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Huslage M, Jones A, Wallis D, Scoresby K. Resilience Amid Chaos: Abortion Provision Across the United States During COVID-19. J Womens Health (Larchmt) 2024; 33:294-300. [PMID: 38061048 DOI: 10.1089/jwh.2023.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Background: Pregnant people face many challenges to obtaining abortion services, including cost, stigma, administrative requirements, and legislative barriers. In 2020, the COVID-19 pandemic added additional barriers for clients and abortion service providers to overcome. Methods: The current study uses the Family Planning Visits During COVID-19 longitudinal dataset to explore abortion service provision from April 2020 through November 2020 from a sample of clinics (N = 63) providing abortion services across the United States. Results: Clinics in the sample were 49.2% academic/hospital-based, based in urban counties (96.8%), with a majority (82.5%) utilizing in-house providers for abortion care. Results show that the majority of clinics (59%) experienced staffing changes in response to COVID-19, including staff and clinicians who took extended leave, quit, were furloughed, or hired. Although the volume of overall abortion service provision decreased March through July 2020, the volume returned to pre-COVID numbers by August and surpassed pre-COVID volume in September and October 2020. Conclusion: Findings from this study demonstrate the adaptability and resilience shown by providers to ensure the continued availability of abortion services. Strategies adopted during COVID-19, such as telehealth and mail-delivery of abortion medication, may prove useful in a post-Roe legislative landscape.
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Affiliation(s)
- Melody Huslage
- School of Social Work, University of Nevada, Reno, Nevada, USA
| | - Aubrey Jones
- College of Social Work, University of Kentucky, Lexington, Kentucky, USA
| | - Dorothy Wallis
- Department of Social Work, Utah State University, Logan, Utah, USA
| | - Kristel Scoresby
- College of Social Work, University of Kentucky, Lexington, Kentucky, USA
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2
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Burry K, Beek K, Vallely L, Worth H, Haire B. The experience of abortion for Cook Islands women: exploring the socio-cultural dimensions of abortion safety. CULTURE, HEALTH & SEXUALITY 2024:1-16. [PMID: 38315568 DOI: 10.1080/13691058.2024.2305814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/11/2024] [Indexed: 02/07/2024]
Abstract
Abortion is significantly restricted by law in most Pacific Island countries, impacting the rights, health and autonomy of people who experience pregnancy. We undertook qualitative research between February and August 2022 on Rarotonga, Cook Islands, where abortion is illegal under most circumstances. We conducted interviews with women who had accessed or tried to access abortion services; people who had supported women to access abortion services; health workers; and advocates to understand their experiences regarding abortion. We conducted focus groups to explore broader social perceptions and experiences of sexual and reproductive health and rights, including abortion. Participants described their abortion decisions and methods, and their negotiation of the personal context of their sexual behaviours, pregnancies, and abortions relative to their socio-cultural context and values. As defined by the World Health Organization, safe abortion relates to the methods and equipment used and the skills of the abortion provider. We argue for an expansion of this definition to consider inclusion of reference to individuals' 'abortion safety nets' as the sum of their access to financial, political, health care and socio-cultural resources. These safety nets are shaped by discourses related to abortion and socio-cultural support and values, impacting physical, emotional, psychological, social and spiritual health.
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Affiliation(s)
- Kate Burry
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Kristen Beek
- School of Population Health, UNSW Sydney, Sydney, Australia
| | - Lisa Vallely
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Heather Worth
- Te Puna Vai Mārama Centre for Research, University of the South Pacific, Rarotonga, Cook Islands
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3
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Bernard M, Niemann J, Weinhold L, Jepsen D, Miani C, Luck-Sikorski C. Abortion stigma among abortion seekers, healthcare professionals and the public in high-income countries: A mixed-methods systematic review protocol. BMJ Open 2024; 14:e076602. [PMID: 38238049 PMCID: PMC10806672 DOI: 10.1136/bmjopen-2023-076602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Abortion is a crucial sexual and reproductive right. However, the legal situation of pregnancy termination is rather heterogeneous across countries and regions. The political climate and cultural perception may result in abortion-related stigma. This mixed-methods systematic review protocol aims to detail the proposed methods for assessing the current state of research on abortion stigma in high-income countries from an abortion seeker, healthcare provider and public perspective. METHODS AND ANALYSIS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline, we conducted a systematic literature search of peer-reviewed studies from high-income countries in relevant electronic databases: PubMed, CINHAL, PsycINFO, LIVIVO and Cochrane Library. Qualitative, quantitative and mixed-method studies that measured or examined abortion-related stigma in abortion seekers, healthcare professionals and the general public will be included. Assessment of risk of bias, data synthesis and qualitative meta-aggregation will be carried out. ETHICS AND DISSEMINATION The results of the systematic review will be submitted to peer-reviewed journals and presented at relevant conferences.
