Young women make pregnancy decisions (i.e., the decision to parent, have an abortion or adopt) considering norms that dictate social acceptability, and stigma, which may manifest in negative attitudes and social judgement. These norms and stigmas may contribute to forms of reproductive coercion such as pressure to terminate a pregnancy or to choose adoption in order to hide a pregnancy. When unwanted pregnancy is continued to term, potentially due to reproductive coercion, women are at risk for poor prenatal behaviors (i.e., lack of prenatal care use, and substance use during pregnancy) and adverse birth outcomes (i.e., low birth weight and infant mortality). Further, abortion stigma contributes to psychological distress among women seeking abortion, late presentation for abortion services, and use of unsafe abortion services. The potential health effects of parenting and adoption stigma are less clear.
Given possible public health consequences and gaps in current scientific knowledge, researchers at the University of Alabama at Birmingham (UAB) and the Sea Change Program developed and tested scales to measure individual-level perceptions of norms and stigma regarding pregnancy decisions. Led by Drs. Whitney S. Rice and Janet M. Turan, who respectively are a recent alumnus from and current professor of Health Care Organization and Policy at UAB School of Public Health, the researchers created these new measurement tools in multiple stages. First, an understanding of norms and stigma regarding pregnancy decisions was established using qualitative data (published previously in Perspect Sex Reprod Health, Vol. 48, Issue 2, pgs. 73-81). Next, survey items were created to capture these concepts quantitatively. The items were pretested with a small group of women, reviewed by topic experts, and then revised according to the feedback. The revised survey items were then administered to 642 young women (ages 18-24) in Alabama, and the psychometric properties of the items were assessed in order to develop multidimensional measures – one for each possible pregnancy decision.
The resulting parenting, adoption, and abortion norms and stigma scales were 20-21 items in length. The measures were psychometrically valid in the study sample of young Alabama women and distinct from one another. The scales may be useful in future programmatic efforts to monitor and address the pervasiveness of reproductive norms and stigma. They may also be of use in future research exploring the association between reproductive norms and stigma and health behavior as well as health outcomes.
This study was published in PLoS ONE as part of the special collection Neglected Populations: Decreasing Inequalities & Improving Measurement in Maternal Health, supported by the Maternal Health Task Force at Harvard T.H. Chan School of Public Health. For more information and to read this publication, please visit: http://dx.doi.org/10.1371/journal.pone.0174210.