Original research article| Volume 98, ISSUE 6, P517-521, December 2018

Relationship of job role and clinic type to perceived stigma and occupational stress among abortion workers



      To describe the role of worksite characteristics, job role and abortion stigma in clinical abortion workers' occupational stress.

      Study design

      We recruited nurses, medical assistants and counseling staff who provide abortion care at five hospitals and four freestanding clinics in Massachusetts. Study instruments assessed individual-level abortion stigma (the perception that others treat abortion as shameful, dirty and socially taboo) using the Abortion Providers Stigma Scale; job strain through the Job Content Questionnaire; and emotional burnout through the Depersonalization, Emotional Exhaustion and Personal Accomplishment subscales of the Maslach Burnout Inventory. Multivariable linear and logistic regression modeling tested for associations between job role, worksite type, stigma, job strain and burnout, accounting for demographic and job characteristics.


      Of 205 eligible workers, 136 participated (66%). Forty-one percent were medical assistants, 50% nurses, and 9% counselors. In adjusted models, abortion workers with high stigma had increased odds of experiencing job strain [adjusted odds ratio (aOR) 3.94, 95% CI 1.19–13.05]. Compared to working in a freestanding clinic, working in a hospital was associated with lower odds of experiencing the low personal accomplishment dimension of burnout (aOR 0.49, 95% CI 0.29–0.84) and lower odds of experiencing the depersonalization dimension of burnout (aOR 0.05, 95% CI 0.01–0.28). Counselors had higher odds of depersonalization compared to nurses (aOR 4.56, 95% CI 2.3–9.0).


      Hospital-based abortion workers experience lower risk for burnout than comparable workers in freestanding clinics, accounting for abortion stigma and job characteristics.


      Implementing structured supports to alter workflows or improve coping among workers in freestanding abortion clinics may help mitigate risk of worker burnout and associated turnover.


