The role of community and culture in abortion perceptions, decisions, and experiences among Asian Americans

Introduction

Culture and community can play a role in views, stigma, and access related to abortion. No research to date has documented the influence of culture and community attitudes on Asian American (AA) experiences accessing abortion care in the United States (US). This paper aims to fill gaps in research and understand how cultural and community views influence medication abortion access and experiences among AAs.

Methods

We used a community-based participatory research approach, which included collaboration among experts in public health, advocates, practitioners, and community partners to understand abortion knowledge, attitudes, and experiences among AAs. Using a semi-structured interview guide, we interviewed twenty-nine eligible people of reproductive age over 18 that self-identified as Asian American or mixed race including Asian American, Native Hawaiian, and/or Pacific Islander (AANHPI), and had a medication abortion in the US between January 2016 and March 2021. Interviews were analyzed and coded in NVivo 12 using a modified grounded theory approach.

Results

Participants described various influences of religion negatively impacting acceptability of abortion among their family and community. Lack of openness around sexual and reproductive health (SRH) topics contributed to stigma and influenced most participants' decision not to disclose their abortion to family members, which resulted in participants feeling isolated throughout their abortion experience. When seeking abortion care, participants preferred to seek care with providers of color, especially if they were AANHPI due to past experiences involving stigma and judgment from White providers. Based on their experiences, respondents recommended ways to improve the abortion experience for AAs in the US including, (1) more culturally aware abortion providers from one's community who better understand their needs; (2) clinics providing abortion services located in or near AA communities with signage in local languages; and (3) tailored mental health resources with culturally aware therapists.

Conclusion

This study demonstrates ways in which culture and community opinions toward SRH can influence both the acceptability of abortion and experiences seeking abortion care among AAs. It is important to consider family and community dynamics among AAs to better tailor services and meet the needs of AAs seeking abortion care in the US.

Asian American and Pacific Islander Access to Abortion During COVID-19: A Complex Interplay of Factors

Often stereotyped as the “model minority,” health care providers, lawmakers, and the general public regularly underestimate and ignore the health concerns of Asian American and Pacific Islanders (AAPIs). The COVID-19 pandemic has exposed the racism that AAPIs face—many communities report facing severe xenophobia during the pandemic, which has increased hesitancy to obtain needed medical treatment and heightened mental health issues at a time of isolation. The pandemic is also exacerbating the barriers that already exist in accessing abortion care—with travel restrictions, quarantine measures, lesser availability of appointments, and more burden on the health care staff and system. There has been no discussion on the impact of the pandemic on AAPIs' access to abortion care. We discuss challenges that are specific to AAPIs in accessing sexual and reproductive care, especially abortion, and how these are compounded by the lack of appropriate data and methods. We then discuss the added complexity that comes with accessing abortion care during a pandemic and provide recommendations for research methods to better reach these populations.