'Stigma R us': Stigma management at the intersection of abortion care and transgender care in family planning clinics

Rationale: Research shows an increase in the number of family planning clinics, which may or may not provide abortion care, offering transgender healthcare services in the last 10 years. The intersection of LGBTQ health and reproductive health represents several stigmatized social locations in health care work. Abortion care work is highly stigmatized. Although we know that transgender people also face stigma in healthcare settings, we know less about the possible stigma related to provision of transgender and transition-related care. Abortion providers have extensive experience navigating stigmatized healthcare work, but less is known about if or how stigma of transgender care may impact providers' experience of their work in these clinics.Methods: Using theories of stigma management and "dangertalk" discourse, we examined qualitative data from 25 in-depth interviews with family planning clinic staff members in the United States. Results: The majority of staff members who disclosed utilizing stigma management strategies worked at independent abortion-providing clinics. Previous experiences with abortion provider stigma equip staff to navigate the structural stigmas built into providing transgender healthcare, which helps them expand clinic service options with little-to-no community resistance. Offering transgender care also presents an avenue for abortion providers to practice stigma management during interpersonal interactions about their jobs. Providers can publicly celebrate providing transgender care in ways they cannot with abortion care. Conclusions: Family planning care providers who work in independent abortion-providing clinics are able to tap into dominant discourses of pride and activism related to the provision of transgender health care. This helps them expand access to care for a stigmatized and underserved population. However, providers' hesitation in sharing their abortion care work remains. This can lead to burnout or even internal dissonance when a transgender patient also needs an abortion. This study highlights the need for more research on the intersection of transgender healthcare and abortion care at a variety of health facilities.