ALCOHOLISM: CLINICAL AND EXPERIMENTAL RESEARCH Vol. **, No.

*
** 2017

The Public Stigma of Birth Mothers of Children with Fetal

Alcohol Spectrum Disorders
Patrick W. Corrigan, Juana Lorena Lara , Binoy Biren Shah, Kathleen T. Mitchell,
Diana Simmes, and Kenneth L. Jones

Background: Stigma aects not only the person with a stigmatizing condition such as fetal alcohol
spectrum disorders (FASD), but also their family members. This study examined whether there are stig-
matizing attitudes about biological mothers of children with FASD in a crowdsourced sample.
Methods: Three hundred and eighty-nine participants were asked to rate levels of dierence, dis-
dain, and responsibility on 4 conditions: serious mental illness (MI), substance use disorder (SUD), jail
experience, and FASD. A budget allocation task was administered as a proxy of discrimination. Prior
experience with each of the 4 conditions was noted to assess familiarity.
Results: Research participants viewed mothers of children with FASD as more dierent, disdained,
and responsible than women with serious MI, SUD, and jail experience. Budget allocation toward
FASD service programs was signicantly lower than that toward all other human service programs.
Familiarity with the 3 comparison conditions moderated most of the stigma ratings, but this eect was
not seen in the FASD condition.
Conclusions: Results supported the notion that mothers of children with FASD are highly stigma-
tized for their past behavior. The data also suggested that the public might discriminate against this
population. Stigma reduction interventions should focus on contact-based strategies, rather than educa-
tion-based strategies.
Key Words: FASD, Stigma, Mothers, Alcohol, Familiarity.

