Abortions are not uncommon; it is common knowledge that one in four people who are assigned female at birth have had an abortion at some point in their lives. However, the stigma that still enshrouds abortion is still a threat to the mental health of these individuals. Abortion stigma has been defined 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” (Kumar et al., 2009). Although the terminology of the definition should be updated to be more inclusive, the majority of it is still accurate, despite pregnancy termination having been around for thousands of years.
The stigma has been integrated into various institutions, including healthcare systems, although “Most women reported stigma from multiple sources. The most frequently cited sources were society (often referred to as ‘others’ or ‘other people’), the community, and significant others (family, friends, and sexual partners)” (Hanschmidt et al., 2016). That being said, not all of the stigma is external; Hanschmidt also stated that “Study results also revealed that many women experienced abortion stigma in the form of negative feelings, like guilt, shame, or self-blame. This finding is especially concerning because internalized stigma has been identified as a major risk factor for reduced mental health, impaired psychosocial functioning, and delays in seeking professional care.” The societal stigma surrounding abortion is so powerful that it oftentimes becomes internalized, affecting the emotional and even, quite possibly, the physical well-being of those who have had or want to exercise their right to choose.
Stigma also affects individuals who have abortions out of medical necessity in the second trimester of pregnancy or who seek but are denied abortions, which has become increasingly common in the United States since Roe v. Wade was overturned last year. A study performed by obstetric and gynecologic experts found that “Perceived abortion stigma was strongly associated with experiences of psychological distress years later, both among people who had abortions and people who were denied abortions. This association suggests that people may have internalized these perceptions of stigma, with long-term consequences for their mental health” (Biggs et al., 2020). This has likely been exacerbated by new laws that outlaw completely outlaw abortion and traveling to another state to obtain an abortion, which not only leads to AFAB – or assigned female at birth – people feeling more alienated for seeking to terminate pregnancies but could also lead to a felony conviction and jail time. In a study published by doctors at UCSF, it was stated that “Given the growing number of state-level gestational age restrictions on abortion in the US, particular attention to how legal restrictions on abortion impact stigma is warranted” (Kerns et al., 2022). The authors conclude the study by saying that “Abortion providers may benefit from training to identify women who display signs of self-judgment since these women may be at higher risk for experiencing grief after abortion due to pregnancy complications” (Kerns et al., 2022). Providing psychological care before, during, and after the procedure could greatly improve outcomes.
Abortion stigma is unfortunately still prevalent in our society, thus making pregnancy termination much more psychologically painful than it may already be. It is likely to only become worse post-Roe, leading to more internalized stigma as well in the form of guilt, distress, and self-judgment. Healthcare providers should be trained to identify individuals who are at a higher risk for these complications in order to more effectively provide psychological services, including therapy and bereavement services.
References
Biggs, M. A., Brown, K., & Foster, D. G. (2020, January 29). Perceived abortion stigma and psychological well-being over five years after receiving or being denied an abortion. PloS one. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988908/
Hanschmidt, F., Linde, K., Hilbert, A., Riedel-Heller, S. G., Kersting, A., Holten, L., Kleiverda, G., Lindberg, L., Kost, K., Maddow-Zimet, I., Desai, S., Zolna, M., Cullen, P., Korolczuk, E., Kimport, K., Chor, J., Tusken, M., Young, D., Lyman, P., . . . Baum, S. E. (2016). Abortion Stigma: A Systematic Review. Perspectives on Sexual and Reproductive Health, 48(4), 169-177. https://doi.org/48576829
Kerns, J., Cheeks, M., Cassidy, A., Pearlson, G., & Mengesha, B. (2022, March 28). Abortion stigma and its relationship with grief, post-traumatic stress, and mental health-related quality of life after abortion for fetal anomalies. Women’s health reports (New Rochelle, N.Y.). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8994429/
Kumar, A., Hessini, L., & Mitchell, E. M. H. (2009). Conceptualising abortion stigma. Culture, Health & Sexuality, 11(6), 625–639. http://www.jstor.org/stable/27784486