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Affiliation(s)
- Marie Bernard
- Institute of Medical Sociology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Jana Niemann
- Institute of Medical Sociology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Laura Weinhold
- Institute of Medical Sociology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Dennis Jepsen
- Institute of Medical Sociology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Celine Miani
- Department of Social Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Claudia Luck-Sikorski
- SRH Hochschule fur Gesundheit GmbH, Gera, Germany
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, Leipzig University, Leipzig, Germany
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4
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Berndt VK, Bell AV. Beyond knowledge: Introducing embodied aversion through the case of contraception. Soc Sci Med 2024; 341:116516. [PMID: 38141383 DOI: 10.1016/j.socscimed.2023.116516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
Family planning programs have largely operated at the individual level, seeking to enhance individuals' knowledge of, change attitudes towards, and improve consistent use of efficacious contraception. Social science research has added to these efforts by emphasizing the structural influences that shape individuals' contraceptive attitudes, beliefs, and behaviors. Such work highlights the importance of embodied knowledge which is informed by social contexts and provides individuals with a sense of assuredness in knowing which contraception works well for them (and within their bodies). However, through qualitative analysis of in-depth interviews with 59 self-identified women conducted from 2017 to 2018 across the state of Delaware in the United States, we argue that there is a powerful facet of contraceptive decision-making that lies beyond articulatable, conscious knowledge, which we name "embodied aversion." We draw on affect theory and stigma theory to introduce embodied aversion as an influential feeling and orientation away from implantable and insertable contraceptive methods that arises from internalized stigma around the reproductive body. Embodied aversion overpowers conscious understanding of contraceptive benefits like efficacy, ease of use, and longevity. Our research presents embodied aversion as a missing piece of contraceptive understanding that we argue is vital in more fully conceptualizing experiential dimensions of contraceptive use. Doing so enhances patient-centered care, shared decision-making, and reproductive autonomy.
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Affiliation(s)
- Virginia Kuulei Berndt
- Department of Social Sciences, Texas A&M International University, 5201 University Blvd., Laredo, TX, 78941, USA.
| | - Ann V Bell
- Department of Sociology & Criminal Justice, University of Delaware, 18 Amstel Ave., Newark, DE, 19716, USA.
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5
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Millar E. Abortion stigma, abortion exceptionalism, and medical curricula. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2023; 32:261-276. [PMID: 36916481 DOI: 10.1080/14461242.2023.2184272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
ABSTRACTWhile it is well established that medical student learning about abortion is inadequate and lacks systemisation, there is little research on why this might be the case. This exploratory study draws on a survey sent to 438 medical educators at Australia's 21 accredited medical schools through March-May 2021. Forty-eight educators responded to the survey. In this article, I examine their responses alongside policy and research on medical education to consider how curricula are determined. I conceptualise abortion exceptionalism - the singling out of abortion from other areas of medicine on the grounds that it is special, different, or more complex or risky than is empirically justified - as a mode of 'stigma-in-action', arguing that medical curricula are powerful sites for its reproduction and undoing.
