Introduction

According to a World Health Organization (WHO)’s report, approximately 60% of unwanted pregnancies and 30% of all pregnancies end in abortion each year. Notably, when women who seek to terminate a pregnancy are confronted with barriers to accessing safe abortion techniques, they may be forced to choose unsafe methods; however, unsafe abortion may lead to maternal complications, mortality, and mental health impairment (Starrs et al., 2018; WHO, 2023). Financial unaffordability, geographic inaccessibility, a sense of disrespect, and public stigma are vital barriers that prevent women from seeking a safe abortion (WHO, 2023). Among these, abortion stigma may be pervasive and may threaten a woman’s physical and mental health; therefore, it should not be overlooked in one’s experience of abortion (Hanschmidt et al., 2016; WHO, 2023).

Guaranteeing women and girls have the right to access safe, respectful, and stigma-free abortion services is one of the primary goals of the Sustainable Development Goals (SDGs), which emphasize universal access to sexual and reproductive healthcare services (target 3.7 and 5.6) and gender equality (Goal 5) (United Nations, 2015; WHO, 2023). Nevertheless, abortion is still not legally protected in some countries (Bearak et al., 2020), and in countries with more lenient laws toward abortion, abortion stigma may persistently exist (Starrs et al., 2018). Importantly, women who have had an abortion may fear being stigmatized by society, community, or significant others, and this stigma can threaten their physical and psychological well-being (Biggs et al., 2020; O’Donnell et al., 2018; Starrs et al., 2018).

In China, abortion is not illegal (except sex-selective abortion); however, the national level of unintended pregnancies and abortions, especially premarital pregnancies and abortions, has long been a government concern (Lai, 2019; Zhou et al., 2021). Moreover, Chinese women’s gender roles have long been restricted by Chinese traditional culture and family values (Li & Jiang, 2019; Wu et al., 2021). In recent years, issues concerning reproduction and women’s gender roles have often sparked widespread and heated discussions on social media (Mao, 2020). With the growth of the feminist movement in China, Chinese women today are striving for equal rights in the workplace, freedom from violence, and liberation from traditional gender roles in the domestic sphere (South China Morning Post Reporters, SCMP, 2022). Nevertheless, few studies have focused on Chinese people’s attitudes toward abortion, especially stigmatized attitudes toward abortion and its correlates.

The Importance of Understanding the Abortion Stigma

Abortion stigma is rooted in the traditional gender role expectation that a woman who has an abortion violates two ideals of womanhood: motherhood and sexual purity (Kumar et al., 2009; Norris et al., 2011). Women who seek to terminate their pregnancies will be seen in a negative light and marked as violating traditional norms of motherhood and sexual purity (Kumar et al., 2009). Abortion stigma can include stigma against women who have abortions, those whose work involves abortions, and those who support women’s abortions (Norris et al., 2011). Public stigmatization of women who have experienced abortions is widespread, and frequently cited sources of this stigma include society, community, and significant others (Hanschmidt et al., 2016).

The stigma attached to abortion can be a significant concern for women who had such experiences; for instance, they may judge themselves, be afraid of being judged by society, and may want to conceal their abortion experiences. More importantly, keeping an abortion secretive may force women to suppress their related thoughts and emotions, and lead them to feel isolated (Hanschmidt et al., 2016). Women who internalized greater stigma and isolated themselves from others reported more psychological distress and somatic symptoms (Biggs et al., 2020; O’Donnell et al., 2018). Moreover, women’s perceived abortion stigma was associated with their lower levels of pre-abortion psychological health (including more depressive, anxiety, and stress symptoms; Steinberg et al., 2016). Abortion stigma also had a longitudinal effect on women’s post-abortion negative emotions and perceived decision rightness (Rocca et al., 2020).

Notably, abortion stigma can influence the quality of abortion care (Sorhaindo & Lavelanet, 2022) and may constitute a significant barrier to women’s access to safe abortion services (Starrs et al., 2018). Hence, in-depth knowledge of abortion stigma may contribute to overcoming its detrimental effects, facilitate access to high-quality abortion services for women and girls, and further improve their sexual and reproductive health.

Gender Roles Norms and Abortion Stigma

Social role theory (Eagly & Wood, 2011; Eagly et al., 2000) contends that men and women occupy different roles in the social structure; therefore, different gender role expectations were formed for men and women. These sex-typed roles are due to the complex interactions between the physical differences that have evolved between men and women (i.e., greater physical size and strength for men and childbearing and nursing infants for women) and the distinct factors that arose from each society’s socioeconomic development and ecology. However, when people violate the formed gender role norms, they may be disliked or ostracized by society (Eagly & Wood, 2011; Eagly et al., 2000).

