As I read Stephanie Herold and Aspen Baker’s comments in the Nation regarding the recent trend toward tweeting abortion, I could not help thinking of reality television.  On reality TV, producers often create drama by creating a competition between two teams. At the end of the show, the losing team is forced to stand before a panel of judges and justify their actions over the course of episode. Where did the teamwork breakdown? Who wasn’t pulling their weight? More than in the actual competition, this is where the real drama of reality TV comes into play.  Within those losing teams, tensions between players are revealed to the judges as accusations fly about who threw who “under the bus.” Inevitably, someone on the team says, “I’m not here to make friends. I’m here to win.”

In a better world, reality TV would not exploit the tensions that come into play when any team faces the prospect of another loss. Instead, the producers would bring in experts in teambuilding and conflict resolution to help the various members’ air their grievances and listen to the other players making their cooperation more successful.  They would build the team up, instead of tearing it down. But this is not the world we live in.

In the reality show of abortion politics, the competing teams might be characterized as “Team Choice” and “Team Life” Each team has its own internal conflicts. For example, members of Team Life have argued bitterly over the merits of an incremental approach to policy change versus maintaining a hard line and advocating for sweeping changes. Team Choice is currently debating the nature of abortion stigma. Although most members of Team Choice (providers, advocates, women who have abortions) agree that abortion stigma negatively affects anyone involved in abortion, there is little agreement about who or what is to blame for stigma, what stigma feels like, and what needs to change to reduce stigma. 

Herold (a provider advocate) feels that patients often abandon Team Choice once their procedure is over leaving quality providers who care about the needs of women to fight the battle by themselves. Baker (a patient advocate) feels that women’s experiences and needs are ignored or misrepresented in order to secure political wins for Team Choice. Baker feels so unrepresented by Team Choice about this that she’s advocating for a new team named “Team Voice.” It is in their individual approaches to ending abortion stigma that these former team members feel “thrown under the bus.” If we don’t take some time to analyze the reasons behind the growing tension between advocates like Baker and Herold, I fear that each will miss important opportunities to defeat abortion stigma. A better way to move forward is to take a closer look at the nature of stigma and prejudice and how it can affect providers and patients differently.

According to psychologist Gregory Herek, “stigma constitutes shared knowledge about which attributes and categories are valued by society, which ones are denigrated, and how these valuations vary across situations.” (Herek, 2009)  Some folks are born into stigma and other stigmas are produced through lived experience.  Some people (like many providers) have stigmas which are known to others because they are visible or conspicuous in some other way. Other people (like many patients example) have to grapple with whether or not to reveal their stigmatizing characteristic to others.  All people are keenly aware of how their opportunities and their reputation are affected by the attitudes of those around them. Those people who have stigmas will look for ways to manage their identities so that their reputations and their opportunities are not damaged by the way other people perceive them.

Consider an abortion provider living in a so-called red state. Lately she’s been seeing 15-20 protestors every day and has been engaged in periodic legal battles with antiabortion advocates and legislators who work tirelessly to close her doors. Safety is also an issue; an abortion provider in an adjacent state was stalked and killed last year. After that, her sister begged her to stop providing abortions and do some other kind of work. However, she loves her work and prides herself on being a compassionate healthcare provider. She thinks women who have abortions have nothing to be ashamed of; her own mother had two abortions before it was legal.  However, when the pressure is on she does become irritated with women who don’t understand the lengths that she and her colleagues go to provide these services.  She believes that attitudes will change when women are willing to talk about their experiences with others.

Consider a woman living in the same state who has become pregnant by a man she knows from work. He already has two kids that he doesn’t take responsibility for.  When she told him about the pregnancy he denied his involvement and told her to take care of it herself. The mother of his other children has even gotten involved, calling her names and threatening to tell people about the affair. Drama! She’s appalled that she made the mistake of getting involved with him and is ashamed to ask for time off of work for her abortion. What if people knew? Walking through the 15-20 protestors and having to spread her legs for an intimate and uncomfortable procedure just adds insult to injury. The people in the clinic have been nice to her, but she is really looking forward to getting this over with and moving on with her life.

Given the pervasiveness of negative attitudes toward abortion, involvement in abortion in any way can negatively affect an individual’s reputation and opportunities. Involvement in abortion taints a person’s character and leaves her susceptible to stereotypes, discrimination, judgment and abuse.  The vignettes above illustrate how negative societal attitudes about abortion can contribute to personal experiences. They also highlight how stigma can be experienced in profoundly different ways depending on who you are, who you know, where you live, and how you are involved in abortion.

Because of her abortion work, the provider (who is apparently known to her community) endures legal and personal harassment. She receives mixed support from family members who desire her safety and believe she will benefit if she distances herself from such intense controversy. Despite these pressures, she’s never turned such stigma inward. To the contrary, she actually gets pride and pleasure from her work. But the pressures are so intense, she often finds herself looking for answers.  How can we show people that abortion is a normal part of reproductive care? If only they could see the women we see, hear their stories, then the stigma of abortion would end and we could do our work peacefully.

Because of her pregnancy, the woman has endured humiliation and rejection. Not only has her lover turned out to be a different man than she thought he was, he has also maligned her by suggesting the pregnancy belonged to someone else.  Moreover, she’s internalized his rejection by coming to believe that her involvement in the relationship reveals something negative about her own character. She should have known better! If people at work knew about the relationship and her abortion, her humiliation would just become more pronounced. It’s bad enough to believe that you are worth rejecting, imagine if others knew as well. The clinic experience, especially the protestors, contributes to her pain.  But she is willing to persevere with the promise that this entire sordid affair will be over soon.

Both of these composites are based on real life stories that I have heard as a researcher studying abortion.  One thing I appreciate in this work is how many people are interested in challenging and transforming abortion stigma. It seems that many people, women who have abortions, providers, and their allies, have noted that we need a change in our culture. The goals are clear. We need a culture that is characterized by less judgment and more understanding, that accepts that abortion is a part of normal reproductive experiences, that supports and protects abortion providers who labor tirelessly to keep abortion safe for women, that does not assign or expect an emotional toll associated with abortion, and that accepts and validates the diversity of women’s experiences.

However Herold and Baker (and many others) are not in agreement about the strategies that are necessary to meet the goal of culture change. Herold’s calls for political self-disclosure of abortion experience. Baker calls for more opportunities for private connection among women who have abortions. Each of these are valid strategies that stemming from personal experience with abortion stigma. Yet as more and more advocates engage in the effort to change the culture around abortion, they must also develop sensitivities to one another. Advocates like Herold can show more understanding about why most women do not speak publicly about their abortions and the risks that they take when they do speak out. Advocates like Baker can show more understanding of provider stigma and acknowledge the courage of their work. 

Some people experience abortion stigma as a battle, while others experience it as a broken heart.  The path to a stigma-free culture must be paved with open and direct communication by all of those affected by abortion stigma. I see the Nation piece as a good start to producing understanding and cooperation between these two members of Team Eliminate Abortion Stigma.  Advocates like Herold and Baker may not be here to make friends but they will need to make friends in order to collaboratively create a culture that is free of abortion stigma.

Herek, G. (2009). Sexual Stigma and Sexual Prejudice in the United States: A Conceptual Framework. In D. Hope (Ed.), Contemporary Perspectives on Lesbian, Gay, and Bisexual Identities. New York: Springer.

Kumar, A., Hessini, L., & Mitchell, E. M. (2009). Conceptualising abortion stigma. Cult Health Sex, 1.