Abortion stigma: shame on you

Safe and legal access to abortion, like clean drinking water and poverty, is often thought about in ‘third world’ terms. Australia is, after all, the ‘lucky country’, with a not-perfect, but nevertheless top class public health system, right? As we often highlight in our WRAP articles, ensuring access in all of its forms (legal, financial, physical and cultural), is key to improving immigrant and refugee women’s health. Access to choice free from judgement is an equally important factor and can seriously impact on a woman’s health and wellbeing, wherever she happens to live.

The 28th of September is the Global Day of Action for Access to Safe and Legal Abortion, and this year’s Call for Action focuses on addressing abortion stigma. Abortion stigma is one of the main obstacles towards ensuring the availability and accessibility of comprehensive abortion services. Silence, shame, guilt and fear are all very real barriers, not only to accessing safe abortion but to speaking openly about it. And while it’s true that every year, almost all of the 21 million women (approximately) who undergo unsafe abortion are in developing countries (WHO 2011), abortion stigma can be and is experienced by women in the ‘developed’ world.

Although there are clear actions we can take, both in Australia and internationally, to make abortion legal and safe, it will not guarantee that all women have ready access to it. Even in countries such as Australia where abortion is less legally restricted, women can resort to unsafe abortion because of abortion stigma. A case in point: if you’re a non-English speaking immigrant woman on a temporary visa living in a small, rural town with only one health service, it’s doubtful you would have access to culturally appropriate health service or be able to retain medical privacy. (Albury, for example, has about 100,000 residents and one abortion clinic.)

Stigma can manifest itself in many ways. Secrecy, shame or feelings of regret, guilt and fear associated with seeking a termination can impact on a woman’s ability to make an independent and autonomous choice. As Anuradha Kumar and others have highlighted, abortion stigma is in effect ‘compound stigma’ because ‘it builds on other forms of discrimination and structural injustice’. The stigma around abortion is tightly interwoven with other social expectations and stereotypes around gender roles in relation to motherhood, sexuality and family responsibility.

Prevailing social, cultural and religious attitudes within different communities can create and reinforce negative attitudes towards women seeking abortion. These potential pressures are often magnified in rural and regional areas where gossip in one community can mean dishonour for a woman in another. But abortion stigma can also be created and perpetuated through organisations and institutions, as is the case of insurance companies who limit the extent of pregnancy-related cover to international students.

In reality, safe access to abortion is far more complex than making it legal, opening more clinics and making medication available (although obviously this is essential). Without social support, abortion stigma will continue to impact on women’s physical and mental health and well-being long after the decision ‘to abort’ or ‘not to abort’ has been made.

Safe and legal abortion free from stigma and discrimination is a women’s health and human right issue. On Sunday, we call for action for the 26% of world citizens where abortion is prohibited. But we also call for action to develop our thinking on the ways that Australian society, including media representations and government policy, can take the stigma out of the decision-making process for all women who seek an abortion.

Research Project: Contraceptive Technologies and Reproductive Choice Among Immigrant Women


Professor Lenore Manderson (front, left); Associate Professor Andrea Whittaker (front, right) and Ms Azam Naghavi (back, right) from Monash University with the MCWH bilingual educator interview team.

Professor Lenore Manderson (front, left); Associate Professor Andrea Whittaker (front, right) and Ms Azam Naghavi (back, right) from Monash University with the MCWH bilingual educator interview team.

Last week researchers from Monash University conducted an interview training workshop with a group of MCWH bilingual health educators.  Our bilingual health educators were trained to conduct research interviews for the Contraceptive Technologies and Reproductive Choice Among Immigrant Women ProjectThe research will identify how immigrant and refugee women access information and advice about contraceptives; their use of sexual and reproductive health services; and how providers ensure women’s informed choice.  The research team will interview 70 women from at least four different countries, including India, China, Afghanistan and Sudan.  The Project is being conducted in partnership with Monash University, the Centre for Culture, Ethnicity and Health and Family Planning Australia Alliance.

