Abortion services in the United States represent perhaps one of the clearest examples of a stigmatized industry. Over the years, abortion clinics have faced regulatory targeting, harassment, and even violence. Of course, the recent repeal of Roe v. Wade in the U.S. Supreme Court will likely be the final blow to many clinics that were already on the verge of closure. However, prior to this ruling, we saw variation in the survival of clinics, with some surviving seemingly “against the odds.” Despite operating in the same industry, clinics seemed to be facing very different experiences of stigma within their local environments. This observation begged the question of how opposition and support from multiple external stakeholders and audiences within a local context might affect the odds of survival for organizations within a stigmatized industry.

Looking at the patterns of abortion clinic closures in recent years

Our recent study, published in the Journal of Management Studies, investigates this question. To carry it out, we gathered data on the full population of abortion clinics operating in the U.S. between 2011-2017. We also gathered data on many types of stakeholder and audience support and opposition, including the degree of local support or opposition for the practice of abortion amongst the local public, the degree of political support or opposition at the U.S. state level, the degree of pro- or anti-abortion legislation on the books at the U.S. state level, the strength of anti-abortion activism in the local level, and the estimated demand for abortion in a given geographic area.

We look at these factors through a fuzzy-set QCA analysis, which enables us to examine the effects of multiple factors simultaneously.

Uncovering the pathways to clinic survival

We find that in many cases a lack of overt opposition is sufficient for abortion clinic survival. In many contexts, clinics survived as long as they did not face local public opposition, regardless of whether or not they had support from the public, from politicians, or operated in a supportive legislative context. Staying under the radar (or not being overtly stigmatized) was enough for them to survive. An example from our data is a Planned Parenthood clinic in Anchorage, Alaska which was able to survive despite Alaska being a hostile environment for abortion provision in many other ways, including legislation targeted at abortion access and an anti-abortion political environment.

This finding is interesting, because much effort from abortion supporters has been focused on fighting in the legal realm, with focus during our period of study on reducing targeted legislation of abortion providers (informally called “TRAP” laws). TRAP laws place a burden on providers to, for example, meet requirements such as certain hallway widths that are usually in place for hospitals. While these laws certainly place barriers in the way of operating, lack of local opposition was a better predictor of survival in our findings, meaning that the effort that abortion clinics spent on repealing this legislation could have perhaps been re-directed towards the (arguably much more complicated) approach of campaigns aimed at educating and changing the minds of local publics who oppose the practice.

In another set of cases, however, support was key, and especially support from elected politicians. With this support, clinics survived even if they faced other threats, such as activism targeted at their operations. An example of this is a clinic in Bakersfield, California, where there is staunch anti-abortion activism, but that clinic has enjoyed political support and nonetheless survived. Although legislation was important in some of these cases, the party in power was a clearer explanatory factor for survival. We think this shows some of the informal ways that politicians matter beyond the laws they pass (such as their ability to make political appointees who may go after a certain industry).

What these cases can help us learn

All in all, our study goes beyond looking at stigma management strategies as the only explanation for survival in stigmatized industries to examine how the experience of stigma can vary based on socio-political factors, such as the support or opposition of certain stakeholders. Our research can help organizations in stigmatized industries understand that there are multiple pathways they can pursue for survival. And while the recent U.S. Supreme Court decision in Dobbs and the consequent overturning of Roe v. Wade have resulted in a markedly unfavorable landscape for abortion services nationwide, our results show that organizational resilience—and, by extension, survival in the face of overwhelming odds—are a function of local patterns of opposition and support for the core practices central to the organization at the local level.