How Texas Created a Culture of Shame and Silence Around Abortion
Tens of thousands of Texas women have abortions every year, but because of the stigma that surrounds the procedure, many of them won't even say the word.
In the counseling room of an Austin abortion clinic, one of the clinic's patient advocates pages through a purple diary where staff encourage women to share their feelings. In loopy script and chicken-scratch scribble in English and Spanish, patients and their partners leave behind black-ink windows into their experience with one of the most intimate, fraught, and hotly debated medical procedures around.
Some of the entries thank the clinic staff, and many offer some variation of, "This is the best choice for me right now." But others divulge a great deal of pain, shame, and anxiety. Women write they don't believe in abortion but they already have children they can barely care for. They write they hope they see their baby in heaven. They write they're afraid they're going to hell.
In the brief counseling session women have here, the patient advocate urges them to voice their often competing emotions so they can walk out knowing they've processed their decision and are secure, if somber, in their choice.
"I'm hearing their whole life story in 20 minutes," he told Cosmopolitan.com. "I'm just trying to help them find a new page to write on."
Many women who come to the clinic, he says, have grown up hearing that abortion is evil and they should be ashamed for even considering it. This little room is often the only place where patients find a nonjudgmental ear to talk about a deeply stigmatized procedure. He understands: He doesn't want his photograph taken or his name used in this article.
Texas is one of the country's biggest abortion rights battlegrounds, with its controversial H.B. 2 legislation making national news when state senator Wendy Davis filibustered for 11 hours to prevent its passage in 2013. She succeeded, until Gov. Rick Perry called a special session to vote on it and subsequently signed it into law. Parts of H.B. 2 have already been implemented and have shut down abortion clinics across the state. When the rest of the bill's provisions go into effect this September, abortion providers say there will be six clinics left in the state, serving 5.4 million women of reproductive age, 75,000 of whom terminate pregnancies in Texas every year.
"These incremental laws are totally insulting," said Amy Hagstrom Miller, CEO of Whole Woman's Health, who operates three abortion clinics in Texas and was recently forced to shutter two others. "The frustrating part is that not enough women are insulted by it. You see this acceptance of 'Where do I sign? How long do I have to wait? What movie do I have to watch?' - this acceptance of what I have to go through to terminate my pregnancy and this internalized stigma and shame. People believe they deserve to go through this."
Abortion stigma exists in every state in this country, but it is particularly powerful in Texas, where most ob-gyns don't perform abortions and women typically have to go to abortion clinics, many of which are shutting down due to extreme regulations. In 2003, Whole Woman's Health founded the nonprofit Bush Relief Fund to help offset the cost of restrictions passed by then-President George W. Bush, but in 2008 it changed its name to something reflective of the organization's ongoing mission: the Stigma Relief Fund.
Legislating Shame
"No one wants to be our patient," Hagstrom Miller said. "The vast majority of our patients are religious, and they bring a lot of the culture that's outside the clinic into the clinic. They've been told Christians don't have abortions. They want to pray or talk to their fetus or say good-bye. They are not going into that decision without thinking it through. You can have a tremendous amount of grief about the decision and still know it's the right decision. But all we have introduced in our culture is this narrative of regret."
Anti-abortion activists and their political proxies increasingly rely on that narrative of regret to restrict access to abortion. The Silent No More campaign, a project of Priests for Life and Anglicans for Life, protests with signs reading, "I Regret My Abortion" and, "I Regret Lost Fatherhood." Those signs were on display at the Texas state capitol last summer. And outside Hagstrom Miller's Austin clinic, two "sidewalk counselors" with the Central Texas Coalition for Life hand out anti-abortion and anti-contraception literature, which claims abortion has negative mental health consequences and that emergency contraception "can kill little human beings."
One of the activists, a 30-year-old named Christina, said she tries to dissuade women from entering the clinic, because women regret abortions. "It's natural for a mother to want to protect her child," she said.
