Abstract
Limited research has utilized public abortion narratives to understand how individuals process through their abortion experiences. To address this gap in the literature, this study used thematic analysis to consider the public abortion stories of 39 participants from the Tennessee Stories Project, focusing on how individuals process through these experiences and the context of the abortion experience in a person’s life course. Participants were primarily those who were abortion patients; however, abortion providers and supporters including partners or spouses, family members, and friends of those who received abortion care were also represented. Data analysis indicated that abortion seekers engage in introspection, involving political and religious/spiritual considerations; report specific feelings about their abortion experience, including having no regrets and feeling gratitude; process emotions related to the abortion experience by normalizing emotional responses and using mementos; and position their abortion in the context of their life, both in terms of their family and career opportunities and personal development. These findings provide valuable insight into how individuals process through the abortion experience, before, during, and after the abortion procedure, and suggest possible directions for service providers, advocates, and policy makers in order to better support abortion patients, providers, and family members.
Approximately 1 million abortions are performed annually in the United States (Jones & Jerman, 2017). Since abortion is common, many individuals will interface with abortion care either as an abortion patient or through the experiences of loved ones (Guttmacher Institute, 2019; Moore et al., 2011). Abortion is stigmatized in the United States, and the abortion-seeking process requires complex navigation of barriers to abortion care (Sperlich et al., 2019; Cockrill & Nack, 2013; Cockrill et al., 2013; Ely et al., 2018; Greene, 2006; Guttmacher Institute, 2019; Hanschmidt et al., 2016; Jerman et al., 2017; Moore et al., 2011). Although existing literature has examined individual abortion experiences, there is little published research analyzing public abortion narratives, and the existing research has not fully considered the context of the abortion across a person’s life course. Further, little current research represents these experiences as lived by those who are close to the abortion seeker. The purpose of this study was to address these gaps in the literature through thematic analysis, using a trauma-informed and feminist framework, of 39 stories/narratives from the Tennessee Stories Project (n.d.).
Abortion Stories
Recently, projects and advocacy efforts have emerged to provide space for abortion seekers and those close to them to process and freely discuss their abortion experiences. As examples, the Tennessee Stories Project (n.d.) at the state level and the Shout Your Abortion (n.d.) movement at the national level encourage abortion seekers to give voice to their abortion experiences, rejecting the stigma often surrounding the abortion experience in the United States.
From a research perspective, abortion narratives are a rich database for exploring aspects of abortion experiences. The benefits of public abortion narratives are notable and include, for example, benefits to activists in Argentina who have used abortion narratives to cope with disappointment and to imagine future tactics related to abortion advocacy (Borland, 2014) and Native women in South Dakota who have used abortion storytelling to articulate support for abortion rights (Thomsen, 2015). Additionally, abortion narratives have been used in research, with findings indicating that both pro-choice and antichoice advocates justify their political stance on abortion using their view of women’s social roles represented in abortion narratives (Allen, 2014; Thakkilapati, 2019). Recently, this same story/narrative project was examined in relation to stress and coping themes, with findings indicating that stressors were present in the narratives prior to, during, and after abortion procedures, supporting the need for social work responses that work to eliminate the stress inherent in abortion seeking (Sperlich et al., 2019).
Study Purpose
Despite the potential for abortion narrative projects to provide rich data sources, few published studies have utilized the themes inherent in the stories posted through public abortion narrative projects. Furthermore, studies tend to focus solely on the abortion patient (e.g., Allanson, 2007; Biggs et al., 2017; Blanchard et al., 2017; Cockrill & Nack, 2013) rather than considering how experiences are characterized by those who more broadly encounter abortion, including abortion seekers, their support people, and associated health providers. To address these gaps in the literature, this study sought to consider people’s experiences with cognitively and emotionally processing (i.e., reflecting on, growing, changing, or recovering through; Foa et al., 2006; Stockton et al., 2011) their abortion experiences among individuals who shared their abortion narrative through the Tennessee Stories Project (n.d.). These public abortion narratives offer a rich opportunity to examine personal accounts of how people process an abortion experience and position it within the context of their life course. Using these data, we sought to answer the following research questions: (1) how do those interfacing with abortion services process the abortion experience? and (2) how do these individuals situate such experiences within the course of their life?
