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An Abortion Story Both Radical and Ordinary

1:52 pm in Uncategorized by RH Reality Check

Written by Cynthia R. Greenlee for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Groom & Bride Wedding Decorations

An abortion on the road to wedded bliss.

For more than 20 years, the New York Times’ Vows column has shared newly hitched couples’ idiosyncratic paths to marriage. Vows has followed Wall Street wunderkinds down the aisle as well as a flame-throwing bride, a couple who admitted they fell in love while meeting at their children’s pre-K class (and while married to other people), and countless stories about partners whose first meetings did not foreshadow connubial bliss.

In a September 1 Vows column titled “Taking Their Very Sweet Time,” the paper profiled a couple who talked openly about their shared abortion experience. It’s an atypical abortion mention for the Times, where coverage is more likely to focus on state-level efforts to restrict the procedure. And, indeed, it would be rare in most newspapers, where formulaic wedding announcements often contain little more than references to wedding fashion and family trees.

At first glance, the wedding announcement of 32-year-old stay-at-home mom Faith Rein and 33-year-old Miami Heat basketball player Udonis Haslem fits the mold of many Vows columns: a meeting in college, stumbling blocks, and an extended courtship. Athletics helped them bond despite the differences in her suburban upbringing and Haslem’s hardscrabble Miami childhood; she ran track at the University of Florida, while Haslem was a Gators basketball standout.

But in the column written by Linda Marx, Rein and Haslem described the unplanned pregnancy that threatened to derail her junior year, his NBA draft plans, and their educations. Haslem was already a father and said that while “I am not a huge fan of abortion,” they had sports careers to think about and very little money to start a family together. Haslem’s support of Rein solidified their bond. Rein said, “I saw another side of him during that difficult time and fell deeply in love. He had a big heart and was the whole package.”

The announcement’s matter-of-fact tone and the couple’s understanding of their abortion as just one important event in their relationship makes the article remarkable, says Tracy Weitz, a public health professor and director of the University of California, San Francisco’s Advancing New Standards in Reproductive Health (ANSIRH) research group and think tank.

“From my perspective, what is amazing about this story is that the abortion is not the beginning or end of the story—the way we usually tell abortion stories,” she said.

The usual abortion story often unfolds in this way, according to Weitz: “Here’s a woman in crisis. She doesn’t get the abortion or she does. Either way, her whole life trajectory is determined by this one event. Maybe she’s 21 weeks’ [pregnant] and there’s a fetal anomaly, and it’s a terrible situation. The story isn’t actually about the woman, it’s about the abortion.” The Vows article, by contrast “was really about the couple. Part of their story was about the abortion, part was about professional athletics, and part of it was about their class differences.” It reflected the totality of their lives and not just a single moment.

As extraordinary as the inclusion of abortion in a wedding announcement is, the Times article is just one of many abortion stories to be publicized. For example, the Oakland, California-based group Exhale addresses the emotional well-being of men and women after abortion and sponsors abortion “storyteller” tours. Films like I Had an Abortion to initiatives such as the Abortion Conversation Project have all tried to open a broader, more constructive conversation about abortion in small, intimate groups or larger public venues.

The New York Times itself has weighed in on the public sharing abortion of stories. In June, its Room for Debate series offered different perspectives—from, among others, an artist who integrates her abortion experience into her performances and an Anglicans for Life representative—about whether or how women should share their abortion stories.

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Evidence-Based Advocacy: How Do Abortion Providers Experience Stigma?

1:59 pm in Uncategorized by RH Reality Check

Written by Steph Herold for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Evidence-Based Advocacy is a monthly column seeking to bridge the gap between the research and activist communities by profiling provocative new abortion research that activists may not otherwise be able to access.

DC Anti-abortion protest banner reads: 3500 Americans Aborted Daily

In today's culture, abortion providers face considerable stigma. Researchers at the University of Michigan study ways to mitigate its effects.