Anti-abortion groups roundly claim that women who terminate pregnancies experience "post-abortion syndrome," which they say resembles depression and PTSD. The increased focus on the supposed mental health consequences of abortion is part of an anti-abortion strategy in play since the mid-1990s to make it appear as if anti-abortion activists are as concerned about women as they are about the unborn. And yet "post-abortion syndrome" is not recognized by any medical authority, and exhaustive academic reviews, including by the American Psychological Association, indicate there is no evidence that abortion leads to mental illness. The former president of the American Psychiatric Association also wrote in the journal of the American Medical Association that "there is no evidence of an abortion-trauma syndrome." And study after study has shown that psychological problems are no more common among women who had abortions after an unintended pregnancy than among those who gave birth.
But despite the word of medical experts, "post-abortion syndrome" is seeing increasing legal and political salience. The Texas-based conservative legal organization the Justice Foundation took it to the courts in 2000 when they tried to re-open Roe v. Wade using the argument that abortion causes women serious emotional harm. The case was unsuccessful, but the group continues to collect statements from women saying abortion hurt them. Though they've gathered just over 5,000 compared to the more than a million abortions performed in the U.S. every year, the statements have been used in advocacy work and legal filings, often successfully. In 2007, the Texas foundation submitted a friend-of-the-court brief when the Supreme Court evaluated a law banning a type of procedure opponents labeled "partial-birth abortion," a rare late-term procedure often performed on women who discover severe abnormalities or health complications late in their pregnancy. The court upheld the ban, and Justice Anthony Kennedy cited the foundation's brief when he wrote that banning the procedure made sense because "some women come to regret their choice to abort the infant life they once created and sustained."
And when the Texas House of Representatives was considering H.B. 2, they heard testimony from a series of anti-abortion activists who claimed the procedure had adverse mental effects. Self-described "sidewalk angel" Brian McAuliffe, who attempts to counsel women outside abortion clinics, testified that abortion "hurts women every day"; Allan Parker, an attorney with the Justice Foundation whose practice focuses on anti-abortion causes, claimed that "having an abortion gives you an increased risk of suicide"; and Elida Muñoz, a member of the Catholic Pro-Life Committee, stated that women who have terminated pregnancies live with "unbearable psychological pain" as a result of knowing "they killed their own children in such a horrible and inhumane way."
Many women do feel regret and sadness after abortion, and some women have more serious psychological responses. But, in fact, the most common feeling after abortion is "relief" One study of women who had abortions near the gestational age limit showed that even among the women who reported experiencing sadness or regret, 80 percent say terminating the pregnancy was the right choice. In 2008, a special task force organized by the American Psychological Association (APA) released a comprehensive report examining abortion and mental health and found that one of the most predictive factors of more negative psychological responses after abortion is stigma itself: Women who perceive abortion as shameful, who see low social support for their decision, or who hear that they should feel regretful are more likely to experience shame and regret in what the APA calls a "self-fulfilling prophecy."
Yet the ongoing abortion wars in the states, at the national level, and in the courts send a different message: that abortion is morally wrong or, at best, a private shame. That message has particularly resonated in Texas, especially with the rise of "family values" and Tea Party conservatives in the state.
"When I came here 14 years ago, there was more of a libertarian view of abortion - whatever you do in your own backyard is your business and the government shouldn't interfere," Hagstrom Miller said. "The language and strategy that's been used by our opposition has really built up over the last 14 years."
Politicians further stigmatize the procedure by setting up complex barriers that set it apart from other medical procedures. In addition to the 24-hour waiting period for women seeking abortions, physicians have to perform a sonogram on the pregnant woman seeking to terminate during which a doctor must explain the fetus's development and offer the woman an opportunity to see an image and hear the fetal heartbeat.
Gina*, 25, who protested the H.B. 2 legislation in Texas last year, recalls the Planned Parenthood clinic she visited for an abortion last fall offered her headphones so she wouldn't have to listen to that part. Gina was able to get a surgical abortion before 20 weeks - H.B. 2 outlaws abortions after that point - but when it was time for her follow-up appointment, the clinic where she had it performed had been shuttered because of the state's extreme abortion restrictions. Afterward, it was not just the abortion itself that left her distressed - it was also, she says, "all the hoops I had to jump through, all the things that these medical professionals had to do because they had one arm twisted behind their backs by the state of Texas."
"All in all, I made the right choice," Gina said. "But it was a nightmare. It was emotionally very difficult to heal."
Even now, Gina remains reluctant to talk about her experience.
"I talked to my best friend," she said. "But other than that, I don't have anyone else. I was raised by very conservative, very southern Christian family members. I will take it to my grave before I say anything."
