“It’s something that marks you”: Abortion stigma after decriminalization in Uruguay

“I have nothing to say; what needed to be said got said and that’s that. I did it, I’m fine, and ciao.” (Age 23).

“I didn’t talk about it with my husband, or my sister, or my friends, or with anybody. The topic is now closed, that’s that.” (Age 34).

“[…] I think I’m going to carry this until I die.” (Age 23).

“I think it is a trauma that one does not get over, even though one learns to live with it […] this guilt is going to be lifelong.” (Age 22).

“When I think about going to the gynecologist and they are going to ask me about my medical history, I’m ashamed to have to tell them that I just had an abortion.” (Age 38).

“It was strange because it was a new experience, but it was a lifesaver. You avoid the trauma of doing it in a clandestine place where they can do anything to you and where no one is going to take responsibility for anything.” (Age 29).

“[…] I had sworn to myself that I would never have an abortion and I ended up doing it. It was kind of ironic and I was surprised to find myself contradicting myself about something that I said I wouldn’t do.” (Age 23).

“[…] I said it would never happen to me and it happened.” (Age 34).

“I’m against abortion, so it was a very difficult decision to make and to this day it still weighs on me.” (Age 31).

“[..] I was against abortion until it was my turn.” (Age 22).

“In line with my upbringing, I had always been against it; I imagined it to be pretty cruel because of what they say and they tell you.” (Age 27).

“If you already did it once, why are you going to do the same thing again? Once is fine, but those who do it two, three, four times, [it’s] like they kind of do it just for fun.” (Age 22).

“I see many women who do it like just for fun […] people who say: ‘well, I got pregnant and I can do it one, two, and even three times.’” (Age 31).

“[…] others get pregnant real easy and have abortions [as easily/often as] they change their jeans.” (Age 23).

“[…] there are other cases of women where it’s like they don’t care if they get pregnant and abort and go back and repeat the story […] it’s different for those who want to come every year to do it, but for women whose case is like mine, it’s okay.” (Age 38).

“I think there should be limits because they’re going to get pregnant ten times and they’re going to take the life of an innocent being […] Names and record numbers should be recorded and tell them ‘look, there’s a limit, you can’t get pregnant five times and get rid of it every time you feel like it.’” (Age 22).

“At first, I was a little afraid of the whole procedure. After the counseling, I felt safe and calm. I felt confident.” (Age 29).

“I thought they would be a little more hostile, because of the fact that one is killing a person, but no, everything [was] just fine.” (Age 22).

“You arrive afraid that you’re going to be judged by the same doctors whose job is to save lives, but it was nothing like that, everything super good, marvelous, in fact, they protect you.” (Age 29).

“When I came in for the ultrasound, the person who was doing it looked at me and said ‘I don’t do IVE and they looked me up and down. When I gave them the paper, they looked at it and said that the doctor didn’t do IVE and the other went and told them: ‘it doesn’t matter, she’s a patient and you have to take care of her’. She went and took her the paper and the woman came and told me to my face, ‘I don’t do IVE. There were a lot of people outside the examining room and even though not everyone knows what IVE is, it was like […] they were judging me.” (Age 38).

“I thought they were going to do the procedure here, not that it had to be in my home. I was very scared. If I had been given a choice, I would have liked to be admitted because I would have felt calmer” (Age 22).

“When they sent me home to take the pill I thought it was risky and that it would be much better to be seen in a hospital” (Age 22).

“Since there’s the law, more [people] are in favor [of women’s right to choose].” (Age 22).

“Hopefully no one stops this law, it saves us all, it’s a choice so that one can live as one wants, as one likes. It makes no sense to have children to keep them deprived. It’s a choice they give us to live well.” (Age 29).

“Up to 12 weeks is okay and that is already a lot, because the baby [sic] is already formed and it’s somewhat traumatic, it gives you quite a shock, it had everything: its fingers were formed, even the features on its face. I say that eight weeks would be okay.” (Age 29).

“Those five days were endless for me, because when you are sure and you want to be done with it, you want it to be now.” (Age 38).

“If it is already a difficult decision and they make you wait, it becomes torture.” (Age 22).

“You want to be done with it. When they give you that requirement, they don’t strictly consider it to be five days. In my case, it was fifteen days.” (Age 29).