Ask anyone to tell you who’s doing the most innovative research on abortion provider stigma and they’€™ll tell you it’€™s Dr. Lisa Harris and her interdisciplinary team at the University of Michigan. Together they pioneered the Provider Share Workshop, a pilot project testing the possibility that a support group for abortion providers could help reduce the negative impact of stigma. She writes about topics that others in even the most pro-choice communities shy away from €”the need to have open and honest conversations about second trimester abortion provision, how stigma affects abortion complications, and, recently, the need to recognize conscience as a motivating factor in abortion provision. Now, Dr. Harris and her team, which includes social worker Jane Hassinger, and public health PhDs Michelle Debbink and Lisa Martin, have gone a step further and actually mapped out how abortion providers experience abortion stigma, coining a new term: the legitimacy paradox.

Based on their interviews with abortion clinic staff who participated in the Provider Share Workshop, Dr. Harris and her team theorize that the combination of stigma and silence perpetuate a vicious cycle:

When abortion providers do not disclose their work in everyday encounters, their silence perpetuates a stereotype that abortion work is unusual or deviant, or that legitimate, mainstream doctors do not perform abortions. This contributes to marginalization of abortion providers within medicine and the ongoing targeting of providers for harassment and violence. This reinforces the reluctance to disclose abortion work, and the cycle continues.

The marginalization of abortion providers within medicine and society at large is not a new issue. In fact, as Dr. Harris and others have written, negative portrayals of abortion providers go back at least two centuries in the United States. In the nineteenth century, the American Medical Association opposed abortion in part because non-physicians (such as midwives, osteopathic doctors, and others) were the majority of abortion providers at that time and took away valuable business from physicians. The AMA sought to criminalize abortion to push these competing practitioners out of business, and thus began the association of abortion provision with “deviance” from mainstream medicine.

As the women’€™s liberation movement made the case for safe and legal abortion in the mid-twentieth century, abortion providers were depicted as “back alley butchers.” This portrayal and the grotesque images associated with it communicated the very real dangers of illegal and unsafe abortion, but neglected that many thousands of safe illegal abortions that were provided by both clinicians and lay-people during this time. While the use of the “back alley butcher” imagery certainly helped to legalize abortion in the United States, Dr. Harris argues that it did so while further stigmatizing abortion providers.

To track how abortion providers experience stigma today, Dr. Harris’ team conducted a focus group with abortion clinic staff in a Midwestern abortion clinic. She documented that all abortion clinic staff, including clinicians, counselors, front desk workers, and others, feel the negative impacts of doing stigmatized work. Providers commented on encountering stigma in public discourse, such as in political rhetoric, from institutions, such as hospitals and churches, as well as in their every day relationships with family, friends, and even their patients. As a result of this stigma, providers often have to choose if and how to disclose their involvement in abortion provision, weighing the possibilities of relationship conflict and threats to their safety if they decide to disclose, or isolation and disconnection if they keep their work a secret.

What are the consequences of this stigma? One possibility is that it may contribute to violence and harassment of abortion providers. Dr. Harris and her team explain:

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Abortion Stigma Is Simply Discrimination: Here Is How We Get Rid of It

10:55 am in Uncategorized by RH Reality Check

Written by Leila Hessini for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

A downcast woman

Why do we shame women for abortions? (Photo: gogoloopie / Flickr)

Last week, I attended the annual International Federation of Gynecology and Obstetrics conference in Italy. During the five days I was there, nearly 500,000 women had abortions. Many of these women faced stigma, a mechanism of social control used to dehumanize and devalue women who need, or decide, to terminate pregnancies.

When we began to examine the social construct of abortion stigma several years ago, we found that very little had been published. And yet, it’s really the root of all barriers that women — and even providers — face to obtain or perform abortions.  Why do we legally deprive women of a health care service that could safe their lives? Why are women forced to undergo a waiting period in order to get an abortion? Why are abortion clinics often separate from other reproductive health care clinics? Why do women trade safety for secrecy and turn to “back-alley” providers? And the questions go on…

Stigma contributes to the idea that women who have abortions are not the norm, although they are. The social construct of abortion stigma creates an “us-versus-them” mentality — in spite of the fact that in the United States one in three women have abortions and a much higher share of all women globally terminate a pregnancy sometime during their reproductive lives, abortion is still constructed as something that is wrong, inappropriate, or deviant. Discriminating against women is therefore considered normal; 26 percent of women live in countries where abortion is legally restricted and many more live in places where they have to justify their abortion. If this isn’t discrimination, I don’t know what is.

