Monday, February 1, 2016

Constructing a Validated Scale to Measure Community-Level Abortion Stigma in Mexico

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.

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.

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.

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.

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.

Purchase full article at:

  • 1Population Council, Mexico City, Mexico. Electronic address:
  • 2Population Council, Mexico City, Mexico. 
  •  2016 Jan 26. pii: S0010-7824(16)00033-0. doi: 10.1016/j.contraception.2016.01.013. 

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