A RECENT REPORT from the National Academy of

Sciences (NAS; 2016) suggested public stigma has
harmful eects on people with behavioral health disorders
mental illnesses (MI) and/or substance use disorders (SUDs)
frequently undermining life goals related to education,
work, independent living, and relationships. Public stigma is
dened as stereotypes, prejudice, and discrimination
extended to a labeled group by the general population (Thor-
nicroft, 2006). The NAS report showed that while the harm-
ful eects of stigma on MI versus SUD varied, both were
viewed worse than most other comparison conditions includ-
ing previous experience in jail. Jail experience is often used as
an anchor of a highly stigmatized condition (Corrigan et al.,
2010). Given that fetal alcohol spectrum disorders (FASD)
fall within the broad class of behavioral health disorders, we
might expect that children with FASD are harmed by stigma
as outlined by the NAS. FASD is caused by prenatal alcohol
From the Illinois Institute of Technology (PWC, JLL, BBS), Chi-
cago, Illinois; National Organization on Fetal Alcohol Syndrome
(NOFAS) (KTM), Washington, District of Columbia; and Department
of Pediatrics (DS, KLJ), University of California, San Diego, La Jolla,
California.
Received for publication November 21, 2016; accepted March 20,
2017.
Reprint requests: Patrick W. Corrigan, PsyD, 3424 South State St.,
First floor, Chicago, IL 60616; Tel.: 312-567-6751; Fax: 312-567-6753;
E-mail: corrigan@iit.edu
Copyright 2017 by the Research Society on Alcoholism.
DOI: 10.1111/acer.13381
Alcohol Clin Exp Res, Vol **, No *, 2017: pp 18
exposure that yields varied adverse outcomes in children
born to women who consume alcohol during pregnancy,
including signicant structural brain damage (Jones and
Smith, 1973; Riley et al., 2011). The stigma experienced by
people with serious MI is often extended to family members,
which Goman (1963) called courtesy stigma. Parents, in
particular, are often blamed for their adult childs MI
(Moses, 2014). Hence, the research question in this study is
whether there is public stigma toward birth mothers of chil-
dren with FASD.
While several authors have conceptually tackled concerns
related to stigma and mothers of children with FASD (Arm-
strong and Abel, 2000; Bell, 2014; Bell et al., 2015), very little
research has examined the phenomenon. A 1-year news
media analysis in Australia showed 2 themes reecting
FASD stigma: sympathy for the child with FASD and dis-
dain for the biological mother (Eguiagaray et al., 2016). A
2016 Washington Post article describing a personal story of
one familys experience with FASD yielded more than 750
online responses from the general public (Fleming, 2016);
42% were rated negative in a post hoc analysis conducted by
one of the authors (KTM). For example, Women who are
unable to stay clean during their pregnancy,. . . should not be
allowed to have children. A qualitative study of interviews
from mothers who drank alcohol heavily during pregnancy
uncovered themes such the following: These mothers are
bad, this often happens because of poverty, and there are
several hurdles to recovery (Jacobs and Jacobs, 2014). Find-
ings from these qualitative studies provide useful hypotheses
1
2 CORRIGAN ET AL.
to be tested in future work. In this study, we test the hypothe-
ses with quantitative methods, state-of-the-art measures, and
experimental design.
This study compares the public stigma of mothers of chil-
dren with FASD to women with MI, SUD, or jail experience.
Cross-condition studies of stigma such as these can be di-
cult because the stereotypes of a labeled group are specic to
that group. For example, stereotypes about psychiatric disor-
ders frequently reect concerns about unpredictable violence,
while those for SUDs represent concerns about crime and
lawlessness. One research program has found perceptions of
dierence as a trans-health condition measure of stigma:
that an indexed group is stigmatized to the degree that they
are viewed as dierent than everyone else (Corrigan et al.,
2015; Link and Phelan, 2001). Dierence leads to disdain;
notions that labeled people who are distinct from the average
member of the general population are less valued and more
disrespected. Dierence and disdain are exacerbated by ideas
of responsibility; that is, the labeled individual is to blame
for the stigmatized condition (Corrigan et al., 2000, 2002).
In this study, we compare public perceptions of dierence,
disdain, and blame in 4 groups: women with MI, SUD, jail
experience, and history of being a birth mother of a child
with FASD. We expect the public to view the latter group
with greater dierence, disdain, and blame.
Stigmatized conditions are moderated by familiarity, the
degree to which research participants know about or interact
with people that have the stigmatized condition (Angermeyer
et al., 2004). Familiarity varies from the least aware (never
met a person with MI, SUD, or jail experience) to the most
intimate familiarity (actually being a woman with one of
these conditions). Research suggests those with MI or SUD
are less likely to view others with these conditions in a stig-
