{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T14:29:30Z","timestamp":1793456970645,"version":"4.5.0"},"reference-count":10,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,12,25]],"date-time":"2024-12-25T00:00:00Z","timestamp":1735084800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Research funded by Anonymous Donor, via RCOG, no award number"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2024,12,12]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Social stigma and the marginalisation of abortion care within medical settings can negatively affect abortion providers. While some research has evaluated stigma interventions in legally restrictive settings, little work has explored the experiences of healthcare professionals (HCPs) providing abortion and post-abortion care (PAC) outside the USA. This study, part of the Royal College of Obstetricians and Gynaecologists\u2019 \u2018Making Abortion Safe\u2019 programme, aimed to understand providers\u2019 experiences of abortion stigma in four African countries with restrictive legislation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In-depth interviews with 44 abortion and PAC providers were conducted in Nigeria, Rwanda, Sierra Leone and Zimbabwe.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four themes emerged: personal and professional effects of stigma, multiple manifestations of stigma, driving forces of stigma, and positivity and resilience. Stigma affects providers' professional identity, community belonging and relationships. Restrictive legal frameworks are the main driver of abortion stigma, operating at multiple levels that reinforce each other. The legal status of abortion labels it as \u2018dirty work\u2019, conflicting with healthcare principles. Judgmental attitudes from other HCPs negatively impact providers\u2019 well-being and care quality. However, providers showed resilience through professional and personal commitment, and the belief in \u2018doing the right thing\u2019 helped them resist stigma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Legal changes are crucial for increasing access and reducing stigma among the workforce. In these countries, providers face challenges in offering legal healthcare. Organisational interventions are needed to address stigmatising values and create positive workplaces. Ongoing support is essential for HCPs to remain resilient against abortion stigma, helping to normalise abortion care and those who provide it.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjsrh-2024-202495","type":"journal-article","created":{"date-parts":[[2024,12,25]],"date-time":"2024-12-25T13:20:12Z","timestamp":1735132812000},"page":"45-50","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["\u2018Making abortion safe\u2019: abortion and post-abortion care providers\u2019 experiences of stigma in Rwanda, Zimbabwe, Sierra Leone and Nigeria"],"prefix":"10.1136","volume":"52","author":[{"given":"Suzanna","family":"Bright","sequence":"first","affiliation":[{"name":"Royal College of Obstetricians and Gynaecologists, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Parnham","sequence":"additional","affiliation":[{"name":"Royal College of Obstetricians and Gynaecologists, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Blaylock","sequence":"additional","affiliation":[{"name":"British Pregnancy Advisory Service (BPAS), Stratford-upon-Avon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Bury","sequence":"additional","affiliation":[{"name":"Independent Research Consultant, Manningtree, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friday","family":"Okonofua","sequence":"additional","affiliation":[{"name":"University of Benin, Benin City, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunhurai","family":"Mukwambo","sequence":"additional","affiliation":[{"name":"University of Zimbabwe College of Health Sciences, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munyaradzi","family":"Nyakanda","sequence":"additional","affiliation":[{"name":"East Central and Southern Africa College of Obstetricians and Gynaecologists, Arusha, United Republic of Tanzania"},{"name":"Sally Mugabe Central Hospital, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3146-0926","authenticated-orcid":false,"given":"Theodomir","family":"Sebazungu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University of Global Health Equity, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godwin","family":"Akaba","sequence":"additional","affiliation":[{"name":"University of Abuja Teaching Hospital, Gwagwalada, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4786-7950","authenticated-orcid":false,"given":"Lesley","family":"Hoggart","sequence":"additional","affiliation":[{"name":"Faculty of Health and Social Care, The Open University, Milton Keynes, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,12,25]]},"reference":[{"key":"2026102002201431000_52.1.45.1","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1016\/j.socscimed.2011.08.019","article-title":"Resistance and vulnerability to stigmatization in abortion work","volume":"73","author":"O\u2019Donnell","year":"2011","journal-title":"Soc Sci Med"},{"key":"2026102002201431000_52.1.45.2","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1363\/46e8720","article-title":"Addressing Abortion Provider Stigma: A Pilot Implementation of the Providers Share Workshop in Sub-Saharan Africa and Latin America","volume":"46","author":"Mosley","year":"2020","journal-title":"Int Perspect Sex Reprod Health"},{"key":"2026102002201431000_52.1.45.3","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.contraception.2018.07.003","article-title":"Relationship of job role and clinic type to perceived stigma and occupational stress among abortion workers","volume":"98","author":"Janiak","year":"2018","journal-title":"Contraception"},{"key":"2026102002201431000_52.1.45.4","doi-asserted-by":"publisher","DOI":"10.1080\/03630242.2014.919981"},{"key":"2026102002201431000_52.1.45.5","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1016\/j.socscimed.2011.07.004","article-title":"Dynamics of stigma in abortion work: Findings from a pilot study of the Providers Share Workshop","volume":"73","author":"Harris","year":"2011","journal-title":"Soc Sci Med"},{"key":"2026102002201431000_52.1.45.6","first-page":"1691898","article-title":"From stigma to pride: health professionals and abortion policies in the Metropolitan Area of Buenos Aires","volume":"27","author":"Fern\u00e1ndez V\u00e1zquez","year":"2019","journal-title":"Sex Reprod Health Matters"},{"key":"2026102002201431000_52.1.45.7","doi-asserted-by":"publisher","DOI":"10.1080\/13691050902842741"},{"key":"2026102002201431000_52.1.45.8","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1080\/03630242.2014.919987","article-title":"A learning agenda for abortion stigma: recommendations from the Bellagio expert group meeting","volume":"54","author":"Hessini","year":"2014","journal-title":"Women Health"},{"key":"2026102002201431000_52.1.45.9","doi-asserted-by":"crossref","first-page":"17455057241233124","DOI":"10.1177\/17455057241233124","article-title":"Health providers\u2019 reasons for participating in abortion care: A scoping review","volume":"20","author":"Merner","year":"2024","journal-title":"Womens Health (Lond)"},{"key":"2026102002201431000_52.1.45.10","unstructured":"Ipas . Toward a sustainable abortion ecosystem: a framework for program design, action and evaluation. Chapel Hill, NC Ipas; 2020. Available: https:\/\/www.ipas.org\/resource\/toward-a-sustainable-abortion-ecosystem-a-framework-for-program-design-action-and-evaluation\/"}],"container-title":["BMJ Sexual &amp; Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsrh-2024-202495","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T09:20:36Z","timestamp":1792488036000},"score":1,"resource":{"primary":{"URL":"https:\/\/jfprhc.bmj.com\/lookup\/doi\/10.1136\/bmjsrh-2024-202495"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,25]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,15]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bmjsrh-2024-202495"],"URL":"https:\/\/doi.org\/10.1136\/bmjsrh-2024-202495","relation":{},"ISSN":["2515-1991","2515-2009"],"issn-type":[{"value":"2515-1991","type":"print"},{"value":"2515-2009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,25]]}}}