Trauma-Informed and Feminist Framework
A trauma-informed framework seeks to acknowledge stressful or traumatic experiences that have happened to people who are seeking care, aiming to minimize stress, address trauma, and promote healing (Harris & Fallot, 2001; The Institute on Trauma and Trauma-Informed Care, n.d.). A trauma-informed framework is guided by five principles: (1) choice, (2) empowerment, (3) trustworthiness, (4) collaboration, and (5) safety (Freeman Williamson & Kautz, 2018; Harris & Fallot, 2001). A sixth principle, “cultural, historical gender issues,” has also been identified in a guidance document by the Substance Abuse and Mental Health Services Administration (2014) suggesting that a trauma-informed framework should also address intersecting contextual factors. As suggested by Ely et al. (2018), this framework can be applied to the abortion-seeking experience to validate patient experiences and promote safety and empowerment for those interfacing with abortion services. While the abortion procedure itself is not typically a source of trauma (Robinson et al., 2009), a trauma-informed framework can be useful in understanding abortion experiences in ways that minimize traumatization or retraumatization (Ely et al., 2018). Considering sources of potential stress and trauma throughout the abortion-seeking experience, this thematic analysis was guided by a trauma-informed framework, allowing for a deeper understanding of how individuals process through their abortion experiences.
Additionally, we approached this analysis using a feminist lens to critically appraise public abortion narratives with the goal of promoting understanding of the abortion experience and considering ways in which gender, power, and privilege may impact the abortion-seeking experience as well as the way that these experiences fit into a person’s life course. The feminist framework complements the trauma-informed framework well. Throughout this analysis, we acknowledge that the abortion-seeking experience and the processing of these experiences throughout the life course are shaped by the stigma often associated with abortion (Cockrill & Nack, 2013; Cockrill et al., 2013), the physical and social barriers that can prevent someone from obtaining abortion care (Ely et al., 2017a; Jerman et al., 2017), and the health disparities that help determine who can and cannot obtain abortion services (Bearak et al., 2017; Dehlendorf et al., 2013; Dehlendorf & Weitz, 2011). By sharing and interpreting these narratives, we seek to promote social justice and discuss possibilities for social work education, research, policy, and practice with the goal of encouraging equitable and accessible abortion care.
Methodology
The current study used qualitative secondary data (Heaton, 2008), originally reported to the Tennessee Stories Project (n.d.) in 2017. The project, an effort of Planned Parenthood of Tennessee and North Mississippi designed to reduce stigma around abortion in the region, aims to increase discourse about abortion, normalize abortion experiences, and promote societal acceptance of abortion services (Tennessee Stories Project, n.d.). Anyone with some kind of experience with abortion could contact the Tennessee Stories Project to provide a narrative via email or interview. Stories could have been shared based on any experience throughout the life course although many individuals shared recent (within the preceding 5 years of data collection) experiences.
The project narratives are publicly available via the Tennessee Stories website. The data used for this study represent the first 39 narratives collected for the Tennessee Stories Project. This analysis was limited to 39 narratives because that is how many narratives the project gathered in their first wave of responses, and these were the data that were provided to the researchers for analysis. Furthermore, based on the aim of the study, our analysis strategy, our theory application, and the quality of the narratives, our analysis of these 39 narratives suggested that sufficient information power was obtained (Malterud et al., 2016). The narratives used for analysis were initially de-identified and provided to the researchers by a Planned Parenthood staff member.
