Abstract
Abortion is highly stigmatized in most settings and severely underreported in demographic surveys. In the USA, variation in the context of abortion between states may influence respondents’ exposure to abortion stigma and create geographic variation in their likelihood of disclosing abortion in surveys. We used restricted geographic data from the 2006–2010 and 2011–2015 National Survey of Family Growth (NSFG) to investigate the association between abortion reporting in the USA and state-level structural factors that may influence respondents’ experience of abortion stigma. At the aggregate level, we compared the weighted number of abortions women reported in the NSFG to abortion counts derived from abortion provider censuses and test for variation in underreporting by state-level structural measures. At the individual level, we tested if state-level structural factors were associated with less reporting of abortion in the face-to-face (FTF) survey mode than the more confidential audio computer-assisted self-interviewing mode (ACASI) of the NSFG. We found that at the aggregate level, there were no differences in reporting by the state-level measures. At the individual level, about 40% of women and men who reported an abortion in their ACASI did not fully report in the FTF interview; however, there were few differences by any state-level factors. This study documents that abortion stigma plagues the quality of reporting in the USA for both women and men, regardless of which state they live in. Survey improvements to reduce abortion underreporting are needed.
Highlights
Underreporting of abortion compromises the quality of individual-level demographic data in surveys in Europe, the USA, and the Global South (Houzard et al, 2000; Jones & Kost, 2007; Lindberg et al, 2020; MacQuarrie et al, 2018; Scott et al, 2019)
Among women and men reporting any abortions in the audio computer-assisted self-interviewing mode (ACASI) portion of the National Survey of Family Growth (NSFG), we identified if respondents had reported fewer abortions in the FTF interview.For female respondents, we restricted the FTF counts to abortions ending in the five calendar years prior to the interview to parallel ACASI reports, including a buffer period of 6 months on either side to account for slight misdating; for male respondents the counts referred to abortions over their lifetime
This study is the first to explore state-level correlates of the substantial abortion underreporting found in the NSFG; we find no evidence that state-level measures of abortion stigma drive variation in underreporting as compared to external counts
Summary
Underreporting of abortion compromises the quality of individual-level demographic data in surveys in Europe, the USA, and the Global South (Houzard et al, 2000; Jones & Kost, 2007; Lindberg et al, 2020; MacQuarrie et al, 2018; Scott et al, 2019). It is well established that respondents may not report sensitive behaviors to provide more socially desirable responses (Tourangeau & Yan, 2007); with abortion, the sensitivity of the behavior is assumed to reflect high levels of abortion stigma in most settings. Kumar et al (2009) characterize abortion stigma as “a negative attribute ascribed to women who seek to terminate a pregnancy that marks them, internally or externally, as inferior to ideals of womanhood”. Prior literature on abortion stigma distinguished between internalized and perceived stigma at the individual level (how women feel about their own abortion and the reactions they expect from others) and enacted stigma at the interpersonal level (how others treat them post disclosure) (Hanschmidt et al, 2016). Broader work on stigma conceptualize it as a multilevel process, with structural stigma defined as “societal-level conditions, cultural norms, and institutional policies that constrain the opportunities, resources, and well-being of the stigmatized,” (Hatzenbuehler & Link, 2014) playing an important role
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