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        • Theorell T.
        Working conditions and health.
        in: Berkman L.F. Kawachi I. Social epidemiology. Oxford University Press, Oxford2000: 95-117
        • Marmot M.G.
        • Bosma H.
        • Hemingway H.
        • Brunner E.
        • Stansfield S.
        Contribution of job control and other risk factors to social variations in coronary disease incidence.
        Lancet. 1997; 350: 235-239
        • Theorell T.
        • Tsutsumi A.
        • Hallquist J.
        • Reuterwall C.
        • Hogstedt C.
        • Fredlund P.
        • et al.
        Decision latitude, job strain, and myocardial infarction: a study of working men in Stockholm.
        Am J Pub Health. 1998; 88: 382-388
        • Amick B.C.
        • Kawachi I.
        • Coakley E.H.
        • Lerner D.
        • Levine S.
        • Colditz G.A.
        Relationship of job strain and iso-strain to health status in a cohort of women in the United States.
        Scand J Work Environ Health. 1998; 24: 54-61
        • Storr C.L.
        • Trinkoff A.M.
        • Anthony J.C.
        Job strain and non-medical drug use.
        Drug Alcohol Depend. 1999; 55: 45-51
        • Han K.
        • Trinkoff A.M.
        • Gurses A.P.
        Work-related factors, job satisfaction and intent to leave the current job among United States nurses.
        J Clin Nurs. 2015; 24: 3224-3232
        • Jones R.K.
        • Jerman J.
        Abortion incidence and service availability in the United States, 2014.
        Perspect Sex Reprod Health. 2017; 49: 17-27
        • Guttmacher Institute
        Targeted regulation of abortion providers.
        Guttmacher Insitute
        ([Internet.]. Updated 1 June 2017. Accessible at:)
        • Turk J.K.
        • Preskill F.
        • Landy U.
        • Rocca C.H.
        • Steinauer J.E.
        Availability and characteristics of abortion training in US ob-gyn residency programs: a national survey.
        Contraception. 2014; 89: 271-277
        • McLemore M.R.
        • Levi A.
        • James E.A.
        Recruitment and retention strategies for expert nurses in abortion care provision.
        Contraception. 2015; 91: 474-479
        • McLemore M.R.
        • Levi A.J.
        Expanding access to sexual and reproductive health services through nursing education.
        J Obstet Gynecol Neonatal Nurs. 2017; : e149-e156
        • Kumar A.
        • Hessini L.
        • Mitchell E.M.H.
        Conceptualising abortion stigma.
        Cult Health Sex. 2009; : 625-639
        • Harris L.H.
        • Debbink M.
        • Martin L.
        • Hassinger J.
        Dynamics of stigma in abortion work: findings from a pilot study of the providers share workshop.
        Soc Sci Med. 2011; 73: 1062-1070
        • O'Donnell J.
        • Weitz T.A.
        • Freedman L.R.
        Resistance and vulnerability to stigmatization in abortion work.
        Soc Sci Med. 2011; 73: 1357-1364
        • Joffe C.
        The regulation of sexuality: experiences of family planning workers.
        Temple University Press, Philadelphia1986
        • Harris L.H.
        Recognizing conscience in abortion provision.
        N Engl J Med. 2012; 367: 981-983
        • Parker W.
        Life's work: a moral argument for choice.
        Simon and Schuster, New York2017
        • Simonds W.
        Abortion at work: ideology and practice in a feminist clinic.
        Rutgers University Press, 1997
        • Karasek R.
        • Theorell T.
        Health work: stress, productivity, and the reconstruction of working life.
        Basic Books, New York1990
        • Karasek R.A.
        Job demands, job decision latitude, and mental strain: implications for job redesign.
        Admin Sci Q. 1979; 24: 285-307
        • Maslach C.
        • Jackson S.E.
        • Leiter M.P.
        Maslach burnout inventory manual.
        3rd edition. Menlo Park, Calif, Mind Garden1996
        • Wilson J.C.
        The street politics of abortion. Speech, violence and America's culture wars.
        Stanford University Press, Stanford2013
        • Martin L.A.
        • Debbink M.
        • Hassinger J.
        • Youatt E.
        • Harris L.H.
        Abortion providers, stigma and professional quality of life.
        Contraception. 2014; 90: 581-587
        • Martin L.A.
        • Hassinger J.A.
        • Seewald M.
        • Harris L.H.
        Evaluation of abortion stigma in the workforce: development of the revised Abortion Providers Stigma Scale.
        Womens Health Issues. 2018; 28: 59-67
        • Massachusetts Department of Public Health
        Abortion Statistics.
        2015 (Received May 26, 2016)
        • Berkman L.F.
        • Buxton O.
        • Ertel K.
        • Okechukwu C.
        Managers' practices related to work-family balance predict employee cardiovascular risk and sleep duration in extended care settings.
        J Occup Health Psychol. 2010; 15: 316-329
        • Karasek R.
        • Brisson C.
        • Kawakami N.
        • Houtman I.
        • Bongers P.
        • Amick B.
        The Job Content Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics.
        J Occup Health Psychol. 1998; 3: 322-355
        • Hurtado D.A.
        • Sabbath E.L.
        • Ertel K.A.
        • Buxton O.M.
        • Berkman L.F.
        Racial disparities in job strain among American and immigrant long-term care workers.
        Int Nurs Rev. 2012; 59: 237-244
        • Stulberg D.B.
        • Dude A.M.
        • Dahlquist I.
        • Curlin F.A.
        Abortion provision among practicing obstetrician-gynecologists.
        Obstet Gynecol. 2011; 118: 609-614
        • United States Department of Labor
        • Bureau of Labor Statistics
        Labor Force statistics from the current population survey.
        US Bureau of Labor Statistics
        Washington, DC
        Date: 2017
        ([Internet.] Accessible at:)
        • Shanafelt T.D.
        • Boone S.
        • Tan L.
        • Dyrbye L.N.
        • Sotile W.
        • Satele D.
        • et al.
        Burnout and satisfaction with work-life balance among US physicians relative to the general US population.
        Arch Intern Med. 2012; 172: 1377-1385
        • U.S. Department of Labor and State of Minnesota
        • Career OneStop
        Medical assistants.
        ([Internet.] Accessible at:)
        • U.S. Department of Labor and State of Minnesota
        • Career OneStop
        Registered nurses.
        ([Internet.] Accessible at:)
        • Sinclair R.R.
        • Sears L.E.
        • Zajack M.
        • Probst T.
        A multilevel model of economic stress and employee well-being.
        in: Houdmont J. Leka S. Contemporary occupational health psychology: global perspectives on research and practice. vol. 1. Wiley-Blackwell, Chichester, UK2010: 1-20