The narratives represented people who identified as abortion patients (
Data Analysis
Data analysis was completed using Atlas.ti (2017) and relied on thematic analysis, an empirical approach for identifying, analyzing, and reporting themes inherent in the data, specific to context (Braun & Clarke, 2006; Krippendorff, 2012; Vaismoradi et al., 2013). We approached this analysis by reading through the narratives while identifying and categorizing themes. The first three narratives were independently coded by four researchers, allowing for emergent themes. The researchers then met to discuss the emerging codes and develop an initial codebook. Subsequently, two of the researchers independently coded the remaining narratives in waves of 10. Once each round of 10 narratives was coded, the two researchers met to review and compare codes. Any discrepancies were discussed, and a consensus on the most appropriate code was reached. This process of coding helped promote the trustworthiness and credibility of the data (Graneheim & Lundman, 2004). After all narratives were coded, the information was reviewed in Atlas.ti (2017), and codes were organized into categories, subthemes, and themes (Graneheim & Lundman, 2004). Twelve overarching themes were identified in the data as a whole, and the themes and subthemes related to stress in the abortion-seeking experience were reported in another paper (Sperlich et al., 2019). For the current study, we report on four themes related to personal perspectives about emotionally and cognitively processing through the abortion experience.
Results
Results indicated the following dominant themes: (a) introspection, including personal, political, religious, and spiritual considerations; (b) feelings about the abortion experience, including feeling gratitude and lack of abortion regret; (c) processing emotions, including normalizing emotional responses and using mementos; and (d) importance of abortion access within the context of the arc of one’s life, including familial and career opportunities and professional development.
Introspection
Throughout their narratives, participants discussed their internal decision-making processes when deciding to have an abortion. Participants seemed to engage in introspection, spending time and effort considering multiple options and ultimately desiring to make informed and thoughtful decisions. Many abortion seekers described, for example, how seriously they weighed their decisions to terminate their pregnancy, with one participant stating, “I would like to say at this point, that it was not an easy choice to make…. I thought long and hard about it and I looked at all options available.” When turning decision making inward, participants frequently discussed influences including personal, political, spiritual, and religious considerations.
Personal values and beliefs
In making the decision to obtain an abortion, many individuals spoke of turning their perspectives inward and reflecting on personal values and beliefs. One participant explicitly stated, “It also didn’t fit with my personal beliefs” and went on to summarize how personal perspectives influenced the decision to obtain an abortion. Another participant explained, “I knew my circumstances, I knew my heart and mind, and that heart and mind wanted no pregnancies and no children.” Analysis supported that, in processing the abortion experience, individuals engaged in insight and reflected on their personal perspective.
Political perspectives
Participants discussed how their political ways of thinking and beliefs about being a responsible citizen influenced their reproductive decisions. For example, one person shared, “I’m really concerned with the environment and global population. I always said I’ll have one [child], and if I want more then I’ll adopt. I just could not square myself with it.” Participants framed their abortion as a decision they made based on, in part, their personal values systems including their concern for the morality of childbearing in the context of macro concerns like the environmental impact of overpopulation.
Religious and spiritual considerations
Some participants commented on how, as a part of decision making, they turned their introspections inward and considered the influence of a higher power. As one participant stated: I did not take this decision lightly…I would like to tell you that my decision-making process was like making a pros and cons list, but it wasn’t. I took a long walk along the river and prayed and prayed and prayed for guidance. While I appreciated my loving boyfriend’s input, there was only one place I turned to know the right thing to do. After a very long walk and many tears, I finally felt relief when I knew that God has different plans for me; this choice was purposeful; he understood my choice and he loved me.
Similarly, other participants described religious or spiritual values that, along with political beliefs, directly affected decision making. One participant described: I’m a fiscally and socially conservative Christian with strong beliefs that people are in charge of and responsible for their own lives. One of the reasons I have conservative values is because I know what it is like to pull yourself up by your own bootstraps to survive and hopefully, by the grace of God, come out happy and grateful in the end.
Feelings About the Experience
Despite the sometimes-difficult decision-making process and the emotions associated with the abortion experience, many participants reported specific, often positive, feelings about their abortion experience, with subthemes related to not having abortion regret and feelings of gratitude.
No regrets
Many participants commented on their confidence in their decision and lack of regret following their abortion. One such abortion seeker described that, although they were not completely content with the abortion experience itself, they felt firmly satisfied with the decision to have an abortion, stating, “I never second-guessed the choice I made, even if I was unhappy with the experience. I didn’t want to discuss that unhappiness and have it confused with a regret I’d never felt.” Another participant corroborated the feeling of having no regrets about the decision to have an abortion, stating, “I do not hate that I had an abortion. Having an abortion was one of the best decisions I have ever made. If I were to get pregnant today I would most likely make that same exact decision.” Similarly, participants described their lack of regret about their abortion decision and positive feelings that followed the experience, with one participant stating, “I don’t have an ounce of regret. The only thing I’ve ever felt about it was relief.”
