Abortion stigma plays a critical role in the social, medical and legal marginalization of abortion care around the world and leads to negative health outcomes for women, girls, trans people and their communities. Stigma shames and silences people seeking abortions, providers of abortion care and anyone who demonstrates support for a person’s right to decide whether to continue or terminate a pregnancy. As a result, abortion stigma drives the high number of preventable deaths and injuries around the world due to unsafe abortion.
Sexual and reproductive health organizations, women’s rights organizations and other social justice advocates have been raising awareness about abortion stigma in communities, in advocacy and information campaigns and in programs designed to meet women’s reproductive health needs. Many have expressed the desire for a collection of tools and activities to address abortion stigma in various settings and contexts. This toolkit was created to help meet that need.
This toolkit is designed for use with the staff or members of community-based organizations (CBOs) and/or non-governmental organizations (NGOs), community health workers and community members themselves with a range of education and literacy levels.
This toolkit was originally developed for Ipas staff and community partners working to reduce abortion stigma and increase access to safe abortion. However, thanks to tremendous support from inroads (The International Network for the Reduction of Abortion Discrimination and Stigma) embers, who piloted and reviewed activities, we have edited the toolkit to be used by others who want to raise awareness about and plan action to address abortion stigma. The activities are designed to be led by trained facilitators who may be CBO or NGO staff or members, community health workers and/or individual trainers or activists. They are also designed to be easily adapted to fit different settings and contexts. For example, they can be carried out in multi-day workshops with typical workshop supplies or included in meetings over a longer stretch of time in settings requiring few
or no extra resources. They can be used in community dialogues, in awareness-raising campaigns, in schools or in outdoor health talks. They can also be integrated into other training, educational or capacity-building programs such as comprehensive sexuality curricula in schools, training curricula in nursing or medical programs, community outreach programs or staff capacity-building initiatives of an organization implementing programming to advance abortion access.
While the intended audience for this toolkit is non-professional community members, community health workers, activists and the staff of CBOs, many activities can be used or adapted for use with other specialized audiences. These audiences include doctors, nurses and other health-care providers; journalists and media professionals; police, lawyers and policymakers; and faith-based leaders, local chiefs and other influential
community members in terms of their professional or formal roles and influence on abortion access.
Some of the activities are based on stigma-reduction exercises that have been tested in other fields (for example, HIV stigma). Some have been used by Ipas for several years to help people reflect on and clarify the values that they hold around abortion. And some are new exercises that have been tested in several countries by community organizations.
Naming abortion stigma is a way to start reducing it. However, this toolkit does not take participants through the process of developing a stigma-reduction intervention. This toolkit was designed to increase understanding of abortion stigma and to support individuals and organizations in naming what abortion stigma looks like in their settings. It was also designed to build the capacity of individuals and organizations to address and help eliminate abortion stigma.
Building a collective understanding of abortion stigma and helping a group of people determine how to think or talk about abortion differently helps to interrupt abortion stigma. In this sense, this toolkit can provide the structure and content for an intervention focused on building a group or organization’s understanding of and capacity to reduce abortion stigma.
The activities in this toolkit can also be used to build the capacity of individuals and/ or organizations to create a broader abortion stigma-reduction strategy, campaign or programmatic intervention. While there is not specific guidance included on how to do this, the toolkit’s activities serve as a foundation for a common language, understanding and shared analysis of abortion stigma that is needed to design such strategies.
This toolkit is dedicated to increasing understanding of abortion stigma and to supporting individuals and organizations (CBOs, small NGOs, etc.) in naming what abortion stigma looks like in their settings. Abortion attitude transformation: A values clarification toolkit for global audiences, created by Ipas in 2008, was designed to help groups clarify their values and reach more supportive actions and attitudes toward abortion care.
While separate and distinct, the two toolkits—along with the Abortion care for young women: A training toolkit—complement one another, and together, will help groups begin to address abortion stigma. If you are looking for additional ideas, we encourage you to consult all three resources when designing your workshop. This toolkit uses activities adapted from Abortion attitude transformation: A values clarification toolkit for global audiences, which are marked as “VCAT.” Please note that the activities have been adapted to focus on abortion stigma, so review them before facilitating to note how they might be different than the VCAT activities to which you are accustomed.
Throughout this toolkit, we use the terms “women, girls and trans people,” “people who are pregnant,” and at times, the gender-neutral “people,” to refer to those who have had—or may someday have—an abortion. We seek to acknowledge the full range of gender identities held by people who have abortions. While abortion stigma affects everyone, we name women, girls, trans people and people who are pregnant— rather than exclusively using gender-neutral language—to recognize that abortion stigma is rooted in gender inequity and oppression. Because of this, women, girls, trans people and other people who are pregnant specifically experience the impact of abortion stigma. We recognize that the language to express a richer diversity of gender identity and expression is evolving, and we seek to contribute to more inclusive language in the abortion field. We welcome your feedback and suggestions on how we might do better in the future.
LGBTIQ stands for Lesbian, Gay, Bisexual, Transgender, Intersex and Queer/Questioning. It refers to identities based on sexual orientation that exist in addition to a heterosexual sexual orientation. There are many other identities and expressions of sexual orientation in addition to these. However, LGBTIQ—and other similar combinations— are often used as a common starting point for recognizing the diverse ways that we as humans orient in our sexual relationships and interactions.
Because people who identify as LGBTIQ can become pregnant and have abortions, and yet are frequently underserved in sexual and reproductive health and rights (SRHR) programming, this toolkit strives to include examples, activities and references that demonstrate how abortion stigma impacts LGBTIQ people. It also aims to explore how abortion stigma—and stigma based on sexual orientation and gender identity— compound one another and cause harm. Ipas believes that it is important to address the ways in which abortion stigma affects all members of our communities, including LGBTIQ people, who often experience extreme marginalization, discrimination and violence.
Some facilitators and groups of participants will have greater familiarity with this terminology and segment of people than others. We acknowledge that in some settings it is difficult and even risky to discuss LGBTIQ rights explicitly. Where possible, we encourage you to include these examples, activities and references in your workshops and to get support so that you do not have to avoid what can feel like a difficult subject. For more information on including these topics in your workshops, please contact Ipas (www.ipas.org) or a local LGBTIQ organization in your community. You can also refer to the “Key resources” section of Module 5 for more resources.
Corporate Author: Ipas