"It makes it more real": Examining ambiguous fetal meanings in abortion care. (March 2021)

• Record Type: Journal Article
• Authors: Becker, Andréa; Hann, Lena R.
• Is Part Of: Social science & medicine. Volume 272(2021)
• Publication Date: 2021-03
• Subjects: Abortion -- Reproduction -- Culture -- Fetus -- Symbolic interaction -- Patient centered tissue viewing -- Stigma -- Dangertalk; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2021.113736
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: The role of fetal development in abortion work is unresolved, mirroring a broader cultural ambivalence regarding the fetus. The collective, cultural notion of fetuses tends to lie on a dichotomy between "clump of cells" and "baby, " with little public attention to the realities of fetal development during all stages of pregnancy. This tension is exacerbated by an absence of medically accurate images of aborted fetal tissue available to lay audiences. In this paper, we examine how independent abortion providers manage contradictory messages surrounding the fetus when providing patient-centered pregnancy tissue viewing (PCV). More specifically, we investigate how providers navigate public and private understandings of the fetus in their healthcare provision amidst a void of nuanced fetal imagery. Through interviews with 25 independent abortion providers in the United States, we analyze the discursive framings providers employ to make sense of the fetus and provision of PCV. Using a symbolic interactionism framework, we grouped results into three overarching themes: tensions in language, the impact of gestation as de- or re-stigmatizing, and looking as "making it more real." Our findings support the notion that the fetus is largely socially constructed, mutable, and variant across individuals, context, and time; our findings also highlight abortion providers' ability to hold nuanced and sometimes conflicting thoughts and feelings about fetuses while providing patient-centered care. This study addresses a largely overlooked practice within medical sociology and furthers our understanding of how cultural narratives shape the provision and meanings of patient-centered care, the professional socialization of healthcare workers, and the patient-provider interaction. Highlights: The "baby vs clump of cells" cultural binary affects interactions in the clinic. Fetal symbolism is malleable and variant across individuals, context, and time. Providers use mirroring and affect assessment to navigate cultural fetal ambiguity. Language and gestational age shape fetal meaning and PCV makes abortion "more real." Providers can have complicated feelings about fetuses but be confident in their work.