Disgust,stigma,and the politics of abortion

Abstract

Despite the growing body of research on the emotion of disgust – including its relationship to political ideology, moral judgment, matters of sex and sexuality, and death – the global reproductive rights movement has paid relatively little attention to the role disgust plays in the debate over abortion. By focusing on the right of a woman to make her own decision about an unwanted pregnancy, the pro-choice community has allowed anti-choice groups to define and frame the abortion procedure, abortion providers, and women who have abortions in terms associated with disgust. This commentary encourages further examination of what triggers disgust, its measurement, and ways of mitigating it, which could be useful for reducing abortion stigma, in future legal cases and in abortion research, advocacy, and communications.

The study of disgust is a large and growing body of work with implications for many social issues, including abortion. This paper introduces the concept of disgust, reviews select literature, and explores the ramifications of disgust on the topic of abortion. Three aspects of the abortion rights and care movement are considered: policy and advocacy, the abortion procedure itself, and the stigma associated with abortion. This paper is not an exhaustive review, but draws on examples from the US abortion debate to make the argument that the global reproductive rights movement should consider the role disgust plays in that debate in order to counter its use by those who oppose expanding access to safe abortion. Because opposition groups export their ideology and tactics largely from the United States, this topic should be of global interest.

In her thought-provoking paper, Cahill (2013) weaves together research findings from the fields of moral psychology, anthropology, and the law to highlight the role that the emotion of disgust plays in abortion law. Her article notes that feelings of disgust are now explicitly mentioned in legal decisions in the United States, pointing to the US Supreme Court rulings Stenberg v Carhart in 2000 and Gonzales v Carhart in 2007, which upheld a federal ban on the use of the dilation and extraction procedure (a second-trimester abortion procedure often described in graphic ways). Given the hundreds more state regulations on abortion enacted since 2007 in the United States, it seems the reproductive rights community has missed an opportunity to consider the issue of disgust and its role in legal, political, and social spheres.

There is a large body of research on disgust and its measurement (Haidt, McCauley, & Rozin, 1994; Miller, 1997; Olatunji, Cisler, Deacon, Connolly, & Lohr, 2007; Rozin, Haidt, & McCauley, 2008a, 2008b), its relationship with various phobias and mental health issues (Olantunji et al., 2007), political ideology (Brenner & Inbar, 2015; Inbar, Pizzaro, Knobe, & Bloom, 2009), sexual morality (Crawford, Inbar, & Maloney, 2014), moral judgment (Haidt & Bjorklund, 2008) and communication or rhetoric (Winderman & Condit, 2015). There is even a growing body of work on the role of disgust in public health campaigns (Lupton, 2015; Meunier & Tolin, 2009). Disgust has been shown to be a powerful predictor of conservative political ideology with matters of sex and sexuality, particularly homosexuality, evoking disgust in laboratory studies (Inbar et al., 2009; Inbar, Pizzaro, Iyer, & Haidt, 2012). Disgust sensitivity is also strongly correlated to opposition to abortion (Crawford et al., 2014).

Theorists suggest disgust can be separated into three categories. The first, “core disgust,” is a reaction to contaminated or rotten food and is an evolutionary defense mechanism that humans use to protect themselves (Rozin et al., 2008a). The second, “animal-reminder disgust,” is a reaction to bodily processes or actions, such as improper hygiene, sexual acts, and death, that remind us that humans are part of the animal kingdom (Haidt et al., 1994). The third, “sociomoral disgust,” is an emotion that emerges when social taboos or social norms such as heterosexuality are violated. This category of disgust is particularly relevant to abortion as it centers on “holes in the body,” i.e. mouth, vagina (Rozin et al., 2008b). Interestingly, it appears that disgust of all types is not innate but learned, and further, it is subject to cultural variation (Rozin et al., 2008a).

