Commentary Abortion

Confronting Abortion Stigma

Leila Hessini

Abortion stigma is a form of gender discrimination and punishment, and it represents social control of both women who need abortions and providers who provide them.

Late last month, a New Mexico state representative introduced a bill that would further punish women who are raped, as if sexual violence isn’t enough of a violation. The original bill was based on the notion that having an abortion following a rape equated “tampering with evidence” and would have made abortion in case of rape a felony offense. The absurdity of the bill eventually led to it being withdrawn, but that the idea of forcing raped women into pregnancy and motherhood was proposed at all—and in a state where one in four women reports having been raped—is odious to say the least.

While this bill was particularly offensive, every day of every week several state legislatures are hard at work creating more and more restrictions to punish both women in need of abortion and the medical professionals providing safe abortion care.

In North Dakota, the state senate passed a “personhood” bill that endows fertilized eggs with the same rights as the rest of us. In another bill in Alabama, one representative referred to a fetus as “the biggest organ in a body.” And in Indiana, a new bill seeks to prevent the one clinic that provides medical abortion from doing so by forcing it to adhere to ridiculous criteria such as widened halls, even though the clinic doesn’t provide any surgical abortions.

What do all of these actions across the country share? They’re all rooted in abortion stigma.

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Look around. It’s everywhere.

The effort to take away a woman’s ability to make independent decisions is rooted in abortion stigma: the process of dehumanizing and discriminating against women, not for who they are, but because they need an abortion. How is it that in the 21st century women still do not have the right to make a decision about one of the most profound and life-transforming decisions any person can make: whether or not to carry a pregnancy to term or to become a parent for life?

Abortion stigma is a form of gender discrimination and punishment, and it represents social control of both women who need abortions and providers who provide them.

We have to keep naming abortion stigma for what it is; we have to keep calling it out. And we have to work together to find ways to both mitigate it and reflect on the societal mechanisms that produce it and structures and systems that support it.

A series of webinars co-produced by ANSIRH and Ipas seeks to explore these issues. In the first webinar, Ipas senior research associate Kristen Shellenberg and I talked about our work to define, measure, and mitigate abortion stigma. Here is some of what we discussed.

How it Works

Abortion stigma is difficult to isolate because it is produced and reproduced at the individual, community, organizational, and legal level and is played out through private and public discourse, including the media. Women who need abortions face stigma as do providers of abortion information and services. Entire communities have developed ways of separating, stereotyping, and discriminating against women who need abortions. Legal frameworks create categories of “acceptable” and “unacceptable” abortions and sometimes reward privilege to those women who obtain early abortions. Abortions have been separated from comprehensive reproductive healthcare services and from insurance programs, as well as totally dissociated from family planning.

Abortion stigma is circular and non-hierarchal. First, women who choose to terminate an untenable pregnancy are labeled as different, which sets up a distinct “us vs. them” mentality in society. These women are then linked to undesirable characteristics: in different contexts they may be characterized as being sinful, selfish, dirty, irresponsible, heartless, or murderous. But these labels belie the fact that abortions are common—one in three women in the United States will have one by the time they reach the age of 45—and many women have abortions to preserve the health and well-being of members of their family. Women who abort are punished socially; they’re shamed into silence and are often overtly discriminated against through inaccurate medical information and unnecessary and invasive procedures like vaginal ultrasounds.

The roots of abortion stigma are found in socially-created ideas of womanhood, including the notions that women are responsible for sex, that sex should lead to procreation, that women instinctively want to become mothers, and that women should never end a potential life. Proposed restrictions on abortion around the country punish women for sex, even if it is unwanted, and attempt to give pregnant women just one option: to become a mother. And as soon as an egg is fertilized, scores of state legislators believe its rights trump that of the woman. What does this say about the status of women in the United States?

Measuring Abortion Stigma

So what is the impact of abortion stigma on women’s health, lives, opportunities, and well-being? Abortion stigma begins with the health impact of internalized stigma and the secrecy, silence, and shame that go along with it. It extends to women waiting to seek care, to women who don’t know they have the right to nonjudgmental, accessible, and quality abortion care, and to women who don’t have the same opportunities as men because their rights to make critical decisions are being curtailed. It means there is a widespread lack of support for all women considering abortion.

We know that the costs of not addressing stigma are huge. So we’ve developed a tool to measure abortion stigma called the Stigmatizing Attitudes, Beliefs, and Actions Scale. The scale includes 18 items and three sub-scales developed from research in Ghana and Zambia. It can be used to assess what is going on in a community, to create strategies to reduce abortion stigma, and as a “pre and post-test” measure of change at the individual and community level. At Ipas, we are currently testing the scale in Uganda, Kenya, and Mexico and the International Planned Parenthood Federation is doing the same in Burkina Faso and Pakistan.

