Abortion as stigma: cognitive and emotional implications of concealment

“Often studies that do address abortion stigma analyze it from the perspective of those who have experienced abortion and perceived stigma [13,14].”

“For example, immediate distress has been reported as being higher in those who belong to a society that is antagonistic towards abortion (Major & Gramzow, 1999), in those who experienced difficulty making the decision (Lyndon, Dunkel-Schatter, Cohan, & Pierce, 1996), and in those who are younger,…”

“…how women feel about their pregnancy decision, and how they cope with their feelings (Kimport et al., 2011; Kumar, Hessini, & Mitchell, 2009; Major & Gramzow, 1999; Quinn & Chaudior, 2009), and also increase post-abortion distress and physical health symptoms (O’Donnell, O’Carroll, & Toole,…”

“Indeed, anticipating and receiving support has been shown to prompt intimate disclosures in a variety of stigma-related contexts (Major & Gramzow, 1999; Serovich, 2001; Smith, Rossetto, & Peterson, 2008).”

“It produces shame, isolation, and loss of self-esteem.(8,10,11) This seriously confounds efforts to link abortion to adverse mental health outcomes.”

“A study that examined women's emotional reactions to their abortions with respect to abortion as a stigmatized procedure ( Major & Gramzow, 1999 ) found that, counter to their hypothesis that women who did not emotionally disclose their abortion to others would suffer more intrusive thoughts about the procedure and th…”

“…indicate that people who hide a stigmatised identity report worse physical health (Cole, Kemeny, Taylor, & Visscher, 1996; Pannebaker, Kiecolt-Glaser, & Glaser, 1988) andmore negative affect than people who choose to reveal a stigmatised identity (Harris, 2001; Major & Gramzow, 1999; Paxton, 2002).”

“Whereas scholarship in intergroup interactions typically focuses on the experiences of the stigmatized partner engaging in concealment (Major & Gramzow, 1999; Smart & Wegner, 1999), much less attention has focused on how concealment affects nonstigmatized interaction partners’ prejudicial behavior.”

“mental and emotional health [10,11].”

“abortion [5,7], low levels of anticipated social support [7], and perceived stigmatization and need for secrecy [8].”

“Abortion stigma, not the abortion itself, can contribute to negative mental health outcomes (Crocker, Major, & Steele, 1998; Major & Gramzow, 1999) and can be experienced as internalized stigma, felt stigma, and enacted stigma (Cockrill & Nack, 2013) that exists within a system of inequality…”

“care providers, which further puts her health and future fertility at risk [10].”

“…social contexts in which unwanted pregnancies occur can result in abortion experiences that affect women emotionally and influence their well-being (Major and Gramzow 1999; American Psychological Association, Task Force on Mental Health and Abortion 2008; Lafaurie et al. 2005; Kimport, Foster and…”

“Third, research suggests that people become keenly aware of socially devalued and denigrated behaviors and attempt to conceal these aspects of themselves from others (Kuran, 1990; Major & Gramzow, 1999).”

“more women experience such stigma, the more likely they are to have adverse emotional outcomes, and vice versa (15).”

“…status hidden report heightened psychological distress (e.g., Major & Gramzow, 1999), whereas those who disclose their stigmatized status typically report decreased distress (e.g., Major & Gramzow, 1999; Ullrich, Lutgendorf, & Stapleton, 2003) and greater well-being (Beals et al., 2009).”

“However, the political context, particularly the stigma and need for secrecy, in which abortion decisions must be made can increase stress (Major & Gramzow, 1999).”

“…(Hanschmidt, Linde, Hilbert, Riedel-Heller, & Kersting, 2016; Shellenberg et al., 2011; Shellenberg & Tsui, 2012), even when faced with complications, which can lead to unsafe abortion seeking, harmful selfinduction attempts, and psychological distress (Harris, 2012; Major & Gramzow, 1999).”

“” Thirdly, internalized stigma: “ when a woman incorporates devaluing social norms, beliefs, and attitudes related to abortion in her self-image, creating a sense of shame, guilt or other negative feelings ” (Hanschmidt et al., 2016, pp. 169 – 170; Major & Gramzow, 1999; Shellenberg et al., 2011).”

“…has focused on identities that are assumed to be concealable by researchers such as homosexuality (e.g., S. W. Cole et al., 1996; Goh et al., 2019; Jackson & Mohr, 2016; Quinn et al., 2017; Riggle et al., 2017; Ullrich et al., 2003) or having had an abortion (e.g., Major & Gramzow, 1999).”

“…stigma has mostly focused on the effects of prejudice and discrimination on global indicators of emotional wellbeing, like state self-esteem, distress, or depressed mood (e.g., Hatzenbuehler, Nolen-Hoeksema, & Dovidio, 2009; Kaiser, Major, & McCoy, 2004; Major & Gramzow, 1999; McCoy & Major, 2003).”

