Abortion Reporting in the United States: An Assessment of Three National Fertility Surveys

Lindberg, Laura Duberstein; Kost, Kathryn; Maddow‐Zimet, Isaac; Desai, Sheila; Zolna, Mia R.

doi:10.1007/s13524-020-00886-4

Cited by 51 publications

(52 citation statements)

References 53 publications

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“…While we found no evidence for systematic bias in the number of non-sensitive items reported (the design effect test), it could be that respondents accurately represented the number of non-sensitive items experienced but simply did not add abortion to their tally of experiences. Even in less legally punitive settings, it is well established that people have reservations about reporting abortion experiences [ 1 , 2 ]. Thus, it seems reasonable to assume that these same concerns could have contributed to the lower than anticipated list experiment estimates.…”

Section: Discussionmentioning

confidence: 99%

“…Accurate epidemiological surveillance of abortion (induced termination of pregnancy) is crucial for developing informed and responsive family planning programs, policies, and interventions [1]. However, abortion is highly stigmatized in many settings, complicating reliable measurement of its occurrence [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…Methodologies commonly used to estimate abortion incidence have widely acknowledged limitations [3,[5][6][7][8]. Direct measurement methods, whereby respondents are asked directly about their abortion experience(s), may result in underreporting due to social desirability bias and privacy concerns [2,3]. Underreporting is likely magnified in contexts where abortion is legally restricted [3,5,7,9], due to fears for personal safety and desires to avoid legal or social repercussions.…”

Section: Introductionmentioning

confidence: 99%

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Reducing underreporting of abortion in surveys: Results from two test applications of the list experiment method in Malawi and Senegal

et al. 2021

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Background Accurately measuring abortion incidence poses many challenges. The list experiment is a method designed to increase the reporting of sensitive or stigmatized behaviors in surveys, but has only recently been applied to the measurement of abortion. To further test the utility of the list experiment for measuring abortion incidence, we conducted list experiments in two countries, over two time periods. Materials and methods The list experiment is an indirect method of measuring sensitive experiences that protects respondent confidentiality by hiding individual responses to a binary sensitive item (i.e., abortion) by combining this response with answers to other non-sensitive binary control items. Respondents report the number of list items that apply to them, not which ones. We conducted a list experiment to measure cumulative lifetime incidence of abortion in Malawi, and separately to measure cumulative five-year incidence of abortion in Senegal, among cisgender women of reproductive age. Results Among 810 eligible respondents in Malawi, list experiment results estimated a cumulative lifetime incidence of abortion of 0.9% (95%CI: 0.0, 7.6). Among 1016 eligible respondents in Senegal, list experiment estimates indicated a cumulative five-year incidence of abortion of 2.8% (95%CI: 0.0, 10.4) which, while lower than anticipated, is seven times the proportion estimated from a direct question on abortion (0.4%). Conclusions Two test applications of the list experiment to measure abortion experiences in Malawi and Senegal likely underestimated abortion incidence. Future efforts should include context-specific formative qualitative research for the development and selection of list items, enumerator training, and method delivery to assess if and how these changes can improve method performance.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reducing underreporting of abortion in surveys: Results from two test applications of the list experiment method in Malawi and Senegal

et al. 2021

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“…In countries where abortion is legal yet highly stigmatized, the clandestine circumstances under which many abortions are performed make official records incomplete. Further, respondents are often reluctant to directly admit to having had an abortion in a survey (Jones and Forrest 1992;Jones and Kost 2007;Lindberg et al 2020), and efforts to encourage direct reporting through anonymized response methods have failed to consistently generate reliable abortion incidence estimates (Juarez et al, 2010;Moseson et al, 2017;Oliveras & Letamo, 2010).…”

Section: Introductionmentioning

confidence: 99%

An assessment of third-party reporting of close ties to measure sensitive behaviors: the Confidante Method to measure abortion incidence in Ethiopia and Uganda

