Each weekday morning, the employees at the small abortion clinic in Southern California arrive for work, putting on their scrubs, powering on the lights and equipment and setting up for the day’s patients. The doctors and nurses who perform the procedures will be arriving soon.
To Kelly Ward, an assistant professor in the Departments of Sociology and Gender and Women's Studies, the day-to-day work these employees are doing is neither mundane nor trivial. It is a microcosm of the state of women’s reproductive health care in the United States.
“When we think about abortion providers, we examine their reasons for going into this field and the challenges they face doing this work,” Ward says. “In places where there are relatively fewer restrictions on abortion, there's a sort of health workforce that is a part of abortion as a practice. I'm interested in understanding what that workforce looks like, and the particular social context and experiences of those in the less prestigious or elite positions in a clinic like this.”
For the past year, Ward has been interviewing the men and women (mostly women) who work as medical assistants in the clinic, in roles that typically require obtaining 6- to 9-month certification rather than a college degree or more prolonged medical training. Ward sees her research as a means of destigmatizing abortion care by mapping what the workforce looks like and how the work resembles many other sorts of outpatient care, like kidney dialysis and wisdom teeth removal.
“These are often the people who take your blood pressure and temperature—they might weigh you or ask a couple of questions before the doctor or nurse sees you,” says Ward. “These are the people at the bottom of the medical hierarchy. They're trained to do some very specific things, but they don't have the specialized training of nurses.”
Most of the medical assistants Ward interviewed had some level of high school education but no college degrees. They were largely from low-income communities of color. And while the doctors and nurses who choose to work at abortion clinics are often strongly committed to providing services to patients, for the medical assistants, it was a different situation.
“Either it was the first job that they found outside of their credentialing, or it made sense given where they lived and their schedule,” says Ward. “Not one single person that I talked to said, ‘Oh, I was looking to get into reproductive health care or abortion care.’”
Some of the medical assistants had religious and or ethical concerns about working at the clinic. And not all of them received support from their friends and family or felt comfortable discussing their work in their personal lives.
Ward, who works as a birth doula in her non-academic time, believes that understanding why these jobs are attractive to people and where they fit within the larger scheme of healthcare could lead to professional development opportunities and a greater awareness of how the work they’re doing fits into a growing reproductive justice movement that aims to give women the choice to give birth or not give birth in healthy, supportive ways.
“It could be helpful for them to have more context about the politics of reproductive health care—how it's situated and why their work matters,” she says.
In addition to her work studying abortion clinic workers, Ward is also studying the experiences of people in Midwestern states who have used an abortion medication by mail service. She is interested in how people care for themselves in the home setting, and in the larger question of the growing medicalization of reproductive and sexual health care. This project ties closely to Ward’s work with the interdisciplinary UW-Madison Center for Reproductive Equity (CORE).
“When I talk to my undergraduates about reproductive health issues, we think about whether we’re trying to fix a problem upstream before it happens or we’re coming downstream and pulling people out of the river,” she says. “Obviously, the answer is both. It's like a trick question, because we can't just let people drown while we're desperately trying to figure out what's going on upstream.”