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Study documenting how women and men who disclosed abortions perceived others' reactions and determinants of those perceptions and found that whereas most people disclosing an abortion received support or sympathy, a substantial minority received stigmatizing reactions, which could plausibly have a negative impact on health.
‘To decide in order to live’ is a radio novela about the histories of women and men who take important decisions in the face of difficult situations in their lives. These decisions break down barriers and are possible because they are based in human rights. The characters and situations are based on real-life – life stories that echo in your heart.
A comparative case study investigating the efficacy and acceptability of laws and policies that permit conscientious objection and ensure access to legal abortion service.
A qualitative study exploring pregnancy intentions among low-income women in Western Pennsylvania. Authors found that women's reactions to antiabortion attitudes may perpetuate abortion stigma
A synthesis of qualitative literature that reports findings about abortion stigma paints a picture of how stigma appears in different geographic regions, and across the different levels of the ecological model.
A systematic literature review found that more research, using validated measures, is needed to enhance understanding of abortion stigma and thereby reduce its impact on affected individuals.
A systematic review of articles and reports focused on indicators of quality abortion care found that there is little agreement about indicators for measuring quality; more work is needed to ensure efforts to assess quality are informed and coordinated.
A video panel describing the different contexts of women who seek abortion after the first trimester.
Although abortion is now legal in Kenya under expanded circumstances, access is limited and many providers and individuals still believe it is illegal. This study aimed to characterise Kenyan women’s perceptions and experiences with abortion and post-abortion care (PAC) services in Nairobi regarding barriers to care, beliefs about abortion, and perceived stigma. In response to stigma, participants developed a sense of agency and self-reliance, which allowed them to prioritise their own healthcare needs over the concerns of others. To adequately address perceived stigma as a barrier to abortion- and PAC-seeking, significant cultural norm shifting is required.
Although Benevolent Sexism (BS)—an ideology that highly reveres women who conform to traditional gender roles—is cloaked in a superficially positive tone, being placed upon a pedestal is inherently restrictive.
Although illegal abortion is believed to be widely practised in Haiti, few data exist on such practices. This study aimed to learn about illegal abortion access, methods, and perceived barriers to abortion-related care. Additionally, the study aimed to identify the proportion of unscheduled antepartum visits to a public hospital that were attributable to unsafe abortion in Cap Haitien, Haiti. Among the focus groups, there was widespread knowledge of misoprostol self-managed abortion. Women described use of multiple agents in combination with misoprostol. Men played key roles in abortion decision-making and in accessing misoprostol.
An evaluation was conducted to assess women's access to abortion services as part of an ongoing program to operationalize the new exemptions for legal abortion. Abortion stigma and court order requirement are major barriers to access services.
Analysis explores how stigma contributes to unethical behavior by physicians resulting in care that is delayed or refused.
Analysis of nationally representative data to estimate the prevalence of negative abortion attitudes in South Africa and to identify racial, socioeconomic and geographic differences.
Analysis of social media used and perceived stigma suggest that stigma has a similar dampening effect on face-to-face and Twitter interactions.
Analysis of Texas abortion law exploring how language in legislative documents use generates abortion stigma.
Approximately 47 000 women die each year worldwide as a result of the complications of unsafe abortion, almost exclusively in low- and middle-income countries with restrictive abortion laws. In these countries, very few women who comply with the conditions imposed by the law can access safe abortion services in the public health system. The main obstacle is the unwillingness of gynecologists and obstetricians to provide abortion services by claiming conscientious objection, which is often used to hide their fear of the stigma associated with abortion. This happens because many colleagues are unaware that without access to legal services these women will resort to an unsafe abortion and its consequences. This violates the statement from FIGO's Committee for the Ethical Aspects of Human Reproduction and Women's Health, which asserts that: “The primary conscientious duty of obstetrician–gynecologists is at all times to treat, or provide benefit and prevent harm, to the patients for whose care they are responsible. Any conscientious objection to treating a patient is secondary to this primary duty.”
Article about the movement towards a democractic vote for abortion rights in Ireland
Article analysis of the consequences of unsafe abortion in Malawi based on 485 in-depth interviews. Stigma related to unwanted pregnancy and to abortion discussed.
Article commentary discussion the stigmatization of abortion within the context of medicine.
Article commentary exploring what a world without abortion stigma might look like at the individual, community, and institutional level.
Article conceptualizing abortion stigma roots, manifestations and impacts. Lays out a research agenda to measure and map abortion stigma and impact on health.
Article describing rates of internalized stigma in the USA; comparison by race/Hispanic ethnicity.
Article describing small rural community context in Ghana, contrasting social restrictions around abortion to national-level laws that permit it.
Article describing sociohistorical and geopolitical context for Indonesia's abortion laws and culture.
Article describing the development of a scale to measure individual-level abortion stigma. Includes an analysis of the characteristics of women who report abortion stigma.
Article describing the development of the Stigmatizing Attitudes, Beliefs, and Actions Scale grounded in qualitative research in Ghana and Zambia
Article describing the history and development of abortion counseling in the United States.
Article discussing abortion stigma and how abortions are provided on UK National Health Service.
Article discussing abortion stigma and how it manifests. Includes an analysis of legal restrictions and abortion stigma in US Supreme Court decisions.
Article discussing abortion stigma, drawing from social science literature to describe groups affected by abortion stigma.
Article discussing barriers to safe abortion internationally
Article discussing implications for privileging faith-based organizations for international development aid.
Article discussing qualitative findngs contextualizing unsafe abortion in rural Ghana, identifying shame and stigma as a key theme.
Article discussing the manifestation and consequences of stigma in reproductive health.
Article examines circumstances underlying adolescent girls' decisions to have abortions outside of the health care setting. Stigma identified as a barrier to safe abortion.
Article examines how the US Supreme Court's abortion decisions contribute to abortion stigma.
Article examines the economic consequences of the stigmatisation and illegality of abortion and its almost complete removal from public health services in Poland since the late 1980s
Article examining abortion stigma in five countries. Stigma was perceived in both legally liberal and restrictive settings.
Article examining abortion discourse among Bolivian doctors.
Article examining abortion practice in the Carribean. Findings suggest that an increasing number of women are self-inducing abortions with misoprostol to avoid doctors, high fees and public stigma
Article examining evidence-based practices for providing emotional care for other stigmatized services. Discusses these strategies and applying them to abortion care settings.
Article examining lay narratives and their implications about abortion among men and women in central Kenya.
Article examining stigma construction in "post-abortion recovery groups" and its linkages to anti-abortion activism
Article examining stigmatizing attitudes towards abortion among HIV positive women who choose to end a pregnancy and those who choose to give birth.
Article explores relationship between stigma and abortion complications in the US, where unsafe abortion is rare.
Article explores the experience of doctors and how they are prevented and prohibited from performing abortions in both explicit and implicit ways.
Article explores the role that stigma the role of a clinician as a social, economic, and political agent in determining how conscientious objection is practiced.
Article exploring experience of stigma among health care providers. Findings suggest that the experience of stigma for those providing abortion care is not a static or fixed loss of status. It is a dynamic situation in which those vulnerable to stigmatization can avoid, resist, or transform the stigma that would attach to them by varying degrees within selective contex
Article exploring HIV-positive women's abortion decisions in South Africa. Findings suggest that stigma and discrimination affect connections between abortion, pregnancy and HIV/AIDS, and that abortion may be more stigmatised than HIV/AIDS
Article exploring how low-income abortion clients in US states where public funding was and was not available perceived the role of public funding.
Article exploring how men and women make decisions about pregancy and abortion in Peru. Stigma surrounding abortion and some pregnancies identified.
Article exploring psychometric properties of a scale to measure stigma experienced by abortion providers.
Article exploring the experience of young women terminating pregnancy in a tertiary hospital abortion clinic in India.
Article exploring the sources, experiences and consequences of abortion stigma among women who had abortions, their male partners, and the general population.
Article looking at social stigma, motherhood, and physicians' experience in Ghana.
Article offers a social-psychological framework for understanding how women manage the stigma of having an abortion.
Article presenting a sociological framework for understnading how new cultural constructions that draw equivalences and remove blame shape public and structural stigma over time.
Article presenting findings from a nationally representative survey about stigmatizing attitudes in Mexico.
Article presenting results from qualitative inquiry into attitudes towards abortion and unwanted pregnancy in in Amukpe, Nigeria.
Article presenting theoretical framework for describing the narratives of abortion decision-making in Ethiopia.
Article presents a refined conceptual framework for abortion stigma and proposes a learning agenda to guide research and programmatic efforts to address abortion stigma.
Article presents a theoretical overview of stigma and a taxonomy of four types of stigma (public, self, by association, and structural).
Article presents an application of stigma theory to nurses attending abortions.
Article proposes three major strategies that would help to destigmatise abortion in the Ghana.
Article providing results from qualitative pilot study of post-abortion intervention designed to mitigate the effects of abortion by creating a "culture of support." Results suggest that women felt positively about the intervention.
Article reporting characteristics of women seeking abortion in Iran based on Iran Low Fertility Survey and exploring reasons for and consequences of abortion using in-depth interviews. Stigma discussed.
Article reporting findings from an evaluation of the Provider Share Workshop intervention to reduce stigma experienced by abortion providers in the US.
Article reporting findings from interviews with Ghanain physicians, which identifies stigma as a key factor leading to abortion complications.
Article reporting on a validation of the key ingredients of contact-based interventions to address stigma associated with mental illness.
Article reporting qualitative findings illustrating stigma as a factor in post-abortion care.
Authors adapted global stigma and discrimination measurement tools and field tested them for use in Thailand, including a health facility questionnaire to capture staff attitudes, and the policy environment, and a brief questionnaire for people living with HIV to capture their experiences.
Authors developed an analyzed multi-dimensional measures of norms and stigmas around all pregnancy decisions in the U.S. South.
Authors explored reproductive agency in relation to unsafe abortion among young women seeking post-abortion care and found that reproductive agency was constrained by gender norms and power imbalances and strongly influenced by stigma.
Authors present a illustrative evidence on the health consequences of stigma and a conceptual framework describing the psychological and structural pathways through which stigma influences health.
Authors propose a framework to understand stigma using a multilevel approach that can be tailored to stigmatized statuses.
BACKGROUND: The aim of this post-intervention assessment was to measure the effects of community intervention on the knowledge and attitudes of women regarding safe abortion in Ethiopia. METHODS: In 2014, following implementation of an educational intervention on sexual and reproductive health from December 2012 to December 2013, 800 women were interviewed about their knowledge, attitudes and practices regarding abortion. Multivariate regression analyses of respondents' demographics, sources of abortion information, knowledge and attitudes about safe abortion were conducted. RESULTS: More women in the intervention community knew safe abortion was available in the community (76% vs. 57%; p < 0.001). Women in the intervention community had greater odds of feeling that women should have access to safe abortion services (adjusted odds ratio [aOR]: 1.55, 95% confidence interval [CI]: 1.06, 2.28) after adjusting for socio-demographic characteristics. They had significantly greater odds of feeling comfortable and confident talking to a healthcare provider (aOR: 2.44, 95% CI: 1.55, 3.84) and/or her partner (aOR: 2.47, 95% CI: 1.58, 3.85) about abortion. CONCLUSIONS: Increased mobilization of community networks in disseminating sexual health and abortion information was followed by increased knowledge of abortion services in the intervention community and improved reproductive choices for women.
Barriers related to knowledge and information, along with logistic, emotional, financial, cultural and religious barriers culminated in delays in obtaining comprehensive abortion services. Religion influenced social stigma, which manifested most powerfully in the obstructive behavior of health care providers and health insurance companies. Lack of understanding of current laws on abortion and conscientious objection was evident on the part of patients, health care providers and insurers.
Based on content analysis of online pregnancy forums, researchers identified attitudes towards abortion as a factor in women's decision-making about genetic screening.
Based on qualitative interviews with unmarried women in Iran, researchers found that the stigma surrounding sexuality activity creates limitations for unmarried women in accessing reproductive health services, even when services are available.
Based on themes from an inroads-member discussion, this proposed framework integrates concepts of stigma with the WHO framework for quality care.
Best practice tools for health facilities to counter stigma related to HIV status, gender identity, sexual orientation, and behaviors such as sex work or drug use.
Blog post explores how popular culture can play a role in either upholding stigma or dismantling it.
Blog post highlights steps for identifying, adapting and implementing scales to measure abortion stigma.
Blog post reporting an interview with Katie Gillum about using video to destigmatize and normalize women's experiences with abortion.
Book chapter examines how legal actors advovate, regulate and adjudicate abortion and its relationship to stigma.
Briefing that provides information, ideas and tools to help facilitate dynamic workshops. Aimed at CBOs and NGOs working HIV and AIDS. Not specific to stigma, but an essential skill in stigma busting.
Briefing that provides information, ideas and tools to help facilitate dynamic workshops. Not specific to stigma, but an essential skill in stigma busting.
Commentary and agenda for action for getting misoprostol in women's hands.
Commentary discussing legitimacy paradox: when abortion providers do not disclose their work, their silence perpetuates a stereotype that abortion work is unusual, or that legitimate, mainstream doctors do not perform abortions.
Commentary examining conceptualization of abortion stigma and argument for precision in understanding stigma in order to carry out better research to understand and measure it, design interventions to mitigate it, and evaluate those interventions.
Comparison of reported HIV stigma experienced by women requesting contraception at inegrated sexual health clinics vs. family planning-only clinics in the UK. Perceived stigma is higher at integrated clinics than family planning-only.
Content analysis of television plotlines found that abortion is presented differently depending on legal setting, and that abortion provision is linked to violence
Cross-sectional examination of midwives' attitudes toward abortion in Ethiopia to understand their decisions about service provision.
Currently, abortion can be lawfully performed in China at any gestational stage for a wide range of social and medical reasons. This article critically explores the Chinese regulatory model of abortion in order to examine its practical effects on women
Description of an 8-week course on managing stigma based on social psychology and social neuroscience research. Includes conceptualization of stigma and recommendations for intervention.
Description of the implementation of 5 Safe Abortion Information Hotlines in countries where abortion is restricted.
Description of the making of a film to share knowledge about barriers to safe abortion in Asia and to facilitate conversations about the right to safe abortion.
Despite the presence of abortion services in Great Britain, a diverse group of women still experiences logistical and personal barriers to accessing care through the formal healthcare system, or prefer the privacy of conducting their abortions in their own homes.
Diagnosis of fetal anomaly is a significant life event and social stigma can negatively impact on the well-being of women opting for an abortion. This study investigated the psychometric properties of a measure of stigma among women who had had an abortion after diagnosis of fetal anomaly in a German setting.
Discourse analysis of abortion expressed in two main Ugandan daily newspapers.
Discussion about the similarities and differences between abortion and multi-fetal pregnancy reduction, including the tug-of-war over naming, highlights ongoing contestation about the relationship between the law, ethics, and women's bodies.
Discussion of conscious objection and its relationship to fear of experiencing stigma and discrimination by providing abortion care. Discusses a need for a paradigm shift in order to ensure access to services.
Discussion of role of stigma in both abortion and surrogacy and a common legal paradigm: state regulation on the pregnant body, rooted in traditional gender roles.
Discussion of the need for collaboration across sectors to support sexual health on the basis of human rights laws and standards. Discusses the role of stigma.
Discussion of the role of "conscious" in abortion provision.
Discussion of the role of stigma in abortion and surrogacy, including they way that legal restrictions perpetuate social stigma. Examination of Paula Abrams' article "The Bad Mother: Stigma, Abortion, and Surrogacy"
Downloadable toolkit with facilitator instructions for activities designed for participants to understand, identify and challenge HIV stigma.
