Interventions to reduce stigma related to contraception and abortion: a scoping review

Abstract

ObjectivesWe conducted a scoping review to identify the types, volume and characteristics of available evidence and analyse the gaps in the knowledge base for evaluated interventions to reduce contraception and abortion stigma.DesignWe conducted a search of five electronic databases to identify articles published between January 2000 and January 2022, and explored the websites of relevant organisations and grey literature databases for unpublished and non-commercial reports. Articles were assessed for eligibility, and data were extracted.Data sourcesWe searched MEDLINE, PubMed, Embase, Web of Science and PsycINFO.Eligibility criteriaArticles included were: (1) published between January 2000 and January 2022, (2) written in English, (3) reports of the evaluation of an intervention designed to reduce contraceptive and/or abortion stigma, (4) used any type of study design and (5) conducted in any country context.Data extraction and synthesisIncluded studies were charted according to study location, study aim, study design, type of contraceptive method(s), study population, type of stigma, and intervention approach.ResultsSome 18 articles were included in the final analysis (11 quantitative, 6 qualitative and 1 mixed methods). Fourteen of the studies focused exclusively on abortion stigma, and two studies focused on contraception stigma only; while two studies considered both. A majority of the studies aimed to address intrapersonal stigma. We found no interventions designed to address stigma at the structural level. In terms of intervention approaches, seven were categorised as education/training/skills building, five as counselling/peer support, three as contact and three as media.ConclusionThere is a dearth of evaluations of interventions to reduce contraception and abortion stigma. Investment in implementation science is necessary to develop the evidence base and inform the development of effective interventions, and use existing stigma scales to evaluate effectiveness. This scoping review can serve as a precursor to systematic reviews assessing the effectiveness of approaches.

The intersection of stigma, quality of care, and structural barriers: a qualitative study of interactions between abortion seekers and healthcare workers in Australia

“…Training can help providers develop proactive strategies to overcome the common stigma-related barriers that abortion seekers may encounter, including conscientious objection and gatekeeping. Stigma-reduction strategies are also of relevance to other maternal and reproductive health services, where clients may be disrespected, stigmatized, mistreated, and their preferences not considered (55,60).…”

“…Recent systematic and scoping reviews have identi ed a need for theory-based and tested stigma reduction interventions (2,55,56). This study contributes by identifying speci c behaviors -both positive and negative -on which stigma reduction strategies could focus.…”

“…Case studies of the subtle to overt forms of stigma that abortion seekers experience as stigmatizing can help providers identify blind spots in their own practice and consider bystander approaches if they observe these behaviors among colleagues. There is modest or inconclusive evidence, primarily in low-and middle-income contexts, to support using Value Clari cation principles when aiming to change knowledge, attitudes, and behaviors of healthcare workers (55,56,63). The Value Clari cation approach could be re ned and refocused to support stigma reduction in the interactions between abortion seekers and healthcare providers.…”

“…This is relevant in Australia (67, 68), where a 2023 proposal to the Therapeutic Goods Administration in Australia aims to remove 'exceptional' regulations (69). A focus on structural stigma, which operates within organizations, government, institutions, laws, and public discourse (13), is important for future intervention development -particularly as reviews of stigma-reduction efforts have found no have found no interventions that focus on the structural and societal drivers of stigma (13,55,56).…”

Exposure to Lived Representations of Abortion in Popular Television Program Plotlines on Abortion-Related Knowledge, Attitudes, and Support: An Exploratory Study

“…Little research has investigated the association between exposure to television abortion plotlines and viewer abortion knowledge, attitudes, and behaviors. Indeed, a recent scoping review found only two studies analyzing the relationship between abortion portrayals and viewer attitudes over a ten-year period (Sorhaindo & Loi, 2022). The present study uses a quasi-experimental ex post facto design with an online sample of natural viewers of three television shows with abortion plotlines to examine if viewers exposed to any of the three abortion plotlines (and to each of the three individual plot lines) were more likely to have greater knowledge about abortion compared to unexposed audiences (Hypothesis 1), lower stigmatizing attitudes towards abortion compared to unexposed audiences (Hypothesis 2), and higher willingness to support a family member or friend seeking an abortion compared to unexposed audiences (Hypothesis 3).…”