Exploring providers' experience of stigma following the introduction of more liberal abortion care in the Republic of Ireland

Abstract

Objective: To explore if abortion care providers in the Republic of Ireland experience abortion-related stigma.

Study design: The survey was distributed to abortion care providers working in community and hospital units nationwide. We measured stigma using the 35-item version of the Abortion Providers Stigma Scale (APSS). We also collected data on demography, professional involvement in providing abortion care, and risk of burnout (measured by the Maslach Burnout Inventory).

Results: Of the 309 providers invited to take part, 156 (50.5%) completed the survey between January to May 2020. The sample reported a mean score of 70.9 on the total scale of the APSS. This was comparable with the scores of providers in a Massachusetts-based study but was lower than a sample of providers from across the USA. Linear regression analyses found that the Irish hospital-based obstetricians (b = 10.51, 95% CI 3.16-17.86) and midwives/nurses (b = 10.88, 95% CI 2.3-19.47) reported higher stigma than their colleagues working in general practice.

Conclusions: Comparing the scores of the current sample to published studies highlight the factors that may drive stigma in the Irish context. The Irish providers reported fewer issues in disclosing their abortion work than providers in the USA, which may be explained as they also reported fewer experiences of judgment and discrimination. They did, however, report higher levels of social isolation. Additionally, the findings suggest that providing surgical and/or later-gestation abortion care and providing within the hospital environment may present additional challenges for staff which increase level of stigma.

Implications: Despite widespread support for the expansion of the abortion care services, providers in Ireland still experience stigma related to this work. Our findings suggest that Irish providers, particularly those working in hospitals, may benefit from supports to reduce abortion-related isolation and challenges posed by collegial interactions or later-gestation care.

Keywords: Abortion; Abortion providers; Dirty work; Health workers; Republic of Ireland; Stigma.