Abortion remains a contentious and stigmatised medical procedure, despite being a commonly performed gynaecological procedure.
It is often framed as a moral, religious or legal issue rather than a medical one and is reinforced at structural, policy, community, and individual levels. Abortion stigma is a multifaceted phenomenon, impacting on the experiences of women who undergo abortion and the health care professionals involved in abortion care. Public discourses focussed on particular types of abortion that are viewed as problematic – ‘repeat, ‘late’ – are further stigmatising and potentially discriminating. Even the language itself is inherently judgemental. This presentation will review contemporary evidence of the experience of abortion stigma among women and providers, the implications of this for health and wellbeing and inequalities, and how abortion stigma can be countered and challenged.
Challenging stigma and the undesirable: late presentation and multiple abortions
University of Glasgow, Glasgow, Scotland, UK
‘Repeat' and ‘late' abortion are often framed as problematic, and there is continuing concern from a policy and provision perspective about the proportion of women presenting for ‘repeat' and ‘late' abortions. This presentation draws on findings from two studies of women in Scotland to demonstrate how and why such framings should be challenged.
In 2013, we completed an audit of 281 women presenting for abortion at ≥ 16 weeks gestation in Scotland and conducted qualitative interviews with 23 of these. Women presenting later were young and a significant proportion were from more deprived areas. Our qualitative analysis suggested that reasons for later presentation were complex, varied and highly context-specific, with the majority having not expected to become pregnant. Factors which necessitated later abortion were often unforeseen and thus not easily amenable to intervention.
In 2015, we collected questionnaires from 1662 women presenting for abortion and completed qualitative interviews with 23 women identified as having undergone a previous abortion in the preceding two years. 34% reported a previous abortion, while just under half of these reported two or more in the previous two years. Age, education, deprivation and experience of domestic abuse were associated with having had more than one abortion. Our qualitative data suggested more commonalties than divergences between experiences of women who have undergone more than one abortion and those who have not.
The presentation will address how a disproportionate focus on ‘repeat' and ‘late' abortion' exacerbates stigmatisation and distracts from a more productive focus on improving abortion provision, when in fact it appears women in this position are no different from all women seeking abortion. I will conclude by discussing how efforts could be better spent focusing on how to improve the experiences of women seeking abortion and working to challenge prevailing, negative, social attitudes to abortion.