Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-25T01:50:58.072Z Has data issue: false hasContentIssue false

Chapter 24 - Stigma and Abortion Care

Implications for Training

from Section III - Family Planning Curricular Design & Implementation

Published online by Cambridge University Press:  30 July 2021

By
Meghan Seewald ,
Lisa A. Martin  and
Lisa H. Harris
Edited by
Uta Landy ,
Philip D Darney  and
Jody Steinauer
Uta Landy
Affiliation:
University of California, San Francisco
Philip D Darney
Affiliation:
University of California, San Francisco
Jody Steinauer
Affiliation:
University of California, San Francisco
Get access

Summary

Abortion stigma is a phenomenon in many regions and cultures. Those receiving training in clinical abortion care should understand abortion stigma both as a theoretical concept and as a lived experience for the abortion-care workforce. Indeed, one of the most challenging aspects of abortion care is managing and negotiating the stigma that often comes with it.In this chapter we define abortion stigma, and discuss its impact on people who seek abortion and on those who care for them.We introduce key concepts in stigma dynamics, in particular the ways in which stigma and silence create vicious cycles that affect psychosocial well-being, abortion complications, and law and policy.We consider the ways in which training settings bring unique stigma-related challenges for both trainer and trainee, including learner dilemmas about seeking abortion training, disclosing abortion training, and interacting with other healthcare providers who may be opposed to abortion.We conclude by reviewing strategies for managing stigma and developing resilience to its consequences, including values clarification trainings and the Provider's Share Workshop.