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Affiliation(s)
- Erica Millar
- Department of Social Inquiry, School of Humanities & Social Sciences, La Trobe University, Bundoora, Australia
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6
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Makleff S, Belfrage M, Wickramasinghe S, Fisher J, Bateson D, Black KI. Typologies of interactions between abortion seekers and healthcare workers in Australia: a qualitative study exploring the impact of stigma on quality of care. BMC Pregnancy Childbirth 2023; 23:646. [PMID: 37679674 PMCID: PMC10486119 DOI: 10.1186/s12884-023-05902-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/06/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Abortion stigma involves the stereotyping of, discrimination against, and delegitimization of those who seek and provide abortion. Experiences of abortion care are shaped by stigma at the meso (e.g., lack of local providers) and macro (e.g., abortion regulations) levels. Yet abortion stigma and quality of care are often examined separately. This study sought to articulate the impact of abortion stigma on quality of care in the context of healthcare interactions. It did so by characterizing the features of stigmatizing and non-stigmatizing care in the context of macro-level stigma and other structural factors that influence abortion-seeking experiences, including the coronavirus pandemic's influence on the health system. METHODS This qualitative study comprised in-depth interviews with people who sought abortion across Australia between March 2020 and November 2022, recruited through social media and flyers in clinics. Thematic analysis drew on concepts of micro, meso, and macro stigma and person-centered care. We developed typologies of the interactions between abortion seekers and healthcare workers by analytically grouping together negative and positive experiences to characterize features of stigmatizing and and non-stigmatizing care in the context of macro-level influences. RESULTS We interviewed 24 abortion seekers and developed five typologies of stigmatizing care: creating barriers; judging; ignoring emotional and information needs; making assumptions; and minimizing interactions. There are five corresponding positive typologies. Macro-level factors, from abortion regulations to rural and pandemic-related health system pressures, contributed to poor experiences in care. CONCLUSIONS The positive experiences in this study illustrate how a lack of stigma enables patient-centered care. The negative experiences reflect the interrelationship between stigmatizing beliefs among healthcare workers, macro-level (policy and regulatory) abortion stigma, and structural health service limitations exacerbated during the pandemic. Interventions are needed to reduce stigmatizing interactions between abortion seekers and healthcare workers, and should also consider macro-level factors that influence the behaviors of healthcare workers and experiences of abortion seekers. Without addressing stigma at multiple levels, equitable access to high-quality abortion care will be difficult to achieve. Efforts to integrate stigma reduction into quality improvement have relevance for maternal and reproductive health services globally.
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Affiliation(s)
- Shelly Makleff
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.
| | - Madeleine Belfrage
- School of Social Science, The University of Queensland, Forgan Smith Building, St Lucia, Brisbane, QLD, 4072, Australia
| | - Sethini Wickramasinghe
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Deborah Bateson
- Faculty of Medicine and Health, The University of Sydney, Science Road, Camperdown, Sydney, NSW, 2050, Australia
| | - Kirsten I Black
- Faculty of Medicine and Health, The University of Sydney, Science Road, Camperdown, Sydney, NSW, 2050, Australia
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7
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Brott H, Townley G. Reproductive justice for unhoused women: An integrative review of the literature. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1935-1960. [PMID: 36525556 DOI: 10.1002/jcop.22980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/07/2022] [Accepted: 12/02/2022] [Indexed: 06/14/2023]
Abstract
This review examines the reproductive health experiences of unhoused women and youth. Guided by the reproductive justice framework, this review examines barriers to accessing contraception, medical abortion, and prenatal care while homeless. Twenty-one articles were identified through keyword searches in Google Scholar, Ebscohost Academic Search Premier, and PsycINFO. In included articles, barriers were identified at the individual, relational, and contextual levels. Findings from this scoping review illustrate the need to examine multiple levels of analysis when seeking to improve access to family planning services for individuals experiencing homelessness. Included literature suggests an overabundance of research documenting barriers to contraceptive care relative to the literature examining abortion and prenatal care experiences and a scarcity of research examining barriers to reproductive justice among unhoused individuals who do not identify as women.
