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Internalised abortion stigma: Young women’s strategies
of resistance and rejection
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Hoggart, Lesley (2017). Internalised abortion stigma: Young women’s strategies of resistance and rejection.
Feminism and Psychology, 27(2) pp. 186–202.

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Internalised abortion stigma: young women’s strategies of resistance and rejection

Abstract: This paper examines the ways in which young women demonstrated strategies of resistance to internalised abortion stigma. It does so

through secondary analysis of young women’s narratives from two qualitative studies in England and Wales. Whilst participants felt stigmatised

by their abortion[s] in different ways, many also resisted stigmatisation. They did this through different stigma resistance strategies, depending

on their socio-economic situation; family and relationship situations; the circumstances in which they became pregnant; and their beliefs and

values with respect to abortion and motherhood. Being able to construct their abortion decision as morally sound was an important element of

stigma resistance. Although socio-cultural norms and values on abortion, reproduction and motherhood were shown to constrain women’s

reproductive choices, these norms were all open to challenge. The women were more likely to struggle with their abortion decision-making

when they had internalised negativity around abortion.

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The concept of abortion stigma can help explain a range of negative aspects of women’s abortion experiences, such as why women experiencing

an unintended pregnancy may find it difficult to decide to have an abortion and why women who have an abortion may wish to conceal this.

Women’s abortion experiences, though, and their feelings about their abortion, can vary substantially (Cockrill & Nack, 2013; Kimport, Foster, &

Weitz, 2011). It is therefore important to develop nuanced understandings of abortion stigma and ways in which it may be resisted, and

rejected. Such understandings could inform strategies oriented to mitigate experiences of abortion stigma, as well as provide insights to be

applied in other areas of stigma research. This article draws on data from two studies of young women and abortion in England and Wales in

to analyse variations in how the women may have felt stigmatised by their abortion[s] and to explore individual stigma resistance

strategies. Particular attention is paid to considering how women resolve personal dilemmas generated when their decision to have an abortion

clashes with their own moral views on abortion. Insights into these processes can also provide insights into methods of managing complex

decision-making.

In the UK, apart from Northern Ireland, the legal framework for abortion is the 1967 Abortion Act. This Act, as amended by the Human

Fertilisation and Embryology Act 1990, permits abortion up to 24 weeks in specific circumstances (when two doctors agree that continuing with

the pregnancy would be more harmful to the physical or mental health of the pregnant woman, or any existing children of her family, than if the

pregnancy was ended). After 24 weeks an abortion is permitted in very limited circumstances concerning health of the pregnant woman or her

child if the pregnancy proceeds. Abortion, however, remains politically controversial and subject to regular attempts by those opposed to

abortion to introduce a more limiting framework or restrict particular types of abortion (Hoggart, 2003; Lee, 2013). Most recently these have

included attempts to introduce mandatory abortion counselling and proposals to change the law to prevent sex-selective abortions. These

challenges to current abortion provision, alongside the frequently expressed assumption that abortion is inherently undesirable, have

contributed to what has been characterised as ‘abortion negativity’ (Lee, Clements, Ingham, & Stone, 2004). Researchers have begun theorising

this negativity through the study of the generation of abortion-related stigma, and the consequences for women seeking an abortion (Astbury-

Ward, Parry, and Carnwell, 2012). The sociocultural positioning of abortion in the UK thus invokes moral deliberations (Purcell, Brown, Melville,

& McDaid, 2017).

Theoretical Framework

Stigma was originally theorised by Ervin Goffman (1968) as a discrediting or discreditable attribute, behaviour or reputation. Goffman

distinguished between three different types of stigma: those related to personal appearance; character blemishes which include moral failings;

and ‘tribal stigma’ (related, for example, to race, religion, or ethnicity). This paper builds upon more recent theorisations of stigma, in relation to

the sociology of health, as well as a body of work, primarily originating in the United States (US), that examines abortion-related stigma.

Research has shown that although the stigma of abortion may exist in both liberal and restrictive legal settings, it is more evident in settings

where abortion is highly restricted (Cockrill & Nack, 2013; Major & Gramzow, 1999; Quinn & Chaudoir, 2009; Shellenberg & Tsui, 2012).

