Measuring abortion stigma in Australia and Aotearoa New Zealand: the development, adaptation, and validation of multiple individual-level instruments

Abstract

The stigmatisation of abortion is a pervasive influence on the prohibiting, threatening, and undermining of quality abortion care. In Australia and Aotearoa New Zealand (ANZ) abortion stigma impacts abortion care quality, including the experiences of accessing, providing, and supporting abortion. Although there are qualitative reports of how abortion stigma is experienced in ANZ, quantitative details are scant. This thesis aimed to address gaps in quantifying abortion stigma in ANZ.

To understand how to best measure abortion stigma in ANZ, we conducted a systematic review of approaches quantifying abortion stigma globally. No instrument measuring abortion stigma in ANZ was found. The Individual Level Abortion Stigma scale (ILAS) and Abortion Providers Stigma Scale – Revised (APSS-R) have the most robust psychometric properties according to rigorous guidelines for evaluating measurement properties. The ILAS and APSS-R measure individual level abortion stigma. Through qualitative inquiry, the ILAS and APSS-R were reviewed for use in ANZ and their appropriateness for measuring stigmatisation of people, groups, and organisations supporting abortion care in ANZ. Four instruments measuring individual-level abortion stigma in ANZ were generated for: A) people who have had an abortion; B) people who provide abortion related care; C) people who publicly support abortion; and, D) groups/organisations supporting and/or providing abortion care. The four ANZ instruments were revised by representatives of the relevant end-user groups. Through an online survey, the instruments have been psychometrically tested for Australia demonstrating validity and reliability.

These instruments can improve our understanding of abortion stigma and the evaluation of interventions addressing abortion stigma. Future co-designed research should explore the role of research in stigmatising abortion, revise the instruments for specific subgroups, and explore short form versions of the instruments.