As I look out over the Arizona desert at Saguaro cacti glistening in the crisp morning sun, I ponder the life of a desert caballero. Of course I have my own set of assumptions about what a desert cowboy might look like with his/her sun-painted leather skin, blue jeans, bolo tie, silk neck scarf and felt cowboy hat. These images are based on what I have been exposed to in my life or absorbed in our media-cluttered world; they are my stereotypes. My husband and I fantasize about the cowboy’s “simple life” on horseback as we both attempt to tackle the challenges of integrated care in our work lives back home in Colorado. However, this imaginary cowboy dream got me thinking: Do I really know what it is like to be a caballero? Do I truly comprehend the ins and outs of a cowboy’s day?
Contemplating how stereotypes impact my thoughts, feelings and behavior, I am reminded of the Providers Share Workshops created by Jane A. Hassinger, Lisa H. Harris, Lisa A. Martin and Michelle Debbink at The University of Michigan to help explore the experiences of people around the world who provide safe abortion services.1 The Provider Share Workshop was designed to both support and study the experiences of abortion providers and to lessen the burdens of stigma for providers.
Sadly, we live in a world today where stereotypes and stigma not only shape our perceptions, but also strongly influence the national healthcare dialogue. Abortion providers are one example of a highly stigmatized group silenced by stereotypes and judgment. Abortion providers live in a world of harassment, hate mail, and violent language surrounding the care they provide. The most recent shootings that occurred outside of a Colorado Springs Planned Parenthood clinic this past November highlights the ongoing threat of violence focused on abortion providers. It has been over 40 years since the Supreme Court’s decision to legalized abortion in Roe vs. Wade, yet abortion providers often still work in a cloud of silence.
As a facilitator of Provider Share Workshops I learned about how abortion providers rarely feel comfortable disclosing their professional reproductive health work to neighbors, friends and even family. In order to keep at it--providing the high quality comprehensive reproductive healthcare in a safe and supportive environments-- many abortion providers report “a walling off” from fellow colleagues, family and friends. Their silence is associated with disproportionally higher rates of attrition (compared to their primary care counterparts) despite decades of stable abortion rates. Additionally, the number of abortion providers has declined in the US because fewer and fewer hospitals provide abortion care.2 Harris et al. explain these dynamics as the “legitimacy paradox”.3 One would think that because we don’t talk about abortion that it is rare, when in fact about half of American women will have an unintended pregnancy, and nearly 3 in 10 will have an abortion, by age 45.4-5
Jane A. Hassinger, Lisa H. Harris, Lisa A. Martin and Michelle Debbink at The University of Michigan have referred to abortion care as a kind of socially stigmatized ‘dirty work‘ that can both positively and negatively impact providers. In facilitating Provider Share Workshops in North and South America I have been given a snap shot of the palpable stigma that harms the future of safe reproductive care in our society. The stigma of abortion doesn’t just impact the women who seek care, but it impacts the lives of the courageous providers who show up to work daily to ensure that reproductive healthcare is accessible to all. While facilitating these workshops I have witnessed the processes by which stigma, prejudice, discrimination, criminalization and misrepresentation of reproductive healthcare providers are acknowledged, deconstructed, and resisted. By creating a safe space for sharing and exploring abortion provider experiences, this type of provider support acts as a form of stigma management. Like most support groups, the Provider Share Workshop fosters interpersonal connections that help alleviate many of the burdens of abortion stigma.
What makes Provider Share Workshop unique is that it provides a space to develop hope for silenced providers through different medium then transactional daily interactions. The activities in the workshop collage-making, sharing stories of memorable patients, and exploring the challenges of disclosure create a vehicle of expression for the men and women who provide safe abortion care. The space created by the artistic expression of these exercises gives voice to the individual and collective silence surrounding abortion care. As a facilitator of these workshops I am honored to support abortion providers, and I am humbled by the courage they demonstrate daily to provide safe and high quality care. I am also challenged to envision other ways in which we can fight stigma and silence.
As my cowboy dream fades away while watching the desert shadows move in the morning light, I am reminded that we have a long ride ahead in our efforts to breakdown the stereotypes and stigma which plague reproductive healthcare providers. I invite CFHA readers to explore their own internalized stigma regarding abortion care and contemplate how these stereotypes may impact the care of their patients and collaboration with fellow reproductive healthcare providers. Take a moment and imagine if we lived in a world where abortion providers were given as much respect as surgeons, oncologist and family medicine providers; maybe our patients would experience fewer stigmas and more opportunity to access safe reproductive care. Abortion is in fact one of the safest common surgical procedures for women in the United States.2 Maybe abortion services would take their rightful place on the continuum of reproductive choices and reproductive health services for women around the world.
To learn more click here: An Overview of Abortion in the United States. January 2014
Thekla Brumder Ross, PsyD is a bilingual Behavioral Health Clinician at Kaiser Permanente’s Care Management Institute and Northern California’s Division of Research. She has worked for the Care Management Institute since 2014 and Northern California since 2009. Prior to joining Kaiser Permanente in 2009, she received a Bachelor of Arts in psychology from Colorado College in Colorado Springs, CO and her Master and Doctorate degrees from the California School of Professional Psychology in San Francisco, California. She has also completed additional training in integrated behavioral health consultation and management from the University of Massachusetts Medical School. Dr. Ross facilitates Provider Share Workshops domestically and internationally in collaboration with Planned Parenthood Federation and The University of Michigan.
1. Dynamics of stigma in abortion work: findings from a pilot study of the providers share workshop. Soc Sci Med. 2011;73:1062–1070(]
2. Guttmacher Institute. An Overview of Abortion in the United States. January 2014
3. Physicians, abortion provision and the legitimacy paradox. Lisa H. Harris; Lisa Martin; Michelle Debbink; Jane Hassinger. Contraception. 2013;87(1):11-16
4. Henshaw SK, Unintended pregnancy in the United States, Family Planning Perspectives, 1998, 30(1):24–29 & 46.
5. Jones RK and Kavanaugh ML, Changes in abortion rates between 2000 and 2008 and lifetime incidence of abortion, Obstetrics & Gynecology, 2011, 117( 6):1358–1366