There are many reasons abortion may evoke disgust, including that women, in many cultures, are considered closer to animals than men because they menstruate, give birth, and are associated with blood outside the body. Women in many parts of the world are considered “unclean” when menstruating or after giving birth, leading to prohibitions related to their mobility and actions. The abortion procedure is also likely to evoke disgust because it involves death, blood, and in the case of surgical abortion, penetration of the body. Finally, those involved with the procedure are also likely to be considered disgusting given their proximity to blood, death, and fetal parts.

Sociomoral disgust may also be evoked because an induced abortion challenges social norms that insist women must always be mothers to be “real” women (Kumar, Hessini, & Mitchell, 2009). Abortion is also linked to non-procreative sex, challenging traditional ideas of female sexuality, gender roles, and women’s agency. From this perspective, abortion is a socially dis-ordering act and one that has long been subject to attempts to contain it.

The relationship between disgust and abortion has been implied in previous research and explicitly mentioned by Cahill (2013), who draws on the work of anthropologist Mary Douglas (1978), arguing that disgust is experienced when social taboos are violated and the social order disturbed. Previous exploration of the idea of “dirty work” is linked to animal-reminder disgust, because abortion involves “confrontation with blood, vomit, and in some instances, discernible fetal parts” (Joffe, 1978, p. 119). Research with abortion counselors in the United States in the 1970s revealed that some counselors thought the abortion procedure had a sexual aspect to it because of how vulnerable and exposed a woman is during the procedure (Joffe, 1978). Others have also noted the connections between disgust, dirty work, and stigma, suggesting that the stronger the moral stain of an act, the dirtier it is (Ashforth & Kreiner, 2014). The concept of liminality, the idea that the abortion procedure is neither fully death nor life, but rather an in-between stage, may also be relevant here with its connections to pollution/purity and the need to maintain purity and limit exposure to disgusting items or those deemed disgusting (Purcell, Brown, Melville, & McDaid, 2017; Rozin et al., 2008b). Nussbaum (2010) has argued that disgust is an important variable in moral judgments and is considered a “natural” way to police social morality. Others have shown that evoking even a temporary sense of disgust can shift political beliefs toward being more conservative and lead to harsher moral judgments (Graham, Haidt, & Nosek, 2009). Despite this scholarship, there is no empirical research that links disgust to abortion or abortion stigma.

Policy and advocacy

Nussbaum (2010) argues that the politics of disgust, marked by fear and anxiety of the “other,” is in dynamic tension with the politics of humanity, which requires both respect and sympathy for those who are not like us. Respect and sympathy require imagination, that is, the ability to imagine oneself facing the challenges that another may face and responding in a sympathetic manner. Such an imaginative leap has taken place in the United States and other parts of the world with regard to same-sex marriage. This leap has yet to be made with abortion, where laws, regulations, and policies continue to assume that women are weak, in need of protection, and unable to make decisions on their own. In the case of abortion, the politics of disgust is in ascendance, with the politics of humanity only occasionally glimpsed.

Following the US Supreme Court decision in Whole Women’s Health v Hellerstedt in 2016, which found that scientific evidence of harm must be present before abortion access can be curtailed, anti-abortion activists have concentrated their efforts on laws involving the procedure or the embryo/fetus, aspects that are emotionally contested. Anti-choice activists in the United States have introduced federal legislation that would ban abortion at or around 20 weeks, as has already been done in 13 American states. These bills, and others focused on fetal pain, sex-selective abortion, and mandatory ultrasounds, are rooted in a desire to promote abortion as a disgusting procedure which harms an unborn person.

Another tactic used by opponents of abortion rights is to frame the use of medical abortion pills by women or non-physicians as dangerous. This extends the argument that abortion, in general, is dangerous. Graphic descriptions of “do-it-yourself” abortions, along with images of dismembered fetuses and the now discredited videos depicting the alleged sale of fetal body parts at Planned Parenthood clinics, are attempts to elicit disgust as an emotional response (Mainwaring, 2017; Weatherbe, 2017). The hope is to move the emotional response to political behavior, for which there is evidence of success.