Gender role norms are designed to maintain a hierarchy to reinforce men’s power and privilege over women, and this gender inequality and restrictive gender norms evolved into a host of health problems that may endanger all individuals, especially women and girls (Heise et al., 2019). One of the aims of the traditional gender role norms is to limit women’s reproductive choices, and such reproductive experiences will always be scrutinized and judged (Huang, 2019; Huang et al., 2016). For instance, people’s belief that “women should play roles in society that are appropriate to their identity” may influence their attitudes toward abortion (Osborne et al., 2022). Consequently, when women, for various reasons, choose to terminate a pregnancy, people’s negative attitudes and opposition toward them may arise. In this study, we thus focused on how certain gender role norms (including ambivalent sexism, traditional motherhood norms, and the sexual double standard) relate to abortion stigma.

Ambivalent Sexism and Attitudes Toward Abortion

According to ambivalent sexism theory (Glick & Fiske, 1996, 2001), hostile sexism (HS) represents a set of hostile and derogatory attitudes toward women that portray women as exaggeratedly emotional and always trying to gain the power to control men. In contrast, benevolent sexism (BS) encompasses a set of attitudes that praise those women who adhere to traditional gender roles. BS appears to view women in a positive light; however, they actually constrain women’s rights with the aim of relegating them to a subordinate position (Glick & Fiske, 1996, 2001). Notably, patriarchal protection may only be available to women who conform to traditional gender roles; contrastingly, women who challenge these roles may be considered unworthy of protection (Connor et al., 2017). In sum, both HS and BS aim to perpetuate traditional gender role stereotypes (Glick & Fiske, 1996, 2001).

Previous studies have revealed that individuals who identify with either type of sexism exhibit more anti-choice or stigmatizing attitudes toward abortion. For instance, people’s endorsement of HS and BS were significantly associated with their more attitudes against women’s elective abortions (e.g., terminating a pregnancy for reasons like career aspirations, financial insecurity, or a low desire to have children) and traumatic abortions (e.g., terminating a pregnancy for reasons like women’s health being threatened by the fetus or pregnancy due to rape) (Huang et al., 2014, 2016; Osborne & Davies, 2012), more anti-choice attitudes (Begun & Walls, 2015), and more stigmatizing attitudes toward abortion (Patev et al., 2019). Furthermore, men identified with higher levels of HS were more likely to believe that they have the right to limit women’s reproductive choices (Petterson & Sutton, 2018).

The emphasis on the hierarchy of men and women has a long history in traditional Chinese culture, one of which is the subordination of women to their husbands (Hong et al., 1993; Ruan, 2013). In terms of ambivalent sexism, prior studies have revealed that there are both disparities and consistencies in the acceptance of HS and BS between Chinese and American samples, and both similarities and differences exist between the two groups in terms of the effects of ambivalent sexism on mate selection preferences (Chen et al., 2009; Lee et al., 2010). Yet, there are few studies investigating the association between ambivalent sexism and abortion attitudes in a Chinese sample.

Motherhood and Abortion Attitudes

Traditional gender roles expect men to be breadwinners and women to be homemakers, thus, it can be observed that men are more likely to be involved in paid work and women are more likely to be involved in domestic behavior (Eagly & Wood, 2011). Accordingly, taking care of the family and being a good mother are perceived as central to a woman’s life and identity (Holton et al., 2009; McQuillan et al., 2008). Motherhood is considered a natural drive, an inevitable stage in intimate relationships, and an important factor in enabling women to feel socially, psychologically, and physically complete (Ulrich & Weatherall, 2000). However, these ideologies about motherhood may constrain women’s options and reproductive experiences in life (Ganong & Coleman, 1995; Huang, 2019; Huang et al., 2016), limit their agency in reproductive decisions, and overlook their own personal, social, and economic experiences (Ulrich & Weatherall, 2000).

Although traditional gender roles emphasize the importance of motherhood in family/marriage, women who become pregnant out of wedlock also need to confront the issue of abortion or childbirth. On the one hand, women who choose to terminate a pregnancy, whether outside of marriage or within marriage, may face stigma from others (Kumar et al., 2009; Norris et al., 2011). On the other hand, although out-of-wedlock motherhood/childbearing has become increasingly common among young women in Western countries in recent years (Peri-Rotem, 2016; Sawhill et al., 2014), women who give birth out of wedlock may face multiple dilemmas; for instance, single mothers are more likely to bear impaired mental health, poverty, social stigma, their children’s difficulties, and so forth (Brown & Moran, 1997; Ellison, 2003; Lipman et al., 2002). In summary, attitudes toward women who have abortions may be complex when women face a variety of dilemmas related to pregnancy or childbirth outside of wedlock.

Traditional Chinese culture also emphasizes that men are the breadwinners and women are the homemakers (男主外, 女主内), defining the roles that men and women should play in society (Xu, 2016). Today, given the promotion of relevant national policies, gender equality in China has made great progress; however, traditional gender role expectations still play a role in families and romantic relationships (Wu et al., 2021). A study of infertile women in Hong Kong revealed that some Chinese women showed a strong desire to have children in order to fulfill the requirements of motherhood and have a family, but those who were infertile may be blamed for their current situation (Tiu et al., 2018). In addition, being a mother is considered one of the criteria for an ideal woman in post-socialist China (Ho et al., 2018).

