Objective To evaluate the effect of a narrative intervention on individual-level abortion stigma in patients undergoing abortion.
Study design This randomised controlled trial examined individual-level abortion stigma and psychological distress among patients undergoing outpatient abortion. Patients were randomised to a narrative intervention verus usual care. The intervention consisted of viewing a digital narrative and responding to a writing prompt. Abortion stigma was measured using the Individual Level Abortion Stigma Scale (ILAS) and psychological distress was assessed with a modified Profile of Mood States-Short Form (POMS-SF) at baseline and after 2 weeks. The primary outcome compared change in ILAS score from baseline to follow-up between groups. The secondary outcome compared change in the modified POMS-SF score.
Results We randomised 215 participants. Baseline characteristics were similar between groups. Overall baseline stigma scores were low. The study groups did not differ significantly in the primary ILAS outcome (mean change=0.07 in both groups with score range 0 to 3.5, 95% CI -0.11 to 0.11, p=0.98). There was also no significant difference in the secondary modified POMS-SF outcome (mean change −0.64 for the intervention group and −0.65 for the control group with score range −8 to 8, 95% CI -1.10 to 1.12, p=0.98). Black participants, comprising the majority, demonstrated lower levels of individual-level abortion stigma and psychological distress at baseline than participants identifying with any other race (mean baseline ILAS score of 0.70 vs 1.00 and mean modified POMS-SF score of −3.00 vs −1.45, 95% CI 0.12 to 0.46 and 95% CI 0.28 to 2.01, p=0.001 and p=0.02, respectively).
Conclusions Patients who participated in a narrative intervention did not score lower on an individual-level abortion stigma scale compared with a control group at 2-week follow-up. Demographic characteristics may predict levels of individual-level abortion stigma and psychological distress among patients seeking abortion.
- family planning services
- randomized controlled trial
- reproductive Health
Data availability statement
Data may be obtained from a third party and are not publicly available. Data will not be shared publicly but may be available if an independent request is submitted to the authors.
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Contributors MGS: conceptualisation, project administration, methodology, investigation, data curation, formal analysis, visualisation, writing: original draft preparation, revisions. SYL: investigation, data curation, formal analysis, and writing: original draft review and editing, revisions.SN: methodology, investigation, and writing: original draft review and editing. DSL: formal analysis, data curation, supervision, and writing: original draft review and editing, revisions. MG: conceptualisation, methodology, supervision, writing: original draft review and editing, revisions.
Funding This work was supported by the Society of Family Planning grant SFPRF19-60. This study was approved by the Institutional Review Board at the University of Chicago IRB18-1683.
Disclaimer The findings and conclusions in this article are those of the authors and do not necessarily reflect the views of Planned Parenthood Federation of America, Inc. Data will not be shared publicly but may be available if an independent request is submitted to the authors. This study was discussed at Grand Rounds presentations at the University of California at Irvine on 1 November 2019 and at the University of Chicago on 3 April 2020. It was presented at the virtual annual meeting of the Society of Family Planning on 9 October 2020.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer reviewed.
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