Structural stigmatisation of abortion in the health system
Perspectives of abortion care-seekers, providers, managers, and funders in England and Wales
Bibliographic Data
| ID | 4955145 |
|---|---|
| Authors | Katy Footman (0000-0001-8606-7326, London School of Economics and Political Science, corresponding author) |
| Year | 2025 |
| Volume | 365 |
| Pages | 117566 |
| Publication date | 2025-01-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Social Science & Medicine (JOURNAL) |
| Journal identifiers | ISSN: 0277-9536 • E-ISSN: 1873-5347 |
| Publisher | Elsevier BV (PUBLISHER) |
| DOI | 10.1016/j.socscimed.2024.117566 |
| PMID | 39631301 |
| OpenAlex | W4404794650 |
| Language | EN |
| Citations received | 4 |
| References cited | 35 |
Abortion has been legally permitted in England and Wales for over fifty years, yet this health service continues to be stigmatised within the health system. Stigma is a dominant focus of abortion research, but a structural stigma framework is rarely used to understand how abortion stigma is produced at a macro-level. This study explored how structural abortion stigma is produced and experienced in the health systems of England and Wales, and its influence on person-centred care, including choice of abortion methods. Data from in-depth interviews with abortion care-seekers in 2022-23 and from key informant interviews with abortion care providers, managers, and commissioners in 2021 were analysed using reflexive thematic analysis. From the perspectives of key informants, structural abortion stigma is produced through the avoidance of abortion by decision-makers, the permitting of conscientious objection, and the exclusion of abortion from mainstream healthcare. These factors create health system pressures which increase abortion service fragility. The resulting vulnerability of abortion services reduces access to person-centred care, including abortion method choice, which can reinforce individual-level stigma. There are tensions between care-seekers' experiences of specialist abortion care as less stigmatising, while the 'abortion clinic' becomes a site of stigma due to its segregation from mainstream healthcare. This research contributes to a structural understanding of abortion stigma by identifying some of the mechanisms through which structural stigma is produced within health system institutions, and how these forms of institutional stigma might be resisted or dismantled. Power is essential to the (re)production of structural stigma within the health system, which can reinforce individual-level stigma for both care-seekers and providers. Restrictions on method choice and the increasing reliance on medication abortion can be a product of structural abortion stigma, and these limitations on method choice can also reproduce stigma at the individual level
Abortion · Criminology · Political science · Pregnancy · Seekers · Sociology · Adolescent Sexual and Reproductive Health · Grief, Bereavement, and Mental Health · Law · Medicine · Reproductive Health and Contraception
Stigma
Inclusion of abortion-related care in national health benefit packages
Navigating paradox in self-care
Structural barriers or patient preference? A mixed methods appraisal of medical abortion use in England and Wales
Governmental decisions to allow home use of misoprostol for early medical abortion in the UK
Abortion policy implementation in Ireland
Health care providers' attitudes towards termination of pregnancy
Implementation considerations when expanding health worker roles to include safe abortion care
Abortion Stigma
Resisting abortion stigma in situ
Why does abortion stigma matter? A scoping review and hybrid analysis of qualitative evidence illustrating the role of stigma in the quality of abortion care
The Sociology of Women's Abortion Experiences
Exploring provider preference and provision of abortion methods and stigma
Abortion stigma as a social process
Shame on Us
Conceptualising abortion stigma
Introduction to the special issue on structural stigma and health
The illusion of treatment choice in abortion care
Normalizing the exceptional
Rethinking the sociology of stigma
Abortion stigma, abortion exceptionalism, and medical curricula
Abortion
The changing landscape of abortion care
Conceptualizing Stigma
| Unique citing works | 4 |
|---|---|
| Citations per year | 4 |
| Citation span | 2025 - 2026 (2) |
| Citation velocity | current |
| Highly cited | No |
| Citation types | Neutral: 2 |