Abortion stigma amongst the public in high-income countries: a mixed-method systematic review

The public plays a central role in producing and sustaining abortion stigma by shaping dominant narratives, reinforcing moral norms, and passing judgment on individuals associated with abortion. These collective attitudes are expressed through social exclusion and symbolic condemnation - practices that shape both personal experiences and structural access to care. This mixed-methods systematic review updates the state of research by synthesizing recent evidence from high-income countries (HICs), with particular focus on how the public enact and experience abortion stigma. We conducted a mixed-methods systematic review of peer-reviewed quantitative and qualitative studies published since 2015, following international standards for systematic reviews. Due to heterogeneity in measurement, quantitative and qualitative data were narratively synthesised. Methodological quality was assessed using standardized appraisal tools for both quantitative and qualitative research. Nineteen studies were included (12 qualitative, 7 quantitative). Quantitative findings reveal that abortion stigma in HICs persists at moderate levels and is associated with religiosity, political conservatism, lower income, and male gender. Qualitative studies demonstrate how stigma is enacted, perceived, and anticipated across diverse social settings, highlighting prevailing stereotypes and uncovering experiences of verbal harassment and social exclusion. Abortion stigma remains deeply embedded within the public. By updating and expanding on previous work, this review underscores the need for targeted, group-specific stigma reduction strategies and more robust instruments for capturing stigma.