Research associate, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA,
Research associate, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA.
Int Perspect Sex Reprod Health. 2020 Dec 14;46(Suppl 1):13-24. doi: 10.1363/46e0520.
Abortion is particularly difficult to measure, especially in legally restrictive settings such as Pakistan. The List Experiment-a technique for measuring sensitive health behaviors indirectly-may minimize respondents' underreporting of abortion due to stigma or legal restrictions, but has not been previously applied to estimate abortion prevalence in Pakistan.
A sample of 4,159 married women of reproductive age were recruited from two communities of Karachi in 2018. Participants completed a survey that included a double list experiment to measure lifetime abortion prevalence, as well as direct questions about abortion and other background characteristics. Data were used to calculate direct and indirect estimates of abortion prevalence for the overall sample and by sociodemographic characteristics, as well as to test for a design effect. Regression analyses were conducted to examine associations between characteristics and abortion reporting from direct questioning and the list experiment.
The estimate of abortion prevalence from the list experiment was 16%; the estimate from the direct question was 8%. No evidence of a design effect was found. Abortion reporting was associated with most selected characteristics in the regression model for direct questioning, but with few in the list experiment models.
That the estimate of abortion prevalence in Karachi generated from the list experiment was twice that generated from direct questioning suggests that the indirect method reduced underreporting, and may have utility to estimate abortion in similar settings and to improve the accuracy of data collecting for other sensitive health topics.
堕胎尤其难以衡量，尤其是在巴基斯坦等法律限制严格的环境中。列表实验——一种间接衡量敏感健康行为的技术——可能会因耻辱感或法律限制而最小化受访者对堕胎的漏报，但此前并未应用于估计巴基斯坦的堕胎率。
2018 年，在卡拉奇的两个社区招募了 4159 名处于生育年龄的已婚妇女作为样本。参与者完成了一项调查，其中包括一项双列表实验，以衡量一生中的堕胎率，以及关于堕胎和其他背景特征的直接问题。数据用于计算总体样本和按社会人口特征的直接和间接堕胎率估计值，并测试设计效果。回归分析用于检查直接提问和列表实验中特征与堕胎报告之间的关联。
列表实验估计的堕胎率为 16%；直接问题的估计值为 8%。未发现设计效果的证据。在直接提问的回归模型中，堕胎报告与大多数选定的特征相关，但在列表实验模型中与少数特征相关。
从列表实验中得出的卡拉奇堕胎率估计值是直接提问得出的估计值的两倍，这表明间接方法减少了漏报，并且可能有助于在类似环境中估计堕胎率，并提高其他敏感健康主题数据收集的准确性。