A study of the 2008 US presidential election found that social conservatism is most closely linked to higher levels of disgust sensitivity and that disgust sensitivity translates to actual voting behavior, even in non-US settings (Inbar et al., 2012). If, as the evidence indicates, disgust could be a predictor of voting behavior, then the reproductive rights community should develop strategies to mitigate the negative impacts of disgust on laws and policy. For as Nussbaum (2010) warns, “disgust provides no good reason for limiting liberties or compromising equalities that are constitutionally protected” (p. 21).

Images and messaging

Surgical abortion is very safe. Surgery itself, however, is particularly open to be considered disgusting as it involves blood, tissue, and the possibility of death, thereby eliciting the animal-reminder form of disgust. Referring to abortion as surgery, framing it as a disgusting procedure, and portraying abortion providers and clinic workers as doing “dirty” work has not been vigorously contested by the pro-choice community. Protective buffers to help abortion providers manage stigma through, for example, professional organizations like the National Abortion Federation in the United States, do exist, but they do not operate at a public scale (Ashforth & Kreiner, 1999). We still see images of dismembered fetuses, the feet of “babies,” and fetuses that suck their thumbs or smile in the image gallery used by anti-choice groups along with misleading commentary that explains the images and what viewers should feel.

When the reproductive rights community does discuss abortion as a physical act, it is generally to remind us of how gruesome it was in pre-Roe v Wade times, conjuring images of coat hangers. However, that image, even when accompanied by blood, was deemed less persuasive to the general public than those mentioned above because understanding it required historical knowledge of abortion prior to its legalization (Condit, 1990). Similarly, the iconic image published in Ms. magazine in 1973 of a woman sprawled in a pool of blood after dying from complications from an illegally induced abortion did not persuade the American public (Condit, 1990).

Since the 1990s, the pro-choice community has focused on the importance of the decision that a woman must make facing an unwanted pregnancy, her absolute right to make this decision, and the consequences if she is denied this right. Excluding the pregnancy and the embryo/fetus from public discussion has allowed anti-choice activists to pit the woman against the embryo/fetus and portray the embryo/fetus as a victim and the woman as an aggressor. Thus, scholars have argued that it is imperative for feminists to sensitively and carefully engage with the embryo/fetus or risk continuing to cede moral ground to those who oppose abortion (Kissling, 2004; Morgan & Michaels, 1999). Now that anti-choice groups have been allowed to frame the rhetoric about women who have abortions and abortion providers, the challenge for reproductive rights advocates is to acknowledge that abortion leads to a form of death or the loss of a potential life while at the same time asserting women’s moral agency to cause that death or loss.

The relationship between death and disgust is an important one. Some have theorized that feelings of disgust towards rotten meat, blood, or individuals who are engaged in socially taboo actions are a means of avoiding or denying the existence of death (Rozin et al., 2008b). Evans (2008) points out that pro-choice messaging has refused to acknowledge abortion as a form of death and, therefore, defends “a choice stripped of content, since the subject matter of the choice to which we have both right and obligation is precisely life or death” (p. 8). This vacuum permits the opposition to define and frame the abortion procedure as vile, abortion providers as murderers, and women who have abortions as amoral.

Reproductive rights advocates have avoided the subject of death for good reasons. Discussing death invites examination of the abortion procedure and the possibility of the embryo/fetus being considered philosophically and legally a separate human being. And, yet, decisions about life and death are increasingly commonplace and complex in our medically advanced world, particularly with an aging population.

Acknowledging abortion as a type of death or a loss allows us to care for women who may want closure after an abortion by providing counseling or the time and space for rituals of loss. It would also permit a fuller explanation of the abortion procedure and demystify it so that women fully understand what will happen to them and the embryo/fetus (Purcell et al., 2017). By acknowledging the death or loss that abortion represents to some women, providers, and advocates would have greater ability to describe their true feelings about abortion in popular discourse and their experience of it, including positive feelings such as relief, optimism for the future, and powerfulness. And we could finally, unequivocally, state that women are fully autonomous humans with the moral ability to make life and death decisions.

