Dynamics of stigma in abortion work: Findings from a pilot study of the Providers Share Workshop

Harris, Lisa H.; Debbink, Michelle; Martin, Lisa; Hassinger, J.

doi:10.1016/j.socscimed.2011.07.004

Cited by 133 publications

(152 citation statements)

References 32 publications

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“…In Ghana, a 2016 study also found that courtesy stigma resulted in health care provider reluctance to provide TOP [22]. In the USA, Harris et al advanced the concept of courtesy stigma by describing both the negative stereotypes of abortion providers and the multiple levels at which providers experience stigma, as well as developing tools to measure abortion stigma [43]. Importantly, abortion provider stigmatisation has implications for the psychosocial well-being of TOP providers, availability of scarce human resources, patient safety and health policy [21].…”

Section: Discussionmentioning

confidence: 99%

‘I am all alone’: factors influencing the provision of termination of pregnancy services in two South African provinces

Teffo

Rispel

2017

Global Health Action

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Background: Globally, universal access to sexual and reproductive health care services has been re-emphasised. One-third of maternal deaths could be averted by improving access to safe abortion services. Anecdotal evidence suggests that the implementation of the Choice of Termination of Pregnancy Act has been suboptimal in South Africa. Objectives: In two South African provinces, determine: the proportion of designated termination of pregnancy (TOP) facilities that provide these services; explore the factors that influence the provision of TOP services; and explore the work experiences of health care providers at designated TOP facilities. Methods: During 2014 and 2015, we conducted a cross-sectional study at designated TOP facilities in Gauteng and North West provinces. A combination of methods was used, consisting of: site visits to, and observation of, each of the designated facilities using a checklist, and in-depth interviews with a sub-set of 30 TOP service providers, using a semi-structured interview schedule. The interview questions focused on the factors influencing TOP service provision, and the work experiences of TOP service providers. We used interpretative phenomenological analysis to analyse the data from the interviews. Results: Overall, 77% (47/61) of designated facilities were providing TOP services, with 87.5% (28/32) in Gauteng Province, compared with 65.5% (19/29) in North West Province. Service provision was influenced by health system deficiencies, human resource challenges, lack of prioritisation and lack of management support. Study participants reported a heavy burden of care provision and expressed an overwhelming feeling of loneliness, courtesy stigma and lack of support from other nurses and doctors, which further influence TOP service provision. Conclusions: South Africa has an enabling legal environment for the provision of TOP services. Supportive management, prioritisation of TOP services and employee wellness programmes to address the psychosocial issues experienced by providers are critical elements of an enabling health policy environment.

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Section: Discussionmentioning

confidence: 99%

‘I am all alone’: factors influencing the provision of termination of pregnancy services in two South African provinces

Teffo

Rispel

2017

Global Health Action

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“…… I think my mother sometimes feels the stigma from me being in this line of work. (R#12) Not being able to talk openly with family and friends about their job for fear of disapproval, or a reluctance to burden others with tensions that surround the work, resulted in a sense of isolation for some staff, a finding that supports other research regarding withdrawal of social support for stigmatized work (Harris et al 2011;Snyder et al 1999). …”

Section: Contexts Of Stigma By Associationmentioning

confidence: 57%

“…Using a longitudinal design, Snyder and colleagues (1999) found higher rates of turnover among volunteers supporting persons with AIDS compared to other hospice volunteers, which they linked to lower social support for the work in the personal networks of AIDS volunteers. Another study found that physicians who performed abortions faced significant workplace stigma, resulting in reluctance to speak about work publicly and in personal networks, politicization of their workplace purpose and workplace strain (Harris et al 2011).…”

Section: Résumémentioning

confidence: 99%

“…Dirty work has been associated with a vast range of occupations, including waiting on tables, personal support, garbage collection, abortion support and the sex trade (Harris et al 2011;Hughes 1962;Twigg et al 2011). Scholars studying dirty work have investigated, in particular, the various ways that workers interpret and ascribe meaning to their work in the face of public derision (Harris et al 2011).…”

Section: Résumémentioning

confidence: 99%

“…We have to work way harder than other agencies or other causes do … . (R#6) Workers at PEERS, like others who perform morally contested work, also described their activities with clients as a social justice activity, adding an additional element of pride to their caregiving roles (Harris et al 2011 Patterns in program funding may be one of the key areas where stigmas against clients intersect on a structural level with the workplace experiences of those who serve them (Link and Phelan 2006;Stuber et al 2008). …”

Section: Workplace Benefits and Constraintsmentioning

confidence: 99%

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Exploring Stigma by Association among Front-Line Care Providers Serving Sex Workers