matizing manner, that is, less likely to view them as dierent
or with disdain and blame. In this study, we hypothesize that
research participants familiar with the specic conditions
MI, SUD, jail, FASDthrough their lived experience will
endorse dierence, disdain, and blame lower than other
research participants.
Stigma has its behavioral impact in terms of discrimina-
tion. One way discrimination has been measured in the
research literature is in terms of policy decisions (Skitka and
Tetlock, 1992). For example, legislators who endorse stigma
of a group are less likely to support policies that provide or
encourage resources for that group. Research suggests MI
stigma is inversely related to budget recommendations for
mental health programs (Corrigan et al., 2004). Policy deci-
sions have been operationalized for survey measures as hypo-
thetical budget allocations; research participants are
instructed to allocate $100 million of state monies to 10
human service programs. Past research showed that stigma-
tized conditions such as MI and SUD are allocated signi-
cantly fewer dollars than programs such as HIV/AIDS
services, Medicaid assistance, and healthy kids (Corrigan
et al., 2004). We hypothesize that research participants will
allocate the least amount of funds to programs that serve
mothers of children with FASD.
MATERIALS AND METHODS
Adults were solicited to participate in this study using Amazons
Mechanical Turk (MTurk), a crowdsourcing Internet marketplace
network that, among other things, is used to recruit participants for
social science research. Qualications to be an MTurk worker are
limited to being age 18 and over and being able to read text. Ama-
zon limits qualications to grow the MTurk pool because research
on a large pool is likely to yield more diverse samples that are
more representative of the population. Data show that more than
500,000 workers in more than 190 countries are registered with
MTurk (Amazon Web Services, 2011) with approximately 80% of
this group being from the United States (MTurk, 2015). While
research is mixed regarding the degree to which demographics of
MTurk workers match the U.S. population (Buhrmester et al.,
2011; Paolacci et al., 2010; Ross et al., 2010), this is less of a prob-
lem for studies such as the current one in which internal validity to
test hypotheses is more of a concern. Psychometric reliability and
validity of responses are signicantly better for MTurk compared to
other crowdsourcing platforms (Kraiger et al., 2017). For example,
each MTurk worker ID is linked to a unique credit, so the odds of
having multiple responses from same participant are low. Research
supports high internal consistency of MTurk data with a coecients
ranging from 0.73 to 0.93 (Buhrmester et al., 2011). Although time
expectation and reward may aect participation rates, it does not
aect reliability (Rouse, 2015). Qualtrics was the platform used to
develop an electronic version of the questionnaire and to record
responses, which was distributed to the pool of potential partici-
pants using MTurk.
For recruitment of a U.S. sample, a solicitation was posted in
MTurk requesting workers to participate in a 15-minute survey to
measure and compare the public stigma of Fetal Alcohol Syn-
drome. MTurk also has a unique feature that allows researchers to
select the location from where they want to recruit their sample.
This feature was used to ensure a U.S. sample for this study. Consis-
tent with our commitment to pay MTurk workers minimum wage,
participants completing this task took, on average, 17 minutes and
were reimbursed $1.83.
Four hundred and fty MTurk workers responded to the solicita-
tion and were assessed for eligibility, yielding a total sample size of
389. One concern about online surveys is having research partici-
pants who demonstrate insucient eort responding (Huang et al.,
2015) by failing to fully attend to the task. Threats to internal valid-
ity were minimized by including validity questions within the ques-
tionnaire. We excluded people in this group who were not attending
well; for example, Please choose the number 4 for your answer
below. Additionally, people whose time on task was below mini-
mal cuto (3 minutes after viewing vignette) to complete the survey
competently were excluded. As a result, 389 MTurk workers pro-
vided useable data. Prior to beginning the survey, prospective
research participants were informed of the goals and methods of the
study and were asked for an electronic signature of consent. The
study was fully reviewed and approved by the IRB at the Illinois
Institute of Technology. Participants were exposed to the consent
form, measures, and conditions through Qualtrics, an online self-
administered survey platform.
Survey respondents answered items about demographics; these
are summarized in Table 1. Overall, the sample was 35.2 years of
age on average (SD = 10.9) and 45.0% female. Research partici-
pants self-reported largely as white (82.0%) although also included
African/African American and Asian/Asian American participants
at rates consistent with the U.S. census. About 6% of the sample
THE STIGMA OF BIRTH MOTHERS OF CHILDREN WITH FASD 3

