Developing and testing novel measures of misoprostol use for induced abortion using the list experiment in Pakistan
Awarded 2016
Small Research Grants
Erin Pearson, PhD, MPH
Harvard University

Objectives: Misoprostol-alone is an increasingly common method of induced abortion in countries such as Pakistan where abortion is legally restricted, but measurement poses significant challenges. The list experiment is a secret-answer technique that has been shown to more accurately measure sensitive behaviors like abortion compared to traditional face-to-face interviews. This study developed measures of misoprostol use for induced abortion and misoprostol failure and pilot tested them in the list experiment compared to face-to-face interviews in a population with known misoprostol outcomes in Karachi, Pakistan. Methods: Twenty in-depth interviews were conducted with abortion clients to develop measures of misoprostol use for induced abortion and misoprostol failure, and measures were refined using cognitive interviewing techniques with abortion clients and providers. A total of 100 women participated in the survey; 53 were randomly assigned to a face-to-face interview and 47 to the list experiment. The prevalence of the outcomes estimated from the list experiment and face-to-face interviews was compared to the prevalence based on the clients’ medical records. Results: Overall, the measures of misoprostol use performed well. Both the list experiment and the face-to-face interviews resulted in prevalence estimates that were higher than those reported in the medical record, which was expected to be a lower bound. Conclusion: Women understood the list experiment and trusted the privacy associated with this survey method. More research is needed to ascertain whether the list experiment performs better than face-to-face interviews for measuring sensitive behaviors in the general population in Pakistan.