Drawing on ethnographic fieldwork in Senegal, the author illustrates how post-abortion care accomplished reproductive governance where abortion is prohibited. Although post-abortion care offers life-saving care to women with complications of illegal abortion, it institutionalizes abortion stigma by scrutinizing women's bodies and masking induced abortion within and beyond the hospital.
Drawing on ethnographic research, this article describes how Burkina Faso's post-abortion-care policy emerged, resulting in widespread support for PAC but stifled debate about further legalisation of abortion.
Drawing on intra-categorical intersectionality, the supportability aspect starts from the event of a pregnancy to unravel the interwoven embodied and social realities implicated in women experiencing pregnancy as personally supportable/unsupportable, and socially supported/unsupported.
Early reports heralded the development of abortion pills as promising a reproductive revolution. Some twenty-five years on, this article considers the extent to which this promise has been fulfilled in the context of the Republic of Ireland. It focuses in particular on the work of two online collectives, Women on Web and Women Help Women. Drawing on a small number of interviews with activists, support groups, service providers, doctors, and government officials, the article assesses, first, the extent to which abortion pills have empowered women and, second, their offer of privacy. It argues that while home use of pills has had enormous importance in furthering each of these goals and, more generally, women’s health, it does not offer a panacea for current deficiencies in reproductive health care. The empowerment offered by abortion pills is necessarily precarious and partial, with the privacy offered by the pills operating not just as part of that empowerment but also as a significant limitation on it. The article also suggests that privacy readily collapses into secrecy, feeding a carefully choreographed silence regarding abortion, which allows the state to ignore its existence and thus to avoid responsibility for women’s reproductive health.
Examination of frequency and reasons that women were denied abortion care in Columbia, South Africa, Tunisia and Nepal.
Examination of the effect of criminilization of abortion on women's reproductive health, including the role of the judicial system in persecuting women and increasing stigma.
Examination of women’s emotions about abortion. Authors found that women experienced decreasing emotional intensity over time, and the overwhelming majority of women felt that termination was the right decision for them over three years.
Exploration and illustration of the variations in Muslim belief and practice related to abortion.
Exploration of knowledge and decision-making surrounding abortion among university students in Ghana.
Exploration of the experiences of nurses providing genetic termination for fetal abnormality in Canada.
Exploration of women’s experiences from Nepal and Bangladesh illustrates that even where services are provided legally, women can still face multiple barriers to access to services, and problematic quality of care.
Focos is a digital platform in Spanish with the objective of making visible the practice and experience of abortion in Mexico. Focos es una plataforma digital que tiene por objetivo visibilizar la práctica de aborto inducido en México, como un evento reproductivo frecuente.
Following an unintended pregnancy, the study participants had experienced different levels of fear and threat depending on their personal, family, and socio-cultural backgrounds. An unintended pregnancy can threaten women's lives through social deprivations, growing instability, and putting both mother and baby at risk for physical and psychosocial problems.
Guided by the biopsychosocial model, the study revealed that fear of societal stigma, shame, and rejection by partners, as well as self-imposed stigma constituted some of the pre and post abortion experiences the respondents
Here is considered a harm reduction approach to first-trimester abortion as a way for physicians to honor clinical and moral obligations to care for women, negotiate ever-increasing abortion restrictions, and support women who consider abortion self-induction.
Here, we identify eight pitfalls that practitioners must avoid as they plan to integrate a social norms perspective in their interventions, as well as eight learnings. These learnings are: 1) Social norms and attitudes are different; 2) Social norms and attitudes can coincide; 3) Protective norms can offer important resources for achieving effective social improvement in people’s health-related practices; 4) Harmful practices are sustained by a matrix of factors that need to be understood in their interactions; 5) The prevalence of a norm is not necessarily a sign of its strength; 6) Social norms can exert both direct and indirect influence; 7) Publicising the prevalence of a harmful practice can make things worse; 8) People-led social norm change is both the right and the smart thing to do.
In 1988, the Supreme Court of Canada decriminalized abortion in R. v. Morgentaler. Almost immediately thereafter, the Maritime province of Prince Edward Island (“P.E.I.”) passed a legislative resolution opposing the provision of abortion services on the Island except to save the life of a pregnant woman. P.E.I. is a small pastoral province of rolling hills and ocean coves in the St. Lawrence Gulf, and since 1988, through various regulatory actions, its government has honored this policy promise to keep the Island abortion-free and to preserve its moral landscape
In 2014-2015, the authors conducted a mystery client study with 17 postabortion support providing organizations in Ontario. Although all counselors effectively used active listening techniques such as supportive utterances and attentive silences, the interactions with lay counselors from religious talklines and CPCs contained shaming and stigmatizing language and medically inaccurate information. These interactions appear to be premised on the counselors' belief that abortion is traumatic and always requires a grieving process, regardless of the client's expressed feelings and needs. The expanded provision of postabortion support by CPCs in Ontario represents a new method for these organizations to pathologize abortion. Our findings suggest that their services are judgmental and shaming, thereby contributing to abortion stigma.
In a country in which abortion is paid for and supplied by a government department, one might expect there to be substantially reduced stigma around performing abortion work. It is therefore significant that not only do patients experience stigmatisation, but those who choose to work in abortion care also do so, even though it is part of a national commitment to universal health care. Although there are many examples of exceptional care provided to women who request abortion from NHS providers, and the rationale for providing state-funded abortion care is laudable, nevertheless the gesture is diminished by its continued invisibility in the very system that upholds it.
In Luanda, Angola, researchers analyzed women's perceptions of how their partners, friends, communities, and the media perceived contraception, and examined associations between those perceptions and respondents' abortion stigma. These results suggest that increasing partner support of family planning may be one strategy to help reduce abortion stigma. Results also suggest that some abortion stigma in Angola stems not from abortion itself, but rather from judgment about socially unacceptable pregnancies.
In regard to their pregnancy and abortion experiences, servicewomen cited concerns about confidentiality, stigma and negative effects on their career, which prevented half of participants from seeking care from the military.
In this paper, the positioning theory is used to show how the ways in which Zimbabwean health service providers' position women and themselves are rooted in cultural and social power relations. In light of recent efforts by the Zimbabwean Ministry of Health and foreign organisations to improve post abortion care, this study also explores the implications that these positionings have for post abortion care.
In-depth interviews with women in Bangladesh revealed that women have positive experiences with menstrual regulation, but are strongly influenced by health providers in which method to use.
Informed by overlapping theoretical frameworks of human rights and reproductive justice, this study examined a large, nationwide survey of social work students in the United States (N = 504). Linear regressions indicated that students' endorsements of permissive sexual attitudes and support for birth control are inversely associated with holding anti-choice abortion views.
Inpatient insertion of long-acting reversible contraceptives (LARC) (intrauterine devices and implants) is increasingly offered to women immediately after childbirth. Enthusiasm for this approach stems from robust safety, effectiveness, and cost-effectiveness data and responsiveness to women's needs and preferences. Although clinical evidence for immediate postpartum LARC is well-established, the ethical implications of enhancing access to this care have not been fully considered. Contraceptive policies and practices often embody a tension between fostering liberal availability and potentially coercive promotion of some methods. Historical contraceptive policies and contemporary disparities in LARC use point to the need to consider whether health policies and health care practices support all women's reproductive wishes. Immediate postpartum LARC services need to be designed and implemented with the goal of ensuring autonomy and equity in postpartum contraceptive care. To this end, these services should include strategic plans to promote universal availability, prevent coercion, and enable device removal.
Internalized stigma is associated with long-term psychological distress following a TOPFA. Perceived stigma at the time of the TOPFA may contribute to increased trauma and grief symptomatology, but results need to be validated in longitudinal studies.
Introduction to a special issue on abortion stigma in the journal Women and Health.
investigation of social perceptions of abortion. Findings suggest shifting attention from characteristics of the stigmatized to observers' characteristics to understand stigmatization process.
Investigators explored how viewing the film interacted with viewers’ previous understandings of later abortion. Findings reveal the potential of onscreen pseudo-experiences as a means for social change, but also reveal their limits and varying impacts.
Investigators focused on pre-abortion mental health and suggest that addressing stigma among women seeking abortions may significantly lower their psychological distress.
Ipas offers this toolkit to address and help mitigate abortion stigma. It is designed to help community members, community health workers, activists and staff of community-based organizations and others address abortion stigma in various settings and contexts.
Journalist explores themes of stigma, law and access in rural women's experiences of abortion in Australia, and the role that telemedicine and abortion pills can play.
Leveraging close elections to generate quasi-random variation in the religious identity of state legislators in India, lower rates of female foeticide are found in districts with Muslim legislators, which results in an arguement that reflects a greater (religious) aversion to abortion among Muslims. This study finds no evidence of greater postnatal neglect of girls once more girls are born. These findings show that politician preferences over abortion influence abortion-related outcomes, most likely through greater enforcement of laws against sex determination.
Literature review looking at 36 studies across sub-Saharan Africa and SE Asia, focusing on reservations towards abortion held by providers.
Mixed method study exploring sources of authoritative knowledge shaping women's pregnancy-related decision-making and role of social stigma.
Mixed-methods study exploring the experiences of women who have had more than one abortion. Women who have experienced more than one abortion expressed intensified abortion shame.
My Body My Life’ is a public engagement project that seeks to address this stigma around abortion by bringing real stories of abortion into the open.
OBJECTIVES: Authors report on the development of a scale measuring abortion providers' experiences of stigma. STUDY DESIGN: Using previous measures, qualitative data, and expert review, a 49-item question pool was created and administered to 315 abortion providers before participation in the Providers Share Workshop. Authors explored the factor structure and item quality using exploratory factor analysis and assessed reliability using Cronbach's alpha. To test construct validity, authors calculated Pearson's correlation coefficients between the stigma scales, the Maslach Burnout Inventory, and the K10 measure of psychological distress. RESULTS: Factor analysis revealed a 35-item, five-factor model: worries about disclosure, internalized states, social judgment, social isolation, and discrimination (Cronbach's alphas 0.79-0.94). The stigma measure was correlated with psychological distress (r = 0.40; p < .001), and with Maslach Burnout Inventory's emotional exhaustion (r = 0.27; p < .001), and depersonalization (0.23; p < .001) subscales, and was inversely correlated with Maslach Burnout Inventory's personal accomplishment subscale (r = -0.15; p < .05). CONCLUSIONS: Psychometric analysis of this scale reveals that it is a reliable and valid tool for measuring stigma in abortion providers, and may be helpful in evaluating stigma reduction programs.
Observational study examining abortion stigma and the psychological implications of concealment.
On both sides of the border, poor information about the health systems, services affordability, and perceived stigma resulted in barriers to access SRH services, with women preferring to access private doctors in their destination country or delaying uptake of until their next trip home.
Paper explores an innovative strategy in the field of legal mobilization demonstration how law can be shaped not just by public officials and universities but also by social actors engaged in the creation and diffusion of legal knowledge.
Paper explores how international and regional human rights norms have evolved significantly to recognize that the denial of abortion care in a range of circumstances violates women’s and girls’ fundamental human rights.
Paper offering a panoramic view of laws and policies on abortion around the world, giving a range of country-based examples.
Participants described negative feelings towards women seeking induced abortions, and their own desire to avoid associated "sin". This highlights the effects of unintended pregnancy and induced abortion on young Filipino men, including their own experience of abortion stigma.
Personal narrative from a woman who obtained an abortion from a private provider in the UK; focuses on stigma perpetuated by providers and policy.
Pilot study of the Providers Share workshop. Pilot study findings suggest can reduce the experience of abortion stigma for participants. Authors present conceptual model of dynamics of stigma.
Qualitative analysis of how pro-choice and opposition movements frame abortion narratives.
Qualitative analysis of parents in the UK who choose to terminate pregnancies for fetal abnormality. Examines whether or not--and to what extent--parents shared news of their decisions with their social networks (including their children).
Qualitative analysis of women and men in low-income areas in 5 countries to better understand how couples manage pregnancy risk.
Qualitative content analysis to examine if and how the print media in contributes to the stigmatization of abortion.
Qualitative exploration of abortion decision-making among women living with HIV in Cape Town, South Africa. Abortion may be more stigmatised than HIV despite a liberal abortion law. Participants were generally satisfied with the abortion care received.
Qualitative exploration of abortion patients' perspectives on regulations of abortion services in the United States.
Qualitative exploration of Kenyan women's conceptualization of safety. Rather than dangerous, poor quality abortion procedures and providers are key to women's self- preservation, management of stigma, and protection of their livelihoods.
Qualitative exploration of perceptions and practices of illegal abortion among young adults in the Philippines.
Qualitative exploration of women who have experienced abortion in the UK. Perception that abortion is taboo affected disclosure and perception of response of others.
Qualitative exploration of women's pathways to abortion in South Carolina,
Qualitative exploration of women's views and experiences viewing ultrasound images before abortion.
Qualitative investigation examining secrecy and disclosure around abortion in Burkina Faso
Qualitative longitudinal study of satisfaction, grief, and coping among women who terminated a pregnancy due to fetal anomaly; conclusions include associates between real and perceived stigma.
Qualitative study exploring abortion clinic patients’ opinions about receiving abortions from general women’s health care providers in the Heartland of the United States
Qualitative study looking at what happens when women are denied abortions in South Africa. Most common reason for being denied an abortion was for a pregnancy that has progressed beyond the legal cutoff for termination.
Qualitative study that explores the experience of low socioeconomic status teenage women in Hong Kong who had had abortions.
Report documenting Sea Change's research surveying public abortion storytellers in the US, with recommendations for sharing your abortion story and for support storytellers.
Researchers analyzed the abortion related plot-lines in American film and television. They found that stories are not representative of real risks and outcomes and may contribute to social myths.
Researchers describe hardships experienced by abortion patients, examining administrative health cases from 2010-2015 in the United States. Case data were analyzed to assess types and numbers of hardships experienced by age, race and geographic origin
Researchers examine fictional depictions of abortion to describe how women who seek abortions are portrayed on television, recognizing that onscreen fictional stories can shape the public's beliefs.
Researchers explored private discourse by documenting the nature of women's discussions about abortion in a book club.
Researchers explored social norms and stigma related to unintended pregnancy and decision-making in Alabama.
Researchers interviewed women who received an abortion at a clinic and found that they reacted negatively to some processes and structures.
Respondents from both Nigeria and Zambia demonstrate tempered support of (continued) childbearing among HIV-positive women while anti-abortion attitudes remain strong. Access to ART did not impart a strong effect on these attitudes. Therefore, pronatalist attitudes remain in place in the face of HIV infection.
Results show that PSW fulfills the dual role of a supportive group intervention-helping create connections and foster resilience-and a research tool, producing rich, multi-perspective narratives of the abortion provision team. This method provides useful insight into supporting abortion care workers specifically, and may also prove useful in the study and support of other stigmatized workers generally.
Results showed that the extent of active concealment predicted self-reported psychological and physical QOL over and above general levels of outness and outness to specific others, neither of which were significant predictors with concealment in the model. By examining the need for active concealment, researchers may be better positioned to predict and intervene to improve health outcomes for people with concealable stigmatized identities.
Review article looking at the political context in which abortion counselling becomes stigmatized in Britain.
Safe and legal abortions are rarely practiced in the public health sector in Kenya, and rates of maternal mortality and morbidity from unsafe abortion is high. Study participants described a variety of factors that influence women's experiences with abortion in their communities. According to participants, limited knowledge of sexual and reproductive health information and lack of access to contraception led to unplanned pregnancy among women in their community. Participants cited stigma and loss of opportunities that women with unplanned pregnancies face as the primary reasons why women seek abortions. Participants articulated stigma as the predominant barrier women in their communities face to safe abortion. Other barriers, which were often interrelated to stigma, included lack of education about safe methods of abortion, perceived illegality of abortion, as well as limited access to services, fear of mistreatment, and mistrust of health providers and facilities.
