CommentaryPhysicians, abortion provision and the legitimacy paradox☆
Section snippets
Two centuries of marginalization and negative representation
Depictions of shady, disreputable and greedy “abortionists,” date back to at least the 1800s when such images were deployed in the effort to make abortion illegal [6], [7]. As historians have documented, physicians were among the most vocal advocates for the criminalization of abortion [6]. The American Medical Association (AMA) opposed abortion in part because unsafe practices harmed women but also because it was a good business strategy. Midwives, osteopathic doctors, homeopathic doctors and
Contemporary stigma and stereotypes of moral and technical deficiencies
The stereotypes embodied in contemporary law also impact physicians’ day-to-day provision of abortion care. In the course of our efforts to understand the meanings of abortion work for those who do it, we carried out a series of six 2-h focus groups over a 3-month period in 2007–8, at a Midwestern reproductive health clinic that offered abortion care. The methods for this study have been previously described in detail [1]. Briefly, seventeen workers in all job categories participated, including
Consequences of stigma: violence and silence
Stigmatizing, negative images of abortion providers may also contribute to violence, harassment and other acts of domestic terrorism. Since the National Abortion Federation began collecting data in 1977 in the United States, eight abortion workers have been killed, and there have been 17 attempted murders, over 400 death threats, 41 clinic bombings, 175 arsons as well as other kinds of attacks on clinics and providers [17]. Sociologists and psychologists tell us that stigma can lead to violence
Stigma+silence=legitimacy paradox
We suggest that stigma and silence work together to distort the image of abortion providers, and to create a vicious cycle in which erroneous, negative images of providers are perpetuated, and rarely or never dispelled. We base this assessment in part on Kumar et al.'s [2] conceptual work on the distorting effects of stigma and silence for women who seek abortion. As they describe, women's silence about abortion experiences leads to the broad misperception that abortion is unusual or deviant.
So what?
The significance of the legitimacy paradox needs to be measured by its potential impact on women and families who use — or may at some time use — abortion services. Indeed, the legitimacy paradox likely impacts the availability of abortion services in multiple ways: Negative images of abortion providers in popular culture (or negative internalized self-image) may deter some physicians from providing abortion care, contributing to provider shortages. For those who ultimately do provide abortion
Acknowledgment
The authors would like to thank Emily Youatt, Meghan Eagan and Stephen Harris for helpful comments on earlier drafts of this manuscript. This paper was based upon research funded by the Society of Family Planning. The views and opinions expressed are those of the authors and do not necessarily represent the views and opinions of the Society of Family Planning.
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2023, Social Science and MedicineSociety for Maternal-Fetal Medicine Special Statement: A critical examination of abortion terminology as it relates to access and quality of care
2023, American Journal of Obstetrics and GynecologyWhen doctors are “doxxed:” An analysis of information posted on an antiabortion website
2022, ContraceptionCitation Excerpt :Doctors who perform abortions have long been targets of harassment, threats, and violence to deter them from providing their services and discourage others from entering the field [1,2]. These doctors have also been subjected to inaccurate, inflammatory rhetoric about their competence [3]. Online platforms and public records laws present additional avenues for harassing and vilifying doctors and disseminating their personal information [4,5] in a practice known as doxing.
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The work was funded by the Society of Family Planning (SFP). The views and opinions expressed are those of the authors and do not necessarily represent the views and opinions of SFP.