Stigma and issues of conscience

Kelly R. Culwell, Caitlin Gerdts

Research output: Chapter in Book/Report/Conference proceedingChapter


Abortion is a common experience for women of reproductive age around the world [1]. Just as common is the experience of abortion-related stigma. In different contexts, social, cultural and religious factors may all engender abortion stigma and may contribute to who is affected by abortion stigma and why and how [2, 3]. Despite near universal stigma surrounding abortion [3], and most likely in response to the devastating public health consequences of unsafe abortion, the trend in recent decades has been toward liberalization of abortion laws in nearly all regions of the world [4]. With this progress has come an increased understanding of the role that abortion stigma plays as a barrier to safe services, in both legally restricted and legally permissive contexts. And in some countries, implementation of less restrictive abortion laws has been hindered by negative attitudes among healthcare workers leading to widespread, and often unregulated, conscientious objection [4]. In this chapter, the current theoretical understandings of these issues will be covered as well as the key research which has begun to explore how to measure abortion stigma as well as some early interventions to address stigma with the ultimate goal of improving access to safe abortion services. The potential links between abortion stigma and issues of conscience in abortion care will also be described along with the ways that professional organizations and health systems aim to balance refusals to provide abortion services based on conscience with women’s right to access information and safe services. Finally, gaps in our current knowledge will be identified and recommendations made for future research in theory building, measurement and intervention. Conceptualization. Over nearly half a century, and in multiple disciplines, the topic of stigma has received much theoretical and empirical consideration. In his seminal book, Erving Goffman offered a comprehensive description of the many manifestations of stigma and the mechanisms through which stigmas impact upon social interactions [5]. Goffman defined stigma as attributes that reduce an individual from a 'whole and usual person to a tainted, discounted one'. Throughout human history stigmas have been associated with myriad physical, behavioural and ideological differences that operate at the individual and group levels. Stigmas can be damaging to both individuals and to society [6]. Stigma-related research is necessary to improve understanding of the causes and consequences of stigmas and is important in mitigating the negative effects associated with stigmas.

Original languageEnglish (US)
Title of host publicationAbortion Care
PublisherCambridge University Press
Number of pages9
ISBN (Electronic)9781107338623
ISBN (Print)9781107647381
StatePublished - Jan 1 2014
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)


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