Amnesty International © 2014
Estimation of induced abortion incidence through self-report vs. asking social networks
Studies in Family Planning Early view, 22 October 2022
by Suzanne O Bell, Georges Guiella, Selena Anjur-Dietrich, Fiacre Bazie, Yentema Onadja, Saifuddin Ahmed, Caroline Moreau
Induced abortion is legal in Burkina Faso only in cases of rape, incest, fetal defects, or when the woman’s health is in danger. The most recent national estimates based on abortion cases admitted for treatment of complications at a health facility in 2008 show a one-year incidence rate of 25 induced abortions per 1,000 women of reproductive age, while the estimated incidence using a social network-based approach as part of the same study was 18 per 1,000. Subsequent declines in the total fertility rate, resulting from increasing demand for and use of modern contraception may have affected levels and patterns of unintended pregnancy and related abortion trends. These demographic shifts have taken place amid a changing abortion landscape, characterized by an expansion of legal grounds for abortion as well as the diffusion of medication abortion drugs outside of the health care system in many parts of Africa. These social and legal changes make it important to understand how the frequency and correlates of abortion have changed. A recent model-based estimate of the national abortion incidence suggests a rate of 30 (95 percent CI 18–49) abortions per 1,000; however, the wide confidence interval means we are unable to determine if the change is significant. These prior incidence studies also offer little to no information concerning the safety of abortions in Burkina Faso and few if any details on the characteristics of women having an abortion, yet such data are critical to inform the public health rationale for legal reform and the provision of quality, safe abortion care for legal indications as well as post-abortion care to treat unsafe abortion-related complications, a leading cause of maternal mortality in West Africa.
Social network-based methods are increasingly used to estimate induced abortion incidence and investigate correlates. Approaches differ in the social tie definitions used to identify which social network members’ abortion experiences respondents will report. This study compares the effect of using the “best friend” (closest female friend) versus “confidante” (specifying mutual sharing of personal information) definition on abortion incidence estimation. We use data from a nationally representative survey of women aged 15-49 in Burkina Faso (conducted in 2020–2021) where respondents were randomized into two versions of an abortion module, using different friend definitions. We computed abortion rate estimates by friend definition and adjusted for assumption violations (transmission bias, surrogate sample selection bias). Unadjusted incidence rates varied from 11.7 [4.1–19.2] abortions per 1,000 women to 15.6 [9.7–21.4], depending on friend definition. The confidante definition yielded higher adjusted estimates (36.2 [25.1–47.2]) than the best friend definition (17.0 [8.7–25.3]) due to greater transmission bias adjustment. Both estimates exceeded the respondent self-reported abortion incidence (4.0 [2.2–5.9]). Our results indicate that either friend definition produces higher incidence estimates than self-report but suggest a potential advantage for the “best friend” over the “confidante” definition, given lower transmission bias. Further research should assess generalizability of these findings in other contexts.