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Affiliation(s)
- Holly Brott
- Department of Psychology, Portland State University, Portland, Oregon, USA
| | - Greg Townley
- Department of Psychology, Portland State University, Portland, Oregon, USA
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8
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Ratcliffe SE, Smylie CS, Pinkus RT, Dar-Nimrod I, Juraskova I, Dhillon HM. What is the optimal tool for measuring abortion stigma? A systematic review. EUR J CONTRACEP REPR 2023; 28:97-112. [PMID: 36803281 DOI: 10.1080/13625187.2023.2177506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
PURPOSE Abortion stigma is a barrier to accessing and delivering comprehensive, sustainable healthcare. This study aimed to systematically identify measures of abortion stigma, and assess their psychometric properties and uses. MATERIALS AND METHODS The systematic review was preregistered with PROSPERO (ID#127339) and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight databases were screened for articles measuring abortion stigma. Data were extracted by four researchers and checked for accuracy by two reviewers. Psychometric properties were assessed with COSMIN guidelines. RESULTS Of 102 articles reviewed, 21 reported original measures of abortion stigma. Instruments assessed individual and community level stigma for people who have had an abortion (n = 8), healthcare professionals (n = 4), and the public (n = 9), and predominantly originated from the United States (U.S.). Measures varied in structure, use, and comprehensiveness of psychometric properties. On psychometric properties, the Individual Level Abortion Stigma scale and Abortion Provider Stigma Scale - Revised performed best for individual-level stigma and the Stigmatising Attitudes, Beliefs and Actions Scale for community-level stigma. CONCLUSION Gaps in abortion stigma measurement include geography, conceptualisation, and structural-level stigma. Continued development and testing of tools and methods for measuring abortion stigma is needed.
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Affiliation(s)
- Sarah E Ratcliffe
- School of Psychology, Centre for Medical Psychology & Evidence-based Decision-Making, The University of Sydney, Sydney, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Camperdown, Australia
| | - Clare S Smylie
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, Australia
| | - Rebecca T Pinkus
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, Australia
| | - Ilan Dar-Nimrod
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, Australia.,The Charles Perkins Centre, University of Sydney, John Hopkins Dr, Camperdown, Australia
| | - Ilona Juraskova
- School of Psychology, Centre for Medical Psychology & Evidence-based Decision-Making, The University of Sydney, Sydney, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Camperdown, Australia
| | - Haryana M Dhillon
- School of Psychology, Centre for Medical Psychology & Evidence-based Decision-Making, The University of Sydney, Sydney, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Camperdown, Australia
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9
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Bergman ME, Gaskins VA, Allen T, Cheung HK, Hebl M, King EB, Sinclair RR, Siuta RL, Wolfe C, Zelin AI. The Dobbs Decision and the Future of Occupational Health in the US. OCCUPATIONAL HEALTH SCIENCE 2023; 7:1-37. [PMID: 36843836 PMCID: PMC9940085 DOI: 10.1007/s41542-023-00143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 02/25/2023]
Abstract
Access to abortion care has a profound impact on women's ability to participate in the workforce. In the US, restrictions on abortion care have waxed and waned over the years, including periods when abortion was broadly permitted across the nation for most pregnant people for a substantial proportion of pregnancy and times when restrictions varied across states, including states where abortion is banned for nearly all reasons. Additionally, access to abortion care has always been a reproductive justice issue, with some people more able to access this care than others even when it is structurally available. In June 2022, the US Supreme Court handed down the Dobbs v. Jackson Women's Health Organization, returning to states the ability to determine restrictions on abortion, including near-total bans on abortion. In this anthology, ten experts share their perspectives on what the Dobbs decision means for the future, how it will exacerbate existing, well-researched issues, and likely also create new challenges needing investigation. Some contributions are focused on research directions, some focus on implications for organizations, and most include both. All contributions share relevant occupational health literature and describe the effects of the Dobbs decision in context.
