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Commentary: Abortion Provider Stigma and Mainstream Medicine a
Carole Joffe PhD a
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California, USA Accepted author version posted online: 25 Jul 2014.Published online: 25 Sep 2014.
To cite this article: Carole Joffe PhD (2014) Commentary: Abortion Provider Stigma and Mainstream Medicine, Women & Health, 54:7, 666-671, DOI: 10.1080/03630242.2014.919985 To link to this article: http://dx.doi.org/10.1080/03630242.2014.919985
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Women & Health, 54:666–671, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 0363-0242 print/1541-0331 online DOI: 10.1080/03630242.2014.919985
Commentary: Abortion Provider Stigma and Mainstream Medicine CAROLE JOFFE, PhD
Downloaded by [University of Strathclyde] at 04:58 12 October 2014
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California, USA
This commentary describes the various manifestations of the stigmatization and marginalized status of abortion providers in relation to mainstream medicine. The article also addresses some of the current efforts to respond to this stigmatization. KEYWORDS
abortion, stigma, mainstream medicine
In the 40+ years since the Roe v. Wade decision by the U.S. Supreme Court, abortion providers have been targeted in a number of ways. For example, eight members of the abortion-providing community (four physicians, two receptionists, one off-duty policeman, one escort) have been assassinated (NAF, 2014). Thousands more incidents of harassment, stalking, and vandalism have been directed at providers and their staff. Laws in 23 states mandate that abortion providers provide false information to patients (Gold & Nash, 2007). Legislators in Arizona and Kansas, among other places, have passed laws stipulating that doctors cannot be sued if they deliberately withhold from patients information, such as amniocentesis results, that might cause them to seek an abortion (Shepherd, 2012). Congress has interfered in an unprecedented manner in the practice of medicine, such as banning a certain technique used occasionally in later abortions (intact dilation and extraction) that abortion-providing physicians feel is the safest in certain situations (ACOG, 2006)—a ban ultimately upheld by the Supreme Court (Guttmacher Institute, 2007). Hundreds of “TRAP laws” (Targeted Regulation of Abortion Providers) have been passed, such as those pertaining to the physical requirements for abortion-providing facilities, which are widely Received February 17, 2014; accepted February 17, 2014. Address correspondence to Carole Joffe, PhD, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Oakland, CA 94612. E-mail: [email protected]; [email protected]
666
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Abortion Provider Stigma and Mainstream Medicine
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acknowledged to have little to do with safety and everything to do with forcing clinics to close as many cannot afford the required plant upgrades (Gold & Nash, 2013). Ultrasound viewings, and listening to a doctor’s description of the ultrasound, have been made mandatory for abortion patients in some states, and up to 72-hour waiting periods are required in others. As the above suggests, abortion provision has been highly regulated in the United States, and abortion providers have been subjected to unacceptable levels of violence and harassment—with some researchers referring to this violence as an “epidemic” (Grimes et al., 1991; Russo, Schumacher, & Creinin, 2012). How did this happen? In general, sociologists of occupations and professions have long taught that medicine is among the more “powerful” and prestigious of professions (Freidson, 1988) and historically, physicians’ organizations have been able to avoid most regulation by governmental bodies, and medical authority has been widely respected by the public. To be sure, this power has diminished in recent years for various reasons, especially the deliberations around health reform, but the fact remains that abortion providers, in their degree of marginality and thus vulnerability, are clearly outliers when compared to the rest of medicine. My own scholarship (Joffe, 1995) has argued that the origins of