Induced abortion incidence and safety in Côte d’Ivoire

Abstract

Background In Cô te d'Ivoire, induced abortion is legally restricted unless a pregnancy threatens a woman's life. Yet the limited available evidence suggests abortion is common and that unsafe abortion is contributing to the country's high maternal mortality. Our study aimed to estimate the one-year incidence of induced abortion in Cô te d'Ivoire using both direct and indirect methodologies, determine the safety of reported abortions, and identify the women most likely to experience a recent induced abortion or an unsafe abortion. Methods In 2018, we conducted a nationally representative, population-based survey of women age 15 to 49 in Cô te d'Ivoire. Women reported their own abortion experiences and those of their closest female confidante. We estimated the one-year incidence of induced abortion, and the safety of the abortions women experienced. Using bivariate and multivariate regression, we separately assessed sociodemographic characteristics associated with having had a recent abortion or an unsafe abortion. Results Overall, 2,738 women participated in the survey, approximately two-thirds of whom reported on the abortion experiences of their closest female friend. Based on respondent data, the one-year incidence of induced abortion was 27.9 (95% CI 18.6-37.1) per 1,000 women of reproductive age, while the confidante incidence was higher at 40.7 (95% CI 33.3-48.1) per 1,000. Among respondents, 62.4% of abortions were most unsafe, while 78.5% of confidante abortions were most unsafe. Adolescents, less educated women, and the poorest women had the most unsafe abortions.

A Little Bit Pregnant? Productive Ambiguity and Fertility Research

“…Other recent survey data from Nigeria, Côte d'Ivoire, and India also suggest this behavior is common. Interviewers asked women if they had ever done something to remove a pregnancy at a time when they could not or did not want to be pregnant followed by a question about whether they had ever done something to bring back their menses when they were worried they were pregnant (Bell et al 2020a;Bell et al 2020b;Ahmad et al 2020). Investigators captured significant rates of menstrual regulation among women who reported "no" to the prior question about ever ending a pregnancy.…”

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

“…Biases introduced by respondents reporting zero confidantes have been documented in other social network-based incidence studies, including the problem of the "zero female respondent" in the Sibling Method (Gakidou & King, 2006;Masquelier, 2013). Gakidou and King (2006) proposed a weighting adjustment to correct for this problem in measuring mortality, which has been adapted by other Confidante Method studies Bell, Sheehy, et al, 2020;Keogh et al, 2020).…”

“…Given the fact that this imputation approach requires two substantial assumptions that are not supported by the available data, it seemed untenable to produce estimates when a large portion of the data was imputed and not observed. Other studies using this adjustment technique have imputed even larger proportions of their data, ranging from one-third in Ghana (Keogh et al, 2020) to over 50% in Nigeria Bell, Sheehy, et al, 2020), and interpretations of the resulting incidence estimates should be made with caution.…”

“…The ATPR and Best Friend Method have been used to estimate abortion incidence in Burkina Faso (Rossier et al, 2006;Sedgh et al, 2011) and Malawi (Yeatman & Trinitapoli, 2011). The Confidante Method has been tested even more broadly, including in Côte D'Ivoire (Bell, Sheehy, et al, 2020), Ghana (Keogh et al, 2020), India (Bell, et al 2019), Indonesia (Stillman et al, 2020), Kinshasa, DRC (Ishoso et al, 2019), and Nigeria . Given the fact that all three of these methods share several potential biases and limitations that have been well documented in the Sibling Method literature, an in-depth examination of the methods' assumptions and associated biases is needed in order to determine the validity of the resulting incidence estimates.…”

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

“…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]. Other studies have employed different methods to collect information on TOP such as the confidante method, the list experiment, the abortion incidence method (AICM), and the modified AICM [12][13][14].…”