Improving abortion underreporting in the United States: a cognitive interview study
Background: Abortion is a difficult-to-measure behavior with extensive survey underreporting, which compromises the ability to study and monitor abortion. The purpose of this study was to improve our understanding of how women interpret and respond to survey items asking if they have ever had an abortion. Methods: We developed multiple new questions hypothesized to improve abortion reporting, using approaches that aim to clarify which experiences to report as an induced abortion; reduce the stigma and sensitivity of induced abortion; reduce the sense of intrusiveness of asking about abortion; and increase the motivation to report. We conducted cognitive interviews with cisgender women aged 18-49 in two US states (N=64) to iteratively assess these new approaches and questions for improving abortion reporting. Results: 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. Conclusions: Opportunities exist to improve survey measurement of abortion. Reducing underreporting of abortion in surveys has the potential to improve sexual and reproductive health research that relies on pregnancy histories.