abortion providers’ present predicament lie in the pre-Roe era, when illegal abortions were plentiful and supplied by a wide range of providers. Some of those providing abortions were trained and competent physicians, “doctors of conscience” as I have called them, who risked imprisonment and loss of license for offering abortions to desperate women; others, whether doctors, other health care professionals, or laypersons, were far less competent, and often unethical—the infamous “back alley abortionists” or “butchers” as they have been named. For many in mainstream medicine, these incompetent practitioners became the face of abortion providers; after all, it was the “butchers’” patients (along with women who attempted self-abortion) who were disproportionately seen in hospital emergency rooms. Therefore, immediately after the Roe v Wade decision in 1973—a decision that was then strongly supported by most of the medical community—ob/gyn departments were highly resistant to normalizing abortion care within their hospitals (Jaffe, Lindheim, & Lee, 1980). This initial exclusion of abortion provision from hospital-based clinics was one of several factors that led to freestanding clinics becoming the major site for abortion services in the U.S. The freestanding clinics were (and remain) a positive development in a number of ways: e.g., lowered costs as compared to a hospital procedure, the ability to hire nursing and counseling staff who—unlike many hospital nurses—support women’s abortion decisions. The freestanding clinics, moreover, have amassed an impressive safety record—according to researchers, (Raymond & Grimes, 2012) about 14 times safer than childbirth. However, these facilities also made abortion even more separate from mainstream medicine, and, ultimately, more vulnerable to
Downloaded by [University of Strathclyde] at 04:58 12 October 2014
668
C. Joffe
abortion opponents. By 1988, some 15 years after Roe, blockades, fire bombings, and aggressive “sidewalk counseling” at clinics were commonplace; as Randall Terry, the founder of the militant anti-abortion group, Operation Rescue, put it in 1993, shortly before the first abortion-providing doctor was killed: “We’ve found the weak link is the doctor . . . We’re going to expose them. We’re going to humiliate them” (Bazelon, 2010). The provider community has responded to these attacks—both legislative and physical—in expected ways. That is, providers have expended huge amounts of resources on legal fees to try to challenge various restrictions, or failing that, to figure out how to best comply with them without compromising patient care. (Also, the two leading legal groups specializing in abortion cases, the Center for Reproductive Rights and the ACLU, have done an enormous amount of legal work pro bono.) Providers have spent similarly large sums on security upgrades—bullet-proof glass, video cameras, and so on—at both their offices and their homes. But what about the response from elsewhere in medicine? Have levels of adequate outrage been expressed from others in the medical community about the violence and the egregious level of regulation directed at their abortion-providing colleagues? Arguably, in the years since Roe, relatively little overt defense has been offered of abortion providers. One can speculate that this reluctance to defend abortion providers openly stems from a combination of still-lingering memories of the pre-Roe era, wariness about the potential of retribution from the anti-abortion movements, and perhaps most significantly, the medical profession’s longstanding aversion to controversy of any kind. (A notable exception to this reluctance to speak out is the organization Medical Students for Choice. The group was founded in direct response to the first murder of an abortion provider, David Gunn, in 1993, as well as to a mailing, around the same time, to medical students of a vulgar pamphlet urging violence against providers, sent by the anti-abortion group, Life Dynamics). In recent times, however, as the number of restrictions on abortion has multiplied, and grown ever more extreme, more individual physicians and medical organizations have protested this treatment. Most notably, in May 2012, two highly respected individuals—Marcia Angell, the former editor of the New England Journal of Medicine and currently a professor at Harvard Medical School, and Michael Greene, a professor of obstetrics and gynecology, also at Harvard—wrote, in a blistering essay in USA Today (the paper with the highest daily circulation in the country): . . . there is now an unprecedented and sweeping legal assault on women’s reproductive rights. New legislation is being introduced, and sometimes passed, in state after state that would roll back access to abortion . . . mainly by intruding on the relationship between doctor and patient . . . . But where are the doctors? They have been strangely silent