“The reasons are worthy; no one can decide what a woman should do or what is best for her.” (Physician).

“Every woman has the right to terminate a pregnancy for whatever reason. I don’t think that it’s right or wrong.” (Physician).

“One doesn’t stop being a person, but my feelings don’t matter when I’m supporting the women. If a woman comes in who is using contraceptives, lives alone, has four children, does not have a pension, and gets pregnant, of course we’ll feel more empathy than for a woman who does not take care of herself, who doesn’t care whether she gets pregnant; but regardless of my feelings and opinions, the decision is the woman’s.” (Physician).

“What matters most to me is to support the patient; that’s why I became a gynecologist.” (Physician).

“The experience is an abortion in general, whether medicated or surgical. The experience marks a before and an after.” (Physician).

“It’s mostly the system’s fault, due to a lack of understanding, time, or information. It is not an ideal situation; it’s not that I like it, but I don’t place the blame on the patient.” (Physician).

“I talk about my job with everyone. Family, friends, colleagues. At the family level, sometimes there are differences on the subject of principles or religious values.” (Physician).

In general, these health professionals expressed great satisfaction with the increase of legal abortion services in the country, without denying that abortion stigma still exists in Uruguayan society. When asked directly about its existence, the interviewed health professionals described this stigma in the following ways:

“[…] it shows in abortion clients’ fear, and is manifested quietly, with rejection and with indifference.” (Physician).

“[…] it exists. I don’t know if it’s to such an extent as to produce consequences. When the law was being defended, a segment of society demonstrated their opposition.” (Physician).

“Many patients who do terminate [pregnancies] want to keep it a secret for fear of what others might say. Where I work, it’s a small town; people gossip about this and are judgmental. These comments affect patients emotionally.” (Physician).

“Uruguay is a stigmatizing society around abortion and a number of other issues.” (Psychiatrist).

“Since it’s a small town, people ask questions and try to judge, but we try to maintain confidentiality.” (Physician).

“[…] the greatest obstacle is patient demand where sometimes we feel a little overloaded; more human resources are needed and more time given to visits.” (Physician).

“Delays in the process make [some] women still prefer clandestine abortions. The process is very long; so they prefer to do it outside.” (Midwife).

“Improving access to the different services and the interaction among them, for example, with the administrative side, nursing, medical staff, laboratory, they should have periodic meetings to fine-tune issues. Administrators and doctors see voluntary termination of pregnancy in totally different ways.” (Physician).

“Not a single administrator works with us [the IVE teams]; there is a lot of turnover in receptionists and they aren’t trained.” (Midwife).

“Very good work is done on logistics, on timing, coordination. The only detail is with the sonographers, because this needs special handling and technicians are not always trained and can intimidate patients.” (Physician).

“It is an option that suits all parties: the woman, because she can do it at home in a setting that is not unfamiliar and if we talk about it as a law, that abortion is medicated and not surgical, it serves the state itself and the different institutions, and health professionals. It’s more economical than hospitalizing all those women.” (Physician).

“If the woman requests the surgical method, I withdraw. I wouldn’t have my colleagues’ support. The situation would get messy. I believe that the woman has to accept that she is the one who is terminating the pregnancy.” (Physician).

“I always say what I do, and that I don’t have to actively participate in the termination. If I had to participate actively I would conscientiously object. I had a very bad experience with a fetus when I was a resident, and I said that I wouldn’t do that again because it was very traumatic.” (Physician).

“We take care of the woman and we take care of the law because if a complication occurs the opponents will take advantage of it.” (Physician).

“Yes, I have seen colleagues who were not very convinced that this is a right […], and there are others who are conscientious objectors. But in general, the attitude [towards abortion] is more open now.” (Physician).

“Discussion about the issue is a little more fluid and open; even though you may or may not agree, the woman’s decision is respected.” (Physician).

“Colleagues who were very negative seem calmer now.” (Physician).

“I don’t think it’s advisable, I think it’s more a contradiction: we say that we respect the patient and then we tell her to go think about her decision.” (Physician).

“Most women have already thought about it and they come in to terminate; very few decide to continue with the pregnancy after counseling.” (Physician).

“There shouldn’t be a set time period. For some it simply does more harm. The person already thought about it before coming to the clinic.” (Midwife).