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Affiliation(s)
- Mindy E. Bergman
- grid.264756.40000 0004 4687 2082Texas A&M University, College Station, TX USA
| | | | - Tammy Allen
- grid.170693.a0000 0001 2353 285XUniversity of South Florida, Tampa, FL USA
| | - Ho Kwan Cheung
- grid.22072.350000 0004 1936 7697University of Calgary, Calgary, Alberta Canada
| | - Mikki Hebl
- grid.21940.3e0000 0004 1936 8278Rice University, Houston, TX USA
| | - Eden B. King
- grid.21940.3e0000 0004 1936 8278Rice University, Houston, TX USA
| | | | - Rose L. Siuta
- grid.264756.40000 0004 4687 2082Texas A&M University, College Station, TX USA
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10
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Lambert VC, Hackworth EE, Billings DL. Qualitative analysis of anti-abortion discourse used in arguments for a 6-week abortion ban in South Carolina. Front Glob Womens Health 2023; 4:1124132. [PMID: 37066038 PMCID: PMC10098009 DOI: 10.3389/fgwh.2023.1124132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/27/2023] [Indexed: 04/18/2023] Open
Abstract
Background On June 24, 2022, The U.S. Supreme Court overturned Roe v. Wade, leaving abortion legislation entirely up to states. However, anti-abortion activists and legislators have organized for decades to prevent abortion access through restrictive state-level legislation. In 2019, South Carolina legislators proposed a bill criminalizing abortion after 6 weeks gestation, before most people know they are pregnant. The current study examines the anti-abortion rhetoric used in legislative hearings for this extreme abortion restriction in South Carolina. By examining the arguments used by anti-abortion proponents, we aim to expose their misalignment with public opinion on abortion and demonstrate that their main arguments are not supported by and often are counter to medical and scientific evidence. Methods We qualitatively analyzed anti-abortion discourse used during legislative hearings of SC House Bill 3020, The South Carolina Fetal Heartbeat Protection from Abortion Act. Data came from publicly available videos of legislative hearings between March and November 2019, during which members of the public and legislators testified for and against the abortion ban. After the videos were transcribed, we thematically analyzed the testimonies using a priori and emergent coding. Results Testifiers (Anti-abortion proponents) defended the ban using scientific disinformation and by citing advances in science to redefine "life." A central argument was that a fetal "heartbeat" (i.e., cardiac activity) detected at 6 weeks gestation indicates life. Anti-abortion proponents used this to support their argument that the 6-week ban would "save lives." Other core strategies compared anti-abortion advocacy to civil rights legislation, vilified supporters and providers of abortion, and framed people who get abortions as victims. Personhood language was used across strategies and was particularly prominent in pseudo-scientific arguments. Discussion Abortion restrictions are detrimental to the health and wellbeing of people with the potential to become pregnant and to those who are pregnant. Efforts to defeat abortion bans must be grounded in a critical and deep understanding of anti-abortion strategies and tactics. Our results reveal that anti-abortion discourse is extremely inaccurate and harmful. These findings can be useful in developing effective approaches to countering anti-abortion rhetoric.
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Affiliation(s)
- Victoria C. Lambert
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, SC, United States
- Correspondence: Victoria C. Lambert
| | - Emily E. Hackworth
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, SC, United States
| | - Deborah L. Billings
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, SC, United States
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Sorhaindo A, Rehnstrom Loi U. Interventions to reduce stigma related to contraception and abortion: a scoping review. BMJ Open 2022; 12:e063870. [PMID: 36396313 PMCID: PMC9677031 DOI: 10.1136/bmjopen-2022-063870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES We conducted a scoping review to identify the types, volume and characteristics of available evidence and analyse the gaps in the knowledge base for evaluated interventions to reduce contraception and abortion stigma. DESIGN We conducted a search of five electronic databases to identify articles published between January 2000 and January 2022, and explored the websites of relevant organisations and grey literature databases for unpublished and non-commercial reports. Articles were assessed for eligibility, and data were extracted. DATA SOURCES We searched MEDLINE, PubMed, Embase, Web of Science and PsycINFO. ELIGIBILITY CRITERIA Articles included were: (1) published between January 2000 and January 2022, (2) written in English, (3) reports of the evaluation of an intervention designed to reduce contraceptive and/or abortion stigma, (4) used any type of study design and (5) conducted in any country context. DATA EXTRACTION AND SYNTHESIS Included studies were charted according to study location, study aim, study design, type of contraceptive method(s), study population, type of stigma, and intervention approach. RESULTS Some 18 articles were included in the final analysis (11 quantitative, 6 qualitative and 1 mixed methods). Fourteen of the studies focused exclusively on abortion stigma, and two studies focused on contraception stigma only; while two studies considered both. A majority of the studies aimed to address intrapersonal stigma. We found no interventions designed to address stigma at the structural level. In terms of intervention approaches, seven were categorised as education/training/skills building, five as counselling/peer support, three as contact and three as media. CONCLUSION There is a dearth of evaluations of interventions to reduce contraception and abortion stigma. Investment in implementation science is necessary to develop the evidence base and inform the development of effective interventions, and use existing stigma scales to evaluate effectiveness. This scoping review can serve as a precursor to systematic reviews assessing the effectiveness of approaches.
