Invited paperAbortion Stigma: A Reconceptualization of Constituents, Causes, and Consequences
Introduction
Abortion stigma, an important phenomenon for individuals who have had abortions or are otherwise connected to abortion, is under-researched and under-theorized. The few existing studies focus only on women who have had abortions, which in the United States represents about one third of women by age 45 (Henshaw, 1998). Kumar, Hessini, and Mitchell (2009) recently theorized that women who seek abortions challenge localized cultural norms about the “essential nature” of women. We posit that that stigma may also apply to medical professionals who provide abortions, friends and family who support abortion patients, and perhaps even to prochoice advocates. Does abortion stigma affecting these groups stem from the same root? Do they experience this stigma in the same way? We build on Kumar et al.’s work by exploring how different groups experience abortion stigma and what this tells us about why abortion is stigmatized.
Stigmatization is a deeply contextual, dynamic social process; it is related to the disgrace of an individual through a particular attribute he or she holds in violation of social expectations. Goffman (1963, p. 3) described stigma as “an attribute that is deeply discrediting,” reducing the possessor “from a whole and usual person to a tainted, discounted one.” Many have built on Goffman’s definition over the past 45 years,1 but two components of stigmatization consistently appear across disciplines: The perception of negative characteristics and the global devaluation of the possessor. Kumar et al. (2009) define abortion stigma 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” (p. 628, emphasis added). Like Kumar et al. (2009), we dispute any “universality” of abortion stigma. We retain their useful multilevel conceptualization, understanding stigma as created 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).
Abortion stigma is usually considered a “concealable” stigma: It is unknown to others unless disclosed (Quinn & Chaudior, 2009). Secrecy and disclosure of abortion often pertain to women who have had abortions, but may also apply to other groups—including abortion providers, partners of women who have had abortions, and others—who must also manage information about their relationship to abortion. As with women who have had abortions, none are fully in control of whether their status is revealed by—and to—others. Consequently, those stigmatized by abortion cope not only with the stigma once revealed, but also with managing whether or not the stigma will be revealed (Quinn & Chaudior, 2009). Researchers have theorized that concealing abortion is part of a vicious cycle that reinforces the perpetuation of stigma (Kumar et al., 2009, Major and Gramzow, 1999).
We examine how abortion stigma, created across levels of human interaction, is made manifest for different individuals within groups and across groups. Abortion stigma can affect all women. Here, we focus on how different groups—women who have had abortions, abortion providers (e.g., doctors, nurses, counselors, clinic staff), and others who are supporters of women who have had abortions (e.g., husbands, boyfriends, family members, close friends, as well as advocates and researchers)—although not homogeneous, are positioned differently with regard to abortion. Intergroup differences illuminate how people manage abortion stigma and begin to reveal the roots of abortion stigma itself. Understanding abortion stigma will inform strategies to reduce it, which has direct implications for improving access to care and better health for those stigmatized. We limit our focus here to the United States; a thorough analysis of abortion stigma in other settings is beyond the scope of this paper and deserves attention in its own right.
Section snippets
Women Who Have Had Abortions
Women in the United States voice complex emotions after abortion, and not all women feel stigmatized by it. Many, however, follow the “implicit rule of secrecy”: Women are expected to keep quiet about abortion (Ellison, 2003). Recent research indicates that two out of three women having abortions anticipate stigma if others were to learn about it; 58% felt they needed to keep their abortion secret from friends and family (Shellenberg, 2010). The experience of stigma varies by individual
Abortion Is Stigmatized Because It Violates “Feminine Ideals” of Womanhood
As Kumar et al. (2009) deftly demonstrate, abortion violates two fundamental ideals of womanhood: Nurturing motherhood and sexual purity. The desire to be a mother is central to being a “good woman” (Russo, 1976), and notions that women should have sex only if they intend to procreate reinforce the idea that sex for pleasure is illicit for women (although it is acceptable for men). Abortion, therefore, is stigmatized because it is evidence that a woman has had “nonprocreative” sex and is
Conclusion
One pernicious effect of abortion stigma may be that physicians are unable to receive training in abortion procedures, decline to be trained, or, if trained, face barriers to providing abortions. Future studies should investigate whether abortion stigma leads some physicians to refuse to provide legal abortions. Conscientious objection on religious grounds, by challenging the morality of abortion, may lead both to lack of training opportunities and to trainees refusing to be trained, further
Acknowledgments
An earlier version of this paper was presented at the Social Science Networking Meeting at the National Abortion Federation meeting in April 2010. We are grateful for the many helpful comments we received at that time from participants and panelists, as well as the suggestions of two anonymous reviewers. We also gratefully acknowledge the funding and support of the Charlotte Ellertson Social Science Postdoctoral Fellowship in Abortion and Reproductive Health.
The six authors were Ellertson Fellows from 2008–2010.
Alison Norris, MD, PhD, is a Postdoctoral Fellow the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD. She pursues multi-method research on sexual and reproductive health in under-served women and men.
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The six authors were Ellertson Fellows from 2008–2010.
Alison Norris, MD, PhD, is a Postdoctoral Fellow the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD. She pursues multi-method research on sexual and reproductive health in under-served women and men.
Danielle Bessett, PhD, is an Assistant Professor of Sociology at the University of Cincinnati, Cincinnati, OH. Her research interests are in medical and family sociology, focusing on sexual and reproductive health issues and inequality.
Julia R. Steinberg, PhD, is an Assistant Professor of Health Psychology in the Department of Psychiatry at UCSF. Her research interests are at the intersection of psychology and reproductive health.
Megan L. Kavanaugh, DrPH, is a Senior Research Associate at the Guttmacher Institute, New York, NY. Her research portfolio has focused on unintended pregnancy, contraceptive use, post-abortion contraception and attitudes about abortion.
Silvia De Zordo, PhD, is a Visiting Researcher at Goldsmiths College-University of London. Her research interests are in social and medical anthropology, focusing on sexual and reproductive health issues and inequality.
Davida Becker, PhD, is a Research Scholar at the Center for the Study of Women at the University of California, Los Angeles. Her research focuses on the accessibility and quality of reproductive health services and disparities in reproductive health outcomes.