Constructing a Validated Scale to Measure Community-Level Abortion Stigma in Mexico
OBJECTIVE:
In
Mexico, abortion stigma in the general population is largely unexplored. We
developed a scale to measure abortion stigma at the community-level, examine
its prevalence, and explore factors associated with abortion stigma in a
nationally representative sample.
STUDY DESIGN:
Following
intensive qualitative work to identify dimensions of the stigma construct, we
developed a comprehensive list of statements that were cognitively tested and
reduced to 33 to form a scale. We piloted the scale in a nationally and
sub-regionally representative household public opinion survey administered to
5,600 Mexican residents.
RESULTS:
Factor
analysis tested the internal consistency and reliability of five previously
hypothesized dimensions of abortion stigma: secrecy, religion, autonomy, discrimination,
and guilt/shame. Under the assumption that these dimensions were independent,
confirmatory factor analysis indicated that each of these dimensions functioned
as independent sub-scales. However, to test this assumption, we conducted
exploratory factor analysis which revealed a strong co-dependence between
discrimination, guilt/shame and religion statements, resulting in a 23-item
four factor model of abortion stigma and the elimination of the guilt/shame
dimension. Both methods revealed a full scale and sub-scales with Cronbach's
alphas between 0.80-0.90. Regression analyses suggested that older, less
educated individuals living in the north of Mexico report higher levels of
stigma, especially related to discrimination and religion.
CONCLUSIONS:
This
community-level abortion stigma scale is the first to be developed and tested
in Mexico. This tool may be used in Mexico and other similar country settings
to document the prevalence of community-level abortion stigma, identify
associated factors, and test interventions aimed at reducing abortion stigma.
IMPLICATIONS:
Abortion
stigma prevents women from accessing safe abortion services. Measuring
community-level abortion stigma is key to documenting its pervasiveness,
testing interventions aimed at reducing it, and understanding associated
factors. This scale may be useful in countries similar to Mexico to support
policymakers, practitioners and advocates in upholding women's reproductive
rights.
- 1Population Council, Mexico City, Mexico. Electronic address: sorhaindoannik@gmail.com.
- 2Population Council, Mexico City, Mexico.
- Contraception. 2016 Jan 26. pii: S0010-7824(16)00033-0. doi: 10.1016/j.contraception.2016.01.013.
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