Confronting Abortion Stigma

Abortion stigma is a form of gender discrimination and punishment, and it represents social control of both women who need abortions and providers who provide them.

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Late last month, a New Mexico state representative introduced a bill that would further punish women who are raped, as if sexual violence isn’t enough of a violation. The original bill was based on the notion that having an abortion following a rape equated “tampering with evidence” and would have made abortion in case of rape a felony offense. The absurdity of the bill eventually led to it being withdrawn, but that the idea of forcing raped women into pregnancy and motherhood was proposed at all—and in a state where one in four women reports having been raped—is odious to say the least.

While this bill was particularly offensive, every day of every week several state legislatures are hard at work creating more and more restrictions to punish both women in need of abortion and the medical professionals providing safe abortion care.

In North Dakota, the state senate passed a “personhood” bill that endows fertilized eggs with the same rights as the rest of us. In another bill in Alabama, one representative referred to a fetus as “the biggest organ in a body.” And in Indiana, a new bill seeks to prevent the one clinic that provides medical abortion from doing so by forcing it to adhere to ridiculous criteria such as widened halls, even though the clinic doesn’t provide any surgical abortions.

What do all of these actions across the country share? They’re all rooted in abortion stigma.

Look around. It’s everywhere.

The effort to take away a woman’s ability to make independent decisions is rooted in abortion stigma: the process of dehumanizing and discriminating against women, not for who they are, but because they need an abortion. How is it that in the 21st century women still do not have the right to make a decision about one of the most profound and life-transforming decisions any person can make: whether or not to carry a pregnancy to term or to become a parent for life?

Abortion stigma is a form of gender discrimination and punishment, and it represents social control of both women who need abortions and providers who provide them.

We have to keep naming abortion stigma for what it is; we have to keep calling it out. And we have to work together to find ways to both mitigate it and reflect on the societal mechanisms that produce it and structures and systems that support it.

A series of webinars co-produced by ANSIRH and Ipas seeks to explore these issues. In the first webinar, Ipas senior research associate Kristen Shellenberg and I talked about our work to define, measure, and mitigate abortion stigma. Here is some of what we discussed.

How it Works

Abortion stigma is difficult to isolate because it is produced and reproduced at the individual, community, organizational, and legal level and is played out through private and public discourse, including the media. Women who need abortions face stigma as do providers of abortion information and services. Entire communities have developed ways of separating, stereotyping, and discriminating against women who need abortions. Legal frameworks create categories of “acceptable” and “unacceptable” abortions and sometimes reward privilege to those women who obtain early abortions. Abortions have been separated from comprehensive reproductive healthcare services and from insurance programs, as well as totally dissociated from family planning.

Abortion stigma is circular and non-hierarchal. First, women who choose to terminate an untenable pregnancy are labeled as different, which sets up a distinct “us vs. them” mentality in society. These women are then linked to undesirable characteristics: in different contexts they may be characterized as being sinful, selfish, dirty, irresponsible, heartless, or murderous. But these labels belie the fact that abortions are common—one in three women in the United States will have one by the time they reach the age of 45—and many women have abortions to preserve the health and well-being of members of their family. Women who abort are punished socially; they’re shamed into silence and are often overtly discriminated against through inaccurate medical information and unnecessary and invasive procedures like vaginal ultrasounds.

The roots of abortion stigma are found in socially-created ideas of womanhood, including the notions that women are responsible for sex, that sex should lead to procreation, that women instinctively want to become mothers, and that women should never end a potential life. Proposed restrictions on abortion around the country punish women for sex, even if it is unwanted, and attempt to give pregnant women just one option: to become a mother. And as soon as an egg is fertilized, scores of state legislators believe its rights trump that of the woman. What does this say about the status of women in the United States?

Measuring Abortion Stigma

So what is the impact of abortion stigma on women’s health, lives, opportunities, and well-being? Abortion stigma begins with the health impact of internalized stigma and the secrecy, silence, and shame that go along with it. It extends to women waiting to seek care, to women who don’t know they have the right to nonjudgmental, accessible, and quality abortion care, and to women who don’t have the same opportunities as men because their rights to make critical decisions are being curtailed. It means there is a widespread lack of support for all women considering abortion.

We know that the costs of not addressing stigma are huge. So we’ve developed a tool to measure abortion stigma called the Stigmatizing Attitudes, Beliefs, and Actions Scale. The scale includes 18 items and three sub-scales developed from research in Ghana and Zambia. It can be used to assess what is going on in a community, to create strategies to reduce abortion stigma, and as a “pre and post-test” measure of change at the individual and community level. At Ipas, we are currently testing the scale in Uganda, Kenya, and Mexico and the International Planned Parenthood Federation is doing the same in Burkina Faso and Pakistan.

We are also conducting research on institutional and structural stigma at health facilities in Kenya, Uganda, Mexico, and India. We hope to identify specific policies, protocols, and procedures within public and private health-care delivery systems that stigmatize abortion providers as well as women seeking abortion care, and to develop strategies for change.

Right now our efforts focus on understanding and reducing abortion stigma. But while we continue to learn more, we will also continue to shed light on stigma where it exists, to talk about it openly, and to call it out when and where we see it.