“It would be demeaning to the topic [of abortion] to talk about it in a half-hour sitcom.”
How would it be “demeaning” to talk about abortion in a sitcom about a gynecologist’s office? Many sitcoms have talked openly about abortion, including Girls and Sex and the City, as well as recent films, like Obvious Child. In its first two seasons, Kaling’s show, The Mindy Project, has tackled many issues related to reproductive health care, such as the distribution of condoms, birth control, and teen sex. Why not abortion?
But then I remembered, it always comes back to stigma—in this case, abortion provider stigma.
Half of women in the United States will experience an unintended pregnancy, and one in three will have an abortion before she turns 45. Kaling’s character, Dr. Mindy Lahiri, would surely see patients who want pregnancy options counseling, and some of those patients would likely seek an abortion. Why wouldn’t she provide them with one in her practice, or at least refer them to an abortion provider?
Actually, Dr. Lahiri’s behavior is reflective of a real-life norm: There are many OB-GYNs who don’t provide abortions based on fear of violence, lack of training, or their own internalized stigma toward abortion care. A 2011 survey found that only one in seven OB-GYNs are willing or able to provide abortions. However, 97 percent of OB-GYNs stated that they have encountered people seeking abortion care.
One of the reasons for this is lack of access to medical training on abortion. In 2009, the American Congress of Obstetricians and Gynecologists (ACOG) found that only 32 percent of medical schools include at least one lecture on abortion in their curricula. The group also found that 45 percent of schools offer clinical experience in providing abortion care, though participation at those schools is low because the program is opt-in rather than integrated into the curricula like most other forms of health care. The Accreditation Council for Graduate Medical Education does require that OB-GYN residency programs offer training in family planning and abortion. Still, residency programs can opt out of providing this training in-house, forcing students to attend training at another program.
Even when clinicians do receive training to provide abortions, they face barriers in offering those service to patients. Because of the stigma associated with abortion, many hospitals, especially religiously affiliated ones, refuse to allow providers to offer abortion care.
“Private practice groups as well as hospitals routinely prohibit their group members and staff from performing abortions either because of institutional religious affiliations or because they fear protest from the community,” explained Dr. Kathleen Morrell, a reproductive health advocacy fellow at Physicians for Reproductive Health. “For example, a colleague of mine who received abortion training and wanted to offer her patients comprehensive reproductive health care joined a private practice that refused to let her offer abortion care. The other doctors in the practice were concerned about possible backlash from the community if they became known as an abortion provider.”
So perhaps Dr. Lahiri’s colleagues don’t want her to provide abortions. Wouldn’t that make an interesting plot device!
Backlash from colleagues and the community is a constant fear and barrier for providers. The stigma of abortion leads them to receive death threats, see protests outside of their clinics, and fear for the safety of their family and friends. While many providers are proud of the compassionate care they are able to offer their patients, abortion providers often keep their work a secret to alleviate some of the impact of the stigma. Understandably, this secrecy allows them to live a more normal life and continue doing their work, yet it can also perpetuate stigma.
“When abortion providers do not disclose their work in everyday encounters, their silence perpetuates a stereotype that abortion work is unusual or deviant, or that legitimate, mainstream doctors do not perform abortions,” writes Dr. Lisa Harris on the cycle of silence and stigma. “This contributes to marginalization of abortion providers within medicine and the ongoing targeting of providers for harassment and violence. This reinforces the reluctance to disclose abortion work, and the cycle continues.”
But there are providers who refuse to let stigma and shame keep them from providing care. In a recent interview with Esquire, Dr. Willie Parker, who provides abortion care at the last abortion clinic in Mississippi, spoke frankly about how stigma affects his work, the role his faith plays in abortion care, and why he began providing abortions full-time the day Dr. George Tiller was murdered in 2009. “The protesters say they’re opposed to abortion because they’re Christian,” Parker said. “It’s hard for them to accept that I do abortions because I’m a Christian.”
It’s media coverage like the Esquire profile of Dr. Parker and abortion plot lines in television shows and movies that can help to disrupt the cycle of abortion stigma in our society. “Media can shift stigma by portraying abortion as most people experience it: normal, manageable, social, and not the end of the world,” Steph Herold, deputy director of the Sea Change Program, told me. “Positive portrayals of abortion provision may even help providers feel less isolated, and reinforce the simple truth that providing abortion should be part of routine health care.”
Abortion stigma may be keeping Mindy Kaling from talking about abortion on her show, but if she were to do so it could help educate the public, inspire future providers, and fight abortion provider stigma. (Dr. Parker as a guest star, anyone?) Also, I’ll bet viewers would love to see Dr. Lahiri tackle an issue so many of them have experienced.