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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.

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.

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.

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Comment Preferences

  •  Do not even try to put unearned guilt on me. (4+ / 0-)
    Recommended by:
    OldDragon, martydd, Odysseus, Neon Mama

    I am not reccing or tipping your diary because you did try to do that. I am not at all guilty of stigmatizing women who get abortions.

    Here is my position and you can go and stick it.  

    Wherein I End the Abortion Debate

    There is nothing to 'debate.'

    My ova, my fetuses, my children and my sexual organs are mine. They are not YOURS. They are not the State's. My sexual life is private and not subject to public or religious review.

    My sexuality is private. Why would anyone presume to discuss it with me? Or follow me down the street trying to give me a baby blanket or wave a sign in my face. Simple. They are getting off.

    A fact of women's lives, from the moment they get close to puberty and sometimes before, is that somebody is always trying to rub up against you. I am drawing a line in the sand. No discussion. My sexuality is private. Mind your own business. That is a truly American value.

     Anyone who performs some action on my life/body to resolve or relieve their own desires or discomfort without request or consent from me is a rapist. That is the definition of rape.

    I include in the set (rapists) those who describe themselves as 'prochoice' whose benevolence includes acting economically and morally to 'make abortion rare.' Bugger off. You are all intrusive, annoying, and perverted in your focus. Mind your own sex organs. I do not want you thinking about or doing anything about mine.

    I want the Democratic Party to live up to the party platform and defend and provide for the welfare of women by unequivocally supporting safe and legal medical abortion and contraception. I am encouraged by some signs that Democrats will do so. Or if you cannot stand Democrats, vote Green or Socialist or Independent. But Vote.

    Governments only responsibility is to teach human biology to those in public schools. When the Government has the Stones to do that, at the least, then we can talk. The European countries have lower teen pregnancy rates and lower rates of infant/mother mortality because they teach human biology to their children. And they provide universal health care.

    I make no bones about it. My issue is Women's Health and Freedom. You could be the best thing since sliced bread on all the issues, but mess with Roe v. Wade and abortion access and your ass is mine. Figuratively speaking of course. I am no slimy terrorist.

    I used to be Snow White. And then I drifted. - Mae West

    by CherryTheTart on Tue Oct 23, 2012 at 12:29:12 PM PDT

  •  I have more to say. (0+ / 0-)

    Do you know where you are? Do you have any idea who you are talking to?

    I get a personal apology from you or you will never get another read or any donations from me, not ever.

    If I can do without Walmart, I can do without you.

    I used to be Snow White. And then I drifted. - Mae West

    by CherryTheTart on Tue Oct 23, 2012 at 12:35:25 PM PDT

    •  LOl wow. (3+ / 0-)
      Recommended by:
      jennylind, alain2112, Neuroptimalian

      yeah, nothing batshit crazy about demanding apologies for imaginary slights at all.

      •  Well, the article did state: (1+ / 0-)
        Recommended by:
        CherryTheTart

        "We're all guilty of stigmatizing women who seek abortions."

        That's a gross generalization, but I think it would be fair to say that way too many people -- even many of those who consider themselves strongly pro-choice -- do stigmatize women who seek abortions.

        I wish the search function was working here, because there was a diary from a few years ago that shocked me. Planned Parenthood had launched a campaign with the slogan (and I hope I'm remembering the exact wording) "I had an abortion".  One part of it was a diverse array of women wearing "I had an abortion" t-shirts.  To my surprise, many of the comments here were critical of the approach, saying that it trivialized abortion, or that the women looked too "proud of themselves", and that we should never promote the notion that abortion is somehow a good thing. It should always be treated as a necessary evil, and no woman should ever choose one without experiencing the requisite soul-searching, agonizing, and life-long uncertainty.

        It wasn't the kind of reaction I expected to read here, and I think it's that sort of thing the diary meant to address.

      •  I am batshit crazy at times. (0+ / 0-)

        I do not have a problem with it. You do.  

        Why would you make my "problem" your problem?

        Do not fix me, Sorca. I am not broken.

        I used to be Snow White. And then I drifted. - Mae West

        by CherryTheTart on Tue Oct 23, 2012 at 04:38:18 PM PDT

        [ Parent ]

  •  Abortion is self defense. (0+ / 0-)

    If they were really "pro-life" they wouldn't fund bombs.

    De fund + de bunk = de EXIT--->>>>>

    by Neon Mama on Tue Oct 23, 2012 at 04:23:33 PM PDT

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