How Does Abortion Go Agains Religion

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Research Article

Abortion attitudes, religious and moral beliefs, and pastoral intendance among Protestant religious leaders in Georgia

• Monique Hennink,
• Elizabeth Mosley,
• Subasri Narasimhan,
• Johanna Pringle,
• Lasha Clarke,
• John Blevins,
• Latishia James-Portis,
• Rob Keithan,
• Kelli Stidham Hall,
• Whitney Southward. Rice

Abortion attitudes, religious and moral beliefs, and pastoral care amongst Protestant religious leaders in Georgia

• Jessica 50. Dozier,
• Monique Hennink,
• Elizabeth Mosley,
• Subasri Narasimhan,
• Johanna Pringle,
• Lasha Clarke,
• John Blevins,
• Latishia James-Portis,
• Rob Keithan,
• Kelli Stidham Hall

x

• Published: July 17, 2020
• https://doi.org/10.1371/journal.pone.0235971

Figures

Abstruse

Objective

The purpose of this study is to explore Protestant religious leaders' attitudes towards abortion and their strategies for pastoral care in Georgia, Us. Religious leaders may play an important role in providing sexual and reproductive health pastoral intendance given a long history of supporting healing and health promotion.

Methods

We conducted twenty in-depth interviews with Mainline and Black Protestant religious leaders on their attitudes toward abortion and how they provide pastoral care for ballgame. The study was conducted in a county with relatively higher rates of abortion, lower access to sexual and reproductive health services, higher religiosity, and greater denominational diversity compared to other counties in the country. Interviews were audio-recorded, transcribed verbatim, and analyzed by thematic analysis.

Results

Religious leaders' attitudes towards abortion fell on a spectrum from "pro-life" to "pro-option". Nonetheless, well-nigh participants expressed attitudes in the eye of this spectrum and described more nuanced, complex, and sometimes contradictory views. Differences in ballgame attitudes stemmed from varying beliefs on when life begins and circumstances in which abortion may be morally acceptable. Religious leaders described their pastoral care on abortion as "journeying with" congregants by advising them to make well-informed decisions irrespective of the religious leader's ain attitudes. All the same, many religious leaders described a lack of grooming and training to have these conversations. Leaders emphasized not condoning abortion, yet beingness willing to emotionally support women because spiritual leaders are compelled to love and provide pastoral intendance. Paradoxically, all leaders emphasized the importance of empathy and pity for people who have unplanned pregnancies, nonetheless only leaders whose attitudes were "pro-selection" or in the center of the spectrum expressed an obligation to confront stigmatizing attitudes and behaviors towards people who experience abortion. Additionally, many leaders offering misinformation about ballgame when offering pastoral intendance.

Determination

These findings contribute to limited empirical testify on pastoral care for ballgame. We found religious leaders concur diverse attitudes and beliefs about ballgame, rooted in Christian scripture and doctrine that inform advice and recommendations to congregants. While religious leaders may have formal grooming on pastoral intendance in full general or theological educational activity on the upstanding bug related to abortion, they struggle to integrate their knowledge and training across these two areas. Still, leaders could be potentially important resources for empathy, compassion, and affirmation of bureau in abortion decision-making, peculiarly in the Southern U.s..

Commendation: Dozier JL, Hennink M, Mosley E, Narasimhan S, Pringle J, Clarke L, et al. (2020) Abortion attitudes, religious and moral behavior, and pastoral care among Protestant religious leaders in Georgia. PLoS ONE 15(vii): e0235971. https://doi.org/10.1371/periodical.pone.0235971

Editor: Jonathan Jong, Coventry University, UNITED KINGDOM

Received: Jan vii, 2020; Accepted: June 26, 2020; Published: July 17, 2020

Copyright: © 2020 Dozier et al. This is an open up access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted utilise, distribution, and reproduction in whatsoever medium, provided the original writer and source are credited.

Data Availability: Our data are comprised of transcripts from qualitative interviews with Protestant religious leaders in Georgia surrounding abortion attitudes and pastoral intendance. These information cannot be shared publicly, equally the qualitative data presents potential risks and harms across those agreed to past study participants in the consent process and approved by the Emory University Institutional Review Lath. However, information access requests may exist sent to IRB@emory.edu. In lodge to facilitate research transparency, nosotros provide the report interview guide and codebook as Supporting Data files.

Funding: This study was funded by the Middle for Reproductive Health Research in the SouthEast (https://rise.emory.edu) with support from an bearding foundation (to KSH). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors accept alleged that no competing interests exist.

Introduction

Abortion is a mutual feel for U.S. women of reproductive age—approximately one in 4 volition have an abortion by historic period 45 [i]. In the U.s.a., 13.five abortions per 1,000 women of reproductive historic period were reported in 2017. While national and regional abortion rates accept been declining, rates in the state of Georgia have increased in contempo years [ii]. The rate of abortion in Georgia was 16.9 abortions/1,000 women aged 15–44 in 2017 [2].

