“It’s something that marks you”: Abortion stigma after decriminalization in Uruguay

Abstract

BackgroundAbortion stigma is experienced by women seeking abortion services and by abortion providers in a range of legal contexts, including Uruguay, where abortion was decriminalized up to 12 weeks gestation in 2012. This paper analyzes opinions and attitudes of both abortion clients and health professionals approximately two years following decriminalization and assesses how abortion stigma manifests among these individuals and in institutions that provide care.MethodsIn 2014, we conducted twenty in-depth, semi-structured interviews with abortion clients (n = 10) and health care professionals (n = 10) in public and private facilities across Uruguay’s health system. Interviews were recorded, transcribed, and then coded for thematic analysis.ResultsWe find that both clients and health professionals express widespread satisfaction with the implementation of the new law. However, there exist critical points in the service where stigmatizing ideas and attitudes continue to be reproduced, such as the required five-day waiting period and in interactions with hospital staff who do not support access to the service. We also document the prevalence of stigmatizing ideas around abortion that continue to circulate outside the clinical setting.ConclusionDespite the benefits of decriminalization, abortion clients and health professionals still experience abortion stigma.

From stigma to pride: health professionals and abortion policies in the Metropolitan Area of Buenos Aires

“…In relation to the strategies the providers used, as has been found in other studies, 1,9 when abortion stigma was at its worst, during the early days of harm and risk counselling, there were very few providers who were protected, and then only by silence. Secrecy forced them to work alone and this contributed to maintaining abortion stigma and reducing what they could do as providers.…”

“…This process places them in a framework of economic, political, and social power relations that perpetuate stigma in order to maintain the status quo." 9 Abortion stigma In the case of abortion, stigma relates not only to the imperative of motherhood, life and death, women's and fetal rights, but also to general socio-economic factors such as poverty, education, place of residence, or access to healthcare facilities. Abortion stigma is linked with gender and with the way society distributes its resources and the status assigned to each person.…”

Experience obtaining legal abortion in Uruguay: knowledge, attitudes, and stigma among abortion clients

“…They reported experiencing this judgement while receiving services and at the reception. A qualitative study in 2014 at the same hospital in Uruguay also found that hospital staff can perpetuate stigma and obstruct access to care; this applies in particular to staff who are not on SRH teams, such as sonographers [17]. Research in Colombia similarly found that women seeking legal abortion services may fear and experience mistreatment and stigma [27], and nearly one third of women in a study in Cape Town, South Africa, reported seeking abortion care outside the formal care sector due to worries about stigma and mistreatment from health care providers [28].…”

“…Nearly half of Uruguay’s population of approximately 3.2 million lives in Montevideo [22], and the CHPR was selected as the site for data collection because it is the largest women’s hospital in the country—providing the highest number of abortion services out of any facility [23]. We analyzed quantitative and qualitative data separately; the qualitative findings from this study are published elsewhere and are referenced throughout this paper [17].…”

“…Abortion stigma can be defined as a shared understanding that abortion is morally wrong and/or socially unacceptable [15] and as “a negative attribute ascribed to women who seek to terminate a pregnancy that marks them, internally or externally, as inferior to ideals of womanhood” [16]. The mandatory waiting period, obligatory counseling, and conscientious objection may perpetuate stigma or impede timely access to care [9, 10, 17]. In addition, the “repeat abortion prevention policy” implemented at the CHPR, which promotes post-abortion contraception [18], could also have unintentionally contributed to abortion stigma towards women who have more than one abortion.…”