How to End Abortion Stigma Without Throwing Your Teammate under the Bus


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.

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  • ahunt

    Lots to digest. Thank you for this.

  • kate-ranieri

    Thanks for your insights. I also encourage others to read the Kumar, et al, article because it helps us understand how concepts are often socially constructed, not necessarily natural. I particularly found this article helpful for my college students who are naive about reproductive rights issues. The authors hypothesis about abortion as a transgression against three cherished feminine ideals (perpetual fecundity, the inevitability of motherhood, and instinctive nurturing) was especially enlightening for them.

  • stacey-burns

    While I don’t presume to speak for her, I believe this is a misreading of Steph Herold’s intent. In providing a forum–Twitter–for women to publicly share their abortion experiences, she was simply inviting those who are comfortable with disclosure, in the hopes that others would get a glimpse at the commonality of the experience. A social media campaign is not a substitute for private discussion and doesn’t preclude it. These opportunities can and should exist simultaneously. And neither is a substitute for the real social change that needs to occur before stigma can be lifted.

     

    Clearly, not everyone has the luxury of public disclosure: the teen whose peers would shame her or parents abuse her, the married woman having an affair with a co-worker, the mother of five who simply has no time for or interest in discussion, the woman still grieving after her wrenching decision to terminate a wanted pregnancy that would never come to term. Some of these women might be able to share the fact of their abortions one day. Some might not.  But Herold doesn’t direct her frustration with abortion stigma towards people who have had abortions–she is merely suggesting that those who do have the luxury should feel welcome to come forth, and that others might see their own reflection in their stories. Even the stories expressed in just 140 characters.

  • stephh

    Thanks for writing this piece, Kate! Stacy is right, though — I don’t expect women to sacrifice their privacy and tell their abortion stories (whether on twitter or at a rally) if they feel uncomfortable or unsafe doing so.  I think women need a diversity of places to be able to share their stories if they so choose, public forums like twitter AND private forums, as Aspen suggests. I don’t think there can be a one size fits all abortion story sharing model, since every woman experiences abortion differently.  I do think we need to connect the dots between the safety and valuing of abortion providers and women who’ve accessed these services speaking out in support of providers.

     

    I don’t think it’s productive to categorize us as on different teams – I don’t want to stigmatize those who are on “team choice” versus “team voice,” as you put it. We’re all working together towards the same end, even if we have slightly different means of getting there. Aspen and I have a mutually respectful relationship and, while I can’t speak for her, I don’t think she would consider us on different “teams” either. 

  • freewomyn

    I don’t think this is an either/or discussion.  We need both strategies in order to eliminate abortion stigma.  And I know Steph has already clarified her position, but I think you unfairly characterized the #ihadanabortion campaign.  No one has to tweet #ihadanabortion if they don’t want to – it’s not a public outing campaign.

  • aspen-baker

    Kate, as always, I appreciate your indepth analysis and insights.  My hope is that all of us that care about the wellbeing of women who have had abortions and who want to reduce stigma can role model respectful public disagreement with one another.  I’m less interested in getting us all doing the same things at the same time in the same ways, and most excited by a thoughtful exchange of ideas and open sharing of new information that helps us grow our understanding about all the many, possible ways to move forward.  Sometimes conflict and disagreement are a healthy, active part of a learning process.  And, with conflict we must work extra hard to be respectful of one another and set groundrules and guidelines for how to be in disagreement together.  I look forward to hearing your ideas about how we can continue to respectfully disagree as we all move forward with our strategies to reduce stigma and promote the wellbeing of women. 

  • forced-birth-rape

    Aspen cute name.

  • kate2

    I’m glad to see these comments!

    I had several purposes in writing this piece. The first to explore how stigma can be a different experience for providers than for patients.  The second, to explore how different experiences can lead to different strategies for change. Finally, I wanted to express my observation that these different strategies can bring up certain conflicts within the prochoice movement.

    Aspen, I think that disagreeing on how to approach stigma is certainly okay. And given your different backgrounds I would say that it is inevitable. And I think the way you discussed your perspectives in the Nation piece was very respectful. But I think there are missed opportunities here that would be better met if those who were focused on reducing stigma around abortion worked together at least some of the time.

    Here’s an example. What if, Herold’s twitter feed had linked those who disclosed their abortions publicly to Baker’s online community?  Then women would have the option of self-disclosure AND the possibility of an understanding community to discuss these experiences privately. 

    Stephanie, I was not trying to place you and Aspen on “separate teams” but rather characterized you as on the same team with different approaches to addressing stigma. Approaches that sometimes feel in conflict with one another.

    In your remarks in the nation you said “I really appreciate a poem called Poem to 45 Million Women, which is told from the perspective of an abortion provider.”

    Reading this poem, I felt a real need coming from the provider. Maybe the need could be characterized as “I feel unsupported right now…and I wish I had someone who supported me.”  It makes me wonder, are we (the prochoice community) doing all we can to ensure that providers feel support?  What kinds of support are the most sustaining? When do providers feel the “most” unsupported? Who is in the best position to provide that support?

    In the poem, the women who have abortions are given primary responsibility for meeting that need through “coming out.” I would suggest that this is not always appropriate precisely because many women are dealing with their own form of stigma. And it also ignores the fact that support for providers can come from other sources including providers, family members, mental health or counseling professionals or clergy.

    When I hear the statement “More women need to come out about their abortions”… especially when it comes from an abortion provider…I sometimes wonder if what they are really saying is “I feel unsupported right now.”

