Randomized experimental testing of new survey approaches to improve abortion reporting in theUnitedStates

Abstract

Context Abortions are substantially underreported in surveys due to social stigma, compromising the study of abortion, pregnancy, fertility, and related demographic and health outcomes. Methods In this study, we evaluated six methodological approaches identified through formative mixed‐methods research to improve the measurement of abortion in surveys. These approaches included altering the placement of abortion items in the survey, the order of pregnancy outcome questions, the level of detail, the introduction to the abortion question, and the context of the abortion question, and using graduated sensitivity. We embedded a preregistered randomized experiment in a newly designed online survey about sexual and reproductive health behaviors (N = 6536). We randomized respondents to experimental arms in a fully crossed factorial design; we estimated an average treatment effect using standardized estimators from logistic regression models, adjusted for demographic covariates associated with reporting. Results None of the experimental arms significantly improved abortion reporting compared to the control condition. Conclusion More work is needed to improve reporting of abortion in future surveys, particularly as abortion access becomes increasingly restricted in the United States. Despite this study's null results, it provides a promising path for future efforts to improve abortion measurement. It is proof of concept for testing new approaches in a less expensive, faster, and more flexible format than embedding changes in existing national fertility surveys.

“Technically an abortion”: Understanding perceptions and definitions of abortion in the United States

“…Respondents were eligible to participate in the study if they were aged 18–49 years old, assigned female at birth, identified as a woman, spoke English, lived in a study state, and had ever had penile-vaginal sex. Participants were asked about their abortion history during the screening process to ensure the sample included those who did and did not report an abortion to satisfy analytic requirements for other aspects of the overall study ( Lindberg et al, 2022 ; Mueller et al, 2022 ). In this study component, we did not compare differences in responses by participant abortion history or state of residence.…”

“…The items examined in the quantitative component of this analysis were part of a broader survey measuring sexual and reproductive health experiences with eligibility requirements that matched the qualitative research, except that eligible respondents had to be assigned female at birth but did not have to identify as women at the time of the interview (results published elsewhere ( Lindberg et al, 2022 )). Following our qualitative research, 2009 study participants were recruited via the Qualtrics online panel to complete adapted forms of both the card sort and vignette activities; Qualtrics is a private research software company specializing in Web-based data collection that partners with panel providers.…”

“…Legal exemptions for certain abortions create notions of ‘acceptable’ and ‘unacceptable’ abortion ( Nandagiri, 2019 ), creating hierarchies of justifications that impact a person’s experience of care ( Beynon-Jones, 2017 ). Abortion stigma is also linked to substantial underreporting of abortions in surveys ( Desai et al, 2021 ; Lindberg et al, 2022 ; Maddow-Zimet et al, 2021 ).…”

Training in Residency and Provision of Reproductive Health Services Among Family Medicine Physicians

“…17 To address these gaps in training, some residency programs opt into the Reproductive Health [18][19][20] One challenge to fully understanding the contraception and abortion workforce, including the role of residency training, has been the availability of reliable national level data. 21,22 Although surveys and self-report can illuminate important aspects of the workforce, they can also be subject to reporting bias. This study uses national-level Medicaid claims data to examine the associations between FM physicians' residency training and actual service provision of widely used methods of contraception and D&C.…”

“…One challenge to fully understanding the contraception and abortion workforce, including the role of residency training, has been the availability of reliable national level data . Although surveys and self-report can illuminate important aspects of the workforce, they can also be subject to reporting bias.…”