Characterizing Community-Level Abortion Stigma in the United States.

Abstract Objective : Estimate community-level abortion stigma among U.S. adults and characterize factors associated with high stigma and less favorable opinions toward policies supportive of abortion care. Study Design : We recruited respondents (U.S. adults, English-speaking) from a nationally representative, probability-based online panel in December 2018. We used multivariable logistic regression to identify factors associated with high abortion stigma using the Community Attitudes Abortion Scale (CAAS), a Reproductive Events and Experiences Scale (REES) subscale, and a Community Level Abortion Stigma Scale (CLASS) subscale. We measured favorability toward policies supportive of abortion care using widely used polling questions. Results : Of 1800 eligible individuals contacted, 984 opened the invitation (54.6%) and 886 (90%) completed the survey. The majority demonstrated mid-range stigma scores on all three scales. Increased likelihood of high stigma measured by CAAS was demonstrated among individuals reporting Catholic (OR 2.97, 95%CI 1.49-5.91) and Evangelical or Protestant religion (OR 4.78, 95%CI 2.53-9.00) compared to no religion, and Republican (OR 11.56, 95%CI 6.21-21.52) and Independent political affiliation (5.80, 95%CI, 3.17-10.60) compared to Democratic. Similar trends were seen with REES. Measured by CLASS, we found high stigma in Catholics compared to those with no religion (OR 1.91, 95%CI 1.09-3.32) and Blacks compared to Whites (OR 1.66, 95%CI 1.02-2.68). Identifying as Catholic, Evangelical or Protestant, and Republican were associated with holding less favorable opinions toward policies supportive of abortion care. Identifying as Catholic was the only characteristic associated with high stigma across all measures. Conclusions : Across multiple measurement tools, factors associated with high stigma and less favorable opinions toward policies supportive of abortion care include Catholic, Evangelical or Protestant religion and Republican political affiliation. Implications : Multiple measures are needed to fully understand the extent of and characteristics associated with community-level abortion stigma. Religion and political identity are frequently associated with high stigma. Understanding these relationships may aid in developing interventions to decrease stigma and in turn reduce barriers to abortion care.