Despite abortion existence common, nearly people in Georgia face systemic and socio-cultural barriers limiting access to ballgame services. Attitudes that condemn ballgame emerge in policy, systems, and at the customs-level [3]. Manifestations of abortion stigma [3–6] may influence people's power to practice reproductive autonomy [7, 8]. Researchers suggest "abortion stigma confounds a woman's decision to terminate a pregnancy due to worries about judgment, isolation, self-judgment, and community condemnation" [nine]. In 2014, simply iv% of counties had clinics that provided abortion, leaving 58% of women in Georgia without a dispensary in their county. Restrictive state legislation threatens to impose boosted barriers to abortion access. For example, in 2019, Georgia legislators introduced HB 481, a pecker that sought to outlaw abortion one time a fetal heartbeat is detected [10]. This pecker aimed to restrict abortion every bit early as 6 weeks gestation, before many people know they are pregnant [11]—ane of the strictest abortion bans in the nation [12]. A federal guess granted an injunction in early on October 2019, which blocked the law while it is argued in courtroom [13].

More than restrictive policies go out the virtually vulnerable, economically disadvantaged, and socially isolated people with few choices but to bear pregnancies they feel they are unable to support to term; however, those who carry pregnancies as well face systemic barriers including limited access to perinatal care. Georgia has one of the highest maternal mortality rates in the United States [14], yet access to obstetric services is limited past a declining obstetrician/gynecologist workforce, especially in rural areas [xv]. Moreover, half of all counties in Georgia are without a single obstetrician/gynecologist or hospital where women can give nascence or access basic services [16].

Religious leaders are pivotal in their organized religion communities [17] and may be influential in shaping attitudes towards sexual and reproductive health (SRH), norms, and behaviors at the individual, family and customs levels [8, 17, 18]; however, religious doctrine and beliefs may come in direct conflict with public health recommendations regarding abortion and contraception [19]. Previous research [4] has establish links betwixt religiosity and experiences of abortion stigma and it is "often the religious voices that oppose sexual and reproductive rights that take been the virtually visible in the media and near influential in policy debates" [17]. In a landmark 2014 example, Burwell v Hobby Lobby Stores, Inc., the Supreme Courtroom ruled that the Religious Freedom Restoration Act (RFRA) of 1993 allows a for-profit company to deny its employees coverage for contraception through the employer-based health plan because of the religious objections of the Hobby Entrance hall owners [20]. Conversely, Mainline Protestant religious leaders have historically played a function in shaping SRH policy, specifically with advancement efforts for increased access to contraception and abortion during the twentieth century [17].

While many religions are perceived to condemn abortion [21], religiously affiliated women do take abortions—the bulk (62%) of women who obtained an abortion in 2008 and 2014 claimed a religious affiliation [22]. Of these women, 17% identified an affiliation with a Mainline Protestant denomination [22]. This percentage is higher than that found in the American population as a whole; in 2010, Mainline Protestants but represented 7.2% of the U.s.a. population [23].

Religious leaders may play an important part in providing SRH-related pastoral care and resources given that "religions have a venerable tradition supporting healing, wellness care, affliction prevention, and health promotion [and a] commitment to the most marginalized, the most vulnerable, and the about likely to be excluded" [17]. Still, piddling is known nearly the pastoral care practices of religious leaders as they relate to abortion, especially in the southern states of the United states and there are few resources in pastoral theology that accost abortion. In fact, a review of publications from Mainline Protestant publishing houses over the concluding two decades identified only two books published on pastoral care and abortion [24, 25]. A keyword review of the American Theological Library Association (ATLA) database identified no peer-reviewed manufactures exploring abortion published in pastoral theology journals over the terminal twenty years. Given their potential accomplish and influence, there is a demand to understand the religious and moral views that shape religious leaders' attitudes toward abortion, and their pastoral care practices, particularly in Georgia, a country with high religious influence [26] and gaps in reproductive healthcare [xv, 16, 27]. This written report aims to explore Mainline and Blackness Protestant religious leaders' attitudes towards ballgame and how they provide pastoral care regarding abortion.

Materials and methods

Participant recruitment

Participants were recruited from ii religious traditions based on categorization developed by Steensland and colleagues [28]. Mainline Protestantism is a branch of Protestantism that consists of denominations that are generally considered theologically liberal and moderate (e.chiliad. Presbyterian Church (USA), the United Methodist Church, Episcopal Church, and the United Church building of Christ). Black Protestantism (too known as "the Black Church") is theologically and structurally similar to white evangelical denominations, "but also emphasizes social justice and community activism" [29]. Co-ordinate to the Association of Religious Data Archives, Black Protestant denominations are generally economically liberal and socially conservative [29]. The tradition consists of seven major denominations, such as the African Methodist Episcopal Church building, the Church of God in Christ, and the Progressive National Baptist Church [29].

