Differences in abortion attitudes by policy context and between men and women in the World Values Survey

Support for sexual and reproductive health and rights in Sub-Saharan Africa: a new index based on World Values Survey data

BACKGROUND

Addressing attitudes is central to achieving sexual and reproductive health and rights (SRHR) and Agenda 2030. We aimed to develop a comprehensive index to measure attitudinal support for SRHR, expanding opportunities for global trend analyses and tailored interventions.

METHODS

We designed a new module capturing attitudes towards different dimensions of SRHR, collected via the nationally representative World Values Survey in Ethiopia, Kenya, and Zimbabwe during 2020-2021 (n = 3,711). We used exploratory factor analysis of 58 items to identify sub-scales and an overall index. Adjusted regression models were used to evaluate the index according to sociodemographic characteristics, stratified by country and sex.

RESULTS

A 23-item, five-factor solution was identified and used to construct sub-indices reflecting support for: (1) sexual and reproductive rights, (2) neighborhood sexual safety, (3) gender-equitable relationships, (4) equitable masculinity norms, and (5) SRHR interventions. These five sub-indices performed well across countries and socioeconomic subgroups and were combined into a comprehensive "SRHR Support Index", standardized on a 1-100 scale (mean = 39.19, SD = 15.27, Cronbach's alpha = 0.80) with higher values indicating more support for SRHR. Mean values were highest in Kenya (45.48, SD = 16.78) followed by Ethiopia (40.2, SD = 13.63), and lowest in Zimbabwe (32.65, SD = 13.77), with no differences by sex. Higher education and being single were associated with more support, except in Ethiopia. Younger age and urban residence correlated with more support among males only.

CONCLUSION

The SRHR Support Index has the potential to broaden SRHR attitude research from a comprehensive perspective - addressing the need for a common measure to track progress over time.

Analysis of the relationship between religion, abortion, and assisted reproductive technology: Insights into cross-national public opinion

With advancement in reproductive technologies, public opinion regarding these procedures varies considerably across the world. While prominent public debates have focused on abortion, we know less about the factors shaping feelings regarding Assisted Reproductive Technologies (ART). Both procedures challenge the idea that human life starts with conception - with the fertilization of an embryo. Using European Values Survey data and multilevel modeling, we compare how religion and other personal and country-level factors shape disapproval toward abortion and ART. Conservative Protestants and people who are more engaged with their religion and live in a more religious country are more likely to disapprove of abortion and ART. More supportive polices and attitudes regarding ART, but not abortion, are correlated. Additionally, economic development moderates the relationship between personal religiosity and abortion, but not ART. This finding provides important insight into why abortion has remained such a controversial issue, even in richer nations.

Gender balance in the workforce and abortion attitudes: A cross-national time-series analysis

This article explores the relationship between gender balance in the workforce and attitudes towards abortion worldwide. Studies on macro-level conditions related to abortion attitudes overlook the role of gender balance in the workforce-specifically the degree of female representation in a country's workforce. There are strong reasons why this factor could shape abortion attitudes. We argue that such a gender balance creates necessary conditions to break with traditional, anti-abortion ideology and facilitates dissemination and public acceptance of pro-choice views. We test this argument with two different datasets - the Integrated Values Survey and three waves of the International Social Survey Programme-along with two outcomes: general tolerance towards abortion and tolerance towards abortion for pregnant women of low income. Using three-level random intercept models and multiple controls for individual and country-level conditions, the results support our hypothesis: In countries with higher gender balance in the workforce, individuals display higher tolerance towards abortion.

Attitudes towards induced abortion among gynecologists in Kurdistan region of Iraq

BACKGROUND

Unsafe abortion is a major contributor to maternal morbidity and mortality in countries where induced abortion is restricted. In Kurdistan Region of Iraq, induced abortion is strictly forbidden except for life-threatening situations, increasing the risk of seeking unsafe abortions. Attitudes among healthcare professionals who directly encounter cases and consequences of induced abortion can be studied to improve women's access to safe abortion. This study aimed to examine attitudes towards induced abortion among gynecologists in Kurdistan Region of Iraq.

METHODS

This cross-sectional facility-based study was conducted in the first quarter of 2022 in Kurdistan Region of Iraq in the cities of Erbil, Sulaymaniyah, and Duhok. Convenient sampling was used to invite 330 gynecologists to participate, with 171 ultimately completing the questionnaire, giving a response rate of 53%. Questionaries using the Taylor and Whitehead abortion attitude scale were sent in person or digitally. The data was then analyzed using Chi-square and Fisher's exact tests to determine the independence of attitudes and associations between attitudes and sociodemographic factors.