Keywords

abortion provisionstigmaabortion stigmaabortion trainingclinical trainingstigma interventions
Type
Chapter
Information
Advancing Women's Health Through Medical Education
A Systems Approach in Family Planning and Abortion
 , pp. 240 - 252
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Goffman, E. Stigma: Notes on the Management of Spoiled Identity. New York: Simon & Schuster; 1963.Google Scholar
Link, BG, Struening, EL, Rahav, M, Phelan, JC, Nuttbrock, L. On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. J Health Soc Behav. 1997 Jun;38(2):177–190.CrossRefGoogle ScholarPubMed
Hughes, CE. Good people and dirty work. Soc Problems. 1962;10(1).CrossRefGoogle Scholar
Kumar, A, Hessini, L, Mitchell, E. Conceptualising abortion stigma. Cult Health Sex. 2009;11(6):625–639.Google Scholar
Cockrill, K, Nack, A. “I’m not that type of person”: managing the stigma of having an abortion. Deviant Behav. 2013;34:973–990.Google Scholar
Izugbara, C, Egesa, C, Okelo, R. “High profile health facilities can add to your trouble”: women, stigma and un/safe abortion in Kenya. Soc Sci Med. 2015;141:9–18.Google Scholar
Harris, L, Martin, L, Hassinger, J, Debbink, M. Dynamics of stigma in abortion work: findings from a pilot study of the Providers Share Workshop. Soc Sci Med. 2011;73(7):1062–1070.CrossRefGoogle ScholarPubMed
Jones, RK, Witmer, E, Jerman, J. Abortion Incidence and Service Availability in the United States, 2017. Washington, DC: Guttmacher Institute; 2019.CrossRefGoogle Scholar
Harris, LH, Martin, LA, Youatt, E, Bonnington, A, Hassinger, J, Debbink, M. Michigan’s HB5711: a case study of the role of abortion provider stigma in anti-abortion legislation. Contraception. 2013 Sep;88(3):443.CrossRefGoogle Scholar
Sisson, G, Kimport, K. Doctors and witches, conscience and violence: abortion provision on American television. Perspect Sex Reprod Health. 2016;48(4):161–168.Google Scholar
LeTourneau, K. Abortion Stigma around the World: A Synthesis of the Qualitative Literature. A Technical Report for Members of the International Network for the Reduction of Abortion Discrimination and Stigma (inroads). Chapel Hill, NC: inroads.Google Scholar
Harris, L, Martin, L, Hassinger, J, Debbink, M. Physicians, abortion provision and the legitimacy paradox. Contraception. 2013;87:11–16.Google Scholar
Right to Life of Michigan. Abortion abuses and state regulatory agency failure. November 2011, revised March 2012. www.lifesitenews.com/images/pdfs/MichiganRTL-03152012-Abortion_Clinic_Abuses_March_2012.pdfGoogle Scholar
Kissing, F. Is there life after Roe? How to think about the fetus. Conscience. 2004–2005;25(3):10–18.Google Scholar
Martin, LA, Hassinger, J, Debbink, M, Harris, LH. Dangertalk: Voices of abortion providers. Soc Sci Med. 2017 Jul;184:75–83.CrossRefGoogle ScholarPubMed
Martin, LA, Debbink, M, Hassinger, J, Youatt, E, Harris, LH. Abortion providers, stigma and professional quality of life. Contraception. 2014;90:581–587.Google Scholar
Steinauer, J, LaRochelle, F, Rowh, M, Backus, L, Sandahl, Y, Foster, A. First impressions: what are preclinical medical students in the US and Canada learning about sexual and reproductive health? Contraception. 2009;80(1): 74–80.Google Scholar
Cessford, T, Norman, W. Making a case for abortion curriculum reform: a knowledge-assessment survey of undergraduate medical students. J Obstet Gynaecol Can. 2011 Jan;33(1):38–45.Google Scholar
Shotorbami, S, Zimmerman, F, Bell, J, Ward, D, Assefi, N. Attitudes and intentions of future health care providers toward abortion provision. Perspect Sex Reprod Health. 2004 Apr;36(2):58–63.CrossRefGoogle Scholar
Steinauer, J, Turk, J, Pomerantz, T, Simonson, K, Learman, L, Landy, U. Abortion training in US obstetrics and gynecology residency programs. Am J Obstet Gynecol. 2018 Jul;219(1):86.e1–86.e6.CrossRefGoogle ScholarPubMed
Stulberg, D, Dude, A, Dahlquist, I, Curlin, F. Abortion provision among practicing obstetrician–gynecologists. Obstet Gynecol. 2011 Sep;118(3):609–614.CrossRefGoogle ScholarPubMed
Freedman, L, Landy, U, Darney, P, Steinauer, J. Obstacles to the integration of abortion into obstetrics and gynecology practice. Perspect Sex Reprod Health. 2010;42(3):146–151.Google Scholar
Harris, L. Recognizing conscience in abortion provision. N Engl J Med. 2012 Sep 13;367:981–983.Google Scholar
Martin, LA, Seewald, M, Johnson, TRB, Harris, LH. Trusted colleagues or incompetent hacks? development of the attitudes about abortion providing physicians scale. Womens Health Issues. 2019;30(1):16–24.Google Scholar
Seewald, M, Martin, LA, Echeverri, L, Njunguru, J, Hassinger, J, Harris, LH. Stigma and abortion complications: stories from three continents. Sex Reprod Health Matters. 2019 Dec; 27(3):1–11.Google Scholar
Upadhyay, U, Desai, S, Zlidar, V, et al. Incidence of emergency department visits and complications after abortion. Obstet Gynecol. 2015 Jan;125(1):175–183.Google Scholar
Seewald, M, Martin, L, Hassinger, J, Harris, L. Abortion providers as stigmatized and stigmatizing: findings from East Africa. Contraception. 2016 Oct;94(4):388.Google Scholar
Woodman, M. Holding the Tension of the Opposites. E-book. Sounds True, Incorporated; 1994.Google Scholar
Metzl, J, Hansen, H. Structural competency: theorizing a new medical engagement with stigma and inequality. Soc Sci Med. 2014 Feb 1;103:126–133.CrossRefGoogle ScholarPubMed
Tervalon, M, Murray-Garcia, J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998 May;9(2):117–125.CrossRefGoogle ScholarPubMed
Turner, K, Chapman Page, K. Abortion Attitude Transformation: A Values Clarification Toolkit for Global Audiences. IPAS; 2008. https://ipas.azureedge.net/files/VALCLARE14- VCATAbortionAttitudeTransformation.pdfGoogle Scholar
Turner, KL, Pearson, E, George, A, Andersen, K. Values clarification workshops to improve abortion knowledge, attitudes and intentions: a pre-post assessment in 12 countries. Reprod Health. 2018;15(40):1–11.Google Scholar
Debbink, M, Hassinger, J, Martin, LA, Maniere, E, Youatt, E, Harris, LH. Experiences with the Providers Share Workshop method: abortion worker support and research in tandem. Qual Health Res. 2016;26(13):1823–1827.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×