Increasing misreporting levels of induced abortion in Turkey: is this due to social desirability bias?

Abstract

Women tend to under-report or misreport their abortion experiences, mainly because abortion is considered a sensitive issue for cultural, religious, political or other reasons in many countries across the world. Turkey, where induced abortion is an increasingly sensitive issue due to intense statements against induced abortion on religious grounds by influential politicians, and a hidden agenda to prohibit the practice, especially in public health facilities, in recent years, is no exception. This study focused on the increase in level of misreporting of induced abortion in Turkey and its link to social desirability bias using pooled data from 1993 and 2013 Turkish Demographic and Health Surveys. A probabilistic classification model was used to classify women’s reported abortions. The findings confirmed that the level of misreporting of induced abortions has increased from 18% to 53% among all terminated pregnancies over the period 1993–2013 in Turkey. This marked increase, especially among women in the lower socioeconomic sections of society, may be largely associated with the prevailing political environment, and increase in social stigmatization against induced abortion in Turkey over recent decades.

The Impact of Abortion Underreporting on Pregnancy Data and Related Research

“…Indeed, because of widespread abortion stigma in the US (Bommaraju et al, 2016 ; Norris et al, 2011 ; Shellenberg & Tsui, 2012 ), we would expect incomplete reporting of abortion to be universal in this setting—whether in a large survey system (e.g., the NLSY) or a smaller clinical survey (Udry et al, 1996 ). Moreover, surveys outside of the US can also face these challenges of incomplete reporting in settings where abortion is legal but still socially sensitive (Saraç & Koç, 2020 ; Scott et al, 2019 ) or where it is illegal (Sedgh & Keogh, 2019 ). Researchers need to consider the completeness of abortion reporting and its potential impact on analyses when using data on pregnancy outcomes from any survey in which respondents are asked to report on all pregnancy outcomes.…”

Detecting underreporters of abortions and miscarriages in the national study of family growth, 2011–2015

“…Those with a miscarriage felt that they lost a child and did something wrong, and felt guilty, alone, and ashamed [ 13 , 14 ]. Abortions were sometimes misreported as miscarriage [ 8 , 10 ]. There is limited evidence that miscarriage is also prone to misreporting [ 4 , 15 ].…”

Affective and Substance Abuse Disorders Following Abortion by Pregnancy Intention in the United States: A Longitudinal Cohort Study

“…Furthermore, because the effect of under-reporting bias on mental health measures can plausibly be specified, abortion concealment is a much smaller problem for studies of abortion and mental health than may be the case with other topics. Abortion non-disclosure, which is comparable to that for miscarriage or other negative pregnancy outcomes, is generally interpreted to reflect similar social desirability bias or, put negatively, perceived or internalized stigma [76,77,78], as well as indications of psychologically distressing guilt and grief reactions [79,80,81]. As Cowan has recently observed, “women who terminate pregnancies are much more likely to have feelings of guilt and shame after the procedure than women who miscarried” [78] which affects disclosure.…”