reported being Latino. The sample was 90.0% heterosexual. Educa- Table 1 also includes indices of familiarity with the 4 health con-
tional achievement varied, with more than 75% reporting some ditions of interest. More than one-fth of the sample reported hav-
college or higher. In terms of employment, 60.4% were working ing been diagnosed or treated for MI, about 8% diagnosed/treated
full-time and 15.4% part-time. Incomes varied with 78.2% of for SUD, and 11.3% with previous jail stays. From the entire sam-
participants reporting annual income less than $75,000. ple of 389, only 2 participants reported being a biological mother of
a child with FASD. However, 7.2% of the sample reported knowing
a child with FASD. After signing the consent form electronically,
Table 1. Demographics
participants were provided with brief denitions of the 4 health con-
ditions.
1. By MI, we mean women who show symptoms of severe depres-
Means (SD) or N and sion, anxiety, hallucinations, delusions, or paranoia.
Demographic variable frequencies (%)
2. By SUD, we mean women who are addicted to alcohol or other
Age M = 35.2 drugs.
SD = 10.9 3. By jail, we mean women who have been incarcerated for less than
Gender 2 years, generally for a lesser crime.
Female N = 175 (45.0 %) 4. Fetal alcohol syndrome (FAS) is a condition experienced by new-
Male N = 212 (54.5 %)
borns often causing a range of developmental, cognitive, or
Transgender N = 1 (0.3%)
Preferred not to answer N = 1 (0.3%)
behavioral problems. The child gets FAS because the mother
Race was binge drinking or regular heavy drinking during pregnancy.
American Indian/Alaskan Native N = 8 (2.1%)
We described the condition as FAS rather than FASD because of
African/African American N = 37 (9.5%)
Asian/Asian American N = 31 (8.0 %) qualitative data from a single focus group of 8 adults (3 men). These
Native Hawaiian or Pacific Islander N = 2 (0.5%) adults were recruited as representatives of the general population
European/European American N = 319 (82.0%) using an interview guide developed by the authors of this study.
Other N = 3 (0.8%) Independent raters examined responses specic to the goals outlined
Ethnicity (Latino/Latina) in this study. Transcripts were reviewed for recurrent themes using
Yes 22 (5.7%) Loand and Loands (1984) systematic ling system and Bergs
No 367 (94.3%) (2004) themes-to-concepts paradigm, which allowed us to combine
Sexual orientation similar themes into categorical frameworks. Research assistants
Straight N = 350 (90.0%)
reviewed all responses for each question identifying category labels
Gay/Lesbian N = 15 (3.8%)
Bisexual N = 20 (5.1%) that summarized key concepts. Two research assistants, not
Other N = 3 (0.8%) involved in the initial sorting process, were asked to sort the con-
Preferred not to answer N = 1 (0.3%) cepts into corresponding categories. Analyses included considera-
Education tions of reexivity. Recognizing that interpretation cannot occur
Some high school N = 5 (1.3%) outside of the interpreter (Gergen and Gergen, 2000), margin
High school diploma N = 89 (22.9%) remarks were added to the data collected and used in analyses to
Vocational or technical training N = 34 (8.7%) represent facilitator and scribe perceptions of the context in which
Associated degree N = 63 (16.2%) remarks were provided (Miles and Huberman, 1994). Subsequent
Bachelors degree N = 145 (37.3%)
review of the data sought to answer questions about how the general
Some graduate school N = 12 (3.1%)
Graduate degree N = 37 (9.5%) population comprehends FASD, its course, and treatment. Two
Other N = 4 (1.0%) ndings are relevant here and used for the denition. First, the con-
Employment cept of FASD was less familiar than FAS, hence the use of the latter
Full-time N = 235 (60.4%) term for the questionnaire. Second, participants typically associated
Part-time N = 60 (15.4%) FAS with newborns. In all cases, people with the condition were
Retired N = 7(1.8%) described as women and the order of conditions was randomized
Attending school N = 15 (3.9%) across research participants.
Unemployed N = 31 (8.0%) After reading each denition, research participants answered 3
Stay-at-home parent N = 33 (8.5%)
items about dierence (the women are similar, like, or comparable
Other N = 8 (2.1%)
Household income to others) and 3 items about disdain (the women are not good, not
0 to $25,000 N = 78 (20.1%) respected, or not favorable compared to others) on a 9-point agree-
$25,001 to $49,999 N = 122 (31.4%) ment scale. After reverse-scoring some items in each scale, mean
$50,001 to $74,999 N = 104 (26.7%) scores were determined with higher scores representing greater per-
$75,001 to $99,999 N = 45 (11.6%) ceptions of dierence and disdain. The range of internal consisten-
$100,000 to $124,999 N = 19 (4.9%) cies for dierence across the 4 conditions was good (range of
$125,001 to $149,999 N = 13 (3.3%) adi = 0.80 to 0.84). Those for disdain were noticeably lower (range
Greater than $150,000 N = 8 (2.1%) of adis = 0.64 to 0.73). Research participants also completed a single
Previous experience with MI
item representing blame for each conditionHow responsible do
