2022 was a relatively eventful year for abortion rights, both in the UK and beyond. In the United States, a long-brewing challenge to safe abortion provision finally became concrete, with the overturning of the Supreme Court ruling which, in 1973, had legalised abortion in America. While never quite so politically polarised in the UK, an increasing level of anti-abortion protests (commonly supported by US-based organisations) have recently been seen and heard outside abortion clinics in the UK. As such, so-called ‘buffer zones’ (or ‘safe zones’) have been proposed as a means of protecting those attending sexual and reproductive health clinics, as well as the staff/health professionals who work in them.
While abortion is partially decriminalised in the UK, this does not translate into equitable access across the board, nor to reproductive rights in pregnancy being a given. Home self-management of early abortion using medication (now the most common form of abortion) has been allowed since early in the COVID-19 pandemic. This may have improved access for some, and research on this provision is due to be published next year. However, access to abortion at later gestations is limited and, in Scotland, is not currently provided after 20 weeks, despite the legal limit of 24 weeks. Although recommended by Royal College of Obstetricians and Gynaecologists, a choice of method (namely between medication and surgical alternatives) may not always be a choice per se, especially where the pregnant person would face a much longer wait for a surgical option.
Moreover, provision in Northern Ireland is still problematic, despite having been decriminalised in 2019. The United Nations Committee on the Elimination of Discrimination against Women (CEDAW) found in 2018 that ‘thousands of women and girls in Northern Ireland are subjected to grave and systematic violations of rights’, due to denial of abortion access. However, the recommendations made in that report are yet to be fully implemented. While almost 3000 early medical abortions have been provided via interim services since March 2019, hundreds continue to have to travel for treatment where surgical abortions are needed, unless a foetal abnormality has been detected. Abortion services in Northern Ireland are yet to receive government funding, and currently rely on the good will of abortion providers.
Between 2018 and 2021, we conducted a qualitative secondary analysis (QSA) study of datasets relating to abortion from across the UK. We drew on data from 11 studies conducted from 2008 to 2018, using QSA to look at them again with different research questions in mind. We were particularly focused on manifestations of stigma, and how these related to norms of femininity.
As the study evolved, and we closely examined the language used around abortion in these various datasets, we became interested not only in how and where stigma appears and what it does, but also in normalisation. As the flip side of stigmatisation, a normalisation lens focuses attention on ways in which the negativity which often dominates talk about abortion might be challenged and how change might be embedded. Focusing on the language of abortion, we identified ways in which abortion is talked about by those with first-hand experience: namely women* who had undergone the procedure and health professionals involved in providing it. Using a narrative inquiry approach, we examined the language that forms the building blocks of common understandings of what abortion ‘is’.
What we found is that, while abortion is often framed negatively – as a social problem, or something that people might morally disagree with – it is not experienced negatively by everyone who has had one. We identified examples from our data where abortion was described as a positive life event. Abortion was presented by many as the ‘right choice’ and, for some, as something which made them happy. This counters the view, commonly presented in the media and elsewhere, that abortion is by default negative, and should by default be framed as problematic.
However, we also found strongly positive accounts of abortion experiences to be rare. Where relatively positive descriptions did appear, they were often closely intertwined with negative language relating, for example, to the rejection of shame and guilt (“I did not feel guilty”, “I am not ashamed”). This finding highlights both the complexity of women’s feelings about abortion, and suggests that some may feel they can only talk about abortion in ways that are currently the norm, namely that abortion is, by default, difficult and negative. As such, talking about it in other ways may not always be seen as an option, even where it more accurately reflects lived experience.
Importantly, we noted a conflict between ways women talked about abortion in general (as a positive option which should be available), and abortion as their lived experience (which was in some ways challenging for them as an individual). Understanding and accepting that these two points of view can co-exist is key to recognising the complex reality of abortion as a lived experience.
Based on our findings, we have suggested that the dominance of negativity around abortion needs to shift in order to normalise a broader repertoire of language to describe and understand abortion. Reworking negative framings of abortion in healthcare, the media, and elsewhere in society could support anyone undergoing abortion to more effectively and accurately articulate and interpret their experiences. Positive changes could include encouraging a shift in how health professionals talk about abortion in order to support normalisation, that is, to widen understanding of it as essential, everyday reproductive healthcare.
We can see the way that the events of 2022 are evidence of the deep embedding of abortion stigma in complex social structures and power relationships. At present, measures to combat abortion stigma tend to emerge at the level of individuals, such as supporting women and pregnant people not to feel negatively should they need to seek an abortion. A bigger challenge, and a question which would benefit from greater sociological attention, is how abortion stigma might be addressed at a more fundamental level, in order to drive normalisation more broadly.
You can find out more about the SASS study here: www.sassproject.org.uk
*In the case of these studies, all were cisgender women.
Dr Carrie Purcell is a Research Fellow at the Open University. Carrie is a medical sociologist specialising in qualitative research in the context of reproductive health. As PI on the SASS project, Carrie led the only qualitative secondary analysis study to date looking at abortion across the UK’s different jurisdictions. Her work has been published in a range of journals including Sociology of Health & Illness, Contraception, Feminism & Psychology, and BMJ Sexual & Reproductive Health. Carrie has conducted various abortion-related projects over the last decade, including women’s experiences of later (16+ weeks) abortion, more than one abortion, and women and health professional’s experiences of early medical abortion. Carrie is a recognised expert on abortion in Scotland, and is a regular contributor to policy and public debate. Twitter: @DrCarrieP / @SASS_project
Professor Lesley Hoggart is Professor of Social Policy Research, in the School of Health, Wellbeing and Social Care at the Open University. Lesley specialises in qualitative research, and her research interests are focused on reproductive health; abortion policy and politics; teenage pregnancy and motherhood; and sexual health. Her recent publications include work on fertility knowledge, abortion stigma and contraception. She is an Associate Editor of BMJ Sexual and Reproductive Health.
Lesley’s work on understanding abortion stigma has resulted in the multi-media MyBodyMyLife travelling pop-up installation and website. Lesley’s research is based firmly on women’s experiences, and her public engagement work utilises storytelling to convey powerful messages. Lesley also leads development and evaluation of the charity Abortion Talk. Twitter: @DrHoggart
Dr Fiona Bloomer is a Senior Lecturer at Ulster University, in the School of Applied Social and Policy Sciences. Her research centres on abortion, and its intersections with policy, stigma, and faith. She has led on studies of abortion as a workplace issue, the political discourse on abortion, the translation of human rights norms into discourses on abortion, as well as collaborating on a study of adult community education on abortion. Fiona is co-author of Reimagining Global Abortion Politics: A Social Justice Perspective (2019), and co-edited Crossing Troubled Waters: Abortion in Ireland, Northern Ireland, and Prince Edward Island (2018). She is a founding member of the Reproductive Health Law and Policy Advisory Group and, in 2016, she hosted the UKs first international interdisciplinary conference on abortion (Abortion and Reproductive Justice: The Unfinished Revolution II). Twitter: @DrBloomer