrual product advertising, just because it opens up a wider audience, and we should be speaking to anybody and everybody who would be interested in these types of products. But you are seeing it in advertising across a variety of different products, because the people who are making these ads, I think, are increasingly -- I can see it in my students, and I can see it in my former students -- are increasingly seeing this as an important issue, to make sure that their advertising is reflective of their audience.

[00:14:52] Host Amber Smith: Now, another legislative area that's getting attention has to do with medical care and legal protections provided to the LGBTQ population. How are advertisers navigating this topic?

[00:15:05] Rebecca Ortiz, PhD: Oof! You know, I think we're sort of in the thick of that, and just like I said about racial, gender, body type inclusivity in advertising, there is a clear attempt by advertisers to be inclusive around gender identity, sexual identity. And so we're seeing attempts to do that.

Unfortunately, I think for many, it becomes a political statement to some audience members that then see it negatively. I think the most obvious example that will come to mind, at least right now, the Bud Light controversy, where, and I hate to even call it that, but where they partnered with a trans influencer to promote Bud Light, and then there was a backlash from people.

And what you have to keep in mind is, there was a backlash, and then there was discussion around, like, "Oh, are they alienating their audience?" When these companies are creating advertisements where they're engaging in inclusive messages, I think the biggest mistake that they can make is not being consistent with that.

So, when they received that backlash from, I don't even know that they were necessarily people that were current customers, but let's just say backlash from people, probably one of the biggest missteps they make was not to continue to support the decisions that they had made. And so you not only alienated -- that word's tricky -- like, alienated, or made a certain segment of the consumer population upset, you then alienated the people who would have been there to support the brand, given that they made that decision. So, it's tricky. It's a space right now that is a political discussion, unfortunately. And a lot of companies, I think, are still trying to figure out how to navigate it.

[00:16:49] Host Amber Smith: Well, regarding taking sides, thinking back to COVID-19, public health messaging about the vaccine or masking was seen by some to be taking a side.

Is there any evidence or lessons learned for navigating disinformation during a public health crisis?

[00:17:06] Rebecca Ortiz, PhD: So, this is the question that I can tell you many, many bright, intelligent people are trying to tackle, and I think some people feel they have the answers and they may absolutely be right, and others are still in the space of "... don't really know; we're still trying to figure that out."

I'm perhaps one of those that is not entirely sure how we address it because what we're dealing with is, we're dealing with emotions. We're dealing with feelings. People feel certain ways about certain things and where they may be making those decisions based upon what they believe are facts or rational thinking, a lot of advertising and a lot of promotion of messaging is meeting people where they are emotionally. And so I think what you have to consider is, if you're trying to counter misinformation, disinformation, these kinds of things, we, as health communicators, as advertisers, need to remember that just throwing facts at people, just throwing rational thinking at people, is not always going to get at the heart of what is making them feel or believe misinformation or disinformation.

So, I don't have the answer. I think a lot of people are still figuring out what that answer is, but to remember that a lot of decisions that we make as consumers, as people, is emotional, and whether we want to acknowledge it or not, we need to make sure that we're talking to people in respectful ways that don't just sort of question their knowledge or question how they feel, because feelings matter, and emotions are very influential in how we make decisions.

[00:18:40] Host Amber Smith: Well, getting back to sexual health advertising, have you given any thought to where it's headed and what the future holds or what the ads will be like in the future?

[00:18:49] Rebecca Ortiz, PhD: There's a project that I alluded to earlier about New York and Oregon doing those sexual health messagings during the height of the pandemic, and a colleague of mine who is also at Newhouse, Kyla Garrett Wagner, and I started a project soon after those promotional materials came out, because we wanted to see, so there was this greater openness to talk about sexual health, because it was in conjunction with trying to reduce transmission of the virus, and we were interested to see, like, is this sort of a tipping point? Is this a point where we're going to start talking more openly about sexual health, especially by public health departments? And we're at the point where we don't know the answer yet, because there's still many more years to come to see how it translates.

But it was very interesting to see public health departments making these statements. And we wanted to see: Will that translate over time into healthier discussion and more open discussion around sexuality and sexual health? So my optimistic part of me is hopeful that we will continue that, that we'll continue to be more inclusive, that we'll continue to ask the big questions and make sure that we are engaging in conversations around sexual health.

But I think it still remains to be seen.

[00:20:00] Host Amber Smith: Well, this has been very interesting, and I appreciate you making time for this interview, Dr. Ortiz.

[00:20:05] Rebecca Ortiz, PhD: Thank you so much. I appreciate it.

[00:20:07] Host Amber Smith: My guest has been Rebecca Ortiz. She's an associate professor in advertising at Syracuse University's S.I. Newhouse School of Public Communications.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.

Find our archive of previous episodes at ngskmc-eis.net/informed.

This is your host, Amber Smith, thanking you for listening.