Since traditional Chinese culture emphasizes motherhood and family values, motherhood/childbearing out of wedlock is generally disapproved by Chinese people (Yu & Xie, 2015). Chinese single mothers may face financial penalties, economic poverty, and stigmatization from society (Kuang et al., 2022); thus, the percentage of out-of-wedlock childbearing is very low in China (Gietel-Basten & Verropoulou, 2018). Finally, most unmarried people who experience an unintended pregnancy are either forced to marry or have an abortion (Tang, 2022). In sum, Chinese traditional culture may still influence people’s views and choices about marriage and fertility in China (Li & Jiang, 2019).

As previously mentioned, the ideals of motherhood are at the root of abortion stigma (Kumar et al., 2009; Norris et al., 2011), and empirical studies have demonstrated that in New Zealand, people who agreed that women should fulfill their maternal duties reported more negative attitudes toward women’s abortions (Huang et al., 2016). However, studies exploring the association between motherhood norms and abortion attitudes remain relatively scarce, and few studies have explored this association in a Chinese cultural context.

The Potential Effect of Traditional Sexual Double Standard

The sexual double standard (SDS) contends that people hold different standards for men’s and women’s sexual behaviors and that these double standards provide more sexual freedom for men while imposing more sexual restrictions on women (Milhausen & Herold, 2002; Reiss, 1956). Accordingly, men are expected to play a dominant and active role, while women are expected to play a submissive and passive role in sexual behaviors (Muehlenhard & Quackenbush, 1998). Moreover, studies have revealed that sexually active women were rated more negatively than sexually inactive women (Endendijk et al., 2020). Reiss (1956, 1964) first raised and measured the concept of a double standard regarding premarital sex. Today, although premarital sex and sex outside a committed relationship are more accepted (Bordini & Sperb, 2013), people still hold the traditional double standards regarding casual sex, sexual debut at an early age, and general levels of sexual activity (Endendijk et al., 2020).

In China, traditional Confucianism and Taoism emphasized women’s chastity (i.e., sex can only happen in marriage), the suppression of women’s sexuality, and women’s submission to their husbands (Chi et al., 2015; Hong et al., 1993; Ruan, 2013). With the implementation of China’s opening-up policy, Chinese people’s attitudes toward sexuality have become more tolerant, and premarital sex is becoming more acceptable (Blair & Scott, 2019; Qian & Jin, 2020; Ruan, 2013). However, some Chinese male and female college students still believed that premarital sex is less acceptable for women than for men (Shu et al., 2016). Furthermore, Chinese young women’s attitudes toward sexual intimacy were associated more with family characteristics (e.g., parental educational attainment), whereas young men’s sexual attitudes were related more to their own individual traits (Blair & Scott, 2019). This may indicate that Chinese women’s sexuality is more likely to be affected by family values, whereas men’s sexuality is in their own hands. In sum, the traditional Chinese concept of sexuality may still be deeply rooted in Chinese society (Lyu et al., 2020), and Chinese women may still endure more restrictions on their sexuality.

Regarding abortion issues, researchers have emphasized that women’s experiences of sexuality and abortion are not isolated from each other. Conversely, abortion can be seen as part of a series of sex-related experiences (e.g., beginning with the vaginal sexual intercourse between a man and a woman, involving their choice of contraception, and the experience of pregnancy); therefore, the issue of abortion should be studied and understood in the context of sexuality (Kimport & Littlejohn, 2021). Moreover, claims of abortion stigma emphasize the ideal of women’s sexual purity, and the control of women’s sexuality by traditional gender roles contributes to the persistence of abortion stigma (Kumar et al., 2009; Norris et al., 2011). In sum, the issue of abortion is closely linked to the restrictions on women’s sexuality.

In sum, traditional SDS serves to govern women’s sexuality and limit their sexuality to reproduction. Accordingly, those who agree that a woman’s sexuality should be restricted may hold more stigmatizing attitudes when they learn that a woman has had an abortion. However, few studies have examined the association between traditional SDS and attitudes toward abortion.

The Current Study

To enhance the understanding of correlates to abortion stigma in a sample of Chinese people, this study examined the associations between Chinese people’s endorsement of ambivalent sexism (HS and BS), traditional motherhood norms, and traditional SDS with abortion stigma through a cross-sectional study. To the best of our knowledge, few studies have examined these associations in a sample of Chinese people.

In this study, we focused on heterosexual people who were in romantic relationships and had had sexual intercourse, as it may be in these groups that are more likely to face issues such as traditional gender role norms, unintended pregnancies, and abortions. Moreover, ambivalent sexism is fostered in heterosexual intimate relationships; although HS exhibits hostile/derogatory attitudes and behaviors toward women, BS serves to offset these costs by providing placating, caring, and protecting behaviors that enhance intimacy in romantic relationships (Hammond & Overall, 2017). In addition, young people in China are enduring a lot of pressure from the older generation and society; they are encouraged to get involved in heterosexual romantic relationships and get married as soon as possible, and married women are expected to have one or two children (Lu, 2022; Ni, 2022). Moreover, there is still a strong bond between reproduction and marriage in Chinese culture (Li, 2022). As a result, people in heterosexual romantic relationships in Chinese society may face much pressure regarding marriage and motherhood, and in this environment of multiple stressors, we would like to explore the views of this group on gender roles and abortion.

