nursing (health Policy draft re)

In addition to legislative restrictions, women further face the complication of abortion stigma, the strength of which has led many women to seek unsafe abortions in order to escape judgements by society (Oginni et al., 2018). Oginni et al. (2018) discovered four correlates that contribute to a woman’s feeling of individual level abortion stigma (ILAS): age, education, provider’s cadre, and type of abortion procedure. The researchers assert that understanding what influences/contributes to ILAS is imperative for coming up with ways to prevent ILAS (Oginni et al., 2018). Some preventative measures posited by Oginni et al. (2018) include public evidence-based interventions, support groups, public expression, and self-awareness assessments. By reducing ILAS, more women could feel empowered to make informed decisions about their reproductive, elect to choose safe abortions, and ultimately reduce abortion complications/abortion-related deaths (Azzam, 2019).

Finally, one main issue with abortion stigma is that it is a “concealable” stigma: no one knows if a woman has had an abortion unless she discloses the information (Norris et al., 2011). As a stigma that can only be externally felt if a woman is open about her abortion behaviors, abortion stigma is most often internalized, a consequence that can be very damaging to women who have had abortions. Norris et al. (2011) state women who are stigmatized by abortion are left to cope with both external and internal stigma, and constantly worry about whether or not the stigma will be revealed. Consequently, concealing abortions contributes to the cycle the perpetuates the stigma, and abortions are wholly not discussed (Norris et al., 2011) (Azzam, 2019).

The implicit “rule of secrecy” seems contradictory when considered with the fact that in the United States, one-third of women by the age of 45 will have a legal or safe abortion (Norris et al., 2011). This statistic does not consider women who have self-induced abortions, so the number could be higher. Norris et al. (2011) have found regardless as to the sheer quantity of abortions performed in the United States alone, two out of three women who have abortions anticipate stigma and feel they are expected to keep quiet about their experiences. As previously mentioned, however, abortion stigma reaches more than just women who have had abortions: Norris et al. (2011) define three main groups affected by abortion stigma: women who have had abortions, individuals who work in abortion provision, and supporters of women who have had abortions. All of these groups face serious psychological and physical health risks as a result of their connections to abortion and the very strong, occasionally violent protests by opposers of abortion. Clinics that provide abortions are targeted by protesters and the climate of violence was aggravated by the 2009 murder of abortion provider Dr. George Tiller, who was shot in the head at point-blank range during a church service where he was serving as an usher (Norris et al., 2011) (Azzam, 2019).

In addition to defining groups affected by abortion stigma, Norris et al. (2011) posit reasons that abortion is stigmatized: abortion violates “feminine ideals” of womanhood, opposers attribute personhood to the fetus and therefore wrongly consider abortion to be murder, stigma is perpetuated by legal restrictions, abortion is viewed as dirty or unhealthy, and anti-abortion forces have found stigma to be a powerful tool. Similarly to Oginni et al., Norris et al. (2011) have proposed recommendations to counter abortion stigma that include normalizing abortion within public discourse and being aware of language used within the community of abortion supporters, such as avoiding language endorsing “good” or “bad” reasons for getting an abortion. Those who are prochoice should not distance themselves from abortion, and slogans such as “safe, legal, and rare” only serve to perpetuate the stigma. Norris et al. (2011) also suggest possible solutions such as maintaining and strengthening training initiatives and conducting research into experience of stigma within and among groups. Ultimately, abortion is a topic that needs to be normalized in public discourse, and interventions should be put in place to counter, reduce, and eventually eradicate abortion stigma (Azzam, 2019).

The World Health Organization reported every eight minutes a woman in a developing country will die of complications from an unsafe abortion (Bhattacharyya et al., 2011). These women, due to social stigma, conservative laws, and lack of access, have no other choice than to risk unsafe abortion for the sake of making the best decision for themselves. These are often unable to even seek medical help for complications due to laws holding both caregiver and patient liable for unsafe abortions (Bhattacharyya et al., 2011). However, pro-choice advocates have been fighting back with introducing new Acts and education programs. One such act, the Equal Access to Abortion Coverage in Health Insurance (EACH) Woman Act, would ensure abortion coverage for all women regardless of income or insurance (About the EACH Woman Act). Internationally, women’s health groups work to liberate Medical Termination of Pregnancy (MTP) acts, the laws that hold patients liable for unsafe abortions, decentralize MTP units, and provide family planning services (Bhattacharyya et al., 2011).

In a study done by Stanger-Hall and Hall (2011), a review of the sex education policies of the 50 states was compared to the rates of teenage pregnancies and abortion. The researchers organized the states by sex education policies that fit into one of four categories relating to abstinence: “no provision, abstinence covered, abstinence promoted, and abstinence stressed,” and assigned an ordinal value of 0-3 to each respective category (Stanger-Hall & Hall, 2011). Level 0 policies did not specifically mention abstinence whereas level 3 policies were the most strict and stressed abstinence until marriage (Stanger-Hall & Hall, 2011). (Fun fact: Virginia does have abstinence laws and is a level 2 state).

Stanger-Hall and Hall (2011) reviewed statistics concerning teen pregnancy rates and four that the teen pregnancy rates for level 0 states was on average 58.78 whereas level 3 states had an average teen pregnancy rate of 73.24. Even after controlling for potential confounding variables such as socioeconomic status, educational attainment, and ethnicity, abstinence education policies continued to positively correlate with teen pregnancy rates (Stanger-Hall & Hall, 2011). While correlation does not imply causation, there is an irrefutable trend that comprehensive sex education results in a lower teen pregnancy rate. Comprehensive sex education does include covering abstinence in the curriculum, but also teaches safe sex practices and contraception and condom use, thereby allowing teenagers the best chance to make informed sex decisions (Stanger-Hall & Hall, 2011).

Ultimately, for the sake of women around the world, the United States needs to readopt its initial outlook on abortion, deliver on the promise to separate church and state, and fund family planning services both domestically and internationally. As the largest donator to international family planning, it is the responsibility of the United States to ensure the safety of vulnerable groups of women, by providing safe and legal access to contraception, family planning education, and abortion. Without the support of the United States, millions of women around the world will continue to needlessly die of complications from unsafe abortion; and anyone who claims to be pro-life cannot possibly stand in the way of these efforts to make abortion safe and legal for the sake of women everywhere.

References

Azzam, N. (2019). The History of United States Abortion Policy and its International Impact. Christopher Newport University.

Bhattacharyya, S. K., Saha, S. P., Bhattacharya, S., & Pal, R. (2011). Consequences of unsafe abortion in India- a case report. Issues in Womens Health Proceedings in Obstetrics and Gynecology, 2, 1-4.

King, C. R. (1992). Abortion in Nineteenth Century America: A conflict between women and their physicians. Women's Health Issues, 2(1), 32–39. https://doi.org/10.1016/s1049-3867(05)80135-5

n.a., n.d., Roe v. Wade: The Constitutional Right to Access Safe, Legal Abortion. Retrieved from https://www.plannedparenthoodaction.org/issues/abortion/roe-v-wade