Professional Pragmatism and Abortion Stigma: Assessing the Performance of the Stigmatizing Attitudes, Beliefs and Actions Scale (SABAS)among Ethiopian Midwives

Sarah Jane Holcombe, Sahai Burrowes, Dawit Hailu, Ryan Scott, Aster Berhe

Abstract

This study assessed the applicability to medical professionals in Ethiopia of an abortion stigma assessment tool developed for community members, and examined the relationship between stigma and willingness to provide safe abortion care (SAC). The Stigmatizing Attitudes, Beliefs and Actions Scale (SABAS) was fielded to a convenience sample of 397 Ethiopian midwives. Scale reliability and validity were assessed, and associations were examined using multivariate linear and logistic regression. Levels of stigma were low compared to those reported elsewhere, and 49% of midwives were willing to provide SAC. The revised SABAS was reliable (alpha = 0.82), but items did not group into SABAS’ conceptual categories, and some had limited face validity. SABAS scores had a small but significant negative association with willingness to provide SAC (OR=0.95, p < 0.05), with negative stereotyping subscale items most predictive. SABAS’ limitations found here suggest the need for an adapted scale for medical professionals. (Afr J Reprod Health 2018; 22[2]:26-39).

Full Text:

PDF

References

Abdella A. Maternal Mortality Trend in Ethiopia. Ethiop J Health Dev. 2010;24(1):115–122.

Ahman E and Shah I. New Estimates and Trends Regarding Unsafe Abortion Mortality. Int J Gynecol Obstet. 2011; 115:121–126.

Central Statistical Agency-Ethiopia and ICF. Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: CSA and ICF International; p. 452.

Holcombe SJ, Berhe A and Cherie A. Personal Beliefs and Professional Responsibilities: Ethiopian Midwives’ Attitudes toward Providing Abortion Services after Legal Reform. Stud Fam Plann. 2015;46(1):73–95.

Moore AM, Gebrehiwot Y, Fetters T, Wado YD, Bankole A, Singh S, Gebreselassie H and Getachew Y. The Estimated Incidence of Induced Abortion in Ethiopia, 2014: Changes in the Provision of Services Since 2008. Int Perspect Sex Reprod Health. 2016;42(3):1-10.

World Health Organization, Health Worker Roles in Providing Safe Abortion Care and Post-Abortion Contraception. Geneva; 2015.

Central Statistical Agency-Ethiopia, ICF. Ethiopia Demographic and Health Survey 2016 [Internet]. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF; 2017.

Lakew Z, Asres Y, Gebre F and Abdella A. KAP Study On Abortion Among Ethiopian Health Workers. Addis Ababa: Ethiopian Society of Obstetricians &Gynecologists; 2002.

Abdi J and Gebremariam M. Health Providers’ Perception towards Safe Abortion Service at Selected Health Facilities in Addis Ababa. Afr J Reprod Health. 2011;15(1):31–36.

Chavkin W, Leitman L and Polin K. Conscientious Objection and Refusal to Provide Reproductive Healthcare: A White Paper Examining Prevalence, Health Consequences, and Policy Responses. Int J Gynecol Obstet. 2013;123(S3): S41–S56.

Rehnström Loi U, Gemzell-Danielsson K, Faxelid E and Klingberg-Allvin M. Health Care Providers’ Perceptions of and Attitudes towards Induced Abortions in Sub-Saharan Africa and Southeast Asia: A Systematic Literature Review of Qualitative and Quantitative Data. BMC Public Health. 2015;15(1):1–13.

Goffman E. Stigma: Notes on the Management of Spoiled Identity. New York: Touchstone. 1986.

Link B and Phelan J. Stigma and its Public Health Implications. Lancet. 2006; 367:528–529.

Yang L, Kleinman A, Link B, Phelan J, Lee S and Good B. Culture and Stigma: Adding Moral Experience to Stigma Theory. Soc Sci Med. 2007; 64:1524–1535.

Major B and O’Brien LT. The Social Psychology of Stigma. Annu Rev Psychol. 2005;56(1):393–421.