First, although previous studies have examined the associations between ambivalent sexism and attitudes against abortion (Begun & Walls, 2015; Huang et al., 2014, 2016; Osborne & Davies, 2012; Patev et al., 2019), data in the context of Chinese culture are still lacking. Therefore, we examined the association between ambivalent sexism and abortion stigma to verify the generality of prior findings and extend the understanding of abortion stigma in Chinese culture.

Second, given that abortion stigma emphasizes traditional norms of motherhood and sexual purity (Kumar et al., 2009; Norris et al., 2011) and Chinese women are constrained by traditional Chinese culture (Li & Jiang, 2019; Wu et al., 2021), we also tested the associations of traditional motherhood norms and traditional SDS endorsement with stigmatized attitudes toward abortion in a sample of Chinese people to validate the proposition of abortion stigma.

Based on the extant literature, we hypothesized that: participants’ endorsement of HS and BS are significantly and positively associated with stigmatized attitudes toward abortion (H1); participants’ endorsement of traditional motherhood norms is significantly and positively associated with stigmatized attitudes toward abortion (H2); participants’ endorsement of traditional SDS is significantly and positively associated with stigmatized attitudes toward abortion (H3).

Method

Participants and Procedure

Participants were recruited from a pool of respondents from a Chinese survey website, Credamo (www.credamo.com). The pool includes about three million participants from different provinces in China engaging in various occupations. Initially, 837 participants completed our survey, but 39 individuals were excluded from the analysis (12 individuals who did not identify themselves as heterosexual, 12 individuals whose responses’ z-scores fell outside three standard deviations of the mean, and 15 individuals who had not yet had sexual intercourse). This resulted in a convenience sample of 798 participants (18 to 56 years; M = 29.8, SD = 5.14).

Before conducting the online survey, the study was approved by the Ethics Committee of the authors’ university. The online survey was conducted from January to February 2022 and lasted about a month. Participants can actively and freely browse the company’s official website to fill out the survey, or they can freely click on the link in the tweets randomly sent to them by the company through WeChat or other platforms. We first presented the study’s purpose and inclusion criteria in Chinese on the first page of the online survey. The purpose was presented as “This survey aims to assess your attitudes toward gender roles and reproductive experiences,” and the inclusion criteria were presented as “We need you to be at least 18 years old, currently in a heterosexual romantic relationship, and to have had sexual intercourse with your partner.” Next, participants were provided clear instructions and assurances of confidentiality and were informed that they could withdraw from the survey at any time if they felt uncomfortable with the questions. Further, they provided their informed consent and completed the main survey. Finally, participants who completed the survey were paid approximately 5 CNY.

Except for the ambivalent sexism inventory (ASI), the Chinese versions of the scales used in this study were developed using the back-translation method. We additionally invited a psychology professional to review these Chinese versions to ensure that they were consistent with the original English text.

Measures

Ambivalent Sexism

The ambivalent sexism inventory (Glick & Fiske, 1996) was adopted to measure participants’ sexist attitudes. This scale includes 22 items assessing participants’ hostile and benevolent sexist attitudes. There were 11 items in both the HS and BS subscales. Sample items were “Women are too easily offended,” and “Women should be cherished and protected by men.” Responses were rated on a 6-point Likert scale (1 = strongly disagree to 6 = strongly agree) and summed and averaged. A higher score on the HS subscale indicated that participants endorsed more hostile attitudes toward women, while a higher score on the BS subscale indicated participants held more benevolent attitudes toward women (Cronbach’s α for HS = .84, and for BS = .76). The Chinese version of the ASI was developed by Chen et al. (2009) and Lee et al. (2010) and has been successfully used with Chinese respondents (Shi & Zheng, 2020; Xiao & Wang, 2021).

Motherhood Traditionalism

Following Holton et al. (2009), we adopted a subscale from the Attitude toward Women and Motherhood Scale. This subscale includes eight items that assess participants’ endorsement of traditional motherhood norms. A sample item was “A woman is not a ‘real woman’ until she becomes a mother.” Responses were rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) and were summed and averaged. A higher score indicated that participants were more inclined to believe that women should adhere to traditional norms of motherhood (Cronbach’s α = .83). The model fit indices of the confirmatory factor analysis (CFA) for this subscale were acceptable: χ2 = 92.95; df = 20; χ2/df = 4.65; standardized root mean square residual [SRMR] = .04; root mean square error of approximation [RMSEA] [90% CI] = .07 [.05–.08]; comparative fit index [CFI] = .96, Tucker-Lewis index [TLI] = .95.

