Stigma Is Contagious

This post was co-authored by Leila Hessini, Ipas Director of Community Engagement & Mobilization, chair of the board of the Global Fund for Women, and a member of the steering committee of inroads--the International Network for the Reduction of Abortion Discrimination and Stigma.

Every day, we read or hear news of the Ebola outbreak in West Africa. In one story, The New York Times put a nurse from Sierra Leone on the front page over the weekend. Her story was both hopeful and disheartening.

Her determination--and that of countless others--to do what has to be done to stem the tide of the disease despite the risk to themselves is remarkable. We need people like them, just as we need more supplies, more beds, more clinics, more running water and more health workers. The efforts must be multi-pronged and they must be quick. But what can't be left out is how to deal with the stigma attached to the disease. The stigma is every bit as contagious as the disease itself.

There are very real, life-threatening risks associated with working in afflicted areas. Yet those who choose to take those risks or have just been exposed are, in many cases, tainted by their association. Nurses, doctors and aid workers all tell stories of stigmatization. Health workers have been told to go away by their own families. Burial workers and hospital janitors are kicked out of their communities. And people with Ebola are not only quarantined for health reasons but effectively quarantined by their own communities and villages. In some communities, health workers are believed to be the very root of Ebola.

As a result, entire regions are now stigmatized. A World Health Official said just the other day that the flight cancellations to affected regions were "further adding to the stigmatization."

Stigma isn't new.

Think about the beginning of the AIDS epidemic. Anyone who might have been perceived to have AIDS or know someone who had AIDS or loved someone who had AIDS was stigmatized.

People with AIDS were banned from public places, refused treatment by frightened health-care providers and any number hid their symptoms in shame.

What about mental illness--which affects millions? Robin Williams' recent suicide ignited renewed discussions of mental illness and the stigma attached to it that compels some people to hide their illness or to never seek treatment.

In our work at Ipas, we see abortion stigma all over the world. Anyone associated with abortion is marked with disgrace. One young midwife from Nigeria tells of how people call women who have abortions murderers. In Zambia, some communities believe women who have abortions are contagious and spread disease. And abortion providers all over the world are under constant attack--socially, politically and sometimes physically.

The stigma surrounding abortion plays a critical role in the social, medical, and legal marginalization of abortion care around the world. And it spreads--sometimes from the highest levels of government through policies and laws, like the criminalization of abortion, down to personal interactions among friends and family.

Stigma is similar

Regardless of the disease or health issue in question, stigma functions in much the same way. Abortion stigma shames and silences women seeking abortions and providers, and is a major contributor to unsafe and often lethal conditions for women. Even after abortion, women often keep it a secret, even from friends and family, for fear of how they might be treated--just as survivors of Ebola continue to battle the stigma long after they've recovered.

Ending the contagion

Information is key. In West Africa, the Red Cross has sponsored community dialogues that include accurate information about how Ebola spreads (not simply by touching or breathing around an infected person), as well as social support groups for survivors. Social behaviors--starting in a health facility--are purposefully practiced. In Guinea, for example, survivors are discharged with handshakes to dispel fear.

At Ipas, we are still trying to understand abortion stigma and develop community interventions aimed at reducing stigma--and we are pulling from knowledge in other fields. We also host inroads--the International Network for the Reduction of Abortion Discrimination and Stigma, which is building a community of practice for those invested in working toward a world without abortion stigma. We do this because when women are made to feel ashamed about their decisions, they are more likely to take risks with their health care--often resorting to back-alley abortions and unsafe providers.

Stigma is a terrible and undeserved punishment, whether associated with a communicable disease, a mental health condition or a reproductive decision. And it puts human lives in danger. Eradicating public health crises requires not just supplies, medications and trained health providers, but a concerted effort to eradicate stigma as well. Let's do everything we can to stop its spread before it infects others.