For this study, 20 semi-structured, in-depth interviews were conducted with religious leaders serving in Mainline and Blackness Protestant churches in a county with urban and rural areas outside of Atlanta, Georgia. The study site was selected due to its higher ballgame rates, lower SRH service access, a higher religious adherence, greater denominational variety, and an abundance of Mainline Protestant and Blackness Protestant churches as compared to other similar counties in Georgia. Religious leaders were eligible to participate if they were currently serving in a Mainline Protestant or Black Protestant church as a clergy member or lay leader (i.due east. a not-ordained fellow member of a Christian church [29]) for at to the lowest degree half-dozen months prior to the interview, were over xviii years old, and spoke English language.

Purposive sampling was used to recruit a sample of religious leaders diverse in denomination and sociodemographic characteristics. Churches were identified using a publicly bachelor list of churches by county published by The Clan of Religious Data Archives. Names and contact information for the primary religious leader of these churches were obtained from church building websites and social media. Lay leaders were recruited past social media messages and snowball sampling because their contact information was often non publicly available on church websites. Religious leaders were contacted up to five times by email, phone, and social media message using standard Institutional Review Board (IRB)-approved scripts. Leaders were besides approached in person and recruited at centers of commerce (e.g. local strip malls) in the county using a standard recruitment script, screened for eligibility, and interviewed at a after date in a private location.

Participant characteristics

Socio-demographic characteristics of study participants are presented in Tabular array i. The majority of participants recruited were men (80%) serving in senior pastoral roles (60%). Other religious titles reported included: pastor, associate pastor, first lady, minister, regional minister, youth minister, and lay leader. The average length of fourth dimension served in the participant'southward current role was 8.3 years (6 months to twoscore+ years). Historic period ranged from 28 to 72 years, with a mean age of 48. Sixty-five percent of participants had a graduate degree—near commonly a Masters of Divinity. Church building membership size ranged from less than l to over 1000 people.

Information collection

In-depth interviews were conducted between Oct 2018 and September 2019 using a semi-structured interview guide (Encounter S1 Appendix). The interview guide included questions on participants' views virtually unplanned pregnancy and abortion, pastoral care on these topics, and suggestions for discussions and programming around unintended pregnancy and abortion in faith settings. Some of the questions included, "What are your personal views on abortion?" and "What advice would you give someone in your congregation considering abortion?" Researchers probed for barriers and facilitators to providing pastoral care on these topics and specific resources and scripture religious leaders would rely on during these conversations. The interview guide was airplane pilot-tested in four interviews with clergy members serving in Mainline and Black Protestant churches in metro-Atlanta and then refined for clarity. Iterative changes were made to the interview guide and to participant recruitment throughout the data drove menses to explore new topics raised and to include participants with differing perspectives, as is usual in qualitative data collection.

Participants were consented verbally. They were read an IRB-approved consent script, invited to ask follow-upwards questions, and asked if they agreed to take office in the study. A short demographic survey was administered subsequently the informed consent procedure. Interviews were conducted in private offices at the participant's church, at Emory University, or another location (e.g. a private room in a coffee shop) and digitally sound-recorded. Interviews lasted between 45 and ninety minutes, and participants received a $50 gift card. The study was canonical by the IRB at Emory University (IRB 00106069).

5 researchers nerveless the information. They were trained on qualitative research methods, the report protocol, and inquiry ethics. All researchers were cisgender women of reproductive age: four multi-ethnic women and one white woman. They had varying religious backgrounds and level of feel inside Christian churches. Throughout information drove, the researchers practiced reflexivity past journaling their own thoughts and impressions about the research topic or participant'southward experiences. They also noted potential biases that may have influenced information collected. Researchers shared these reflexive notes in squad debriefing sessions and discussed ways to minimize researcher influence on the data collection process. Debriefing sessions included discussions on how researcher'due south social identities and preconceptions about the report issues may have influenced the data likewise as strategies to minimize these influences. For case, reflexivity revealed emerging data on race and religion, whereby the team felt that matching the race of researchers and participants may provide a more than enabling environment for a deeper, more nuanced information on participants views on race and abortion.

Data analysis

Thematic assay was used to describe Mainline and Black Protestant religious leaders' attitudes towards ballgame and how they provide pastoral care regarding ballgame. Interviews were transcribed verbatim by a professional transcription company and de-identified by the enquiry team. Data were managed and organized using Dedoose version 8.0.35, a software package for qualitative information analysis [30]. Data drove, coding, and analysis occurred simultaneously to appraise meaning saturation, or a "richly textured understanding" of ballgame attitudes and pastoral care practices [31]. Saturation was reached at 20 interviews when a diverseness of views and denominations was achieved and no new themes were observed.

Information were read in detail and memoed in lodge to develop a codebook (See S2 Appendix). Codes were developed through inductive (emerging from the information) and deductive (pre-determined topics from the interview guide) strategies. An inter-coder agreement practice was conducted prior to coding all data to ensure consistency in the coding procedure. Weekly team meetings were held to refine lawmaking definitions, resolve discrepancies in coding, and discuss reflexivity in data interpretation during the coding procedure. For case, researchers discussed how our underlying epistemologies, public wellness training, and differing views on scripture and doctrine, might influence estimation of data during analysis.