“How can this decision be wrong?” asks Dr. Nozer Sheriar, a gynecologist in India. “How can any decision, choice or action taken by 43 million women each year around the world be wrong?” If all the women in the world who have had an abortion live together in one country, he points out, it would be the third most populous country in the world. Think about the level of discrimination against a group so large.

My colleague and fellow presenter at FIGO 2012, Tracy Weitz, has also spoken out about abortion stigma in the United States, arguing that even in the pro-choice community, we further the stigma by creating hierarchies of women — some who deserve an abortion, some who do not. And who gets to decide who can have an abortion? Doctors, institutions and policymakers do. We insist on talking about abortion with language such as “safe, legal and rare,” which reinforces the notion that abortion is wrong and abnormal. And even abortion providers and clinics — sometimes unknowingly — create an atmosphere that stigmatizes women. Some American women have shared that paying for their abortion felt “like a drug deal” and others say the security, while justified, made it “seem all the more like a shameful, secretive thing.”

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Evidence-Based Advocacy: Expanding Our Thinking About “Repeat” Abortions

4:13 pm in Uncategorized by RH Reality Check

Written by Steph Herold for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

 

Evidence-Based Advocacy is a bi-monthly column seeking to bridge the gap between the research and activist communities. It will profile provocative new abortion research that activists may not otherwise be able to access.

Poster: Break the Silence about abortions

Poster: Faviana Rodriguez / ihadanabortion.org

About 1.2 million abortions are performed in the United States every year, and of women seeking abortions, about half have had an abortion before. Women who have had more than one abortion are often targets of public-health interventions designed to increase women’s use of post-abortion contraception, or, to put it another way, to prevent them from having another abortion. Instead of seeing these women as “repeaters,” it’s time we viewed each abortion as a unique experience with its own set of complex circumstances.

Tracy Weitz and Katrina Kimport, sociologists with Advancing New Standards in Reproductive Health (ANSIRH), analyzed the interviews of ten women who’d had multiple abortions (full disclosure: I interned at ANSIRH this summer). Their research was part of several larger studies. The women interviewed varied in age, race, and geographic location, although most were from the Northeast or the West Coast. Together, they’d had a total of 35 abortions. Weitz and Kimport examined how these women thought about each abortion experience. Were they similar or different from each other? How did the circumstances of each abortion affect women’s emotional outcomes?

The researchers found that women talked about their abortions as separate events. Each abortion came with its own set of unique emotional and social circumstances, some more difficult or easy than others. In other words, a woman who’s had three abortions wasn’t repeating the same experience each time. Health interventions and policies that target women who have had more than one abortion should take into account that each abortion — and the circumstances of that pregnancy — may reflect a different emotional experience.

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Evidence-Based Advocacy: What Do Low-Income Women Think about Public Funding for Abortion?

10:18 am in Uncategorized by RH Reality Check

Written by Steph Herold for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Evidence-Based Advocacy is a bi-monthly column seeking to bridge the gap between the research and activist communities. It will profile provocative new abortion research activists may not otherwise be able to access. 

September 30th marks the anniversary of the Hyde Amendment, which prevents Medicaid coverage of abortion in most circumstances. When activists and advocates talk about Hyde, we discuss the injustice of health care denial, the importance of grassroots abortion funds, and the stories of people who’ve sacrificed rent, food, and monthly bills in order to pay for an abortion their insurance won’t cover. And rightly so—there’s no denying that the more we talk about the horrific ramifications of the Hyde Amendment and the more awareness we raise, the better. We know what we think about Hyde. But what do women who are on Medicaid, the very people who are most affected by Hyde, think about the restrictions it places on their insurance coverage?

