IRELAND – Exploring providers’ experience of stigma following the introduction of more liberal abortion care

by Brendan Dempsey, Mary Favier, Aoife Mullally, Mary F Higgins

Contraception, 14 April 2021  (Article in press, Open access)

Abortion services were introduced in Ireland in 2019. A survey was sent to 300 abortion providers – doctors, nurses and midwives, and GPs – between January and May 2020, of whom 156 hospital doctors and GPs responded. The survey was carried out by researchers in the National Maternity Hospital and the Coombe, and was published in the journal Contraception in April 2021.

The main aim of the survey was to measure any stigma experienced, using a 35-item version of the Abortion Providers Stigma Scale. Data were also collected on demography, professional involvement in providing abortion care, and risk of burnout. Hospital-based obstetricians who responded and midwives/nurses reported higher stigma than their colleagues working in general practice. The findings also raise some questions about whether more stigma may be attached to surgical abortion, which happens in hospitals, than medical abortion. Burnout did not appear to be a problem.

A number of comparisons were made with providers’ experiences in the USA. For example, the research found that while Irish doctors suffered fewer verbal or physical attacks than their American counterparts and reported fewer issues in disclosing their abortion work than providers in the USA, they did report higher levels of social isolation.

The need to conceal abortion work to preserve safety does not appear to be as prominent for the Irish providers as they also reported fewer experiences of judgment compared to the USA sample. Discrimination also appeared to be lower for the Irish sample, for example, 15% in Ireland had experienced a verbal threat or attack related to their abortion work compared to 51% in the USA. Fewer experiences of judgment and discrimination among the Irish providers may be related to the public support for the service, as evidenced by the strength of the national vote for expanded abortion care.

The hospital staff in the Irish sample were all involved in providing surgical and/or later-gestation abortion care, meaning they had to work in a team to provide care and that may be how they are exposed to stigma. Difficulties in providing abortion care as part of a team have been discussed by fetal medicine specialists in Ireland, where feelings of disapproval and disrespect from colleagues, as well as resistance and conflict were noted. By contrast, the GPs in Ireland work in much smaller practices, and provide early medical abortion, so they can provide care without the assistance of others, shielding them from stigmatising interactions.

The study was not necessarily representative but it opened a door to issues that deserve further exploration. The authors call for quantitative research in this area to be conducted throughout Europe to document and compare providers’ experience of stigma and to explore if designated supports for providers may be beneficial. However, they note that stigma is only one facet of the challenges related to providing abortion care.