Abortion Stigma and Its Relationship with Grief, Post-traumatic Stress, and Mental Health-Related Quality of Life After Abortion for Fetal Anomalies

BACKGROUND: Despite the prevalence of abortion stigma in the United States, few studies have examined the relationship between stigma and psychological well-being postabortion among women who undergo abortion for fetal anomalies. MATERIALS AND METHODS: We conducted a cross-sectional study of women who underwent second-trimester abortion for pregnancy complications to assess the association between abortion stigma and psychological outcomes. We asked women to retrospectively report self-judgment and perceived community condemnation at the time of their abortion and evaluated present-day grief, post-traumatic stress, and self-reported mental health. We recruited participants using Facebook, Craigslist, and other public online forums. We used multivariable linear regression to evaluate relationships between abortion stigma and psychological outcomes. In adjusted models, we controlled for covariates that were associated with the outcome at a level of p < 0.1. RESULTS: Adjusted models, including 80 women, revealed that higher self-judgment at the time of abortion was significantly associated with increased postabortion grief (β = 2.5 and p = 0.02). Self-judgment was not associated with statistically significant differences in post-traumatic stress or mental health. There was no association between perceived community condemnation and psychological outcomes. DISCUSSION: Abortion stigma may be associated with increased postabortion grief, but does not appear to be associated with differences in post-traumatic stress or mental health. Investigating how different preprocedure counseling methods can impact self-judgment might inform future interventions aimed at improving psychological outcomes postabortion. IMPLICATIONS FOR PRACTICE AND/OR POLICY: Abortion providers should consider that women who display signs of self-judgment may be at higher risk for increased grief after pregnancy termination for fetal anomalies or maternal complications.