‘Obvious Child’ for the Web: New Online Course Combats “Abortion Stigma”

Americans love to argue about abortion, in the moral-philosophical sense. Is it right or wrong? In what circumstances is it OK, or allowable? The debate goes back and forth, and so do the laws. Just last night, the Supreme Court reversed a circuit court’s decision (which had reversed a still lower court’s decision) to close a number of Texas abortion clinics — roughly accomplishing what Wendy Davis was initially trying to do with her filibuster. The shuttered clinics will now be able to re-open, until they’re targeted yet again. There’s no doubt they will be.

But the decibel-shattering, football-game quality of the debate doesn’t really make it easier for women to actually talk about abortions or find doctors willing to perform them. In fact, it makes it harder. Political and moral hollering perpetuates ignorance and shame around a procedure that’s still needed rather frequently. And that shame makes it easier for still more restrictive, misogynist laws like forced ultrasounds, waiting periods, and more to squeak through. In other words, it’s a vicious cycle. Bad laws lead to stigma, stigma enables bad laws.

A new massive online open course, “Abortion: Quality Care and Public Health Implications,” from the University of California San Francisco, available to anyone who registers, is trying to change that status quo. Its goal is to normalize abortion in a global public health context, and to get the full set of facts and context spread to as wide an audience as possible — especially to doctors and medical students. As of last week, the class had over 3,000 sign-ups and counting. “We welcome any health practitioner or student to participate in the course, especially those who feel uncomfortable or uninformed about abortion,” the founders write. But many “students” (including me) are not in the medical community. We’re signing up to browse the extensive materials and self-educate. At the very same time, a free issue of the medical journal Women & Health released an issue today devoted to “abortion stigma,” and are making it available for free.

The course’s creators, a group of professors, doctors and health experts, want to combat that abortion stigma — and get their community to stop sidelining abortion in classes, clinics, and hospitals. “While abortion is common, it is often omitted from health professional education,” says the course’s originator, Jody Steinauer, MD, in the very first lecture. “We may be ill-prepared to care for our patients who have had, or may be facing, a decision about whether to have an abortion.” 

What Dr. Steinauer means is that the very same stigma that made Obvious Child a revolutionary movie also affects actual abortion care. A technical definition of stigma, offered by nonprofit Sea Change, calls it “a shared understanding that abortion is morally wrong and/or socially unacceptable.” This shared understanding comes from inaccurate or absent portraits of abortion on TV and in the media (remember that study that said that women in film who get abortions end up dead too much of the time?). It also comes from the refusal of doctors to perform the procedure for fear of protests or worse, the omission of abortion on medical school syllabi, the targeting of clinics by state laws, the inability of people to even mention the word in conversation contributes to stigma.

And that’s why many of these cultural and social topics are addressed in the UCSF online course lectures, sandwiched in between harm reduction models and maternal mortality statistics.

The taboo has grown so deep that even staunchly pro-choice people are influenced. This week Elle magazine writer Laurie Abraham described her own abortions — one early in life, one later, after she was a mom — in a long (and must-read) piece responding to Katha Pollitt’s new book, Pro: Reclaiming Abortion Rights. In Elle’s pages, Abraham acknowledges that she had trouble mentioning the word in the run-up to publication, and so did her colleagues. Abraham describes this as a “penumbra of shame.” “In several meetings at work in which this essay was discussed, I noticed that none of the other editors in the room, all of them pro-choice, could bring themselves to utter the word abortion,” Abraham writes, adding, “The truth is, I felt uncomfortable saying it out loud too. Abortion is a conversational third rail, women’s dirtiest dirty laundry…” 

But here’s the thing: it’s not actually dirty laundry. For Abraham, and for so many others, it’s a part of a long, rich, life filled with wise and less wise decisions. Women are human beings with long reproductive lives, who inevitably make mistakes or get caught off guard, as Pollitt notes emphatically in her book. Without the ability to decide when to procreate, our lives are curtailed. So as important as things like this class, books like Pro, and movies like Obvious Child are, ending abortion stigma starts even smaller, with ourselves. We have to seek out the stories of people who have had abortions, tell our own, and really — here’s the hardest part — resist the impulse to judge.

That includes men’s stories. This week, a Texas man named Charles Vestal described his wife’s thwarted abortion in the most tragic of circumstances — they were told that their expected child would not survive, but because of Texas’ laws, they could not mercifully terminate their pregnancy. Instead, they went home, “to wait for our son to be born, so that he can die.” 

Vestal writes about the restrictive laws that unexpectedly affected his life. “We are denied the opportunity to even make a humane and doctor sanctioned medical decision by a bill that we never thought would affect us. I was there at the capitol, fighting for the rights of women. It never crossed my mind I would be fighting for my own.” 

The importance of the science and facts presented by the UCSF online course cannot be overstated. But, as the course’s designers clearly understand, science and health do not exist in a vacuum. The stories we tell at dinner, the films we watch, and the way we size up each others’ experiences can actually influence the medical care we receive.