Private troubles and public issues: Providing abortion amid competing definitions

Abstract

Sixteen years after the Supreme Court liberalized abortion policy, the United States continues to debate two competing and seemingly irreconcileable definitions of abortion. The experience of those who provide abortion has received relatively little research attention despite this unique set of historical circumstances. This paper presents findings from an exploratory study of 130 abortion workers (physicians, nurses and counselors). The data suggest that, despite formal beliefs about abortion rights, the situated experience of providing legal abortion evokes a range of abortion definitions. Seven central definition themes were cited repeatedly by the respondents: abortion as a woman's right, a destructive act, part of the practitioner's work, a technical procedure, a positive act, murder and an irresponsible act. Respondents perceived each definition to fit within one of three fixed and familiar perspectives: medical, pro-choice or pro-life. Each perspective was understood to have its own exclusive meanings, vocabulary and imagery which automatically remanded the situated definitions to a broader social context. Each definition of abortion was seen to define the event itself as well as to impute specific meaning and differential value to what is aborted, the woman terminating her pregnancy, the nature of abortion work and the role of the practitioner. These definition components were perceived to be specific, codified and mutually exclusive within the different definition themes. They also were found to be linked to expected and specified feelings. The co-existence of feelings or definitions that were perceived as consistent was hardly noted by respondents. However, situated definitions perceived as inconsistent with formal beliefs did not fit the respondents' expectations. If the challenging feeling or definition could not be located within the practitioner's understanding of the configured components of a comfortable definition, the result was the uncomfortable co-existence of competing definitions. This type of ambivalence was found to be familiar and consistently disturbing to study respondents. Practitioners frequently connected their personal ambivalence to dramatic social outcomes. This perception led to a private and anguished ambivalence and drove attempts to resolve it underground. Practitioners reported its interference with quality of care and willingness to participate in abortion work. Respondents seldom saw the way in which ambivalence about abortion work may be socially caused: created and maintained by the promotion, assimilation and institutionalization of simplistic and competing definitions of abortion. Their experience points to the urgent need for fuller, more resonant frameworks within which to deliver abortion services.