I’m supposed to be a helper: Spiritual distress of abortion providers after Dobbs v. Jackson

Abstract

On June 24, 2022, the Supreme Court of the United States voted to overturn Roe v. Wade, the 1970 landmark case protecting abortion rights in America, in Dobbs v. Jackson Women’s Health Organization. The decision has the potential to affect the way that physicians and learners in the field of Obstetrics and Gynecology (OBGYN), and specifically abortion providers, practice their specialty by interacting with patients and making meaning from their work. Meaning making in one’s work has been shown to be integral in fostering spiritual well-being and preventing burnout in medicine. We sought to demonstrate the spectrum of spirituality of abortion providers and their subsequent spiritual distress in the aftermath of Dobbs. We conducted thirty-minute interviews on Zoom with 26 abortion providers from 17 states from November 2022 to February 2023. Demographics collected included age, racial identity, location of practice (by state), years in practice, fellowship training, and practice setting (community, academic, hybrid). States were then classified according to the Guttmacher Institute classifications of Most Restrictive, Restrictive, Some restrictions/protections, Protective, and Very protective as of December 2022. Interviews consisted of questions such as "What are the major tenants of your spiritual beliefs (if none, how you make meaning)?” and “Tell me about any spiritual distress or alienation from your religious or spiritual community as a result of the Dobbs decision.” Interviews were transcribed using the closed caption feature on Zoom and coded by LB, KK, and JM. After achieving consensus, interviews were analyzed using NVivo 14. Sixteen providers were fellowship trained (14 Complex Family Planning and 2 Maternal Fetal Medicine), one was a family medicine physician, and one was a Nurse Practitioner. Practice type was equally distributed amongst community (34.6%), academic (34.6%), and hybrid (30.8%). Location of practice (state) was well-distributed across the restrictive-protective spectrum: 7.7% Most Restrictive, 30.8% Restrictive, 15.4% Some restrictions/protections, 30.8% Protective, and 15.4% Very Protective. The majority of participants identified a personal spirituality, while less than half were tied to an organized religion, such as Christianity, Judaism, Hinduism, or Buddhism. Fifteen participants (57.7%) identified a concept of “good” in their spirituality, using words such as “greater good” or “common good”. Sixteen participants (61.5%) cited ethical principles of justice, non-maleficence, respect for human life, or autonomy as major tenets of their spirituality. The subject of abortion care as related to spirituality was brought up in a number of ways. Ten subjects (38.5%) felt spiritually called to provide abortion care; 11 others (42.3%) perceived abortion care as an obligation born from their spiritual beliefs. Twelve participants (46.2%) noted the act of providing an abortion as a spiritual act, for provider and/or patient. Most participants experienced spiritual distress relating to the Dobbs decision. Spiritual distress was related to conflict with differently minded community members (30%), the perceived inability to live out their calling by providing abortion care (38%), and their physical location (38%). Those who did not experience spiritual distress (26%) noted location and alignment with spiritual values as protective factors. 38% of participants identified some other form of distress (e.g., moral) but did not identify it as spiritual distress. Of note, 92% of participants described their spirituality as helpful in coping with the fall of Roe v. Wade. Sources of strength included advocacy (34.6%), agency (e.g., “I feel strength knowing that I’m still able to do this job”) (57.7%), legislative work (30.8%), and community (50%). Community strength was further broken down into the abortion provider community (57.7%), family and friends (53.8%), and a faith or spiritual community (26.9%). Eight participants (30.8%) identified a perceived conflict, discordance, or lack of discussion between spirituality and medicine. Five subjects (19.2%) acknowledged that their personal spirituality is underexplored. This qualitative study demonstrates that abortion providers are spiritual individuals. For many, the decision to be an abortion provider is motivated by this identity, or in some cases an obligation. Regarding the fall of Roe v. Wade, many abortion providers endorsed feelings of spiritual distress. Many reported being distressed due to not being able to comply with their moral and/or spiritual obligation of providing abortions secondary to new restrictions. Location played a large role in whether providers were experiencing this distress. It can be deduced that state restrictions on provision of abortions have directly impacted the spiritual well-being of abortion providers. As many laws pertaining to abortion are influenced by religious beliefs, it is important to recognize that abortion providers themselves are overwhelming spiritual.