Seminal piece defining and conceptualizing stigma as the co-occurrence of its components–labeling, stereotyping, separation, status loss, and discrimination–and further indicating that for stigmatization to occur, power must be exercised.
Several Central and Eastern European countries have recently enacted retrogressive laws and policies introducing new preconditions that women must fulfill before they can obtain legal abortion services. Mandatory waiting periods and biased counseling and information requirements are particularly common examples of these new prerequisites. The present article considers these requirements in light of international human rights standards and public health guidelines, and outlines the manner in which, by imposing regressive barriers on women's access to legal abortion services, these new laws and policies undermine women's health and well-being, fail to respect women's human rights, and reinforce harmful gender stereotypes and abortion stigma.
Some abortion patients do not agree with abortion legality, and this subset could experience a degree of cognitive dissonance, which could influence the method by which they seek to abort.
Story explores the moral case that abortion and reproductive justice advocates make for abortion
Study explores challenges to providing abortion care from the perspective of health providers in Ghana
Study explores how race and reported history of abortion are associated with abortion stigma and miscarriage stigma
Study instruments assessed individual-level abortion stigma (the perception that others treat abortion as shameful, dirty, and socially taboo) using the Abortion Provider Stigma Scale, job strain through the Job Content Questionnaire, and emotional burnout through the Depersonalization, Emotional Exhaustion, and Personal Accomplishment subscales of the Maslach Burnout Inventory. Study results show that hospital-based abortion workers experience lower risk for burnout than comparable workers in freestanding clinics, accounting for abortion stigma and job characteristics.
Study of low-income women in Mexico receiving abortions; explores mental frameworks used to manage abortion stigma.
Study presents a valid, reliable instrument for assessing SRH stigma and its impact on family planning, the Adolescent SRH Stigma Scale can inform and evaluate interventions to reduce/manage stigma and foster resilience among young women in Africa and beyond.
Study that investigated medical abortion provision and referral by general practitioners in Australia, and found that some interested GPs were concerned about stigma.
Systematic literature review to determine barriers and facilitators to accessing first trimester abortion care in the developed world.
The 72% response they would attend or denounce the woman who underwent an abortion outlawed. The remaining 28% showed negative attitudes, from informing the couple or parents (18%), scold women (2%) or reporting it to the authorities (8%). In 39%, they felt that the medical profession who practice discriminates abortions; 28% admit stigmatize partener and 27% feel stigmatized if performing abortions.
The aim of the study was to understand midwives' readiness to be involved in legal induced abortions, should the law become less restricted in Ghana. Different views were expressed regarding readiness to engage in abortion services. Some expressed it as being sinful and against their religion to assist in abortion care, whilst others felt it was good to save the lives of women.
The author posits key differences between a discourse analytic approach to women's accounts of abortion and that taken by the growing body of research exploring women's experience of abortion stigma, and suggests that research on stigma often risks reifying it by failiing to consider how identities are continutially re-negotiated through language use.
The current study uses data from 353 women seeking abortions at three community reproductive health clinics to examine predictors of pre-abortion psychological health. Childhood and partner adversities, including reproductive coercion, were associated with negative mental health symptoms, as was perceived abortion stigma. Before perceived abortion stigma was entered into the model, 18.6%, 20.7%, and 16.8% of the variance in depressive, anxiety, and stress symptoms respectively, was explained. Perceived abortion stigma explained an additional 13.2%, 9.7%, and 10.7% of the variance in depressive, anxiety, and stress symptoms pre-abortion.
The difficulties journalists described when reporting on abortion were often rooted in abortion stigma and the political polarization around the issue. This pattern was true even for reporters who worked to counter abortion stigma through their reporting.
The emergence of Islamist movements and religious symbolic repertoires in the aftermath of the Tunisian revolution has elicited the political, moral, and practical contestation of women’s right to abortion. While, after several heated debates, the law was eventually not modified, several practitioners working in government family planning clinics have changed their behaviour preventing women getting abortions. Pre-existing state and medical logics, political uncertainties, and new religious and moralising discourses have determined abortion practices in the government health-care facilities generating unequal treatments according to women’s marital status, class, and education. This paper will investigate the multiple logics affecting abortion practices in post-revolutionary Tunisia, focusing on the dissonant logics mobilised by health-care professionals as well as structural socioeconomic factors.
The existence of abortion stigma and the shifting of the government structure from unitary system to federalism in absence of a complete clarity on how the safe abortion service gets integrated into the local government structure might create challenge to sustain existing developments.
The objective of this study is to assess the opinions of service providers on tailoring sexual and reproductive health services to the needs of adolescents. All respondents expressed the opinion that it is a good idea to tailor sexual and reproductive health services to the needs of adolescents. They admitted that very limited sexual and reproductive health programs targeting adolescent needs were available in the study area. Service providers also reported very low levels of health facilities use by adolescents for sexual and reproductive health information and services. Health professionals attributed the poor sexual and reproductive health services utilization by adolescents to stigma from the society and attitudes of service providers.
The objective was to investigate the effect of mandated abortion counseling requirements intended to dissuade women from having abortions on patients' individual-level abortion stigma. Women who heard the mandated counseling had reduced stigma scores. A larger study is needed to better characterize this effect.
The phrase ‘termination of pregnancy’ has recently been adopted by a number of British medical institutions as a preferred descriptor of induced abortion. How it is used by abortion care providers is unclear, although the ongoing stigmatisation of abortion may play a role. This study found that ‘Termination of pregnancy’ is the most commonly used term to describe induced abortion in patient consultations in Scotland. This and the term ‘abortion’ appear to play different roles, with the former being used euphemistically, and the latter as a more emphatic term.
The purpose of this review is to summarize studies published in the last year examining women's experiences with abortion care and to describe facilitators and barriers to person-centered care. Institutions and providers may be limited in their ability to provide patient-centered abortion care because of deeply embedded social stigma, institutional regulations and legal restrictions.
The Republic of Ireland has one of the world's most restrictive abortion laws, allowing abortion only to preserve a pregnant woman's life. This study examined the impact of the law on women's options for accessing abortion, their decision-making regarding whichpathway to follow, and their experiences with their chosen approach. Despite the country's restrictive abortion law, women in Ireland do obtain abortions, using methods that are legal and safe elsewhere. However, the law negatively impacts women's ability to discuss their options with their healthcare professionals and to seek follow-up care, and can have serious implications for their physical and emotional health.
The results from our evaluation are overwhelmingly positive. The Circles offered women a place to talk about their abortion in an affirmative and supportive environment,unlike the context of their daily lives where stigma generated silence and affected their well-being. For those who had never told family or friends, the Circles proved transformative as they could break the silence and speak of their experiences with women who had lived similar situations. Seeing themselves reflected in other women created a sense of community for the participants. This was confirmed in the results of the ILAS Scale, which show that the intervention was successful in reducing the ‘isolation’ dimension of individual abortion stigma.
The role of language in reflecting and perpetuating stigma is also an important consideration when mandating the use of any particular term. ‘TOP’ offers no advantages in either specificity or clarity while posing clear disadvantages for research visibility and the potential to reinforce stigma.
The study aimed to understand better the ways that women who have had multiple abortions talk about and view those experiences. Women described intensified feelings of shame and both internalized and externalized stigma surrounding their decision to have more than one abortion. However, the overwhelming majority were confident in their decisions
The term "elective abortion" is variably defined, misrepresents the complexity and multiplicity of indications for abortion and perpetuates stigma.
The term "elective" enables the creation and perpetuation of abortion stigma, and contributes to a hidden curriculum for abortion training in medical education that distracts from core content, incorporates social judgment of patients into medical practice, and promotes normative gender concepts.
The way abortion is presented in the media can have a major influence on people’s thinking. This guide has been written for those working in the media to encourage accurate reporting of the facts about abortion, and honest portrayals of abortion as part of real people’s lives and relationships.
Thematic analysis of the interviews revealed three main themes: (1) protective paternalism, (2) complementary gender differentiation, and (3) the categorization of women. These themes connect strongly with benevolent sexism, providing evidence that abortion is still a stigmatized procedure. This stigma has shifted from viewing women who have abortions in an overtly negative way to viewing them as pitiable and poor decision makers.
There exist critical points in the service where stigmatizing ideas and attitudes continue to be reproduced, such as the required five-day waiting period and in interactions with hospital staff who do not support access to the service. We also document the prevalence of stigmatizing ideas around abortion that continue to circulate outside the clinical setting.
These findings suggest that the level of power and control a woman experiences in her intimate relationship is associated with perceived or experienced stigma associated with her abortion. Stigma-reduction interventions related to abortion may consider focusing on women who have lower levels of reproductive autonomy, including those experiencing reduced partner communication or low decision-making power.
This analysis explores the gaps in access and quality that persist despite an enabling legal environment. Authors note that stigma plays a noteable role, and that community health workers may be important change agents in decreasing stigma.
This analysis offers that the field of abortion advocacy start taking seriously the emotional reactions that abortion engenders -- including disgust.
This analysis posits that contemporary post-structural work on class provides a framework to examine how social classifications occur; who has the power to classify; and how classifications might be resisted. This framework is demonstrated with emerging findings from a life history study of abortion experiences in England. The applications of this to the work on abortion are potentially rich, because the act of ending a pregnancy invites classification from many quarters, from the legal (legal/illegal) to the medical (early/late) to the moral (deserved/undeserved). This work, therefore, speaks to public health concerns about access to and stigma around abortion and social inequalities.
This annotated bibliography considers a subset of studies on the social and gender norms that influence access to safe abortion, focusing on adolescent girls.
This article analyzes the scientific output on abortion and social stigma and the potential of the stigma category for abortion care in Brazil.
This article describes the relatively new field of research on structural stigma, which is defined as societal-level conditions, cultural norms, and institutional policies that constrain the opportunities, resources, and well-being of the stigmatized
This article documents the creation of a community-level abortion stigma scale, developed and tested in Mexico.
This article explores obstetricians-gynaecologists' experiences and attitudes towards abortion and argues that the increasing medicalisation of contraception as well as of reproduction has reinforced the stigmatisation of voluntary abortion in a context of declining fertility rates.
This article explores the culture around abortion in South Africa post-legalization. Women continue to terminate unwanted pregnancies as they always have: away from the glare of public censure, in the shadows of the reproductive arena.
This article explores the factors that serve as a barrier to reproductive health services for people with disabilities in the Philippines. Substantial efforts to reduce stigma are required.
This article focuses on three struggles over time in abortion and human rights law: struggles in morality, health, and justice. The article focuses on the passage of time in pregnancy and thus legal regulation by gestational age. It offers a more complex understanding of what these struggles over time mean for morality, health, and justice, which underlie human rights protections in abortion law and policy.
This article is the first to examine the stigma attached to abortion and surrogacy and consider how law may stigmatize women for failing to conform to social expectations about maternal roles.
This article presents a case for promoting a harm reduction model in Uganda, with evidence that it may reduce maternal mortality and morbidity due to unsafe abortion while addressing related stigma and discrimination and advancing women's reproductive health rights.
This blog posts explores the needed linkages between movements to expand rights for sex workers and right to abortion.
This brief proposes a draft framework for analyzing the interplay between stigma and quality of care, including suggested signs of stigma-free care.
This commentary encourages further examination of what triggers disgust, its measurement, and ways of mitigating it, which could be useful for reducing abortion stigma, in future legal cases and in abortion research, advocacy, and communications.
This Coursera lecture explores abortion stigma, defining the terms, and exploring examples of how it manifests from diverse areas around the world.
This essay considers factors determining provision of second trimester abortion and argues that silence about second trimester abortion care is harmful to providers, the pro-choice movement, and to women who need abortion care.
This fact sheet details a buddy system as a method of overcoming stigma and other barriers to access that youth face.
This guide is intended for advocates interested in supporting expanded access to safe abortion care in their countries. It will help you and your colleagues develop a strategy that considers the unique considerations for abortion-related advocacy.
This guide provides tips about what to consider when developing materials about abortion.
This is a collection of personal testimonies in Spanish and Náhuatl gathered by the Red Necesito Abortar (Monterrey, Nuevo León, México), with technical support provided by Centro Las Libres. Together, these frank testimonies from people who have accompanied or been accompanied through their abortion experiences offer powerful material that can be used in discussions, workshops, and other forums aimed at eliminating abortion-related stigma.
This journal follows the lives of ten resilient and courageous women as they recount how they escaped FGM, fought for abortion rights for their minor daughters, how they underwent unsafe abortions despite laws criminalising them or decided to raise children in spite of being victims of rape.
This paper examines the ways in which young women articulated strategies of resistance to internalised abortion stigma. Being able to construct their abortion decision as morally sound was an important element of stigma resistance.
This paper scrutinises the concepts of moral reasoning and personal reasoning, problematising the binary model by looking at young women’s pregnancy decision-making. Data from two UK empirical studies are subjected to theoretically driven qualitative secondary analysis, and illustrative cases show how complex decision-making is characterised by an intertwining of the personal and the moral, and is thus best understood by drawing on moral relativism.
This piece explores stigma as a barrier for physicians to even be trained in abortion care.
This practitioners Toolkit on Women’s Access to Justice, developed by UNDP, UN Women, UNODC, and OHCHR provides evidence-based guidance for a coherent and consistent policy and programming approach to overcoming barriers women face in accessing justice. This guidance will help to ensure UN system coordinated responses when addressing legal and justice challenges that women face within the context areas of marriage, family, and property rights; ending violence against women; and women in conflict with the law. Designed primarily for staff of the UN system, the toolkit presents a menu of options for scaling-up work and responding to current deficits in women’s access to justice programming and the growing demand for technical assistance in this area. This toolkit consolidates and complements existing resources and aims at enhancing the impact of UN support by stimulating bolder gender-responsive justice interventions for the full realization of the rights of women and girls.
This purpose of this article is to discuss the abortion seeking experience in relation to stress, trauma, and trauma-informed care. This article discusses a trauma-informed lens for considering the abortion seeking experience in the United States, and a trauma-informed social work framework for interacting with clients during the abortion experience is presented as a practice approach for reducing and eliminating trauma and trauma triggers. Then the potential benefits of this approach is presented. The article concludes with some additional recommendations for a trauma-informed approach to aspects of social work advocacy.
This qualitative study found higher levels community-level stigma in areas where the prevalence of unsafe abortion is higher, and that abortion stigma is a barrier to accessing safe services.
This report paints a picture of how stigma appears in different geographic regions, and across the different levels of the ecological model.
This report presents analysis of two years worth of news coverage (and over 3,000 articles) about abortion to pinpoint how abortion stigma manifests in the news. Authors found that news coverage perpetuated stigma in many ways, including through the frequent use of inflammatory language in quotes from anti-abortion advocates, the lack of firsthand stories from people who have had abortions, and the near absence of scientifically accurate information about the safety, prevalence, and support for abortion.
This report shares the results of interviewswith 14 experts in the field of resilience and support for young families.
This report synthesizes the state of the field of abortion research in Latin America and the Caribbean (in Spanish).
This review and analysis identified global factors that affect the likelihood of women to be able to access safe abortion and found that women have more access when abortion is less stigmatized, legal, and covered by a public health system.
This review of Katie Watson's book, "Scarlet A: The Ethics, Law, & Politics of Ordinary Abortion" explores both the richness and limitations of the author's focus on a plurality of perspectives in dialogue to shift the public discourse on abortion.
This study aimed to measure individual-level abortion stigma (ILAS) and determine its correlates among women receiving safe elective abortion services. Among 382 respondents, 43% expressed high ILAS. Women’s age and education, provider’s cadre and type of abortion procedure were significant correlates in the model.
