Abortion stigma among abortion providers in high-income countries: a mixed methods systematic review

Negative attitudes toward abortion affect providers who perform abortions and lead to discrimination and emotional distress. This review examines the prevalence, forms, and consequences of felt abortion stigma among providers in high-income countries. A mixed-methods systematic review was conducted to update a 2016 review on abortion stigma. Following the PRISMA guidelines, searches in MEDLINE, CINAHL, PsychINFO, LIVIVO, and the Cochrane Library identified peer-reviewed studies published after March 2015. Qualitative, quantitative, and mixed-method studies were included. Data extraction and synthesis followed JBI guidelines. Twenty-eight studies were included (23 qualitative, 4 quantitative, 1 mixed-methods). Quantitative findings showed that abortion-related stigma varies by legal and sociocultural context and is higher in restrictive settings. Greater felt stigma was associated with burnout, emotional exhaustion, and job strain. Qualitative synthesis identified three main themes: (1) institutional and structural stigma linked to legal restrictions, limited training, and professional isolation; (2) individual-level stigma, including harassment, social exclusion, and concerns about disclosure; and (3) mitigating factors, such as legal reforms (e.g., decriminalisation) and provider advocacy for reproductive rights through patient empowerment and respectful, balanced communication. Abortion stigma at the individual level is strongly shaped by institutional and structural contexts, underscoring the need for interventions beyond individual coping strategies. Efforts to reduce abortion stigma should address not only personal attitudes but also the broader social, cultural, and legal frameworks that sustain it. Healthcare systems are critical intervention points, as clinical practices and gatekeeping can reinforce stigma, while reforms in training and policy can help challenge it. (246).