Improving measurement of abortion incidence and safety: Innovations in methodology and recent empirical studies

Mombasa, Kenya, 19-21 November 2024

 

The international seminar on “Improving measurement of abortion incidence and safety: Innovations in methodology and recent empirical studies” was held in Mombasa, Kenya 19-21 November 2024, organized by the IUSSP Scientific Panel on Abortion Research.   

 

 

Abortion research, and in particular measurement of abortion incidence and safety, continues to be of high priority and we recognized that it would benefit greatly from scientific exchange. Two factors continue to change and affect measurement needs.  The first is abortion law and its implementation: While the law on abortion has continued to change in many settings, more often in the direction of broadening criteria under which abortion is legally permitted. in some countries legal criteria have become more restrictive.  In addition, implementation of law changes may take place in parts of a country but not in all provinces or states.  The second main factor is the extent to which clandestine abortion using relatively safe methods, such as medication abortion, are increasingly being used.  Changes in legality and access to safe or safer abortion services call for new methodologies or adaptations to previously used methods to measure both incidence and safety. In addition, in settings where abortion was broadly legal and the law now is restrictive – such as the situation of a large number of states in the US – methodologies that were used to document abortion incidence in the past are no longer adequate, and new approaches need to be developed or adapted. These changes underscore the need for improved methodologies to measure abortion incidence and safety so as to assess the extent to which safe and legal services are being used and to identify which groups have inequitable access to legal, safe abortion services. They also highlight the importance of removing previous geographical silos in abortion research so that researchers who work in different legal contexts can learn from one another’s experiences to produce innovative new approaches.

 

The objective of this seminar was to provide a forum for researchers to discuss their work on innovative methods to measure abortion incidence, abortion safety and related morbidity and the impact of abortion law. The seminar aimed to bring together researchers who were developing and testing different study designs, methodologies, and approaches. The studies presented were implemented in a variety of abortion law contexts, ranging from those where abortion is broadly legal, to those where abortion is highly legally restricted and safe abortion is more difficult to access.

 

 

A total of 21 papers were selected for presentation at the seminar, and they were presented in 6 sessions.  

 

  • Two of the sessions covered papers on indirect approaches for measuring abortion incidence, including an assessment of one method (ATPR, Anonymous Third Party Reporting), adaptations of another method (AICM, Abortion incidence Complications Method) to measure incidence in four different contexts: in humanitarian settings in East Africa; in a subnational area (one state in Nigeria); in the USA after the Dobbs decision led to restrictions in abortion legality in many states, measuring self-managed medication abortions; and lastly, in two restrictive contexts (Kaya, Burkina Faso and Kenya) Respondent Driven Sampling was used to conduct a survey of women to improve measurement of a key input into the AICM methodology, the multiplier or number of women who have safe abortions (i.e. did not have complications that need treatment in a facility) for each woman who was treated for complications in a health facility.  
     
  • One session focused on direct approaches for measuring abortion incidence: a paper assessed results from large scale national surveys that asked women about their abortions; and two papers addressed issues based on a survey of women in the Rohingya refugee camps in Bangladesh-- perceptions of interlinked concepts of family planning, miscarriage and pregnancy termination, and secondly, issues affecting data collection on abortion in this complex humanitarian context.  
     
  • Two sessions focused on measurement of morbidity from unsafe abortion and of abortion safety.   Papers addressed the following issues: safety and effectiveness of self-managed abortion medication abortion; trends in rate of treatment for abortion complications, treatment seeking behaviors; the relationship between abortion law and abortion morbidity; measurement of abortion safety using data collected through Response Driven Sampling; classification according to safety; and (a little-explored topic) incidence of failed abortion attempts.  
     
  • One session addressed issues related to abortion law change and its impact: where the law became more restrictive (United States), more liberal (Argentina), variation in cost of medication abortion where the law supports it (Ghana), and assessing the impact of abortion legislation in South America using digital trace data.  

In addition, the seminar included a session on Current Research on Abortion at APHRC, to improve participants’ awareness of research on abortion in Kenya.  Also, 4 experts were invited to participate in the seminar including leading a session on "Advances in research on the measurement of abortion safety and abortion incidence, and future work needed".

 

 

The 21 papers that were presented at the seminar addressed innovative research on the measurement of abortion incidence, abortion safety, and abortion-related morbidity. The papers covered different countries and contexts. The papers that focused on methodology provided findings from applications of innovative methods and/or adaptations of existing methods for abortion measurement, mostly at the country or subnational levels. The papers presented responded to the need for improving measurement of abortion incidence and safety, limitations of existing methods, law change, inadequate implementation of existing legal criteria, inadequate and unequal access to safe abortion due to restrictive abortion laws, high stigma, and poor capacity of health systems to offer quality services that meet women’s needs. Overall, the seminar offered valuable assessments and some improvements with respect to existing methodologies in this field, explained and tested some new approaches and also provided new substantive evidence on access to safe and legal abortion.

 

Seminar participants included authors of the papers, invited experts on abortion research, colleagues from APHRC-Nairobi, and some members of the IUSSP panel on abortion research. They represented Latin America (5), Asia (2), Sub-Saharan Africa (9), North America (12), and other developed countries (3). Participants represented different career stages – those who have worked on abortion research for many years, junior scholars and doctoral candidates. 

 

IUSSP Scientific Panel on Abortion Research

  • Panel Co-Chairs: Fatima Juárez (El Colegio de Mexico) and Susheela Singh (Guttmacher Institute);
  • Panel members: Harriet Birungi (Population Council, Nairobi), Margaret Giorgio (Guttmacher Institute), Rishita Nandagiri (King’s College London) and Ndola Prata (School of Public Health, University of California, Berkeley)