Gratitude
Participants also articulated feelings of gratitude for being able to have an abortion, with one abortion seeker stating, “In 46 years, I’ve never felt anything but gratitude that I was able to have an abortion.” Another participant expressed gratitude, particularly for the medical providers who helped them have an abortion, which they feel has allowed them to now have the family they now have. That participant stated: Only gratitude came pouring through me. I have felt close to joy that those doctors were there that day and I was able to have that abortion because I am so in love with my son and he wouldn’t exist otherwise.
Processing Emotions
Participants also described processing through their emotions during and after their abortions, including (a) normalizing emotional responses and (b) using mementos.
Normalizing emotional responses
Participants discussed how emotional responses during and after abortion experiences are individualized, though each person’s unique abortion experience is normal. One participant provided a message to others choosing abortion, expressing that it is alright to struggle and feel emotions, which will dissipate with time: The one thing I would say to somebody reading my story is you’re going to be okay, not you have to be okay right now. Not you have to be totally one hundred percent fine, feeling happy —you might feel anxious, you might feel depressed, you might feel lonely. Honestly, just the experience of having a termination is very hormonal, so you could feel all of those things and it’s normal, it’s okay, and you’re allowed to feel whatever you’re feeling, but you’re going to be okay. That’s always the message I want women to hear. Not that you should be okay or not that you should feel any certain way. But you’re going to be okay. The point of the story is just to show the diversity of our experiences. A lot of women have stories like mine, and a lot of women have stories very different from mine, and every abortion story is okay. You’ll be okay.
Using mementos
Participants also described using mementos to heal and remember their pregnancy and abortion experiences. In this sample, such experiences seemed to be more common among participants who terminated pregnancy due to medical issues or fetal abnormalities. After terminating their pregnancy due to a fetal abnormality, one participant described setting aside a specially made blanket and plans to create an ornament, both as keepsakes and reminders. Another participant in a similar situation explained purchasing a piece of jewelry with a particular birthstone, so the memory of a wanted pregnancy would not be lost. Using mementos seemed to be a way for participants to acknowledge their experience and heal from it.
Some participants who terminated their pregnancies for reasons other than fetal abnormality also described using mementos after their abortion experience. For example, one participant described keeping the clothing they wore to their abortion procedure as a reminder of the day they had an abortion, stating: I remember that it said on the website to wear loose clothing so I wore these loose men’s sweatpants and an ET t-shirt…I still have those clothes, and I can’t really wear them or look at them very much, but I kept them.
Abortion in the Context of the Arc of One’s Life
The abortion seekers reported that the abortion experience influenced the trajectory of their lives in positive ways. There were two subthemes related to (a) the participants’ familial and career opportunities and (b) personal development.
Familial and career opportunities
Many participants described how their current family and career was made possible by their ability to obtain their abortion, which allowed them to attain an education, develop financial stability, and/or shed unhealthy relationships or begin or continue healthy relationships. One participant described how their education, relationship with a loving husband, and the ability to provide for eventual children—essentially the arc of their entire current life—would not be possible without the abortion: Then you go on with your life, and your life is what you thought it could be. I got to go to graduate school. I have two amazing children now with a husband I love—we’ve been together forever—and everything is great. I would not have been able to have this life and provide for my children the way I can now if I had been a mother so young. I can’t imagine not having access to a safe abortion. Holding our first baby boy in 1988—what a joy it was. A joyful pregnancy too, with friends and family support, and now this little bundle of love. I was a mature 30-year-old, married to my high school sweetheart, a career woman with a master’s degree in education and a wonderful, loving husband. We had built our new dream house with a big backyard in an affluent community a few years before. Our daughter was born 3 years later. We were ready for a family, and it was wonderful. We had life by the tail. Fourteen years earlier though, I had a very different story.