Yes N = 86 (22.1%)
No N = 303 (77.9%) you think a woman with _______ is for her condition?on a 9-
Previous experience with SUD point scale (9 = very responsible). Previous research has found this
Yes N = 30 (7.7%) single item to be a reliable and valid measure of blame (Corrigan
No N = 359 (92.3%) et al., 2000, 2002). Research participants were then instructed to
Previous experience with jail complete the budget allocation task.
Yes N = 44 (11.3%)
No N = 345 88.7 (%) The budget in your state for all human services is 100 million
Do you know a child with FASD? dollars. In this exercise, we want you to act as a legislator who
Yes N = 28 (7.2%) must decide how to divide the 100 million dollars among the ten
No N = 361 (92.8%) human services programs listed below. You can decide to give as
4 CORRIGAN ET AL.
little as nothing or as high as the entire 100 million to any indi-
vidual human service. All money must be assigned, however; the
total should add up to 100 million dollars. Write zero in any
space to which you decide to give NO money. Assign monies to
each Human Service Program in million dollar increments (for
example, if you want 2 million, 27 million, 78 million just write 2,
27, 78) and not fractions thereof (for example, 1,500,000 or
25,300,000).
Research participants were given 10 human service programs
across which funds were to be dispersed. This allocation included
programs for MI, SUD, jail, and FASD. The full list is summarized
at the bottom of Fig. 2. Previous research has found this to be a reli-
able and valid measure of discrimination toward health conditions
(Corrigan et al., 2004; Skitka and Tetlock, 1992).
Statistical Analyses
Data were examined for patterns of missing data; consistent with
previous MTurk studies, almost no missing data were found, so no
imputations were conducted. Distributions of dierence, disdain,
and blame scores were examined and showed minimal skew or kur-
tosis, so no transformations were conducted. One-way repeated-
measures ANOVAs were completed to examine dierence, disdain,
and blame scores across conditions. Post hoc tests were completed
where signicant ndings emerged.
Then, 2 9 4 mixed analyses of variance (ANOVAs; familiarity
group by perception of conditions) were conducted to determine
whether previous experience with MI, SUD, and jail moderated dif-
ference, disdain, and blame. Because self-report of previous experi-
ence as a mother of a child with FASD was so low (2 respondents),
we used knowledge of a child with FASD as the proxy of experience
(Do you know a child with Fetal Alcohol Syndrome FAS?). Post
hoc between-group ANOVAs (experience with condition: yes or no)
were completed to determine whether familiarity diminished dier-
ence, disdain, and blame with its corresponding condition. This rep-
resented 48 post hoc tests, so signicance was reported as p < 0.05
and as its Bonferroni correction, p < 0.001.
Means and standard deviations of dollars allocated to human ser-
vice programs were then determined. A 1-way repeated-measures
2
dierence
SMI
F(3,386)=60.09, p<.001, F(3,386)=135.09, p<.001,
2=0.32
Fig. 1. Mean ratings of difference, disdain, and blame for serious mental illness (SMI), substance use disorder (SUD), jail, and fetal alcohol spectrum
disorder (FASD).
ANOVA examined dierences in allocated monies across programs.
Post hoc tests compared allocations for FASD services to other
human service programs.
RESULTS
Means of dierence, disdain, and blame ratings across the
4 health conditions are summarized in Fig. 1. One-way
repeated-measures ANOVAs were completed for dierence,
disdain, and blame ratings and are summarized in the gure.
In each case, F tests between conditions were highly signi-
cant (p < 0.001) and marked by small-to-medium eect sizes
(g2 range: 0.32 to 0.67) using Cohens criteria for assessing
eect size (Cohen, 1988). Post hoc analyses showed that
research participants viewed mothers of children with FASD
as signicantly more dierent than all the other 3 conditions
(p < 0.001, g2 > 0.18). Similarly, research participants rated
mothers who have given birth to a child with FASD with
greater disdain than the other 3 conditions (p < 0.001,
g2 > 0.29). Interestingly, women with serious MI were
viewed with less disdain than the other conditions
(p < 0.001, g2 > 0.19). Finally, mothers of children with
FASD were viewed as signicantly more to blame for the
condition than the other groups although eect sizes were a
little lower (p < 0.001, g2 > 0.04). Once again, women with
serious MI were viewed better (with less blame) than the 3
conditions (p < 0.001, g2 > 0.49).
The relationships between familiarity and perceptions of
dierence, disdain, and blame are summarized in Table 2.
Post hoc 1-way ANOVAs with p-values meeting the Bonfer-
roni criterion (p < 0.001) are boldfaced in the table. Cells
with p-values less than 0.05 are shaded in the table. Note that
familiarity with MI, SUD, and jail moderated many of the
dierence and disdain ratings and one of the blame ratings.
disdain blame
SUD jail FASD
F(3,386)=259.59, p<.001,
2=0.51 2=0.67
THE STIGMA OF BIRTH MOTHERS OF CHILDREN WITH FASD 5