Researchers explored data by codes (east.chiliad., ballgame, attitudes & beliefs, and pastoral care), conducted structured comparisons of codes by sub-groups of participants (eastward.k., by sociopolitical attitudes, denomination, and gender). Patterns in the data were examined and sub-themes within codes were identified. Illustrative quotes were then selected for each sub-theme.

Results

Results were organized around i) ballgame attitudes; 2) moral and religious beliefs; and 3) pastoral care.

Abortion attitudes

When asked most their views on ballgame, most participants noted amalgamation with sociopolitical attitudes regarding abortion (due east.g. "pro-life" and "pro-choice"). Differences amongst attitudes were observed in the participant'south understanding of when life begins, an affirmation of a women's autonomy, and expression of the circumstances in which abortion may be morally acceptable. All participants identified at least one circumstance in which abortion may exist the best determination for a pregnant person. Participants who identified their views equally "pro-life" offered fewer moral exceptions for abortion, explaining that the circumstances of most unplanned pregnancies are surmountable, and therefore do non need to exist resolved by abortion.

Nonetheless, the majority of participants expressed statements not readily fitting into a dichotomy of attitudes, just rather intermediate between "pro-life" and "pro-option" in the so-called "gray expanse." Attitudes in the "grey area" were nuanced, complex, and fell along a spectrum between "pro-life" and "pro-choice" attitudes. "Gray Area" attitudes were distinguished by an understanding that people have to make decisions on their own, yet "all life is sacred" and should be protected. In add-on, participants with these "gray expanse" attitudes expressed tentativeness near taking a stiff opinion of "pro-life" or "pro-choice," noting tensions between beliefs held in both categories and a desire to hold onto religious behavior while acknowledging legal right to abortion. Illustrative quotes of the range of common attitudes are presented in Table ii.

"Pro-life".

At that place was no design among participants with "pro-life" attitudes by gender, tradition, denomination, or leadership role; participants included both men and women, senior pastors and a kickoff lady and other lay leaders, and came from multiple denominations, including United Methodist Church, Congregational Methodist, National Missionary Baptist Convention, Inc., and a Non-denominational congregation. Those with "pro-life" attitudes felt abortion is "likewise common" and "ought to exist a final resort" that is not rushed into or taken lightly given the gravity of its implications. They expressed perceptions that abortion is too often thought of as a first choice and explained that they would encourage congregants to make well-informed, carefully considered decisions when faced with an unplanned pregnancy. Moreover, participants with "pro-life" attitudes explained that ballgame is too often discussed in a "cold and sterile" medical manner. They explained that this perspective is express considering it presents abortion only as a solution to a medical problem, but detaches moral implications of ending the "potential for life." Participants with "pro-life" attitudes explained information technology is incommunicable to honestly discuss abortion in but medical terms; morality must too be considered and negotiated. These participants emphasized the importance of sharing religious behavior of life and scared worth when providing pastoral care for someone considering abortion.

Participants with "pro-life" attitudes acknowledged abortion as a legal pick but explained they would only counsel women to consider this recourse in cases of risk to maternal life or in some cases of sexual attack. Some participants were less decided nigh the moral acceptability of abortion in cases of rape, stating tensions betwixt the belief that something good might come out of the pregnancy and concerns for the mental health of the mother. One Mainline Protestant pastor raised concerns about abortion in cases of rape and expressed that it may be morally acceptable only when the adult female has no shared "responsibleness for [the pregnancy]," such every bit a woman existence nether the influence of booze versus beingness "attacked by an evil person." The same participant explained that abortion is non a morally acceptable option for fetal anomaly because such anomalies are the issue of "the sinful nature that we're built-in into (due to original sin of Adam and Eve)", and because God does not make mistakes, therefore all pregnancies should exist carried to term.

Attitudes in the intermediate, "Gray Area".

Participants from several denominations such as United Methodist Church, Evangelical Lutheran Church in America, African Methodist Episcopal expressed attitudes intermediate between "pro-life" and "pro-pick." These participants were tentative most making strong statements well-nigh what the platonic resolution of unplanned pregnancies should be and explained that they were not "qualified" to make such determinations for others. Several participants expressed the importance of individual autonomy to make ballgame decisions and careful consideration of the context of an unplanned pregnancy in deciding on the ideal resolution of the pregnancy; however, most of the participants with attitudes in the "gray area" expressed that they would adopt abortions are less mutual. Participants cited tension between belief in the sanctity of life and respect for individual autonomy. I participant described this tension:

"'So I don't believe that it'south my correct every bit a human being to tell a woman what they're going to exercise with their torso because a woman and a child are literally inexorably linked as far as being in utero and in womb. Then I have no correct to say to someone who's carrying a kid that y'all tin or cannot practice this or that or the other considering that child is your body and you accept the correct to encounter your torso. But at the same fourth dimension, in that location is also the potential for a life being carried inside of that body. And the part of me that values the sacredness of all life says, 'Oh, but look at the potential in that location. Look what good that future homo being could practise in the world.' So I sort of stand at a very strange grayness area and crossroads with ballgame." (Senior Pastor, Mainline Protestant)