This study assessed the applicability to medical professionals in Ethiopia of an abortion stigma assessment tool developed for community members, and examined the relationship between stigma and willingness to provide safe abortion care (SAC). The Stigmatizing Attitudes, Beliefs and Actions Scale (SABAS) was fielded to a convenience sample of 397 Ethiopian midwives. Scale reliability and validity were assessed, and associations were examined using multivariate linear and logistic regression. Levels of stigma were low compared to those reported elsewhere, and 49% of midwives were willing to provide SAC. SABAS‘ limitations found here suggest the need for an adapted scale for medical professionals.
This study assesses whether a book-club intervention can support abortion disclosure among book club participants and improve participants’ affective responses towards women who have abortions and abortion providers. ollowing the book club intervention, women reported having more positive feelings toward women who have abortions and abortion providers. Greater improvement and longer lasting effects were seen in groups where there was also an in-person disclosure of abortion experience. Findings suggest that exposure to the stories of women who have had abortions can reduce abortion stigma.
This study describes the process and results of galvanizing access to medical abortion in Zambia where abortion has been legal for many years, but provision severely limited. It highlights the challenges and successes of scaling up abortion care using implementation science to document 2 years of implementation.
This study examined how anticipation, perception, internalization, and stigma-related isolation are related to psychological distress and somatic (physical) symptoms. This question was examined through an online volunteer sample of women in Ireland who have had an abortion. The findings complement and extend the existing literature on the relations between stigmatized identities, psychological distress, and physical health problems, particularly regarding women who have accessed abortion. They also indicate that those involved in policy-making and activism around reproductive rights should avoid inadvertently increasing the stigma surrounding abortion.
This study explored the meaning of abortion provision work to providers, how providers experience and manage stigmatization of their work, and how these experiences and stigma management strategies differ for providers in various work roles, clinics and clinic settings.
This study explores the content of abortion provider stigma. It finds that study participants held two kinds of believes about abortion providers: (1) providers are agentic and intentional actors and (2) providers are non-agentic victims of a larger system. These findings lead to a new component of abortion provider stigma: the belief that abortion providers are harmed by abortion and that they are to be pitied for this. This stigmatizing attitude both constructs the provider as untrustworthy and unable to properly care for women.
This study found that abortion values clarification and attitude transformation (VCAT) workshops improve participants’ knowledge and attitudes about abortion as well as their intentions to support abortion care, especially among those who come to the workshops with the least knowledge and most negative attitudes.
This study investigated the hashtag #ShoutYourAbortion that was created to combat the stigma that can be associated with the medical procedure of abortion. When devising health campaigns, it is essential to consider the tone of the campaign and whether it is likely to provoke citizens who may have opposing views. Moreover, future campaigns could communicate information surrounding the dangers of unsafe abortions and the broad spectrum of reasons that women may seek abortion, for example, when the child and/or mothers health is at risk.
This study investigates stigmatising attitudes related to adolescent pregnancy, abortion and contraceptive use among healthcare providers working with postabortion care (PAC) in a low-resource setting in Kenya. Stigmatising attitudes towards young women in need of abortion and contraception is common among PAC providers.
This study sought to estimate the rate of abortion visibility in the city of Kerman, Iran-that is, the percentage of acquaintances who knew about a particular abortion. For estimating the visibility rate, it is crucial to use the network scale-up method, which is a new, indirect method of estimating sensitive behaviours more accurately.
This study uses a Foucauldian feminist approach to show how resistance to religious and patriarchal norms can be fostered through adult community abortion education.
This tool describes a strategy for providing youth friendly spaces within health facilities to reduce stigma and other barriers to access that youth face.
This tool details a strategy for using social media to reduce stigma and other barriers to care that youth face.
This tool details a strategy to reduce stigma and other barriers to access that young people face by partnering with educational institutions.
This toolkit (with inputs from Georgia, Lithuania, Republic of Macedonia, Poland and Romania) offers a framework for youth-led storytelling.
This toolkit has been developed for trainers and educators who want to deliver workshops or training on abortion to young people, especially those training young peer educators.
This toolkit is designed to address the harmful impact of stigma while providing techniques to fight it by ensuring that responses to anyone with unwanted pregnancy are supportive, engaging, and empowering.
This video details a broad history of abortion, placing it in cultural and medical context.
This video explores how representations of abortion in film and television can shape individual and cultural understanding of abortion.
This video lecture provides an overview of the findings from the Turnaway Study.
This website - The Stigma Toolkit - documents the research, tools, and strategies that have been instrumental thus far in changing the culture around reproduction. It includes products and tools from Sea Change and beyond, and was created to live on as a resource to the field and to anyone hoping to learn more about shifting stigma
This white paper defines abortion stigma, discusses how to measure stigma and presents an overview of interventions to address stigma
This workbook is about engaging the courts to promote social change.
Though most women in this study had at least one person to turn to for assistance with abortion decision making, many participants avoided confiding in some or all members of their social network about their abortion decision due to concerns of judgment and stigma.
To some extent, harm reduction for reducing unsafe abortion is a well-trodden path, deployed and studied in various contexts for well over a decade. But the United States presents a distinctive context.
To understand the motivations around and practices of abortion referral among women's health providers, authors analyzed clinician's responses to open-ended questions on abortion referral thematically and found that abortion stigma impacts referral as clinicians explained that patients often desire additional privacy and clinicians themselves seek to avoid tension among their staff.
Toolkit to assist activists to think through their communication strategies in a way that supports movement building.
Tools to facilitate patient-provider conversations and create a context where women's choices are normalized, their concerns validated and their feelings addressed.
Unmarried, young women constitute a significant proportion of women who undergo unsafe abortion in Ethiopia. Based on material from an ethnographic study, the experiences of young, unmarried women who had been admitted to the hospital in the aftermath of an unsafe, clandestine abortion are explored in this article. The routes the young women followed in their search of abortion services and the concerns and realities they had to negotiate and navigate are at the fore. Despite their awareness of the dangers involved in clandestine and illegal abortion, the young women felt they had no choice but to use medically unsafe abortion services. Two reasons for this are highlighted: such services were affordable and, significantly, they were considered socially safe in that the abortion remained unknown to others and the stigma of abortion and its consequences could hence be avoided. In situations in which choices had to be made, social safety trumped medical safety. This indicates a need for abortion services that address both the medical and social safety concerns of young women in need of such services.
Unpublished undergraduate thesis comparing cultural context for abortion legislation between the U.S. and the Netherlands.
User submissions to a text-based SMS Q&A platform demonstrate an unmet need for basic SRHR information. Users benefited from a mechanism to ask about stigmatized topics in privacy.
Using interviews with 10 obstetrician–gynaecologists and 44 other leaders familiar with Ethiopia’s reproductive health policy context, as well as other primary and secondary sources, this research examines why, counter to theoretical expectations from the sociology of medical professions literature and experience elsewhere, the Ethiopian Society of Obstetricians & Gynecologists (ESOG) actively supported reform of national law on abortion.
Using theAdolescent Sexual and Reproductive Health (SRH) Stigma Scale, authors investigated factors associated with perceived SRH stigma among adolescent girls in Ghana. The Adolescent SRH Stigma Scale comprised 20 items and 3 sub-scales (Internalized, Enacted, Lay Attitudes) to measure stigma occurring with sexual activity, contraceptive use, pregnancy, abortion and family planning service use. Authors assessed relationships between a comprehensive set of demographic, health and social factors and SRH Stigma with multi-level multivariable linear regression models. RESULTS: In unadjusted bivariate analyses, compared to their counterparts, SRH stigma scores were higher among girls who were younger, Accra residents, Muslim, still in/dropped out of secondary school, unemployed, reporting excellent/very good health, not in a relationship, not sexually experienced, never received family planning services, never used contraception, but had been pregnant. In multivariable models, higher SRH stigma scores were associated with history of pregnancy and excellent/very good self-rated health, while lower stigma scores were associated with older age , higher educational attainment, and sexual intercourse experience. CONCLUSIONS: Findings provide insight into factors contributing to SRH stigma among this young Ghanaian female sample. Further research disentangling the complex interrelationships between SRH stigma, health, and social context is needed to guide multi-level interventions to address SRH stigma and its causes and consequences for adolescents worldwide.
Video and accompanying slides detailing how abortion is conceptualized across many frameworks and levels in the ecological model.
Video lecture examining the role that securing abortion access through the right to privacy in the US has in reinforcing and being reinforced by fear of personal disclosure. Delivered to a UK audience at Birmingham Univeristy. Hosted on Youtube.
Video lecture gives an overview of federal and state laws on abortion access in the United States.
Video lecture offers an overview of abortion stigma and how it impacts women's health.
Video outlining a history of abortion in the United States since legalization.
We argue that the social construction of target populations is an important, albeit overlooked, political phenomenon that should take its place in the study of public policy by political scientists. The theory contends that social constructions influence the policy agenda and the selection of policy tools, as well as the rationales that legitimate policy choices. Constructions become embedded in policy as messages that are absorbed by citizens and affect their orientations and participation. The theory is important because it helps explain why some groups are advantaged more than others independently of traditional notions of political power and how policy designs reinforce or alter such advantages.
We expected and found that the decision to abort increased moral outrage toward a woman (Study 1 and Study 2) and her male partner (Study 2). Moreover, we found that the decision to abort reduced a woman’s (Study 1 and Study 2) and man’s (Study 2) humanness through the mediation of elicited moral outrage.
Webinar hosted by the Abortion Care Network with guidance for how to make a video about abortion.
White paper from Global Doctors for Choice examining the prevalence and impact of consciencious refusal. Rviews policy efforts to balance individual conscience, autonomy in reproductive decision making, safeguards for health, and professional medical integrity.
Women are attempting informal sector abortion because they seek privacy and fear mistreatment and stigma in health facilities.
Women undergoing more than one TOP within 2 years may experience particular challenges and vulnerabilities. Service provision should recognise this and move away from stigmatising discourses of 'repeat abortion'.
Authors (Ruth Zurbriggen, Nayla Vacarezza, Graciela Alonso, Belen Grosso, María Trpin) expand knowledge on what for some is a controversial issue: Medical abortion during the second trimester of pregnancy. Based on their extensive practice of providing information and accompanying later abortion, the Socorristas have developed this text, which systematically captures their experience and knowledge on the topic. The book presents the experiences and reflections of 23 women who had second-trimester medical abortions and 16 feminist activists who support and accompany this practice. The study was conducted by Colectiva La Revuelta, which is part of Socorristas en Red, the national Socorrista network in Argentina. The English translation was supported by Women Help Women and inroads.
This study presents results from focus group discussions that explored community members’ attitudes towards women who induce abortion and their care-seeking behaviour in programme areas. Results indicate that while abortion stigma was widespread, community members’ attitudes towards women who induced abortions were not one-dimensional. Although they initially expressed negative opinions regarding women who induced abortion, beliefs became more nuanced as discussion shifted to the specific situations that could motivate a woman to do so. For example, many considered it understandable that a woman would induce abortion after rape: perhaps unsurprising, given the prevalence of conflict-related sexual violence in this area. While community members believed that fear of stigma or associated negative social consequences dissuaded women from seeking PAC, a majority believed that all women should have access to life-saving PAC. This commitment to ensuring that women who induced abortion have access to PAC, in addition to the professed acceptability of induced abortion in certain situations, indicates that there could be an opening to destigmatise abortion access in this context.
This study (in Spanish) explores attitudes towards induced abortion among young people in Mexico. Their attitudes were more favorable than not towards induced abortion, but they didn't think that law reform would really impact the risk of unsafe abortion.
This systematic review of multi-level stigma reduction interventions examined studies that evaluated interventions that operated on more than one level of stigma, across a variety of stigmatized topic areas. Most reported declines in stigma, but effect sizes were limited.
This study tested the validity of a scale to measure providers attitudes about the morality of abortion.
There is broad consensus that abortion is stigmatized, but the role of interpersonal interaction in this process is underspecified. I examine interviews with 25 women in the United States who visited crisis pregnancy centers (CPCs)—antiabortion organizations that offer one‐on‐one “prolife counseling”—for how and when interactions matter for abortion stigmatization. I identify two primary ways CPC counselors stigmatized abortion and describe variation in their impact: counselors' efforts were “successful,” were misrecognized as ideologically‐neutral, or were resisted. The findings demonstrate the importance of women's current consideration of abortion and preexisting beliefs for understanding how interpersonal interactions contribute to abortion stigma.
Identifying how activists frame the topic of abortion is key to unpacking their understanding of “abortion” in Peru. It is important to explore how and why certain frames are privileged in attempts to shift policy and social norms. In 2016, the authors conducted qualitative interviews with 10 activists in Lima, Peru to develop a deep understanding of these issues. Activists worked through different approaches and lenses, including law, medicine, sociology, psychiatry, journalism, non-governmental organisational management, LGBTQ rights, and indigenous rights. Four common frames emerged through the analysis and those frames shifted based on whether activists were speaking to the general public or to policymakers. Understanding Peru's activist framing of abortion can contribute to a deeper analysis of regional and global movements to legalise abortion, which also take into account local specificities.
In the context of abortion stigma, most abortion stories remain untold. The stories we do tell of abortion are often told to morally recuperate the status of the woman who has an abortion through a recourse to tragedy. Tragedy frames experiences where every choice produces some suffering, so decisions are geared toward maintaining individual integrity rather than adherence to absolute moral truths. This article argues that one dominant tragic abortion narrative, that of the disabled fetus, works to recuperate the moral status of “fit” mothers while actively constructing disabled lives as unlivable and undesirable. The option to stigmatize disability in recuperating the moral status of the woman who has an abortion relies on eugenic logics that also construct a variety of women (racialized, poor, disabled, and young) as illegitimate reproductive subjects. The article analyzes narratives of Sherri Finkbine's 1962 abortion in relation to contemporary narratives of late‐term abortions involving nonviable fetuses to expose how investment in medical judgments of good births enables particular women to make use of tragic narratives to maintain their status as moral mothers without disturbing broader abortion stigma or eugenic logics.
This paper draws lessons and implications on scaling social norms change initiatives for gender equality to prevent violence against women and girls (VAWG) and improve sexual and reproductive health and rights (SRHR), from the Community for Understanding Scale Up (CUSP). CUSP makes the following recommendations for donors and implementers to scale social norms initiatives effectively and ethically: invest in longer-term programming, ensure fidelity to values of the original programmes, fund women’s rights organisations, prioritise accountability to their communities and demands, critically examine the government and marketplace’s role in scale, and rethink evaluation approaches to produce evidence that guides scale-up processes and fully represents the voices of activists and communities from the Global South.
A moderated moderation analysis aimed to demonstrate the effects of abortion stigma on abortion legality attitudes, and explore interactions between gender, religiosity, and abortion stigma. Results showed a significant main effect of stigma on legality attitudes, such that increased stigma was related to more negative attitudes. Furthermore, there was a significant three-way interaction of religiosity, gender, and stigma. For men, religiosity significantly predicted abortion legality attitudes at low stigma, but for women, religiosity was related to legality attitudes at all levels of stigma. These results have implications for prediction of abortion legality attitudes, policy support, and voting behaviors and can inform abortion stigma reduction programs.
Partners across the sexual and reproductive health sector have come together to launch the SafeAccess Hub – a digital platform sharing best practice guidance on safe abortion and post-abortion care. The aim is open up implementational knowledge from across the sector on what quality safe abortion and post-abortion care looks like. This way, those working on the frontline, providers and policy makers alike, can use this knowledge to expand access to life-saving services in their regions too.
