Norms and stigma regarding pregnancy decisions during an unintended pregnancy: Development and predictors of scales among young women in the U.S. South

Abstract

BackgroundNorms and stigma regarding pregnancy decisions (parenting, adoption, and abortion) are salient to maternal well-being, particularly for groups disproportionately affected by unintended pregnancy. However, there are few validated measures of individual-level perceptions of norms and stigma around pregnancy decisions. Additionally, little is known about variation in the content of norms regarding pregnancy decisions, and in stigma related to violations of these norms, across socio-demographic groups.MethodsTo create measures of perceived norms and stigma around pregnancy decisions, we developed and pre-tested 97 survey items using a mixed methods approach. The resulting survey was administered to 642 young adult women recruited from health department clinics and a public university campus in Birmingham, Alabama. Principal components factor analyses, reliability analyses, independent t-tests, and correlation analyses were conducted to establish the reliability and validity of scales. Additionally, multiple linear regression was used to identify demographic predictors of higher scale scores.ResultsFactor analyses revealed four subscales for each pregnancy decision: conditional acceptability, anticipated reactions, stereotypes/misperceptions, and attitudes. The total scales and their subscales demonstrated good internal reliability (alpha coefficients 0.72–0.94). The mean scores for each scale were significantly associated with each other, with related measures, and differed by sociodemographic characteristics. Specifically, in adjusted analyses, women in the university setting and White women expressed more negative attitudes and stigma around parenting. Minority women endorsed more negative norms and stigma around adoption. Finally, women from the health department, White women, and religious women expressed more negative norms and stigma around abortion.ConclusionFindings suggest that our multidimensional measures have good psychometric properties in our sample of young women in the U.S. South, and highlight the importance of conceptualizing and measuring norms and stigmas around all pregnancy decisions. These scales may be of use in research on pregnancy decision-making and evaluation of stigma-reduction interventions.

Perceived abortion stigma and psychological well-being over five years after receiving or being denied an abortion

“…Abortion stigma is one of a broader range of reproductive stigmas that affects most people seeking abortion [1,2]. A national study of over 4,000 U.S. abortion patients indicated that nearly two-thirds reported that people would look down on them if they knew they had an abortion [3].…”

Norms and stigma around unintended pregnancy in Alabama: Associations with recent contraceptive use and dual method use among young women

“…While the aforementioned studies have explored social norms or stigmas regarding several sexual and reproductive health behaviors, to our knowledge, no recent U.S. studies have explored social norms and stigma concerning unintended pregnancy as related to use of dual contraceptive methods among young adult women. Social norms and stigma involving unintended pregnancy are closely tied to social expectations and sanctions for the circumstances by which women have unintended pregnancies, including uncommitted sexual relationships and financial instability, behavior that results in unintended pregnancy, such as sexual activity and contraceptive failure, and motherhood (Smith et al 2016, Rice et al 2017. Women may be motivated to use contraceptive methods to avoid any or all of the intersecting stigmas that women who have an unintended pregnancy face.…”

Should prenatal care providers offer pregnancy options counseling?

“…This study has limitations. First, women’s reports about their preferences for abortion or adoption may be underreported due to stigma [ 18 , 19 ]. We note, however, that more than 30% of women disclosed they had considered abortion during this pregnancy, indicating that our study procedures did encourage women to disclose.…”