Stigma related to contraceptive use and abortion in Kenya: scale development and validation

Abstract

Background Stigma related to abortion and contraceptive use is a serious public health threat for young people, and validated scales to measure this stigma are scarce. The purposes of the study were to validate a newly constructed scale to measure the stigma of contraceptive use and to adapt a scale to measure the stigma of abortion. Methods A study nested in a cluster-randomised trial. In 2017, data was collected from 633 secondary school youths, in a semi-urban setting in western Kenya. A qualitative pre-phase (face-validity) were initially utilised to draft and validate a seven-item scale to capture contraceptive use stigma (CUS) and to adapt the Stigmatizing Attitudes, Beliefs and Actions (SABA) scale (18 items), which captures aspects of abortion stigma. Statistical tests used included test-retest reliability analysis, Pearson’s correlation coefficients, Wilcoxon signed-rank test, Factor Analysis, Principal Component Analysis, interclass correlation and Cronbach’s alpha. Results For the CUS scale, paired t-test and Wilcoxon signed-rank test showed no significant score changed between time points ( p = 0.64; 0.67). CUS had similar patterns between time points, with two relevant components: promiscuity and lack of autonomy . Cronbach’s alpha indicated acceptable internal consistency between time points (0.71;0.7). The confirmatory factor loadings for each item in the modified three subscales of SABA had a similar pattern to the original SABA scale, in particularly regarding negative stereotyping and, excluding and discriminating factors. The Cronbach’s alpha was adequate, although lower for the modified SABA (0.74) as compared to the original SABA (0.9). The SABA scale was renamed into Adolescents Stigmatizing Attitudes, Beliefs and Action (ASABA) scale. Conclusions The CUS scale is considered valid and reliable for measuring contraceptive use stigma, and the ASABA scale was rated as reliable for capturing abortion stigma based on negative stereotyping and excluding and discriminating factors. The CUS, up to date the first ever proposed CUS scale, and the ASABA scale can be used to measure effects of stigma reduction interventions with the aim of preventing unintended pregnancies, motherhood and unsafe abortion among adolescents in Kenya and similar low-resource settings.

Social judgments on abortion and contraceptive use: a mixed methods study among secondary school teachers and student peer-counsellors in western Kenya

“…Three dimensions of abortion stigma are covered as subscales in the SABA scale: 1) negative stereotypes (8 items), 2) discrimination and exclusion (7 items) and 3) fear of contagion (3 items). Based on previous research within this project, the SABA scale was modified to address the perspective of adolescent girls [26]. This was done by replacing the word woman with girl in all items of the original scale.…”

“…This was done by replacing the word woman with girl in all items of the original scale. Furthermore, two items were added: "A married woman is more deserving of an abortion than an unmarried woman" and "A girl who has had an abortion should be prohibited from going to school" [26]. The modified SABA scale used in this study included a total of 20 items.…”

“…The modified SABA scale used in this study included a total of 20 items. Based on a similar framework, the Contraceptive Use Stigma (CUS) 7-item scale was developed within this project to measure stigmatising attitudes towards adolescent girls associated with contraceptive use [26]. The responses to the modified SABA and the CUS scales were set up on a Likert scale ranging from 1 ('strongly disagree') to 5 ('strongly agree').…”

Perceptions on abortion and long-acting contraceptive use among women of reproductive age in selected Nigerian States: a cross-sectional study

“…Implantable long-acting hormonal contraceptives, such as intrauterine devices (IUDs) and subcutaneous implants, will last for years as birth control methods that offer effective long-term contraception without the need for consumer intervention [18,20,21,35]. They are safer, cost-effective and have lower failure rates because of their low reliance on user compliance for e cacy compared to short-acting contraceptives [20,[36][37][38]. Studies have found that LARC can contribute to reducing subsequent unintended conceptions and that women having an abortion may be highly motivated to secure contraception, particularly LARC [18,38]; also, policies considering for heavy subsidization and upfront cost have been advocated [39] to ease the nancial burden of the users.…”

“…Although access to safe abortions and effective contraceptives has increased worldwide, accessibility is still a great barrier in many Low-and Middle-Income Countries (LMIC), including Nigeria. Also, the social stigma surrounding unintended pregnancies and abortion plays a critical role in the social, medical and legal marginalization of contraceptive services and abortion care [37], it is then surprising, given the demographic and programmatic signi cance of induced abortion that the research literature contains few probing investigations of the juxtaposition of contraception and abortion in the minds of those exposed to pregnancy risk [28] thus this research tends to examine the perception of women on abortion and its in uence on Long-Acting Contraceptive (LARC) use among women of reproductive ages in selected Nigerian states employing a cross-sectional study approach…”