Nearly Half of Abortion Care Providers Fear Sting Operations

Caroline Helwick

December 08, 2014

NEW ORLEANS, Louisiana — Concerns about encountering "fake" patients and being threatened by "sting" operations are pervasive among abortion providers and their clinic staff, somewhat out of proportion to their actual risks, according to research conducted at the University of Michigan, Ann Arbor.

Lead author Emily J. Youatt, MPH, a doctoral candidate at the university, said this fear "introduces a new stress to an already burdened workforce" and can "negatively influence the patient–provider relationship."

At the American Public Health Association (APHA) 142nd Annual Meeting here, Youatt presented the results of a survey that explored stigma and fears among abortion care providers.

Abortion is highly stigmatized in the United States, and this stigma negatively influences both the women seeking abortions and the abortion providers, she said. Abortion providers, she continued, encounter stigma in a number of ways and at multiple sites: through cultural discourse, laws, and policies; in relationships with family, friends, and colleagues; outside the clinic via antiabortion protesters; and inside the clinic via coworkers and patients.

"This can lead to isolation, burnout, and interpersonal disconnection," Youatt indicated.

One of the most distressing experiences for providers are antichoice "sting" operations, she noted. Women pose as patients and videotape their encounters with staff in an effort to expose improper patient counseling or other practices that could be negatively presented or perceived.

Survey of Medical and Management Staff

To better understand clinicians' experiences, Youatt and colleagues conducted a national study of 311 abortion care providers from 22 clinics. The population included physicians (10%), nurses (22%), medical assistants (28%), office managers (21%), and senior leadership (1%); a number of the respondents overlapped in these roles.

Nearly 40% of the respondents worked in a state where a sting had occurred, but none reported having actually been the target of a sting operation.

The participants completed a Web-based questionnaire that used a variety of instruments to measure stigma (35-item Abortion Provider Stigma Scale), psychological empowerment and distress, job commitment, and burnout.

The survey also explored how staff might respond to sting operations based on their response to three statements: I have been suspicious about whether a patient is a real patient or is posing as a fake patient who is trying to trap me; I am afraid that I will be recorded while at work and that it will show up on the news and Internet; and I would know what to do and who to talk to if I encountered a fake patient. Responses could range from 0 (strongly disagree) to 6 (strongly agree).

Approximately Half Were Suspicious or Afraid

Overall, 58% of respondents said they had been suspicious of a patient and 48% were afraid of being recorded during patient encounters. Interestingly, 93% said they would know what to do should this happen, Youatt reported.

"We showed that the fear was disproportion to the actual risk," she said. "None of these providers had been the subject of attack, yet many believed they had."

Compared with those in states without sting attempts, providers in states with sting operations were more afraid of being targeted and recorded (P = .007), more suspicious of encountering a fake patient (P = .02), and less confident they knew how to respond to fake patients (P = .04).

The provider's experience of stigma significantly predicted for suspicion of encountering a fake patient (P < .001), fear of being recorded (P < .001), and diminished confidence in knowing how to respond to a fake patient (P = .01), the authors also found.

"This finding sits well with other research among abortion providers that shows stigma is a predictor of higher burnout and compassion fatigue, higher emotional exhaustion, more psychological distress, and lower feelings of personal accomplishment related to abortion care," she noted.

"The message is that addressing stigma among abortion providers is critical to alleviating concerns about encountering fake patients and is a critical component of supporting the abortion-providing workforce," Youatt emphasized.

Future research should address not only the effect of sting attempts on workers but also their potential to burden patients by introducing suspicion into therapeutic clinical relationships, she suggested.

She also said clinics should help defuse fears and suspicions by "recalibrating those expectations around encountering fake patients," should train providers how to best respond to fake patients, and should reassure providers of organizational support should a sting attack occur.

In the discussion of the paper, many attendees commented on the pervasiveness of stigma and the need for a campaign to enhance understanding and tolerance. "Providers tend to stay in the dark and lay low," said Martin T. Donohoe, MD, adjunct associate professor in the Department of Community Health at Portland State University in Oregon, senior physician at Kaiser Permanente Sunnyside Hospital, and a member of the Social Justice Committee of Physicians for Social Responsibility. "My sense, as a physician and teacher, is that this movement really needs a good PR campaign."

Whitney Mendel, MSW, a doctoral candidate at State University of New York in Buffalo, said the stigma is felt not only from antiabortionists but from other healthcare providers. "It's amazing the physical and palpable distance you experience once you say you are connected to someone who honors choice," said Mendel, whose own friend was assassinated in his home for providing abortion care.

"Even in my affiliation as a researcher and social worker within this community, I have felt the distance from other maternal and child health providers, and I have seen a divide among physicians about abortion. It's very black and white," she said.

Mendel is now working within a facility where abortions are performed and babies are delivered. "Now that we are pulling 'choice' together under this huge umbrella in one place, I am seeing even more pushback from physicians against our one and only provider," she said. "We really need a unified front within the provider community."

Youatt, Dr Donohue, and Mendel have disclosed no relevant financial relationships.

American Public Health Association (APHA) 142nd Annual Meeting: Abstract 299326. Presented November 17, 2014.

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