Some participants in the "Gray Surface area" cited that abortion may exist the best decision for some people if having an abortion would alleviate potential suffering or in cases in which a mother is not able to intendance for herself or for a kid. Another senior pastor explained his view on abortion,

"My personal views on abortion is that I believe that in some cases, ballgame could be the best selection for that individual, if they come up to that determination, such as poorly–development of a fetus that does not have, medically speaking, the chance for–productive or normal life outside of the womb. Okay? People make those decisions on their own. One of the more sensitive issues is having a healthy child, but if that kid is the result of rape or incest, I don't believe that God cannot forgive anyone for any determination that possibly could exist confronting his will. His volition, of course, is that we have life, but I also hold to this belief that every, every, every–conceivable sin is forgivable by God, except for blasphemy …" (Senior Pastor, Black Protestant)

"Pro-choice".

There was no identifiable pattern by gender, tradition, denomination, or leadership office among participants who identified themselves as "pro-choice." These participants discussed tensions between the demand for ballgame and the need for women to practise bodily autonomy. They felt pregnancy-related decision making should rest with a pregnant person and God, but they would try to guide people because ballgame to the best outcome for the female parent and the baby. They emphasized that their pastoral care would consist of much listening and understanding. A senior pastor at an Episcopal church who identified as "pro-selection" explained that he could non brand decisions about abortion for people because to do then would be "treading on a violation of the relationship between [them] and God."

Most participants with "pro-option" attitudes expressed that abortion is a psychologically difficult decision that they wished people did not take to go through but underscored that it may be the best option for some people. These participants explained that abortion might be the best decision if in that location is a hazard to the life of the mother, in cases of rape or incest, and in cases of fetal anomaly. Conversely, some participants expressed that abortion should not be used as a master ways of birth control or contraception. A senior pastor at an Episcopal church building expressed that abortion should not be allowed for sex-selection, although he did not believe this was a mutual occurrence. Several other participants acknowledged abortion every bit a legal pick but emphasized the importance of supporting women and providing children the care they demand then in that location are better alternatives to abortion.

Religious and moral behavior across the abortion attitude spectrum

All life has sacred worth.

All participants expressed that their abortion attitudes are influenced by the understanding and interpretation of Christian scripture and doctrine (Meet Tabular array 3). The majority of participants identified beliefs about sanctity and sacredness of all life every bit central to their views on abortion. They explained that people are created in God'due south prototype, therefore human life has sacred worth which should be protected. The majority of participants stated views that public and pastoral care conversations about ballgame should include recognition of the sacredness of life because Christian believers walk that experience (i.e. it is fundamental to Christian beliefs).

Many participants across the mental attitude spectrum expressed the perception that abortion is ending life; all the same, participants had mixed views about when life begins and starts to bear the prototype of God. Participants with a "pro-life" mental attitude toward abortion described the beginning of life at early stages in fetal evolution, with some reporting life begins at formulation, and others explaining that life begins when there is a fetal heartbeat. Participants expressing intermediate attitudes in the "grey expanse" did not have a consensus about when life begins, or, in other words, whether an abortion would end a life that was created in God's image. One senior pastor with abortion attitudes in the "grayness area" stated that he rejects the notion that "a fetus is just a grouping of cells." Another senior pastor who besides expressed attitudes falling in the intermediate "gray surface area" stated that he was non qualified to state when life begins but was confident it was not conception. He expressed dubiety nigh when a fertilized egg starts "bearing the image of God," but expressed that it was former between formulation and nascency. One participant with a "pro-pick" attitude toward ballgame expressed beliefs most the beginning of life that were unique amidst other participants. She discussed views about life offset when God's spirits are brought into "our earthly journey" through the process of nascency. She explained that whatever spirits that are not birthed get back to God and wait for the next take chances at life, even equally flesh dies during an ballgame. She expressed this happens because God is loving:

"If God is a God of love, why would God punitively respond to that entity of life that has no choice? I think God is bigger than that …" (Regional Minister, Mainline Protestant)

Redemption.

Many participants across the attitude spectrum expressed that there is a process of healing, redemption, or becoming "whole" that women must undergo post-obit an abortion to resolve adverse psychological and spiritual furnishings. Almost participants draw these effects, such every bit emotional guilt, regret, and spiritual effects, such every bit questioning whether God would forgive them. They expressed that these furnishings are often lasting and lifelong for those who cannot or will non "do the work [of] resolving their own minds." Across abortion attitudes, participants expressed that adverse psychological effects are especially salient for women who never end up having children or learn later that they are infertile. In addition, some participants from both Mainline and Black Protestant churches expressed that there may be guilt, condemnation, criticism, and judgment from members of their congregation towards people who have an abortion. These participants expressed that stigmatizing responses from members of the congregation would go on to distress women after an ballgame until they sought spiritual and emotional healing. Several participants explained the procedure of redemption and healing afterwards having an abortion involves women reckoning with catastrophe a life, recognizing they are covered by God'southward grace and God does not condemn them, even if they may condemn themselves for their decision to stop a pregnancy.