A factsheet exploring Ipas’s work to understand, challenge and measure abortion stigma
Stigma is a well-documented barrier to health seeking behavior, engagement in care and adherence to treatment across a range of health conditions globally. In order to halt the stigmatization process and mitigate the harmful consequences of health-related stigma (i.e. stigma associated with health conditions), it is critical to have an explicit theoretical framework to guide intervention development, measurement, research, and policy. Existing stigma frameworks typically focus on one health condition in isolation and often concentrate on the psychological pathways occurring among individuals. This tendency has encouraged a siloed approach to research on health-related stigmas, focusing on individuals, impeding both comparisons across stigmatized conditions and research on innovations to reduce health-related stigma and improve health outcomes. We propose the Health Stigma and Discrimination Framework, which is a global, crosscutting framework based on theory, research, and practice, and demonstrate its application to a range of health conditions, including leprosy, epilepsy, mental health, cancer, HIV, and obesity/overweight. We also discuss how stigma related to race, gender, sexual orientation, class, and occupation intersects with health-related stigmas, and examine how the framework can be used to enhance research, programming, and policy efforts. Research and interventions inspired by a common framework will enable the field to identify similarities and differences in stigma processes across diseases and will amplify our collective ability to respond effectively and at-scale to a major driver of poor health outcomes globally.
This paper systematically reviews implementation studies of health-related stigma reduction interventions in LMICs and critically assesses the reporting of implementation outcomes and intervention descriptions
Employing a conceptual model adapted from Weiss, the current paper demonstrates the commonalities among several major stigmatized conditions by examining how several stigma measurement instruments, such as the Social Distance Scale, Explanatory Model Interview Catalogue, Internalized Stigma of Mental Illness, and Berger stigma scale, and stigma reduction interventions, such as information-based approaches, contact with affected persons, (peer) counselling, and skills building and empowerment, were used successfully across a variety of conditions to measure or address stigma. The results demonstrate that ‘health-related stigma’ is a viable concept with clearly identifiable characteristics that are similar across a variety of stigmatized health conditions in very diverse cultures.
The aim of this study was to measure stigmatising attitudes and beliefs regarding abortion and contraceptive use among secondary school students in western Kenya. A self-reported classroom questionnaire-survey was administered in February 2017 to students at two suburban secondary schools in western Kenya. Two scales were used to measure the stigma surrounding abortion and contraceptive use – the Adolescent Stigmatizing Attitudes, Beliefs and Actions (ASABA) scale and the Contraceptive Use Stigma (CUS) scale. Abortion and contraceptive use are stigmatised by students in Kenya. The results can be used to combat abortion stigma and to increase contraceptive use among adolescents in Kenya.
In this study, we tested a novel method – the list experiment – that aims to reduce underreporting of sensitive events by asking participants to report how many of a list of experiences they have had, not which ones. We applied the list experiment to measure “self-managed abortion” - any attempt by a person to end a pregnancy on one’s own, outside of a clinical setting – a phenomenon that may be underreported in surveys due to a desire to avoid judgement.
The present study examined relationships between sexual disgust and abortion stigmatizing attitudes, and the mediating effects of hostile sexism and right-wing authoritarianism (RWA). These relationships were examined in two samples, culled online via Amazon's Mechanical Turk. Controlling for age and gender, both studies found that increased disgust was linked to increased abortion stigmatizing attitudes, with significant, independent indirect effects of both hostile sexism and RWA. Importantly, in both samples, hostile sexism and RWA mediated the connection between sexual disgust and abortion stigmatizing attitudes. Specifically, increased sexual disgust was related to more sexism, which was connected to increased RWA; in turn, more RWA was linked to more stigmatizing abortion attitudes. These findings provide numerous pathways for better understanding and combating abortion stigma.
This guide was designed to help reporters understand the issues surrounding sexual and reproductive health and rights (SRHR), including the right to safe abortion, so they can report on SRHR issues in an accurate, fair and balanced manner. Although the guide specifically targets print and online journalists, all journalists—including those who work in TV and radio—can benefit from the information provided. The guide can also be used by organizations and coalitions as a guide to training reporters on SRHR issues.
A spokesperson is the face of an organization and represents the organization when addressing an audience or speaking to the press. The topic of sexual and reproductive health and rights (SRHR) is sometimes sensitive or controversial, making the job of a spokesperson for an SRHR-focused organization very important. This tool is designed to help spokespeople excel at their jobs and craft messages that effectively reach their intended audiences.
Drawing on narrative data from research conducted on womxn’s and healthcare providers’ experiences of the pre-abortion healthcare encounter in the South African public health sector, we highlight how stigma may be resisted in social ways within this context. Everyday chatter and informal social support amongst womxn in the waiting room provided a counterpoint for health service providers’ ascription of shame to the womxn, and a sense of solidarity amongst the womxn. Health service providers narrated their decision to do abortion work through the socially affirming hero canonical narrative, and womxn described their counselling as helpful. These social and discursive practices resist the awfulisation of abortion and provide relief for the womxn and the healthcare providers in particular contexts.
Abortion Out Loud, formerly the 1 in 3 Campaign, harnesses the power of storytelling, grassroots organizing, leadership development, and policy advocacy to end abortion stigma and strengthen support for young people's access to abortion. Activists leading the Abortion Out Loud project in their community host abortion speakouts, lead public education campaigns, and work with campus and local officials to strengthen young people's access to abortion services.
The current study examined false memories in the week preceding the 2018 Irish abortion referendum. Participants (N = 3,140) viewed six news stories concerning campaign events—two fabricated and four authentic. Almost half of the sample reported a false memory for at least one fabricated event, with more than one third of participants reporting a specific memory of the event. “Yes” voters (those in favor of legalizing abortion) were more likely than “no” voters to “remember” a fabricated scandal regarding the campaign to vote “no,” and “no” voters were more likely than “yes” voters to “remember” a fabricated scandal regarding the campaign to vote “yes.” This difference was particularly strong for voters of low cognitive ability. A subsequent warning about possible misinformation slightly reduced rates of false memories but did not eliminate these effects. This study suggests that voters in a real-world political campaign are most susceptible to forming false memories for fake news that aligns with their beliefs, in particular if they have low cognitive ability.
Purpose: To investigate the opinions of Brazilian medical residents in Obstetrics and Gynaecology on abortion legislation according to their personal beliefs. Material and methods: A multicentre cross-sectional study. Residents at 21 university teaching hospitals completed a self-report questionnaire on their opinions in abstract terms, and about punishing women who abort in general and women they know. Results: In abstract terms, 8% favoured allowing abortion under any circumstances (fully liberal); 36% under socioeconomic or psychological constraints (broadly liberal); 75.3% opposed punishing a woman who has aborted (liberal in general practice); and 90.2% opposed punishing women they knew personally (liberal in personal practice). Not having a stable partner and not being influenced by religion were factors associated with liberal opinions. In personal practice, however, 80% of those who are influenced by religion were liberal. The percentage of respondents whose opinions were liberal was significantly greater among those who believed that abortion rates would remain the same or decrease following liberalisation. Conclusions: Judgements regarding the penalisation of women who abort are strongly influenced by how close the respondent is to the problem. Accurate information on abortion needs to be provided. Although about one third of the respondents were broadly liberal, the majority oppose punishment.
Harpers Bazaar profiles the Abortion Dream Team - a group of activists (and inroads members) working share information about self-managed abortion AND to change the broader cultural discourse around abortion in Poland
This piece has been published as a part of the Health Over Stigma campaign, which is aimed at dismantling the stigma surrounding sexual health of unmarried women, and demanding accountability from medical service providers for stigma-free, non judgemental sexual and reproductive healthcare services. In this piece, a senior gynaecologist who is associated with the campaign reflects on being a feminist gynaecologist in a patriarchal medical universe.
MAMA information materials for community distribution of protocols for medical abortion using Mifepristone and Misoprostol during the first 10 weeks of pregnancy. Downloadable in Chichewa, English, French, Igbo, Luganda, Swahili
MAMA information materials for community distribution of protocols for medical abortion using Misoprostol during the first 9 weeks of pregnancy. Downloadable in Chichewa, English, French, Igbo, Luganda, Swahili
This fact sheet outlines guidelines for medical management of abortion after 12 weeks. (The Later Abortion Initiative; Ibis Reproductive Health)
On Wednesday 6 th November 2019, Marie Stopes International launched a campaign – #SmashAbortionStigma – to shine a light on the widespread stigma faced by women who access safe abortion care. Worldwide, 25% of pregnancies end in abortion. Yet despite it being a common healthcare procedure, women still face judgement and stigma as a result of making choices that are right for them. Through the launch of the new, multi-channel campaign, #SmashAbortionStigma, we are addressing the need for open conversations on abortion by calling on people to break the silence. We’ll be using our social media channels, our website, and the voices of our supporters to amplify support for choice and show women that they’re supported and not alone. The more voices we have, the faster we can #SmashAbortionStigma, so we’d love your support with this campaign. You can find details on ways to get involved in this toolkit.
Health-related stigma remains a major barrier to improving health and well-being for vulnerable populations around the world. This collection on stigma research and global health emerged largely as a result of a 2017 meeting on the “The Science of Stigma Reduction” sponsored by the US National Institutes of Health (NIH). An overwhelming consensus at the meeting was reached. It was determined that for stigma research to advance further, particularly to achieve effective and scalable stigma reduction interventions, the discipline of stigma research must evolve beyond disease-specific investigations and frameworks and move toward more unified theories of stigma that transcend individual conditions. This introduction reflects on the value of taking this cross-cutting approach from both a historical and current perspective, then briefly summarizes the span of articles. Collectively, the authors apply theory, frameworks, tools, interventions and evaluations to the breadth of stigma across conditions and vulnerabilities. They present a tactical argument for a more ethical, participatory, applied and transdisciplinary line of attack on health-related stigma, alongside promoting the dignity and voice of people living with stigmatized conditions.
In this collection, BMC Medicine presents a series of articles on stigma research and global health that cut across sectors and fields with the goal of breaking down silos and improving our understanding of the role stigma plays in several disease areas.
Health-related stigma research can reduce the health inequities faced by stigmatized groups if funders and institutions require and reward community participation and if researchers commit to reflexive, participatory practices. A research agenda focused on participatory praxis in health-related stigma research could stimulate increased use of such methods.
A facility based descriptive cross-sectional study found that the majority of mid-level providers claimed to know the current abortion law; however, many failed to understand the specific provisions of the law. Type of profession and years of experiences were important in explaining providers’ knowledge related to abortion. Being male and having the knowledge significantly influenced providers’ attitude toward safe abortion. Knowledge related to abortion also influenced the practice of SAC. Efforts to improve mid-level as well as other health care providers’ knowledge on abortion are necessary, for example, through pre−/on-service training
This paper analyses interviews with providers who work in the public health system in the Metropolitan Area of Buenos Aires, Argentina. Between 2014 and 2017, authors conducted interviews with abortion providers in public facilities across healthcare services in the Metropolitan Area of Buenos Aires and found the way that health providers dealt with abortion stigma evolved over the course of time, as the abortion debate moved from the margins to the heart of political debate and public policies in Argentina between 2007 and 2017. Providers’ experiences changed as the social and legal context changed. FAL/12 – as a clear, legal ruling – was a landmark and turning point in the way health professionals in public health facilities conduct their activities, making it possible for them to move from providing silent and hidden abortion care, to acknowledging it with pride.
Social work has been largely silent on matters of reproductive rights, particularly in relation to abortion. This may partially be explained by abortion being secured as a part of health care in many countries. However, elsewhere, abortion remains in criminal codes with service access controlled via medico-legal barriers. This paper makes a case for the increased visibility of reproductive justice within education and professional activity, employing case studies from Australia, the Republic of Ireland and New Zealand to illustrate recent social work advocacy on abortion rights. Social work abortion activists report two themes: professional bodies have varied their approach to advocacy for abortion rights due to political sensitivities; and social work involvement in campaigns has reflected individual and grass-roots advocacy. Improved education about reproductive justice for social workers, alongside greater collective professional advocacy, are needed to contribute to campaigns together with women’s and human rights groups, as well as public health champions.
Rwanda amended its abortions law in 2012 to allow for induced abortion under certain circumstances. This study explores how Rwandan health care providers (HCP) understand the law and implement it in their clinical practice. HCPs express ambiguities on their rights and responsibilities when providing abortion care. A prominent finding was the uncertainties about the legal status of abortion, indicating that HCPs may rely on outdated regulations. A reluctance to be identified as an abortion provider was noticeable due to fear of occupational stigma. The dilemma of liability and litigation was present, and particularly care providers’ legal responsibility on whether to report a woman who discloses an illegal abortion. The lack of professional consensus is creating barriers to the realization of safe abortion care within the legal framework, and challenge patients right for confidentiality. This bring consequences on girl's and women's reproductive health in the setting. Implications for practice To implement the amended abortion law and to provide equitable maternal care, the clinical and ethical guidelines for HCPs need to be revisited.
This exploratory study looked into the experiences of abortion clients when completing the Individual Level Abortion Stigma Scale. They found that many participants have neutral and even positive experiences, but some do have negative experiences. These findings highlight the importance of carefully considering when it is appropriate to implement the ILAS and exploring safeguards for those participants who may have negative reactions.
We are at a crossroads in models of medication abortion care, forced by fear of COVID-19 infection but driven by implementing long overdue innovations based on science, common sense, and feminist praxis.
When health care workers refuse to provide safe abortion care (SAC) for religious, moral, or personal reasons, they jeopardize their clients’ health and violate the right to care. Scholars believe that health care workers’ professional commitments to patient care and to their profession’s goals can help them prioritize patient care over their personal biases. The Ethiopian government has assigned midwives a central responsibility to provide SAC, but there is no comprehensive understanding of Ethiopian midwives’ willingness to provide SAC and allied rationales, or the relationships between their sense of professional duty and willingness to provide. To answer these questions, a survey and focus groups with midwives in Ethiopia’s five most populated regions were conducted. Almost half of midwives were unwilling to provide SAC, and half disbelieved that it was midwives’ duty to do so. Most believed that midwives should be able to refuse to provide SAC based on religious or moral objections. Midwives were motivated to provide care by a belief that clients would die without care and by a sense of professional duty. When asked about how they would treat women requesting abortion care and contraceptives, many midwives said that they would encourage the woman to do what the midwife him- or herself thought best, rather than support her in making her own decision. These regionally representative findings suggest the need for new provider guidelines to clarify practices surrounding conscientious objection and refusal to provide safe abortion care and for programs to better train midwives to provide respectful counseling.
Leveraging the shared goal of systematic research on self-managed abortion, researchers and accompaniment groups have begun to explore if and when research collaboration can advance knowledge and understanding. In this commentary, the authors share the experiences and perspectives of activists and researchers in the development of a collaboration designed to collect transformative evidence about people’s experiences self-managing abortions with accompaniment group support, as well as the safety and effectiveness of the model. They consider this through the stages of the partnership from formation to structure and process to lessons learned.
This commentary aims to highlight the importance of understanding the context when designing digital tools for SRH self-care in humanitarian settings. We draw insights from the contextual analysis that was essential to the design process of Aya Contigo, a digital self-care tool that provides information and virtual accompaniment during the medical abortion process up to the first trimester. The overall research and design process included the following phases: (a) contextual analysis and stakeholder engagement and mixed-method exploratory research, (b) user-centred design principles to design and develop the mobile-based digital tool, and (c) mixed-methods feasibility and acceptability pilot study. We focus on findings from the exploratory research. In this phase, we conducted a contextual analysis through a desk review of Venezuela’s complex humanitarian emergency; a mapping of national SRH and abortion legislation, policies, programmes, and main stakeholders; and in-depth interviews with local activists, SRH service providers, and prospective users. We also facilitated workshops where stakeholders shared their inputs on the pertinence of digital self-care tools in the Venezuelan context.