Benoit

2013

hcpol

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Stigma by association, also referred to as "courtesy stigma," involves public disapproval evoked as a consequence of associating with stigmatized persons. While a small number of sociological studies have shown how stigma by association limits the social support and social opportunities available to family members, there is a paucity of research examining this phenomenon among the large network of persons who provide health and social services to stigmatized groups. This paper presents results from a primarily qualitative study of the workplace experiences of a purposive sample of staff from an organization providing services to sex workers. The findings suggest that stigma by association has an impact on staff health because it shapes both the workplace environment as well as staff perceptions of others' support. At the same time, it is evident that some staff, owing to their more advantaged social location, are better able to manage courtesy stigma than others. RésuméLa stigmatisation par association, aussi appelée « stigmatisation de courtoisie », implique une désapprobation publique évoquée comme conséquence d'une association avec des personnes stigmatisées. Bien qu'un petit nombre d' études sociologiques aient démontré comment la stigmatisation par association limite le soutien social et les possibilités sociales pour les membres d'une famille, il y a peu de recherches qui se penchent sur ce phénomène dans le vaste réseau de personnes qui fournissent des services de santé et sociaux à des groupes stigmatisés. Cet article présente les résultats provenant d'une étude principalement qualitative de l' expérience en milieu de travail d'un échantillon choisi à dessein parmi les membres du personnel d'un organisme qui fournit des services à des travailleurs du sexe. Les résultats font voir que la stigmatisation par association a un impact sur la santé du personnel parce qu' elle donne forme à l' environnement de travail aussi bien qu' à la perception, par le personnel, du soutien reçu par les autres. En même temps, il est évident qu' en raison d'une situation sociale plus avantageuse, certains membres du personnel sont plus en mesure que d' autres de faire face à la stigmatisation par courtoisie.

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Integration of Catholic Values and Professional Obligations in the Provision of Family Planning Services

et al. 2020

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IMPORTANCE Religious leaders of the Catholic church created guidelines for practicing medicine, that involve reproductive care restrictions that may conflict with professional obligations. OBJECTIVE To explore how Catholic obstetrician-gynecologists integrate their religious values and professional obligations related to family planning services. DESIGN, SETTING, AND PARTICIPANTS In this qualitative investigation, in 2018, US-based obstetrician-gynecologists were recruited through an online survey and were invited to participate in audio-recorded telephone interviews using a semistructured interview guide. Participants were obstetrician-gynecologists who self-identified as Catholic and reported providing reproductive health care as follows: (1) provide natural family planning only (low practitioners), (2) provide additional contraceptive methods (moderate practitioners), and (3) provide family planning services including abortion (high practitioners). The study purposively sampled those with higher selfreported religiosity. Data were analyzed from November 2018 to February 2019. MAIN OUTCOMES AND MEASURES The primary outcome was understanding how participants describe integration of Catholic values with family planning service provision. The telephone interviews explored their integration of Catholic values and professional obligations, and 3 coders analyzed the responses using grounded theory. RESULTS Among the 34 Catholic obstetrician-gynecologists interviewed (27 women [79.4%]), there were 10 low, 15 moderate, and 9 high practitioners from 19 states. Participants' description of morality was consistent with Albert Bandura's Social-Cognitive Theory of Moral Thought and Action. The findings were used to create a modified framework. Within each group of physicians, 3 themes demonstrating their reconciliations between Catholic values and professional obligations emerged; each of these themes reflected one of the medical ethical principles of autonomy, beneficence, nonmaleficence, or justice. All 10 low practitioners primarily promoted natural family planning approaches to avoid iatrogenic risks and none provided abortion, reflecting nonmaleficence. Alternatively, moderate practitioners focused on nonmaleficence by offering contraception to prevent abortions. High practitioners primarily promoted patient autonomy by separating religious doctrine from medical practice. All had concerns for beneficence. In each group, 1 of the 4 medical ethical principles was underrepresented. CONCLUSIONS AND RELEVANCE In this qualitative analysis, Catholic obstetrician-gynecologists establish their family planning care provision practices by emphasizing certain moral and/or ethical principles over others. These findings highlight how physician morality in the realm of family planning service provision often involves certain religious and/or professional reconciliations. Understanding (continued) Key Points Question How do Catholic obstetriciangynecologists integrate their religious beliefs with family planning services? Findings In ...

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Dynamics of stigma in abortion work: Findings from a pilot study of the Providers Share Workshop

Cited by 133 publications

References 32 publications

‘I am all alone’: factors influencing the provision of termination of pregnancy services in two South African provinces

‘I am all alone’: factors influencing the provision of termination of pregnancy services in two South African provinces

Exploring Stigma by Association among Front-Line Care Providers Serving Sex Workers

Integration of Catholic Values and Professional Obligations in the Provision of Family Planning Services

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