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Affiliation(s)
- Annik Sorhaindo
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneve, Switzerland
| | - Ulrika Rehnstrom Loi
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneve, Switzerland
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12
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Baker MR, Papp LJ, Crawford BL, McClelland SI. Abortion Stigma: Imagined Consequences for People Seeking Abortion Care in the United States. PSYCHOLOGY OF WOMEN QUARTERLY 2022. [DOI: 10.1177/03616843221131544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prior to and since the 2022 Dobbs decision, U.S. state laws have endorsed individuals surveilling and punishing those associated with abortion care. This practice presents an urgent need to understand the characteristics of abortion stigma, particularly the perspectives of individuals with stigmatizing beliefs. To examine the concept and characteristics of abortion stigma, we interviewed 55 individuals about whether they thought there should be consequences for getting an abortion and, if so, what the consequences should be. Adults from three states (Michigan, Kansas, and Arizona) were purposively sampled to include a range of abortion identities and levels of religious engagement. We used reflexive thematic analysis to code and interpret the data. Participants imagined consequences including financial penalties, incarceration, and forced sterilization. Three themes highlighted how abortion was described as violating the law, women's gender roles, and religious doctrine; accordingly, abortion was imagined as deserving of negative consequences, although abortion was legal in all states during data collection. We argue that these imagined consequences relied on carceral logics and interconnected sexist, racist, and classist stereotypes that reflect and reproduce abortion stigma. This study deepens the understanding of abortion stigma from the perspective of the stigmatizer, underscoring the danger of legislation grounded in stigmatizing beliefs.
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Affiliation(s)
- Majel R. Baker
- College of Saint Benedict & Saint John's University, St. Joseph, MN, USA
| | - Leanna J. Papp
- Departments of Psychology and Women's & Gender Studies, University of Michigan, Ann Arbor, MI, USA
| | - Brandon L. Crawford
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Sara I. McClelland
- Departments of Psychology and Women's & Gender Studies, University of Michigan, Ann Arbor, MI, USA
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13
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The influence of feminist abortion accompaniment on emotions related to abortion: A longitudinal observational study in Mexico. SSM Popul Health 2022; 19:101259. [PMID: 36238820 PMCID: PMC9552094 DOI: 10.1016/j.ssmph.2022.101259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/22/2022] Open
Abstract
Emotions can reflect how individuals internalize identities, social roles, and broader power structures, including abortion stigma. Abortion accompaniment, in the form of logistical, informational, and emotional support offered by individuals and organizations, takes a person-centered, feminist, and rights-based approach. We tested the extent to which abortion accompaniment may decrease negative and increase positive feelings an individual holds related to their abortion. Using observational longitudinal data collected between January 2017 and mid-2018, we compared negative and positive emotional responses to a personal abortion experience one month and six months following the abortion to emotions immediately prior to the abortion ("baseline"), among women travelling from outside of Mexico City to abortion clinics in Mexico City with and without support of the accompaniment organization, Fondo MARIA. We used doubly robust longitudinal mixed effects models with inverse probability weighting methods. At baseline, accompanied and unaccompanied participants experienced an average of 4.9 and 4.4 negative emotions out of eight respectively (i.e., anguish, nervousness, scared, anxious, sadness, guilt, anger, shame) and 1.7 and 1.9 positive emotions of out 4 respectively (happiness, calmness, decidedness, and relief). From our model results, women accompanied (n = 77) had larger decreases in negative feelings (p < .05) and larger increases in positive feelings (p < .01) toward their abortion compared to those who were not accompanied (n = 119) at six months. These changes led the majority of accompanied respondents to have primarily positive feelings about their abortion by endline. Abortion accompaniment through Fondo MARIA in Mexico City was associated with a larger decrease in negative feelings, particularly those related to stigma, and a larger increase in positive feelings six months after abortion. Accompaniment's focus on person-centered support, self-determination, and autonomy may enable people seeking abortion to view their decision as one that is valid and legitimate, and resist the predominant stigmatizing narratives framing abortion as something that is transgressive.
