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

Abstract

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.

Pregnancy and pregnancy intention after experiencing infertility: A longitudinal study of women in Malawi

“…Recalling past experiences using a two-year time marker may not be salient in this population. Another study using UTHA cohort data suggested that recalling the timing of specific events may be inaccurate in this lownumeracy population [37]. It is possible that women reported trying for two years to become pregnant, but, in fact, they had tried for a shorter amount of time.…”

Trading HIV for sheep: Risky sexual behavior and the response of female sex workers to Tabaski in Senegal

“…In the second wave of this survey, direct questioning yielded a prevalence of 97% and 78% via the list experiment (Treibich & Lépine, 2019 ), implying the use of condoms is a socially desirable behavior and is over‐reported. Previously, the list experiment method has been used for eliciting self‐reported answers for topics including abortion (Bell & Bishai, 2019 ; Moseson et al., 2021 ), voting preferences (Gonzalez‐Ocantos et al., 2012 ; Holbrook & Krosnick, 2010 ), use of micro‐finance loans (Karlan & Zinman, 2012 ), opinions on undocumented migrants (McKenzie & Siegel, 2013 ), gay marriage (Lax et al., 2016 ) and racism (Krumpal, 2013 ) and has been shown to be effective to measure condom use (LaBrie & Earleywine, 2000 ).…”

Comparison of abortion incidence estimates derived from direct survey questions versus the list experiment among women in Ohio

“…The indirect nature of measures like the list experiment are expected to yield a higher estimate of abortion utilization compared to direct questions, because there is greater privacy afforded to the respondent and their experiences are less visible to the researcher. Indeed, list experiment estimates of abortion have improved reporting over direct measures in several studies of abortion utilization in Iran, Liberia, Pakistan, Senegal, and the US [ 13 – 17 , 22 , 23 ]. However, the list experiment has not always succeeded in reducing underreporting.…”

“…However, the list experiment has not always succeeded in reducing underreporting. Several applications of the list experiment to measure abortion have failed to find higher estimates than direct questions, such as in studies conducted in Malawi, Turkey, Tanzania, and Vietnam [ 18 – 22 ]. Given the mixed performance of list experiments in measuring abortion across contexts, the method requires further study.…”