Norms and stigma regarding pregnancy decisions during an unintended pregnancy: Development and predictors of scales among young women in the U.S. South.

Whitney S Rice,Bulent Turan,Anna Helova,Kari White,Kristi L Stringer,Janet M Turan,Kate Cockrill,Soraya Seedat

doi:10.1371/journal.pone.0174210

Whitney S Rice, Bulent Turan + Show 6 more

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https://doi.org/10.1371/journal.pone.0174210

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Journal: PloS one	Publication Date: Mar 22, 2017
Citations: 19	License type: CC BY 4.0

Affiliation: University of Alabama at Birmingham, Tides Foundation

Abstract

BackgroundNorms and stigma regarding pregnancy decisions (parenting, adoption, and abortion) are salient to maternal well-being, particularly for groups disproportionately affected by unintended pregnancy. However, there are few validated measures of individual-level perceptions of norms and stigma around pregnancy decisions. Additionally, little is known about variation in the content of norms regarding pregnancy decisions, and in stigma related to violations of these norms, across socio-demographic groups.MethodsTo create measures of perceived norms and stigma around pregnancy decisions, we developed and pre-tested 97 survey items using a mixed methods approach. The resulting survey was administered to 642 young adult women recruited from health department clinics and a public university campus in Birmingham, Alabama. Principal components factor analyses, reliability analyses, independent t-tests, and correlation analyses were conducted to establish the reliability and validity of scales. Additionally, multiple linear regression was used to identify demographic predictors of higher scale scores.ResultsFactor analyses revealed four subscales for each pregnancy decision: conditional acceptability, anticipated reactions, stereotypes/misperceptions, and attitudes. The total scales and their subscales demonstrated good internal reliability (alpha coefficients 0.72–0.94). The mean scores for each scale were significantly associated with each other, with related measures, and differed by sociodemographic characteristics. Specifically, in adjusted analyses, women in the university setting and White women expressed more negative attitudes and stigma around parenting. Minority women endorsed more negative norms and stigma around adoption. Finally, women from the health department, White women, and religious women expressed more negative norms and stigma around abortion.ConclusionFindings suggest that our multidimensional measures have good psychometric properties in our sample of young women in the U.S. South, and highlight the importance of conceptualizing and measuring norms and stigmas around all pregnancy decisions. These scales may be of use in research on pregnancy decision-making and evaluation of stigma-reduction interventions.

Highlights

Unintended pregnancy is a significant public health concern in the United States
Findings suggest that our multidimensional measures have good psychometric properties in our sample of young women in the U.S South, and highlight the importance of conceptualizing and measuring norms and stigmas around all pregnancy decisions
These scales may be of use in research on pregnancy decision-making and evaluation of stigma-reduction interventions

Summary

Introduction

Unintended pregnancy is a significant public health concern in the United States. While the national rate of unintended pregnancy decreased in the past decade, significant disparities remain [1]. The highest rates of unintended pregnancy occur in U.S women who identify as minority, socioeconomically disadvantaged, less educated, unmarried, and younger (under 24 years of age). Women in the South have less access to the full spectrum of reproductive health services than women in other parts of the country [8] These factors contribute to the complexity with which women perceive their options during unintended pregnancy [9]. Recent studies hypothesizes that norms and stigma influence pregnancy decision-making processes during unintended pregnancy [10], among young women in the U.S South [11, 12]. Norms and stigma regarding pregnancy decisions (parenting, adoption, and abortion) are salient to maternal well-being, for groups disproportionately affected by unintended pregnancy. Little is known about variation in the content of norms regarding pregnancy decisions, and in stigma related to violations of these norms, across socio-demographic groups

Methods

Results

Conclusion