Giorgio¹,

Sully²,

Chiu³

2021

Preprint

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Indirect estimation techniques are an important tool for measuring sensitive and stigmatized behaviors. This includes third-party reporting methods, which have become increasingly common in the field of abortion measurement, where direct survey approaches notoriously lead to underreporting. This paper provides the first in-depth assessment of one of the most widely used of these techniques in the field of abortion measurement: the Confidante Method. We outline six key assumptions behind the Confidante Method and describe how violations of these assumptions can bias resulting estimates. Using data from modules added to the nationally representative Performance Monitoring for Action (PMA) surveys in Uganda and Ethiopia in 2018, we compute one-year abortion incidence estimates using the Confidante Method. We also perform a validation check, using the method to estimate IUD and implant use. While our results reveal that the method performed differently in each country, there were implementation problems in both settings. Several of the method’s foundational assumptions were violated, and efforts to adjust for these violations either failed or only partially addressed the resulting bias. Our validation check also failed, resulting in a gross over-estimate of IUD and implant use. We identify substantial biases in both the numerator and denominator of our abortion estimates and challenge the continued use of this method to estimate abortion incidence. These results have implications more broadly for the potential biases that can be introduced in using third-party reporting of close ties to measure other sensitive or stigmatized behaviors.

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“…Unsafe TOPs contribute significantly to maternal morbidity and mortality [3,5,6]. However, underreporting of TOP remains a universal concern as evidenced in some countries with relatively liberal laws in which between 20 and 60% of cases were not disclosed during surveys [7][8][9][10]. Data regarding TOP in LMICs is predominantly generated from health facility data and household surveys, notably Demographic and Health Surveys (DHS), plus special Maternal Health Surveys [11].…”

Section: Introductionmentioning

confidence: 99%

Termination of pregnancy data completeness and feasibility in population-based surveys: EN-INDEPTH study

Enuameh

Dzabeng

Blencowe

et al. 2021

Popul Health Metrics

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Background Termination of pregnancy (TOP) is a common cause of maternal morbidity and mortality in low- and middle-income countries. Population-based surveys are the major data source for TOP data in LMICs but are known to have shortcomings that require improving. The EN-INDEPTH multi-country survey employed a full pregnancy history approach with roster and new questions on TOP and Menstrual Restoration. This mixed methods paper assesses the completeness of responses to questions eliciting TOP information from respondents and reports on practices, barriers, and facilitators to TOP reporting. Methods The EN-INDEPTH study was a population-based cross-sectional study. The Full Pregnancy History arm of the study surveyed 34,371 women of reproductive age between 2017 and 2018 in five Health and Demographic Surveillance System (HDSS) sites of the INDEPTH network: Bandim, Guinea-Bissau; Dabat, Ethiopia; IgangaMayuge, Uganda; Kintampo, Ghana; and Matlab, Bangladesh. Completeness and time spent in answering TOP questions were evaluated using simple tabulations and summary statistics. Exact binomial 95% confidence intervals were computed for TOP rates and ratios. Twenty-eight (28) focus group discussions were undertaken and analysed thematically. Results Completeness of responses regarding TOP was between 90.3 and 100.0% for all question types. The new questions elicited between 2.0% (1.0–3.4), 15.5% (13.9–17.3), and 11.5% (8.8–14.7) lifetime TOP cases over the roster questions from Dabat, Ethiopia; Matlab, Bangladesh; and Kintampo, Ghana, respectively. The median response time on the roster TOP questions was below 1.3 minutes in all sites. Qualitative results revealed that TOP was frequently stigmatised and perceived as immoral, inhumane, and shameful. Hence, it was kept secret rendering it difficult and uncomfortable to report. Miscarriages were perceived to be natural, being easier to report than TOP. Interviewer techniques, which were perceived to facilitate TOP disclosure, included cultural competence, knowledge of contextually appropriate terms for TOP, adaptation to interviewee’s individual circumstances, being non-judgmental, speaking a common language, and providing detailed informed consent. Conclusions Survey roster questions may under-represent true TOP rates, since the new questions elicited responses from women who had not disclosed TOP in the roster questions. Further research is recommended particularly into standardised training and approaches to improving interview context and techniques to facilitate TOP reporting in surveys.

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Abortion Reporting in the United States: An Assessment of Three National Fertility Surveys

Cited by 51 publications

References 53 publications

Reducing underreporting of abortion in surveys: Results from two test applications of the list experiment method in Malawi and Senegal

Reducing underreporting of abortion in surveys: Results from two test applications of the list experiment method in Malawi and Senegal

An assessment of third-party reporting of close ties to measure sensitive behaviors: the Confidante Method to measure abortion incidence in Ethiopia and Uganda

Termination of pregnancy data completeness and feasibility in population-based surveys: EN-INDEPTH study

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