We are also conducting research on institutional and structural stigma at health facilities in Kenya, Uganda, Mexico, and India. We hope to identify specific policies, protocols, and procedures within public and private health-care delivery systems that stigmatize abortion providers as well as women seeking abortion care, and to develop strategies for change.

Right now our efforts focus on understanding and reducing abortion stigma. But while we continue to learn more, we will also continue to shed light on stigma where it exists, to talk about it openly, and to call it out when and where we see it.

News Politics

Anti-Choice Democrats: ‘Open The Big Tent’ for Us

Christine Grimaldi & Ally Boguhn

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

Democrats for Life of America gathered Wednesday in Philadelphia during the party’s convention to honor Louisiana Gov. John Bel Edwards (D) for his anti-choice viewpoints, and to strategize ways to incorporate their policies into the party.

The group attributed Democratic losses at the state and federal level to the party’s increasing embrace of pro-choice politics. The best way for Democrats to reclaim seats in state houses, governors’ offices, and the U.S. Congress, they charged, is to “open the big tent” to candidates who oppose legal abortion care.

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

Democrats for Life of America members repeatedly attempted to distance themselves from Republicans, reiterating their support for policies such as Medicaid expansion and paid maternity leave, which they believe could convince people to carry their pregnancies to term.

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Their strategy, however, could have been lifted directly from conservatives’ anti-choice playbook.

The group relies, in part, on data from Marist, a group associated with anti-choice polling, to suggest that many in the party side with them on abortion rights. Executive Director Kristen Day could not explain to Rewire why the group supports a 20-week abortion ban, while Janet Robert, president of the group’s board of directors, trotted out scientifically false claims about fetal pain

Day told Rewire that she is working with pro-choice Democrats, including Sen. Kirsten Gillibrand and Rep. Rosa DeLauro, both from New York, on paid maternity leave. Day said she met with DeLauro the day before the group’s event.

Day identifies with Democrats despite a platform that for the first time embraces the repeal of restrictions for federal funding of abortion care. 

“Those are my people,” she said.

Day claimed to have been “kicked out of the pro-life movement” for supporting the Affordable Care Act. She said Democrats for Life of America is “not opposed to contraception,” though the group filed an amicus brief in U.S. Supreme Court cases on contraception. 

Democrats for Life of America says it has important allies in the U.S. House of Representatives and the U.S. Senate. Sens. Joe Donnelly (IN), Joe Manchin (WV), and Rep. Dan Lipinski (IL), along with former Rep. Bart Stupak (MI), serve on the group’s board of advisors, according to literature distributed at the convention.

Another alleged ally, Sen. Bob Casey (D-PA), came up during Edwards’ speech. Edwards said he had discussed the award, named for Casey’s father, former Pennsylvania Gov. Robert P. Casey, the defendant in the landmark Supreme Court decision, Planned Parenthood v. Casey, which opened up a flood of state-level abortions restrictions as long as those anti-choice policies did not represent an “undue burden.”

“Last night I happened to have the opportunity to speak to Sen. Bob Casey, and I told him … I was in Philadelphia, receiving this award today named after his father,” Edwards said.

The Louisiana governor added that though it may not seem it, there are many more anti-choice Democrats like the two of them who aren’t comfortable coming forward about their views.

“I’m telling you there are many more people out there like us than you might imagine,” Edwards said. “But sometimes it’s easier for those folks who feel like we do on these issues to remain silent because they’re not going to  be questioned, and they’re not going to be receiving any criticism.”

During his speech, Edwards touted the way he has put his views as an anti-choice Democrat into practice in his home state. “I am a proud Democrat, and I am also very proudly pro-life,” Edwards told the small gathering.

Citing his support for Medicaid expansion in Louisiana—which went into effect July 1—Edwards claimed he had run on an otherwise “progressive” platform except for when it came to abortion rights, adding that his policies demonstrate that “there is a difference between being anti-abortion and being pro-life.”

Edwards later made clear that he was disappointed with news that Emily’s List President Stephanie Schriock, whose organization works to elect pro-choice women to office, was being considered to fill the position of party chair in light of Rep. Debbie Wasserman Schultz’s resignation.

“It wouldn’t” help elect anti-choice politicians to office, said Edwards when asked about it by a reporter. “I don’t want to be overly critical, I don’t know the person, I just know that the signal that would send to the country—and to Democrats such as myself—would just be another step in the opposite direction of being a big tent party [on abortion].” 

Edwards made no secret of his anti-choice viewpoints during his run for governor in 2015. While on the campaign trail, he released a 30-second ad highlighting his wife’s decision not to terminate her pregnancy after a doctor told the couple their daughter would have spina bifida.

