Strategies to Reduce Sexual and Reproductive Health Stigma: A Systematic Review of Interventions to Reduce Abortion, Infertility, Contraceptive Use, and Sexuality Stigma 公开
Cooper, Christine (Spring 2020)
Abstract
Background: Globally, stigma has been observed around sexual and reproductive health in the areas of contraceptive use, infertility, abortion, and sexuality. Stigma across socioecological levels (internalized, interpersonal, organizational, community, and structural) can cause stress, isolation, depression; affect the quality of life; and avoidance of healthy behaviors and health services, all leading to poor health outcomes. Interventions to reduce stigma associated with SRH are required to avoid these poor health outcomes.
Methods: A systematic literature search in PubMed, PsycINFO and CINAHL was completed to identify articles with the primary or subsequent goal of reducing stigma regarding contraceptive use, abortion, infertility, or sexuality. The search was limited to English-language studies published by December 2019. Data was abstracted on study- and intervention-level characteristics, and populations included. The data was synthesized and relevant gaps were identified.
Results: Forty-six studies met inclusion criteria and were analyzed. The studies were divided into pregnancy related stigma (n=9) – abortion, contraceptive, and infertility stigma – and sexuality related stigma (n=37) – sexual minority status, sexual behavior, and female sex work. Most studies focused on changing attitudes, beliefs, and prejudice among those who hold stigmatizing SRH attitudes (46%) while a third of the studies focused on reducing internalized stigma. More interventions employed a one-time presentation that lasted three-hours or less (41%) and one-third required multiple sessions of four or more hours. Participants were 64% female, 31% male and 5% Transgender. Twenty-six studies provided racial and ethnic demographic data showing participants were 64% White, 14% Black, 9% Hispanic/Latino(a), 6% Asian, 1% Native American, 2% Multi-racial, 1% Other and 4% missing. Sixty-five percent of the studies were conducted in North America.
Conclusion: Published SRH stigma intervention studies over the last 26 years in the literature largely focused on sexuality stigma in North America and relatively less contraceptive use, infertility, and abortion stigma intervention studies were available. There is need for more interventions that incorporate multi-level approaches and integrate several types of intervention that have shown some efficacy. The results of this review point to opportunities for SRH stigma intervention work in less studied pregnancy-related stigma areas and areas outside of high-income countries.
Table of Contents
Table of Contents
Distribution Agreement ...………………………………………………………….......…i
Approval Sheet ...…………………………………………………………………....………ii
Abstract Cover Page ...………………………………………………………………........iii
Abstract …………………………………………………………………………………........iv
Cover Page ………………………………………………………………………………........v
Acknowledgements ………………………………………………………………………...vi
Chapter One: Introduction ……………...…………………………………………...…...1
Background and Rationale …………………………………………………………...……1
Problem Statement ………………………………………………………………….….…..7
Purpose Statement and Research Question ………………………………….……....8
Significance Statement ……………………………………………………….……………8
Definition of Terms……………………………………………………………….………....9
Chapter Two: Literature Review ………………………………………………….…....10
Why We Need Interventions (What is the big deal with stigma) …………....…10
Status of Stigma Interventions (HIV and Mental Health) ………………………..12
Stigma and Sexual and Reproductive Health …………………………………….….14
Chapter Three: Methods ……………………………………………………………....….21
Search Strategy …………………………………………………………………………......21
Study Selection ……………………………………………………………………....……..22
Data Abstraction ……………………………………………………………………....……23
Figure 1. PRISMA flow diagram ………………………………………………….….…..24
Chapter Four: Results …………………………………………………………………...…25
Study Characteristics ...…………………………………………………………………....25
Table 1. Study Level Description ………………………………………………….…..…26
Intervention Characteristics ………………………………………………………...…...28
Table 2. Intervention Level Characteristics …………………………………..………29
Populations Included ……………………………………………………………….....…...31
Table 3. Population Level Characteristics……………………………………………...32
Pregnancy Related Stigma Studies ………………………………………………….......33
Sexuality Related Stigma Studies ………………………………………………………...34
Table 4. Geographic Region by Sexuality ……………………………………………….39
Chapter Five: Discussion, Conclusion, Recommendations ….…………………….40
Discussion …………………………………………………………………………........……..40
Limitations and Strengths …………………………………………………....................49
Conclusion ………………………………………………………………….......……………..50
Public Health Implications …………………………………………………...…………….50
References ...……………………………………………………………………………….......55
Appendix A Studies included in Review …....……………………………….....……....92
Appendix B Search Terms for Databases …..…………………………………………...108
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