Tackling Stigma Champion #7

For our seventh Tackling Stigma Champion, we spoke with Gillian Love, Assistant Professor in Sociology and Criminology at the University of Sussex.
Gillian’s research spans abortion, fertility, parenthood, and trans inclusion in perinatal services. But the relevance of her work goes far beyond reproductive health. Across very different contexts, she has seen how stigma often becomes visible only when we listen closely; to the language people use, to what they anticipate might happen, and to the ways they justify themselves before anyone has even questioned them.
Love’s central message is clear: stigma can determine whether someone feels safe enough to seek treatment. And in some cases,that is literally life and death.

Gillian’s tips at a glance

Pay close attention to the language people use to describe their own experiences, and mirror it
Notice when patients pre-emptively justify themselves. That can signal internalised stigma
Recognise that anticipated stigma can shape behaviour before anything overt happens
Use clear, descriptive terminology that avoids unnecessary assumptions
If you make a mistake, apologise and move on
Do not avoid pronouns. Avoidance can feel more alienating than getting it wrong
Reflect back what you’ve heard to check you’ve understood correctly
Use simple validating statements to show you are listening
Look for stigma in systems, forms and processes, not just in individual behaviour
Remember that fear of stigma can stop people engaging with care altogether

Tell us a bit about yourself and how you became involved in stigma

I’m an assistant professor at the University of Sussex in Sociology and Criminology. I’m a sociologist interested in reproduction and the body. My PhD was about abortion experiences in the UK. I interviewed women about their abortion experiences and looked at how gender and class intertwined in their stories.

I still work on abortion, but I’ve also researched parenthood and, more recently, trans inclusion in maternity services. I never set out with stigma as my central concept. But if you research abortion, stigma is always present in one way or another.

Reproduction raises fundamental questions: who is encouraged to reproduce and who is not? What barriers exist? What facilitates certain people and restricts others? Whether we are looking at fertility, abortion, or perinatal care, stigma runs through the whole spectrum in different ways.

Across your research, how does stigma tend to surface?

With abortion in England, what I found was that not many people reported direct stigma such as someone saying something overtly negative to them. But a lot of people described anticipated stigma.

They feared that if they disclosed their abortion, they might be judged or discredited. That fear shaped how they told their stories.

One really interesting pattern was that if people disclosed having had an abortion, they would often immediately say something like, “I was using contraception, by the way,” or “I had to because…” and then list all the things they’d done to prevent being in that position.

It’s almost like a pre-emptive defence. They’re demonstrating responsibility before anyone has even questioned them.

Some people also described internalised stigma. A few told me they almost wanted their abortion experience not to be pleasant, so they would never be in that position again. That’s like a form of self-regulation, and I think it reflects a common idea that if you’ve had an abortion, you’ve somehow been irresponsible.

There were also strong class dynamics. If you’re young and don’t have a lot of money, you might reach for a narrative like, “I want to prioritise my education.” That might be seen as more socially acceptable than other reasons. If you’re older and more established, people might ask, “Why now?” So people reach for different narratives to negotiate anticipated stigma.

There’s a book called Happy Abortions by Erica Miller which asks the question: can anyone ever just say that they've had an abortion? That they're really, really happy about it.That they were really relieved and it made their life better.

You also mentioned that stigma can show up even in pro-choice language. Tell us more about that

Yes, stigma can even show up in pro-choice language. The phrase “safe, legal and rare,” for example, implies abortion is something undesirable. I actually think it’s desirable to live in a society where abortion is safe, legal and accessible, whether people need it often or rarely.

Even terms like “late abortion” can carry assumptions. I’ve started thinking more about using more descriptive language, like “second-trimester abortion,” instead.

What about trans inclusion in perinatal services? How is stigma showing up there?

Maternity services in the UK are very gendered. The language is focused on “mothers” and “women.” Midwifery is very woman-focused, and for good historical reasons. But there’s a growing number of trans men and non-binary people who become pregnant and give birth.

They can feel really out of place in a service that hasn’t even considered that they might be there.

Some research shows quite direct stigma, such as misgendering, lack of dignity and respect. But there’s also structural stigma. For example, administrative forms that only allow certain gender markers. Systems that don’t recognise pronouns.

And sometimes people avoid engaging with services altogether. In Brighton, midwives told me they had heard of trans people giving birth at home without any antenatal contact because they were terrified of engaging with maternity services.

That wasn’t a philosophical choice to free birth. It was the fear of stigma. And that can obviously lead to serious negative outcomes.

