Exploring providers’ experience of stigma following the introduction of more liberal abortion care in the Republic of Ireland

Dempsey, Brendan; Favier, Mary; Mullally, Aoife; Higgins, Mary

doi:10.1016/j.contraception.2021.04.007

Cited by 18 publications

(18 citation statements)

References 25 publications

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“…The recognition of the need for privacy and confidentiality is an important form of support for providers that is built into the Irish model of care. It shields providers in a sociocultural and political context in which abortion stigma continues to play a substantial role [ 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Abortion policy implementation in Ireland: Lessons from the community model of care

et al. 2022

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Background In 2018, the right to lawful abortion in the Republic of Ireland significantly expanded, and service provision commenced on 1 January, 2019. Community provision of early medical abortion to 9 weeks plus 6 days gestation delivered by General Practitioners constitutes the backbone of the Irish abortion policy implementation. We conducted a study in 2020–2021 to examine the barriers and facilitators of the Irish abortion policy implementation. Methods We collected data using qualitative in-depth interviews (IDIs) which were conducted in-person or remotely. We coded and analysed interview transcripts following the grounded theory approach. Results We collected 108 IDIs in Ireland from May 2020 to March 2021. This article draws on 79 IDIs with three participant samples directly relevant to the community model of care: (a) 27 key informants involved in the abortion policy development and implementation representing government healthcare administration, medical professionals, and advocacy organisations, (b) 22 healthcare providers involved in abortion provision in community settings, and (c) 30 service users who sought abortion services in 2020. Facilitators of community-based abortion provision have been: a collaborative approach between the Irish government and the medical community to develop the model of care, and strong support systems for providers. The MyOptions helpline for service users is a successful national referral model. The main barriers to provision are the mandatory 3-day wait, unclear or slow referral pathways from primary to hospital care, barriers for migrants, and a shortage and incomplete geographic distribution of providers, especially in rural areas. Conclusions We conclude that access to abortion care in Ireland has been greatly expanded since the policy implementation in 2019. The community delivery of care and the national helpline constitute key features of the Irish abortion policy implementation that could be duplicated in other contexts and countries. Several challenges to full abortion policy implementation remain.

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Section: Discussionmentioning

confidence: 99%

Abortion policy implementation in Ireland: Lessons from the community model of care

et al. 2022

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“…21,22 Qualitative studies in the United States (US), Pakistan, Ireland, and South Africa have suggested providers may feel more comfortable providing medication abortion care than instrumentation abortion care because they feel less responsible for the abortion or less engaged in a stigmatized activity. [23][24][25][26][27][28] Quantitative studies in Ireland found hospital providers reported experiencing higher levels of stigma if they only provided instrumentation abortion care 29 and lower willingness to provide instrumentation abortion care among obstetrics and gynecology trainees as it was considered more "real". 30 However, studies have not assessed the association between provider preferences, provision practices, and stigma.…”

Section: Introductionmentioning

confidence: 99%

Exploring provider preference and provision of abortion methods and stigma: Secondary analysis of a United Kingdom provider survey

Footman,

Bright,

Kavanagh

et al. 2024

Perspect Sexual Reproductive

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IntroductionMethod choice is an important component of quality abortion care and qualitative research suggests that abortion stigma can influence provider preference and provision of abortion methods. This study is the first to explore the relationships between abortion providers' method preferences, their provision of medication or instrumentation abortion or both methods, and abortion stigma.MethodsWe conducted secondary analysis of a survey of United Kingdom (UK) abortion providers (N = 172) to describe and compare providers' self‐reported method preferences and provision. We used multinomial logistic regression to assess the association between method preference and provider experiences of abortion stigma (measured using a revised Abortion Provider Stigma Scale (APSS)), adjusting for relevant provider and facility characteristics.ResultsAlmost half (52%) of providers reported that they only provided medication abortion care, while 5% only provided instrumentation abortion care and 43% provided both methods. Most (62%) preferred to provide both methods while 32% preferred to provide only medication abortion and 6% only instrumentation abortion. There was no significant difference in revised APSS scores by provider method preference or provision.DiscussionMost surveyed UK abortion providers prefer to offer both methods, but over half only provide medication abortion. This may reflect patients' preferences for medication abortion, and health system and legal constraints on instrumentation abortion. Addressing these systemic constraints on method provision could expand patient choice. Providers' method preference was not significantly associated with provider stigma but future research should consider the influence of structural stigma on method provision at the health system level.

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“…In the case of abortion, social taint may refer to the providers’ interaction with stigmatized individuals who seek care; physical taint may relate to the providers’ handling of fetal remains; and moral taint may relate to the ongoing debate regarding the unborn’s right to life. In the time since Joffe’s article [ 4 ], a growing body of literature has explored and reflected on the various challenges faced by providers of abortion care throughout the world, with common examples including the stigma ascribed to abortion care [ 5 - 8 ], the marginalization of abortion within mainstream medicine [ 9 , 10 ], and the difficulty of providing care under highly emotional circumstances [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Providers’ Experience of Abortion Care: Protocol for a Scoping Review

Dempsey¹,

Callaghan²,

Higgins³

2022

JMIR Res Protoc

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Background Despite being one of the most common gynecological procedures in the world, abortion care remains highly stigmatized. Internationally, providers have noted negative impacts related to their involvement in the services, and abortion care has been described as “dirty work.” Though much of the existing research focuses on the challenges of providing, many have also highlighted the positive aspects of working in abortion care. Despite the steadily increasing interest in this area over the past decade, however, no one has sought to systematically review the literature to date. Objective The aim of this review is to systematically explore published studies on the experiences of abortion care providers to create a narrative review on the lived experience of providing abortion care, reflecting on what is already known and what areas require further exploration. Methods This review will be conducted according to the framework outlined by Levac et al, which expanded on the popular Arksey and O’Malley framework. We will systematically search for peer-reviewed articles in 6 electronic databases: CINAHL, the Cochrane Library, EMBASE, PsycInfo, PubMed, and Web of Science. Following a pilot exercise, we devised a search strategy to identify relevant studies. In this protocol, we outline how citations will be assessed for eligibility and what information will be extracted from the included articles. We also highlight how this information will be combined in the review. Results As of December 2021, at the time of writing, we have searched for articles in the electronic databases and identified 6624 unique citations. We intend to fully assess these citations for eligibility by the end of January 2022, chart and analyze data from the eligible citations by the end of March 2022, and submit a journal article for peer review by late spring 2022. Conclusions The findings of this review will provide a comprehensive overview on the known experiences of providing abortion care. We also anticipate that the findings will identify aspects of care and experiences that are not reflected in the available literature. We will disseminate the results via a publication in a peer-reviewed academic journal and by presenting the findings at conferences in the areas of abortion care, obstetrics, and midwifery. As this review is a secondary analysis of published articles, ethical approval was not required. International Registered Report Identifier (IRRID) DERR1-10.2196/35481

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Exploring providers’ experience of stigma following the introduction of more liberal abortion care in the Republic of Ireland

Cited by 18 publications

References 25 publications

Abortion policy implementation in Ireland: Lessons from the community model of care

Abortion policy implementation in Ireland: Lessons from the community model of care

Exploring provider preference and provision of abortion methods and stigma: Secondary analysis of a United Kingdom provider survey

Providers’ Experience of Abortion Care: Protocol for a Scoping Review

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