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Survey researchers hope that respondents will provide high-quality data, but evidence suggests that social desirability bias may be commonplace. Social desirability can lead to significant underreporting or overreporting of sensitive behaviors. With better understanding of the cognitive processes that respondents use to prepare and deliver their responses, survey designers could hope to minimize social desirability bias or at least detect settings that lessen its impact. The primary objective of this study was to use survey paradata to understand the psychology of responding to certain types of survey questions. More specifically, we sought to determine how emotional triggering can alter response latencies to cognitively demanding and sensitive survey questions on induced abortion, which is underreported. We hypothesize that having had a prior abortion might lengthen response times to an indirect question about abortion among respondents who have experienced this sensitive reproductive outcome as they hesitate in deciding whether and how to respond to the question. Data come from a representative survey of 6,035 reproductive age women in Rajasthan, India. We used list experiment question active screen time paradata in conjunction with responses from direct questions on abortion to assess our hypothesis. Our final model was a multivariate linear regression with random effects at the level of the interviewer, including adjustments for respondent, community, and interviewer characteristics to estimate within-respondent effects. Results suggest that women who reported an abortion on the direct abortion questions took 5.11 (95% CI 0.21, 10.00) seconds longer to respond to the list experiment treatment list compared to the control list in comparison to women who did not report an abortion on the direct abortion questions. This study demonstrates the additional insights gained when focusing on response latencies to cognitively demanding questions involved in the measurement of sensitive behaviors.

Mary Corse (born 1945) earned acclaim in the 1960s for pieces ranging from shaped-canvas paintings to light works. Corse has dedicated the decades since to establishing a practice at the crossroads of Abstract Expressionism and Minimalism.

In Côte 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 Côte 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. In 2018, we conducted a nationally representative, population-based survey of women age 15 to 49 in Côte 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. 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. This study provides the first national estimates of induced abortion incidence and safety in Côte d'Ivoire, using a population-based approach to explore social determinants of abortion and unsafe abortion. Consistent with other research, our results suggest that legal restrictions on abortion in Côte d'Ivoire are not preventing women from having abortions, but rather pushing women to use unsafe, potentially dangerous abortion methods. Efforts to reduce the harms of unsafe abortion are urgently needed.

This study aims to estimate induced abortion incidence and safety in Burkina Faso using direct and indirect methods, overall and by women’s background characteristics. Data come from a nationally representative survey of reproductive aged women (n = 6,388). To address social desirability bias in abortion reporting, we asked about respondents’ closest female friends’ experience with abortion. The one-year abortion incidence in 2020 for respondents was 4.0 (95% CI 2.2–5.9) per 1,000 women aged 15–49 while the adjusted friend incidence was 22.9 (95% CI 15.8–30.0). Although not significant, abortion incidence was higher for adolescents, unmarried women, those with higher education, and those in urban areas among both respondents and their friends. Approximately nine out of ten abortions were unsafe (90% respondents, 95% friends), with respondent and friend findings suggesting higher risk of unsafe abortion among older women, less educated women, and women residing in rural areas. Despite recent increases in contraceptive use and continued legal restrictions, abortion remains common in Burkina Faso and is largely unsafe, with evidence of potential disparities.

The importance of the family planning service environment and community-level factors on contraceptive use has long been studied. Few studies, however, have been able to link individual and health facility data from surveys that are nationally representative, concurrently fielded, and geographically linked. Data from Performance Monitoring and Accountability 2020 address these limitations. To assess the relative influences of the service delivery environment and community, household, and individual factors on a woman's likelihood of using a modern contraceptive in five geographically and culturally diverse sub-Saharan African countries. Nationally representative, cross-sectional data from PMA2020 were linked at the household and service delivery level. Country-specific and pooled multilevel multinomial logistic models, comparing non-users, short- and long-acting method users were used. The variables elected for inclusion in our multivariate analyses were guided by the conceptual framework to profile the different levels of influences on individual use of modern contraception. Average marginal effects were calculated to improve interpretability. We find that the effect of contextual factors varies widely but that being visited by a health worker who spoke about family planning in the past 12 months was consistently and positively associated with individual use of short-acting and long-acting contraception. Characteristics of the nearest health facility did not generally exercise their own independent influences on a woman's use of contraception, except in the case of Burkina Faso, where the average distance between individuals and the nearest family planning provider was significantly greater than other countries. Inclusion of country fixed effects in the pooled models and the relevance of covariates at different levels in the country-specific models demonstrate that there is significant variation across countries in how community, individual, and service delivery environment factors influence contraceptive use and method choice. Context must be taken into account when designing family planning programs.

