By Marietta Wildt for the profamilia magazine, March 2021

Original Text in German

The 150th anniversary of §218 of the German criminal code provides an opportunity to take a closer look as its diverse implications. As a board member of inroads, International Network for the Reduction of Abortion Discrimination and Stigma, the author points out the reciprocal relationship between abortion stigma and criminalization. inroads is a loose network of academics, advocates, activists and artists and provides a platform for activism and discussion on all facets of abortion stigma and its effective fight. 

Let us start with the concept of stigma. Research used to focus on stigma related to HIV, mental health and sexual orientation but later this concept was also applied to abortion. Erving Goffman, who was one of the first stigma researchers in the 1960s¹, described “stigma as a phenomenon whereby an individual with an attribute which is deeply discredited by their society is rejected as a result of the attribute”.² Stigma is a process categorizing persons as deviant from mainstream society, which leads to them to losing their social status and falling victim to discrimination³. This process serves to maintain the status quo as it punishes deviation from it⁴. In addition, the stigmatized person might tend to internalize stigma as shame and will therefore carry it forward and reproduce it.

“A deviation from traditional women’s roles, such as the desire to have a child, is sanctioned by society “

Applied to abortion, stigmatization means that those having or supporting abortions, are classified as morally inferior. What is being punished is the deviation from traditional women’s roles and societal expectations, such as the desire for motherhood⁵. Depending on their overall social standing, discrimination affects individuals differently. Having to travel for an abortion creates very different levels of burdens and barriers depending on the financial and economic situation of the person concerned, or whether they have to keep the reason for their absence secret at home or at work. If someone cannot travel alone, is not permitted to travel, and/or does not have a passport, multiple intersections of discrimination and marginalisation are coming together and build upon each other. Those affected by racism, poverty and who have disabilities are hit especially hard by these barriers to accessing health services.

The question arises how stigmatisation and criminalization of abortion are connected. Abortion stigma is (re)produced on multiple levels of society: from the individual level to community, institutional, structural and societal levels⁶. These various levels both interact and reinforce each other. As a result, the societal and legal contexts of abortion reinforce stigma, both as external influence and through its internalisation. With the following five points, I want to illustrate what that looks like in detail. The examples I use originate from different geographical contexts but I believe are nevertheless applicable to the German setting.

1. Criminalization implies that something is dangerous and immoral

Criminalization contributes to how we perceive abortion. If something is illegal, we tend to consider it as dangerous or immoral. Through the shadow of criminalization, the state implies abortion to be risky and keeps the issue in the dark⁷. Research from Ireland shows that the very extreme criminalization of abortion has anchored the assumption deeply that abortion is dubious and dangerous, and therefore there is no space to have open and public discussions on the matter⁸.

2. Stigma creates barriers to accessing information

The German criminal code criminalizes abortion not just through the well-known §218 which says that having or providing a termination of pregnancy is illegal. The less known §219a which forbids providers to advertise for abortion for financial gain further criminalizes information on abortion and its methods. It primarily creates barriers to evidence-based and medically approved information from professional sources. This inevitably increases the amount of misinformation that is going around. Opponents of abortion like to use this gap and spread confusion as well as particularly martial depictions of abortion methods. As §219a creates additional barriers to information, it promotes abortion stigma.

3. Stigma leads to shame and embarrassment and does not help to improve services

Both the societal categorization of abortion as wrong as well as the spread of misinformation add to the marginalization of abortion, and the experiences of those having had one. Therefore, those concerned cannot confide in others and tend to be isolated in their experience⁹. Their experiences and perspectives go unheard and will go unused instead of contributing to creating a better, needs- and evidence-based care. If abortion was not stigmatized but treated and regulated as a normal part of public health, it could contribute to holistic health care and health promotion¹⁰.