“Meanwhile, those who support abortion rights assert that women's negative experiences predominately result from the social stigma surrounding abortion ( Major and Gramzow 1999 ).”

“…has shown that women who abort encounter a worrying amount of stigmatization and marginalization that might impact their physical and mental health (APA Task Force on Mental Health and Abortion, 2008; Kumar, Hessini, & Mitchell, 2009; Major & Gramzow, 1999; Major et al., 2009; Norris et al., 2011).”

“This is important because secrecy of one’s abortion is associated with poorer coping (Major & Gramzow, 1999; Major et al., 1997), and may result in further isolation and lack of social support from others (Cockrill & Biggs, 2017).”

“Moreover, attempts at thought suppression can lead to psychological distress (Major & Gramzow, 1999).”

“, self-esteem, perception of control, self-efficacy for coping) [1,10,17–19]; violence exposure [14,16]; anticipated and actual social support [18,19]; and stigma around abortion [20].”

“Stigmatization and disenfranchised grief [21,22] can make it difficult for women to integrate experiences of loss following an abortion into their self-narratives, leading to a crisis in meaning for the individual [19,20].”

“-Disclosure of study participation is very risky [20, 23, 24].”

“This process exerts a mental and emotional toll that can lead to anxiousness and distress (Larson and Chastain 1990; Major and Gramzow 1999).”

“Much less research has been devoted to identifying the cognitive and affective infl uences on the perceptions of the stigmatized targets when interacting with nonstigmatized others (for exceptions, see Major & Gramzow, 1999; Smart & Wegner, 1999; Swim & Stangor, 1998).”

“Most of the women in this long-term study hid the fact of their abortion because of shame, or out of fear of the reactions of family and friends; however, concealment has its costs (Major & Gramzow, 1999).”

“…2010), lower satisfaction with the abortion decision (Franz & Reardon, 1992; Major et al., 2000), feelings of being pressured into abortion (Broen et al., 2005; Ralph, Gould, Baker, & Foster, 2014) and concealing the decision to terminate the pregnancy from the family (Major & Gramzow, 1999).”

“researchers have found a positive relationship between negative affect and suppression ( Major and Gramzow 1999 ), whereas others have found a positive relationship between negative affect and disclosure (Christophe and Rime 1997; Finkenauer and Rime 1998).”

“…secrets, including illegitimate conceptions, adultery, debts, violent acts, mental illness, and chronic illness (Harris, Dersch, & Mittal, 1999; Major & Gramzow, 1999; Selvini, 1997); incarceration (Hagen & Myers, 2003); abortion (Major & Gramzow, 1999); and HIV/AIDS (Murphy, Roberts, &…”

“Stigma related to other identities and medical experiences has welldocumented adverse effects on population-level and individual-level health outcomes [5–7]; likewise, abortion stigma may be associated with psychological distress and poor mental and physical health outcomes [8,9].”

“Another study found that in pregnant women who were planning to have an elective abortion, secrecy regarding the abortion at baseline was associated with greater distress 2 years later; this association was mediated by intrusive thoughts and suppression of thoughts about their abortion [16].”

“Even in today’s relatively liberal society having an abortion is considered by some to be a disgrace (Major and Gramzow, 1999).”

“Such concealment has been linked to increased thought suppression, intrusive thoughts and psychological distress in women two years post‐TOP (Major & Gramzow, 1999 ).”

“As research demonstrates, women are well aware of the stigma surrounding abortion and managing this stigma is a source of considerable stress (Major and Gramzow 1999; Shellenberg and Tsui 2012).”

“…for supposed bad motivations anticipate negative perceptions from significant individuals and experience adverse emotions such as guilt and remorse, as well as engaging in self-critical evaluations such as being selfish and irresponsible (Biggs et al., 2020; Hoggart, 2017; Major & Gramzow, 1999).”

“Additionally, literature on coping with stigma suggests that people who believe that their ingroup is negatively evaluated by the outgroup may hesitate to talk about themselves (Major & Gramzow, 1999; Miller & Major, 2000).”

“Empirical research supports the association between experiencing stigma and perceiving social constraints (e.g., Chapple et al. 2004; Major and Gramzow 1999; Rzepa et al. 2011).”

“Community-based stigma about abortion leads to silence about the topic and can impede the spread of accurate information about abortion (Kumar, Hessini and Mitchell 2009; Major and Gramzow 1999).”

“Rather, abortion-related stigma is positively related to adverse psychological outcomes years later among those who have an abortion (Biggs et al., 2020; Hanschmidt et al., 2016; Major & Gramzow, 1999).”

“Research on women who conceal their past abortions found that they continue to experience psychological distress up to two years post-abortion due to their effort to maintain secrecy (Major & Gramzow, 1999).”

“Researchers who have studied the effect of concealing information, such as that relating to abortion (Major & Gramzow, 1999), eating disorders, (Smart et al., 1999), and homosexuality (Ullrich, Lutgendorf, & Stapleton, 2003), were mainly conducted with adult participants.”