Table 2. Mean and Standard Deviations (M [SD]) of Difference, Disdain, and Blame Ratings Across Health Conditions (MI, SUD, jail, FASD) by
Previous Experience with MI, SUD, Jail, or FASD. Each Cell has a 1-Way Between-Group ANOVA Representing Differences in Ratings Between Those
With and Without Experience. p-Values for Tests Meeting Bonferroni Criteria are in Bold Font. Cells Showing p < 0.05 are Shaded.

Experience with. . . MI SUD Jail FASD

Difference
MI
Yes 4.92 [1.91] 4.49 [2.15] 5.65 [1.69] 5.38 [1.74]
No 5.80 [1.66] 5.70 [1.69] 5.60 [1.77] 5.62 [1.76]
F(1, 387) = 17.49, p < 0.001 F(1, 387) = 13.51, p < 0.001 F(1, 387) = 0.04, n.s. F(1, 387) = 0.48, n.s.
SUD
Yes 5.16 [1.68] 4.23 [1.93] 5.22 [1.83] 5.13 [1.67]
No 5.52 [1.69] 5.54 [1.64] 5.47 [1.68] 5.46 [1.70]
F(1, 387) = 2.98, p < 0.10 F(1, 387) = 17.18, p < 0.001 F(1, 387) = 0.84, n.s. F(1, 387) = 1.00, n.s.
Jail
Yes 5.31 [1.57] 4.53 [1.55] 4.55 [1.65] 5.80 [1.78]
No 5.51 [1.65] 5.54 [1.62] 5.58 [1.60] 5.44 [1.62]
F(1, 387) = 1.00, n.s. F(1, 387) = 10.86, p < 0.001 F(1, 387) = 16.09, p < 0.001 F(1, 387) = 1.24, n.s.
Child w FASD
Yes 6.51 [1.75] 6.11 [1.85] 6.58 [1.84] 6.73 [1.91]
No 6.55 [1.77] 6.58 [1.76] 6.54 [1.76] 6.53 [1.76]
F(1, 387) = 0.04, n.s. F(1, 387) = 1.93, n.s. F(1, 387) = 0.03, n.s. F(1, 387) = 0.33, n.s.
Overall interaction F(3, 385) = 4.41, p < 0.005 F(3, 385) = 2.19, p < 0.10 F(3, 385) = 5.96, p < 0.001 F(3, 385) = 1.63, n.s.
Disdain
MI
Yes 5.67 [1.37] 5.73 [1.38] 5.78 [1.16] 5.93 [1.39]
No 5.97 [1.28] 5.92 [1.30] 5.92 [1.32] 5.90 [1.30]
F(1, 387) = 3.64, p < 0.10 F(1, 387) = 0.55, n.s. F(1, 387) = 0.44, n.s. F(1, 387) = 0.01, n.s.
SUD
Yes 6.61 [1.08] 6.21 [1.21] 6.53 [1.14] 6.58 [1.18]
No 6.68 [1.37] 6.70 [1.31] 6.68 [1.33] 6.67 [1.32]
F(1, 387) = 0.17, n.s. F(1, 387) = 3.92, p < 0.05 F(1, 387) = 0.51, n.s. F(1, 387) = 0.11, n.s.
Jail
Yes 6.41 [1.23] 5.99 [1.34] 5.89 [1.23] 7.10 [1.16]
No 6.65 [1.33] 6.65 [1.30] 6.69 [1.29] 6.56 [1.31]
F(1, 387) = 2.26, n.s. F(1, 387) = 7.14, p < 0.01 F(1, 387) = 15.17, p < 0.001 F(1, 387) = 4.38, p < 0.05
Child w FASD
Yes 7.73 [1.47] 7.48 [1.26] 7.48 [1.43] 7.93 [1.27]
No 7.63 [1.42] 6.67 [1.44] 7.68 [1.43] 7.63 [1.44]
F(1, 387) = 0.30, n.s. F(1, 387) = 0.49, n.s. F(1, 387) = 0.76, n.s. F(1, 387) = 1.12, n.s.
Overall interaction F(3, 385) = 1.52, n.s. F(3, 385) = 1.40, n.s. F(3, 385) = 4.19, p < 0.01 F(3, 385) = 2.10, p < 0.10
Blame
MI
Yes 2.62 [1.70] 2.77 [1.83] 2.86 [1.79] 3.11 [2.13]
No 2.90 [1.85] 2.84 [1.82] 2.83 [1.83] 2.81 [1.80]
F(1, 387) = 1.60, n.s. F(1, 387) = 0.05, n.s. F(1, 387) = 0.01, n.s. F(1, 387) = 0.67, n.s.
SUD
Yes 5.71 [2.42] 4.97 [2.77] 5.50 [2.80] 6.71 [2.11]
No 6.11 [2.57] 6.11 [2.50] 6.08 [2.50] 5.96 [2.56]
F(1, 387) = 1.64, n.s. F(1, 387) = 5.66, p < 0.05 F(1, 387) = 2.08, n.s. F(1, 387) = 2.28, n.s.
Jail
Yes 6.60 [1.75] 6.40 [1.73] 6.41 [2.25] 7.07 [2.12]
No 6.92 [2.17] 6.89 [2.11] 6.90 [2.06] 6.83 [2.08]
F(1, 387) = 1.51, n.s. F(1, 387) = 1.51, n.s. F(1, 387) = 2.21, n.s. F(1, 387) = 0.35, n.s.
Child w FASD
Yes 7.33 [2.81] 7.20 [2.83] 6.55 [3.37] 7.64 [2.79]
No 7.43 [2.80] 7.43 [2.79] 7.52 [2.69] 7.39 [2.79]
F(1, 387) = 0.10, n.s. F(1, 387) = 0.18, n.s. F(1, 387) = 4.80, p < 0.05 F(1, 387) = 0.21, n.s.
Overall interaction F(3, 385) = 0.23, n.s. F(3, 385) = 1.49, n.s. F(3, 385) = 1.00, n.s. F(3, 385) = 0.45, n.s.

