Abortion stigma among abortion providers in high-income countries: a mixed methods systematic review.

Abstract

Negative attitudes toward abortion affect providers who perform abortions and lead to discrimination and emotional distress. This review examines the prevalence, forms, and consequences of felt abortion stigma among providers in high-income countries. A mixed-methods systematic review was conducted to update a 2016 review on abortion stigma. Following the PRISMA guidelines, searches in MEDLINE, CINAHL, PsychINFO, LIVIVO, and the Cochrane Library identified peer-reviewed studies published after March 2015. Qualitative, quantitative, and mixed-method studies were included. Data extraction and synthesis followed JBI guidelines. Twenty-eight studies were included (23 qualitative, 4 quantitative, 1 mixed-methods). Quantitative findings showed that abortion-related stigma varies by legal and sociocultural context and is higher in restrictive settings. Greater felt stigma was associated with burnout, emotional exhaustion, and job strain. Qualitative synthesis identified three main themes: (1) institutional and structural stigma linked to legal restrictions, limited training, and professional isolation; (2) individual-level stigma, including harassment, social exclusion, and concerns about disclosure; and (3) mitigating factors, such as legal reforms (e.g., decriminalisation) and provider advocacy for reproductive rights through patient empowerment and respectful, balanced communication. Abortion stigma at the individual level is strongly shaped by institutional and structural contexts, underscoring the need for interventions beyond individual coping strategies. Efforts to reduce abortion stigma should address not only personal attitudes but also the broader social, cultural, and legal frameworks that sustain it. Healthcare systems are critical intervention points, as clinical practices and gatekeeping can reinforce stigma, while reforms in training and policy can help challenge it. (246). Abortion is a common medical procedure but people who provide abortion care often experience stigma. This means that they may face discrimination, social isolation, or emotional distress simply because of their work. Stigma can also reduce the number of healthcare professionals willing to provide abortion care. This can lead to reduced access to safe abortions, particularly in places where abortions remain controversial. Although numerous recent studies have explored this topic, a comprehensive, updated review is lacking. We conducted a systematic review of 28 quantitative and qualitative studies to gain a full picture of the issue. Our goal was to examine how abortion providers in high-income countries experience stigma and how much it affects them. Quantitative studies have found that stigma levels vary depending on the country and professional role. Providers in countries with restrictive abortion laws reported the highest stigma and those in more liberal settings experienced less stigma. Stigma was linked to negative effects such as emotional exhaustion, job strain, and burnout. Qualitative studies have focused on personal experiences and highlighted how stigma affects daily life. Many providers described feeling judged, isolated, or even harassed. Some providers kept their work secret to avoid negative reactions. This study highlights the need for legal protection, workplace support, and public awareness campaigns to reduce abortion stigma.