RESULTS

Among 171 gynecologists, 25% of the gynecologists agreed that induced abortion is unacceptable under any circumstances. Most (71%) disagreed that a woman has the right to choose to have an induced abortion. Around 51% considered induced abortion murder, and 41% agreed that induced abortion goes against all morals. Around 57% disagreed with the legalization of induced abortion, while 43% agreed. Gynecologists who were unmarried (P = 0.025), under the age of 40 (P = 0.044), and with less than 10 years of clinical experience (P = 0.043) were more likely to support the legalization of induced abortion in Kurdistan Region. None of the variables was found to be independently associated with attitudes towards abortion legalization.

CONCLUSIONS

Despite some younger gynecologists having more favorable attitudes towards induced abortion, most gynecologists in Kurdistan Region had less favorable views. Most gynecologists were willing to provide post-abortion care regardless of their legal status. We recommend conducting more studies to investigate the consequences of current abortion legislation among women in need of induced abortion in Kurdistan Region of Iraq.

People's perception of changes in their abortion attitudes over the life course: A mixed methods approach

Research examining the extent that people's attitudes toward abortion vary across the life course is mixed. Some studies do not show a strong relationship between abortion attitudes and life stage, while others do find strong associations in both directions-older age associated with both more and less favorable attitudes toward legal abortion. Taken together, these findings suggest that individual attitudes toward abortion are static for some but malleable for others. Little is known about the prevalence, reasons, and directionality of attitude changes. This explanatory sequential mixed methods study investigates people's perceptions of whether, how, why, and for whom their abortion attitudes may have changed over their life course. We qualitatively investigated the reasons (e.g., experiences, life events) that triggered changes in respondents' abortion attitudes and quantitatively explored the sociodemographic factors associated with the perceived direction of those changes. The quantitative data come from a 2020 online survey completed by 1501 English and Spanish-speaking adults in the US. Qualitative data were collected from a subsample (n = 24) of the survey respondents who indicated interest in a follow-up in-depth interview. Our findings indicate that access to information and knowledge played an important role in changing abortion attitudes across a spectrum of support or opposition. For those who indicated becoming more opposed to abortion over time, experiencing parenthood was an important trigger for change and family/religious upbringing were key to shaping attitudes. For those who became more supportive of abortion over time, empathy for women was an important trigger for change and disagreeing with or distancing oneself from family/religious upbringing were key to shaping their attitudes. If attitudinal change occurs, becoming more supportive of abortion over the life-course is more common than becoming more opposed, however there are some nuances across age and gender. Understanding the different factors that influence attitudinal change regarding abortion has important implications for public opinion research and possible ramifications for abortion legality.

Don't Be My Neighbor: Exploring Social and Value Predictors of Sexual Prejudice Expressed by Those Who Fully Accept Sexual Minorities

It is without a doubt that acceptance of sexual minorities is growing across the globe. Two major narratives are commonly assumed to be true about this increased acceptance. First, this acceptance is increased by proximity to the stigmatized. Second, this acceptance is enduring. These might not be entirely true as multiple attitudinal datasets frequently show a diversity among the accepting population, especially for those who express full acceptance of the stigmatized while refusing neighboring proximity to them. This inconsistency in acceptance is the main focus of this study. Using rejection of neighboring proximity to sexual minorities as a case for stigma and data from the Integrated Values Surveys (n = 52,796; 48.15% male), this study explores the similarities and differences between those who fully accept sexual minorities and those who express heightened sexual prejudice when rejecting neighboring proximity to sexual minorities. Logistic regression models show those in the accepting population who reject neighboring proximity to sexual minorities are more likely to be men, lower educated, highly religious, hold a traditional gender-related belief, and are attracted to right-wing political ideologies. While those with extreme sexual prejudice share sex, age, and traditional gender-related beliefs in rejecting neighboring proximity to sexual minorities, no effects for educational attainment and political ideology were discovered. Theoretical and practical implications are discussed.

A Mixed-Methods Approach to Understanding the Disconnection between Perceptions of Abortion Acceptability and Support for Roe v. Wade among US Adults

The relationship between people's attitudes about abortion acceptability and the Supreme Court decision in Roe v. Wade-two distinct but related issues-has not been rigorously explored. The authors used a mixed-methods approach for analyzing in-depth interviews to better understand how participants' feelings toward abortion acceptability are related to perceptions of whether abortion should be legal. The authors then assessed (1) correlations between abortion acceptability and different measures of support for Roe v. Wade, and (2) how the phrasing of survey items related to Roe v. Wade may evoke different responses via an online survey fielded in 2018. The study's qualitative results highlight that there is a disjuncture between people's moral feelings toward abortion and their attitudes toward abortion legality. The study's quantitative results further demonstrate that correlations between abortion acceptability and support for Roe v. Wade are moderate, and the differences in responses to the phrasing of survey items related to Roe v. Wade are moderated by knowledge. The authors recommend that when researchers develop survey items, they avoid ambiguities of abortion as a general construct, especially when public opinion measures on abortion are employed for research and the design of social and health policy and practice.