This study aimed to measure abortion safety in Nigeria, Cote d'Ivoire, and Rajasthan, India using population-based abortion data from representative samples of reproductive age women. Interviewers asked women separately about their experience with \"pregnancy removal\" and \"period regulation at a time when you were worried you were pregnant\", and collected details on method(s) and source(s) of abortion. We operationalized safety along two dimensions: 1) whether the method(s) used were non-recommended and put the woman at potentially high risk of abortion related morbidity and mortality (i.e. methods other than surgery and medication abortion drugs); and 2) whether the source(s) used involved a non-clinical (or no) provider(s). We combined source and method information to categorize a woman's abortion into one of four safety categories. In Nigeria (n = 1,800), 29.1% of abortions involved a recommended method and clinical provider, 5.4% involved a recommended method and non-clinical provider, 2.1% involved a non-recommended method and clinical provider, and 63.4% involved a non-recommended method and non-clinical provider. The corresponding estimates were 32.7%, 3.0%, 1.9%, and 62.4% in Cote d'Ivoire (n = 645) and 39.7%, 25.5%, 3.4%, and 31.4% in Rajasthan (n = 454). Results demonstrate that abortion safety, as measured by abortion related process data, is generally low but varies significantly by legal context. The policy and programmatic strategies employed to improve abortion safety and quality of care are likely to differ for women in different abortion safety categories.

Fertility researchers rely upon a simple binary: pregnant versus not pregnant. However, this conceptualization does not capture many women's experiences, both historically and in numerous settings today. We suggest that pregnancy status may be a much more ambiguous state, and that such ambiguity is often productive for women. Building a culturally sensitive understanding of what we are calling “productive ambiguity” can foster more rigorous studies of fertility that better capture potential pregnancy and the range of post‐coital fertility‐inhibiting actions women take, both intentionally and not. In this paper, we aim to: 1) describe the ambiguity that exists around pregnancy; 2) explain the ways in which this ambiguity is productive for women; 3) analyze two concrete examples of such ambiguity in practice: the case of menstrual regulation and the unexpected conceptual overlaps between contraception and early abortion in a variety of settings, and finally; 4) suggest ways that this more nuanced understanding might inform fertility research, including abortion measurement research. We combine recent qualitative and quantitative data with historical sources to analyze the cultural logics and power dynamics of this ambiguity.

Although induced abortion is common, measurement issues have long made this area of research challenging. The current analysis applies an indirect method known as the list experiment to try to improve survey-based measurement of induced abortion. We added a double list experiment to a population-based survey of reproductive age women in Rajasthan, India and compared resulting abortion estimates to those we obtained via direct questioning in the same sample. We then evaluated list experiment assumptions. The final sample completing the survey consisted of 6,035 women. Overall, 1.8 percent of the women reported a past abortion via the list experiment questions, whereas 3.5 percent reported an abortion via the direct questions, and this difference was statistically significant. As such, the list experiment failed to produce more valid estimates of this sensitive behavior on a population-based survey of reproductive age women in Rajasthan, India. One explanation for the poor list experiment performance is our finding that key assumptions of the methodology were violated. Women may have mentally enumerated the treatment list items differently from the way they enumerated control list items. Further research is required to determine whether researchers can learn enough about how the list experiment performs in different contexts to effectively and consistently leverage its potential benefits to improve measurement of induced abortion.

Background The widespread availability of private-sector family planning services in low- and middle-income countries can be complementary to public-sector efforts to increase population coverage of modern contraceptive methods. The comparative advantages of a private-sector family planning program are more locations with shorter wait time. The disadvantages are higher prices and more variation in service quality. Our study quantifies how the balance of relative advantages and disadvantages might alter levels of contraceptive uptake in simulated urban and rural markets that present characteristics of markets throughout many low- and middle-income countries. Methods We used agent-based simulation, a computational model that simulates the actions and interactions of artificial agents in a defined environment to understand how their collective behaviors affect outcomes of interest. Our agent-based model simulated one public vendor and one private vendor competing to serve a heterogeneous population of varied income and varied demand for higher service quality. We allocated new funding to one of the two policies: (1) invest in public-sector marketing and quality; or (2) invest in private-sector marketing, quality, and/or offer price support. Linear regression was applied to 6000 person-months of simulated outcomes per policy to compare modern contraceptive prevalence rates for each policy option. Results The optimal policy differed for urban and rural market segments. Price reductions accompanying quality improvements in the private sector enhanced overall service utilization to the greatest extent. In the urban market, low-income women with a high preference for quality were the most responsive to price reductions from private vendors. In the rural market, high-income women with a high preference for quality were the most responsive to quality improvements while other population subgroups were responsive to price reductions in a similar manner. Conclusions The factors that family planning policies should target to maximize their effect on modern contraceptive prevalence differ for markets characterized by different social contexts. Success of a policy will require policymakers’ attention to the relative preferences for low price, short wait time, short travel time, and quality among population subgroups. Our study results suggest that quality improvement in the private sector most benefit the urban populations, while price reductions are crucial for making family planning services more accessible to urban low-income populations and to rural populations across all income levels.