Dynamics of stigma in abortion work: Findings from a pilot study of the Providers Share Workshop Lisa Hope Harris a, * , Michelle Debbink b , Lisa Martin c , Jane Hassinger d a Department of Obstetrics and Gynecology, Department of Women’s Studies, Program in Sexual Rights and Reproductive Justice, University of Michigan, L4000 Women’s Hospital,1500 East Medical Center Drive, Ann Arbor, MI 48109, USA b Department of Health Management and Policy, School of Public Health and Medical School, University of Michigan, MI, USA c Women’s and Gender Studies and Health Policy, University of Michigan - Dearborn, MI, USA d Department of Women’s Studies, Institute for Research on Women and Gender, University of Michigan, MI, USA article info Article history: Available online 28 July 2011 Keywords: Abortion Stigma Dirty work Workshop USA Care providers Health workers Abortion clinic abstract Abortion is highly stigmatized in the United States. The consequences of stigma for abortion providers are not well understood, nor are there published accounts of tools to assess or alleviate its burdens. We designed The Providers Share Workshop to address this gap. Providers Share is a six-session workshop in which abortion providers meet to discuss their experiences, guided by an experienced facilitator. Seventeen workers at one US abortion clinic participated in a pilot workshop. Sessions were recorded and transcribed, and an iterative process was used to identify major themes. Participants highlighted stigma, located in cultural discourse, law, politics, communities, institutions (including the abortion clinic itself), and relationships with family, friends and patients. All faced decisions about disclosure of abortion work. Some chose silence, fearing judgment and violence, while others chose disclosure to maintain psychological consistency and be a resource to others. Either approach led to painful interpersonal disconnections. Speaking in the safe space of the Workshop fostered interpersonal connections, and appeared to serve as an effective stigma management tool. Participants reflected favorably upon the experience. We conclude that the Providers Share Workshop may alleviate some of the burdens of abortion stigma, and may be an important intervention in abortion human resources. We present a conceptual model of the dynamics of stigma in abortion work. Ó 2011 Elsevier Ltd. All rights reserved. Introduction For complicated moral and political reasons, abortion is highly stigmatized in the United States (Luker, 1985; McKeegan, 1993). Stigma may arise from the conviction that women who have abortions deviate from feminine ideals, eschewing rather than embracing motherhood, and harming rather than nurturing chil- dren (Joffe, 1987; Kumar, Hessini, & Mitchell, 2009). Stigma’s roots may lie in some people’s belief that abortion is equivalent to killing a born person, or in disapproval of behaviors believed to have led to abortion e for example pre-marital sex, or “irresponsible” use of contraceptives. Abortions in the US are commonly performed in stand-alone clinics, which reflects and may reinforce its margin- alized status (Gottlieb, 1995; Joffe, 1995). Significant adverse consequences of stigma for women who seek abortion have been documented, but the impact of stigma on abortion providers has received relatively little attention (Kumar et al., 2009; Littman, Zarcadoolas, & Jacobs, 2009; Major & Gramzow, 1999). Goffman (1963a, p. 3) first described stigma as an “attribute that is deeply discrediting”, and noted that stigma transforms people from “whole and usual” individuals to “tainted”, discounted ones in the minds of those around them. Link and Phelan (2001) empha- sized the relational nature of stigma e that it always includes a stigmatizer e and they accent the agency and resistance of those who are stigmatized. Hughes (1956, 1958, 1971, pp. 338e347) called stigmatized work “dirty work”, and its practitioners “dirty workers”. These workers perform socially necessary functions that are tainted by physically disgusting, socially degrading, or morally dubious elements. Classic examples include garbage collectors, gravediggers, and executioners (Hughes, 1956, 1958, 1971, pp. 338e347). Abortion work is dirty work, associated with all three taints: physical (blood, fetal parts); social (contact with stigmatized patients); and moral (ambiguous fetal moral status) (Ashforth & * Corresponding author. Tel.: þ1 734 546 2849. E-mail address: lhharris@med.umich.edu (L.H. Harris). Contents lists available at ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed 0277-9536/$ e see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2011.07.004 Social Science & Medicine 73 (2011) 1062e1070