Investigating social consequences of unwanted pregnancy and unsafe abortion in Malawi: The role of stigma

Abstract

Malawian women in all sectors of society are suffering from social implications of unwanted pregnancy and unsafe abortion. Unwanted pregnancies occur among women who have limited access to family planning and safe abortion. A legally restrictive setting for safe abortion services leads many women to unsafe abortion, which has consequences for them and their families. In-depth interviews were conducted with 485 Malawian stakeholders belonging to different political and social structures. Interviewees identified the impact of unwanted pregnancy and unsafe abortion to be the greatest on young women. Premarital and extramarital pregnancies were highly stigmatized; stigma directly related to abortion was also found. Community-level discussions need to focus on reduction of stigma.

Development and Validation of a Scale to Measure Adolescent Sexual and Reproductive Health Stigma: Results From Young Women in Ghana

“…The scale demonstrated strong face, content, and construct validity, reliability, and internal consistency, with good model fit statistics, significant factor loadings, and moderate correlation coefficients (inter-item and interscale). The resulting conceptualization of stigma is consistent with our prior qualitative work, existing theoretical frameworks, and other health-related stigma measures (Atuyambe et al, 2005; Berger et al, 2001; Cockrill et al, 2013; Garnets, Herek, & Levy, 2003; Goffman, 1963; Hall, Manu, et al, 2015; Hatzenbuehler et al, 2013; Herek, 1993; Herrman & Waterhouse, 2011; Holzemer et al, 2007; Kalichman et al, 2009; Kelly, 1996; Levandowski et al, 2012; Link et al, 2004; Martin et al, 2014; Norris et al, 2011; Nybade & MacQuarrie, 2006; Ritsher et al, 2003; Shellenberg et al, 2014; Turan et al, 2012; USAID, 2005; Van Brakel, 2006; Wiemann et al, 2005). …”

“…Stigma was described as precluding young women’s use of contraceptive methods and services. Several other studies have reported similar themes specific to stigma associated with adolescent pregnancy in several countries in sub-Saharan Africa and in the United States (Atuyambe et al, 2005; Hall, Manu, et al, 2015; Herrman & Waterhouse, 2011; Kelly, 1996; Levandowski et al, 2012; Wiemann et al, 2005). …”

“…Interviews elicited information regarding perceptions and experiences (participants’ own and/or of women in their communities) with regard to sex, pregnancy, childbearing, abortion, contraception, family-planning services, and STIs. Related preparatory work entailed comprehensive reviews of the literature focused on conceptualizations of stigma broadly, health- and reproductive health–related stigmas, validated stigma measures, and the social context of adolescent SRH (Atuyambe et al, 2005; Berger et al, 2001; Cockrill et al, 2013; Garnets, Herek, & Levy, 2003; Goffman, 1963; Hall, Manu, et al, 2015; Hatzenbuehler et al, 2013; Herek, 1993; Herrman & Waterhouse, 2011; Holzemer et al, 2007; Kalichman et al, 2009; Kelly, 1996; Levandowski et al, 2012; Link et al, 2004; Martin et al, 2014; Norris et al, 2011; Nybade & MacQuarrie, 2006; Ritsher et al, 2003; Shellenberg et al, 2014; Turan et al, 2012; USAID, 2005; Van Brakel, 2006; Wiemann et al, 2005). …”

“…In sexual and reproductive health (SRH), the social, cultural, and religious norms that frame adolescent sexual behavior and its consequences (i.e., pregnancy, early childbearing, abortion, sexually transmitted infections [STIs]) as immoral and problematic may contribute to stigma (Atuyambe, Mirembe, Johansson, Kirumira, & Faxelid, 2005; Fenton, 2010; Fourcroy, 2006; Hall, Kusunoki, et al, 2015; Hall, Manu, et al, 2015; Herrman & Waterhouse, 2011; Kelly, 1996; Kimmel & Garnets, 2003; Levandowski et al, 2012; Luker, 1996; Schalet, 2004; Wiemann, Rickert, Berenson, & Volk, 2005). In turn, SRH stigma may pose barriers to and ultimately prevent the use of family planning, subsequently leading to high rates of unintended pregnancy, unsafe abortion, and maternal mortality among young women in Africa and elsewhere (Hall, Manu, et al, 2015; Hindin, Christiansen, & Ferguson, 2013; Singh, Sedgh, & Hussain, 2010; United Nations Population Fund, 2007; World Health Organization, 2004).…”

Social Discrimination, Stress, and Risk of Unintended Pregnancy Among Young Women

“…The strongest predictor of moderate/high discrimination was a history of adolescent pregnancy. A few studies have pointed to the social stigmatization of adolescent pregnancy and childbearing in the U.S. and abroad [30–32]. Young women, especially adolescents, who become pregnant may suffer marginalization and discrimination, which may be further exacerbated by the pregnancy resolution – that is, abortion and childbearing are uniquely stigmatizing experiences.…”