A randomized pilot evaluation of individual-level abortion stigma resulting from Pennsylvania mandated abortion counseling

Objective The objective was to investigate the effect of mandated abortion counseling requirements intended to dissuade women from having abortions on patients' individual-level abortion stigma. Methods We randomized women presenting for abortion to complete a demographic survey and the validated Individual Level Abortion Stigma (ILAS) scale either before (unexposed) or after (exposed) hearing the mandatory Pennsylvania Abortion Control Act counseling via a standardized video. A sample size of 46 (23 per group) allowed us to detect a 1-standard-deviation difference in mean ILAS score between the groups. The ILAS scale ranges from 0 to 3.5, with higher scores indicating greater stigma. Results From November 2015 to April 2016, 46 participants completed the study. All baseline characteristics were balanced except that the unexposed group had a greater proportion of low-income participants. The mean ILAS score among all participants was 1.02±0.60. ILAS scores were significantly higher among the unexposed group (median 1.25, interquartile range [IQR] 0.7–1.9) compared to the exposed group (median 0.75, IQR 0.5–1.05; p=.016). However, when controlling for participant income category, the effect of the mandated counseling on stigma scores was no longer present (p=.068). Conclusions In this randomized trial, stigma scores were higher among women who had not heard the mandated abortion counseling when compared with stigma scores for those who had heard the script, but this effect was confounded by participants' income category. Implications Despite the small sample size in this pilot study, differences in stigma scores for women exposed and unexposed to mandated counseling approached significance even after controlling for income category. Women who heard the mandated counseling had reduced stigma scores. A larger study is needed to better characterize this effect. Further research is needed to understand how state policies, counseling interactions and socioeconomic status are related to abortion stigma.