  • pegjohnston

    In dealing with stigma, it’s good to tease out the various threads in our discourse and even better to do it in a forum where the players and the community can clarify, refine, and agree!  Let’s remember though that the media, even movement media like The Nation have a stake in conflict–it is their modus operandi to reduce things to two sides and find the conflict. The mainstream media will never do a story about one side without a comment by the other, even “our own” Rachel Maddow. Why?

    It seems patently obvious that some women are comfortable and brave enough to tweet about something as personal as an abortion (though I would love to talk more with them about how people reacted to them) and that some need to work it through in a safe supportive space. Not that one “team” is braver than the other– they both clearly are in different ways, but perhaps the tweet team has had more support personally, or it was just not such a gut wrenching decision for them. Our goals, as Kate is pointing out, are multiple–breaking the public silence, exploring abortion experiences and our reactions to them in depth, keeping it legal, and supporting providers, pro choice activists, women, and everyone else. All require different strategies. All are challenging stigma. It’s a good thing.

    http://www.abortionconversation.org

  • aspen-baker

    Kate,

     

    I have to point out that the Exhale Online Community 1) it is not “my” community and; 2) the decision about whether the community goes public in the way you recommend (by linking to the #ihadanabortion campaign) is not, in fact, my decision to make.  The thing is – it is an actual community by and for women who have had abortions – and this means that I am just one member out of hundreds.  I don’t make decisions for the group. Our members determine the content, drive the discussion and decide what public campaigns, if any, to participate in.  If I made the kind of decision you are suggesting, I would destroy the very thing that I am passionate about building – a social movement driven by the diverse voices and experiences of women who have had abortions.  My job as the Executive Director of Exhale is not to tell other women who have had abortions what to feel, what to say or what to do, but to facilitate supportive connections that create an environment where every member feels confident making decisions for herself, and as members of a larger community.  The support and respect we need as women who have had abortions doesn’t stop at our emotional experience, it extends to how we choose to express our feelings, who we chose to express them to, and in what forums we prefer to share. It is difficult to take your hard knocks and public criticism as the only public member of our online community, but I feel confident knowing that I am staying true to the values and principles that guide Exhale and our growing pro-voice movement.  Being part of a supportive community that understands this challenge helps too.

  • alice-s

    Kate, I appreciate your taking on this issue!  However, I have to say that I found myself disagreeing with you from the start – while there are a number of different takes on how to reduce the stigma around abortion, I don’t see them as necessarily being in conflict.  Even when we as individuals embrace or prioritize one avenue over another, I haven’t (personally) seen anyone taking a ‘my way or the highway’ stance , and I don’t think that advocating one approach over another constitutes throwing someone under the bus.

    As a person who’s been involved with Exhale for a number of years, though, I’m definitely a fan of looking at things through a both/and lens.  Being pro-voice for me means listening and supporting people through their experiences with abortion, whatever they are.  As someone who also volunteers at an abortion clinic and who works on the administrative side of reproductive health services, I’ve had my own interactions with abortion, politics and protestors that bring up additional issues.  All of those roles are a part of my everyday reality, but none of them have to ‘win’ over the others.

    Given the variety of needs that many of us have around the current politics of abortion, I embrace having a multitude of approaches. 

  • kate2

    Alice, I appreciate your comment. It seems that you and many of the commenters think that I over-emphasized the conflict in Aspen Baker’s and Steph Herold’s positions on how to approach abortion stigma.  I can appreciate this point. Creating conflict (where it does not already exist) was not my intention in writing in response to the Nation piece. 

    When I read the piece in Nation, I did see conflict in Aspen Baker and Steph Herold’s position on how to approach stigma.  But I have also seen conflicts over how to approach stigma in my research and my interactions with many other people in the movement. One of the things I apprecated about The Nation piece was that it brought this tension and conflict into the light…so that we could talk about it.

    I agree that no strategy has to ‘win’ over another. But I think that recognizing that there are at least two victims of stigma (providers and patients) who have different needs is imperative for building strategies that can promote the well-being of both. Which I think is possible.

    Here’s what I hope will happen. I hope that more people will hear Steph and Aspen’s words in the Nation and see that stigma is a real problem for providers and patients alike.  I hope they will see and appreciate the unique experiences that patients and providers have related to stigma.  I hope that providers (like the one quoted in Steph’s interview) will feel heard and valued for their work. I hope that the women who have abortions will find the validation and connection they need, in whatever form they choose. My final hope is that advocates who claim reducing abortion stigma as their goal will listen to each other, engage with each other and find ways to work together.  They have a common enemy.

     

  • susan-l

    As an Exhale Online Community Moderator, I see that women come to the community to process their own experiences, to explore and learn from their abortions while in conversation with others who are doing the same. This is (often)a different step- or stage-than the one in which she speaks out about her abortion or stands up for her right to have an abortion. Allowing private space helps end stigma because women who need privacy have a quiet matrix in which to consider their experience and those of others. And, as/if they determine,they ask questions and comment about society, beliefs and reproductive rights. Private space will then lead some of these women to more public voicing which ends stigma on a more global basis, promoting the well-being of all women. 

     

     

  • alice-s

    Thanks for your response, Kate!

    I agree that listening to each other and engaging is key – it’s often easy to get entrenched in one approach, and to then feel like we’re disparate groups, rather than members of a coalition.  As someone who works on patient advocacy and provider advocacy (to borrow your phrasing), I can get blinded to the fact that not everyone sees the challenges for those two groups as being as intermingled as I do!

    Working with multiple constituencies and multiple types of stigma makes it even tricker.  Recognizing that we’re all working towards the same goal – a society where abortions are seen as a normal medical procedure – can be harder when we’ve got a multitude of approaches, but I think that’s the only way we can accomplish the changes we want to see.