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


METHODS
To 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.


RESULTS
Factor 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.


CONCLUSIONS
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.
Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, United States of America.
Whitney S
http://orcid.org/0000-0003-1749-023X
WS
Rice
Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, United States of America.
Bulent
B
Turan
Department of Medical Sociology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, United States of America.
Kristi L
KL
Stringer
Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America.
Anna
A
Helova
Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America.
Kari
K
White
Sea Change Program, Tides Foundation, Oakland, CA, United States of America.
Kate
K
Cockrill
Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America.
Janet M
JM
Turan
D000293:Adolescent; D000328:Adult; D003657:Decision Making / Q000502:physiology; D005163:Factor Analysis, Statistical; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000523:psychology*; D011594:Psychometrics / Q000379:methods; D015203:Reproducibility of Results; D066262:Social Norms; D057545:Social Stigma; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult