Internalized shame and stigma-related isolation predict worse health for women who get an abortion

New research from Ireland has found that the stigmatization of abortion is linked to psychological distress and negative health outcomes for women who terminate their pregnancy. The study, published in Psychology of Women Quarterly, found that internalized shame about abortion and deliberate isolation from others were associated with impaired mental and physical well-being.

“I started off interested in stigmatized identities, and their impact on psychological and physical well-being. I had done some earlier research on the stigma and unemployment, so I knew that most stigma research focuses on psychological well-being only,” said Aisling T. O’Donnell of the University of Limerick, the study’s corresponding author.

“I was keen to investigate whether the link between stigma and physical health symptoms would be evident for a different stigmatized group. I challenged my undergraduate final year project students to think of groups in society that they believed would be stigmatized but which were not research much, yet.

“Remarkably, myself and two of these students independently came up with the idea of investigating abortion stigma,” O’Donnell said. “There was a little research on this, but not much, and we felt it would be especially interesting in our setting because we’re based in Ireland, where abortion is currently illegal except to save the woman’s life, so women who need to access abortion travel to neighbouring countries.”

The researchers surveyed 155 women who had received an abortion. The age of the women ranged from 18 to 68 years and the average age at which they had an abortion was 23.67.

O’Donnell and her colleagues found that both internalized abortion stigma and stigma-related isolation predicted psychological distress and physical symptoms such as headache, insomnia, and stomach upsets.

“Abortion is stigmatized in our society, and this can affect our well-being in several ways,” O’Donnell told PsyPost. “In our study, the aspect of stigma that most strongly predicted both psychological distress and physical health symptoms was internalized stigma. This occurs where the person is aware of the stigma before it applies to themselves, and they then accept this culturally held view and stigmatize themselves.”

“The next most important factor was stigma-related isolation, which refers to the feeling that you cannot reach out to those closest to you for support, because abortion is so stigmatizing.”

“We also tested the importance of perceptions of the amount of stigma in society, and anticipation of being stigmatized if you were to reveal experience of abortion,” O’Donnell said. “These did not help to predict health problems as strongly as the other two factors, but they are likely to still be important here: people cannot internalize stigma, or isolate themselves from others because of it, if they are not first aware that the stigma exists and afraid of being treated differently because of it.”

The researchers believe that the psychological distress associated with internalized stigma and especially isolation lead to the increase in physical symptoms. However, the design of the research prevents them from drawing any definite conclusions about cause and effect.

“The main limitation of our study is that our data were collected by cross-sectional survey, so we cannot make any claims about causality. That is, we suspect that greater internalized stigma and stigma-related isolation leads to an increase in psychological distress and physical health symptoms for women who have accessed abortion. However, our data do not conclusively show that one leads to the other, only that they are linked,” O’Donnell explained.

“In order to demonstrate causality, we need to follow up the original study with a longitudinal study. It would also be interesting to investigate any potential impact of the illegality of abortion, perhaps by comparing an Irish sample with women from a country that is otherwise reasonably similar, such as the UK.”

Previous research has found that women in the United States who were denied an abortion reported more symptoms of anxiety and lower self-esteem compared to women who received one. Another study found evidence that mental illness was not a direct consequence of having an abortion.

“We believe these findings are particularly important given that access to reproductive healthcare, including abortion, is currently under threat in a number of locations,” O’Donnell added. “People often assume abortion itself leads to psychological health problems, when in fact there is extensive evidence that abortion is not associated with worse mental health outcomes than continuing an unwanted pregnancy.”

“However, this study shows that the stigmatization of abortion is reliably linked to both psychological distress and physical health symptoms, meaning that if we want to support the health and well-being of women who have accessed abortion, we should work on reducing stigmatization.”

The study, “Internalized Stigma and Stigma-Related Isolation Predict Women’s Psychological Distress and Physical Health Symptoms Post-Abortion“, was authored by Aisling T. O’Donnell, Tara O’Carroll, and Natasha Toole.