AUTHOR=Jim Abongile , Magwentshu Makgoale , Menzel Jamie , Küng Stephanie Andrea , August Sa-Asa , van Rooyen Justine , Chingwende Rumbidzayi , Pearson Erin 

TITLE=Stigma towards women requesting abortion and association with health facility staff facilitation and obstruction of abortion care in South Africa

JOURNAL=Frontiers in Global Women's Health

VOLUME=Volume 4 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2023.1142638

DOI=10.3389/fgwh.2023.1142638

ISSN=2673-5059

ABSTRACT=Background: Abortion stigma has been shown to influence provider attitudes around abortion and may decrease provider willingness to participate in abortion care, or lead some to obstruct care. However, this link remains understudied. 
Methods: The present study uses baseline data collected through a cluster-randomized controlled trial in 16 public sector health facilities in South Africa in 2020. A total of 279 clinical and non-clinical health facility workers were surveyed. Primary outcome measures included: 1) willingness to facilitate abortion care in eight hypothetical scenarios, 2) facilitation of abortion care in the last 30 days, and 3) obstruction of abortion care in the last 30 days. Logistic regression models were used to assess the association between level of stigma as measured through the Stigmatizing Attitudes, Beliefs and Actions Scale (SABAS) and the primary outcomes. 
Results: Overall, 50% of respondents in the sample were willing to facilitate abortion care in each of the eight scenarios, with differences in willingness based on the abortion client’s age and personal situation in each scenario. Over 90% reported facilitating abortion care in the last 30 days, but 31% also reported having obstructed abortion care in the last 30 days. Stigma was significantly associated with willingness to facilitate abortion care and actual obstruction of abortion care in the last 30 days. Controlling for covariates, odds of willingness to facilitate abortion care in every scenario decreased with every one-point increase in SABAS score (reflecting more stigmatizing attitudes), and odds of obstructing abortion care increased with every one-point increase in SABAS score. 
Conclusions: Lower abortion stigma on the part of health facility workers was associated with willingness to facilitate abortion access but not actual facilitation of abortion services. Higher abortion stigma was associated with actual obstruction of an abortion service in the last 30 days. Interventions to reduce stigma towards women seeking abortion, and particularly negative stereotyping, among all health facility staff is key to ensuring equitable and non-discriminatory access to abortion. 
Trial registration: Retrospectively registered on clinicaltrials.gov (ID: NCT04290832) on February 27, 2020.