Developing a scale to measure stigmatizing attitudes and beliefs about women who have abortions: results from Ghana and Zambia.

The objective of this research was to explore the context of abortion stigma in Ghana and Zambia through qualitative research, and develop a quantitative instrument to measure stigmatizing attitudes and beliefs about abortion. Ultimately, we aimed to develop a scale to measure abortion stigma at the individual and community level that can also be used in the evaluation of stigma reduction interventions. Focus group discussions were conducted in both countries to provide information around attitudes and beliefs about abortion. A 57-item instrument was created from these data, pre-tested, and then administered to 531 individuals (n = 250 in Ghana and n = 281 in Zambia). Exploratory factor analyses were conducted on 33 of the original 57 items to identify a statistically and conceptually relevant scale. Items with factor loadings > 0.39 were retained. All analyses were completed using Stata IC/11.2. Exploratory factor analysis resulted in a three-factor solution that explained 53% of the variance in an 18-item instrument. The three identified subscales are: (i) negative stereotypes (eight items), (ii) discrimination and exclusion (seven items), and (iii) potential contagion (three items). Coefficient alphas of 0.85, 0.80, and 0.80 for the three subscales, and 0.90 for the full 18-item instrument provide evidence of internal consistency reliability. Our Stigmatizing Attitudes, Beliefs, and Actions scale captures three important dimensions of abortion stigma: negative stereotypes about men and women who are associated with abortion, discrimination/exclusion of women who have abortions, and fear of contagion as a result of coming in contact with a woman who has had an abortion. The development of this scale provides a validated tool for measuring stigmatizing attitudes and beliefs about abortion in Ghana and Zambia. Additionally, the scale has the potential to be applicable in other country settings. It represents an important contribution to the fields of reproductive health, abortion, and stigma.