Stigmatisation is thus context-sensitive and it has been argued that socio-economic and cultural contexts, particularly gendered norms, influence

abortion stigmatisation (Kumar, Hessini & Mitchell, 2009). Kumar et al (2009) go on to argue that women who have an abortion are stigmatised

because they are transgressing gendered ideals of women’s sexuality and motherhood. Another study (Norris, Bessett, Steinberg, Kavanagh, De

Zordo, & Becker, D. 2011) suggests additional drivers, including attributing personhood to the foetus. Other researchers have pointed to the

importance of religion as a contributor to abortion stigma (Bloomer & Fegan 2014; Bloomer & O’Dowd, 2014; ). The role of media discourses in

framing abortion in negative terms has also been identified by recent studies (Purcell, Hilton, & McDaid, 2014). Overall, these contextual factors,

in different ways, contribute towards a construction of abortion as – to a greater or lesser extent – morally wrong.

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A number of aspects in the theorisation of stigma are relevant. The concept of deviance is particularly important for analysing abortion-related

stigma. Deviance signifies a violation of societal norms and values, implies a moral deficit, and incorporates the notion of blame into the creation

of stigma (Scambler, 2009). Cockrill and Nack’s (2013) adaption of Herek‘s (2009) framework on sexual stigma is key to understanding

individual-level abortion stigma: internalised stigma signifies women’s acceptance of negativity associated with abortion; felt stigma includes

women’s assessment of other people’s attitudes towards abortion; enacted abortion stigma relates to actual experiences of actions that reveal

negative attitudes towards abortion. This article focuses on internalised stigma. Internalised stigma can involve a fear of societal attitudes; an

acceptance of negative stereotype; and perhaps attempts to conceal the ‘moral failing’. Above all, ‘internalized stigma often takes a toll on a

woman’s ability to feel like she is a good woman, both internally and in the eyes of others’ (Cockrill and Nack, 2013, p. 983) Thus, with respect

to internalised abortion stigma, an understanding of how deviance contains the idea of moral transgression is important.

The contextualised construction of abortion-related stigma does have consequences for women seeking an abortion. Goffman (1968) posited

that people respond differently to the normative context. Internationally, small-scale studies, focused on particular geographic areas, have

found that abortion-related stigma generates fear and guilt, and contributes to feelings of shame in societies characterised by a conservative

morality (Schellenberg et al., 2011). Similarly a recent UK study has shown concealment of abortion is related to women’s perceptions of

abortion as potentially stigmatising (Astbury-Ward et al., 2012). In Northern Ireland and Ireland, moral conservatism, gendered social norms and

religious legitimation – all embedded within legal restrictions – contribute towards especially negative experiences for women undergoing an

abortion. Exploratory research on abortion-related stigma in the US has suggested that the more women experience stigma, the more likely they

are to have adverse emotional outcomes (Major & Gramzow, 1999). Recently, Kumar argued that care needs to be taken not to use the concept

of abortion stigma indiscriminately (Kumar, 2013). Other work has shown that abortion stigma may affect women in different ways (Norris et al.,

2011). Stigma processes are thus contested, and this has been shown to be especially pertinent with respect to how women may construct

different moral framings. Cockrill and Nack (2013) found that whilst some women perceived their abortion as instances when they breached

their own moral code, these moral codes themselves may vary. Other work also acknowledges and discusses the importance of women’s own

moral views on abortion as an influence on both their decision-making, and post-abortion emotions (Hoggart 2012) .

This article focuses on how individual women’s views on abortion, their abortion decision-making, and their feelings about their own abortion,

are articulated. Critical realism requires analysing the ways in which individuals give meaning to their experiences in relation to their socio-

cultural context (Archer, Bhaskar, Collier, Lawson, & Norrie, 1998), in this case focusing on individual internalised abortion stigma in relation to

gendered social norms. The central tenets carried forward to the analysis are: an understanding of internalised stigma as varied and diverse, and

influenced by women’s individual contexts as well as socio-cultural norms and values. In to do this, the analysis applies a critical realist

framework. The political and policy context (England and Wales) is one in which a pragmatic acceptance of the need for abortion interlinks with

a moralistic framing of abortion, such that abortion is necessary but also undesirable (Furedi, 2014). The women’s narratives were examined in

relation to how they internalised stigma differently, depending on the interaction between their circumstances; their reactions to gendered

social norms; and their own moral framings. These issues, central to understanding the complex range of women’s reactions to internalised

abortion stigma, and complex decision-making, will be discussed in the body of this paper, following an explanation of the methods adopted.