Amanda Dennis of Ibis Reproductive Health interviewed 71 low-income women who had  abortions while living in Arizona, Florida, New York, and Oregon, states that represent those operating under Hyde’s restrictions and those that have pro-actively provided Medicaid coverage for abortion. These women ranged from 18 to 35 years old, most reported having some college education, and a majority of them had surgical, first trimester abortions within the past two years. All of them met their state’s Medicaid income qualifications.

Most of the women supported government funding for abortion care; in fact, 82 percent said that they support Medicaid coverage of abortion. When asked about whether funding should be available in specific circumstances, however, they wavered. The interviewees didn’t think abortion should be covered if a woman could not afford another child. Similarly, they didn’t think Medicaid should cover abortion if a woman was not in a relationship with the person with whom she had sex. These views held constant even for women who were themselves in these same circumstances when they had their abortions. For example, a majority of the women cited financial instability as the most salient factor in their personal abortion decision, yet when specifically asked if Medicaid should cover abortion as a result of not being able to afford another child, 40 percent said no. Similarly, women often used disparaging language to talk about people who seek abortions for reasons they don’t approve of, again, even if they themselves had abortions in those circumstances.

This seems contradictory: why would women who have abortions for financial reasons disapprove of Medicaid coverage of abortion for the exact same reason? Dennis and her colleagues points to abortion stigma, explaining:

“Women said that they did not support coverage in these circumstances because they felt coverage would promote ‘irresponsible’ behavior…these circumstances conjured images of irresponsible, promiscuous, and callous women, which participants sought to distance themselves from in order to view their own abortion decision as consistent with their moral values.”

Dennis and colleagues propose that abortion stigma operates differently for low-income women, as they are battling both abortion stigma and welfare stereotypes. The researchers note that the overlap between stereotypes of women who have abortions and women on welfare are notable—they’re both thought of as irresponsible, lazy, and promiscuous, the exact qualities from which the women in this study were trying to distance themselves. Indeed, the shame associated with welfare reflects an American view that holds individuals accountable for their own poverty rather than recognizing the systemic determinants of poverty and health.

The point of this research is not to suggest that we should keep Hyde in place because low-income women themselves don’t believe that Medicaid should cover abortion in every circumstance. A person’s character, whether upstanding or “irresponsible,” should not determine whether or not they receive insurance coverage. This particular study uncovers just how pervasive abortion stigma is, so much so that even women who need Medicaid to cover abortion because they can’t afford another child don’t believe women like them deserve to have this coverage. 

The Hyde Amendment has made it acceptable to debate whether different pregnancy circumstances merit abortion coverage. As we see in this particular study, parsing out who does and doesn’t deserve abortion coverage based on the circumstances of a pregnancy only further embeds stereotypes about people who seek abortions, especially among those who need access to these services (in this case, low-income women). Research like this demonstrates that our work on the Hyde amendment can’t just be at the policy level. Repealing Hyde is not enough—it does not undo the damage of stereotypes associated with people who have abortions. We must advocate for policy change coupled with culture change, in which we both repeal Hyde and challenge the multiple stigmas and stereotypes associated with those who need Medicaid coverage of abortion.

If you are interested in having your research profiled, leave your contact information in the comments section. 

Evidenced-Based Advocacy: (Mis)-Understanding Abortion Regret

11:09 am in Uncategorized by RH Reality Check

Written by Steph Herold for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Evidenced-Based Advocacy is a new bi-monthly column that aims to bridge the gap between the research and activist communities. It will profile provocative new abortion research that activists may not otherwise be able to access. 

“I Regret My Abortion:” we’ve all seen this infamous anti-choice sign, whether at a rally or outside a clinic. As pro-choice activists, our knee-jerk reaction may be to respond, whether aloud or in our own minds, with a reference to the plethora of research that suggests that relief, not regret, is the most commonly reported feeling after abortion.  Yet our knee-jerk reaction may be as stigmatizing as the anti-choice sign itself. When we rely on a relief/regret dichotomy, we leave little room for the complexity inherent in women’s reproductive lives.

