In combatting abortion stigma, finding the most responsible and effective tools

by JoAnn DiLernia, Planned Parenthood GlobalMaking inroads, 16 April 2016For more than 45 years, Planned Parenthood Global (PP Global) has been working to expand access to safe and legal abortion services, especially where access to providers is most needed. A big part of that work is combating abortion stigma… We take a multi-pronged approach:The World Health Organization has recommended that abortion be provided at the lowest level of care. PP Global agrees and designed a protocol for misoprostol for first trimester abortion administered by low level health care workers, called Community Based Access to Misoprostol (CBAM). Our trainings and training materials aim to support the delivery of services to women where they are most needed, and access to an abortion provider is limited.Secondly, we have been working with the University of Michigan to implement Provider Share Workshops (PSWs) with providers in the Latin American countries we work in to help reduce their internalized and felt stigma. These workshops have been used to strengthen PP Global’s Abortion Provider Support Network. And third, we are beginning to use research to bolster our efforts against stigma through CBAM. Implemented in 2013 by a local partner, we identified a shift in women’s opinions regarding abortion and decided to explore this further. We designed a mixed-method study aimed to compare the prevalence of abortion stigma in three communities based on their access to a provider. This study consisted of community based surveys and in-depth interviews with providers and their clients. We hypothesized that the presence and length of time a community-based abortion provider was in the community would influence and ultimately reduce the existing levels of abortion stigma.Because abortion is highly stigmatized, it is infrequently discussed in the communities where we work. For example, we feared that conducting research could cause harm to our study respondents by exposing both abortion providers and women seeking abortions. Exposure could put our respondents at risk of being ostracized from the community, shamed, ridiculed, and potentially exposed to legal consequences. We had to ask ourselves what was more important: scientific rigor or the privacy of study respondents. After further examination we ultimately decided that the protection of our providers’ and clients’ privacy was more important than the rigor of the study. In order to respect the privacy of our study group and also gather important evidence on stigma, we decided to use the PP Global staff who already worked with the providers as interviewers; and in turn had the providers interview their own patients.In a three-day workshop, PP Global staff and a representative from Ibis Reproductive Health trained providers on how to conduct in-depth interviews… In all, we conducted seven provider interviews and 30 client interviews. Following data collection, we conducted a semi-structured debrief with the providers to learn more about their overall experience and gather complementary insight that was not captured via the client interview recordings. The debrief served as an opportunity to identify lessons learned and brainstorm ideas with the providers about future research and interventions.All in all, this methodology seemed to be a success. The reaction of providers was overwhelming. They were excited about the process of being involved in a research study, and reported that the clients were excited and happy to help the providers who helped them. The providers also mentioned that the women were also extremely grateful to the providers and presented their story as a testimony. …We gained a safe space for clients and providers alike to talk about and discuss their experience with abortion and abortion stigma. To us, this has proved to be one of the biggest successes of this project.