Sexual Double Standard

The Double Standard Scale (Caron et al., 1993) was adopted to measure the traditional sexual double standard. This scale contains 10 items that assess participants’ acceptance of the traditional sexual double standard toward men’s and women’s sexuality. A sample item was “It is expected that a woman be less sexually experienced than her partner.” Responses were rated on a 6-point Likert scale (1 = strongly disagree to 6 = strongly agree) and were summed and averaged. A higher score indicated that participants held more traditional double standards for men’s and women’s sexual behaviors (Cronbach’s α = .77). The model fit indices of the CFA for this subscale were acceptable: χ2 = 194.223; df = 31; χ2/df = 6.27; SRMR = .05; RMSEA [90% CI] = .08 [.07–.09]; CFI = .94, TLI = .91.

Abortion Stigma

Three subscales (autonomy, discrimination, and secrecy) derived from Sorhaindo et al.’s (2016) abortion stigma were adopted in this study. Owing to the lack of a mainstream religious belief in China, statements such as “Women who have abortions will be punished by God” and “Women who have abortions should go to Church to ask forgiveness for their actions” do not fit the context of most Chinese people; therefore, we did not adopt the religion subscale. The autonomy subscale includes four items assessing participants’ attitudes about women’s right to make decisions about their own reproductive lives. The discrimination subscale includes 11 items assessing participants’ possible judgment and biased treatment of people who chose to terminate a pregnancy. The secrecy subscale includes four items that assess participants’ attitudes regarding whether people should proactively conceal an abortion. Sample items were “Women with children who choose to have an abortion do it to give the kids they already have a better life,” “Women who have an abortion are stupid,” and “Women who have an abortion should not tell anyone.” Responses were rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) and were summed and averaged for all 19 items. A higher score indicated participants endorsed more stigmatized attitudes toward abortion (Cronbach’s α for autonomy = .83, discrimination = .85, secrecy = .85, full scale = .70, respectively). The model fit indices of the CFA for the three subscales were acceptable: χ2 = 168.732; df = 32; χ2/df = 5.27; SRMR = .05; RMSEA [90% CI] = .08 [.07–.09]; CFI = .96, TLI = .94.

Demographic Information

Participants’ age, gender, sexual orientation, education, relationship status, and abortion experience were measured. Regarding abortion experience, women were asked “Have you ever experienced an abortion?” and men were asked “Have you ever experienced your partner’s abortion?” Responses included “yes” and “no.”

Analysis Plan

In this study, all analyses were performed using SPSS 22.0 (SPSS Inc., Chicago, IL, USA). First, descriptive statistics and the correlations of the main variables were calculated. Second, the assumptions of regression-based techniques were tested by assessing several indicators, for instance, ascertaining the absence of auto-correlation between the residuals through the value of Durbin-Watson, the linear relationships between independent and dependent variables through drawing a series of scatter plots, the homogeneity in the variance of residuals through drawing a scatter plot of standardized residuals, the distribution of residuals by drawing a P-P plot (with a normal curve) of standardized residuals, and the multicollinearity through the value of tolerance and variance inflation factors (VIF). Third, the hierarchical multiple regression analysis was performed to examine the associations of HS and BS, motherhood traditionalism, and the SDS with abortion stigma. Specifically, demographic variables including age, gender (0 = men, 1 = women), education (1 = senior high school and below, 2 = bachelor’s degree, 3 = master’s degree and above), marital status (0 = unmarried, 1 = married), and abortion experience (0 = no, 1 = yes) were added in the first step. Main study variables containing HS, BS, motherhood traditionalism, and the SDS were added in the second step.

Results

Descriptive Statistics and Preliminary Analyses

Descriptive statistics for demographic variables are shown in Table 1. In this study sample, the age range of participants was 18 to 56 years, of which 35.1% (n = 280) were men and 64.9% (n = 518) were women. For education, 89.2% of participants reported obtaining a bachelor’s degree. For relationship status and abortion experience, nearly 60% of the participants were married, and 23.7% reported having experienced an abortion.

Table 1 Sociodemographic characteristics by abortion stigma (n = 798)
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The bivariate correlation analysis showed that participants’ endorsement of HS, motherhood traditionalism, and traditional SDS were significantly and positively correlated with abortion stigma at moderate levels. There was also a relatively slight but significant positive correlation between the endorsement of BS and abortion stigma. Moreover, HS and BS were significantly and positively correlated with motherhood traditionalism and traditional SDS at small to moderate levels; motherhood traditionalism was also significantly and positively correlated with traditional SDS at a moderate level. The descriptive statistics for the study variables and correlation results are shown in Table 2.

Table 2 Descriptive statistics and bivariate correlations (n = 798)
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Primary Findings

First, the assumptions of regression-based techniques were basically satisfied, and the multicollinearity diagnostics revealed that all predictors had acceptable tolerance (tolerance = .60–1.00) and variance inflation factors (VIF = 1.01–1.68).