Abortion Provider Stigma and Mainstream Medicine
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about this legal assault, even though it directly interferes with medical practice. (Angell & Greene, 2012)
Additionally, other physician groups, such as medical societies in Pennsylvania, Wisconsin, Texas, and Arizona, have begun to speak out against abortion restrictions, because they interfere with the doctor-patient relationship. Most notably, arguably, the American College of Obstetricians and Gynecologists (ACOG), the professional group most associated with abortion care, has reversed a longstanding pattern of relative silence about abortion and has weighed in forcefully about both state restrictions and politicians’ high profile misstatements about abortion. For example, ACOG issued sharp rejoinders, during the 2012 election to candidates’ claims that no rapes ever result from abortions (ACOG, 2012) and that no women die from pregnancy complications (Brown, 2012). In at least one case, those who have spoken out have found themselves subject to the same intimidation as endured by their abortion-providing colleagues. In Georgia, whose legislature recently passed a bill to ban abortions after 20 weeks, a number of doctors who were not themselves abortion providers, but who testified against the legislation, experienced burglaries, fires, and harassing phone calls at their clinics and offices (Galloway & Simmons, 2012). The path to overcoming the stigma facing abortion providers is not clear-cut. One positive step in the normalization of abortion care within mainstream medicine has been the establishment of a privately-funded Fellowship in Family Planning and Abortion for post-residency ob-gyns interested in specialized training. This Fellowship has meant, among other things, that abortion providers who direct these fellowship programs are now on the faculties of leading medical institutions across the country, and they are training a new cadre of physicians who will not only themselves provide abortions in hospital settings, but also become researchers and publishers in this field. As important a step as this Fellowship is in integrating abortion care into mainstream medicine, for the foreseeable future most abortions will continue to take place in freestanding clinics, and the problems discussed here will remain. Of course, participants in the Fellowship program are also subject to the same state restrictions as other abortion providers are—though perhaps more insulated against the harassment that is commonplace at nearly all freestanding clinics. The situation does not have easy answers—either practical or theoretical—to the dilemmas facing abortion providers. Students of stigma need to push further to distinguish analytically between “stigma” and two related concepts that are often applied to abortion providers: “marginality” and “controversy.” These three phenomena are not identical, though they are often used synonymously. For example, many gatekeepers to abortion
670
C. Joffe
services in mainstream medicine (for example, hospital administrators or department chairpersons) are not opposed to abortion themselves and do not necessarily think of their colleagues who provide abortion as “stigmatized” individuals (Joffe, 2010). But these gatekeepers do fear the controversy that abortion care can bring to an institution. Pushing further on these distinctions is a fruitful way for our work to proceed.
Downloaded by [University of Strathclyde] at 04:58 12 October 2014
