Abortion as stigma: cognitive and emotional implications of concealment

“…stigma, but it is a coping strategy that can backfire and become stressful (Miller & Major, 2000). a study of women who felt stigmatized by abortion, Major and Gramzow (1999) demonstrated that concealment was related to suppressing thoughts about the abortion, which led to intrusive thoughts about…”

“Research on other concealable identities shows that concealing a stigmatized identity was related to thought suppression, which was related to more intrusive thoughts about the stigmatized identity, and consequently related to increased psychological distress (Major & Gramzow, 1999).”

“27 Additionally, results suggest that secretive behaviors can go along with more suppression of thoughts and emotions, as well as social isolation.”

“Stigma is often examined at the group and individual levels (see Dovidio et al., 2000; Major & O’Brien, 2005, for reviews) as well as within the context of specific behaviors (e.g., abortion, smoking; Major & Gramzow, 1999; Swanson, Swanson, & Greenwald, 2001).”

“Major and Gramzow (1999) found that women who expressed their feelings about having an abortion to other people were less distressed by intrusive thoughts than women who did not express these feelings.”

“Specifically, hiding a concealable stigmatized identity may restrict the degree to which one can experience a sense of authenticity, of being true to oneself (Goffman, 1963; Leary, 1999; Major & Gramzow, 1999; Wood, Linley, Maltby, Baliousis, & Joseph, 2008).”

“This phenomenon exists offline as well [9]; it is not uncommon for people who disclose a history of abortion [49], sexual assault [80], or who express pain as they grieve for a deceased person [10] to report social rejection.”

“For example, individuals with mental illness were less likely to disclose if they expected others to devalue them (Link, Mirotznik, & Cullen, 1991), as were women who had had abortions (Major & Gramzow, 1999).”

“In a study of women who felt stigmatized by abortion, Major and Gramzow (1999) demonstrated that concealment was related to suppressing thoughts about the abortion, which led to intrusive 252 I.”

“…coping efforts involve changing some aspect of the self to prevent discrimination in the future; for example, a mentally ill person seeking therapy in an effort to combat his or her mental illness or an obese person trying to lose weight (e.g., Cole, Kemeny, & Taylor, 1997; Major & Gramzow, 1999).”

“Major and Gramzow (1999) explored concealment and fear of stigma for an abortion.”

“Self-disclosure in sensitive settings can sometimes lead to benefits such as receiving support [7, 20], yet other times it leads to negative consequences such as rejection and being more stigmatized [14, 16, 70, 108].”

“In addition, those with concealable stigmas may be cognitively and behaviorally taxed with stigma-management thoughts and behaviors that prevent them from being "outed" or "outing" themselves (Goffman, 1963; Major & Gramzow, 1999; Smart & Wegner, 1999).”

“Research has shown that concealment of a stigma can have a negative impact on a woman’s physical and mental health, and the process of keeping a secret can create a cycle of thought suppression and intrusive thoughts that may lead to psychological distress (Major and Gramzow 1999).”

“More recently, cognitive interpretations of the effects of disclosure have gained theoretical prominence (Tait and Silver, 1989; Clark, 1993; Pennebaker, 1995; Greenberg et al., 1996; Lepore et al., 1996; Lepore, 1997; Kliewer et al., 1998; Lepore and Helgeson, 1998; Kennedy-Moore and Watson, 1999; Lutgendorf and Anto…”

“Similarly, concealing one’s abortion from others predicted an increase in psychological distress over a 2-year period (Major & Gramzow, 1999).”

“Based on prior research findings (Lepore, 1997; Lepore et al ., 1996, 2000; Major and Gramzow, 1999), we predicted that talking about a stressor would reduce participants’ negative psychological and physiological responses during re-exposure to that stressor by facilitating cognitive resolution…”

“…post-traumatic stress disorder a year after a serious motor vehicle accident (Ehlers et al., 1998); higher tension and more intrusive thoughts during bandage change for burn patients (Fauerbach et al., 2002); and psychological distress two years after an abortion (Major & Gramzow, 1999).”

