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August 20, 2012

Stigma, Abortion and Healthcare

Gynaecological nursing has been described as women in a woman’s job carrying out women’s work (Porter, 1992). This makes the world of gynaecological nursing a closed one with its own professional culture and shared meanings.
Research in this area has shown that women, as nurses and patients, value this exclusivity and in certain circumstances celebrate their status in an all-female environment (Bolton, 2005; McQueen, 1997; Webb, 1984).
A counter argument is that nursing is invisible (Bolton, 2005) and gynaecological nursing is dirty work (Lawler, 1991). Many of the procedures associated with gynaecology are uniquely women’s problems of a personal nature which remain inscrutable to those outside the fi eld. Bolton (2005) classed gynaecological nurses as physically, socially and morally tainted. Physically tainted due to the close association with intimate parts of the body, socially tainted because of unmentionable topics such as menstruation and incontinence and morally tainted through the visibility of what should remain invisible.
Within the dirty work of gynaecology lies the taboo area of abortion care. Abortion has had a chequered history from being viewed as a ‘natural’ phenomenon at various times in history to more recently being classifi ed as an illegal act (McIntosh, 2000). Bolton’s (2005) premise of physical, social and moral tainting gains resonance if it is applied to abortion care, as abortion is physically, socially and morally tainted by demise of the foetus as opposed to the nurturing of life.
Much of the literature regarding impact focuses on the women undergoing abortion rather than on the nurses caring for them (Fergusson, 2006; Goodwin & Ogden, 2007; Trybulski, 2005; Wahlberg, 2007). To address this, a recent grounded theory study was undertaken by the author to explore the nurse’s role (Lipp, 2008c). Readers are referred to the study for more detail.
However, a synopsis of the study is outlined below to set this paper into context.
The study was undertaken during 2007/08 and focused on nurses and midwives working in abortion care in the National Health Service (NHS) based in South Wales, UK.
The study aimed to examine:
• How nurses and midwives perceive their role
with women undergoing induced abortion.
• How nurses and midwives cope with their increased involvement with women undergoing
medical abortion.
Grounded theory was chosen because of the limited data available exploring this issue and,
because of the study being for women, by women and about women, feminist methodology was used as a supporting framework. Research governance approval was gained from all NHS organisations as well as National Multiple Site Ethical
Committee approval.
Twenty-seven nurses expressed an interest in participating and 12 were recruited to the study from the 250 letters sent to all nurses/midwives working in abortion care in the NHS in Wales, UK. All participants had 10–30 years’ experience in the field, with a range of positions and expertise. All were female and either registered nurses or midwives.
Individual open-ended interviews were undertaken at a time and place of convenience to the participant. Constant comparative analysis was used to build on initial data gathered in order to inform subsequent interviews. Strauss and Corbin’s (1990) framework was used to categorise the data and eventually the central phenomenon of ‘fostering a woman-centred service was constructed’ (Figure 1).
During the study a major infl uence on the central phenomenon was found to be the increasing number of medical abortions. Subsequently one of the consequences of providing a women-centred service was that nurses had to cope with more medical abortions (Figure 1). Stigma was implicit in these findings in both nurses and women in procured abortions.
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