Methods
The data for the analysis were gathered in two qualitative research projects on young women’s experiences of abortion, undertaken between

2009 and 2014. These were applied social research projects, undertaken by research teams led by the author, for funders whose interest was to

increase knowledge about young women’s need for abortion. Research Ethics Committee approval was obtained for both studies. Women’s

experiences of abortion stigma emerged as an issue in the studies, and data relating to this theme have been analysed for this paper.

In total, forty-six young women (16-24), from a broad range of class, family and ethnic backgrounds in England and Wales, presenting for an

abortion, were interviewed by female interviewers (white British in her early 50s, white British in her late 20s, black Caribbean in her late 30s).

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Most participants self-identified as white British, followed by black British, black African, mixed race, and white European. There was a fairly

even split between women who described their backgrounds as working class and middle class. A range of family situations was evident, though

most reported that they grew up in ‘nuclear’ families. Eight women had experienced more than one abortion, 13 had children, and 3 had also

experienced a miscarriage or ectopic pregnancy.

Participants were recruited in the same way for both studies. We asked providers to approach all women within the age range, only excluding

those who did not speak English or were having an abortion for a foetal anomaly. However, as this task was undertaken by clinic staff who were

not accountable to the research team we are not able to verify whether any other women were excluded. Those who responded positively were

asked for consent to pass their contact details to the research teams. We were able to contact approximately two thirds of those women whose

contact details (mobile phone numbers) were passed to us; the reasons for non-contact were incorrect numbers, and calls not answered (a

maximum of three attempted calls). For those women whom we contacted, the researchers then explained the study, and arranged for an

interview to take place if they were still interested. We lost further participants at this stage, and then again when women did not attend the

interview. We interviewed approximately 40% of the women who had originally given consent for their contact details to be passed to us. We do

not have records of how many women were asked if they would like to take part and refused. We did not aim to recruit a sample that would

accurately represent all women within the age range presenting for an abortion. We recruited a small proportion of the number of women

eligible for the study, resulting in a self-selected group of young women who were willing to talk to researchers about their abortion experience.

Such a sample was appropriate for our qualitative study, in which we aimed to explore a range of views in depth. We continued recruiting to the

projects until we were confident that we had appropriately rich data. This recruitment strategy has implications for the interpretation of the

results: it is not possible to generalise from the findings of these studies.

The participants provided written informed consent immediately prior to the interview. The interviews were recorded with the participants’

permission, the transcripts were anonymised, and pseudonyms were used in all publications. The interviews lasted between forty-five and

ninety minutes and allowed space for women to talk about any issue of concern to them, as well as for the interview questions to be addressed.

The questions were focused on: individual abortion decision-making; sexual and contraceptive behaviour before and after their abortion[s];

perceptions of social and cultural attitudes towards abortion; the influences of ‘significant others’ on decisions and experiences; and post-

abortion feelings and emotions.

In both studies, the data were originally analysed independently by two researchers who checked each other’s selection of themes, and adopted

a data-driven first stage of thematic analysis (Braun & Clarke, 2013). Our reading and familiarisation of the transcripts generated a largely

descriptive coding frame that was used in the qualitative software programme NVivo. Whilst analysing the data in the original projects. We

analysed the narratives with respect to different processes of stigma internalisation and explored these in relation to the women’s

circumstances; their reactions to gendered social norms; and their own moral framings. The researchers found that their interpretations differed

in interesting ways when abortion stigma was in focus, and those disagreements gave the impetus for this article. Some differences were

resolved by further reading of the transcripts and secondary literature, whilst some remained (as noted later in the paper). Indeed, it was

probing these differences that led us towards an understanding that women’s reactions to stigma may involve abortion stigma being

simultaneously internalised and resisted.

For this article, Braun and Clarke’s (2013) approach was again adopted, using a top-down analysis guided by theoretical concepts related to

abortion stigma. Theoretical thematic analysis can identify events, experiences and the reality as described by participants; then the researcher

can analyse and interpret the ways in which as researchers they understand and interpret the women’s narratives. These analyses also involved

interpreting the processes by which individuals understood their own decisions and behaviour. The transcripts were also re-read in to

retain a contextualised understanding of each participant’s analysis. In this way it was possible to analyse complex patterns in the participants’

responses to similar circumstances, and also how their responses drew on norms and values in different ways.