REFERENCES American College of Obstetricians and Gynecologists (ACOG). 2006. Amicus brief on Gonzales v Carhart, Nos. 05-380/1382, September 2006. Retrieved February 1, 2014 from http://reproductiverights.org/sites/default/files/documents/amicusbrief-ACOG.pdf American College of Obstetricians and Gynecologists (ACOG). 2012. Statement on rape and pregnancy. Washington, DC. August 20, 2012. Retrieved February 1, 2014 from http://www.acog.org/About_ACOG/News_Room/News_Releases/ 2012/Statement_on_Rape_and_Pregnancy Angell, M., and M. Greene. 2012. Where are the doctors? USA Today, May 15, 2012. Retrieved February 1, 2014 from http://usatoday30.usatoday.com/news/ opinion/forum/story/2012-05-15/women-contraception-abortion-reproductiverights-doctors/54979766/1 Bazelon, E. 2010. The new abortion providers. New York Times Magazine, July 14, 2010. Retrieved February 1, 2014 from http://www.nytimes.com/2010/07/18/ magazine/18abortion-t.html?pagewanted=all&_r=0 Brown, E. 2012. Doctors dispute ‘inaccurate’ abortion claim from Rep. Joe Walsh. Los Angeles Times, October 19, 2012. Retrieved February 1, 2014 from http://articles. latimes.com/2012/oct/19/news/la-heb-abortion-joe-walsh-backlash-20121019 Freidson, E. 1988. Profession of medicine: A study in the sociology of applied knowledge. Chicago: University of Chicago Press. Retrieved February 1, 2014 from http://press.uchicago.edu/ucp/books/book/chicago/P/bo3634980.html Galloway, J., and A. Simmons. 2012. Doctors fear testifying at State Capitol. Atlanta Journal Constitution, June 19, 2012. Retrieved from February 1, 2014 http:// www.ajc.com/news/news/local/doctors-fear-testifying-at-capitol/nQWcT/ Gold, R., and E. Nash. 2007. State abortion counseling policies and the fundamental principles of informed consent. Guttmacher Policy Rev 10: 6–13. Retrieved from February 1, 2014 http://www.guttmacher.org/pubs/gpr/10/4/gpr100406.html Gold, R., and E. Nash. 2013. TRAP laws gain political traction while abortion clinics—and the women they serve—pay the price.” Guttmacher Policy Rev 16:2. Retrieved February 1, 2014 from http://www.guttmacher.org/pubs/gpr/ 16/2/gpr160207.html Grimes, D., J. Forrest, A. Kirkland, and B. Radford. 1991. An epidemic of abortion violence in the United States. Am J Obstet Gynecol 165: 1263–8. Retrieved February 1, 2014 from http://www.ncbi.nlm.nih.gov/pubmed/1957842 Guttmacher Institute. 2007. Supreme Court upholds federal abortion ban, opens door for further restrictions by states. Guttmacher Policy Rev. Retrieved February 1, 2014 from http://www.guttmacher.org/pubs/gpr/10/2/gpr100219.html
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Jaffe, F., B. Lindheim, and P. Lee. 1980. Abortion politics: Private morality and public policy. New York: McGraw Hill Publishers. Retrieved February 1, 2014 from http://books.google.com/books/about/Abortion_politics. html?id=RmdoAAAAIAAJ Joffe, C. 1995. Doctors of conscience: The struggle to provide abortion before and after Roe v Wade. Boston: Beacon Press. Retrieved February 1, 2014 from http:// www.beacon.org/productdetails.cfm?PC=1469 Joffe, C. 2010. Dispatches from the abortion wars: The costs of fanaticism to doctors, patients and the rest of us. Boston: Beacon Press. Retrieved February 1, 2014 from http://www.beacon.org/productdetails.cfm?PC=2080 National Abortion Federation (NAF). 2014. Violence statistics. Washington, DC. Retrieved February 1, 2014 from http://www.prochoice.org/about_abortion/ violence/violence_statistics.html Raymond, E., and D. Grimes. 2012. The comparative safety of legal induced abortion and childbirth in the United States. Obstet Gynecol 119:215–9. Retrieved February 1, 2014 from http://www.ncbi.nlm.nih.gov/pubmed/22270271 Russo, J., K. Schumacher, and M. Creinin. 2012. Antiabortion violence in the United States. Contraception 86(5):562–6. Retrieved February 1, 2014 from http://www.ncbi.nlm.nih.gov/pubmed/?term=Jennifer+Russo+ Contraception+antiabortion+violence Shepherd, K. 2012. Arizona and Kansas pursue laws letting docs hide information from women. Mother Jones, March 9, 2012. Retrieved February 1, 2014 from http://www.motherjones.com/mojo/2012/03/arizona-and-kansaspursue-laws-letting-docs-hide-information-women
Women & Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wwah20
Commentary: Abortion Provider Stigma and Mainstream Medicine a
Carole Joffe PhD a
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California, USA Accepted author version posted online: 25 Jul 2014.Published online: 25 Sep 2014.