Second, the regression analysis showed that, first, endorsement of HS was significantly and positively associated with abortion stigma, suggesting that participants’ one standard deviation increase in levels of endorsement of HS was associated with a .22 (β = .22) standard deviation increase in stigmatized attitudes toward abortion (H1 was partially supported). Second, participants’ endorsement of traditional motherhood norms was significantly and positively associated with abortion stigma; specifically, participants’ one standard deviation increase in levels of recognition of traditional motherhood norms was associated with a .16 (β = .16) standard deviation increase in levels of stigmatized attitudes toward abortion (H2 was supported). Finally, participants’ endorsement of traditional SDS was significantly and positively associated with abortion stigma, indicating that their one standard deviation increase in levels of endorsement of traditional SDS was associated with a .30 (β = .30) standard deviation increase in levels of stigmatized attitudes toward abortion (H3 was supported). However, participants’ endorsement of BS was not significantly associated with their stigmatized attitudes toward abortion.

In addition, regarding the demographic variables, participants’ abortion experiences were significantly and negatively associated with abortion stigma (β = -.09), suggesting that those who had experienced abortions reported lower levels of stigmatized attitudes toward abortion. Participants’ age, gender, level of education, and marital status were not significantly associated with their stigmatized attitudes toward abortion. The results are shown in detail in Table 3.

Table 3 Gender role norms associated with abortion stigma (n = 798)
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Discussion

As abortion stigma is rooted in traditional gender role norms and may exist in countries where abortion is less restricted, this study explored the associations between endorsement of traditional gender roles (including ambivalent sexism, motherhood traditionalism, and traditional SDS) and abortion stigma based on a sample of Chinese people to extend the current literature regarding abortion stigma.

First, findings demonstrated that participants with more hostile and demeaning sexist attitudes toward women reported more stigmatized attitudes toward women who have abortions (e.g., opposing that women have the right to control their reproductive lives, holding more judgmental and biased attitudes toward women who have abortions, or supporting that abortion experience should be concealed). This result was in line with previous findings (Begun & Walls, 2015; Huang et al., 2014, 2016; Osborne & Davies, 2012; Patev et al., 2019) that HS was positively associated with people’s opposition to abortion and more negative attitudes toward women who have abortions. Moreover, HS is designed to punish women who violate traditional gender roles or those who attempt to override men’s power (Glick & Fiske, 1996, 2001); those women who pursue to terminate a pregnancy may be perceived as attempting to deviate from the domestic sphere they should devote to and violating the natural femininity and womanhood (Patev et al., 2019). Additionally, people with higher levels of HS may generally hold hostile attitudes toward women (Osborne & Davies, 2012). As a result, these people show more stigmatized attitudes toward women who have abortions.

However, in this study, BS was not significantly associated with abortion stigma. This seems inconsistent with previous propositions and findings that BS played a unique role in restricting women’s reproductive rights (Osborne et al., 2022) and was positively associated with opposition to abortion (Begun & Walls, 2015; Huang et al., 2014, 2016; Osborne & Davies, 2012). It is possible that in Chinese culture, notions like “good men should cherish and protect women” as emphasized by BS are always considered positive and more acceptable to Chinese men and women (Chen et al., 2009). The participants recruited in this study may not subjectively perceive the nature of BS as negative. Therefore, participants’ endorsement of BS did not show a strong effect on their stigmatized attitudes toward abortions in the current sample. However, future studies need to delve further into Chinese people’s perceptions of BS and their association with abortion attitudes.

Second, individuals who strongly identified with traditional norms of motherhood (e.g., being a mother should precede a woman’s career; it is selfish not to want children) were more likely to hold more stigmatized attitudes toward women who have abortions. This result was in line with Huang et al.’s (2016) findings, which showed that individuals’ endorsement of traditional motherhood was significantly associated with their opposition to women seeking termination of pregnancy. Notably, this finding also confirmed the proposition of abortion stigma: women who seek to terminate their pregnancies violate the norms of motherhood (Kumar et al, 2009; Norris et al., 2011). Motherhood was considered to be a natural motivator that enriches women physically and spiritually (Ulrich & Weatherall, 2000). When women choose to terminate a pregnancy, people may perceive them as refusing to fulfill their obligations as mothers or choosing to achieve their personal goals rather than continue the pregnancy. As a result, people exhibited more judgmental and biased attitudes toward women who have abortions.

Third, participants who agreed that women’s sexuality should be restricted (e.g., sexually active women are less likely to be considered ideal partners) were more likely to have more stigmatized attitudes toward women who have abortions. This finding verified the claim that women who have abortions violate the ideal of women’s sexual purity or sex for procreation (Kumar et al., 2009; Norris et al., 2011). Moreover, since more than half of all unintended pregnancies end in abortion, it may be easy to associate abortion with unintended pregnancies (Bearak et al., 2020). Accordingly, women who experience unintended pregnancies may be stigmatized and may be blamed for seeking fleeting sexual pleasure without considering the consequences or not using contraception effectively (Norris et al., 2011). In addition, restrictions on women’s premarital sex, as emphasized by the traditional SDS, may also be the reason why abortion stigma affects young and unmarried women more severely (Makleff et al., 2019). Finally, the positive association between traditional SDS and abortion stigma may also reflect the persistence of traditional Chinese cultural restrictions on Chinese women’s sexuality (Chi et al., 2015; Hong et al., 1993; Ruan, 2013).