Alignment of state-level policies and public attitudes towards abortion legality and government restrictions on abortion in the United States

BACKGROUND

Contextual factors can shape public opinion towards abortion. We investigated the association between the state-level abortion legislative climate and individual attitudes towards abortion legality and government restrictions of abortion access in the United States.

METHODS

Data come from the 2020 Cooperative Congressional Election Study (n = 61,000). Using multivariable logistic regression with generalized estimating equations, we explored whether state-level abortion policy climates (based on the Guttmacher Institute's 2020 rating of state abortion policies) were associated with individual attitudes (1) towards abortion legality, and (2) towards government restriction of abortion access, controlling for individual socio-demographic factors.

RESULTS

Eighty-eight percent of participants supported the legality of abortion in some or all circumstances. Conversely, 30% of the sample opposed all federal government restrictions on abortion. More than 60% of the sample lived in highly abortion-restrictive states. Participants living in states with a more supportive abortion legislative climate were more likely to support the legality of abortion in some or all circumstances (AOR = 1.07, (95% CI 1.05, 1.09). Participants in states with more supportive abortion policies were more likely to oppose federal governmental restrictions (AOR = 1.03, 95% CI 1.02, 1.04). Low religiosity, higher educational attainment, and politically liberal views were associated with increased support for abortion legality and increased opposition to government restrictions on abortion.

CONCLUSIONS

State-level abortion policy contexts were positively associated with public attitudes towards abortion. While attitudes towards abortion legality are favorable across the country; there is also strong support at least one type of government restriction on abortion access. Results highlight a disconnect between multifaceted public attitudes towards abortion and polarized state contexts, suggesting that policymaking on abortion represents a higher level of polarization than exists at the individual level. Policymakers and legislators should more carefully consider the desires of the public when designing abortion legislation.

Legalisation of abortion in a poor-resource setting: nigerian undergraduates' perspectives

Background

Abortion is one of the leading causes of morbidity and mortality amongst Nigerian women in a country with restrictive abortion laws. Despite being illegal, abortions are still performed, and about 50% of abortions are performed by untrained persons in unhygienic conditions. This study assessed the determinants of attitude of undergraduates to legalisation of safe abortion in Nigeria.

Methods

It is a descriptive cross-sectional study. We used a three-stage sampling technique to select 423 undergraduates using a pre-tested questionnaire. The predictors of attitude towards abortion and its legalisation were identified during multivariate analysis.

Results

Good knowledge of abortion and its sequelae was found in about two-thirds (62.2%) of the participants, while over half (56.3%) had a negative perspective to abortion legalisation in Nigeria. Older participants were more likely to have positive perspectives to legalisation of abortion compared to their younger counterparts (odds ratio [OR] = 4.72, confidence interval [CI]: 2.61-8.55). Furthermore, respondents from upper social class and those with good knowledge were more likely to have positive perspectives to legalisation of abortion compared to their counterparts (OR = 5.63, CI: 3.12-10.16 and OR = 4.50, CI: 2.89-7.01).

Conclusion

The study showed that respondents' knowledge of abortion was relatively low amongst the study population, and more than half of the respondents did not want abortion to be legalised. Increasing awareness on the importance of abortion and its complications in Nigeria will curb the menace of death due to abortion now and in the future.

Mercy Procedure or a Nightmare? Attitude towards Pregnancy Termination among Polish University Students

Worldwide, there are about 121 million unintended pregnancies per year. The aim of the study was to assess the attitudes in different groups of students from 40 Polish universities towards pregnancy termination. In total, 9686 university students (20.1% male and 79.9% female) took part in our research. Questions about attitudes towards abortion in all possible circumstances were involved in the survey, which also included a socio-demographic questionnaire. Overall, 94.5% of women and 90.7% of men consider that abortion should be legal in the situation of a threat to the mother's life, while only 52% of women and 38.7% of men accept it in the case of a hard financial situation for the mother. Most students stand for abortion in the situation of a threat to the mother's life, in the case of rape, or in the case of a mortal fetus defect. Less than half of the students interviewed consider that abortion should be legal in the case of a hard financial situation for the mother or on the mother's demand. People who declare a religious affiliation more often disagree with abortion, even in the hardest cases such as a danger to the mother's life or a mortal fetus defect. The factor that influences the strongest on attitudes towards abortion is being an active Roman Catholic. The majority of students have a pro-choice attitude in respect of pregnancy termination.