To cite this article: Carole Joffe PhD (2014) Commentary: Abortion Provider Stigma and Mainstream Medicine, Women & Health, 54:7, 666-671, DOI: 10.1080/03630242.2014.919985 To link to this article: http://dx.doi.org/10.1080/03630242.2014.919985
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Women & Health, 54:666–671, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 0363-0242 print/1541-0331 online DOI: 10.1080/03630242.2014.919985
Commentary: Abortion Provider Stigma and Mainstream Medicine CAROLE JOFFE, PhD
Downloaded by [University of Strathclyde] at 04:58 12 October 2014
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California, USA
This commentary describes the various manifestations of the stigmatization and marginalized status of abortion providers in relation to mainstream medicine. The article also addresses some of the current efforts to respond to this stigmatization. KEYWORDS
abortion, stigma, mainstream medicine
In the 40+ years since the Roe v. Wade decision by the U.S. Supreme Court, abortion providers have been targeted in a number of ways. For example, eight members of the abortion-providing community (four physicians, two receptionists, one off-duty policeman, one escort) have been assassinated (NAF, 2014). Thousands more incidents of harassment, stalking, and vandalism have been directed at providers and their staff. Laws in 23 states mandate that abortion providers provide false information to patients (Gold & Nash, 2007). Legislators in Arizona and Kansas, among other places, have passed laws stipulating that doctors cannot be sued if they deliberately withhold from patients information, such as amniocentesis results, that might cause them to seek an abortion (Shepherd, 2012). Congress has interfered in an unprecedented manner in the practice of medicine, such as banning a certain technique used occasionally in later abortions (intact dilation and extraction) that abortion-providing physicians feel is the safest in certain situations (ACOG, 2006)—a ban ultimately upheld by the Supreme Court (Guttmacher Institute, 2007). Hundreds of “TRAP laws” (Targeted Regulation of Abortion Providers) have been passed, such as those pertaining to the physical requirements for abortion-providing facilities, which are widely Received February 17, 2014; accepted February 17, 2014. Address correspondence to Carole Joffe, PhD, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Oakland, CA 94612. E-mail: [email protected]; [email protected]
666
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Abortion Provider Stigma and Mainstream Medicine
667
acknowledged to have little to do with safety and everything to do with forcing clinics to close as many cannot afford the required plant upgrades (Gold & Nash, 2013). Ultrasound viewings, and listening to a doctor’s description of the ultrasound, have been made mandatory for abortion patients in some states, and up to 72-hour waiting periods are required in others. As the above suggests, abortion provision has been highly regulated in the United States, and abortion providers have been subjected to unacceptable levels of violence and harassment—with some researchers referring to this violence as an “epidemic” (Grimes et al., 1991; Russo, Schumacher, & Creinin, 2012). How did this happen? In general, sociologists of occupations and professions have long taught that medicine is among the more “powerful” and prestigious of professions (Freidson, 1988) and historically, physicians’ organizations have been able to avoid most regulation by governmental bodies, and medical authority has been widely respected by the public. To be sure, this power has diminished in recent years for various reasons, especially the deliberations around health reform, but the fact remains that abortion providers, in their degree of marginality and thus vulnerability, are clearly outliers when compared to the rest of medicine. My own scholarship (Joffe, 1995) has argued that the origins of abortion providers’ present predicament lie in the pre-Roe era, when illegal abortions were plentiful and supplied by a wide range of providers. Some of those providing abortions were trained and competent physicians, “doctors of conscience” as I have called them, who risked imprisonment and loss of license for offering abortions to desperate women; others, whether doctors, other health care professionals, or laypersons, were far less competent, and often unethical—the infamous “back alley abortionists” or “butchers” as they have been named. For many in mainstream medicine, these incompetent practitioners became the face of abortion providers; after all, it was the “butchers’” patients (along with women who attempted self-abortion) who were disproportionately seen in hospital emergency rooms. Therefore, immediately after the Roe v Wade decision in 1973—a decision that was then strongly supported by most of the medical community—ob/gyn departments were highly resistant to normalizing abortion care within their hospitals (Jaffe, Lindheim, & Lee, 1980). This initial exclusion of abortion provision from hospital-based clinics was one of several factors that led to freestanding clinics becoming the major site for abortion services in the U.S. The freestanding clinics were (and remain) a positive development in a number of ways: e.g., lowered costs as compared to a hospital procedure, the ability to hire nursing and counseling staff who—unlike many hospital nurses—support women’s abortion decisions. The freestanding clinics, moreover, have amassed an impressive safety record—according to researchers, (Raymond & Grimes, 2012) about 14 times safer than childbirth. However, these facilities also made abortion even more separate from mainstream medicine, and, ultimately, more vulnerable to
Downloaded by [University of Strathclyde] at 04:58 12 October 2014
668
C. Joffe