The research project is funded by an Australian Research Council Linkage Grant 2013-14.


Media Release: International seminar highlights invisibility of abortion as a federal election issue

Variation in abortion law among the states is not the only issue at stake for women in Australia.

Today MCWH will host a visit by Dr Anu Kumar, Executive Vice-President of Ipas, a global nongovernment organisation dedicated to ending preventable death and disability from unsafe abortion.

Dr Kumar’s visit marks the beginning of MCWH’s partnership with researchers from the Social Sciences and Health Research Unit, Monash University on a research project investigating the contraceptive and reproductive choices of immigrant and refugee women.

Executive Director of MCWH, Dr Adele Murdolo said that while abortion law continues to be a matter for the states, both state and federal governments need to ensure that abortion is accessible and available to all women.

Twenty six per cent of the world’s population still live in countries where abortion is generally prohibited, so in that regard Australian women are in the fortunate position of living in a country where induced abortion is legally available. However, access to abortion is still restricted to different groups of women in various ways. It is already well-known that immigrant and refugee women have limited to access to sexual and reproductive health for a range of reasons including visa status, economic reasons and lack of access to culturally sensitive programs.

A recent report has found that living in a rural or regional area can also severely restrict your access to abortion because of the lack of services in certain regions. There’s a triple disadvantage then if you’re an immigrant or refugee woman living in one of these regions.

In many respects there are overlaps with the human rights work being done at an international level. In Australia, immigrant and refugee women’s access to abortion is still determined by such things as visa status and other policies, which can indirectly impact on women’s right to free choice.

Women’s rights aren’t just a matter for the law, although legal reforms are crucial – we’d like to see government make the necessary policy changes, and fund appropriate services, to improve women’s access to abortion.

Position Paper on International Student Access to Pregnancy-Related Care

Through the On Your Own research project we undertook in 2011 with international students in Melbourne, we found that the minimum requirements of the Overseas Student Health Cover (OSHC) Deed pose significant obstacles to female international students who fall pregnant unintentionally. Through further consultation with services and students across Australia, we have found that this is an issue that affects international students nation-wide and has already led to detrimental health outcomes for some women. Our new position paper outlines the reasons why the OSHC deed needs to be changed, and points to wider issues for international student health. We believe that the issue creates further ambiguity about the rights of international students to access health services and could potentially contribute to misunderstandings in health service delivery settings.

Our position has been endorsed by over 20 organisations and we encourage you to read it, talk about it and pass it on.

You can read and download the paper here.

Launch of the Bbkayi Report

Bbkayi means Baby plus two in Cantonese. It’s the title of a report which outlines the enablers and barriers for Chinese women in the City of Whitehorse to access antenatal, maternal and parent support. The study found that family and Chinese cultural practices such as the 30 day confinement period play an important part during pregnancy and childrearing and influence how Chinese women access programs and services. Many factors, including the resettlement experience, lack of familiarity with the Australian health system, and differing health and spiritual beliefs of different cultures can make it difficult for immigrant and refugee communities to access health services.

The study, commissioned by Whitehorse Community Health Service, is a fantastic resource for anyone interested in improving the cultural relevance of health services. Congratulations to Megan Wong, the project leader and author of the report and special thanks to MCWH Chinese BHEs, Dongmei Zhang, Rebecca Heli and Yuki Murdolo, who made invaluable contributions to the project with their experience and knowledge.

You can read the full report here.

Release of the MCWH Position Paper on Female Genital Mutilation/Cutting

February 6 is the International Day of Zero Tolerance to FGM/C, and an important opportunity for us all to affirm our commitment to improving the rights, safety and health of women and girls around the globe.

To mark the day, we are releasing our Position Paper on FGM/C, which was produced with the help of many wonderful women already working to ensure that the practice is not continued in Australia and that migrant and refugee women who have experienced FGM/C have access to services and support which meet their needs.

We’d like to thank again the women who have contributed to this document and the organisations who have endorsed our position. We hope that it provides a solid foundation for the abandonment of FGM/C in one generation in an Australian context.