Abortion Provider Stigma: The Overlooked Side of the Story

More often than not, the discourse on abortion tends to center the experiences of the women who seek abortions. Without a doubt, the focus placed on these women is with good reason. After all, the social stigma they face from their communities when seeking to exercise agency over their own bodies is significant. In some cases, this stigma even poses as an insurmountable obstacle when it comes to accessing safe abortion services. Even so, while the social stigma faced by women who seek abortions is fairly well-documented, there is another group whose experiences tend to be overlooked. These are the abortion providers – a somewhat invisible, but extremely crucial feature of the sexual and reproductive health care rights landscape. Indeed, there is a need for a distinction between pro-choice abortion providers who provide the highest quality of care to abortion seekers and the not-so-great abortion providers unfortunately, who purposefully compromise the quality of care to their abortion patients because of internalized abortion stigma. It is therefore important to note that some women do face obstetric violence and stigma from abortion providers who might tend to bring their own internalized biases to the table.

Nevertheless, it is almost impossible to overstate the importance of pro-choice abortion providers. Not only do they provide the medical support that allows women to make their own reproductive choices, but they also offer critical post-abortion care that, if not made available, could result in life-threatening medical complications for women. Therefore, in a very real sense, abortion care providers offer a much-needed lifeline to women who seek abortions. What’s more, the nature of services they provide means that they, together with the women who seek abortions, are constantly at the center of the abortion scene. 

Why Abortion Providers Face Stigma

What accounts for the stigma typically faced by abortion providers? Just like in the case of the women who seek abortions, a significant portion of it comes from the very community networks in which abortion providers work. In many cases, conservative societal views held by the individuals in a particular community are the drivers of negative attitudes towards abortion. In addition, the conservative norms that surface from such negative attitudes make it difficult for workers to disclose that they offer abortion services to women. 

Institutions such as the law and religion also account for some of the stigma faced by abortion providers. In territories where abortion is illegal, abortion care providers have to contend with the fact that their provision of abortion services practically goes against the law. In addition to that, certain religious institutions may also cast aspersions on their work, therefore painting abortion providers as immoral. In the end, the involvement of abortion providers in what certain factions of the society consider legally and morally reprehensible underlies the stigma to which they are subjected.

The Many Faces of Abortion Stigma

It is also worth considering that the stigma that abortion care providers face is different from that usually faced by women who seek abortions. First, the constant exposure that abortion providers have to abortion makes social stigma a part of their everyday experience and, in some cases, an unshakeable part of their identity. 

Secondly, the fact that abortion care providers are continually exposed to abortion means that they are likely to be subjected to endless stigma as a result of their continued provision of abortion services. 

Thirdly, the fact that abortion care providers tend to be few and far between means that the few providers that exist receive an intense amount of scrutiny, thereby affecting the extent to which they can handle the social stigma. Additionally, the small numbers of abortion providers may lead to provider burnout, therefore intensifying the effect of the stigma. 

The Far-reaching Effects of Abortion Provider Stigma

Abortion stigma emerges out of the social and cultural community contexts in which people exist. As such, the effects that it has on abortion providers are often far-reaching. 

The fear that practitioners may be shunned by their communities may force them to keep their work confidential. This constant need to maintain discretion about what they do on a day-to-day basis may lead to both professional and personal isolation, thereby limiting the access that abortion providers have to much-needed networks of care. 

Abortion care providers may struggle with emotional exhaustion, burnout, and the depersonalization that is often a feature of routine work. This situation, in turn, may lead them to develop negative attitudes not just about abortion, but also the women who have them. The end result of this negative cycle may be the internalization – and reinforcement – of the stigma to which they are subjected.

The fear of being shunned by the community, coupled with the possibility of facing legal consequences for the work they do, could also create an emotionally taxing and mentally damaging environment for abortion providers. 

There may also be higher levels of turnover, lower levels of staff retention, understaffing, and – perhaps more alarmingly – a reduction in the quality of care offered to women who seek abortions. Furthermore, the fact that abortion care providers always have to practice discretion (so as not to fall foul of the law) may bring about an element of hyper-vigilance on their part. This may adversely affect those who genuinely need abortion services by restricting access.

Providing Care for the Abortion Care Providers

Abortion providers are right at the heart of abortion and, by extension,  sexual and reproductive health care rights. To this end, the work of ensuring that women have access to safe abortions has to begin with ensuring that abortion providers have access to the care and resources that they need to carry out their duties efficiently.

There is also an urgent need to entrench a culture of destigmatisation for practitioners who work in abortion care. While there is no end to the strategies that could be used to facilitate this process, they should all be focused on guaranteeing an element of legal safety for the abortion providers; providing networks of care and support for their mental and physical well-being; and cultivating an overall sense of support for the essential and critical services they provide. 

 

Ultimately, making room for the perspective of abortion providers in the abortion story is more than essential – it is crucial. Not only it will lead to the development of more inclusive solutions for the benefit of women who seek abortions, but it will also animate the commitment of abortion providers in promoting women’s sexual and reproductive health care rights. 

safe2choose.org and Ipas CAM recently co-authored an International Survey Report of Abortion Providers and Companions. The report highlights in detail the experiences of abortion providers around the world, especially the effects of discrimination and stigma on their health. Download the full report here.

Sources:

(1) Inter-agency Field Manual on Reproductive Health in Humanitarian Settings: 2010 Revision for Field Review.” Inter-agency Working Group on Reproductive Health in Crises, https://www.ncbi.nlm.nih.gov/books/NBK305158/.  Accessed March 2021.

(2) Addressing abortion provider stigma: Outcomes from Providers Share Workshops Pilots in East Africa and Latin America.” International Perspectives on Sexual and Reproductive Health, https://www.jstor.org/stable/10.1363/46e8720?seq=1. Accessed March 2021.

(3) Abortion providers, stigma and professional quality of life.” Contraception, https://pubmed.ncbi.nlm.nih.gov/25131444/. Accessed March 2021.