abortion opponents. By 1988, some 15 years after Roe, blockades, fire bombings, and aggressive “sidewalk counseling” at clinics were commonplace; as Randall Terry, the founder of the militant anti-abortion group, Operation Rescue, put it in 1993, shortly before the first abortion-providing doctor was killed: “We’ve found the weak link is the doctor . . . We’re going to expose them. We’re going to humiliate them” (Bazelon, 2010). The provider community has responded to these attacks—both legislative and physical—in expected ways. That is, providers have expended huge amounts of resources on legal fees to try to challenge various restrictions, or failing that, to figure out how to best comply with them without compromising patient care. (Also, the two leading legal groups specializing in abortion cases, the Center for Reproductive Rights and the ACLU, have done an enormous amount of legal work pro bono.) Providers have spent similarly large sums on security upgrades—bullet-proof glass, video cameras, and so on—at both their offices and their homes. But what about the response from elsewhere in medicine? Have levels of adequate outrage been expressed from others in the medical community about the violence and the egregious level of regulation directed at their abortion-providing colleagues? Arguably, in the years since Roe, relatively little overt defense has been offered of abortion providers. One can speculate that this reluctance to defend abortion providers openly stems from a combination of still-lingering memories of the pre-Roe era, wariness about the potential of retribution from the anti-abortion movements, and perhaps most significantly, the medical profession’s longstanding aversion to controversy of any kind. (A notable exception to this reluctance to speak out is the organization Medical Students for Choice. The group was founded in direct response to the first murder of an abortion provider, David Gunn, in 1993, as well as to a mailing, around the same time, to medical students of a vulgar pamphlet urging violence against providers, sent by the anti-abortion group, Life Dynamics). In recent times, however, as the number of restrictions on abortion has multiplied, and grown ever more extreme, more individual physicians and medical organizations have protested this treatment. Most notably, in May 2012, two highly respected individuals—Marcia Angell, the former editor of the New England Journal of Medicine and currently a professor at Harvard Medical School, and Michael Greene, a professor of obstetrics and gynecology, also at Harvard—wrote, in a blistering essay in USA Today (the paper with the highest daily circulation in the country): . . . there is now an unprecedented and sweeping legal assault on women’s reproductive rights. New legislation is being introduced, and sometimes passed, in state after state that would roll back access to abortion . . . mainly by intruding on the relationship between doctor and patient . . . . But where are the doctors? They have been strangely silent
Abortion Provider Stigma and Mainstream Medicine
669
Downloaded by [University of Strathclyde] at 04:58 12 October 2014
about this legal assault, even though it directly interferes with medical practice. (Angell & Greene, 2012)
Additionally, other physician groups, such as medical societies in Pennsylvania, Wisconsin, Texas, and Arizona, have begun to speak out against abortion restrictions, because they interfere with the doctor-patient relationship. Most notably, arguably, the American College of Obstetricians and Gynecologists (ACOG), the professional group most associated with abortion care, has reversed a longstanding pattern of relative silence about abortion and has weighed in forcefully about both state restrictions and politicians’ high profile misstatements about abortion. For example, ACOG issued sharp rejoinders, during the 2012 election to candidates’ claims that no rapes ever result from abortions (ACOG, 2012) and that no women die from pregnancy complications (Brown, 2012). In at least one case, those who have spoken out have found themselves subject to the same intimidation as endured by their abortion-providing colleagues. In Georgia, whose legislature recently passed a bill to ban abortions after 20 weeks, a number of doctors who were not themselves abortion providers, but who testified against the legislation, experienced burglaries, fires, and harassing phone calls at their clinics and offices (Galloway & Simmons, 2012). The path to overcoming the stigma facing abortion providers is not clear-cut. One positive step in the normalization of abortion care within mainstream medicine has been the establishment of a privately-funded Fellowship in Family Planning and Abortion for post-residency ob-gyns interested in specialized training. This Fellowship has meant, among other things, that abortion providers who direct these fellowship programs are now on the faculties of leading medical institutions across the country, and they are training a new cadre of physicians who will not only themselves provide abortions in hospital settings, but also become researchers and publishers in this field. As important a step as this Fellowship is in integrating abortion care into mainstream medicine, for the foreseeable future most abortions will continue to take place in freestanding clinics, and the problems discussed here will remain. Of course, participants in the Fellowship program are also subject to the same state restrictions as other abortion providers are—though perhaps more insulated against the harassment that is commonplace at nearly all freestanding clinics. The situation does not have easy answers—either practical or theoretical—to the dilemmas facing abortion providers. Students of stigma need to push further to distinguish analytically between “stigma” and two related concepts that are often applied to abortion providers: “marginality” and “controversy.” These three phenomena are not identical, though they are often used synonymously. For example, many gatekeepers to abortion
670
C. Joffe
services in mainstream medicine (for example, hospital administrators or department chairpersons) are not opposed to abortion themselves and do not necessarily think of their colleagues who provide abortion as “stigmatized” individuals (Joffe, 2010). But these gatekeepers do fear the controversy that abortion care can bring to an institution. Pushing further on these distinctions is a fruitful way for our work to proceed.