Both the pro-choice and pro-life movements create simplistic narratives about women’s attachment to pregnancy. The pro-choice movement claims that women who have abortions do not experience regret afterwards because they form no attachment to their pregnancy, while conversely, the anti-choice movement claims that women always experience regret after an abortion because of an instantaneous bond with the pregnancy. 

The competing narratives of relief or regret alienate women who have more complicated relationships to their unwanted pregnancies. In her article “(Mis)Understanding Abortion Regret,” sociologist Katrina Kimport explores what makes some abortions more difficult emotional experiences than others (for a video abstract of her paper, see here).  She argues that instead of enforcing a relief/regret binary, we need to understand the emotional circumstances in which abortion decisions occur.

To explore what makes some abortions emotionally difficult for some women, Kimport draws on in-depth interviews with 21 women recruited through two separate secular post-abortion support talklines. She postulates that emotional difficulty related to abortion has at least three factors:

1. Social disapproval

Social disapproval encompasses stigma, personal beliefs about abortion, and expectations of certain emotional reactions. For some women, social disapproval takes the form of experiencing judgment about the abortion from friends or family. For other women, it means confronting their lack of grief about the abortion after expecting to feel sadness.

2. Romantic relationship loss

Women who fell into this category were predominantly experiencing grief over the loss of a relationship, not the loss of a pregnancy. This includes shifts in relationships, unsupportive partners, and break-ups (often as a result of the pregnancy, not the abortion). One participant elaborated on the significance of relationship loss, saying, “I don’t think abortion can be emotionally harmful. I think the people in a woman’s life who are not supportive of her can be emotionally harmful.”

 3. Emotional conflict between head and heart

Kimport defines this category as composed of women who “saw abortion as the logical choice in their current circumstances, but some significant part of them also wanted to continue the pregnancy.” This includes myriad circumstances, such as women who want to raise a child but know that they can’t realistically afford to parent, women who want to parent but not with their current partner, and even women with medical conditions that make a current pregnancy unsafe. Notably, there were no clear demographic patterns among women who fit this category, and belonging in this category often also experienced social disapproval and/or relationship loss, compounding their experience of emotional difficulty.

We know that most abortions are not emotionally difficult. So what can we learn from women who have emotional difficulty around abortion? Kimport’s goal is not to provide us with an exhaustive list of sources of emotional difficulty around abortion. Instead, she suggests a new framework that emphasizes focusing on a woman’s relationship to her pregnancy, allowing for complex, even conflicting feelings.

In our continuing efforts to speak about abortion experiences with authenticity, we need to move past a regret/relief dichotomy that debates the effects of abortion procedure. Instead, Kimport suggests ways of framing the issue that more expansively consider the woman’s experience, such as “some circumstances can make abortion emotionally difficult,” or, to put it more simply, some abortions are hard. Kimport’s study adds to the body of literature that asserts that it’s often not the abortion itself that causes emotional difficulty, but rather the circumstances surrounding the abortion.

It’s also important to note that emotional difficulty with abortion is not a reason to restrict abortion. Mandatory ultrasounds, waiting periods, TRAP laws, and other restrictions do nothing to improve the emotional experiences of women obtaining abortions — they do not make friends and family less judgmental, they do not improve relationships, and they do not help a woman overcome a head vs heart conflict.

Kimport’s article opens the door for a more nuanced discussion of supporting women who have abortions on their own terms. She also invites us to consider more complex questions: How can we change the feeling rules around abortion such that women don’t expect to feel grief afterwards?  How can we prepare women for the judgment they may face from friends, or from themselves? Kimport’s article provides more evidence that women need depoliticized support to process any complex feelings they may have after an abortion. It’s our job now to use her research to make that happen.

If you are interested in having your research profiled, leave your contact information in the comments section.