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The themes that were identified in this process centred on stigma resistance – or rejection – strategies that mitigate negative internal

judgements about abortion through minimising or rejecting feelings of shame and/or blame. The themes are: views and values on motherhood;

responsible/irresponsible sexual behaviour; personal views on abortion. I begin by considering those participants – a majority of the young

women – whose narratives indicate that they struggled with internalised abortion stigma, and examine their narrative strategies of resistance. I

then analyse the narratives of those who had not struggled in this way, and examine their narrative strategies of stigma rejection. Individual

quotations are selected to illustrate the three themes, rather than the views of any one participant.

Struggling with internalised abortion stigma

Most women framed their narratives in ways in which internalised abortion stigma was acknowledged, whilst simultaneously to a greater or

lesser extent resisted. Internalised stigma could be expressed as a sense of having morally transgressed, feeling guilty, or having done something

wrong or shameful. It was not uncommon for participants to talk generally of not ‘believing’ in abortion, as an explanation for why they felt they

had done something wrong, as with the interview extract below:

Katie: I didn’t believe in abortions.

Interviewer: That’s what a lot of people say as well, so I wonder if you can try and explain to me why you don’t believe in abortions, or

why you say you didn’t believe in abortions?

Katie: Because, I don’t know, you’re getting rid of say like a part of you.

Interviewer: Your friends or the people you hung out with, what did they think about having abortions, do you know?

Katie: My mate [friend] is pregnant, I said to her “Are you having an abortion?” but she don’t believe in them so she’s going through

with it.

When Katie is pressed to explain why she “doesn’t believe in abortion”, she draws on an identification with the foetus as ‘part of’ her, which

could be interpreted as one of the drivers of internalised stigma mentioned earlier — attributing personhood to the foetus (Norris et al 2011),

but alternatively can be seen to represent a rejection of the foetus as a separate being. Also worthy of note is that Katie’s view is seen to chime

with the belief of her friend, and (at another part of the interview) with her partner, thus suggesting that a context of abortion negativity may be

influencing her own views. However the statement is interpreted, it is clear that Katie is struggling with abortion morality.

Other ways in which women expressed a sense of abortion as morally wrong included talking about ‘not agreeing’ with abortion; describing the

foetus as ‘innocent’ and positioning themselves as ‘guilty’; stating that it was a ‘horrible thing to do’; describing it as ‘not fair’ or as ‘bad’; and

describing themselves as selfish:

I suppose it’s a selfish decision on my part but also I didn’t want to bring a child into something where I couldn’t give them everything I

wanted. (Cassandra)

Whilst what precisely is wrong with abortion was often left vague, it is clear that such formulations chime with a political and policy context in

which abortion may be seen as necessary but also inherently undesirable (Furedi, 2014).

With respect to stigma resistance, the overarching counter-narrative adopted by some of the women was to designate their own abortion as, in

some way, justified and morally sound. This was primarily in relation to the themes outlined above: views on motherhood; sexual

(ir)responsibility; and individually held moral views on abortion. These were not mutually exclusive but coalesce and conflict in complex ways.

Most of the narratives contain multiple, sometimes conflicting, framings and understandings.

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Stigma resistance: the good mother

Deciding to have an abortion in the interests of existing children, thereby drawing on gendered notions of ‘good mothering’ was one of the most

strongly expressed justifications for an abortion. Here are two examples.

Lara became pregnant three months after giving birth. She was still seriously ill following a very difficult pregnancy in which she had suffered

from pre-eclampsia:

And I was like, “I’ve got a three month old baby, what is best for my three month old baby is not for me to be getting very ill, being

pregnant again.”

Lara described her decision to have an abortion as “completely the right decision” and said she had “no regrets at all”, despite describing herself

as personally opposed to abortion, both before and after her own abortion.

Larissa had a three year old daughter and had no doubt that she made the right decision to have an abortion following unanticipated “reunion”

sex:

I’m already a single parent, I’m 22, my daughter is three and a half now, she’s doing brilliantly. I’ve got a nice home, I’m scraping by, like

week on week it is a struggle to get us through. If I had another mouth to feed, it would mean that her quality of life would drop and I know

it probably sounds really horrible because that was a baby as well but she’s here and now, and she’s more important than anything … And

so I just thought really, it was for the best.

