CUNY Graduate Center, Sociology, 365 5th Ave, New York, NY, 10016, USA.
Augustana College, Public Health 639 38th Street, Rock Island, IL, 61201, USA.
Soc Sci Med. 2021 Mar;272:113736. doi: 10.1016/j.socscimed.2021.113736. Epub 2021 Jan 30.
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.
胎儿发育在堕胎工作中的作用尚未得到解决，这反映了人们对胎儿更广泛的文化矛盾心理。集体的、文化上的胎儿观念往往存在于“一团细胞”和“婴儿”之间的二分法中，公众很少关注怀孕所有阶段胎儿发育的现实。这种紧张关系因缺乏可供非专业人士使用的、具有医学准确性的堕胎胎儿组织图像而加剧。在本文中，我们研究了独立堕胎提供者在提供以患者为中心的妊娠组织观察（PCV）时，如何应对围绕胎儿的矛盾信息。更具体地说，我们调查了提供者如何在缺乏细致的胎儿图像的情况下，在医疗保健提供中应对公众和私人对胎儿的理解。通过对美国 25 名独立堕胎提供者的访谈，我们分析了提供者用来理解胎儿和提供 PCV 的话语框架。我们使用符号互动主义框架将结果分为三个总体主题：语言中的紧张关系、妊娠作为去污名化或再污名化的影响，以及观察作为“使其更真实”。我们的研究结果支持了这样一种观点，即胎儿在很大程度上是社会建构的、可变的，并且在个体、背景和时间上都存在差异；我们的研究结果还强调了堕胎提供者在提供以患者为中心的护理时，能够持有细致入微且有时相互矛盾的关于胎儿的想法和感受。这项研究涉及医学社会学中一个很大程度上被忽视的实践，进一步加深了我们对文化叙事如何塑造以患者为中心的护理的提供和意义、医疗保健工作者的专业社会化以及医患互动的理解。
