Abstract
Objectives
We report on the development of a scale measuring abortion providers’ experiences
of stigma.
Study Design
Using previous measures, qualitative data, and expert review, we created a 49-item
question pool. We administered questions to 315 abortion providers before participation
in the Providers Share Workshop. We explored the factor structure and item quality
using exploratory factor analysis. We assessed reliability using Cronbach's alpha.
To test construct validity, we calculated Pearson's correlation coefficients between
the stigma scales, the Maslach Burnout Inventory, and the K10 measure of psychological
distress. We used Stata SE/12.0 for analyses.
Results
Factor analysis revealed a 35-item, five-factor model: worries about disclosure, internalized
states, social judgment, social isolation, and discrimination (Cronbach's alphas 0.79–0.94).
Our stigma measure was correlated with psychological distress (r = 0.40; p < .001), and with Maslach Burnout Inventory's emotional exhaustion (r = 0.27; p < .001), and depersonalization (0.23; p < .001) subscales, and was inversely correlated with Maslach Burnout Inventory's
personal accomplishment subscale (r = −0.15; p < .05).
Conclusions
Psychometric analysis of this scale reveals that it is a reliable and valid tool for
measuring stigma in abortion providers, and may be helpful in evaluating stigma reduction
programs.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Women's Health IssuesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The stigma of having an abortion: Development of a scale and characteristics of women experiencing abortion stigma.Perspectives on Sexual and Reproductive Health. 2013; 45: 79-88
- A first course in factor analysis.2nd ed. Psychology Press, Hillsdale, NJ1992
- National clinic violence report. Feminist Majority Foundation.2017 (Available at:) (Accessed: May 3, 2017)
- Willing and unable: Doctors’ constraints in abortion care.Vanderbilt University Press, Nashville, TN2010
- Obstacles to the integration of abortion into obstetrics and gynecology practice.Perspectives on Sexual and Reproductive Health. 2010; 42: 146-151
- Stigma: Notes on the management of spoiled identity.Simon and Schuster, New York1963
- Dynamics of stigma in abortion work: Findings from a pilot study of the providers share workshop.Social Science & Medicine. 2011; 73: 1062-1070
- Physicians, abortion provision and the legitimacy paradox.Contraception. 2013; 87: 11-16
- The accessibility of abortion services in the United States, 2001.Perspectives on Sexual and Reproductive Health. 2003; 35: 16-24
- Studying the nurse's work.American Journal of Nursing. 1951; 51: 294-295
- What abortion counselors want from their clients.Social Problems. 1978; 26: 112-121
- Dispatches from the abortion wars: The costs of fanaticism to doctors, patients, and the rest of us.Beacon Press, Boston2009
- Abortion incidence and service availability in the United States, 2014.Perspectives on Sexual and Reproductive Health. 2017; 49: 17-27
- Short screening scales to monitor population prevalences and trends in non-specific psychological distress.Psychological Medicine. 2002; 32: 959-976
- Conceptualising abortion stigma. Culture, Health & Sexuality: An International Journal for Research.Intervention & Care. 2009; 11: 625-639
- Sample size in factor analysis.Psychological Methods. 1999; 4: 84-99
- Measuring stigma among abortion providers: Assessing the Abortion Provider Stigma Survey instrument.Women & Health. 2014; 54: 641-661
- The Maslach Burnout Inventory.3rd ed. Consulting Psychologists Press, Palo Alto, CA1996
- Scale development: Ten main limitations and recommendations to improve future research practices.Psicologia: Reflexão e Crítica. 2017; 30 (Epub March 20, 2017)
- Abortion stigma: A reconceptualization of constituents, causes, and consequences.Women’s Health Issues. 2011; 21: S49-S54
- Living with a concealable stigmatized identity: The impact of anticipated stigma, centrality, salience, and cultural stigma on psychological distress and health.Journal of Personality and Social Psychology. 2009; 97: 634-651
- Developing a scale to measure stigmatizing attitudes and beliefs about women who have abortions: Results from Ghana and Zambia.Women & Health. 2014; 54: 599-616
- STATA statistical software: Release 12.StataCorp, LP, College Station, TX2011
- Predictors of abortion provision among practicing obstetrician-gynecologists: A national survey.American Journal of Obstetrics and Gynecology. 2008; 198: 39.e1-39.e6
- Psychosocial factors and pre-abortion psychological health: The significance of stigma.Social Science & Medicine. 2016; 150: 67-75
- Secrecy and safety: Health care workers in abortion clinics.Labour/Le Travail. 2003; 52: 353-361
- Measuring health-related stigma–A literature review.Psychology, Health & Medicine. 2006; 11: 307-334
- Culture and stigma: Adding moral experience to stigma theory.Social Science & Medicine. 2007; 64: 1524-1535
Biography
Lisa A. Martin, PhD, is at the University of Michigan, Dearborn, Women's and Gender Studies Program and Department of Health & Human Services. Her research applies an interdisciplinary approach to historical, social, political, and individual-level factors that influence U.S. abortion policies.
Biography
Jane A. Hassinger, MSW, is a researcher at University of Michigan's Institute for Research on Women and Gender. She is a certified psychoanalyst and Clinical Social Worker whose research interests include developing interventions aimed at reducing stigma and improving workplace teams' functioning.
Biography
Meghan Seewald, MA, is at the University of Michigan, Ann Arbor, in the Department of Obstetrics & Gynecology. Her research interests include the experience of stigma among health care providers, with an emphasis in both qualitative and quantitative analysis.
Biography
Lisa H. Harris, MD, PhD, is an Associate Professor of Obstetrics and Gynecology and Women's Studies at University of Michigan (UM) and is trained as a clinical obstetrician-gynecologist and cultural historian. Her research focuses on ethical issues in obstetrics and gynecology.
Article info
Publication history
Published online: November 10, 2017
Accepted:
October 4,
2017
Received in revised form:
September 22,
2017
Received:
May 12,
2017
Identification
Copyright
© 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc.
