The impact of shouting your abortion on community-level abortion stigma:A randomized clinical trial
Awarded 2018
Complex Family Planning Fellowship Research
Abigail Cutler, MD
Yale University

Background: In an effort to change community-level abortion stigma (public attitudes) about abortion, many reproductive health organizations promote campaigns that encourage people who have had abortions to tell their stories through video or in writing. However, we lack empirical data on whether abortion storytelling reduces community-level abortion stigma.
Objective: To assess the impact of viewing first-person abortion video stories on community-level abortion stigma scores among adults in the US.
Methods: From November 2018 to April 2019, we randomized online survey participants from a probability-based, online, nationally representative sample of US adults to watch 3 first-person abortion video stories chosen to reflect common demographics of people who obtain abortions and why or 3 narrated video stories unrelated to abortion. We assessed community-level abortion stigma at baseline (prior to video exposure), immediately after video exposure, and three months later. We assessed our primary outcome using the Community Abortion Attitudes Scale (CAAS), which utilizes a Likert (range 1-5). Secondary outcomes included the Reproductive Experiences and Events Scale (REES), Community Level Abortion Stigma Scale (CLASS) and 9 polling questions examining positions on abortion policy. Exploratory and confirmatory factor analyses confirmed psychometric properties of all 3 scales. A sample size of 788 people was needed to detect a 0.2 (small) effect size with 80% power and two-sided alpha 0.05.  Statistical analysis accounted for complex survey methodology and sample weighting, including bivariate associations of stigma measures with socio-demographics and abortion policy positions, and multivariable logistic regression to examine the association between specific participant characteristics and high baseline stigma (CAAS score > 3).
Preliminary Results: We randomized 886 participants to intervention (n=460) or control videos (n= 426). Most (83.1%) completed a 3-month follow-up survey. Demographic characteristics, abortion stigma scores and positions on abortion policy were similar between groups at baseline. Overall mean (SD) baseline CAAS score among all participants was 2.186 (0.99). Less than high school education (OR=2.7, 95%CI 1.4-5.1), evangelical or protestant religion (OR=4.2, 95%CI 2.3-7.4), Republican party affiliation (OR=2.1, 95%CI 1.4-3.1), residing in a non-metropolitan area (OR=2.9, 95%CI, 1.7-4.8) or in the south (OR=1.8, 95%CI 1.1-3.2) were associated with increased odds of high stigma. We found no significant differences in our primary outcome within or between groups immediately or 3 months following video exposure.
Preliminary Conclusions: Exposure to first-person abortion video stories did not reduce community-level abortion stigma scores as measured by the CAAS. Factors associated with high stigma included education, religion, metropolitan area, political party and region, warranting further investigation. Analysis on secondary outcomes and 3-month follow-up data is ongoing.