MI, mental illness; SUD, substance use disorder; FASD, fetal alcohol spectrum disorder. Lightly shaded cells represent group differences with experi-
enced research participants endorsing the stigmatizing beliefs significantly less.

Note that previous experience with SUD actually worsened
disdain for mothers of children with FASD. Previous experi-
ence with FASD had no eects on dierence, disdain, and
blame. We specically hypothesized that a research partici-
pants personal experience with an indexed health condition
would decrease their stigma of that condition. Research
participants who have experienced MI, SUD, and jail were
less likely to view women with the respective condition dier-
ently. A similar pattern was seen for disdain. Those who
experienced MI, SUD, and jail were less likely to disdain
women with MI, SUD, and jail experience, respectively. Only
research participants with previous SUD were less likely to
6 CORRIGAN ET AL.

blame women labeled with SUD. Experience with knowing a
child with FAS was not found to moderate any of the stig-
matizing perspectives of mothers of children with FASD.
Means of the budget dollars allocated are summarized by
type of human service in Fig. 2. Results of a repeated-mea-
sures ANOVA across the 10 human services were highly sig-
nicant and portrayed a medium eect size, F(9,
378) = 84,25, p < 0.001, g2 = 0.67. Monies for FASD were
the lowest with 9 post hoc tests showing the dierence to be
signicant when compared to the other 9 human services, F
(1, 387) range: 34.49 to 339.03, p < 0.001, g2 range: 0.08 to
0.47.
DISCUSSION
Advocacy groups such as the National Organization on
Fetal Alcohol Syndrome (NOFAS) have been arguing for
years that birth mothers of children with FASD are stigma-
tized for their past behavior. The NOFAS assertion was sup-
ported in this studyresearch participants viewed mothers
of children with FASD as more dierent, with greater dis-
dain, and more to blame than women with MI or SUD. Jail
is often used in research to anchor the high end of stigma
comparisons, and this dierence was also seen when com-
pared to women with jail experience. Eect sizes for these
ndings were small to medium. Research participants com-
pleted a budget allocation task as a measure of discrimina-
tion. In previous research, groups that were viewed more
negatively were allocated fewer funds. Results showed funds
allocated to a human service program for mothers of chil-
dren with FASD were signicantly lower than funds allo-
cated to all other programs, with the dierence described by
a medium eect size. However, an alternative explanation
could be that the participants perceived that FASD services
apply to fewer people. The lesser allocation of funds might
be a function of lower perceived prevalence rates of FASD
rather than it simply being less important than the other
services.
Consistent with previous research, we expected that per-
sonal experience with a stigmatized condition would yield
less perceptions of dierence, disdain, and blame compared
to those without the condition. Personal experience for MI
and SUD was dened as previous diagnosis or treatment,
and jail was previous incarceration. As expected, research
participants with previous experience with MI, SUD, and jail
were less likely to endorse dierence or disdain for women
with corresponding disorders. Previous experience with a
child with FAS was not found to moderate dierence and
disdain perceptions. Unfortunately, experience with FASD
was operationalized in this study dierently because only 2

