Roadblocks at every turn: What reproductive health experts say about barriers to legislative abortion advocacy.

OBJECTIVES

Advocacy is an important part of the reproductive health care profession, but barriers to participating in the legislative process are not well understood. This study examines the barriers experts in reproductive health experience to testifying at state legislative committee hearings regarding abortion.

STUDY DESIGN

We conducted in-depth semistructured interviews with 40 experts in reproductive health, including obstetrician gynecologists (OBGYNs), midwives, pediatricians, nurses, primary care providers, and professional advocates. We analyzed the interview transcripts using an inductive coding process.

RESULTS

We identified four barriers to testifying at state legislative committee hearings regarding abortion. First, our interviewees described a tension between claiming expertise and stigma: those without direct experience in abortion care often felt too unqualified to testify, but representing oneself as an abortion provider came with stigma that made communicating with legislators difficult. Second, issues of power and identity informed interactions in committee chambers, as well as the structure of advocacy work more broadly. Third, institutional constraints shaped what experts could say and whether they could rely on their professional affiliations for support. Finally, fear of harassment and violence kept many of our interviewees from testifying, especially those who were active abortion providers.

CONCLUSIONS

These barriers appear unique to testifying on abortion and represent a complex web of hurdles that experts in reproductive health must navigate to participate in this part of the policymaking process.

IMPLICATIONS

Our findings suggest multiple strategies for improving the state of expert involvement in abortion policymaking, including expanding the pool of testifiers to include nonabortion providers and experts with a range of backgrounds, as well as supporting organizations that link experts to training and advocacy networks.