Abortion and contraceptive use stigma: a cross-sectional study of attitudes and beliefs in secondary school students in western Kenya

Social stigma related to women's reproductive decision-making negatively impacts the health of women. However, little is known about stigmatising attitudes and beliefs surrounding abortion and contraceptive use among adolescents. The aim of this study was to measure stigmatising attitudes and beliefs regarding abortion and contraceptive use among secondary school students in western Kenya. A self-reported classroom questionnaire-survey was administered in February 2017 to students at two suburban secondary schools in western Kenya. Two scales were used to measure the stigma surrounding abortion and contraceptive use - the Adolescent Stigmatizing Attitudes, Beliefs and Actions (ASABA) scale and the Contraceptive Use Stigma (CUS) scale. 1,369 students were eligible for the study; 1,207 (females = 618, males = 582) aged 13-21 years were included in the analysis. Descriptive statistics, Pearson's χ² test, and the t-test were used to analyse the data. Binary logistic regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI). The students reported stigma associated with abortion (53.2%), and contraceptive use (54.4%). A larger proportion of male students reported abortion stigma (57.7%) and contraceptive use stigma (58.5%), compared to female students (49.0%, p = .003 and 50.6%, p = .007, respectively). Higher scores were displayed by younger rather than older age groups. No associations were identified between sexual debut and abortion stigma (p = .899) or contraceptive use stigma (p = .823). Abortion and contraceptive use are stigmatised by students in Kenya. The results can be used to combat abortion stigma and to increase contraceptive use among adolescents in Kenya.

The Change in Attitudes Towards Abortion in Former West and East Germany After Reunification: A Latent Class Analysis and Implications for Abortion Access

Introduction The legal status of abortion has changed in the regions of former East Germany after reunification due to the adoption of restrictive West German abortion policies. The aim of this study was to evaluate the impact on attitudes towards abortion and the associated health care implications in Western and Eastern Germany.

Materials and Methods Nationally representative data on public support for legally restricting abortion access were taken from the German General Social Survey and included the surveys 1992, 1996, 2000, 2006 and 2012 (N = 14 459). Two indicators of barriers to access to abortion care were calculated for each federal state, based on the number of abortion facilities and the proportion of women seeking abortion outside their state of residency. Data were analysed using latent class analysis.

Results Results suggested that abortion attitudes could be classified into three distinct subgroups: 1) support for abortion access independent of womenʼs reason; 2) support on the basis of maternal or foetal health reasons but not for socio-economic reasons (e.g. financial restrictions); and 3) no support. The size of subgroups in favour of partial or complete restriction on abortion access increased in both regions over the study period and this trend could not be explained by changes in socio-demographic characteristics. Respondents living in a federal state with more barriers to access to abortion care were more likely to hold restrictive abortion attitudes.

Conclusion Negative attitudes towards abortion have increased in Western and Eastern Germany during the two decades following reunification and may harm women by limiting acceptability and accessibility of abortion care. Abortion policies, public discourse and provision of abortion care should be informed by international guidelines protecting womenʼs health and rights.

Medical termination of pregnancy service delivery in the context of decentralization: social and structural influences

Background

Medical termination of pregnancy (MToP) is a safe and acceptable abortion option. Depending on country context, MToP can be administered by general practitioners and mid-level healthcare providers in the first and second trimesters of pregnancy. Like other high-income countries, a range of social and structural barriers to MToP service provision exist in Australia. To counter some of these barriers, geographic decentralization of MToP was undertaken in rural Victoria, Australia, through training service providers about MToP to increase service delivery opportunities. The aim of this study was to investigate the factors that enabled and challenged the decentralization process.

Methods

Face-to-face and telephone interviews were undertaken between April and June 2016 with a purposeful sample of six training providers and 13 general practitioners (GP) and nurse training participants. Study participants were asked about their perceptions of motivations, enablers and challenges to MToP provision. A published conceptual framework of synergies between decentralization and service delivery was used to analyse the study findings.

Results

Three key themes emerged from the study findings. First, the effort to decentralize MToP was primarily supported by motivations related to making service access more equitable as well as the willingness of training providers to devolve their informal power, in the form of MToP medical expertise, to training participants. Next, the enablers for MToP decentralization included changes in the regulatory environment relating to decriminalization of abortion and availability of required medication, formation of partnerships to deliver training, provision of MToP clinical resources and local collegial support. Finally, challenges to MToP decentralization were few but significant. These included a lack of a state-wide strategy for service provision, provider concerns about coping with service demand, and provider stigma in the form of perceived negative community or collegial attitudes. These were significant enough to create caution for GPs and nurses considering service provision.

Conclusions

Decentralization concepts offer an innovative way for reframing and tackling issues associated with improving MToP service delivery. There is scope for more research about MToP decentralization in other country contexts. These findings are important for informing future rural MToP service expansion efforts that improve equity in service access.