“The one that has an abortion is treated as…as bad, as a killer and…the other one is…is a good woman, she has a good heart, she loves children.”
Sound familiar? The quote comes from a woman from the Copperbelt Province in Zambia during focus group interviews with Ipas, but it could be anywhere in the world. Let’s face it: individuals who have had abortions or provide them are too often labeled, discriminated against and dehumanized.
This stigma surrounding abortion and anyone associated with it — women, providers, pharmacists and advocates — contributes toits social, medical and legal marginalization. And this marginalization can keep women from getting the health care they need.
Abortion stigma is never just about abortion but plays out and attaches to different social issues and debates. In the United States, abortion has become a lynchpin in our political debates and cultural wars – and the sentiment has spread to other countries. Ipas’s research in Zambia shows that women in certain communities who terminate their pregnancies are forced to go through a public cleansing process as a form of punishment for not carrying a pregnancy to term.
“In a village setting, when a girl aborts she is supposed to be confined in a house for at least one month. She is also not allowed to touch certain things in the house or go to the stream to fetch for water as well because it is believed that she may cause people to get sick because of the spirit of abortion she bears. The headman would then assign people to go talk to this girl that she needs to be cleansed first before she can begin to mix with people again because she may bring some diseases on people.”
Abortion stigma is difficult to isolate because it is produced and reproduced across different levels, including individual, community, organizational and legal, and is played out through private and public discourse, including the media. Women who need abortions face stigma and may even perpetuate it, as do providers of abortion services. Entire communities have developed ways of separating, sterotyping and discriminating against women who need abortions. Legal frameworks create categories of “acceptable” and “unacceptable” abortions and reward privilege to those women who obtain early abortions. And abortions have been separated from comprehensive reproductive health-care services and from insurance programs, as well as totally dissociated from family planning.
Our current research shows that abortion stigma translates into internalized stigma, fear of disclosure and shame, difficulty finding information and services, and fear of the health system. Stigma creates barriers to open and frank discussion about abortion and to women using services. It leads to the notion that abortions are rare, when they are not. The cost of ignoring stigma and not finding strategies to address it is potentially huge—even a matter of life and death. In many of the countires where Ipas works in the global south, when women feel shame about abortion and can’t access accurate information, they often delay care or turn to untrained, unsafe providers, increasing the likelihood for complications and injuries, even death.
To better understand the manifestations of abortion stigma, Ipas conducted focus group interviews in Ghana and Zambia. Stigma is manifested in different ways – some of which we anticipated in terms of the labeling but others we didn’t. In Ghana and Zambia, for example, interviewees illustrated how abortion stigma is acted out the community level and how it influences attitudes toward women, as well as providers.
While abortions are quite common in both countries, labeling and stereotyping of women who need abortions, and assumptions about their sexual lives, surfaced in various ways:
“Women who have abortions are prostitutes. She is just a nuisance, a whore who has a devil heart.” (married woman, Zambia)
“A woman who has an abortion probably had sex with lots of men. She doesn’t even know who the father is.” (single woman, Zambia)
Stigma fuels the humiliation and exclusion of women by their communities. In some communities women who abort can be excluded from community life.
“We can eat and do other things together but when she is going somewhere we will not go with her,” said a Ghanaian participant about a woman who had an abortion.
Young women, and those who are unmarried are particularly vulnerable to scrutiny.
“When students know that another female student has induced an abortion, the students, especially the boys will organize a funeral ceremony for the aborted child. They will make a coffin for that child, organize a mourning ceremony during which they will cry, roll on the ground just to humiliate the girl. Girls are not always left out in this practice. Once the boys start, the girls too follow,” reported an interviewee in Lusaka, Zambia.
These responses have helped us to identify root causes of abortion stigma and to better understand social norms related to abortion, however much more needs to be done. While we know that stigma exists, we need more information, analysis and data to understand it quantitatively and qualitatively and develop interventions to reduce it. This process will also help us understand our own role in creating and perpetuating it. The pro-choice community has even played a role: when we legitimize some abortions—early versus late or those that don’t need public funding versus those that do—we collectively stigmatize abortion.
While abortion stigma may seem inherent or insurmountable, in fact it is not. This, perhaps, is the most empowering thing we can understand as advocates. Abortion stigma is a social construct used to control women and abortion providers, and it’s a way that we punish women who deviate from social norms for what a woman should be. One of the first steps is to recognize it, own it and discuss it. And then let’s deconstruct what we’ve learned, what people believe to be true and create something different.
This series of blogs is an important step forward in that direction. We’d like to thank our partners Gender Across Borders and RH Reality Check for spondering the series and fostering a place for dialogue, and the many contributors who shared their stories with us to make this discussion possible. Together let’s aspire toward a world where the rights of all women and health professional are upheld, fully and without exception.
Leila Hessini is Director of Community Engagement and Mobilization at Ipas and Board Chair of the Global Fund for Women. Leila has worked to oppose the control and exploitation of women’s bodies through sexuality, reproduction and labor for 20 years. Of Algerian descent, Leila has lived and worked extensively with women’s networks and community-based organizations in Europe, Africa and the United States. This post is adapted from an article appearing in the Fall 2011 issue of Because, the Ipas magazine that connects U.S. readers to women around the world, highlighting reproductive health and rights and making connections between U.S. policy and global health. For a free subscription to Because, click here.