18

16

14

12

10

0
$ millions
medcaid asst woman/chld MH Hlthy kid jail fam plan SUD organ trans HIV FASD

Fig. 2. Mean dollars allotted to 10 human services. Key to human service programs: Medicaid asst = Medicaid and medical assistance programs;
Woman/chld = woman, infants, and children programs; MH = mental health services; Hlthy kid = healthy kids programs; Jail = jail and social services;
Fam plan = family planning; SUD = addiction services; Organ trans = organ transplantation act; HIV = HIV/AIDS services; FASD = programs for bio-
logical mothers of children with fetal alcohol syndrome.
THE STIGMA OF BIRTH MOTHERS OF CHILDREN WITH FASD
of the 389 (less than 0.5%) reported being a biological
mother of a child with FAS. In fact, this is an example of one
of several denitional challenges that emerged from the
study. Familiarity was dened as knowing a child with FAS
to increase the number of research participants that could be
sorted into an adequate subgroup for analysis. This experi-
ence may have engendered sympathy for the child with
FASD and anger toward his or her mother, thereby dimin-
ishing the moderating eect found for the other conditions.
This last point illustrates a second, more subtle concern
that needs to be incorporated into future research. What
exactly is the condition that is the object of stigma? The
health condition, FASD, can be medically diagnosed. Stigma
of the health condition impacts children with these disorders.
The social condition of focus in this study is being a mother
of a child with FASD. We believe that the socially con-
structed label of being a biological mother is especially
harmful and likely dierent from the experience by the child
with FASD. Future research needs to sort this out.
Future research also needs to be more precise in denitions
of familiarity. In this study, mothers of children with FASD
were compared to women with MI and SUD. A more equita-
ble comparison might be mothers of children with FASD
versus mothers of children with ADHD. In this way, any
confound to motherhood would be reduced. There was addi-
tional confusion regarding measuring participant attitudes
about FAS versus FASD. Qualitative ndings from a focus
group suggested participants were familiar with FAS, and
the notion that this condition applies to newborns, but not
with the more recent broader term of FASD that indicates a
lifelong condition, thus guiding the selection and use of the
term FAS. Future research should more carefully control for
this dierence.
There are other limitations in the study. MTurk does not
yield data from a sample representative of the population.
Future research seeking to understand the degree to which
the stigma toward birth mothers of children with FASD is
endorsed across the population, as well as dierently within
a subgroup, needs to adopt big data strategies. Some con-
cerns about the measures emerged. Internal consistency of
the disdain scores was low; additional item development is
needed. Blame assessment was based on a single item. Two
of the 4 outcome variables are questionable adding to the
preliminary nature of these ndings. A more psychometri-
cally sound scale might be indicated.
The study focused solely on public stigma. There are other
types of stigma that need to be examined in future research
for mothers of children with FASD. Self-stigma, for exam-
ple, occurs when people with a stigmatized label internalize
negative stereotypes resulting in harm to ones sense of self-
esteem and self-ecacy (Livingston and Boyd, 2010). Future
research needs to determine whether this kind of self-stigma
leads to similar harm in mothers of children with FASD.
Assuming that research continues to demonstrate the egre-
gious eects of public and self-stigma, investigators need to
join advocates in evaluating programs meant to diminish its
7
impact. Research on the stigma of MI has compared the
eects of education (contrasting the myths of MI with facts)
and contact (promoting relationships between people with
MI and members of their community). Findings from a
meta-analysis showed that contact yielded eect sizes that
were more than twice that education alone (Corrigan et al.,
2012). Are similar eects found for impacting the stigma of
biological mothers of children with FASD? Support for con-
tact programs inuences antistigma strategies in an impor-
tant way. It is the person with the lived conditionmothers
of children with FASDwho must lead the antistigma
eort. To reduce the stigma, they are best suited to craft the
message, develop the intervention, and implement the pro-
gram in the real-world contact approaches.
CONFLICT OF INTEREST
The authors declare no conicts of interests. The authors
alone are responsible for the content and writing of this article.
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