A narrative intervention to decrease individual level abortion stigma: A randomized controlled trial
Awarded 2019
Complex Family Planning Fellowship Research
Maryl Sackeim, MD
University of Chicago

Abortion stigma is pervasive in the United States. This study focuses on individual-level abortion stigma, defined as the way in which stigma is internalized and experienced as guilt and shame. While abortion itself does not cause mental illness, abortion stigma, which induces secrecy, thought suppression, and isolation, may worsen psychological responses to the procedure. Few intervention studies have addressed abortion stigma. Psychological research demonstrates improved coping through cognitive restructuring and reconstructing personal narratives. With a theoretical framework grounded in cognitive therapy and narrative medicine, this study tests whether a narrative intervention reduces abortion stigma.
We randomized 215 women aged 18 or older having medical or surgical abortions at Planned Parenthood of Illinois to the intervention (viewing a digital narrative and responding to a writing prompt) and control (standard of care) groups. All participants completed the Individual Level Abortion Stigma Scale (ILAS) and a modified Profile of Mood States- Short Form (POMS-SF) at baseline and at two-week follow-up. The primary outcome was difference in ILAS score between baseline and follow-up between study groups. The secondary outcome was difference in psychological distress between baseline and follow-up between study groups.
Baseline characteristics were similar between groups. The mean age was 26. Twenty-six participants were White, 55% Black, 4% Asian, and 15% “other.” There was no statistically significant difference in mean change in ILAS score (p=0.98) or modified POMS-SF score (p=0.98) between study groups. The mean baseline stigma score overall was lower in this study than in previous studies. Black women had lower stigma and psychological distress scores at baseline compared to White women (p=0.02).
In conclusion, participants randomized to a narrative intervention did not have a significant improvement in individual-level abortion stigma compared to a control group in a study population with relatively low baseline individual-level abortion stigma. Future studies using this type of intervention might consider focusing on patients with higher baseline stigma scores, including more diverse race groups and those living in more conservative geographic regions.