A conceptual model for abortion stigma reduction in the healthcare workforce: A qualitative study of the values clarification approach

Abortion stigma globally limits access to high-quality abortion care. While stigma has negative consequences, we lack knowledge about how to reduce it. Values clarification and attitude transformation (VCAT), a common approach addressing abortion stigma in healthcare providers, is recommended by the World Health Organization. Yet there is limited evidence about VCAT’s effects and how VCAT works. The study aims to build qualitative evidence towards an empirically based conceptual model for VCAT’s potential mechanisms of abortion stigma reduction in the healthcare workforce. This study used in-depth interviews with VCAT facilitators and participants around the world to understand how stigma might be reduced in healthcare workers. Study design drew on the socioecological model of abortion stigma. We recruited participants online through abortion-related professional networks. Online interviews were audio-recorded and transcribed. Data were analysed thematically and informed conceptual model development. All 17 interviewees described VCAT as a strategy to reduce abortion stigma in healthcare workers. Mechanisms included: knowledge-building, normalisation, self-reflection and self-awareness, attitude change, and increased willingness to support abortion access. Interviewees discussed barriers and facilitators to stigma reduction at the intervention, institution, health system and societal levels. These findings informed a conceptual model showing pathways to reduce anticipated, internalised and enacted abortion stigma in healthcare workers. This fills an evidence gap, as existing frameworks describe abortion stigma but do not identify the mechanisms of stigma reduction. The conceptual model can inform the development and evaluation of interventions to reduce abortion stigma in the health system, with potential relevance for other stigmatised services.