Danielle Bessett

Abortion Stigma: A Reconceptualization of Constituents, Causes, and Consequences

Stigmatization is a deeply contextual, dynamic social process; stigma from abortion is the discrediting of individuals as a result of their association with abortion. Abortion stigma is under-researched and under-theorized, and the few existing studies focus only on women who have had abortions. We build on this work, drawing from the social science literature to describe three groups whom we posit are affected by abortion stigma: Women who have had abortions, individuals who work in facilities that provide abortion, and supporters of women who have had abortions, including partners, family, and friends, as well as abortion researchers and advocates. Although these groups are not homogeneous, some common experiences within the groups--and differences between the groups--help to illuminate how people manage abortion stigma and begin to reveal the roots of this stigma itself. We discuss five reasons why abortion is stigmatized, beginning with the rationale identified by Kumar, Hessini, and Mitchell: The violation of female ideals of sexuality and motherhood. We then suggest additional causes of abortion stigma, including attributing personhood to the fetus, legal restrictions, the idea that abortion is dirty or unhealthy, and the use of stigma as a tool for anti-abortion efforts. Although not exhaustive, these causes of abortion stigma illustrate how it is made manifest for affected groups. Understanding abortion stigma will inform strategies to reduce it, which has direct implications for improving access to care and better health for those whom stigma affects.

Out of Time and Out of Pocket: Experiences of Women Seeking State-Subsidized Insurance for Abortion Care in Massachusetts

BACKGROUND Massachusetts has implemented reforms aimed at providing universal health care coverage and covers abortion through subsidized state insurance programs. Three Massachusetts abortion funds evaluated their referral processes for low-income women from April to October 2010 to learn about womens experiences applying for subsidized insurance and to identify barriers to obtaining insurance or its use for abortion services. METHODS Follow-up interviews were conducted with 39 low-income women thought eligible for subsidized insurance at least 1 month after their initial contact with the funds. RESULTS Health insurance literacy was low, and participants reported confusion distinguishing between levels of subsidized insurance. The process of applying for subsidized insurance delayed a substantial proportion of procedures. More than two thirds of the women who applied for state coverage had become insured or expected to become insured shortly, but only one third of respondents who applied were able to secure insurance in time for their abortion care. Two women were unable to obtain abortions as a result of delays. Delays also limited low-income womens ability to obtain medication abortion. CONCLUSION This analysis suggests that the process for enrolling in subsidized insurance does not currently meet the goal of providing women with coverage for abortion care (and other health needs) in a timely way. Systemic improvements are needed to ensure that enrollments are processed quickly and disruptions in coverage are minimized. Information resources should be developed to help women and their families understand health insurance and coverage of services.

Situating stigma in stratified reproduction: Abortion stigma and miscarriage stigma as barriers to reproductive healthcare

OBJECTIVES To examine whether race and reported history of abortion are associated with abortion stigma and miscarriage stigma, both independently and comparatively. STUDY DESIGN Self-administered surveys with 306 new mothers in Boston and Cincinnati, United States. MAIN OUTCOME MEASURES Abortion stigma perception (ASP); miscarriage stigma perception (MSP); and comparative stigma perception (CSP: abortion stigma perception net of miscarriage stigma perception). RESULTS Regardless of whether or not they reported having an abortion, white women perceived abortion (ASP) to be more stigmatizing than Black and Latina women. Perceptions of miscarriage stigma (MSP), on the other hand, were dependent on reporting an abortion. Among those who reported an abortion, Black women perceived more stigma from miscarriage than white women, but these responses were flipped for women who did not report abortion. Reporting abortion also influenced our comparative measure (CSP). Among those who did report an abortion, white women perceived more stigma from abortion than miscarriage, while Black and Latina women perceived more stigma from miscarriage than abortion. CONCLUSIONS By measuring abortion stigma in comparison to miscarriage stigma, we can reach a more nuanced understanding of how perceptions of reproductive stigmas are stratified by race and reported reproductive history. Clinicians should be aware that reproductive stigmas do not similarly affect all groups. Stigma from specific reproductive outcomes is more or less salient dependent upon a womans social position and lived experience.

P4.02 Effects of a restrictive state law on std/hiv rates in ohio

Introduction In recent years, Ohio has enacted multiple laws that impact sexual and reproductive health. In February 2016, a new law came into effect, which prohibits the state from contracting health services with any organisation that performs or promotes abortion. This law blocks funding of organisations such as Planned Parenthood from receiving state funds for activities related to HIV and STD testing and sexual education. Methods We are conducting a rigorous evaluation of the sexual and reproductive health-related consequences of the new law. In an ecologic analysis of state- and county-level data from Ohio for 2015 and 2016, we will compare trends in prevalence of HIV, chlamydia and gonorrhoea (all nationally notifiable conditions) before and after the implementation of the2016 law. We will examine trends by several characteristics, including sex, race/ethnicity, age, education level, insurance status (Ohio is a Medicaid-expansion state under the Affordable Care Act), sexual orientation, urban/rural residence, and other variables. To disentangle the effect of the law from secular trends in HIV/STD, we will compare Ohio’s outcomes to the same outcomes in nearby Illinois. Illinois has similar population characteristics to Ohio but does not have the same legislative environment impacting allocation of funds for reproductive health services. Results Results will be available in summer 2017. In Ohio, we anticipate a decline in the number of HIV and STD tests performed in 2016 compared to 2015, and an increase in the prevalence of each disease in 2016 compared to 2015. We anticipate no meaningful changes in trends across years in Illinois. Conclusion Multiple states across the United States are considering legislation similar to Ohio’s, to restrict the use of state and federal funding by clinical and community organisations that provide HIV/STD care alongside other sexual health services. Determining the HIV/STD-related impacts of such laws is critical to avoid putting men and women at higher risk of disease.