Downloaded by [University of Strathclyde] at 04:58 12 October 2014
REFERENCES American College of Obstetricians and Gynecologists (ACOG). 2006. Amicus brief on Gonzales v Carhart, Nos. 05-380/1382, September 2006. Retrieved February 1, 2014 from http://reproductiverights.org/sites/default/files/documents/amicusbrief-ACOG.pdf American College of Obstetricians and Gynecologists (ACOG). 2012. Statement on rape and pregnancy. Washington, DC. August 20, 2012. Retrieved February 1, 2014 from http://www.acog.org/About_ACOG/News_Room/News_Releases/ 2012/Statement_on_Rape_and_Pregnancy Angell, M., and M. Greene. 2012. Where are the doctors? USA Today, May 15, 2012. Retrieved February 1, 2014 from http://usatoday30.usatoday.com/news/ opinion/forum/story/2012-05-15/women-contraception-abortion-reproductiverights-doctors/54979766/1 Bazelon, E. 2010. The new abortion providers. New York Times Magazine, July 14, 2010. Retrieved February 1, 2014 from http://www.nytimes.com/2010/07/18/ magazine/18abortion-t.html?pagewanted=all&_r=0 Brown, E. 2012. Doctors dispute ‘inaccurate’ abortion claim from Rep. Joe Walsh. Los Angeles Times, October 19, 2012. Retrieved February 1, 2014 from http://articles. latimes.com/2012/oct/19/news/la-heb-abortion-joe-walsh-backlash-20121019 Freidson, E. 1988. Profession of medicine: A study in the sociology of applied knowledge. Chicago: University of Chicago Press. Retrieved February 1, 2014 from http://press.uchicago.edu/ucp/books/book/chicago/P/bo3634980.html Galloway, J., and A. Simmons. 2012. Doctors fear testifying at State Capitol. Atlanta Journal Constitution, June 19, 2012. Retrieved from February 1, 2014 http:// www.ajc.com/news/news/local/doctors-fear-testifying-at-capitol/nQWcT/ Gold, R., and E. Nash. 2007. State abortion counseling policies and the fundamental principles of informed consent. Guttmacher Policy Rev 10: 6–13. Retrieved from February 1, 2014 http://www.guttmacher.org/pubs/gpr/10/4/gpr100406.html Gold, R., and E. Nash. 2013. TRAP laws gain political traction while abortion clinics—and the women they serve—pay the price.” Guttmacher Policy Rev 16:2. Retrieved February 1, 2014 from http://www.guttmacher.org/pubs/gpr/ 16/2/gpr160207.html Grimes, D., J. Forrest, A. Kirkland, and B. Radford. 1991. An epidemic of abortion violence in the United States. Am J Obstet Gynecol 165: 1263–8. Retrieved February 1, 2014 from http://www.ncbi.nlm.nih.gov/pubmed/1957842 Guttmacher Institute. 2007. Supreme Court upholds federal abortion ban, opens door for further restrictions by states. Guttmacher Policy Rev. Retrieved February 1, 2014 from http://www.guttmacher.org/pubs/gpr/10/2/gpr100219.html
Downloaded by [University of Strathclyde] at 04:58 12 October 2014
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