Personal development
Participants also reported that their abortions allowed them to become who they are now, for which they are grateful. One participant reflected on their abortion experience and the life they had afterward, stating, “All I know is that this is the path I was meant to have. This is the life I thank God for every day.” Another participant agreed, expressing that their abortion was only one piece of their life story, though it was an important piece because it allowed them to become who they are today. As they put it, “My life is so much bigger than one medical procedure. I am grateful that having an abortion allowed me to have my life back and become the person I am today.”
Discussion
This article used thematic analysis to examine the abortion narratives of those who interfaced with abortion and participated in the Tennessee Stories Project (n.d.), as they process through their abortion experiences, considering how these experiences influenced the arc of their lives and categorizing these narratives into four themes. Data analysis indicated that these abortion seekers: (1) engaged in introspection while making abortion decisions, which was based partly on their personal values systems (moral, political, religious, spiritual, etc.), values, and worldview; (2) reported specific feelings about their abortion experience, including feeling relieved and grateful and not having regrets; (3) processed the abortion experience by normalizing emotional responses and using mementos; and (4) positioned their abortion in the context of their life, both in terms of familial and career opportunities and their personal development.
Introspection
Participants reported that complexities related to the abortion experience led them to examine and contemplate their abortion experiences, often requiring them to confront internalized stigma in ways that influenced and were influenced by their personal philosophies. It is possible that this finding is particularly salient among the current study population due to the public nature of these abortion stories, which may encourage those involved in abortion activism to share their story. Nevertheless, the current findings extend prior research showing that the abortion-seeking experience can be stressful and stigmatizing (Allanson, 2007; Cockrill et al., 2013; Ekstrand et al., 2009) and that religion and political affiliation influence abortion attitudes and decisions (Adamczyk & Felson, 2008; Cockrill et al., 2013; Hess & Rueb, 2005; Neto & Munoz Sastre, 2014; Yen & Zampelli, 2017). While previous research has sought to describe the influence of abortion on health and mental health outcomes (e.g., Biggs et al., 2017; Charles et al., 2008; Gerdts et al., 2016; National Academies of Sciences, Engineering, and Medicine, 2018; Thorp et al., 2005), and some research suggests that abortion attitudes may influence religious or political beliefs (Hess & Rueb, 2005; Killian & Wilcox, 2008), little research has explored the ongoing influence that previous abortion experiences may have on personal worldview and life course following an abortion experience. This finding is important and should direct future research to study the influence of the abortion experience on perceptions about the life course as well as political and religious or spiritual values and beliefs and the nuanced ways in which abortion experiences may influence the abortion seekers’ personal worldview.
Feelings About the Experience
Participants also reported specific, often positive, feelings about the abortion experience. They discussed having no regrets about their decision to have an abortion and reported feeling gratitude about being able to access abortion services. Although research does suggest that abortion patients can have a wide range of feelings or emotional responses related to the abortion experience (Charles et al., 2008; Rocca et al., 2015), other research indicates that there are few, if any, long-lasting mental health impacts specifically attributable to abortion, given that most people who have mental health problems after an abortion were also likely experiencing mental health problems before the abortion (Biggs et al., 2017; Charles et al., 2008; Upadhyay et al., 2015). Furthermore, researchers argue that it is impossible to definitively conclude what the mental health impacts of abortion may be, given that any postabortion mental health problems cannot be definitively linked to the abortion experience alone (Reardon, 2018). Such findings are particularly relevant when considered from a trauma-informed social work perspective (Ely et al., 2018). It is important to understand common feelings during and after receiving abortion care so as to decrease potential stress associated with these experiences and promote healing and empowerment for all those with abortion experiences.
Further, many abortion seekers report feeling that their decision to have an abortion was natural, right, practical, and brought them relief and peace (Ekstrand et al., 2009; Lucas, 2010; Rocca et al., 2015). These findings are also in line with previous research that suggests that many abortion seekers do not regret their decision to have an abortion and instead feel grateful for being able to have an abortion (Fielding et al., 2002; Lucas, 2010). Continued research, using trauma-informed and feminist frameworks, exploring the positive and negative aspects of the abortion experience, would help us better understand the needs of abortion seekers and those supporting them. Additionally, abortion seekers’ descriptions of feelings of gratitude and lack of regret following their abortion provide evidence that can be used to counter stigmatizing abortion rhetoric (Ehrlich & Doan, 2019) and promote self-determination and reproductive autonomy that is in line with the social work perspective (National Association of Social Workers [NASW], 2018).