As a narrative-based qualitative researcher, your work focuses a lot on listening to people. What should services be listening for? And how?

Time pressures in healthcare are very real. People working in perinatal services, for example, are under enormous pressure. But one really important thing is to pay attention to the language people use and mirror it.

In abortion care, if someone refers to their pregnancy as a baby, there may be a reason that’s important to them. If someone doesn’t want that language used, that’s equally important. If a clinician uses language that clashes with how someone understands their experience, that can feel jarring and stigmatising.

The same applies in trans-inclusive care. If someone tells you their pronouns, it’s probably because it really matters to them. Even if administrative systems are rigid, as a healthcare provider, you can mirror their language.

Another thing is that it’s not about perfection. If you make a mistake, apologise and move on.

What I’ve seen in research is that sometimes healthcare professionals get so worried about saying the wrong thing that they start walking on eggshells. Patients can tell. It’s a self-fulfilling prophecy that can actually reinforce the sense that they’re an odd one out in the service. Sometimes it’s better just to approach someone as you would any patient, and if you get something wrong, correct it calmly.

I know that people sometimes say, “Well, I’d rather just avoid using any pronouns.” But that’s not going to make someone feel welcome, because you end up using really awkward sentence structures to avoid referring to them properly.

Any other tips on what good listening looks like in practice?

Alongside the mirroring that we’ve already looked at, active listening is really important.

That includes reflecting back what you’ve heard: “I heard you say this, is that what you meant?” It includes neutral but validating statements like, “I can see this has really affected you.”

Those kinds of responses make people feel heard in a human way, not just a clinical one. Small tweaks in how we communicate can make a big difference.

Many services collect patient feedback about stigma, but struggle to act on it. Where do you see the gap?

I think one of the main issues is that stigma isn’t just interpersonal; it can be structural.

If you only think about stigma as something that happens between individuals, you’ll always be on the back foot. Sometimes the problem isn’t a person’s behaviour, it’s the way a service is set up.

A good example of structural stigma is administrative systems that only allow female titles or pronouns in maternity services. That’s an IT problem. A service might collect feedback about it and feel that it’s too baked in to change, especially if systems are outsourced or there isn’t much joined-up thinking.

There’s also a gap between research and practice. Researchers might investigate what’s happening and then leave. Ideally, it should be more collaborative: what does the service want to understand about patients’ experiences, and how can findings be presented in a way that helps them work towards solutions?

Most healthcare providers want patients to feel comfortable and treated with dignity. But structural problems are much harder to change, and that’s often where stigma sits.

Can you share an example of a service that genuinely listened and made changes?

In Brighton, trans midwives working within the local NHS trust began hearing about trans people in the area giving birth without any antenatal contact or midwife care because they were terrified of engaging with maternity services and didn’t know how they would be treated. So they simply didn’t engage at all.

Seeing this, two trans midwives took it upon themselves to act, largely without additional pay. This wasn’t just a service responding to abstract feedback. It was staff who were representative of the community that wasn’t being well served stepping in because they felt strongly the work needed to be done.
That led to the development of gender inclusion protocols in perinatal services. The changes included things such as adding a line for pronouns on intake forms, using small indicators on patient files, and adopting additive language. For example, saying “women and pregnant people” rather than replacing woman-centred language entirely.

They were implemented five years ago but have since disappeared from public facing view. Recent legal rulings in the UK about the interpretation of biological sex in the Equality Act, alongside a more hostile media environment for trans people, have made inclusion work more politically charged.

I think that’s part of the reason why the trust (NHS) may have felt they didn’t want that work to be public-facing anymore. So it is a positive example of a trust listening to its patients and changing something. But it’s also a demonstration of how there are always external forces that can make that kind of change really difficult.

If you had five minutes with a decision maker to make them care about tackling stigma, what would you say?

I would say we should not live in a society where people are terrified of engaging with a healthcare service because they think they might be stigmatised.

Stigma can sometimes be dismissed as just tweaking language and raising awareness. But the real ramifications in people’s lives can lead to the worst possible outcomes.

People giving birth at home with no medical care can lead to people being injured or dying, or their babies dying.

And when it comes to abortion, if people don’t feel they can tell others they need one or have had one, the psychological impact can follow them for the rest of their lives. It’s not the abortion itself that is stigmatising, it’s the social context around it.

This is literally life and death.

Tackling Stigma Champion #7: Gillian Love on life and death listening