He received a 100 percent rating from anti-choice organization Louisiana Right to Life while running for governor, based off a scorecard asking him questions such as, “Do you support the reversal of Roe v. Wade?”

Though the Democratic Party platform and nominee have voiced the party’s support for abortion rights, Edwards has forged ahead with signing numerous pieces of anti-choice legislation into law, including a ban on the commonly used dilation and evacuation (D and E) procedure, and an extension of the state’s abortion care waiting period from 24 hours to 72 hours.

News Law and Policy

Three Crisis Pregnancy Centers Served for Breaking California Law

Nicole Knight Shine

The notices of violation issued this month mark the first time authorities anywhere in the state are enforcing the seven-month-old Reproductive Freedom, Accountability, Comprehensive Care, and Transparency (FACT) Act.

The Los Angeles City Attorney is warning three area fake clinics, commonly known as crisis pregnancy centers (CPCs), that they’re breaking a new state reproductive disclosure law and could face fines of $500 if they don’t comply.

The notices of violation issued this month mark the first time authorities anywhere in the state are enforcing the seven-month-old Reproductive Freedom, Accountability, Comprehensive Care, and Transparency (FACT) Act, advocates and the state Attorney General’s office indicate.

The office of City Attorney Mike Feuer served the notices on July 15 and July 18 to two unlicensed and one licensed clinic, a representative from the office told Rewire. The Los Angeles area facilities are Harbor Pregnancy Help Center, Los Angeles Pregnancy Services, and Pregnancy Counseling Center.

The law requires the state’s licensed pregnancy-related centers to display a brief statement with a number to call for access to free and low-cost birth control and abortion care, and for unlicensed centers to disclose that they are not medical facilities.

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“Our investigation revealed,” one of the letters from the city attorney warns, “that your facility failed to post the required onsite notice anywhere at your facility and that your facility failed to distribute the required notice either through a printed document or digitally.”

The centers have 30 days from the date of the letter to comply or face a $500 fine for an initial offense and $1,000 for subsequent violations.

“I think this is the first instance of a city attorney or any other authority enforcing the FACT Act, and we really admire City Attorney Mike Feuer for taking the lead,” Amy Everitt, state director of NARAL Pro-Choice California, told Rewire on Wednesday.

Feuer in May unveiled a campaign to crack down on violators, announcing that his office was “not going to wait” amid reports that some jurisdictions had chosen not to enforce the law while five separate court challenges brought by multiple fake clinics are pending.

Federal and state courts have denied requests to temporarily block the law, although appeals are pending before U.S. Court of Appeals for the Ninth Circuit.

In April, Rebecca Plevin of the local NPR affiliate KPCC found that six of eight area fake clinics were defying the FACT Act.

Although firm numbers are hard to come by, around 25 fake clinics, or CPCs, operate in Los Angeles County, according to estimates from a representative of NARAL Pro-Choice California. There are upwards of 1,200 CPCs across the country, according to their own accounting.

Last week, Rewire paid visits to the three violators: Harbor Pregnancy Help Center, Los Angeles Pregnancy Services, and Pregnancy Counseling Center.

Christie Kwan, a nurse manager at Pregnancy Counseling Center, declined to discuss the clinic’s noncompliance, but described their opposition to the state law as a “First Amendment concern.”

All three centers referred questions to their legal counsel, Alliance Defending Freedom (ADF), an Arizona-based nonprofit and frequent defender of discriminatory “religious liberty” laws.

Matt Bowman, senior counsel with ADF, said in an email to Rewire that forcing faith-based clinics to “communicate messages or promote ideas they disagree with, especially on life-and-death issues like abortion,” violates their “core beliefs” and threatens their free speech rights.

“The First Amendment protects all Americans, including pro-life people, from being targeted by a government conspiring with pro-abortion activists,” Bowman said.

Rewire found that some clinics are following the law. Claris Health, which was contacted as part of Feuer’s enforcement campaign in May, includes the public notice with patient intake forms, where it’s translated into more than a dozen languages, CEO Talitha Phillips said in an email to Rewire.

Open Arms Pregnancy Center in the San Fernando Valley has posted the public notice in the waiting room.

“To us, it’s a non-issue,” Debi Harvey, the center’s executive director, told Rewire. “We don’t provide abortion, we’re an abortion-alternative organization, we’re very clear on that. But we educate on all options.”

Even so, reports of deceit by 91 percent of fake clinics surveyed by NARAL Pro-Choice California helped spur the passage of the FACT Act last October. Until recently, a person who Googled “abortion clinic” might be directed to a fake clinic, or CPC.

Oakland last week became the second U.S. city to ban false advertising by facilities that city leaders described as “fronts for anti-abortion activists.” San Francisco passed a similar ordinance in 2011.