Abortion Stigma and Its Relationship with Grief, Post-traumatic Stress, and Mental Health-Related Quality of Life After Abortion for Fetal Anomalies

Abstract

Background: Despite the prevalence of abortion stigma in the United States, few studies have examined the relationship between stigma and psychological well-being postabortion among women who undergo abortion for fetal anomalies. Materials and Methods: We conducted a cross-sectional study of women who underwent second-trimester abortion for pregnancy complications to assess the association between abortion stigma and psychological outcomes. We asked women to retrospectively report self-judgment and perceived community condemnation at the time of their abortion and evaluated present-day grief, post-traumatic stress, and self-reported mental health. We recruited participants using Facebook, Craigslist, and other public online forums. We used multivariable linear regression to evaluate relationships between abortion stigma and psychological outcomes. In adjusted models, we controlled for covariates that were associated with the outcome at a level of p < 0.1. Results: Adjusted models, including 80 women, revealed that higher self-judgment at the time of abortion was significantly associated with increased postabortion grief ( β = 2.5 and p = 0.02). Self-judgment was not associated with statistically significant differences in post-traumatic stress or mental health. There was no association between perceived community condemnation and psychological outcomes. Discussion: Abortion stigma may be associated with increased postabortion grief, but does not appear to be associated with differences in post-traumatic stress or mental health. Investigating how different preprocedure counseling methods can impact self-judgment might inform future interventions aimed at improving psychological outcomes postabortion. Implications for Practice and/or Policy: Abortion providers should consider that women who display signs of self-judgment may be at higher risk for increased grief after pregnancy termination for fetal anomalies or maternal complications.

Stigma, Social Support, and Decision Satisfaction in Terminations of Pregnancy for Medical Reasons

“…The study concluded that perceived social condemnation does not predict psychological outcomes. 11 However, this study did not explore whether stigma is directly related to abortion decision satisfaction or the role of social support after the TFMR. Additionally, Kerns et al 11 demonstrated a predictive relationship between abortion stigma and perinatal grief, which has the potential to decrease an individual's satisfaction with their decision to pursue a TFMR.…”

“… 10 Several, large, pre-Dobbs US-based studies have shown that most people who have had an abortion experienced stigma and feel the need to hide the experience from friends and family. 11 , 12 , 21 …”

“…22 , 23 This process is further complicated by the negative effects of abortion stigma. 19 , 24 While abortion itself is not linked to poor psychological outcomes, 11 , 25 , 26 in research on individuals who have had abortions, without isolating by reason for termination, abortion stigma has been linked to poor psychological outcomes ( e.g. , depression, prolonged grief).…”

“…A 2022 study by Kerns et al 11 explored the association of perceived stigma with mental health outcomes, including satisfaction with decision, among individuals who had a TFMR for fetal anomalies in the second trimester. The study concluded that perceived social condemnation does not predict psychological outcomes.…”

Early Pregnancy Loss—Reply

“…Some patients may grieve a pregnancy even if they chose to end it. Conversely, not all patients who have a spontaneous early pregnancy loss uniformly experience significant grief . Intimate partners may also need support after a pregnancy loss, and pregnancy loss can affect the way patients experience or navigate future pregnancies.…”