The Stigma of Having an Abortion: Development of a Scale and Characteristics of Women Experiencing Abortion Stigma

Abstract

This valid and reliable scale can be used in research examining abortion stigma and related outcomes (e.g., women's health, relationships and behavior). The scale can also be used to evaluate programs and interventions that aim to reduce the stigma experienced by women who have abortions.

Development and Validation of a Scale to Measure Adolescent Sexual and Reproductive Health Stigma: Results From Young Women in Ghana

“…The scale demonstrated strong face, content, and construct validity, reliability, and internal consistency, with good model fit statistics, significant factor loadings, and moderate correlation coefficients (inter-item and interscale). The resulting conceptualization of stigma is consistent with our prior qualitative work, existing theoretical frameworks, and other health-related stigma measures (Atuyambe et al, 2005; Berger et al, 2001; Cockrill et al, 2013; Garnets, Herek, & Levy, 2003; Goffman, 1963; Hall, Manu, et al, 2015; Hatzenbuehler et al, 2013; Herek, 1993; Herrman & Waterhouse, 2011; Holzemer et al, 2007; Kalichman et al, 2009; Kelly, 1996; Levandowski et al, 2012; Link et al, 2004; Martin et al, 2014; Norris et al, 2011; Nybade & MacQuarrie, 2006; Ritsher et al, 2003; Shellenberg et al, 2014; Turan et al, 2012; USAID, 2005; Van Brakel, 2006; Wiemann et al, 2005). …”

“…Not surprisingly and in line with prior abortion research, the highest levels of perceived stigma were noted for abortion (Cockrill et al, 2013; Shellenberg et al, 2014). Yet we also found high perceived stigma around sex, pregnancy, and childbearing.…”

“…Interviews elicited information regarding perceptions and experiences (participants’ own and/or of women in their communities) with regard to sex, pregnancy, childbearing, abortion, contraception, family-planning services, and STIs. Related preparatory work entailed comprehensive reviews of the literature focused on conceptualizations of stigma broadly, health- and reproductive health–related stigmas, validated stigma measures, and the social context of adolescent SRH (Atuyambe et al, 2005; Berger et al, 2001; Cockrill et al, 2013; Garnets, Herek, & Levy, 2003; Goffman, 1963; Hall, Manu, et al, 2015; Hatzenbuehler et al, 2013; Herek, 1993; Herrman & Waterhouse, 2011; Holzemer et al, 2007; Kalichman et al, 2009; Kelly, 1996; Levandowski et al, 2012; Link et al, 2004; Martin et al, 2014; Norris et al, 2011; Nybade & MacQuarrie, 2006; Ritsher et al, 2003; Shellenberg et al, 2014; Turan et al, 2012; USAID, 2005; Van Brakel, 2006; Wiemann et al, 2005). …”

“…Existing reproductive health–related stigma measures have focused specifically on HIV/AIDS and abortion. Validated instruments (e.g., HIV Stigma Scale; HIV/AIDS Stigma Instrument Persons living with AIDS (PLWA); Individual Level Abortion Stigma Scale; Abortion Provider Stigma Survey Instrument; Stigmatizing Attitudes, Beliefs, and Actions Scale) have identified common underlying elements of stigma (Berger, Ferrans, & Lashley, 2001; Cockrill, Upadhyay, Turan, & Foster, 2013; Cuca et al, 2012; Holzemer et al, 2007; Kalichman et al, 2009; Martin et al, 2014; Nybade & MacQuarrie, 2006; Shellenberg, Hessini, & Levandowski, 2014; United States Agency for International Development [USAID], 2005). However, these measures do not capture stigma spanning all important dimensions of SRH, including sex, pregnancy, childbearing, and family planning, nor do they focus on young women, for which stigma experiences may be unique and severe (Fourcroy, 2006; Hatzenbuehler et al, 2013; Hindin et al, 2013; Luker, 1996; Schalet, 2004; United Nations Population Fund, 2007; UNICEF, 2002).…”

Partner Violence and Abortion Characteristics

“…The vast majority of abortion procedures take place in the first trimester, but 8.5% are performed in the second trimester, which is a lengthier, more expensive, higher risk procedure with less availability of doctors performing the procedure and in fewer geographic areas (Jones & Kooistra, 2011). Both repeat and second trimester abortions carry social stigma and expense for the women needing them (Cockrill, et al, 2013;Norris et al, 2011), but little is known about what would be helpful for prevention of repeat unwanted pregnancies and/or delays in obtaining an abortion. Further, women are often stigmatized after disclosing partner violence, creating an additional set of psychological barriers for receipt of services (Maier, 2012;Thapar-Bjorkert & Morgan, 2010), which intensifies the need for both universal partner screening in health centers as well as provider training for conducting effective screening and responses to disclosures (Colarossi, Breitbart, & Betancourt, 2010b).…”