Stigma in the context of pregnancy termination after diagnosis of fetal anomaly: associations with grief, trauma, and depression

Arch Womens Ment Health. 2018 Aug;21(4):391-399. doi: 10.1007/s00737-017-0807-9. Epub 2017 Dec 29.


Termination of pregnancy after diagnosis of fetal anomaly (TOPFA) is a contested issue and stigma may negatively impact affected women's psychological reactions. This study examined the influence of perceived and internalized stigma on women's long-term adjustment to a TOPFA. One hundred forty-eight women whose TOPFA dated back 1 to 7 years responded to self-report questionnaires. The associations between perceived stigma at the time of the TOPFA, current internalized stigma and symptoms of grief, trauma and depression were modeled using multiple linear regression. The proportion of participants reporting scores above the cutoffs on the respective scale was 17.6% for grief, 18.9% for posttraumatic stress, and 10.8% for depression. After controlling for time since the TOPFA, pre-TOPFA mental health and obstetric variables, higher levels of current internalized stigma were related to higher levels of grief, trauma, and depression. Mediation analyses suggested that the effect of perceived stigma at the time of the TOPFA on symptoms of grief and trauma was mediated by current internalized stigma, but the cross-sectional design limited causal interpretation of results. Internalized stigma is associated with long-term psychological distress following a TOPFA. Perceived stigma at the time of the TOPFA may contribute to increased trauma and grief symptomatology, but results need to be validated in longitudinal studies. Health care providers and public initiatives should aim at reducing stigma among affected women.

Keywords: Abortion; Depression; Fetal anomaly; Grief; Stigma; Trauma.

MeSH terms

  • Abortion, Eugenic / psychology*
  • Adult
  • Cross-Sectional Studies
  • Depression / etiology*
  • Depression / psychology
  • Female
  • Fetus / abnormalities*
  • Germany
  • Grief*
  • Humans
  • Pregnancy
  • Prenatal Diagnosis / psychology*
  • Social Stigma*
  • Socioeconomic Factors
  • Stress Disorders, Post-Traumatic / etiology*
  • Stress Disorders, Post-Traumatic / psychology
  • Stress, Psychological / etiology
  • Stress, Psychological / psychology
  • Surveys and Questionnaires