Worldwide, roughly 43 million women have an abortion each year. Yet these same women face stigma, a form of social control used to dehumanize, devalue, and isolate them. Providers are grappling with effective ways to reduce abortion stigma.
Last week, I attended the annual International Federation of Gynecology and Obstetricsconference 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."
But there are ways to change the norm. In Mexico City, says Dr. Patricio Sanhueza, they've taken steps to de-stigmatize abortion services by making clinics open and bright, without overt heavy security. "Understanding the story of the woman in the providers' minds has created less prejudice," he adds.
Kelly Culwell of International Planned Parenthood Federation says in their work they're taking cues from clinics treating HIV clients and working to change provider-client interactions. "We are planning to have signs and statements that support women -- that say 'stigma-free services.'"
Part of breaking the stigma is removing the silence and we are doing it loudly and clearly. By talking about abortion stigma we can recognize how it is created and perpetuated and what our individual roles and responsibilities are in working toward stigma-free language, concepts, and services. At Ipas, we've developed a stigma scale to measure stigmatizing attitudes, beliefs, and actions at individual and community levels, and to evaluate stigma reduction interventions. We've already collected data from Ghana and Zambia and will develop interventions based on the findings and we'll do more interviews and investigations using the scale in India, Mexico, Kenya, and Uganda.
Fighting stigma is a daunting challenge -- but the first battle is to start at home. We're all guilty of stigmatizing women who seek abortions. Advocates must continue to change the narrative around abortion: Women are the center. They should have the power and the right to make their own decisions and to not be judged -- by society, by their communities, by the health system, nor by us.