Stigma in the context of pregnancy termination after diagnosis of fetal anomaly: associations with grief, trauma, and depression

Abstract

Termination of pregnancy after diagnosis of fetal anomaly (TOPFA) is a contested issue and stigma may negatively impact affected women's psychological reactions. This study examined the influence of perceived and internalized stigma on women's long-term adjustment to a TOPFA. One hundred forty-eight women whose TOPFA dated back 1 to 7 years responded to self-report questionnaires. The associations between perceived stigma at the time of the TOPFA, current internalized stigma and symptoms of grief, trauma and depression were modeled using multiple linear regression. The proportion of participants reporting scores above the cutoffs on the respective scale was 17.6% for grief, 18.9% for posttraumatic stress, and 10.8% for depression. After controlling for time since the TOPFA, pre-TOPFA mental health and obstetric variables, higher levels of current internalized stigma were related to higher levels of grief, trauma, and depression. Mediation analyses suggested that the effect of perceived stigma at the time of the TOPFA on symptoms of grief and trauma was mediated by current internalized stigma, but the cross-sectional design limited causal interpretation of results. Internalized stigma is associated with long-term psychological distress following a TOPFA. Perceived stigma at the time of the TOPFA may contribute to increased trauma and grief symptomatology, but results need to be validated in longitudinal studies. Health care providers and public initiatives should aim at reducing stigma among affected women.

Role of Social and Informational Support while Deciding on Pregnancy Termination for Medical Reasons

“…Research showed that women do not reveal the information of pregnancy termination for fear of social stigmatization [2,20]. Studies conducted in Germany demonstrated that patients living in the eastern region, which is more liberal than the western one, reported a lower sense of being stigmatized [44,45].…”

Abortion after diagnosis of fetal anomaly: Psychometric properties of a German version of the individual level abortion stigma scale

“…All data were collected in a cross-sectional study using self-administered questionnaires and database information taken from the register of the Department of Obstetrics (University of Leipzig). Details of the same study pertaining to the methods and the sample characteristics have been published elsewhere [ 28 , 38 ].…”

“…Studies involving women who had had abortions after diagnosis of fetal anomaly, due to an unintended pregnancy or for other reasons have linked stigma to women’s need to keep the abortion a secret, increased psychological distress and somatic symptoms [ 24 – 28 ]. The vast literature on other stigmatized conditions (i.e., obesity or mental illness) suggests additional negative consequences of abortion stigma for women’s well-being, such as impaired self-esteem [ 29 , 30 ].…”

Psychosocial Profile and Reproductive Decisions of Women Undergoing Pregnancy Termination for Medical Reasons—A Cross-Sectional Study

“…In practice, few terminations are performed in Poland due to the above maternal indications. Sociodemographic factors such as age, other children, ethnic origin, religion, educational background, marital status, profession, views on abortion, and relations with partners have various impacts on the decision to undergo abortion, depending on the research methodology, country and reasons for making the decision to terminate the pregnancy [4,5,6,7]. Moreover, numerous external factors influence the process of making a decision about termination of a pregnancy: legislation, the healthcare system, scope of medical insurance, access to healthcare services, activity of support groups, social position and access to medical information [8,9].…”