Category Evolution Under Conditions of Stigma: The Segregation of Abortion Provision into Specialist Clinics in the United States
通过分析美国罗诉韦德案后堕胎服务从综合医院转向专科诊所的历史，揭示了价值观驱动创办、综合机构退出和客户行为导致的被动专业化三种机制，解释了污名化类别为何由专科组织主导。
Organizational involvement in stigmatized practices, that is, practices that attract substantial societal condemnation, is often challenging, inasmuch as it requires the successful management of stakeholder disapproval. In this regard, existing work on organizational stigma has highlighted the advantages of situating stigmatized practices within large, generalist organizations, because doing so allows for stigma dilution—that is, organizations can reduce stakeholder disapproval by increasing their relative engagement in uncontested practices, thereby straddling multiple categories in the eyes of audiences. This line of argument, however, runs counter to the empirical observation that stigmatized practices often remain overwhelmingly concentrated within smaller, specialist organizations, even though these are often not optimally positioned to cope with stigma. In this paper, therefore, we undertake an in-depth historical analysis of a revelatory case—abortion provision in the United States following the landmark Roe v. Wade U.S. Supreme Court decision—to build theory of how stigmatized categories can come to be populated predominantly by specialists. Building on primary and secondary archival materials, we identify three mechanisms that shaped category evolution and resulted in the de facto segregation of abortion into specialist organizations: the founding of freestanding facilities by values-driven providers, the exit of generalist organizations from the category, and the involuntary specialization of remaining providers, as customers no longer frequented them for other services and they soon became labeled simply as “abortion clinics.” We conclude by discussing the implications of our findings for the stigma literature and the generalizability of our theorizing to other settings.