Both Lara and Larissa expressed different moral framings during the course of their interviews. As noted above, Lara talked about being morally

opposed to abortion. Larissa did not, although her statement “it probably sounds really horrible because that was a baby” suggests an

internalisation of some abortion negativity on the basis of attributing personhood to the foetus. Both women expressed certainty that they had

made the right decision, had done what was “for the best” (Lara) for existing children, who are “more important than anything” (Larissa). They

have both resisted internalised stigma, drawing on notions of ‘good mothering’ in different ways: Lara is concerned that she needs to protect her

physical health in to take care of her daughter, whilst Larissa is concerned about her economic situation and does not want her daughter’s

“quality of life to drop”. Nonetheless, what was different about these two young mothers was their moral framing of abortion. Although Lara

expresses strong moral opposition to abortion she is able to justify her own abortion by pointing to her extremely poor health:

I’m angry at myself for putting myself in the position where I had to go against what I believe in, because I still believe that abortion is

wrong. But, on the other hand, I know that, I think the thing that swayed it for me and the only reason I went through with it, I would

have kept the baby if it wasn’t going to have killed me.

Lara was interviewed twice, and taking her narratives as a whole, and following discussions with the co-researcher, our interpretation of Lara’s

emotions was that she only felt able to declare having “no regrets” because of the severity of her ill health.

Participants without children also drew upon notions about the ‘right time’, to become a mother. This did not represent a rejection of

motherhood, but a rejection at a particular moment in time. This rationale is articulated as responsible, as opposed to irresponsible,

motherhood. Annette, for example, stated “I’m not in a position right now where I think having a child is a good thing for me or for the child”,

and purposefully sets herself apart from other women who may want a child to fill “a hole in their heart”. Here she is relating the discussion she

had with her partner:

And I said to him, I don’t think it’s fair to the child right now because I don’t have anything to give anyone, like, emotionally. I don’t think

that’s fair. I think a lot of – lots of people, you know, if they feel like they’ve got a hole in their heart or something, they try and fill that

by having a child and making them happy, but I think you should be happy within yourself before you can offer a child anything.

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Annette voiced a view of motherhood timing for herself which precluded continuing with an unintended pregnancy until she was emotionally

ready. Similarly, other women talked about their vision of themselves as a future mother which incorporated other concerns they had for a

future child. One such concern was not having to struggle financially, as highlighted by Anna:

I’d like to be able to give my children what they want and not struggle, I know it can be done, but I don’t want to struggle, I want my kids

to just have anything they want. I don’t want them to be spoiled but I want them to have opportunities and have money really. So the

reason why I did it was because I thought I need to get a job and make sure that I can have a child when I can support it.

A final, important, driver in decision-making was rejection of unplanned motherhood in the context of what they thought might not be a lasting

relationship.

I’ve always said to myself, I’m never going to have children until I’m well off or you know I’m in a relationship where I love that person

and I know that I’m going to be with that person forever, because what’s the point of having a child and bringing it into a broken home.

(Gemma)

These are all examples of how life-stage considerations within an overarching framework of planned, responsible, motherhood, can be drivers in

women’s decision-making and in resisting feelings of shame or blame. Participants considered their own wellbeing, plus the wellbeing of a future

child and of any existing children. In particular, many of these young women, often drawing on popular conceptions of ‘good’ motherhood which

chimed with their own personal values around marriage and family, stated that they would be unable to bring up a child as they wished because

of economic disadvantage.

When talking about such scenarios, the women seemed concerned to present their decision to have an abortion as the responsible course of

action for their own future lives, but within a framework of a future family. Notions of ‘family life’ and ‘stability’ were fore-fronted, as was a

desire “be fair” and not to “struggle” bringing up a child. Their narratives also indicate that they believed they were making morally sound

decisions.

A related response was found in some women’s expression of guilt associated with undergoing an abortion in circumstances in which

responsible motherhood might possibly have been attainable. Although Annette, for example, (as noted above) was certain that she was not in a

position to become a mother, she went on to say that her decision would have been easier had she not been in a stable long-term relationship:

“And then I was very – I think it would have been an easier decision if it had been like a one night stand or something, but the fact I’d been with

[partner] for five years, it was – that sort of made it a harder decision”.

Annette’s narrative indicates that women’s guilt about their abortion may be associated with their …