Processing Emotions
Results indicated that those sharing their abortion story with the Tennessee Stories Project processed through their experience by normalizing lived emotional responses related to the abortion experience and using mementos to remember or memorialize the event. These findings are in line with previous research indicating that the abortion-seeking process is complex and involves varied emotional responses (Allanson, 2007; Ekstrand et al., 2009). These findings expand on previous research, indicating that, throughout the abortion-seeking process, abortion seekers found it important to normalize the emotional response to abortion, often through discussing how everyone’s feelings surrounding the abortion experience are both different and equally valid. This salient message shared by participants provides further support for the benefit of reproductive empowerment projects and the normalization of the abortion-seeking experience, particularly given the prevalence of abortion procedures in the United States.
Additionally, we found that abortion seekers may use mementos as a way to heal and remember their experiences. This is an understudied area, which should be given attention in the future. In particular, the ambiguous loss literature (Boss, 1999; Boss & Yeats, 2014), which has been used to study grief and coping after culturally unclear losses, could be applied to examine how the use of a memento might promote healing after an abortion, especially in cases of termination due to fetal abnormality. As such, future research could focus on how abortion narrative projects may help people process their abortion experiences in light of the heavy stigma that exists toward abortion in the United States.
Abortion in the Context of the Arc of One’s Life
Participants described their abortion in the context of their lives, specifically in regard to their familial and career opportunities and their personal development. These findings indicate that abortion seekers feel that their life course has been positively altered by their ability to access an abortion, supporting the importance of reproductive autonomy and social justice and resulting in the need for advocacy particularly in terms of mobilizing social work efforts toward reforming regressive abortion policy (see Policy Implications section). Further, future research considering personal perceptions about the long-term influences of being able to obtain an abortion, and how those perceptions may change over time, is recommended as very little existing research has explored this particular aspect of the abortion experience, beyond research suggesting that abortion patients often report that abortion was the right decision for them (Rocca et al., 2015). Future research could also consider how social and political contexts may influence both the ability to access abortion care and the meaning that abortion seekers derive from their abortion experiences.
Implications
The purpose of a qualitative study is to provide a thorough description of lived experiences which deepens our understanding of concepts of interest through the analysis of text-based responses. The implications of the findings of the current study in relation to social work education, practice, and policy are discussed below.
Social work education
The findings from the current study reveal that abortion seekers, as they process the abortion experience within the context of their life, can benefit from social workers who are competent in abortion care and access. Despite the NASW’s (2018) and the International Federation of Social Workers’ (2012) acknowledgment of family planning and abortion as relevant to social work, very few social work educational programs provide any training on reproductive health or reproductive justice (Begun et al., 2016; Bell, 2015; Zastrow, 2014), and most social work students report feeling uneducated about and inadequately prepared to discuss reproductive health issues with their clients (Begun et al., 2016; Bell, 2015; Laverman & Skiba, 2012). Moreover, about half of social work students surveyed in one study reported that they would not make a referral for a client to obtain an abortion if requested, despite this assertion violating the NASW Code of Ethics (Ely et al., 2012). This is an astonishing omission in social work educational programs, given the compatibility between the concept of the right to self-determination, which is a cornerstone of social work practice (NASW, 2018), and the concept of reproductive justice, which is a framework developed by black women advocating for the right to have children, the right not to have children, and the right to parent in peace and safety (Ross & Solinger, 2017).
Social work educators can mobilize to address these gaps through adding reproductive health modules to existing courses, offering specific courses on the role of social work in reproductive health and justice, expanding field placement opportunities in reproductive health settings, and providing continuing education opportunities focused on reproductive health and justice. These efforts are imperative to establishing competence and creating social work practitioners equipped to deal with problems that are experienced by vulnerable groups who are in need of accessible and affordable reproductive health care. The development of these kinds of social work skills are particularly important for bridging health access gaps in geographically disadvantaged regions, such as in rural areas or in Appalachia, where reproductive health care access is compromised (Swan et al., 2020), and social workers in public health-oriented roles are well positioned in the community to help better facilitate patient access to care (Ely et al., 2011).
