Published Work: Stigma

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Enacted Abortion Stigma in the United States

Cowan, Sarah K

Published in Social Science and Medicine 177:259-268 (2017)
Rationale: Abortion is a common medical procedure at the center of political debate. Yet, abortion stigma at the individual level is under-researched; the nascent research on abortion stigma has not yet documented experienced (enacted) stigma instead capturing anticipated or internalized stigma.
Objective: This study documents how women and men who disclosed abortions perceived others’ reactions and determinants of those perceptions.
Method: The study uses the American Miscarriage and Abortion Communication Survey, a survey representative of American-resident adults. Data from the sub-sample who had personal experience with abortion were analyzed (total sample, N = 1640; abortion disclosure sub-sample, n = 179). The survey captured each disclosure of the most recent abortion. Respondents had eight possible choices for articulating how the listener reacted. Cluster analyses grouped these reactions. Multinomial logistic regression identified predictors of the perceived reactions. Ordinal logistic regression revealed which disclosers perceived exclusively negative reactions, exclusively positive reactions, and a mix of negative and positive reactions.
Results: Each disclosure fell into one of three clusters: negative reaction, supportive reaction or sympathetic reaction. The majority of abortion disclosures received largely positive reactions (32.6% were characterized as supportive and 40.6% were characterized as sympathetic). A substantial minority of disclosures received a negative reaction (26.8%). The perceived valence of the reaction is predicted, in part, by to whom the disclosure was made and why. Across all their disclosures, most people disclosing an abortion history perceived only positive reactions (58.3%). A substantial minority of people perceived either exclusively negative reactions (7.6%) or a mix of negative and positive reactions (34.1%). Ordinal logistic regression (with people as the unit of analysis) showed perceived reactions are predicted by the number of disclosures made and the revealer’s race and income.
Conclusion: Whereas most people disclosing an abortion received support or sympathy, a substantial minority received stigmatizing reactions, which plausibly negatively impact on health.

This research was covered in Glamour.

Category: Abortion, Stigma

“When you’re in a crisis like that, you don’t want people to know”: Mortgage Strain, Stigma and Mental Health

Keene, Danya E., Sarah K. Cowan, and Amy Castro Baker*

Published in the American Journal of Public Health 105:5 1008-1012 (2015)
Objectives: Mortgage strain can have severe consequences for mental health, but the specific mechanisms underlying this relationship have yet to be revealed. Stigma represents one unexplored pathway. We analyze experiences of stigmatization, concealment and isolation among African-American homeowners who were experiencing mortgage strain.
Methods: We conducted semi-structured interviews with 28 African-American homeowners who were experiencing mortgage strain.
Results: Our data show that mortgage strain can be a concealable stigma. Participants internalized this stigma, expressing shame about their mortgage situation. Additionally, some participants anticipated that others would view them as less worthy given their mortgage trouble. In an effort to avoid stigmatization, many concealed their mortgage trouble which often led to experiences of isolation. This stigmatization, concealment and isolation seemed to contribute to participants’ depression, anxiety and emotional distress.
Conclusions: Stigma may exacerbate the stress associated with mortgage strain and contribute to poor mental health, particularly among upwardly mobile African Americans who have overcome significant structural barriers to home ownership. Reducing stigma associated with mortgage strain may help to reduce the health consequences of this stressful life event.

This research was covered in the Yale Alumni Magazine.

Category: Secrets, Social Networks, Stigma