Moreover, findings also showed that participants’ experience of abortion was associated with their lower levels of stigmatized attitudes toward abortion; this result was consistent with Woodruff et al.’s (2018) findings that women who have experienced an abortion were more likely to support abortion rights. It is possible that individuals with more abortion experience may have a more comprehensive and accurate understanding of abortion. Therefore, they exhibited less stigmatized attitudes toward abortions. Future research could focus on people who have experienced abortion and delve into their views.

In addition, the positive correlations of HS and BS with motherhood traditionalism conformed to previous findings that people living in New Zealand with higher levels of HS/BS reported more traditional attitudes toward motherhood (Huang et al., 2016); both American men’s and Mexican men’s and women’s endorsement of BS were associated with their more positive attitudes toward women who had young babies (Chrisler et al., 2014). Further, the positive correlations of HS and BS with traditional SDS were consistent with previous studies that revealed that people’s higher levels of identification with HS were associated with an increased agreement with traditional SDS (Rudman et al., 2013); they were also consistent with a study that found that men and women who endorsed higher levels of HS and BS rated sexually active women more negatively than sexually active men (Zaikman & Marks, 2014).

In summary, consistent with the claims of social role theory (Eagly & Wood, 2011; Eagly et al., 2000), these traditional gender roles were designed to limit various aspects of women’s equal rights and perpetuate hierarchical differences between men and women; therefore, it is reasonable to expect positive correlations between them. Moreover, these gender roles regulate different aspects of men’s and women’s lives, for instance, both HS and BS serve to justify men’s power over women (Glick & Fiske, 1996, 2001); traditional motherhood norms expect women to become mothers and to be good mothers (Holton et al., 2009; McQuillan et al., 2008); the traditional SDS sets rules for men and women in the area of sexuality (Milhausen & Herold, 2002; Reiss, 1956). Thus, they are related to each other to different degrees, and their associations with abortion stigma also vary.

The associations between gender role norms (HS, motherhood traditionalism, and traditional SDS) and abortion stigma also validate the predictions of social role theory (Eagly & Wood, 2011; Eagly et al., 2000). According to this theory, women are expected to work in the domestic sphere, such as bearing/raising children and taking care of the family; however, when women violate these gender role norms, they may be disliked or ostracized by society (Eagly & Wood, 2011; Eagly et al., 2000). Women who have abortions may be perceived as violating the ideals of motherhood, sexual purity, and dedication to the domestic sphere; therefore, they are subjected to negative judgment (stigma) from others. Furthermore, the potentially detrimental effects of HS, motherhood traditionalism, and traditional SDS on abortion stigma found in this Chinese sample may indicate the cross-cultural consistency in the restrictions on women’s gender roles and their reproductive experience.

Policy Implications

The findings of this study provide several implications for gender equality education, as well as for sexual and reproductive health services. Given the inadequacy of comprehensive sexuality education in China (Zhou et al., 2021) and the potential adverse effects of traditional gender role norms on abortion attitudes found in this study, policies should promote the implementation of comprehensive sexuality education. First, gender equality education should focus on improving students’ ability to identify sexism in their daily lives and should be integrated into the school curriculum structure so that students can develop gender equality consciousness from an early age to reduce later sexism. Furthermore, findings on traditional motherhood norms and traditional SDS may remind us that gender equality education should promote a more comprehensive understanding of gender roles in order to break their stranglehold. In sum, individuals and societies must overcome the barriers rooted in social norms and values, especially gender inequality, to promote people’s sexual and reproductive health (Starrs et al., 2018). Second, given the biased attitudes surrounding abortion, sexuality education should also focus on providing more comprehensive knowledge of sexual and reproductive health (e.g., contraceptive methods and their use, and information on pregnancy and abortion). By raising awareness of contraceptive methods and their use, people may use contraceptives more correctly and effectively, thereby may reduce the number of unintended pregnancies. Moreover, a more comprehensive understanding of pregnancy and abortion can also help reduce misconceptions about them. Third, family planning programs in China have focused primarily on married people, while the sexual and reproductive health needs of unmarried people have not been adequately addressed (Tang, 2022). Thus, policies related to sexual and reproductive health should expand their target population, enrich their services, and pay more attention to the mental health of individuals involved in abortion issues to prevent the potential harm of abortion stigma.

Limitations and Future Directions

This study is not without limitations. First, this study is correlational, so we were unable to draw causal conclusions. Experimental studies should be conducted to elucidate causal relationships between study variables; for example, vignettes can be used to create specific situations regarding gender roles and abortion so that participants can make judgments accordingly. Longitudinal studies and in-depth interviews should also be performed to explore the deep associations between gender roles and abortion attitudes, as well as people’s deeper thoughts regarding gender roles and abortion.

