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      Abortion attitudes, religious and moral beliefs, and pastoral care among Protestant religious leaders in Georgia

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          Abstract

          Objective

          The purpose of this study is to explore Protestant religious leaders’ attitudes towards abortion and their strategies for pastoral care in Georgia, USA. Religious leaders may play an important role in providing sexual and reproductive health pastoral care given a long history of supporting healing and health promotion.

          Methods

          We conducted 20 in-depth interviews with Mainline and Black Protestant religious leaders on their attitudes toward abortion and how they provide pastoral care for abortion. The study was conducted in a county with relatively higher rates of abortion, lower access to sexual and reproductive health services, higher religiosity, and greater denominational diversity compared to other counties in the state. Interviews were audio-recorded, transcribed verbatim, and analyzed by thematic analysis.

          Results

          Religious leaders’ attitudes towards abortion fell on a spectrum from “pro-life” to “pro-choice”. However, most participants expressed attitudes in the middle of this spectrum and described more nuanced, complex, and sometimes contradictory views. Differences in abortion attitudes stemmed from varying beliefs on when life begins and circumstances in which abortion may be morally acceptable. Religious leaders described their pastoral care on abortion as “journeying with” congregants by advising them to make well-informed decisions irrespective of the religious leader’s own attitudes. However, many religious leaders described a lack of preparation and training to have these conversations. Leaders emphasized not condoning abortion, yet being willing to emotionally support women because spiritual leaders are compelled to love and provide pastoral care. Paradoxically, all leaders emphasized the importance of empathy and compassion for people who have unplanned pregnancies, yet only leaders whose attitudes were “pro-choice” or in the middle of the spectrum expressed an obligation to confront stigmatizing attitudes and behaviors towards people who experience abortion. Additionally, many leaders offer misinformation about abortion when offering pastoral care.

          Conclusion

          These findings contribute to limited empirical evidence on pastoral care for abortion. We found religious leaders hold diverse attitudes and beliefs about abortion, rooted in Christian scripture and doctrine that inform advice and recommendations to congregants. While religious leaders may have formal training on pastoral care in general or theological education on the ethical issues related to abortion, they struggle to integrate their knowledge and training across these two areas. Still, leaders could be potentially important resources for empathy, compassion, and affirmation of agency in abortion decision-making, particularly in the Southern United States.

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          Most cited references20

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          Conceptualising abortion stigma.

          Abortion stigma is widely acknowledged in many countries, but poorly theorised. Although media accounts often evoke abortion stigma as a universal social fact, we suggest that the social production of abortion stigma is profoundly local. Abortion stigma is neither natural nor 'essential' and relies upon power disparities and inequalities for its formation. In this paper, we identify social and political processes that favour the emergence, perpetuation and normalisation of abortion stigma. We hypothesise that abortion transgresses three cherished 'feminine' ideals: perpetual fecundity; the inevitability of motherhood; and instinctive nurturing. We offer examples of how abortion stigma is generated through popular and medical discourses, government and political structures, institutions, communities and via personal interactions. Finally, we propose a research agenda to reveal, measure and map the diverse manifestations of abortion stigma and its impact on women's health.
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            Women's Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study.

            The idea that abortion leads to adverse psychological outcomes has been the basis for legislation mandating counseling before obtaining an abortion and other policies to restrict access to abortion.
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              Abortion Incidence and Service Availability In the United States, 2014

              CONTEXT National and state-level information about abortion incidence can help inform policies and programs intended to reduce levels of unintended pregnancy. METHODS In 2015–2016, all U.S. facilities known or expected to have provided abortion services in 2013 or 2014 were surveyed. Data on the number of abortions were combined with population data to estimate national and state-level abortion rates. The number of abortion-providing facilities and changes since a similar 2011 survey were also assessed. The number and type of new abortion restrictions were examined in the states that had experienced the largest proportionate changes in clinics providing abortion services. RESULTS In 2014, an estimated 926,200 abortions were performed in the United States, 12% fewer than in 2011; the 2014 abortion rate was 14.6 abortions per 1,000 women aged 15–44, representing a 14% decline over this period. The number of clinics providing abortions declined 6% between 2011 and 2014, and declines were steepest in the Midwest (22%) and the South (13%). Early medication abortions accounted for 31% of nonhospital abortions, up from 24% in 2011. Most states that experienced the largest proportionate declines in the number of clinics providing abortions had enacted one or more new restrictions during the study period, but reductions were not always associated with declines in abortion incidence. CONCLUSIONS The relationship between abortion access, as measured by the number of clinics, and abortion rates is not straightforward. Further research is needed to understand the decline in abortion incidence.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                17 July 2020
                2020
                : 15
                : 7
                : e0235971
                Affiliations
                [1 ] Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
                [2 ] The Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
                [3 ] Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
                [4 ] Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
                [5 ] Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
                [6 ] Graduate Division of Religion, Laney Graduate School of Arts and Sciences, Emory University, Atlanta, Georgia, United States of America
                [7 ] Reproductive Justice Activist and Movement Chaplain, Atlanta, Georgia, United States of America
                [8 ] All Souls Church Unitarian, Washington, D.C., United States of America
                [9 ] Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States of America
                Coventry University, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-9534-2457
                http://orcid.org/0000-0001-8755-7351
                Article
                PONE-D-20-00472
                10.1371/journal.pone.0235971
                7367465
                32678861
                1d5c6d3f-5196-4e44-94bd-4c429db9703c
                © 2020 Dozier et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 7 January 2020
                : 26 June 2020
                Page count
                Figures: 0, Tables: 4, Pages: 18
                Funding
                This study was funded by the Center for Reproductive Health Research in the SouthEast ( https://rise.emory.edu) with support from an anonymous foundation (to KSH). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
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                Cultural Anthropology
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                Women's Health
                Obstetrics and Gynecology
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                Custom metadata
                Our data are comprised of transcripts from qualitative interviews with Protestant religious leaders in Georgia surrounding abortion attitudes and pastoral care. These data cannot be shared publicly, as the qualitative data presents potential risks and harms beyond those agreed to by study participants in the consent process and approved by the Emory University Institutional Review Board. However, data access requests may be sent to IRB@ 123456emory.edu . In order to facilitate research transparency, we provide the study interview guide and codebook as Supporting Information files.

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