4. Criminalization creates a burden on medical providers

Criminalization affects providers in a variety of ways:

• The legal situation is often unclear and confusing (as shown by the struggle around §219a) which leads to major uncertainty among providers.
• Universities do not teach methods of abortion in med school. This means learning abortion methods is an additional and extracurricular effort, which requires specific interest and outside support, such as through Medical Students for Choice.
• Providers are often victims of threats, intimidations, discrimination and harassment coming from opponents of abortion.
• Providers are portrayed as greedy and immoral and face social prejudice.

Research from the USA shows that abortion stigma is the most common reason why many providers do not want to offer abortions¹¹.

5. Criminalization creates a burden for informal supporters

Not just professional providers, also informal supporters of reproductive autonomy face strain. While medication abortions are still less common in Germany than in international comparison¹², in many countries medication abortion is the norm. Where that is illegal, often feminist care networks help to provide the pills as well as information and support. These supporters face not only legal risks but also stigmatization, when they are associated with abortions.

Criminalization is only one element of stigma, and decriminalization is not simply going to solve the problem and destigmatize abortion. However, it remains one important part of the long journey to making abortion safe and accessible. Research from Mexico shows that in Mexico City, where abortion is legal, stigma is much less than in other parts of the country, where abortion remains illegal¹³. This shows how decriminalization helps to decrease stigma. Nevertheless, stigma remains a moving target, and we will need to continuously adapt our struggle to the changing landscape of stigma.

If you are working on stigma and/or would like to delve deeper into the issue and have conversations with others, you are welcome to join the inroads network. You can find us under makeinroads.org. We share information and resources, have webinars, give seed grants and hold regular meetings for and by network members. Should you have any questions, feel free to get in touch!

Marietta is an advocate for sexual and reproductive health and rights with a focus on youth engagement. You can reach her via mariettawildt@web.de

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 ¹Goffman (E. (1963): Stigma: Notes on the Management of Spoiled Identity, Englewood Cliffs, N. J.: Prentice-Hall.

² Ibd.

³ Cárdenas, R., Labandera, A., Baum, S.E. et al. (2018): “It’s something that marks you”: Abortion stigma after decriminalization in Uruguay. Reprod Health 15, 150; p 9.

⁴ Fernández Vázquez, S. S., Brown, J. (2019): From stigma to pride: health professionals and abortion policies in the Metropolitan Area of Buenos Aires. Sex Reprod Health Matters. 27(3):1691898. 

⁵ Kumar, A., Hessini, L., Mitchell, E.M. (2009): Conceptualising abortion stigma. Cult Health Sex. Aug; 11(6):625-39, p. 625.

⁶ Ibd., p. 593.

⁷ Cook, R. J., Erdman, J. N., Dickens, B. M., Rebecca J. Cook, Joanna N. Erdman (2021): Abortion law in transnational perspective, Penn Press, Pennsylvania.

⁸ Aiken, A., Johnson, D. M., Broussard, K., & Padron, E. (2018): Experiences of women in Ireland who accessed abortion by travelling abroad or by using abortion medication at home: a qualitative study. BMJ sexual & reproductive health, bmjsrh-2018-200113.

⁹ Kumar, A., Hessini, L., Mitchell, E.M. (2009): Conceptualising abortion stigma. Cult Health Sex. Aug; 11(6):625-39, p. 625.

¹⁰ Cook, R. J., Erdman, J. N., Dickens, B. M., Rebecca J. Cook, Joanna N. Erdman (2021): Abortion law in transnational perspective. Pennsylvania: Penn Press.

_¹¹ Harris, L.H., Debbink, M., Martin, L., Hassinger, J. (2011): Dynamics of stigma in abortion work: findings from a pilot study of the Providers Share Workshop. Soc Sci Med. 2011 Oct; 73(7):1062-70.

¹² pro familia (2018): Fakten zum Schwangerschaftsabbruch, pro familia, Last visited: 20. April 2021, https://www.profamilia.de/fileadmin/ profamilia/8_Fakten_zum_zum_Schwangerschaftsabbruch-WEB.pdf.

_¹³ Cockrill, K., Hessini, L. (2014): Introduction: Bringing Abortion Stigma into Focus. Women & Health, 54:7, 593-598, p. 595.