In March 2022, the World Health Organization (WHO) released updated abortion care guidelines based on the most current evidence on abortion care, law, and policy. The updated version of the guidelines contains a range of new recommendations for clinical, service delivery, and law and policy components of abortion care. This brief summarizes the changes to recommendations about self-managed abortion (SMA) in the guidelines, linking those recommendations to research conducted by Ibis Reproductive Health in close partnership with safe abortion accompaniment groups.
Objective Prior work shows that ads related to abortion services often feature crisis pregnancy centers instead of abortion providers. We investigated whether a change in Google's advertising policy that required advertisers to disclose whether they provided abortion services increased the proportion of ads facilitating abortion self-referral. Study Design We used a standardized protocol to search online for abortion services before, during, and after the policy change; we performed searches in August 2016–June 2017, June 2019, and October 2019, respectively, using Google, Bing, and Yahoo search engines. We performed searches for the 25 most populous U.S. cities and the 43 state capitals not already included. We classified up to the first five ads as facilitating abortion referral, hindering abortion referral, or providing neutral content. We compared search engine results using a chi-square test. Results Among ads returned by Google, those shown after the policy change were significantly more likely to facilitate abortion self-referral (66.7% vs. 44.2%; P=0.003) and slightly less likely to hinder abortion self-referral (33.3% vs. 40.6%; P=0.33) compared to before the change. These findings were reversed for ads shown by Bing and Yahoo; ads returned after the change were significantly less likely to facilitate abortion self-referral (24.6% vs. 32.8%; P=0.01) and significantly more likely to hinder self-referral (28.3% vs. 21.6%; P=0.03) compared to before the change. Conclusion A policy requiring advertisers to disclose whether they provide abortion services was associated with increasing the proportion of ads facilitating self-referral. Similar policies should be considered by all search engines.
State-level restrictions on abortion access may prompt greater numbers of people to self-manage their abortion. The few studies exploring perspectives of providers towards self-managed abortion are focused on physicians and advanced practice clinicians. Little is known about the wider spectrum of abortion care providers who encounter self-managed abortion in their clinic-based work. To gain a deeper understanding of this issue and inform future care delivery, we conducted in-depth interviews with 46 individuals working in a range of positions in 46 abortion clinics across 29 states. Our interpretative analysis resulted in themes shaped by beliefs about safety and autonomy, and a tension between the two: that self-managed abortion is too great a risk, that people are capable of self-managing an abortion, and that people have a right to a self-managed abortion. Our findings highlight the importance of increasing knowledge and clarifying values among all abortion care providers, including clinic staff.
In the months since President Biden revoked the GGR, evidence presented in this report indicates that there is a disconnect between the USG’s internal procedure for communicating the revocation and the information that is communicated externally to prime and sub-prime partners around the world. At times, the USG’s and prime partners’ failure to provide comprehensive and prompt guidance to recipients of U.S. global health assistance caused detrimental delays in the policy’s effective revocation. These same delays made it impossible for people to access the abortion care that they were legally entitled to during the nine months between when the policy was revoked in January 2021 and the last interviews were conducted in October 2021. Some organizations that were aware that the GGR had been revoked did not receive guidance that specified how to practically implement the revocation in their programming. Organizations needed urgent and immediate guidance from the USG in January 2021 that clearly instructed them to cease implementing the GGR and explained how to modify ongoing programs to align with the policy change as well as mitigate harmful impacts on communities around the world. Without clear communication, guidance, and compliance mechanisms to monitor the implementation of this policy change, the GGR will continue to impede justice, infringe on national sovereignty, and inflict harm on communities around the world. Without permanent repeal through legislative action, this vicious cycle will continue every time there is a change in U.S. presidential administrations between Democrats and Republicans, as has been the case for nearly 40 years.
Reproductive autonomy is a pivotal part of women’s access to equal citizenship, yet it has not been included in any international nor regional human rights treaty. In the past decades, the U.N. Committees, notably the CEDAW Committee, and regional human rights bodies, particularly the Inter-American System for the Protection of Human Rights, have timidly advanced reproductive justice through their jurisprudence, including through the use of reparations. Drawing from the standards of reparations developed in the field of transitional justice, human rights bodies increasingly rely on reparations to enhance the transformative effects of their decisions. These reparations intend to include a gender-perspective in their design and aim to ensure the non-repetition of human rights violation, not only to the victim, but to society. Constitutional courts in Latin America are increasingly relying on the standards of reparations in their own decisions, including in those on reproductive justice. In this Article, I analyze two recent rulings from Latin American constitutional courts–one from Colombia and one from Ecuador–to understand how courts can use reparations to advance reproductive justice. I analyze these particular rulings for two reasons: (1) Both rulings have the potential to develop reproductive jurisprudence in the region where high courts have traditionally imported international and comparative law to resolve legal debates over reproductive rights; and (2) Both rulings challenge the traditional concept of reparations and offer an opportunity to rethink how the remedy can be deployed in a human rights context.
The abortion landscape is fragmented and increasingly polarized. Many states have abortion restrictions or bans in place that make it difficult, if not impossible, for people to get care. Other states have taken steps to protect abortion rights and access. To help people understand this complex landscape, our interactive map groups states into one of seven categories based on abortion policies they currently have in effect. Users can select any state to see details about abortion policies in place, characteristics of state residents and key abortion statistics, including driving distance to the nearest abortion clinic.
The intense politicization of abortion in U.S. public discourse obscures its status as a health and health care issue. Medical centers may therefore not be doing the careful preparation needed to manage the health system–wide impact of abortion’s criminalization. [This commentary and analysis] is a framework for preparation in a state where abortion will become illegal.
This resource is intended to support advocates who are working to achieve universal access to comprehensive, person-centered abortion care and an enabling environment for people to exercise their sexual and reproductive health and rights.
Policy surveillance offers a novel and important method for comparing law across jurisdictions. We used policy surveillance to examine abortion laws across the globe. Self-managed abortion, which generally takes place outside formal healthcare settings, is increasing in prevalence and can be safe. We analysed provisions that do not account for the prevalence of self-managed abortion and evidence of its safety. Such provisions require that abortion take place in a formal healthcare setting. We also analysed criminal penalties for non-compliance. Our method included development of a legal framework, an iterative process of refining coding schemes and procedures, and rigorous quality control. We limited our analysis to liberal abortion laws for two reasons. Abortion laws globally trend towards less restrictive. In addition, we aimed to focus on how laws relate to abortion outside a formal healthcare setting specifically and excluded laws that prohibit abortion more broadly. We found that in all countries with liberal national abortion laws, the law permits only healthcare professionals or trained health workers to perform legal abortion and the majority require the abortion to take place in a specified health facility. With policy surveillance methods we can illuminate characteristics of law across many jurisdictions and the need for widespread reform, toward laws that reflect scientific evidence and the way people have abortions.
The battle to protect abortion rights in the United States has not been this fierce in fifty years. From a precipitously growing number of states passing draconian laws that drastically limit—and in some states, entirely ban—access to safe and legal abortion services to a Supreme Court that is poised to overturn Roe v. Wade, reproductive freedom is under siege at every turn. Overturning Roe will have devastating consequences for all people, but most acutely for historically marginalized communities, including people with disabilities. Nonetheless, when disability is invoked in discourse concerning abortion, it is typically done to either support or oppose abortions based on fetal disability diagnoses. Critically, by framing disability and abortion only in the context of disability-selective abortions, activists, scholars, legal professionals, and policymakers fail to recognize that it is actual disabled people—not hypothetical fetuses with disability diagnoses—who abortion restrictions will harm. Indeed, disabled people disproportionately experience pervasive and persistent disadvantages that increase their need for abortion services. They also experience considerable structural, legal, and institutional barriers that already put access to safe and legal abortion out of reach for many. In response, this Article proposes a vision to help activists, scholars, legal professionals, and policymakers as they imagine the next steps in the battle to protect abortion rights in a way that fully includes people with disabilities. To do so, first, the Article situates the current battle to protect abortion rights within the social context and institutions that propagate reproductive oppression of people with disabilities by examining how reproduction has been weaponized over time to subjugate disabled people as well as presenting contemporary examples of such injustices. Thereafter, it explores disabled people’s unique needs for abortion services and the myriad ways they are disproportionately and adversely affected by restrictions on abortion rights. Next, the Article presents disability reproductive justice, a jurisprudential and legislative framework, and its application to the fight for abortion rights. Finally, drawing from disability reproductive justice, it suggests normative and transformative legal and policy solutions for challenging the current assault on abortion rights and its impact on disabled people.
This Article launches a critical dialogue about the abortion privilege. On the one hand, most abortion patients are low income or live below the poverty line and are disproportionately women of color. Many of these patients encounter multiple restrictions on abortion and must travel lengthy distances to abortion care facilities. These patients take center stage in abortion rights cases and in abortion rights discourse. On the other hand, there is a smaller but not insignificant group of abortion patients for whom abortion care is paid for by private or public health insurance or available out-of-pocket funds. Many of these patients live in states where abortion is unrestricted, and abortion care facilities are accessible often in the county in which they live. These patients experience abortion as a form of ordinary health care and rarely show up in abortion rights cases and abortion rights discourse. They have the abortion privilege. This Article reveals the abortion privilege and contends that its recognition and thoughtful incorporation into abortion rights law and discourse could help redistribute the oppressive load women without the same privilege carry in connection with the right and help shore up the abortion right.
Purpose Health care professionals’ attitudes and behaviours play a fundamental role in the provision of timely comprehensive abortion care as a maternal health intervention and save hundreds of thousands of women’s lives, annually. This study explores underlying factors influencing Tanzanian and Ethiopian health care professionals’ attitudes and behaviours towards comprehensive abortion care between 2015 and 2020. Materials and methods The study inductively explored Ethiopian and Tanzanian health care professionals’ behaviours using a comparative case study design and a textual analytical approach. Published and unpublished literature, documents and newspapers were used as data sources. The two cases were selected because of their different approaches towards the governance of abortion care, one gradually legalising while the other persistently restricting. Results Results demonstrated that there are both subjective (beliefs, attitudes, images, pre-dispositions) and objective (institutional incapacity) factors that impact the actions of health care professionals in the work environment. Conclusions The study concluded that the intervention of subjective factors results from the institutional failure to effectively bridge the divide between governance and accessibility of safe abortion care.
Where abortion is legal, it is often regulated through a grounds-based approach. A grounds-based approach to abortion provision occurs when law and policy provide that lawful abortion may be provided only where a person who wishes to have an abortion satisfies stipulated ‘grounds’, sometimes described as ‘exceptions’ or ‘exceptional grounds’. Grounds-based approaches to abortion are, prima facie, restrictive as they limit access to abortion based on factors extraneous to the preferences of the pregnant person. International human rights law specifies that abortion must be available (and not ‘merely’ lawful) where the life or health of the pregnant woman or girl is at risk, or where carrying a pregnancy to term would cause her substantial pain or suffering, including but not limited to situations where the pregnancy is the result of rape or incest or the pregnancy is not viable. However, international human rights law does not specify a grounds-based approach as the way to give effect to this requirement. The aim of this review is to address knowledge gaps related to the health and non-health outcomes plausibly related to the effects of a grounds-based approach to abortion regulation. The evidence from this review shows that grounds have negative implications for access to quality abortion and for the human rights of pregnant people. Further, it shows that grounds-based approaches are insufficient to meet states’ human rights obligations. The evidence presented in this review thus suggests that enabling access to abortion on request would be more rights-enhancing than grounds-based approaches to abortion regulation.
The Oceania region is home to some of the world's most restrictive abortion laws, and there is evidence of Pacific Island women's reproductive oppression across several aspects of their reproductive lives, including in relation to contraceptive decision-making, birthing, and fertility. In this paper we analyse documents from court cases in the Pacific Islands regarding the illegal procurement of abortion. We undertook inductive thematic analysis of documents from eighteen illegal abortion court cases from Pacific Island countries. Using the lens of reproductive justice, we discuss the methods of abortion, the reported context of these abortions, and the ways in which these women and abortion were constructed in judges' summing up, judgements, or sentencing. Our analysis of these cases reveals layers of sexual and reproductive oppression experienced by these women that are related to colonialism, women's socioeconomic disadvantage, gendered violence, limited reproductive control, and the punitive consequences related to not performing gender appropriately.
Background In 2018, the right to lawful abortion in the Republic of Ireland significantly expanded, and service provision commenced on 1 January, 2019. Community provision of early medical abortion to 9 weeks plus 6 days gestation delivered by General Practitioners constitutes the backbone of the Irish abortion policy implementation. We conducted a study in 2020–2021 to examine the barriers and facilitators of the Irish abortion policy implementation. Methods We collected data using qualitative in-depth interviews (IDIs) which were conducted in-person or remotely. We coded and analysed interview transcripts following the grounded theory approach. Results We collected 108 IDIs in Ireland from May 2020 to March 2021. This article draws on 79 IDIs with three participant samples directly relevant to the community model of care: (a) 27 key informants involved in the abortion policy development and implementation representing government healthcare administration, medical professionals, and advocacy organisations, (b) 22 healthcare providers involved in abortion provision in community settings, and (c) 30 service users who sought abortion services in 2020. Facilitators of community-based abortion provision have been: a collaborative approach between the Irish government and the medical community to develop the model of care, and strong support systems for providers. The MyOptions helpline for service users is a successful national referral model. The main barriers to provision are the mandatory 3-day wait, unclear or slow referral pathways from primary to hospital care, barriers for migrants, and a shortage and incomplete geographic distribution of providers, especially in rural areas. Conclusions We conclude that access to abortion care in Ireland has been greatly expanded since the policy implementation in 2019. The community delivery of care and the national helpline constitute key features of the Irish abortion policy implementation that could be duplicated in other contexts and countries. Several challenges to full abortion policy implementation remain.
This guide has been produced as resource material for the mentoring programme on rights-based knowledge creation in sexual and reproductive health, conducted by the South Asia Hub of SRHM. It is meant to provide an introduction for researchers, practitioners and activists on how to use a human rights-based approach to knowledge creation in the area of sexual and reproductive health.
Introduction Despite playing an integral part in sexual and reproductive health care, including abortion care, nurses are rarely the focus of research regarding their attitudes about abortion. Methods A sample of 1,820 nurse members of the Association of Women's Health, Obstetric and Neonatal Nurses were surveyed about their demographic and professional backgrounds, religious beliefs, and abortion attitudes. Scores on the Abortion Attitudes Scale were analyzed categorically and trichotomized in multinomial regression analyses. Results Almost one-third of the sample (32%) had moderately proabortion attitudes, 29% were unsure, 16% had strongly proabortion attitudes, 13% had strongly antiabortion attitudes, and 11% had moderately antiabortion attitudes. Using trichotomized Abortion Attitudes Scale scores (proabortion, unsure, antiabortion), adjusted regression models showed that the following characteristics were associated with proabortion attitudes: being non-Christian, residence in the North or West, having no children, and having had an abortion. Conclusions Understanding nurses’ attitudes toward abortion, and what characteristics may influence their attitudes, is critical to sustaining nursing care for patients considering and seeking abortion. Additionally, because personal characteristics were associated with antiabortion attitudes, it is likely that personal experiences may influence attitudes toward abortion. A large percentage of nurses held attitudes that placed them in the “unsure” category. Given the current ubiquitous polarization of abortion discourse, this finding indicates that the binary narrative of this topic is less pervasive than expected, which lends itself to an emphasis on empathetic and compassionate nursing care.