Martin LA, Debbink M, Hassinger J, Youatt E and Harris LH. Abortion Providers, Stigma and Professional Quality of Life. Contraception. 2014;90(6):581–587.

Webb D. Attitudes to 'Kaponya Mafumo’: The Terminators Of Pregnancy in Urban Zambia. Health Policy Plan. 2000;15(2):186–193.

Kumar A, Hessini L and Mitchell E. Conceptualising Abortion Stigma. Cult Health Sex. 2009;11(6):625-39.

Harris LH, Martin L, Debbink M and Hassinger J. Physicians, Abortion Provision and the Legitimacy Paradox. Contraception. 2013;87(1):11-16.

Hall RE. Abortion: Physician and Hospital Attitudes. Am J Public Health. 1971;61(3):517-519.

Grimes DA. Clinicians Who Provide Abortions: the Thinning Ranks. Obstet Gynecol. 1992;80(4):719–23.

van Boekel LC, Brouwers EPM, van Weeghel J and Garretsen HFL. Stigma Among Health Professionals towards Patients with Substance Use Disorders and its Consequences for Healthcare Delivery: Systematic Review. Drug Alcohol Depend. 2013;131(1–2):23–35.

Rao H, Mahadevappa H and Pillay P. A Study of Stigmatized Attitudes towards People with Mental Health Problems Among Health Professionals. J Psychiatr Ment Health Nurs. 2009; 16:279–284.

Peters RMH, Dadun Van Brakel W H, ZweekhorstM BM, Damayanti R, Bunders JFG and Irwanto. The Cultural Validation of Two Scales to Assess Social Stigma in Leprosy. PLoS Neglected Tropical Diseases, 2014; 8(11), e3274.

Brown H, Dickson-Tetteh K, Jewkes R, Levin J and Rees H. Epidemiology of Incomplete Abortion: South Africa 2000. Johannesburg: Reproductive Health Research Unit; 2002.

Harries J, Cooper D, Strebel A and Colvin CJ. Conscientious Objection and its Impact on Abortion Service Provision in South Africa: A Qualitative Study. Reprod Health. 2014;11(16):1–7.

Aniteye P and Mayhew SH. Shaping Legal Abortion Provision in Ghana: Using Policy Theory to Understand Provider-Related Obstacles to Policy Implementation. Health Res Policy Syst. 2013;11(1):23.

Lithur NO. Destigmatising Abortion: Expanding Community Awareness of Abortion as a Reproductive Health Issue in Ghana. Afr J Reprod Health. 2004;8(1):70.

Verhaeghe M and Bracke P. Associative Stigma among Mental Health Professionals: Implications for Professional and Service User Well-Being. J Health Soc Behav. 2012;53(1):17–32.

Dabash R, Koladycz R and Sanghvi R. Assessing IPPF/WHR Staff Perceptions and Experiences with Abortion in Latin America and the Caribbean. 132nd Annual Meeting (November 6-10, 2004) of APHA. 2004.

Bandewar S. Abortion Services and Providers’ Perceptions: Gender Dimensions. Econ Polit Wkly. 2003;38(21):2075–81.

Major B and Gramzow R. Abortion as Stigma: Cognitive and Emotional Implications of Concealment. J Pers Soc Psychol. 1999;77(4):735–745.

Norris A, Bessett D, Steinberg JR, Kavanaugh ML, De Zordo S and Becker D. Abortion Stigma. Womens Health Issues. 2011;21(3): S49–S54.

Aniteye P, O’Brien B and Mayhew SH. Stigmatized by Association: Challenges for Abortion Service Providers in Ghana. BMC Health Serv Res. 2016 Sep;16(1):70.

Hammarstedt M and Jacobsson L. Views of Midwives and Gynecologists on Legal Abortion. Acta Obstet Gynecol Scand. 2005; 84:58–64.

Wheeler SB, Zullig LL, Reeve BB, Buga GA and Morroni C. Attitudes and Intentions Regarding Abortion Provision Among Medical School Students in South Africa. Int Perspect Sex Reprod Health. 2012;38(3):154–163.