“Outcomes Our main outcome variable, perceived abortion stigma, was informed by a single item stigma measure developed by Major and Gramzow [24], and adapted to a context where all people had sought but not necessarily obtained an abortion.”

“Major & Gramzow (1999)31 (U.S.) Measure of stigma weak; significant correlation (.20) reported between feeling stigmatized and psychological distress, but the data were not analyzed in a way that directly compared women who felt stigmatized and those who did not; the clinical significance of the…”

“For example, there is some evidence that women who have had an abortion and kept it hidden from others report more thought suppression and greater psychological distress [14].”

“This study was chosen over [45] because it reported more data.”

“Research has shown that although the stigma of abortion may exist in both liberal and restrictive legal settings, it is more evident in settings where abortion is highly restricted (Cockrill & Nack, 2013; Major & Gramzow, 1999; Quinn & Chaudoir, 2009; Shellenberg & Tsui, 2012).”

“…women who have abortions are stigmatized (Cockrill et al., 2013; Kumar et al., 2009; Norris et al., 2011; Shellenberg et al., 2011; Weidner and Griffit, 1984) and perceive and experience stigma (Cockrill et al., 2013; Major and Gramzow,1999; Shellenberg et al., 2011; Shellenberg and Tsui, 2012).”

“These items were adapted from the 1999 study of Major and Gramzow [11] on abortion as stigma.”

“On the whole, the lack of focus on counter-narratives in which women’s experiences were framed positively creates a dominant impression that abortion is an undesirable practice, with discrediting implications for anyone associated with it.”

“…stereotyped groups (Eberhardt & Fiske, 1994; Frable, 1993a, 1993b; Frable, Blackstone, & Scherbaum, 1990; Frable, Platt, & Hoey, 1998; Major & Crocker, 1993; Major & Gramzow, 1999), research relevant to the present discussion gives us reason to believe that our findings are not limited to women.”

“Similarly, Major and Gramzow (1999) reported that among women experiencing relatively more intrusive thoughts following an elective abortion, emotional expression regarding the abortion resulted in less distress.”

“…interview and survey data to explore how stigma features in women’s experiences of abortion (Astbury-Ward, Parry, & Carnwell, 2012; Cockrill & Nack, 2013; Cockrill, Upadhyay, Turan, & Greene Foster, 2013; Hoggart, 2017; Major & Gramzow, 1999; Shellenberg et al., 2011; Shellenberg & Tsui, 2012).”

“The inner experience of concealment, however, can become a ‘‘private hell’’ (Major and Gramzow 1999).”

“Studies such as the one by Major and Gramzow (1999), although extremely informative, have primarily used single-item measures of abortion stigma, despite the fact that research on stigma more generally shows it to be multifaceted.”

“For instance, Major and Gramzow (1 999) found that women who experienced intrusive thoughts about their abortions reported significantly less distress when they acknowledged their stigma. Similarly, Griffith and Hebl (2002) found that employees who are gay or lesbian and who acknowledged their sexual orientation in th…”

“Because women who conceal an abortion when compared to those who do not are more likely to suppress thoughts of the abortion, experience intrusive abortion-related cognitions, and feel psychological distress (Major and Gramzow, 1999), the incidence of negative consequences should be lower among women who do not concea…”

“Borkovec, Roemer, and Kinyon (1995), for instance, showed that disclosure eased worry, Major and Gramzow (1999) found that revelation decreased distress, and Bouman (2003) reported decreased arousal following the disclosure of a secret.”

“…example, women who disclosed that they had an abortion to close but nonsupportive others (e.g., family member, friend) felt more depressed and coped with the abortion in less effective ways compared with those who told supportive others or those who did not disclose at all (Major & Gramzow, 1999).”

“Since women who conceal their abortions are more likely to feel greater psychological distress (36), the differences observed in our study are probably diluted by the effect of high concealment rates.”

“The depression and anxiety subscales are each six items and have been used in previous research on abortion and mental health (Major & Gramzow, 1999; Cozzarelli et al. 2000; Major et al. 2000).”