Recent shifts in the abortion provision landscape have generated increased concern about how people find abortion care as regulations make abortion less accessible and clinics close. Few studies examine the reasons that people select particular facilities in such constrained contexts. Drawing from interviews with 41 Ohio residents, we find that people's clinic selections are influenced by the risks they associate with abortion care. Participants' strategies for selecting an abortion clinic included: drawing on previous experience with clinics, consulting others online, discerning reputation through name recognition and clinic type, and considering location, especially perceptions about place (privacy, legality, safety). We argue that social myths inform the risks people anticipate when seeking health care facilities, shaping care seeking in ways that are both abortion-specific and more general. These findings can also inform research in other health care contexts where patients increasingly find their options constrained by rising costs, consolidation, and facility closure.
Diverse models of self-managed medication abortion exist—ranging from some interaction with medical personnel to completely autonomous abortion. In this commentary, we propose a new classification of self-managed medication abortion and describe the different modalities. We highlight autonomous abortion accompanied by feminist activists, called “acompañantes,” as a community- and rights-based strategy that can be a safe alternative to clinical abortion services in clandestine as well as legal settings. To improve access, abortion needs to be decriminalized and governments must acknowledge and facilitate the diversity of safe abortion options so women may choose where, when, how, and with whom to abort.
For decades, Ipas has trained doctors, midwives and nurses to safely and respectfully perform abortions and provide counseling on contraceptive options to ensure high-quality abortion care and continues to produce training materials and clinical guidance to support those efforts. As abortion self-care rises globally, so too does our investment in materials and resources developed for women to use to safely and successfully manage their abortion with pills. As the World Health Organization (WHO) strongly reaffirmed in the new Abortion Care Guideline, abortion using medication or vacuum aspiration is a common, safe, and simple health-care intervention when carried out “…in the case of a facility-based procedure – by a person with the necessary skills” and for self-managed abortion, “…individuals with a source of accurate information” (WHO, 2022). To that end, we are pleased to introduce a set of abortion care videos designed to better train health care providers to improve their abortion care and help women safely self-manage their abortion using pills. There are 11 videos for health workers and 3 videos for women. These videos were filmed in facilities in Africa and Asia and are consistent with the latest WHO and Ipas clinical guidance.
The objective of this guideline is to present the complete set of all WHO recommendations and best practice statements relating to abortion. While legal, regulatory, policy and service-delivery contexts may vary from country to country, the recommendations and best practices described in this document aim to enable evidence-based decision-making with respect to quality abortion care. This guideline updates and replaces the recommendations in all previous WHO guidelines on abortion care.
This commentary accompanies the WHO Abortion Care Guidelines. Using this holistic approach to the provision of quality abortion care, the Abortion Care guideline carries a consistent message: access to quality abortion care is both a health and human rights issue. The recommendations and best practice statements in this guideline are only the first step and they still need to be operationalised and implemented. Achieving implementation of the recommendations and best practice statements, while keeping the woman at the centre of quality abortion care, will spur movement towards attaining the highest attainable standard of sexual and reproductive health.
Access to abortion throughout much of Mexico has been restricted. Fondo Maria is an abortion accompaniment fund that provides informational, logistical, financial, and emotional support to people seeking abortion care in Mexico. This cross-sectional study examines the factors that influenced decision-making and contributed to delays in accessing care and explores experiences with Fondo Maria’s support among women living outside Mexico City (CDMX). We describe and compare the experiences of women across the sample (n = 103) who were either supported by Fondo Maria to travel to CDMX to obtain an abortion (n = 60), or self-managed a medical abortion in their home state (n = 43). Data were collected between January 2017 and July 2018. Seventy-seven percent of participants reported that it was difficult to access abortion care in their home state and 34% of participants indicated they were delayed in accessing care, primarily due to a lack of financial support. The majority of participants (58%) who travelled to CDMX for their abortion did so because it seemed safer. The money/cost of the trip was the most commonly cited reason (33%) why participants who self-managed stayed in their home state. Eighty-seven percent of participants said Fondo Maria’s services met or exceeded their expectations. Our data suggest that people seeking abortion and living outside CDMX face multiple and overlapping barriers that can delay care-seeking and influence decision-making. Abortion accompaniment networks, such as Fondo Maria, offer a well-received model of support for people seeking abortion in restrictive states across Mexico.
This study is a discourse analysis of an online abortion-storytelling platform in Mexico called Lightbulbs. The platform contributes to reducing stigma by showing a diversity of experiences and contesting stereotypes through participants’ own voices, which is powerful in a context where public discourse about abortion is polemic and rarely based on personal experience. Yet, tensions exist regarding what kinds of stories are less visible or silenced in online storytelling. We conclude with implications for reproductive rights activists who may unwittingly undermine the potential of storytelling for transformative justice in relation to access to safe and legal abortion
There is a great deal of misinformation and stigma surrounding abortion, even though it is a common reproductive health service. Teaching about abortion encompasses many things: managing the beliefs of students and teachers; state regulations around teaching or talking about abortion in schools; available resources; and the cultural miseducation and stigma around abortion. As social media becomes more accessible and widely used, educators can use it as a tool for teaching sensitive issues and navigating some of the restrictions and difficulties teaching about abortion comes with. This article explores current considerations and issues around abortion education and how TikTok can be used to teach this sensitive topic both inside and outside of the classroom, especially with adolescents and young adults. With its 1 billion monthly active users, TikTok is a potential educational space for teaching about abortion by spreading accurate information, engaging the audience, and working to open lines of communication to combat abortion stigma
Introduction: This study employs sentiment analysis (SA) to examine the semantic structures of restrictive and protective abortion bills enacted in 2019. SA is a Natural Language Processing (NLP) technique that uses automation to extract affective indicators (emotive language) from text data. Assessing these indicators can help identify whether legal texts are framed, or intentionally biased in their wording. Identifying framing is important for understanding potentially biased interpretations of these laws. Methods: We identified a sample of 2019 abortion bills using the legislative tracking tool Legiscan and included those that met specified criteria (N = 19 bills). We categorized each bill as restrictive (n = 12) or protective (n = 7). We ran aggregate (i.e., all bills) and separate (protective × restrictive) SA, generating scores that we interpreted qualitatively (higher scores indicated predominance of positive wording). Results: In the aggregate analysis, 56% of text comprised negative terms (44% positive). Restrictive bills contained more negative language than protective bills (67% vs 58%). Although SA scores varied from -222 to +13, two laws scored 0, indicating neutrality. For comparison, the US Constitution's score equaled 1. Conclusion: Our findings confirm SA is useful to examine legal documents for language biases. The abortion bills we assessed seem framed along political ideologies, although the sample provided evidence that neutral wording is possible. Policy implications: With the recent additions of conservative-leaning Justices to the US Supreme Court, Roe v. Wade is again at the center of partisan conflict. Thus, how abortion laws are framed draws further implications for how they may be interpreted when challenged in the court system.
We explore abortion access, abortion experiences, and abortion stigma. We emphasize global perspectives on abortion diversity and the relationship between pregnancy norms and expectations, abortion stigma, and practical constraints on reproductive freedom. Evolutionary psychological, clinical psychological, and social-psychological perspectives illuminate how abortion decisions are shaped by strategies to optimize survival and success, support services that emphasize the costs and risks of pregnancy termination, and pronatalist norms and punishment of departures from those expectations. We call for future abortion research that integrates multiple subfields in psychology and is rooted in an intention to effect public policy and social change that promotes reproductive autonomy.
This is a commentary on Adair and Lozano’s (2022) article, “Adaptive Choice: Psychological Perspectives on Abortion and Reproductive Freedom.” We offer a critique of its underlying premise that abortion must be justified and identify three substantive concerns. Then, we outline a better way to study abortion, one that draws on feminist and reproductive justice scholarship by: centering the lived experience of real people and their needs; holding that it is a fundamental human right of people to reproduce if and when they desire; and conducting research that benefits people, with a focus on those who are socially marginalized.
This is a commentary on Adair and Lozano’s (2022) article “Adaptive Choice: Psychological Perspectives on Abortion and Reproductive Freedom.” Here, I acknowledge the possibilities for the normalization of abortion that their approach presents. Then, drawing predominantly from South African politics and scholarship, I address how the (future) stories we tell about abortion may limit the potential for normalization and the eradication of stigma. I argue that scholars and activists need to engender a more radical, intersectional, and therefore critically reflexive, inclusive, bold abortion justice politics that envisions itself as one necessary part of the larger struggle for reproductive justice.
This is a commentary on Adair and Lozano’s (2022) article “Adaptive Choice: Psychological Perspectives on Abortion and Reproductive Freedom.” Here I focus on the ways that abortion seekers can achieve their goals outside the formalized health care systems of countries with governments that restrict abortion access or even outlaw it. Self-managed abortion (SMA), especially when supported by local feminist or community organizers, allows pregnant people to make an adaptive choice, safely circumvent the medicolegal system if necessary, and avoid abortion-related stigma. I highlight the work of Women Help Women, an international SMA network.
Objectives: Salient belief elicitations (SBEs), informed by the Reasoned Action Approach (RAA), are used to identify 3 sets of beliefs - behavioral, control, and normative - that influence attitudes toward a health behavior. SBEs ask participants about their own beliefs through open-ended questions. We adapted a SBE by focusing on abortion, which is infrequently examined through SBEs; we also included a survey version that asked participants their views on what a hypothetical woman would do if contemplating an abortion. Given these deviations from traditional SBEs, the purpose of this study was to assess if the adapted SBE was understood by participants in English and Spanish through cognitive interviewing. Methods: We examined participants' interpretations of SBE items about abortion to determine if they aligned with the corresponding RAA construct. We administered SBE surveys and conducted cognitive interviews with US adults in both English and Spanish. Results: Participants comprehended the SBE questions as intended. Participants' interpretations of most questions were also in line with the respective RAA construct. Conclusions: SBE survey questions were comprehended well by participants. We discuss areas in which SBE questions can be modified to improve alignment with the underlying RAA construct to assess abortion beliefs.
Objetivo Explorar las vivencias emocionales de las mujeres en torno a la interrupción voluntaria del embarazo (IVE) a través de la producción científica cualitativa existente. Método Revisión sistemática cualitativa basada en la búsqueda bibliográfica de estudios publicados desde 2010 en PubMed, Science Direct y Scopus. Se incluyeron 19 artículos con diseño cualitativo que se revisaron usando análisis de contenido de tipo inductivo. Resultados Se identificaron tres temas principales en torno a las experiencias emocionales: acceso a la IVE, impacto emocional durante la asistencia sanitaria y aspectos individuales, relacionales y socioculturales condicionantes de la vivencia. Los estudios mostraron la variabilidad de las experiencias emocionales, con los siguientes factores determinantes: acceso y tiempos de espera, características y funcionamiento del sistema sanitario, procedimiento de intervención, grado de presencia y participación de las pacientes en relación a aspectos técnicos y uso de tecnologías médicas, interacción con el personal sanitario y aspectos individuales, relacionales y socioculturales específicos. Las principales dificultades emocionales se relacionaron con el conflicto ético, la toma de decisiones, la relación con el entorno social y sanitario, y la experiencia del estigma. Como elementos facilitadores se refirieron la autonomía en la toma de decisiones y el apoyo emocional; como barreras, las manifestaciones del rechazo social y los mensajes negativos del entorno político, sanitario y sociofamiliar. Conclusiones Las experiencias emocionales en la IVE dependen de factores individuales, relacionales y asistenciales, vertebrados por desigualdades y sesgos de género. En el ámbito asistencial, el potencial de mejora reside en una atención sanitaria integral e individualizada, adaptada a las necesidades de las pacientes.
One out of four women in the United States will have an abortion by age 45. While abortion rates are steadily declining in the United States, the rate of medication abortions continues to increase, with 39% of all abortions being medication abortions. Our study is one of the first to analyze women's narratives after having had a medication abortion. Using relational dialectics theory, we conducted a case study of the nonpartisan website, Abortion Changes You. Our contrapuntal analysis rendered four sites of dialectical tension found across women's blog posts: only choice vs. other alternatives, unprepared vs. knowledgeable, relief vs. regret, and silence vs. openness. Each site of struggle characterized a different noteworthy moment within a woman's medication abortion experience: the decision, the medication abortion process, identity after abortion, and managing the stigmatizing silence before and after the abortion. We discuss theoretical and practical implications about how the larger politicized discourses prevalent within the abortion debate impact the liminality of women who are contemplating a medication abortion and affect their own narrative construction about the medication abortion experience.
CONTEXT Entertainment television can impact viewers' knowledge, attitudes, and reproductive health behaviors, yet little research has examined the impact of scripted abortion plotlines on viewers' abortion knowledge or social supportiveness for those having abortions. We examined the impact of an abortion storyline from Grey's Anatomy on US-based viewers. METHOD We conducted an online survey of likely Grey's Anatomy viewers prior to the episode's airing, assessing abortion ideology, knowledge, and support. After airing, we resurveyed respondents (including both those who had and had not viewed the target episode). We tested three hypotheses: episode exposure would (1) improve abortion knowledge and (2) increase support for medication abortion and decrease support for self-induced abortion, and (3) the effects on knowledge and supportive intention would be moderated by state support for abortion. We used independent samples t tests to examine hypotheses 1 and 2 and PROCESS macro to test the moderated effects (hypothesis 3). RESULTS The results of the pretest/posttest analysis indicated that exposure to the episode significantly improved medication abortion knowledge. Increases in medication abortion knowledge were tied to explicit educational dialogue and did not translate into an increase in general abortion knowledge or social supportiveness. Notably, abortion-related state policy significantly moderated the influence of exposure for respondents in states with policies favorable to abortion access. CONCLUSIONS These findings suggest that entertainment television can contribute to meaningful increases in viewers' knowledge about abortion, but that the potential for impact of entertainment-education is closely linked to episode content and moderated by state-level abortion policy.
In most settings worldwide, abortion continues to be highly stigmatised. Whilst a considerable body of literature has addressed abortion stigma, what is less commonly examined are the ways in which those with experience of abortion describe it in non-negative terms which may resist or reject stigma. Drawing on qualitative secondary analysis of five UK datasets using a narrative inquiry approach, we explore: the use of non-negative language around abortion, potential components of a normalising narrative, and constraints on non-negativity. As such, we present the first empirical UK study to critically examine how a dominant negative abortion narrative might be disrupted.
Objetivo Identificar variables y argumentaciones valóricas que configuran la percepción de la interrupción del embarazo como delito bajo cualquier causal, en una muestra comunitaria de una ciudad al sur de Chile durante el debate de la Ley 21.030. Método Estudio mixto, cuantitativo, observacional, de corte transversal correlacional y cualitativo. Una muestra cuantitativa de 289 personas de Temuco (Chile) contestó a un cuestionario sobre categorías sociales y su percepción de la gravedad de 15 conductas como delito. Para la fase cualitativa se realizaron 12 entrevistas semiestandarizadas sometidas a análisis de contenido, incorporando algunos elementos de la teoría fundamentada desde la perspectiva constructivista. Resultados Con independencia del sexo, más de la mitad de la muestra de estudio consideran el aborto como un delito entre grave y extremadamente grave. Las personas religiosas, sin importar el tipo de religión, políticamente conservadoras y con menor nivel educativo, presentan una percepción del aborto como delito de mayor gravedad. La participación con frecuencia en actos religiosos presenta un efecto mediador. Los resultados cualitativos establecen una perspectiva multidimensional y el dogma de la religión como argumento central para rechazar el aborto. Conclusiones La religión y una visión política conservadora afectan las construcciones tradicionales de género y maternidad, y por ende se observa una tendencia a rechazar el aborto. Estos resultados hacen hincapié en la necesidad de prestar especial atención a la aceptación de la Ley 21.030 sobre la interrupción voluntaria del embarazo para una aplicación efectiva.