Pastoral intendance

Across the ballgame attitude spectrum.

Many participants had little or no experience providing pastoral care related to abortion in their careers. They attributed their inexperience to perceptions that unplanned pregnancy and abortion not being major concerns in their churches and congregant perceptions that the church is not a prophylactic place for conversations due to stigma. In addition, some men perceived women congregants would not come to them for pastoral care surrounding these issues or would prefer to get to women religious leaders. In such cases where leaders had little or no experience, they responded to hypothetical situations in which they would provide pastoral care to congregants because abortion and frequently discussed these issues in the context of unmarried adolescents experiencing an unplanned pregnancy. Many participants expressed incertitude nearly their qualifications to provide this type of pastoral care or lead religion-based wellness programs that included discussions of unintended pregnancy and abortion.

Beyond the spectrum of attitudes, participants expressed the importance of supporting a person facing an unplanned pregnancy and "journeying with" them in their decision-making, yet expressed a articulate preference for continuing an unplanned pregnancy to term and utilizing adoption of the baby as a strategy (See Table 4). Paradoxically, all participants expressed their desire to counsel women away from abortion, or not "encourage" ballgame as a solution to an unplanned pregnancy given beliefs well-nigh all life being sacred and needing protection. Several participants discussed the obligation to preserve God's creation.

Similarly, many participants across the attitude spectrum emphasized the importance of expressing dear when proving pastoral care for someone considering ballgame, even if their theology led them to be morally opposed to abortion. All participants emphasized that they, the congregation, and God love a adult female with an unplanned pregnancy that is considering ballgame. Participants explained a loving response was a part of their duty every bit spiritual leaders. Participants with "pro-choice" attitudes and those falling in the "gray expanse" explained that part of their pastoral care would be to encourage their congregations to love and support someone because ballgame or who has had an ballgame.

Several participants expressed that ballgame volition not separate women from the beloved of God, or the love of the participant, even if the decision to abort is not pleasing to God. Some participants equated abortion to sin such every bit divorce but explained that every sin, except blasphemy, is forgivable by God. These participants believed therefore, information technology was not their task to judge someone who has an ballgame, even if they believe that ballgame is ending a life. Some participants across the mental attitude spectrum expressed that God'due south view of the sanctity of life is not punitive; therefore it is non appropriate for religious leaders to condemn women who accept abortions to Hell or crave them to publicly confess this sin. Additionally, many participants explained that people who accept abortions are covered by God's grace and forgiveness, religious beliefs that they would convey in their pastoral care.

Many participants across the spectrum of attitudes expressed the importance of not condemning a person because of abortion, citing scripture punitively, or passing judgment. A participant from an Episcopal church who identified as "pro-choice" said,

"…I besides think it's letting them know that they're loved. I go dorsum to that, with–that's–love will win. I know it's become sort of a moniker and nobody takes it seriously, but– …It will. Then how practice we love? How exercise we dear that woman who didn't plan, and that baby that'southward going to consequence from information technology? Or the woman that planned, and still she got pregnant. It's not what practice we with them. Information technology's how exercise we dearest them, and make sure they know they're loved? That'southward the part I encounter my office as." (Male Senior Pastor, Mainline Protestant)

When asked most how they would provide pastoral care for ballgame, participants with "pro-life" and "grey area" attitudes cited examples of instrumental support they would provide as role of their pastoral care for unplanned pregnancies and emphasized providing support for standing a pregnancy.

"Pro-life".

Participants with "pro-life" attitudes shared a belief that regardless of the intendedness of pregnancy, there are no "adventitious children" because "God does not make mistakes." They explained that they would describe upon this belief when providing pastoral care and would advise congregants considering abortion to outset consider what God is calling them to do and consider the potential of their unborn child. Additionally, several participants with "pro-life" attitudes expressed that they would encourage people to first see an ultrasound or hear a fetal heartbeat before deciding on abortion. They cited examples of knowing people and hearing stories of immature women who were seeking an abortion until they saw an ultrasound or heard a fetal heartbeat. While most participants across the attitude spectrum expressed they would encourage significant women to seek healthcare services, namely prenatal care, without being prompted, participants with "pro-life" attitudes discussed shut ties to Crisis Pregnancy Centers and local pro-life advocacy groups they would telephone call upon every bit resources. One senior pastor from a United Methodist Church building explained his procedure in providing pastoral intendance to a young adult female and making an appointment for her at a Crunch Pregnancy Center:

"She didn't desire to admit that she was pregnant, then I fix with a crisis pregnancy center a time for her to go in for an ultrasound, commencement receiving prenatal care, and and so she didn't show upwards … she didn't show upwards for the ultrasound, and all that. I was put in the awkward position of having to be a fiddling flake ambitious with them, 'Look, this is your life, and the kid's life are at stake if you don't receive whatsoever prenatal care.' … That was kind of a strange situation that I felt at some times similar possibly I was overstepping my bounds by being pushy, but they weren't even talking to their parents about information technology. … That involved not but counseling merely a lot of, I don't know what yous would say, arm-twisting like, 'You lot need to go get checked out, '… It was a strange role, one of those they don't train you for in seminary, that'southward for sure. " (Male Senior Pastor, Mainline Protestant)

Attitudes in the intermediate "gray expanse"

Participants with attitudes falling in the "gray expanse" explained they would encourage women to irksome down and take stock of their available resources before making a decision about an unplanned pregnancy. These participants explained they would encourage congregants to consider if they had adequate child intendance, family support, and finances to parent a child. Some leaders expressed they would encourage women to conscientious gather all available information most options when faced with an unplanned pregnancy. These participants believed the congregation would likely encourage a fellow congregant with an unplanned pregnancy to continue the infant. Many suggested that they would counsel women because abortion to not brand a "rash" conclusion based on pressure from the congregation. In many of these cases, the participants expressed tension between beliefs shared in a pastoral intendance setting and beliefs of the congregation. These participants shared that they would encourage women to consider both options—to have an ballgame or non have an ballgame. Religious leaders with attitudes in the "grayness area" expressed that they would advise a adult female not to get through with an ballgame unless in that location are where no other options. These leaders often emphasized contraceptive apply as a chief method to prevent a pregnancy.

"Pro-pick".

Many participants who expressed "pro-choice" attitudes explained how they would provide back up to a congregant seeking pastoral following an abortion. They expressed the process of helping a woman to reckon with ending a life and considering how God might view their action. They expressed women would need and want redemption, which would exist bachelor if sought. Others expressed they would try to use scripture to the best of their power to encourage women seeking pastoral care, but would exist careful not to "dictate what the bible says in terms of abortion" because picayune is written and costless choice is allowed.

Discussion

This study provides insight into the circuitous intersection of sociopolitical attitudes almost ballgame, religious and moral beliefs, and pastoral intendance among Mainline and Black Protestant religious leaders in Georgia. This analysis is part of a larger intervention evolution study to understand existing attitudes, norms, and values, in order to inform a organized religion-centered program on sexual and reproductive health that promotes compassionate attitudes and norms in Protestant religious contexts. While abortion attitudes fell on a spectrum ranging from "pro-life" to "pro-choice," the majority of participants expressed attitudes intermediate, or in a "grayness area," betwixt these views. Differences in abortion attitudes stemmed from varying beliefs on when life begins and circumstances in which abortion may exist morally acceptable. Participants stressed that they would support women in pregnancy decision-making and advise them to brand well-informed decisions irrespective of their ain attitudes; yet, many described their lack of preparation and training to have these conversations.

Results showed numerous similarities and differences among Protestant religious leaders' attitudes, beliefs, and pastoral care practices. For instance, all participants agreed that they would participate in providing pastoral care for abortion at the initiation of congregants' advice seeking. Other key similarities in pastoral care across the spectrum of abortion attitudes include recognition of the importance of the sanctity of life, emphasis on using scripture to encourage (i.east., not using scripture in a punitive mode), and acquittance that spiritual leaders are called to beloved and care for people unconditionally. In improver, many participants across denominations highlighted the psychological furnishings of abortion and a need for spiritual healing after abortion. Still, participants differed in their descriptions of their belief most when life begins, acknowledgement of moral agency to make pregnancy- and abortion-related decisions, and the circumstances in which abortion may be morally adequate. For example, participants with "pro-choice" attitudes and participants with abortion attitudes in the "grayness area" emphasized a preference confronting abortion but recognized a pregnant person'due south moral agency to brand decisions for their bodies and lives, whereas participants with "pro-life" attitudes did non express the aforementioned recognition.

These results demonstrate that Protestant religious leaders may provide pastoral care differently according to their abortion attitudes, thus varying their communication and recommendations; even so, several misperceptions regarding abortion underlie religious leaders' attitudes, beliefs, and pastoral care practices and run counter to existing scientific bear witness. For case, many pastors described the agin psychological effects of having an abortion including spiritual questioning, guilt, and lifelong emotional struggle and pain. In contrast, thirty years of research—including studies that measured mental and emotional distress before pregnancy—suggest legal induced abortion does not pose meaning mental health risks for women [32–34]; yet, evidence suggests beingness denied an ballgame may effect in negative psychological effects on women [35]. In add-on, some religious leaders with "pro-option" and "grey area" attitudes stated they would advise against the utilize of ballgame every bit contraception despite clinical guidelines clearly distinguishing between contraception as a form of primary pregnancy prevention while abortion is a class of pregnancy termination [36]. Further, despite religious leaders beliefs that women utilise abortion "conveniently" or every bit a master pregnancy prevention method in the Us, people have abortions for diverse and interrelated reasons (east.chiliad., 73% cited inability to beget a child and 74% cited having a baby would interfere with work, education, or ability to care for dependents) [37] and over half of U.South. ballgame patients were using a contraceptive method when they became meaning [38].