A Culture of Silence
The Rio Grande Valley, which sprawls along the Texas border with Mexico, is one of the poorest regions in the United States. This is where Lucy Felix, a Texas field organizer for the National Latina Institute for Reproductive Health (NLIRH), has been working as a community health promotura, or outreach worker, since 1997. Over the past several years, Texas legislators have made significant cuts to family planning funds in addition to passing laws restricting abortion; those laws disproportionately impact the largely rural, largely Latina women in the Valley, many of whom can no longer access basic family planning services, let alone legally terminate a pregnancy.
To meet the pressing health care needs of women in the Valley, Felix organizes teams of volunteers to go door-to-door educating local women on health care issues and available resources. She teaches monthly health classes on issues including STDs, HIV, and the importance of Pap smears and mammograms. She hosts Bingo games called loterias at supporters' homes to draw women in and help them feel comfortable asking questions about reproductive health.
One thing Felix doesn't do: Speak explicitly about abortion.
"We don't mention the word abortion," Felix said in Spanish, through a translator. "We don't bring it up due to the culture in Texas."
Felix is quick to emphasize that the decision to avoid talking about abortion does not reflect a political position and is instead a strategic one, and that the group regularly discusses the value of reproductive choice. But anything perceived as abortion advocacy puts Felix's broader health education goals at risk as Texas legislators target and defund pro-choice groups, including Planned Parenthood, which mostly provides birth control and health screenings. In the predominantly Latina community she serves, too, abortion is taboo: When Felix did bring it up openly, women stopped coming to meetings.
"We have to treat this very delicately," Felix said. "We aren't scared of the subject. We can talk about abortion openly. Just not everywhere."
Bringing up abortion here means palpable discomfort; as an outsider, you feel as though you've made a major social faux pas and done something at the very least odd, if not outright rude.
"I've never heard about [women in the community] talking about abortion and neither have I talked about abortion," said Melissa Montalvo, a 28-year-old community leader with the NLIRH, adding that women in the Valley are hesitant to talk about their sexual lives generally. "We don't want anybody to get offended. I'm not saying the word abortion is an offense, but we want people to open up to us. Education is our main goal, to get them to talk about anything about their reproductive health."
But just because women don't talk about it with her or other health workers doesn't mean they don't talk about it among themselves. Women here who terminate pregnancies clandestinely find out about illegal providers from friends and relatives; Felix, a trusted figure in the community, also says women have come to her to ask about their options, and some say they've had illegal procedures.
"I think [a woman who needed an abortion] would tell their best friend or their mom," Montalvo said. "I don't know what the support would be or what the response would be, but I think they would."
On one of the loteria afternoons in June, five promoturas, 13 women, and four children gathered around tables in a covered garage as Felix gave a brief speech.
"Maybe I'm the kind of woman who would have 11 or 12 kids," Felix told her audience in Spanish. "But that doesn't mean that other women should, or that I should judge them."
She adds, "Religion tells you that can't talk about reproductive justice, that it's not in our culture. But if you come to me, I will help you. You are my friend, and you are my sister. I will not judge. I will help."
Shifting the Discourse
At her clinics in Austin and San Antonio - the latter, a four-hour drive from the Valley, is the closest abortion facility for women in that region - Hagstrom Miller deals with abortion stigma every day. But there are bright spots too.
Having an abortion, she says, means facing both assumptions about abortion and truly considering what a pregnancy carried to term would mean. For many women, that can be a powerful, if difficult, moment.
"A lot of women in our culture experience life as happening to them," Hagstrom Miller said. "The acceptable narrative is that they're a victim of their circumstances. One of the powerful things about sitting with a woman when she makes that choice is that she gets to be an actor in her own life."
Hagstrom Miller says her goal is to promote an honest, nuanced conversation around abortion that meets women where they are emotionally while politically opposing the laws that block women's access to the procedure and fuel the feelings of ostracism and shame that plague women who terminate pregnancies.
"I'm in the identity-examining and self-esteem-boosting business," she said. "The thing that keeps me doing this work in the long haul is shifting the conversation around abortion in this country, so that people feel their realities and their experience are represented by us. I want to create a space for people to have that ambiguity and those moral and ethical conundrums, and have that be what it ultimately means to be pro-choice."