Pulerwitz J, Michaelis A, Weiss E, Brown L and Mahendra V. Reducing HIV-Related Stigma: Lessons Learned from Horizons Research and Programs. Public Health Rep. 2010;125(2):272–81.

Corrigan PW and Wassel A. Understanding and Influencing the Stigma of Mental Illness. J Psychosoc Nurs Ment Health Serv. 2008;46(1):42–8.

Shellenberg KM, Hessini L and Levandowski BA. Developing a Scale to Measure Stigmatizing Attitudes and Beliefs About Women Who Have Abortions: Results from Ghana and Zambia. Women Health. 2014;54(7):599–616.

Cockrill K, Upadhyay UD and Turan J. The Stigma of Having an Abortion: Development of a Scale and Characteristics of Women Experiencing Abortion Stigma. Perspect Sex Reprod Health. 2013;45(2):79–88.

Martin LA, Debbink M, Hassinger J, Youatt E, Eagen-Torkko M and Harris LH. Measuring Stigma Among Abortion Providers: Assessing the Abortion Provider Stigma Survey Instrument. Women Health. 2014;54(7):641–661.

Sorhaindo AM, Karver TS, Karver JG and García SG. Constructing a validated scale to measure community-level abortion stigma in Mexico. Contraception. 2016;93(5):421-431.

Weisman CS, Nathanson CA, Teitelbaum MA, Chase GA and King TM. Abortion Attitudes and Performance Among Male and Female Obstetrician- Gynecologists. Fam Plann Perspect. 1986;18(2):67.

Costello AB and Osborne JW. Best Practices in Exploratory Factor Analysis: Four Recommendations for Getting the Most From Your Analysis. Practical Assessment, Research & Evaluation. 2005;10(7).

World Health Organization. Safe Abortion: Technical And Policy Guidance for Health Systems. Geneva: World Health Organization; 2012 [cited 2017 Sep 14] p. 132.

Warriner IK, Wang D, Huong NTM, Thapa K, Tamang A, Shah I, Baird DT and Meirik O. Can Midlevel Health-Care Providers Administer Early Medical Abortion as Safely and Effectively as Doctors? A Randomised Controlled Equivalence Trial in Nepal. Lancet Lond Engl. 2011;377(9772):1155–61.

Håkansson M, Oguttu M, Gemzell-Danielsson K andMakenzius M. Human Rights versus Societal Norms: A Mixed Methods Study among Healthcare Providers on Social Stigma Related to Adolescent Abortion and Contraceptive Use in Kisumu, Kenya. BMJ Global Health. 2018;3(2):e000608.

Prata N, Mukundwa A, Ngoga E, Nyirazinyoye L, Hodoglugil N and Khan A. Measuring Abortion Stigma Among Providers in Rwanda. Presentation to the Rwanda Ministry of Health; 2017; Kigali, Rwanda.

Kiprotich Yegon E, Mwaniki P, Echokah E and Osur J. Abortion Stigma Correlates: Comparing Two Kenyan Counties in High and Low incidence of Unsafe abortion. In: AMREF Health Africa International Conference, Nairobi, November 26, 2014. 2014. p. 1–17.

Shellenberg K, Manda M, Voetagbe G and Yegon E. Understanding Abortion Stigma in the African context: Findings from Ghana, Zambia, Kenya and Uganda. Manuscript in preparation. 2017.

Holcombe SJ. Ethiopia's Reform of its Law on Abortion: Agenda-Setting, Advocates, and Implementation [dissertation]. Chapter 3, p. 104-154 . [Berkeley, CA]: University of California, Berkeley; 2014.

Ethiopian Midwives Association and UNFPA. State of Ethiopia’s Midwifery 2012. Addis Ababa, Ethiopia: Ethiopian Midwives Association; 2012

Federal Ministry of Health, Federal Democratic Republic of Ethiopia. Standard of Midwifery Care Practice. Addis Ababa, Ethiopia: Federal Democratic Republic of Ethiopia; 2013.

Ethiopian Midwives Association. Professional Code of Ethics and Conduct for Midwives. Addis Ababa, Ethiopia: Ethiopian Midwives Association; 2011 p. 1–34.

Refbacks

  • There are currently no refbacks.