Background Although abortion was legalized in South Africa in 1996, barriers to safe, legal abortion services remain, and women continue to seek abortions outside of the formal healthcare sector. This study explored the decision-making processes that women undertake when faced with an unintended pregnancy, the sources of information used to make their decisions and the factors that contribute to their seeking of informal sector abortion in Cape Town, South Africa. Methods We conducted 15 semi-structured in-depth interviews in English with women who had accessed an abortion outside of the formal health care sector. Women were recruited with the assistance of a community-based key informant. Data was analyzed using a thematic analysis approach. Results Participants were aware that abortions were legal and accessible in public clinics, however they were concerned that others would find out about their unintended pregnancy and abortion if they went to legal providers. Women were also concerned about judgment and mistreatment from providers during their care. Rather than seek care in the formal sector, women looked past concerns around the safety and effectiveness of informal sector abortions and often relied on their social networks for referrals to informal providers. Conclusions The findings highlight the decision-making processes employed by women when seeking abortion services in a setting where abortion is legal and demonstrate the role of institutional and societal barriers to safe abortion access. Abortion service delivery models should adapt to women’s needs to enhance the preferences and priorities of those seeking abortion care-including those who prefer facility-based care as well as those who might prefer self-managed medical abortions.
Although abortion rates appear to be declining in high-income nations, there is still a need for accessible, safe abortion services. However, limited attention has been paid to understanding the social contexts which shape access to abortion information and services for communities who are less engaged with sexual and reproductive health care more generally. This paper explores the views and experiences of 27 migrant and refugee young people (16-24 years old) living in Sydney, Australia, regarding unintended pregnancy and abortion. Pregnancy outside marriage was described by all participants as a shameful prospect as it revealed pre-marital sexual activity. Even when abortion was described as culturally and/or religiously unacceptable, it was believed many families would find an abortion preferable to continuing an unintended pregnancy outside marriage. However, a pervasive culture of silence regarding sexual and reproductive health may limit access to quality information and support in this area. To better meet the needs of these young people, greater attention must be paid to strengthening youth and community awareness of the availability of contraception including emergency contraception, pregnancy options, and access to abortion information and services.
This new report examines assets and barriers young people face when seeking abortion care, and seeks to determine what cultural change is necessary in youth abortion access. YAAT worked with Rivera Consulting to engage youth and supportive adults in a qualitative survey and interview approach, then developed recommendations for the field to continue the work of removing barriers to abortion access and supporting young people seeking abortion.
The inroads Queer Abortions Festival was held from 30 March to 7 April 2022 over a total of 5 sessions. Sessions were conducted in English and Spanish, ranging from 1.5 to 3 hours. The festival aimed to celebrate and bust the stigma of the lived experiences, intricacies, questions, and reflections surrounding queer abortions through various collaborative activities such as open learning spaces, zine-making, shared dialogue, and collective reflection. Each session of the workshop focused on building co-created spaces of learning between member facilitators and participants. As such, a participatory approach is embedded within the workshop materials, in order to encourage active learning and a diversity of responses. We are including workbooks of the workshop materials in English, French, and Spanish to facilitate broader learning opportunities for your organization and/or abortion stigma-busting community.
The online training for inroads members Mapping and Mobilizing Resources for Abortion Stigma Busting Work, held on 19 January and 1 February 2022, was conducted by Xiomara Carballo Briceño. Through a participatory process guided by collective care principles, inroads members who attended were able to strengthen their resource mobilization capacity through the exploration of key resource mobilization concepts such as: Mapping donor landscapes in the search for value-aligned funding. How to seek out and determine the most appropriate calls for proposals. What a donor pipeline is and how it may be used for resource mobilization continuity in organizational funding. Telling your organization’s story when crafting a proposal. Being aware of the power dynamics implicit within donor relationships.
The first inroads Stigma at the Intersections: Abortion, Disability, HIV and Access workshop was held on October 12,13, and 14. Learning Goals of the workshop: To underline stigma related to abortion, how it affects people with disabilities and other marginalised groups such as people living with HIV, sex workers, people who inject drugs, trans and queer community. To generate discussion and learning on abortion and disability that is genuinely intersectional and goes beyond and anti-abortion narrative of abortion on grounds of disability. To ensure that there is not simply room for this discussion, but that real, safe, and brave spaces are created with the intent of broadening this learning with, and not just on behalf of, of those of us with disabilities. To ensure that the autonomy, agency, and attitude of those of us with disabilities are heard, seen, and hold their rightful place in dismantling stigma. At this link, you can find a workbook version of the the workshop in English, French, and Spanish
We prepared a workbook version of the materials from the workshop about Exploring Definitions and Measurement Tools of Abortion Stigma to facilitate the learning experience of members that were not able to attend the live session. With this workbook, you will be able to: More precisely define stigma and how it manifests. Learn about the diverse tools to measure abortion stigma (SABAS, ILASS, CLASS, APSS), the intended use of each, and understand some of their strengths and weaknesses. Explore the different aspects to be considered when adopting and applying a measuring tool. Follow a step-by-step process to help you choose, prepare, and apply a measuring scale successfully.
The 150th anniversary of §218 of the German criminal code provides an opportunity to take a closer look as its diverse implications. As a board member of inroads, International Network for the Reduction of Abortion Discrimination and Stigma, the author points out the reciprocal relationship between abortion stigma and criminalization. inroads is a loose network of academics, advocates, activists and artists and provides a platform for activism and discussion on all facets of abortion stigma and its effective fight.
It was almost a decade ago that we started conducting research to assess abortion stigma in partnership with service delivery organizations in the Global South. We adapted various stigma scales to learn about perceptions of and experiences with stigma among people seeking abortion, as well as attitudes about abortion among community members. We wanted to learn about experiences responding to the ILAS directly from people who had an abortion. In this exploratory study, we conducted in-depth interviews by phone with 10 people from different parts of Mexico. Participants were recruited by the MARIA Abortion Fund for Social Justice (Fondo MARIA) if they were aged 18 and older, had an abortion in the prior 6 months, and said they had support from someone close to them at the time of the abortion.
Care-Mapping - a guide to facilitate a care-mapping workshop in your own organization. The workbooks have been designed and commissioned specifically with the inroads network in mind, as we pursue wider methods of exploring spaciousness and self-care in a time of increasing resistance and restriction towards reproductive justice, joy, and activism. Find the English, Spanish, and French workbooks at the link!
Objectives The objective of this study was to evaluate a person-centered abortion care mobile-based intervention on perceived social stigma, social support, mental health and post-abortion care experiences among Kenyan women who received abortion services at private clinics. Methods This randomized controlled study enrolled women who obtained an abortion from private clinics in Nairobi county, Kenya and randomized them into one of three study arms: 1) standard of care (follow-up by service provider call center); 2) post-abortion phone follow-up by a peer counselor (a woman who has had an abortion herself and is trained in person-centered abortion care); or 3) post-abortion phone follow-up by a nurse (a nurse who is trained in person-centered abortion care). All participants were followed-up at two- and four-weeks post-abortion to evaluate intervention effects on mental health, social support, and abortion-related stigma scores. A Kruskal-Wallis one-way ANOVA test was used to assess the effect of each intervention compared to the control group. In total, 371 women participated at baseline and were each randomized to the study arms. Results Using Kruskal-Wallis tests, the nurse arm improved mental health scores from baseline to week two; however this was only marginally significant (p = 0.059). The nurse arm also lowered stigma scores from baseline to week four, and this was marginally significant (p = 0.099). No other differences were found between the study arms. This person-centered mobile phone-based intervention may improve mental health and decrease perceived stigma among Kenyan women who received abortion services in private clinics. Conclusions Nurses trained in person-centered abortion care, in particular, may improve women’s experiences post-abortion and potentially reduce feelings of shame and stigma and improve mental health in this context.
Plain Language Summary: We conducted a study to explore and understand the social barriers women face in seeking and obtaining quality safe abortion care in Ethiopia. We implemented focus group discussions with both men and women in four different regions of Ethiopia. We analyzed our findings into themes around stigma, barriers, and the changing nature of attitudes around abortion. Our results show that women seeking abortions are still heavily stigmatized. We found that abortion was deemed unacceptable in most cases. However, we also saw promising indications that changes are taking place in Ethiopian society’s view of abortion, and several participants indicated progress toward a more supportive environment overall for women seeking abortion care. Still, this progress may be limited by variable knowledge of abortion laws. Most participants noted the importance of education and outreach to improve abortion attitudes and norms. We concluded that further awareness is needed in Ethiopia on the availability of quality abortion services in public health facilities and the indications for legal abortion. These efforts should consider gender equality to ensure enduring changes for women’s reproductive choice throughout the country.
Objective: Medical menstrual regulation (MMR) may offer a promising way to reach Senegalese women and girls in need of fertility management, especially in rural contexts. To assess the feasibility of introducing a MMR service in Senegal, the study aimed to (1) understand how women and girls manage their menses and fertility, and (2) document acceptability of MMR among women, youth, and health providers. Methods: Six focus group discussions and 34 in-depth interviews were conducted with women, youth, and health providers in Kaolack, Mbour, and Thiès, Senegal. Results: All participants characterized the pubescent period by a lack of sexual education, familial support, and access to reproductive health services. Reproductive health service utilization in Senegal was portrayed as highly stigmatized, creating barriers to contraception and reliable information on family planning. Unwanted pregnancy and clandestine abortion were depicted as common occurrences among many participants. Senegalese women and youth perceived MMR services as an acceptable method to manage a missed period with discretion, rid of moral and legal ramifications - and framed MMR as a needed mechanism to prevent abortion and avoid undesired pregnancies. The majority of health providers, with the exception of female health volunteers, were reluctant to endorse the service, comparing MMR to abortion. Conclusions: In a context fraught with restrictive abortion laws and limited uptake of modern contraception, MMR is an acceptable among potential service users. Nonetheless, introduction and implementation of MMR will be feasible in Senegal only if policymakers approve and support the service and health provider buy-in is achieved.
Objective We aimed to assess the impact of first-person abortion stories on community-level abortion stigma. Methods Between November 2018 and March 2019, we recruited participants and analyzed data from a nationally representative, probability-based online panel of U.S. adults, randomized to watch three first-person abortion video stories (intervention, n = 460) or three nature videos (control, n = 426). We measured community-level abortion stigma using the Community Abortion Attitudes Scale, Reproductive Experiences and Events Scale, and Community Level Abortion Stigma Scale at baseline, immediately after video exposure, and 3 months later. We dichotomized stigma change scores as decreased stigma compared with no change or increased stigma. Bivariate and logistic regression analysis accounted for complex survey methodology and sample weighting. Results Sample demographics reflected U.S. Census benchmarks (51% female, 68% White, 47% aged 18–44 years). Most participants (83.1%) completed the 3-month follow-up. Viewing the intervention videos was not associated with decreased stigma measured by Community Abortion Attitudes Scale or Community Level Abortion Stigma Scale immediately (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.59–1.09; OR, 1.28; 95% CI, 0.93–1.75) or at the 3-month follow-up (OR, 0.86; 95% CI, 0.62–1.19; OR, 0.98; 95% CI, 0.70–1.37). Intervention exposure was associated with decreased stigma as measured by Reproductive Experiences and Events Scale immediately (OR, 1.74; 95% CI, 1.23–2.46); however, this association was not observed at the 3-month follow-up (OR, 0.98; 95% CI, 0.70–1.37). Conclusions Exposure to first-person video stories may not decrease community-level abortion stigma among U.S. adults.
Objectives: Recognizing and tolerating complexity has been shown to be key in successfully navigating conflict about contested topics. Abortion conversations are often highly polarized and lacking nuance. Yet many Americans experience some level of discomfort with abortion. We sought to understand if acknowledging ambiguity and complexity in abortion conversations could help manage discomfort and ultimately increase support for abortion.
Black feminists know that Roe was never enough. Black reproductive justce leadership and organizers continue to step up to bridge the gap of abortion access for Black women, girls, and gender-expansive people. We must follow in their footsteps and recognize that now is the time to organize, not despair! Nearly 50 years after Roe v. Wade, the most consequential abortion rights case, Black folks in the Midwest and South are forced to fight for expanded access, safe abortion options, and full bodily autonomy. Black women, girls, and gender expansive people are continually on the front end of government protection rollbacks and harmful legislative decisions that fail us, but Black feminisms help us get free! Black reproductive justice organizers will continue to follow in the steps of Black feminists by connecting Black people to the resources and information necessary to take power over their reproductive choices. This Abortion Is Freedom Action Toolkit includes resources that center Black feminist power and abortion access. The Abortion is Freedom Action Kit is a powerful tool for taking action in cities across the country.
This guide is designed to educate and provide practical tools for law enforcement, defense attorneys, child welfare workers, healthcare providers, medical examiners, and legislators to stop the criminalization of pregnancy.
Globally, people self-manage their medication abortions without clinical assistance. Feminist activist collectives (accompaniment groups) support people through self-managed abortion with evidence-based guidance. We sought to understand the impact of COVID-19 and related restrictions on the need for and experiences of self-managed abortion with accompaniment support across varied legal and social contexts. Between May and October 2020, we conducted in-depth interviews with individuals who self-managed abortions with support from accompaniment groups during the pandemic in Argentina, Indonesia, Nigeria, and Venezuela. We conducted a thematic analysis to understand the impact of COVID-19 on participants’ experiences with accompanied self-managed abortions. Across 43 in-depth interviews, participants in all four countries described how the COVID-19 pandemic created challenges at each step of their abortion process, from confirming the pregnancy, accessing abortion pills, finding a private, comfortable place, and verifying abortion completion. For most people, conditions related to the pandemic made it harder to self-manage an abortion; for a minority, being at home made aspects of the experience somewhat easier. Nonetheless, all participants reported feeling supported by accompaniment groups, and COVID-19 and related lockdowns reinforced their preference for accompaniment-supported self-managed abortion. These findings highlight the essential role that accompaniment groups play in ensuring access to high-quality abortion care in a multiplicity of settings, particularly during the COVID-19 pandemic. Efforts are needed to expand the reach of accompaniment groups to increase access to the high-quality abortion support they provide, filling a critical gap left by health systems and legal infrastructure.
Excessive regulation under state law has made it increasingly difficult for Americans to get a legal abortion. State lawmakers passed more than 100 restrictions on abortion in 2021, more than any previous year.1 Meanwhile, the Supreme Court shifted rightward with the appointment of three justices during the Trump administration, threatening constitutional protection for abortion and setting a course for state-level abortion bans. In light of these developments and new research, we revisit the groundbreaking research article “Demand for Self-Managed Medication Abortion Through an Online Telemedicine Service in the United States”2 and comment on its significance and implications since publication. This study by Aiken et al. examined the demand for remote medication abortion (a regimen consisting of mifepristone and misoprostol pills) among US residents in 2017 through 2018 and assessed variation in barriers to clinical abortion care by state policy context (hostile vs supportive). Metrics collected by AJPH demonstrated that this study garnered much attention from AJPH readers and the media (https://bit.ly/3kKAG0I). The article presented a model of abortion care that sidestepped long-standing barriers to clinical abortion care and presented evidence of a strong interest in and need for this model among US residents. The salience of the study has grown as the proportion of Americans who use medications to end their pregnancies has increased and as state-level legal barriers to abortion access have proliferated, with outright bans expected within months.3 The ongoing COVID-19 pandemic has also increased demand for at-home medication abortion because of concerns about the risk of contracting COVID-19 in a clinic or in transit; this has added to long-standing barriers to access for clinic-based abortion care, including long distances to the nearest clinic, arranging care for dependents, and more.4 Aiken et al. note the effect of abortion restrictions on increasing demand for at-home medication abortion and offer a preview into the future of abortion seeking for the growing number of Americans who will be legally unable to obtain abortion in a clinical setting.