Addressing abortion stigma through service delivery: A white paper

The purpose of this paper is to provide a context and background for our work to address abortion stigma through service delivery. Abortion stigma is a major barrier to adequate reproductive health care for women and a primary challenge for service delivery providers to address. Stigma contributes to legal restrictions on abortion that are accompanied by criminal penalties directed at women and abortion providers. In addition to the legal barriers, stigma shames and silences women who seek abortion services, marginalizes abortion providers, and contributes to myths and misperceptions about abortion in communities.

Abortion stigma appears in many parts of the world, though it manifests differently according to law, culture, and religion. It is within these stigmatizing environments that organizations, communities, and individuals are engaged in innovative service-delivery programs to bring safe abortion services to women. Dedicated people, sometimes in incredibly difficult circumstances, conduct these programs. This paper aims to highlight what we currently know about how clinical and community-based interventions do or could address abortion stigma at various levels both directly and indirectly and how a select group of service delivery providers understand stigma in their work.

So what is abortion stigma? In this paper we draw on the following definition: Abortion stigma can be defined as a shared understanding that abortion is morally wrong and/or socially unacceptable. The stigma of abortion manifests within multiple levels, including media, law and policy, institutions, communities, relationships, and individuals. Abortion stigma is experienced through a) negative attitudes, affect, and behaviors related to abortion and b) inferior status experienced by women who seek abortions or who have abortions, abortion providers, and others involved in abortion care. Abortion stigma leads to the social, medical, and legal marginalization of abortion care around the world and is a barrier to access to high quality, safe abortion care.

The first part of this paper discusses the definition of abortion stigma and reviews the existing literature around abortion stigma and interventions that address stigma. We also include social stigma literature from other fields such as HIV and mental health in order to develop a deeper understanding of measurement and programs that have contributed to reducing stigma. The second part of the paper presents the opinions, experiences, and programs of reproductive health care service-delivery organizations. The themes in this section emerged from key informant interviews with directors and staff of organizations that provide reproductive health care services in sub-Saharan Africa and Latin America.

The final section provides recommendations for increasing and expanding programs to address abortion stigma.

We envision this paper as a document that can and should change over time. We list a set of open-ended questions at the end of each section and ask that readers communicate with us and with one another to improve our collective knowledge on how to dismantle abortion stigma.