This is not to say that women must regret their abortion. Studies show that most do not, or, if they do, they also feel relief (Major et al., 2000; Rocca, Kimport, Gould, & Foster, 2013). It also does not imply that providers must feel stress about the procedure. Instead, this shift would provide room for women to be allowed a range of feelings to process their experience. This is also not to suggest that embryos or fetuses have legal, social, or political standing, but that the fact that they are “not nothing” is the very reason that women’s moral agency must be respected (Kissling, 2004, p. 14).

Abortion stigma and disgust

While stigma researchers have noted that a sense of shame and guilt is often experienced by those who are stigmatized, is it possible that disgust is what the stigmatizers feel (Hoggart, 2017)? Are the objects of disgust women having abortions, providers doing the procedure, and the procedure itself? Disgust, then, is the emotional trigger, the “unreliable force,” that sets the stigmatizing process in motion and is also the residue that remains once the stigma has been attached (Nussbaum, 2010, p. 199). Or, as Abrams (2014) states, “The Court's expressed disgust for late-term abortion in Carhart is both reflection and generator of abortion stigma” (p. 317).

Like stigma, disgusting things are contagious: unclean items that are in contact with clean items don’t make them clean; rather, the clean items become contaminated. As one researcher put it, disgust is a communicable emotion (Olatunji & McKay, 2009). Similarly, those who are stigmatized spread the stigma to others (Kecinski, Keisner, Messer, & Schulze, 2016). An example is the language used in the 2011 US Grand Jury report in the trial of Kermit Gosnell, which leads the reader to be repulsed by the medical practices of Dr. Gosnell, who was found to be providing abortions under unhygienic circumstances. This allowed anti-choice groups an opening to connect Gosnell to other abortion providers – a juxtaposition that was likely intended to stigmatize all providers as murderers, with disgust as the driving factor of this association.

Disgust and shame are likely linked emotions, but how? Is the relationship mediated by fear and are those who employ these fear-based tactics attempting to portray the item/entity in question as a threat (Lupton, 2015)? We fear objects and people who evoke disgust because they threaten our health, lives, or sense of morality. Or is it that women have lower social status and are considered objects of disgust by more powerful groups, namely men, because they are more aligned with natural or animal-like processes such as menstruation and childbirth (Nussbaum, 2010)? This is linked to ideas about purity and pollution, clean versus unclean, and other binaries typically thought to organize social life, a life free from fear. The relationship between disgust, stigma, and how each is produced and transmitted would be important to clarify through empirical research.

Conclusion

Some say that “discomfort with disgust pervades progressive scholarship” (Winderman & Condit, 2015, p. 519). This discomfort may come from a fear of engaging with emotions in general – including anger, relief, happiness, regret, and disgust – due to the primacy most scholars and advocates place on moral reasoning. Data and facts paired with rational legal arguments are preferred, even though these are insufficient to persuade broad swaths of the public. As one scholar writes: “People undeniably engage in moral reasoning. But does the evidence really show that such reasoning is the cause, rather than the consequence, of moral judgment?” (Haidt, 2001, p. 817). More likely, and less well understood, these decisions are made using both intuition and reasoning. As advocates, we need to better understand how decisions and judgments are made and the role emotions play.

The emotion of disgust has not been previously discussed in the context of abortion, and its understanding could be important to advancing the cause of women’s reproductive rights, including the right to safe abortion. This article points to the growing body of research on emotions that highlights the importance of disgust, which could guide messaging, legal tactics, and work to reduce abortion stigma. A careful mapping of the role various emotions play in creating and perpetuating abortion stigma is needed to better understand abortion stigma and how to mitigate it. Such a mapping would need to take into account cultural variation. If emotional pathways can be mapped, it may be possible to mitigate or even preempt the creation of abortion stigma by distancing abortion from disgust. I encourage advocates and scholars in the reproductive health and rights field to more closely examine this work and begin to apply its findings to the causes we care about.