Improving abortion underreporting in the USA: a cognitive interview study

Abstract

Abortion is a difficult-to-measure behaviour with extensive underreporting in surveys, which compromises the ability to study and monitor it. We aimed to improve understanding of how women interpret and respond to survey items asking if they have had an abortion. We developed new questions hypothesised to improve abortion reporting, using approaches that aim to clarify which experiences to report; reduce the stigma and sensitivity of abortion; reduce the sense of intrusiveness of asking about abortion; and increase respondent motivation to report. We conducted cognitive interviews with cisgender women aged 18–49 in two US states ( N = 64) to assess these new approaches and questions for improving abortion reporting. Our findings suggest that including abortion as part of a list of other sexual and reproductive health services, asking a yes/no question about lifetime experience of abortion instead of asking about number of abortions, and developing an improved introduction to abortion questions may help to elicit more accurate survey reports. Opportunities exist to improve survey measurement of abortion. Reducing the underreporting of abortion in surveys has the potential to improve sexual and reproductive health research that relies on pregnancy histories.

Randomized experimental testing of new survey approaches to improve abortion reporting in the United States

“…We hypothesized that shifting the level of detail could improve abortion reporting by reducing the perceived intrusiveness and the social desirability of the questions, as people with multiple abortions may feel greater stigma 45 . Our cognitive interviews found that respondents prefer answering a yes/no question instead of the number of abortions due to concerns of being judged for having had multiple abortions 22 …”

“…We adopted a general process identified by Groves and colleagues to develop, refine, and evaluate new survey measures. 21 We conducted foundational mixed‐methods research that included a series of quantitative analyses identifying the scope and correlates of abortion underreporting, 10 , 33 , 34 expert advisory input, cognitive interviews with 64 women, 22 and a pilot survey of 2000 women to evaluate possible question items. 35 Each of these activities was informed by prior research on abortion stigma and methodological research on survey design for eliciting responses on questions addressing sensitive topics.…”

“…Questions can be sensitive for multiple reasons and each type of sensitivity may influence survey responses for self‐reporting abortion. In addition, research on the survey response process suggests that some abortion misreporting could also be due to comprehension issues if respondents are unclear about what experiences to report as abortion 21 ; qualitative research indicates this can be an issue 22 …”

“…In addition, research on the survey response process suggests that some abortion misreporting could also be due to comprehension issues if respondents are unclear about what experiences to report as abortion 21 ; qualitative research indicates this can be an issue. 22 Despite a history of abortion measures in many U.S. surveys ), there is limited documentation of methodological innovations to improve reporting. As early as its first cycle in 1973, the NSFG tried to collect data on abortion and found the reports unreliable.…”

“…In addition, research on the survey response process suggests that some abortion misreporting could also be due to comprehension issues if respondents are unclear about what experiences to report as abortion 21 ; qualitative research indicates this can be an issue. 22 …”