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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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Vaccinating Children Is a Social Responsibility We Can Not Afford To Shirk

10:47 am in Uncategorized by RH Reality Check


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

So, I am that mom on the playground, the one who—while happy to play with my kids— craves adult interaction and looks for opportunities to strike up conversations with other parents.  It’s actually pretty easy (presumably because other mothers find pushing a toddler on a swing as mind-numbingly dull as I often do). I comment on similarities between our kids, something mine is doing, or something hers just said and nine times out of ten we are deep in discussion about our lives and experiences with motherhood within five minutes.  We trade stories and advice about sleep training, breast feeding, potty training, discipline techniques, daycare, and pediatricians.

Of course, I always try to be careful not to be too opinionated during these conversations.  In my liberal New Jersey town, I can be almost certain that the random playground mom agrees with my politics but parenting issues are so much trickier.  I never know who is going to agree with my stance on sleep training (just turn the monitor off, the kid will stop crying eventually) and who will think I’m barbaric; who will agree with me that jarred food is really just as good as pureeing it yourself and who will think I’m lazy; or who will view the sleep fairy (the one who gave my daughter a present every morning that she slept in her own bed the year she was three) as a cute invention by a desperate mother and who will think I was just too wimpy to get bedtime right.  And, yes, before you say anything, the reason I fear the judgment of other parents is clearly because behind the smiling and nodding I’m judging them as well.

Still, in nearly all of these conversations—even if our parenting styles are radically different—we can find a common ground on which to bond and commiserate. There is one topic, however, that I just try to avoid—vaccines. A friend once described it as the third rail of parenthood.  Just don’t touch it.

While vaccines were once widely regarded as the medical miracles they are, today there is a large contingent of parents who distrust them and choose not to get their children vaccinated at all or pick and choose which vaccines they’re going to get and when.  Opposition to vaccinations began when British researcher Andrew Wakefield published a study in the Lancet suggesting a link between vaccines and autism. Over the next decade or so, study after study failed to replicate this link but distrust of vaccines grew anyway and celebrities like Jenny McCarthy publicly blamed vaccines for their children’s autism.  Unfortunately, this trend does not seem to have stopped even after information was released last year which showed that Wakefield fabricated his data. Read the rest of this entry →

From Tuskegee to Transparency: An Evolution in the Ethics and Accountability of Clinical Trials Involving Human Subjects

11:42 am in Uncategorized by RH Reality Check


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

People who participate in clinical trials take the enormous step of volunteering to test a product that may be useful and, sometimes, life-saving if it turns out to be effective. They play an irreplaceable role in research to prevent, treat, and sometimes cure illness – as well as to find other ways to improve people’s health and lives.

Trial participants make a profoundly personal contribution and accept potential medical, social, and personal risks on behalf of others. An ethical trial is one that eliminates or minimizes participants’ risks as much as possible, invests in making sure that participants understand clearly what they are volunteering for, and protects their rights at every step.

For example, without clinical trials, we would not have seen recent advances in antiretroviral drugs to treat HIV, long-acting contraceptive choices that allow women greater control over their use, or microbicides that may be able to protect women from HIV.

The United States government has rules to protect people who participate in federally-funded biomedical and behavioral research. The rules vary depending on which agency is supporting the research, but they all share a starting point known as the Common Rule, a set of regulations for all federally-funded research involving human participants, whether it is conducted inside or outside the U.S. Read the rest of this entry →

Michigan Ballot Initiative Could Transform State into Leader on Stem Cell Research

11:00 am in Uncategorized by RH Reality Check

Juvenile Diabetes. Cancer. Alzheimer’s. Parkinson’s Disease. Spinal Cord Injury. ALS (Lou Gehrig’s Disease). Auto-Immune Diseases. Rheumatoid Arthritis.

Your mother, your child, your brother, your friend, your grandparent, your aunt. You.

I was 14. They said I had Crohn’s Disease and they were without a reason for the illness, without a cure, without a real treatment.

Almost 15 years later, I’m missing my colon and rectum, among other miscellaneous parts and pieces. My body is a walking tribute to the skill of surgeons after 36 surgeries and almost 80 hospitalizations.

To stay alive and functioning in society, I require over $300 in ostomy supplies a month, not to mention the various treatments and medications that keep the other ‘peripheral’ conditions and illnesses at bay. I have a deep love-hate relationship with the insurance industry.

I’d like to have children some day, but I realize that if I’m even able to have children, which is unknown at this point because of my health, there’s a great risk of passing my disease on. Do I want to do that to my child?

Not a day doesn’t pass when I don’t realize how lucky I am to be alive, but I also understand that Read the rest of this entry →