What is the optimal tool for measuring abortion stigma? A systematic review.

Abstract

Purpose: Abortion stigma is a barrier to accessing and delivering comprehensive, sustainable healthcare. This study aimed to systematically identify measures of abortion stigma, and assess their psychometric properties and uses.

Materials and methods: The systematic review was preregistered with PROSPERO (ID#127339) and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight databases were screened for articles measuring abortion stigma. Data were extracted by four researchers and checked for accuracy by two reviewers. Psychometric properties were assessed with COSMIN guidelines.

Results: Of 102 articles reviewed, 21 reported original measures of abortion stigma. Instruments assessed individual and community level stigma for people who have had an abortion (n = 8), healthcare professionals (n = 4), and the public (n = 9), and predominantly originated from the United States (U.S.). Measures varied in structure, use, and comprehensiveness of psychometric properties. On psychometric properties, the Individual Level Abortion Stigma scale and Abortion Provider Stigma Scale - Revised performed best for individual-level stigma and the Stigmatising Attitudes, Beliefs and Actions Scale for community-level stigma.

Conclusion: Gaps in abortion stigma measurement include geography, conceptualisation, and structural-level stigma. Continued development and testing of tools and methods for measuring abortion stigma is needed.