Evaluating indirect survey question methods on reproductive health behavior

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Project Summary: "Evaluating indirect survey question methods on reproductive health behavior" Abortion is a major component of reproductive health and autonomy, but is increasingly subject to access restrictions that may dramatically reduce utilization. Beyond general aggregate statistics, little is known about the characteristics, attitudes, and behaviors of those obtaining abortions at the state and national levels. A lack of validity of direct survey questions is a critical barrier to understanding attitudes and characteristics of abortion patients. Indirect survey question methods have the potential to overcome this barrier. The indirect methods known as the Item Count Technique (ICT) and the Item Sum Technique (IST) estimate respectively whether and how many abortions a woman has experienced. In this study, we evaluate the ICT and IST methods using data from nine states with more and less restrictive abortion policies, in periods when abortion was more and less restricted. The nine states are located in the Mid- Atlantic, Midwestern, Southwestern, and Southeastern regions of the US. The study aims are to: 1) Evaluate ICT and IST internal validity assumptions; 2) Evaluate bias of the estimators from ICT and IST against external abortion statistics from CDC reports and the Guttmacher Institute’s periodic census of abortion providers by state and by age and race/ethnicity; 3) Evaluate the performance of different implementations of multivariate regression estimation of abortion on socio-demographic characteristics and assess sampling-variance gains to incorporating external abortion count data in combined survey and population data estimators; and 4) Estimate differences in incidence and mean numbers of abortions by state policy and by respondent characteristics not readily available in administrative records and provider surveys. Methodologically, our study will contribute to existing literature by evaluating ICT method for abortion to a broad social-geographic range U.S. states, by evaluating for the first time anywhere the validity of the IST method applied to numbers of abortions, and by evaluating the validity of the ICT and IST methods over a limited period, specifically five years. Substantively, we will contribute to understanding characteristics, attitudes, and behaviors of those seeking and obtaining abortions across nine U.S. states both before and after the major state policy changes of 2022.