Abortion providers' resilience to anti-choice tactics in the United States and Canada
Maureen Paul1, Katharine O'Connell White2, Wendy Norman3, Edith Guilbert4, E. Steve Lichtenberg5, Heidi Jones6 1Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA, 2Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts, USA, 3University of British Columbia, Vancouver, British Columbia, Canada, 4Institut National de Sante Publique du Quebec, Quebec City, Quebec, Canada, 5Family Planning Associates Medical Group, LTD, Chicago, Illinois, USA, 6CUNY School of Public Health, Hunter College, New York, New York, USA - firstname.lastname@example.org Objectives: To estimate the prevalence of anti-choice tactics on abortion facilities and to evaluate abortion providers' experiences with stigma in the United States (USA) and Canada. Methods: We conducted a cross-sectional survey of abortion facilities identified via publicly available resources in the USA (N=705) and Canada (N=94) from June through December 2013. Clinic administrators responded to facility-level questionnaires; surgical and medical abortion clinicians responded to individual-level surveys which included a 15-item validated stigma scale. Results: 690 clinicians and 456 facilities participated; 54% of USA facilities and 83% in Canada. 83% of USA and 33% of Canadian facilities experienced at least one form of harassment in 2012, most commonly picketing without blocking (66%). These experiences were more common in private offices (88%) or ambulatory centres (83%) than hospital-affiliated facilities (29%). Only 7% of facilities (all in the USA) reported staff resignations due to harassment. 41% of USA-based clinicians and 18% of Canadian clinicians reported personally experiencing harassment in 2012. 99% disclosed being an abortion provider to their partner or close friend, 88% to a parent, and 74% to a child. The stigma scale showed high reliability with a Cronbach's alpha of 0.80. Only 1% had high stigma scores, 26% moderate to high, 65% moderate to low and 8% low, with no differences by facility type. One third reported always/often/sometimes feeling marginalized by other health workers, but 87% reported always/often feeling they are making a positive contribution to society. Conclusion: Abortion providers and facilities experience several forms of harassment, which is more commonly reported in the USA than Canada. However, providers demonstrate resilience to stigma in both settings.