Second, our survey data were collected online; thus, participants interested in this study were more likely than others to fill out the survey. As participants were recruited from the Internet and 89.2% of them had a bachelor’s degree, most of the participants may have been living in cities. However, previous studies have revealed that young people with urban backgrounds hold more liberal attitudes than those with rural backgrounds (Higgins & Sun, 2007). In addition, most of our participants (89.9%) were within the 18–35 years old range; influenced by Chinese traditional culture, older people may hold more traditional gender role attitudes than young adults. Finally, this study only included participants who identified as heterosexual, were currently in a romantic relationship, and had engaged in sexual intercourse, limiting the generalizability of our findings to individuals with different sexual orientations or relationship statuses, as well as those who have not yet had sexual intercourse. Moreover, people who engage in casual sex may also be at high risk for unintended pregnancy and abortion (Yuan et al., 2022). In addition, although traditional gender roles are primarily relevant for heterosexual people, and non-heterosexual people may not have to face the risk of unintended pregnancy and abortion frequently, this does not mean that they are not affected by traditional gender roles or that they do not have attitudes toward gender roles and abortion. In sum, future studies should focus on the attitudes of non-heterosexual groups, those who engage in casual sex, and those with more diverse characteristics to ensure more in-depth results and gain a more comprehensive picture of abortion attitudes.

Third, this study only focused on people’s general stigmatized attitudes toward abortion. As abortion stigma also includes those whose work involves abortions and who support women’s abortions (Norris et al., 2011), future studies could further explore other forms of abortion stigma to gain a more comprehensive understanding of the abortion stigma in the Chinese cultural context. Moreover, little is known about people’s attitudes toward the men involved in their partner’s abortions. That is, a woman’s decision to terminate a pregnancy may be influenced by her male partner. It may be interesting to investigate people’s attitudes toward those men who are involved in abortion. Notably, we only measured the general level of abortion stigma in this study, and we do not further distinguish whether the abortion stigma is directed toward women who have abortions before marriage or abortions after marriage. In China, premarital pregnancy/abortion is considered a social issue (Lai, 2019; Zhou et al., 2021), and most unmarried people who experienced an unintended pregnancy either end up in a marriage or an abortion (Tang, 2022). Therefore, future studies should further distinguish people’s attitudes toward women who have abortions before versus after their marriage to eliminate this distinction and guarantee reproductive rights for all women.

Finally, other factors that may influence attitudes toward abortion should also be considered in future studies. For example, regarding contraceptive responsibility and unintended pregnancy, men usually implicitly believe that women should be in charge of contraception (Sharp et al., 2015) and abortion may be related closely to unintended pregnancy and contraception use (Bearak et al., 2020), are attitudes about who should be responsible for contraception linked to stigmatizing attitudes related to abortion? And do people also have stigmatizing attitudes toward unintended pregnancies? In addition, feminism in China is springing up in recent years (e.g., on social media), and a portion of Chinese people are awakening to gender equality (SCMP, 2022; Yin & Sun, 2021); it may be interesting and valuable to explore the association between people’s feminist identities/attitudes and their attitudes toward abortion.

Notably, the one-child policy, which limited a couple to only one child, started in 1980, was relaxed in 2013 (selective two-child policy), and officially ended in 2016 (universal two-child policy; Feng et al., 2016). The one-child policy may have exacerbated son preference and led to an imbalance in the sex ratio (Li et al., 2011). Although this policy has now been discontinued, son preference has not disappeared in China today (Wang et al., 2020) and it may contribute to sex-selective abortion (Zhou et al., 2012). However, we did not distinguish between individuals who were affected by the one-child policy at their fertile age, and we also know little about the abortion attitudes of those who exhibit higher levels of son preference. In addition, religious beliefs have been shown to be an important predictor of negative attitudes toward abortion in Western countries (Adamczyk, 2022; Osborne et al., 2022). Although there is no mainstream religion in China, people are legally free to follow any religion (Li, 2020); therefore, people who follow Western Christianity or other forms of religion that oppose abortion should also be considered in future studies.

Conclusion

This study examined the associations between traditional gender role norms (ambivalent sexism, motherhood traditionalism, and traditional SDS) and stigmatized attitudes toward abortion, based on the theoretical frameworks of social role theory and the propositions of abortion stigma, to shed light on the potential effects of traditional gender roles on abortion attitudes in a Chinese sample. The findings revealed that the more people identified with traditional gender role norms (HS, motherhood traditionalism, and traditional SDS), the more stigmatized attitudes toward abortion they may exhibit. The findings also confirmed the propositions of social role theory that women who violate the traditional gender roles would be criticized by society, as well as the assumptions of abortion stigma that women who have abortions violate the ideals of motherhood and sexual purity. Overall, these findings provide a better understanding of traditional gender roles and attitudes toward abortion. Policies should promote comprehensive sexuality education to awaken Chinese people’s awareness of gender equality and increase their knowledge of sexual and reproductive health. Family planning services should expand their target population, enrich service content, and focus on post-abortion mental health care.