Dirty work... has several components: it can be physically repellent, symbolically degrading, morally dubious, and yet, under certain conditions... Abortion counseling encompasses all these aspects of dirty work.

The physically trying parts of the job involve confrontation with blood, vomit, and, in some instances, discernible fetal parts.

A certain symbolic degradation occurs with the counselor's responsibility for the post-abortion cleanup, which includes disposing of the "products of conception."

'Being an abortion provider is very stigmatized. Other doctors look down on you and think of you as like the lowest of the low.'

... [P]roviders discussed the challenge of disclosing their work... and... noted that they do not feel comfortable talking about their work at home as their partners think that abortion is “distasteful”... that some family members or friends would never speak to them again if they knew about their work....

... [M]any described the challenge in deciding whether to share their involvement in abortion care... that disclosing their work could damage existing friendships....

... [M]any said that they were morally challenged by certain aspects of care. These included experiences with the fetus, differences between surgical and medical methods, providing care for cases that are medically indicated versus those that are not, and select cases where providers believed that abortion is being used as a method of contraception.

Many discussed how contact with the fetal remains is a difficult aspect of care. Midwives in Japan noted sadness, confusion, and guilt when handling the remains, while nurses in the UK described the experience as “undignified”, “horrible”, and “like a bereavement”.

Increasing gestational age at the time of abortion was also a significant challenge.

"You always see the pictures that anti-choice people protest with mangled fetuses and stuff. I had never really connected that to our work, so I was like, ‘wow, this actually is, at that point, a little fetus.’ Which is surprising to me, but it didn’t change the way I feel about abortion at all...."

Working in abortion care presented a unique set of social, emotional and practical challenges for staff...some staff expressed a sense of isolation from other colleagues.

They said that those who didn’t work in abortion care considered it an unpopular job and perceived patients requesting abortion as more ‘challenging ‘and ‘problematic’ than other patients, partly because of the...emotional investment which is associated with the role.

Staff’s sense of isolation was manifested because they felt they couldn’t talk to others about their job...

You need to look at the whole picture[;] this is not just a woman with a pregnancy inside her uterus that you need to empty. It’s the whole social, psychological aspect of an unplanned pregnancy. It’s all part of the complex picture.

Although staff said personal opinions did not have a place in the delivery of care some were unable to disassociate themselves professionally from their own deeply held personal convictions.

In addition, some said that they felt unable to voice opposition to an expectation that they would work in this area if it was included as part of a wider women’s health remit...

The subject of repeat abortion provoked particularly negative staff emotions for personal and professional reasons, especially if patients repeatedly accessed abortion services because of non use of contraception.

Often staff admitted they wanted to ‘lecture’ patients about the issue and some implied that eventually patients may be less likely to receive good care in these instances.

However staff reported that women who requested abortion for foetal abnormality were likely to receive more sympathy, understanding and care.

Dirty work... has several components: it can be physically repellent, symbolically degrading, morally dubious, and yet, under certain conditions... Abortion counseling encompasses all these aspects of dirty work.

The physically trying parts of the job involve confrontation with blood, vomit, and, in some instances, discernible fetal parts.

A certain symbolic degradation occurs with the counselor's responsibility for the post-abortion cleanup, which includes disposing of the "products of conception."

'Being an abortion provider is very stigmatized. Other doctors look down on you and think of you as like the lowest of the low.'

... [P]roviders discussed the challenge of disclosing their work... and... noted that they do not feel comfortable talking about their work at home as their partners think that abortion is “distasteful”... that some family members or friends would never speak to them again if they knew about their work....

... [M]any described the challenge in deciding whether to share their involvement in abortion care... that disclosing their work could damage existing friendships....

... [M]any said that they were morally challenged by certain aspects of care. These included experiences with the fetus, differences between surgical and medical methods, providing care for cases that are medically indicated versus those that are not, and select cases where providers believed that abortion is being used as a method of contraception.

Many discussed how contact with the fetal remains is a difficult aspect of care. Midwives in Japan noted sadness, confusion, and guilt when handling the remains, while nurses in the UK described the experience as “undignified”, “horrible”, and “like a bereavement”.

Increasing gestational age at the time of abortion was also a significant challenge.

"You always see the pictures that anti-choice people protest with mangled fetuses and stuff. I had never really connected that to our work, so I was like, ‘wow, this actually is, at that point, a little fetus.’ Which is surprising to me, but it didn’t change the way I feel about abortion at all...."

Working in abortion care presented a unique set of social, emotional and practical challenges for staff...some staff expressed a sense of isolation from other colleagues.

They said that those who didn’t work in abortion care considered it an unpopular job and perceived patients requesting abortion as more ‘challenging ‘and ‘problematic’ than other patients, partly because of the...emotional investment which is associated with the role.

Staff’s sense of isolation was manifested because they felt they couldn’t talk to others about their job...

You need to look at the whole picture[;] this is not just a woman with a pregnancy inside her uterus that you need to empty. It’s the whole social, psychological aspect of an unplanned pregnancy. It’s all part of the complex picture.

Although staff said personal opinions did not have a place in the delivery of care some were unable to disassociate themselves professionally from their own deeply held personal convictions.

In addition, some said that they felt unable to voice opposition to an expectation that they would work in this area if it was included as part of a wider women’s health remit...

The subject of repeat abortion provoked particularly negative staff emotions for personal and professional reasons, especially if patients repeatedly accessed abortion services because of non use of contraception.

Often staff admitted they wanted to ‘lecture’ patients about the issue and some implied that eventually patients may be less likely to receive good care in these instances.

However staff reported that women who requested abortion for foetal abnormality were likely to receive more sympathy, understanding and care.