Measuring abortion stigma for program design and evaluation
Awarded 2010
Large Research Grants
Anu Kumar, PhD, MPH

Background: Abortion stigma is a complex issue, and understanding its manifestation and perpetuation is challenging. However, abortion stigma may have profound social and health consequences for women and it is important for us to better understand it. When faced with unplanned or unhealthy pregnancies, fear of stigma may prevent women from seeking early safe abortions, even in contexts where the procedure is legal. Using a framework of interrelated components (labeling, stereotyping, separating/excluding, and discriminating), Ipas set out to further our understanding of abortion stigma at the community level in Ghana and Zambia, and to develop a scale to measure abortion stigma that can also be used in the design and evaluation of community-based stigma reduction interventions. Objectives: 1) To conduct focus group discussions (FGDs) with women and men about abortion in their communities; 2) To use FGD data to develop a set of items for an abortion stigma scale; 3) To pilot the scale in Ghana and Zambia; 4) To identify scale items that have a consistent factor structure to measure abortion stigma; and 5) To examine the relationships between abortion stigma and age, gender, marital status, educational attainment, and religious affiliation. Methods: The research comprised a sequential mixed-methods design in which we explored the context of abortion stigma through qualitative research and then used the findings to develop items for a potential scale to measure abortion stigma at the individual and community level. Ipas administered a 57-item questionnaire to 531 people (250 in Ghana and 231 in Zambia) and then conducted factor analyses with the data to identify a statistically and conceptually relevant stigma scale. Findings and conclusion: Our FGDs generated a wealth of information about participants’ attitudes and beliefs about abortion, as well as community norms surrounding the issue of abortion. This qualitative data translated into 57 questionnaire items that Ipas piloted with 531 individuals in Ghana and Zambia. Our factor analyses failed to identify a scale that was both statistically and conceptually appropriate. Despite our inability to produce a new scale for measuring abortion stigma, our qualitative and quantitative data provide relevant information on respondents’ attitudes and beliefs about abortion and we plan to use these data to inform the development and implementation of community-based interventions to reduce abortion stigma in Ghana and Zambia.