Relationship of Job Role and Clinic Type to Perceived Stigma and Occupational Stress Among Abortion Workers

Objective: To describe the role of worksite characteristics, job role and abortion stigma in clinical abortion workers' occupational stress.

Study Design: We recruited nurses, medical assistants and counseling staff who provide abortion care at five hospitals and four freestanding clinics in Massachusetts. Study instruments assessed individual-level abortion stigma (the perception that others treat abortion as shameful, dirty and socially taboo) using the Abortion Providers Stigma Scale; job strain through the Job Content Questionnaire; and emotional burnout through the Depersonalization, Emotional Exhaustion and Personal Accomplishment subscales of the Maslach Burnout Inventory. Multivariable linear and logistic regression modeling tested for associations between job role, worksite type, stigma, job strain and burnout, accounting for demographic and job characteristics.

Results: Of 205 eligible workers, 136 participated (66%). Forty-one percent were medical assistants, 50% nurses, and 9% counselors. In adjusted models, abortion workers with high stigma had increased odds of experiencing job strain [adjusted odds ratio (aOR) 3.94, 95% CI 1.19-13.05]. Compared to working in a freestanding clinic, working in a hospital was associated with lower odds of experiencing the low personal accomplishment dimension of burnout (aOR 0.49, 95% CI 0.29-0.84) and lower odds of experiencing the depersonalization dimension of burnout (aOR 0.05, 95% CI 0.01-0.28). Counselors had higher odds of depersonalization compared to nurses (aOR 4.56, 95% CI 2.3-9.0).

Conclusion: Hospital-based abortion workers experience lower risk for burnout than comparable workers in freestanding clinics, accounting for abortion stigma and job characteristics.

Implications: Implementing structured supports to alter workflows or improve coping among workers in freestanding abortion clinics may help mitigate risk of worker burnout and associated turnover.