*Name has been changed
Source
In the counseling room of an Austin abortion clinic, one of the clinic's patient advocates pages through a purple diary where staff encourage women to share their feelings. In loopy script and chicken-scratch scribble in English and Spanish, patients and their partners leave behind black-ink windows into their experience with one of the most intimate, fraught, and hotly debated medical procedures around.
Some of the entries thank the clinic staff, and many offer some variation of, "This is the best choice for me right now." But others divulge a great deal of pain, shame, and anxiety. Women write they don't believe in abortion but they already have children they can barely care for. They write they hope they see their baby in heaven. They write they're afraid they're going to hell.
In the brief counseling session women have here, the patient advocate urges them to voice their often competing emotions so they can walk out knowing they've processed their decision and are secure, if somber, in their choice.
"I'm hearing their whole life story in 20 minutes," he told Cosmopolitan.com. "I'm just trying to help them find a new page to write on."
Many women who come to the clinic, he says, have grown up hearing that abortion is evil and they should be ashamed for even considering it. This little room is often the only place where patients find a nonjudgmental ear to talk about a deeply stigmatized procedure. He understands: He doesn't want his photograph taken or his name used in this article.
Texas is one of the country's biggest abortion rights battlegrounds, with its controversial H.B. 2 legislation making national news when state senator Wendy Davis filibustered for 11 hours to prevent its passage in 2013. She succeeded, until Gov. Rick Perry called a special session to vote on it and subsequently signed it into law. Parts of H.B. 2 have already been implemented and have shut down abortion clinics across the state. When the rest of the bill's provisions go into effect this September, abortion providers say there will be six clinics left in the state, serving 5.4 million women of reproductive age, 75,000 of whom terminate pregnancies in Texas every year.
"These incremental laws are totally insulting," said Amy Hagstrom Miller, CEO of Whole Woman's Health, who operates three abortion clinics in Texas and was recently forced to shutter two others. "The frustrating part is that not enough women are insulted by it. You see this acceptance of 'Where do I sign? How long do I have to wait? What movie do I have to watch?' - this acceptance of what I have to go through to terminate my pregnancy and this internalized stigma and shame. People believe they deserve to go through this."
Abortion stigma exists in every state in this country, but it is particularly powerful in Texas, where most ob-gyns don't perform abortions and women typically have to go to abortion clinics, many of which are shutting down due to extreme regulations. In 2003, Whole Woman's Health founded the nonprofit Bush Relief Fund to help offset the cost of restrictions passed by then-President George W. Bush, but in 2008 it changed its name to something reflective of the organization's ongoing mission: the Stigma Relief Fund.
Legislating Shame
"No one wants to be our patient," Hagstrom Miller said. "The vast majority of our patients are religious, and they bring a lot of the culture that's outside the clinic into the clinic. They've been told Christians don't have abortions. They want to pray or talk to their fetus or say good-bye. They are not going into that decision without thinking it through. You can have a tremendous amount of grief about the decision and still know it's the right decision. But all we have introduced in our culture is this narrative of regret."
Anti-abortion activists and their political proxies increasingly rely on that narrative of regret to restrict access to abortion. The Silent No More campaign, a project of Priests for Life and Anglicans for Life, protests with signs reading, "I Regret My Abortion" and, "I Regret Lost Fatherhood." Those signs were on display at the Texas state capitol last summer. And outside Hagstrom Miller's Austin clinic, two "sidewalk counselors" with the Central Texas Coalition for Life hand out anti-abortion and anti-contraception literature, which claims abortion has negative mental health consequences and that emergency contraception "can kill little human beings."
One of the activists, a 30-year-old named Christina, said she tries to dissuade women from entering the clinic, because women regret abortions. "It's natural for a mother to want to protect her child," she said.
Anti-abortion groups roundly claim that women who terminate pregnancies experience "post-abortion syndrome," which they say resembles depression and PTSD. The increased focus on the supposed mental health consequences of abortion is part of an anti-abortion strategy in play since the mid-1990s to make it appear as if anti-abortion activists are as concerned about women as they are about the unborn. And yet "post-abortion syndrome" is not recognized by any medical authority, and exhaustive academic reviews, including by the American Psychological Association, indicate there is no evidence that abortion leads to mental illness. The former president of the American Psychiatric Association also wrote in the journal of the American Medical Association that "there is no evidence of an abortion-trauma syndrome." And study after study has shown that psychological problems are no more common among women who had abortions after an unintended pregnancy than among those who gave birth.
