The American Psychological Association Task Force on Abortion and Mental Health reports that stigma is major risk factor for people who have had abortions; Stigma can contribute to or worsen anxiety, depression, physiological distress, social withdrawal and avoidance.1
Stigma can stem from medical institutions, from patients’ friends and family and from devaluing social norms about abortion.2,3,4As providers, it is important to create a safe, destigmatizing environment for patients. Terminology can go a long way in perpetuating or undermining stigma, so being aware of the terms that we use to describe abortion is paramount.
Anti-choice groups often use stigmatizing language to describe abortion; they may describe the fetus as “unborn” or “preborn,” or refer to it as a “baby.” Avoiding these terms is important, instead you can refer to the fetus as “the pregnancy,” “the products of conception” or simply as “the fetus.” Further, it is important to avoid terminology like “partial birth abortion” when describing an Intact Dilation and Evacuation (D&E) procedure as an abortion is, by definition, diametrically opposed to a birth. It is also worth noting that abortion technically refers to termination of pregnancy prior to viability, so terminations after viability should not be referred to as “late term abortions” and instead as “termination of pregnancy.”5 You can also simply refer to the abortion by the trimester in which it is taking place, so you’d say “first trimester abortion,” or “third trimester termination.”
In the medical community, abortions are often described as elective, because an elective procedure is any procedure that is not done emergently. However, describing an abortion as elective may be stigmatizing to a patient because it can imply moral judgement/ that they have other viable options and are “electing” to go ahead with abortion.6,7 Practicing using these terms with colleagues can be helpful as it can reduce the chance that you will accidentally use them with a patient; further, by changing the way we speak in all interactions about abortion we work to dismantle deep seeded stigma associated with abortion care. There aren’t many scenarios in which you’d need to specify that an abortion is “elective,” instead you can refer to it simply as an abortion and then specify that it was “emergent” to distinguish between what would traditionally be known as “elective” and “emergent” abortion.
There is also some debate over the terminology of medical and surgical abortions. Some providers advocate for medical abortions to instead by called “medication abortions” and for surgical abortions to be referred to as “aspiration abortions” because those terms are more descriptive and potentially less intimidating to patients. So far, these terms do not seem to have caught on, most providers still use “medical” and “surgical” when describing types of abortions.8,9
Further, some providers argue that the term “abortion” is stigmatizing, and that we should instead be using “termination of pregnancy” to describe the procedure/ process.10 A survey of 2259 women who received induced abortions at clinics in Scotland, England and Wales found that 35% found the term ‘abortion’ distressing, compared to 18% who found the term’ termination of pregnancy’ distressing. 45% expressed a preference for ‘termination or pregnancy’ compared to 12% who preferred ‘abortion.’11
However, other providers insist that by avoiding the word abortion we further contribute to its stigma, and instead we should focus on reclaiming and destigmatizing the word (and, by extension, abortions themselves!). “Abortion” is also used much more often in research and amongst medical providers. “Termination of Pregnancy” is somewhat confusing in that all pregnancies terminate at some point, in either birth, miscarriage or induced abortion, but not all are aborted.5,12
This is an ongoing debate, and more research is needed to determine the least stigmatizing and most correct terms to use with patients. With most sensitive or stigmatized topics, it is recommended to let the patient describe the event/ procedure/ sensitive thing in their own words, so it may be best to let the patient take the lead and then echo back the terminology that they use.13,14 Of course, it isn’t possible to taylor intake paperwork to each patient, so in those cases using ‘abortion’ or ‘termination of pregnancy’ is up to the provider or clinic.
|Terms to avoid||Use these instead|
|“baby” when speaking about fetus||fetus/ products of conception/ the pregnancy|
|Partial birth abortion||Intact Dilation and Evacuation (explain the process to the patient)|
|Late term abortion||Termination of pregnancy First, second or third trimester abortion/ termination|
|Elective abortion||Just say abortion, avoid the ‘elective’ as it can imply moral judgement|
1. Major B, Appelbaum M, Beckman L, Dutton MA, Felipe Russo N, West C. Report of the APA Task Force on Abortion and Mental Health. 2008.
2. Hanschmidt F, Linde K, Hilbert A, Riedel-Heller SG, Kersting A. Abortion Stigma: A Systematic Review. Perspect Sex Reprod Health. 12 2016;48(4):169-177. doi:10.1363/48e8516
3. Cockrill K, Nack A. “I’m not that type of person”: managing the stigma of having an abortion. Deviant Behavior. 2013;34(12):973-990.
4. Shellenberg KM, Tsui AO. Correlates of perceived and internalized stigma among abortion patients in the USA: an exploration by race and Hispanic ethnicity. Int J Gynaecol Obstet. Sep 2012;118 Suppl 2:S152-9. doi:10.1016/S0020-7292(12)60015-0
5. Grimes DA, Stuart G. Abortion jabberwocky: the need for better terminology. Contraception. Feb 2010;81(2):93-6. doi:10.1016/j.contraception.2009.09.005
6. Janiak E, Goldberg AB. Eliminating the phrase “elective abortion”: why language matters. Contraception. Feb 2016;93(2):89-92. doi:10.1016/j.contraception.2015.10.008
7. Watson K. Why We Should Stop Using the Term “Elective Abortion”. AMA J Ethics. 12 01 2018;20(12):E1175-1180. doi:10.1001/amajethics.2018.1175
8. Weitz TA, Foster A, Ellertson C, Grossman D, Stewart FH. “Medical” and “surgical” abortion: rethinking the modifiers. Contraception. Jan 2004;69(1):77-8. doi:10.1016/j.contraception.2003.08.017
9. Berer M. Calling for a rethink on the terminology used to describe the two main categories of induced abortion procedures (medical and surgical): a response to Weitz et al. (2004). Contraception. Aug 2005;72(2):162-3; author reply 163-4. doi:10.1016/j.contraception.2004.12.025
10. Steer PJ. The language of abortion: time to terminate TOP : AGAINST: ‘Termination of pregnancy’ is less likely than ‘abortion’ to be misunderstood or cause distress. BJOG. Aug 2018;125(9):1066. doi:10.1111/1471-0528.15136
11. Cameron S, Lohr PA, Ingham R. Abortion terminology: views of women seeking abortion in Britain. J Fam Plann Reprod Health Care. Oct 2017;43(4):265-268. doi:10.1136/jfprhc-2016-101631
12. Kavanagh Á, Aiken AR. The language of abortion: time to terminate TOP: FOR: Mandating TOP reduces research visibility and engenders stigma. BJOG. Aug 2018;125(9):1065. doi:10.1111/1471-0528.15137
13. Meadows A, Daníelsdóttir S. What’s in a Word? On Weight Stigma and Terminology. Front Psychol. 2016;7:1527. doi:10.3389/fpsyg.2016.01527
14. Marsh CA, Browne J, Taylor J, Davis D. A researcher’s journey: Exploring a sensitive topic with vulnerable women. Women Birth. Feb 2017;30(1):63-69. doi:10.1016/j.wombi.2016.07.003