Social work practice
The findings from the current study support that practitioners, including social workers, need to be comfortable discussing abortion care with clients, both as a family planning option available to them and as a piece of their life story. Social workers need to be equipped to promote self-determination and reproductive justice by being prepared to help their clients understand their family planning options, access abortion care when so desired, and process through the abortion-seeking experience, as needed. Without access to competent social workers who can help clients access these services, client self-determination is at risk of being compromised. In social work practice, social workers should operate from a trauma-informed perspective, valuing principles such as safety and choice (Ely et al., 2018), whether directly interacting with abortion seekers or working in settings where clients may not be expected to need an abortion or a referral to abortion services.
Policy
The findings also have implications for policy. In the geographic Southeastern United States, the area where these abortion stories emerged, there is a hostile view of abortion (Guttmacher Institute, 2019; Sturgis, 2018). However, research finds that most people who get help for funding abortion live in the Southeast (Ely et al., 2017a), suggesting a strong potential that social workers will encounter clients who may need assistance funding abortion care. As such, the findings from our current analysis support the need for policy reform (Guttmacher Institute, 2020), as over 500 state-level policies have been enacted since 2010 to restrict abortion (Nash et al., 2019). Policies should be redesigned to enhance self-determination and reproductive autonomy by increasing access to all reproductive health service providers, replacing nonevidence-based policy requirements with evidence-informed reproductive health policy, and repealing the federal Hyde Amendment, which prohibits the use of Medicaid dollars for funding most abortions (Solinger, 2013) as well as many regressive abortion policies at the state level (Ely et al., 2017b). Social workers, who are committed to the pursuit of social justice, must engage in advocacy at the policy level to achieve the necessary macro-level changes.
Limitations
Although the researchers strove to promote trustworthiness and credibility throughout the data analysis process, the current study has limitations. Primarily, data collection was originally undertaken by the Tennessee Stories Project (n.d.) as part of an abortion narrative project with the stated goal of allowing participants a space to discuss abortion experiences with the purpose of helping to destigmatize abortion. As such, these narratives were not originally collected for research purposes, and, therefore, some of the traditional aspects of qualitative data collection, including probing participants for more information, were not possible for this project. Therefore, these findings might differ if data collection methods had differed. Furthermore, there are several sample limitations that could affect our findings. Since we utilized public abortion narratives, all study participants volunteered for the abortion narratives project. This requires a certain amount of courage as well as time and resources that are likely not possessed by all abortion seekers. Thus, our sample may best capture the experiences of abortion seekers who have better access to these resources. Future research could consider positioning the abortion experience within the life course of abortion seekers who may face greater socioeconomic barriers to abortion care. Finally, due to the Tennessee Stories Project’s focus on empowerment and sharing, additional demographic information was not obtained, and we were, therefore, unable to speak to the demographic characteristics associated with the individual narratives in this study. Future research that includes more demographic information may be able to add more nuanced understanding based on the person and context behind abortion narratives.
Conclusion
The findings from this study provide valuable insight into how those engaging with abortion services process through their experience, before, during, and after the medical procedure, and suggest possible directions for social workers, health and social service providers, and advocates and policy makers, in order to better support abortion patients, providers, and family members. These findings illuminate the potential benefits of public abortion narrative projects that extend beyond offering space for respondents to discuss abortion stories. These projects are rich sources of data for researchers, as the stigmatized nature of abortion makes it difficult to access a sample of people who will admit to having had an abortion. This careful analysis of the topics represented in one wave of these public abortion stories sheds light on an experience that is often stigmatized and gives social workers information that can be useful for assisting clients in accessing reproductive health care.
Footnotes
Authors' Note
Gretchen E. Ely is now affiliated with University of Tennessee, Knoxville, College of Social Work.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for this project was provided by a Les Brun grant through the Buffalo Center for Social Research at the School of Social Work, University at Buffalo, State University of New York.