But despite the word of medical experts, "post-abortion syndrome" is seeing increasing legal and political salience. The Texas-based conservative legal organization the Justice Foundation took it to the courts in 2000 when they tried to re-open Roe v. Wade using the argument that abortion causes women serious emotional harm. The case was unsuccessful, but the group continues to collect statements from women saying abortion hurt them. Though they've gathered just over 5,000 compared to the more than a million abortions performed in the U.S. every year, the statements have been used in advocacy work and legal filings, often successfully. In 2007, the Texas foundation submitted a friend-of-the-court brief when the Supreme Court evaluated a law banning a type of procedure opponents labeled "partial-birth abortion," a rare late-term procedure often performed on women who discover severe abnormalities or health complications late in their pregnancy. The court upheld the ban, and Justice Anthony Kennedy cited the foundation's brief when he wrote that banning the procedure made sense because "some women come to regret their choice to abort the infant life they once created and sustained."
And when the Texas House of Representatives was considering H.B. 2, they heard testimony from a series of anti-abortion activists who claimed the procedure had adverse mental effects. Self-described "sidewalk angel" Brian McAuliffe, who attempts to counsel women outside abortion clinics, testified that abortion "hurts women every day"; Allan Parker, an attorney with the Justice Foundation whose practice focuses on anti-abortion causes, claimed that "having an abortion gives you an increased risk of suicide"; and Elida Muñoz, a member of the Catholic Pro-Life Committee, stated that women who have terminated pregnancies live with "unbearable psychological pain" as a result of knowing "they killed their own children in such a horrible and inhumane way."
Many women do feel regret and sadness after abortion, and some women have more serious psychological responses. But, in fact, the most common feeling after abortion is "relief" One study of women who had abortions near the gestational age limit showed that even among the women who reported experiencing sadness or regret, 80 percent say terminating the pregnancy was the right choice. In 2008, a special task force organized by the American Psychological Association (APA) released a comprehensive report examining abortion and mental health and found that one of the most predictive factors of more negative psychological responses after abortion is stigma itself: Women who perceive abortion as shameful, who see low social support for their decision, or who hear that they should feel regretful are more likely to experience shame and regret in what the APA calls a "self-fulfilling prophecy."
Yet the ongoing abortion wars in the states, at the national level, and in the courts send a different message: that abortion is morally wrong or, at best, a private shame. That message has particularly resonated in Texas, especially with the rise of "family values" and Tea Party conservatives in the state.
"When I came here 14 years ago, there was more of a libertarian view of abortion - whatever you do in your own backyard is your business and the government shouldn't interfere," Hagstrom Miller said. "The language and strategy that's been used by our opposition has really built up over the last 14 years."
Politicians further stigmatize the procedure by setting up complex barriers that set it apart from other medical procedures. In addition to the 24-hour waiting period for women seeking abortions, physicians have to perform a sonogram on the pregnant woman seeking to terminate during which a doctor must explain the fetus's development and offer the woman an opportunity to see an image and hear the fetal heartbeat.
Gina*, 25, who protested the H.B. 2 legislation in Texas last year, recalls the Planned Parenthood clinic she visited for an abortion last fall offered her headphones so she wouldn't have to listen to that part. Gina was able to get a surgical abortion before 20 weeks - H.B. 2 outlaws abortions after that point - but when it was time for her follow-up appointment, the clinic where she had it performed had been shuttered because of the state's extreme abortion restrictions. Afterward, it was not just the abortion itself that left her distressed - it was also, she says, "all the hoops I had to jump through, all the things that these medical professionals had to do because they had one arm twisted behind their backs by the state of Texas."
"All in all, I made the right choice," Gina said. "But it was a nightmare. It was emotionally very difficult to heal."
Even now, Gina remains reluctant to talk about her experience.
"I talked to my best friend," she said. "But other than that, I don't have anyone else. I was raised by very conservative, very southern Christian family members. I will take it to my grave before I say anything."