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Akbulut Ş, Kılıçlı A. Stigmatizing attitudes, beliefs, and actions of women towards abortion in rural regions with high fertility. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wollum A, Makleff S, Baum SE. Exploring Experiences Responding to the Individual Level Abortion Stigma Scale: Methodological Considerations From In-depth Interviews. Front Glob Womens Health 2021; 2:678101. [PMID: 34816229 PMCID: PMC8594028 DOI: 10.3389/fgwh.2021.678101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The Individual-Level Abortion Stigma (ILAS) scale is a tool to measure multiple dimensions of stigma among people who have abortions. Despite use of the scale globally, little is known about participant experiences completing the scale. We assessed reactions to and experiences with the scale among women who obtained abortions in Mexico, exploring how the items made them feel about themselves and their abortion. Methods: We conducted 10 in-depth interviews with women approximately 6 months after their abortion. We explored experiences answering the ILAS overall as well as each sub-scale (self-judgement; worries about judgement; isolation; community condemnation). We used thematic analysis to examine overall experiences with the ILAS and framework analysis to summarize responses by sub-scale. Results: Many respondents reported positive experiences responding to the scale or said it served a therapeutic purpose. Other participants said the scale caused strong or mixed emotions or generated doubts. Women generally described mixed and negative reactions to the “worries about judgement” and “community condemnation” sub-scales, and more neutral or positive reactions to the “isolation” and “self judgement” sub-scales. Nearly all respondents hypothesized that completing the ILAS at the time of their abortion would be more difficult than responding months after their abortion. Conclusions: People can experience both positive and negative effects when responding to abortion stigma scales. Use of the scales may cause discomfort and introduce concepts that further perpetuate stigma. This study highlights the importance of carefully considering when it is appropriate to implement the scale and exploring safeguards for participants.
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Affiliation(s)
| | - Shelly Makleff
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah E Baum
- Ibis Reproductive Health, Oakland, CA, United States
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Thizy L. Esquiver le stigmate lié à l’avortement : le « travail d’invisibilisation » comme renforcement du travail procréatif. ENFANCES, FAMILLES, GÉNÉRATIONS 2021. [DOI: 10.7202/1086957ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Treloar C, Stardust Z, Cama E, Kim J. Rethinking the relationship between sex work, mental health and stigma: a qualitative study of sex workers in Australia. Soc Sci Med 2020; 268:113468. [PMID: 33120206 DOI: 10.1016/j.socscimed.2020.113468] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/07/2020] [Accepted: 10/19/2020] [Indexed: 12/18/2022]
Abstract
AIMS Sex workers may experience stigma both related to their occupation as well as to mental health issues that they face. There is limited research on the lived experience of sex workers managing mental health and stigma. This study examined the experiences of sex workers in Australia in relation to stigma surrounding sex work, and sex workers' mental health, including self-management and experiences of accessing mental health services. METHOD Six focus groups and two interviews were conducted with 31 sex workers. Data collection was co-moderated by a sex worker and a university-based researcher. Analysis was informed by an approach which positioned sex workers as agential and capable, and which drew attention to structural aspects of stigma. RESULTS Sex workers identified that the stigma surrounding their profession had a significant impact on their mental health. The need to manage risks through selective disclosure of sex work was a pervasive experience. Management of mental health and the stigma associated with sex work was described as a responsibility primarily of the individual through self-care activities and occasional access to mental health services. Participants reported poor treatment from mental health practitioners who saw sex workers as victims lacking agency, imposed beliefs that sex work was the pathological root cause of mental health issues, or approached the issue with fascination or voyeurism. Other presenting issues (especially mental health) were lost or obscured in therapeutic encounters resulting in suboptimal care. CONCLUSION The threat of stigma is pervasive and has mental health implications for sex workers. Our findings point to the need for increased training and capacity development for mental health practitioners, funding for peer support services to ameliorate internalised stigma, and action from governments to introduce enabling legal environments, stigma reduction programs and structural protections from sex work stigma.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, Australia.
| | - Zahra Stardust
- Centre for Social Research in Health, UNSW, Sydney, Australia; Scarlet Alliance, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW, Sydney, Australia
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