“Concealable stigmas can result in unique stressors related to the challenges that individuals face in deciding whether and when to disclose their stigmatized identities and to vigilance and fear associated with the possibility of unwanted discovery.(8,11,14,15) Those who possess a concealable stigma may isolate themse…”

“On the other hand, keeping secrets have been shown to cause psychological and immunological stress (Cole, Kemeny, Taylor, & Visscher, 1996; Major & Gramzow, 1999), hyperaccessible or intrusive thoughts (Lane & Wegner, 1995; Smart & Wegner, 1999), and prevent some individuals from gaining beneficial…”

“First, experiencing stigma or discrimination can cause a cascade of physiologic reactions [28-30], contributing to anxiety and other mental health outcomes [31-37].”

“[6] For example, fear of being stigmatized personally may lead those who have had abortions to remain silent about their experience, which may contribute to the promulgation of misinformation about abortion.”

“First, some researchers examine the mental preoccupation and intrusive thoughts that plague individuals who hide a stigmatized status (eg, Frable, Blackstone, & Scherbaum, 1990 ; Major & Gramzow, 1999 ; Smart & Wegner, 2000).”

“Women who have abortions can and do expect negative reactions to disclosure (Cockrill, Upadhyay et al. 2013; Major and Gramzow 1999; Shellenberg et al. 2011).”

“The psychological costs involving social disapproval include disclosure disconnects (Ragins, 2008), self-fulfilling prophecies (Jussim, Palumbo, Chatman, Madon, & Smith, 2000), or self-limiting behavior (Major & Gramzow, 1999).”

“Given that both concealing an abortion and experiencing confl ict with confi dants have been linked to psychological distress, being selective about whom to tell may be the best strategy for minimizing women’s mental distress postabortion.(9,45) However, although potentially benefi cial for individual women, concealin…”

“This stigma translates into shame and silence for women and into marginalization for providers, and creates or perpetuates myths and misunderstandings about abortion [2, 7].”

“Both humiliation and internalized stigma are associated with isolation, emotional suppression, long-term psychological distress, and hesitancy to seek healthcare [18,22,31].”

“This is concerning, because secrecy resulting from anticipated abortion stigma may be associated with “thought suppression” and intrusive thoughts, both of which have been associated with emotional distress following an abortion.(37) Our findings add nuance to evidence in the literature suggesting that most parents, p…”

“Our current political climate stigmatizes women who have abortions and abortion stigma has negative consequences for women ( Major and Gramzow 1999 ).”

“Similarly, women who feared stigmatization for having an abortion tended to suppress thoughts about the abortion, and this thought suppression predicted psychological distress up to 2 years after the procedure (Major & Gramzow, 1999).”

“Research has shown consistently that selfconcealment is detrimental to psychological and physical well-being, independent of self-disclosure (Larson & Chastain, 1990; Major & Gramzow, 1999; Uysal, Lin, & Knee, 2010).”

“Abortion can be characterized as a stigmatized medical service in Nepal and elsewhere in the world [6,11-13].”

“Homosexual people may not only be uncertain of whether they will be able to conceal, but also uncertain of whether they will be able to pull off other important tasks while doing so. Concealment may already be a stressful process ( Major & Gramzow, 1999 ), and all this uncertainty may only increase the stress.”

“In research on women after their abortion, suppression and denial were related to greater psychological distress ( Major & Gramzow, 1999 ).”

“…and physiologically costly (Gross, 1998; Richards & Gross, 2000; Wegner, 1994), may elicit rumination, and likely inhibits the disclosure of thoughts and feelings about the threat, which might otherwise prove beneficial (Major & Gramzow, 1999; Pennebaker, Kiecolt- Glaser, & Glaser, 1988).”

“Important factors related to under-reporting of maternal mortality among registered pregnancy outcomes are problems of identifying early pregnancy maternal deaths before the pregnancy is clearly recognized and deaths due to abortion because of secrecy and stigma [24].”