A Culture of Silence
The Rio Grande Valley, which sprawls along the Texas border with Mexico, is one of the poorest regions in the United States. This is where Lucy Felix, a Texas field organizer for the National Latina Institute for Reproductive Health (NLIRH), has been working as a community health promotura, or outreach worker, since 1997. Over the past several years, Texas legislators have made significant cuts to family planning funds in addition to passing laws restricting abortion; those laws disproportionately impact the largely rural, largely Latina women in the Valley, many of whom can no longer access basic family planning services, let alone legally terminate a pregnancy.
To meet the pressing health care needs of women in the Valley, Felix organizes teams of volunteers to go door-to-door educating local women on health care issues and available resources. She teaches monthly health classes on issues including STDs, HIV, and the importance of Pap smears and mammograms. She hosts Bingo games called loterias at supporters' homes to draw women in and help them feel comfortable asking questions about reproductive health.
One thing Felix doesn't do: Speak explicitly about abortion.
"We don't mention the word abortion," Felix said in Spanish, through a translator. "We don't bring it up due to the culture in Texas."
Felix is quick to emphasize that the decision to avoid talking about abortion does not reflect a political position and is instead a strategic one, and that the group regularly discusses the value of reproductive choice. But anything perceived as abortion advocacy puts Felix's broader health education goals at risk as Texas legislators target and defund pro-choice groups, including Planned Parenthood, which mostly provides birth control and health screenings. In the predominantly Latina community she serves, too, abortion is taboo: When Felix did bring it up openly, women stopped coming to meetings.
"We have to treat this very delicately," Felix said. "We aren't scared of the subject. We can talk about abortion openly. Just not everywhere."
Bringing up abortion here means palpable discomfort; as an outsider, you feel as though you've made a major social faux pas and done something at the very least odd, if not outright rude.
"I've never heard about [women in the community] talking about abortion and neither have I talked about abortion," said Melissa Montalvo, a 28-year-old community leader with the NLIRH, adding that women in the Valley are hesitant to talk about their sexual lives generally. "We don't want anybody to get offended. I'm not saying the word abortion is an offense, but we want people to open up to us. Education is our main goal, to get them to talk about anything about their reproductive health."
But just because women don't talk about it with her or other health workers doesn't mean they don't talk about it among themselves. Women here who terminate pregnancies clandestinely find out about illegal providers from friends and relatives; Felix, a trusted figure in the community, also says women have come to her to ask about their options, and some say they've had illegal procedures.
"I think [a woman who needed an abortion] would tell their best friend or their mom," Montalvo said. "I don't know what the support would be or what the response would be, but I think they would."
On one of the loteria afternoons in June, five promoturas, 13 women, and four children gathered around tables in a covered garage as Felix gave a brief speech.
"Maybe I'm the kind of woman who would have 11 or 12 kids," Felix told her audience in Spanish. "But that doesn't mean that other women should, or that I should judge them."
She adds, "Religion tells you that can't talk about reproductive justice, that it's not in our culture. But if you come to me, I will help you. You are my friend, and you are my sister. I will not judge. I will help."
Shifting the Discourse
At her clinics in Austin and San Antonio - the latter, a four-hour drive from the Valley, is the closest abortion facility for women in that region - Hagstrom Miller deals with abortion stigma every day. But there are bright spots too.
Having an abortion, she says, means facing both assumptions about abortion and truly considering what a pregnancy carried to term would mean. For many women, that can be a powerful, if difficult, moment.
"A lot of women in our culture experience life as happening to them," Hagstrom Miller said. "The acceptable narrative is that they're a victim of their circumstances. One of the powerful things about sitting with a woman when she makes that choice is that she gets to be an actor in her own life."
Hagstrom Miller says her goal is to promote an honest, nuanced conversation around abortion that meets women where they are emotionally while politically opposing the laws that block women's access to the procedure and fuel the feelings of ostracism and shame that plague women who terminate pregnancies.
"I'm in the identity-examining and self-esteem-boosting business," she said. "The thing that keeps me doing this work in the long haul is shifting the conversation around abortion in this country, so that people feel their realities and their experience are represented by us. I want to create a space for people to have that ambiguity and those moral and ethical conundrums, and have that be what it ultimately means to be pro-choice."
*Name has been changed
Source