Participants who identified a "pro-life" attitude towards ballgame cited informational support that encouraged women to go along their pregnancies and carefully consider the potential of the unborn child. Many of these participants expressed that their pastoral intendance would include instrumental back up in the form of making referrals to Crunch Pregnancy Centers (CPCs) and pro-life advancement organizations. Those with a "pro-life" mental attitude explained that CPCs were reliable sources of information and would assistance women to go prenatal intendance. They explained that women could become to a CPC to see an ultrasound or hear a fetal heartbeat. Some participants with a "pro-life" attitude explained that they would propose women to seek services at a CPC earlier deciding to have an abortion. Protestant religious leaders may view CPCs as reliable healthcare services considering of their accent on religious ideology; nonetheless, testify suggests women seeking intendance at these clinics "do not receive comprehensive, accurate, testify-based clinical information virtually all available options" [39].

Merely participants with "gray area" or "pro-choice" attitudes expressed a duty to confront stigmatizing attitudes and behaviors towards women who experience abortion. These participants discussed obligations to encourage empathy and dispel stigmatizing attitudes and treatment inside their congregations. While these participants were the only religious leaders who expressed these views, all participants emphasized the importance of empathy, love, and pity for others. Thus, Protestant religious leaders may be key players in confronting ballgame stigma in Mainline and Blackness Protestant churches and should be involved at the onset of efforts to destigmatize abortion and "shift the cultural conversation from 1 of judgment to one of empathy, compassion, and affirmation of people's moral agency" [17]. These findings hold promise for informing the development of multi-level faith-based interventions and secular and organized religion-based partnerships to reduce abortion stigma.

Many religious leaders cited that they had non had formal training on providing pastoral care for whatever sexual and reproductive upshot, let alone abortion. Pastoral care training and interventions should be developed that emphasize Christian behavior and value the sanctity of life and integrate public wellness recommendations. Key intervention components should: include information on evidence-based healthcare services and local supports, address beliefs near both the psychological and the spiritual furnishings of abortion, dispel misinformation, and integrate strategies to reduce abortion stigma. Some religious scholars are already considering religion-based, reproductive justice, and moral arguments for supporting abortion [nineteen, forty–44]. Existing moral arguments for legal abortion and this qualitative prove could be used to inform intervention development.

These findings should be interpreted in context of the limitations and strengths of the study. Our diverse sample of Mainline and Blackness Protestant churches represent an assortment of perspectives on abortion and pastoral care, only cannot (and were never intended to) exist generalized to all religious denominations (e.thou., Evangelical Protestant, Catholic, and non-Christian groups were purposefully excluded). Additionally, only few women were recruited in this study, which somewhat reflects the gender makeup of senior leadership positions in Protestant religious institutions which are male dominated. It is possible that women lay leaders are providing pastoral care to congregants too and may have dissimilar insights on the provision of pastoral intendance for ballgame. Future inquiry should seek to specifically recruit Mainline and Blackness Protestant women religious leaders. Investigation of how these findings compare to abortion attitudes and pastoral care practices amongst other religious traditions in Georgia, the Southeast region, and other states is warranted. Information technology is possible the participants included in this study stand for a grouping with more liberal views on ballgame given the adequately liberal stances of their denominations compared to other religious traditions. Information technology is a strength of this study, nevertheless, that many diverse political and socio-political attitudes were observed amid participants from the same denominations.

Conclusion

The insights provided past this study help provide an agreement of how Mainline and Black Protestant religious leaders in Georgia provide pastoral intendance to congregants regarding decision-making for unintended pregnancies, including abortion decisions. Protestant religious leaders may play an important role in providing social back up, and facilitating access to information and healthcare services. Finally, these findings aid to empathize complex religious and cultural perspectives on abortion and how these attitudes influence pastoral care. This is an important step towards creating partnerships betwixt public health and Protestant religious organizations that improve reproductive health outcomes, reduce ballgame stigma, and respect the intrinsic value of religious traditions on their own terms. Future enquiry on the larger intervention development projection will take another step by collecting congregant's perspectives on pastoral care for unintended pregnancies and ballgame, and investigate the barriers and facilitators to receiving back up from their religious communities.

Supporting information

Acknowledgments

The authors would like to thank Kelli Komro for her contributions to the study conceptualization, design and leadership. A special thanks to the EnFaith project advisory committee, including Rev. Kim Jackson, Rebecca Todd Peters, M.Div, PhD, Cherisse Scott (SisterReach), and Charity Wood (Interfaith Voices for Reproductive Justice), who provided advice on data collection and research strategies. Thank you to Rebecca Todd Peters for sharing her bibliography on pastoral theological books from which sources for the introduction are drawn. The authors also wish to thank Indya Harrison, Mary Kan and Anastasia Jackson who helped with participant recruitment and interviews.

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Source: https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0235971

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