University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, USA.
University of Cincinnati, Department of Sociology, 1014 Crosley Tower, P.O. Box 210378, Cincinnati, OH, 45221-0378, USA.
Soc Sci Med. 2021 Dec;291:114468. doi: 10.1016/j.socscimed.2021.114468. Epub 2021 Oct 9.
In July 2019, the Trump administration began implementing its domestic gag rule to ban discussion of abortion in pregnancy options counseling and ensure physical separation of contraceptive and abortion services at clinical sites funded by the federal government's Title X Family Planning program. In this paper, we examine how organizational policy utilization correlated with organization-level protocols for discussing abortion in options counseling interactions while the domestic gag rule policy was under legal contest. From April 2018 to July 2019, we conducted in-depth interviews with 50 administrators in charge of setting clinical protocols regarding options counseling after a positive pregnancy test at 20 Title X-covered and 14 non-Title X-covered safety-net healthcare organizations in Ohio. We found that organizational characteristics and Title X policy utilization did not explain the heterogeneity in approaches to abortion referral that administrators reported. Administrators from 2 of 20 organizations covered by Title X policy requirements pre-emptively restricted discussion of abortion in their facilities in advance of policy enactment. Meanwhile, administrators from 10 of 14 non-Title X-covered organizations did not restrict discussion of abortion. Our analysis demonstrates how safety-net healthcare organizations' response to federal policy is shaped by administrators' institutional entrepreneurship within the abortion aversion complex: a pattern of policy miscomprehension and endorsed abortion stigma that facilitates the structural stigmatization of abortion within safety-net healthcare organizations. We conclude that current efforts to reverse the domestic gag rule will fail unless local abortion aversion complexes are targeted with intervention.
2019 年 7 月，特朗普政府开始实施其国内禁言令，禁止在妊娠选择咨询中讨论堕胎，并确保在联邦政府的计划生育项目 Title X 资助的临床地点将避孕和堕胎服务物理隔离。在本文中，我们研究了在国内禁言令政策受到法律挑战的情况下，组织政策的利用如何与组织层面讨论堕胎的协议相关联，以进行选择咨询互动。从 2018 年 4 月到 2019 年 7 月，我们对俄亥俄州 20 家受 Title X 覆盖和 14 家不受 Title X 覆盖的安全网医疗保健机构中负责在妊娠测试呈阳性后制定选择咨询协议的 50 名管理人员进行了深入访谈。我们发现，组织特征和 Title X 政策的利用并不能解释管理人员报告的堕胎转介方法的异质性。20 家受 Title X 政策要求覆盖的组织中的 2 家组织的管理人员在政策颁布前预先限制了他们机构中对堕胎的讨论。与此同时，14 家不受 Title X 覆盖的组织中有 10 家没有限制对堕胎的讨论。我们的分析表明，安全网医疗保健组织对联邦政策的反应是如何受到管理人员在堕胎厌恶综合体中的制度创业精神的影响的：这种模式是对政策的误解和认可的堕胎污名化，促进了堕胎在安全网医疗保健组织中的结构性污名化。我们得出的结论是，除非针对当地的堕胎厌恶综合体采取干预措施，否则当前扭转国内禁言令的努力将失败。
