Abortion stigma—rooted in the pervasive belief that abortion is socially or morally unacceptable—is deeply ingrained in much of American society, yet it remains an under-researched phenomenon with very little empirical understanding of its effects. In an effort to broaden the discussion around abortion stigma and spark further research and critical thinking, the journal Women and Health has published a special issue on abortion stigma compiling peer-reviewed scientific articles examining the topic.
The groundbreaking project was conceptualized and co-edited by Kate Cockrill, Executive Director of the Sea Change program, Leila Hessini and Kristen Shellenberg from Ipas, and Katrina Kimport, Assistant Professor at the Advancing New Standards in Reproductive Health program at the University of California, San Francisco.
“This is a huge step in putting stigma in the center of the frame as opposed to identifying stigma only as a barrier to getting an abortion. We’re taking a closer look at what stigma is, what the consequences of stigma are, and what we can do about it,” says Cockrill, who co-founded Sea Change in 2014 to expand her research on abortion stigma into programming, evaluation and movement building.
Abortion is a reality for one in three American women. Yet rather than existing as an individual experience, abortion is too often examined and dissected through a framework of politics and cultural standards that dehumanize and discriminate against women, not based on who they are as individuals, but on their need for an abortion.
That’s a key characteristic of stigma — that is, individuals are devalued based on an aspect of their identity that is in violation of a social expectation. Abortion stigma, specifically, is defined as as “a negative attribute ascribed to women who seek to terminate a pregnancy that marks them, internally or externally, as inferior to ideals of womanhood” (Kumar, Hessini, & Mitchell, 2009). Far more complex than individual attitudes, stigma exists and is perpetuated “across all levels of human interaction: Between individuals, in communities, in institutions, in law and government structures, and in framing discourses” (Kumar et al., 2009).
Culturally, abortion stigma manifests as silence and shame. As a result of the stigma, people are reluctant to speak openly about abortion and are even more reluctant to share their abortion stories. In the media, abortion stigma manifests as either deafening silence, or myths and mischaracterizations about abortions and the women who have them. In policy and government, abortion stigma is at the heart of efforts to regulate, legislate, and control women’s reproductive decisions, treating the individual lives of those one in three women as nothing more than a statistic.
Thanks to these efforts, abortion is the only FDA approved medical procedure that has ever been outright banned from Medicaid, unlike all other reproductive healthcare services. Abortion is still marginalized within healthcare facilities and providers must comply with regulations that go far beyond the standards for any other outpatient procedure, despite being one of the safest procedures in modern medicine.
Globally, the stigma associated with abortion prevents many women from getting good care, leading to ill-health and deaths — every year, as many as 20 million women around the world have unsafe abortions, resulting in nearly 70,000 deaths and millions of serious medical complications. Evidence shows that access to safe, legal abortion results in better health outcomes for women. Conversely, when abortion is illegal or more difficult to obtain, women’s health and survival suffer.
Breaking the silence
Abortion stigma also affects scholars working to better understand the issue — few schools offer academic concentrations in reproductive justice, and grants for research on abortion are severely limited by federal funding bans. As a result, abortion-related research has been relatively neglected in global sexual and reproductive health research.
However, research plays an essential role in paving the way for more informed dialogue on the need for safe, legal abortion and in facilitating changes in programs and policies. The purpose of this special issue, therefore, is to start that discussion by ending the decades-long silence surrounding abortion stigma.
“This is really an important beginning; abortion stigma needs to be more of a global conversation,” says Leila Hessini, Director of Community Access at Ipas, a global nongovernmental organization dedicated to ending preventable deaths and disabilities from unsafe abortion. “For years, researchers, advocates and policymakers have stumbled over stigma in working toward improving women’s reproductive and sexual health and rights,” adds Kristen Shellenberg, Senior Researcher at Ipas.
In one of the articles, Nickerson, Manski and Dennis interviewed low-income women seeking abortions in four U.S. states and uncovered how individual attitudes often reinforce stigma of women who seek abortions. Sorhaindo and co-authors used focus groups and interviews to explore the stigma experienced by women who had abortions in Mexico.
Two articles provide new ways of measuring abortion stigma. Shellenberg, Hessini, and Levandowski used focus groups with community members in Ghana and Zambia to develop a scale of attitudes toward abortion in those countries. In the United States, Martin et al. tested an instrument to assess the stigma of abortion among providers, who are often devalued and perceived as less competent than other medical professionals simply because of their association with abortion.
The bigger picture
Also in the special issue are three commentaries that explore possibilities for reducing stigma. Joffe examined the harassment, regulation and marginalization of abortion providers from mainstream medicine since Roe v. Wade. Hessini and colleagues refine the definition of abortion stigma and outline a set of priority questions for future research and programmatic efforts.
In her commentary, “Imagine a World Without Abortion Stigma,” Cockrill calls for action to develop a collective vision to guide researchers, advocates, and practitioners toward a future free of stigma. “Mapping a shared vision for a world free of abortion stigma requires a diverse set of cartographers,” including social scientists, theologians, advocates for health, rights and justice, and community members who are affected by abortion stigma, Cockrill writes.
Indeed, grassroots movements — like the 1 in 3 campaign — and anecdotal stories, such as this important piece published recently in Elle magazine, have been instrumental in breaking the silence surrounding abortion. As I wrote about yesterday, recent research shows that opponents of abortion rights are less likely to hear about the abortions women they know have had than are pro-choice Americans. This is important, as studies suggest that those who hear abortion stories are more likely to have a positive shift in their attitude toward abortion. But because of the stigma women encounter when sharing their experiences , particularly with those who oppose the procedure, these stories are kept secret and long-standing misperceptions are allowed to stand.
Far too many women in the United States undergo abortions every year for it to be a topic that is either only discussed in courtrooms and political arenas or downplayed and misrepresented in popular culture. Abortion is a personal and complicated choice that women have the right to make; dialogues about abortion should reflect this. As an academic publication, Bringing Abortion Stigma Into Focus is an important contribution to this fast-growing conversation.