Two newly published studies contribute to the Guttmacher Institute’s body of work documenting long-standing challenges in collecting accurate self-reported survey data on abortion. These studies shed light on the increased difficulties researchers will face measuring abortion incidence in a post-Roe environment in the United States.  

• “Improving abortion underreporting in the USA: a cognitive interview study,” by Jennifer Mueller, Marielle Kirstein, Alicia VandeVusse and Laura D. Lindberg, was recently published in Culture, Health & Sexuality. 

• “Randomized experimental testing of new survey approaches to improve abortion reporting in the United States,” by Laura D. Lindberg, Isaac Maddow-Zimet, Jennifer Mueller and Alicia VandeVusse, was recently published in Perspectives on Sexual and Reproductive Health. 

While the most accurate counts of the number of abortions in the United States are estimated using data from health care facilities, these data do not capture the lived experiences of people who have abortions or inequities in who is able to access care. To try to fill this gap, researchers rely on surveys to ask people directly about their abortion experiences. The use of surveys also presents limitations, as people who have had an abortion are often reluctant to report them in surveys because of societal stigma, and the majority of abortions are not reported.  

Now that Roe v. Wade has been overturned, people in many areas of the country may be less willing to report having an abortion in surveys for fear of social and legal repercussions. In the study published in Culture, Health & Sexuality, Guttmacher researchers conducted interviews with women in two US states and found that the wording and presentation of questions about abortion may influence whether individuals are willing to self-report an abortion on a survey.  

“While no one should be required to report their abortion in surveys if they do not feel comfortable doing so, inaccuracies in abortion data have significant implications for public health and policy decisions that are based on these data and limit our understanding of not just abortion but pregnancy more generally,” says Laura Lindberg, formerly of the Guttmacher Institute and current faculty member at Rutgers School of Public Health. “We need to continue to work to improve surveys in ways that can support  people to feel safer reporting their experiences.”  

In the study published in Perspectives on Sexual and Reproductive Health, Guttmacher researchers used an online survey experiment to evaluate six approaches to asking about abortion in surveys, including:  

• changing the placement and order of abortion-related questions, 

• changing the level of detail requested,  

• adding an introduction to abortion questions, and 

• changing the context in which such questions are asked.  

Highlighting the challenges of abortion measurement, none of the tested approaches significantly improved abortion reporting compared with the standard of the National Survey of Family Growth, a national survey collecting pregnancy data. However, the researchers stress that these results cannot and should not be the end of the effort to improve abortion reporting. Rather, they reflect the strong impact of abortion stigma in the United States and point to a need for further work in this area.  

“These new findings highlight the pervasiveness of abortion stigma, which not only compromises accurate data collection, but also directly harms people by creating barriers to abortion care and worsening existing health inequities,” says Isaac Maddow-Zimet, senior research associate at the Guttmacher Institute. “This stigma will likely worsen in the wake of the overturning of Roe. Improving abortion reporting is crucial to improve pregnancy-related health outcomes and better understand how to support reproductive health care for all people.”