Accurately measuring stigmatized experiences is a challenge across reproductive health research. In this study, we tested a novel method – the list experiment – that aims to reduce underreporting of sensitive events by asking participants to report how many of a list of experiences they have had, not which ones. We applied the list experiment to measure “self-managed abortion” - any attempt by a person to end a pregnancy on one’s own, outside of a clinical setting – a phenomenon that may be underreported in surveys due to a desire to avoid judgement. We administered a double list experiment on self-managed abortion to a Texas-wide representative sample of 790 women of reproductive age in 2015. Participants were asked how many of a list of health experiences they had experienced; self-managed abortion was randomly added as an item to half of the lists. A difference in the average number of items reported by participants between lists with and without self-managed abortion provided a population level estimate of self-managed abortion. In 2017, we conducted cognitive interviews with women of reproductive age in four states to understand how women (1) interpreted the list experiment question format, and (2) interpreted the list item on prior experiences attempting to self-manage an abortion. Results from this list experiment estimated that 8% of women of reproductive age in Texas have ever self-managed an abortion. This number was higher than expected, thus, the researchers conducted cognitive interviews to better understand how people interpreted the list experiment on self-managed abortion. Some women interpreted “on your own” to mean “without the knowledge of friends or family”, as opposed to “without medical assistance”, as intended. The list experiment may have reduced under-reporting of self-managed abortion; however, the specific phrasing of the list item may also have unintentionally increased reporting of abortion experiences not considered “self-managed.” High participation in and comprehension of the list experiment, however, suggests that this method is worthy of further exploration as tool for measuring stigmatized experiences.

中文翻译：

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减少对受歧视妊娠结果的漏报：使用列表实验法对德克萨斯州自我管理堕胎进行的混合方法研究的结果

准确衡量污名化经历是生殖健康研究中的一个挑战。在这项研究中，我们测试了一种新颖的方法——列表实验——旨在通过要求参与者报告他们经历过的一系列经历中的多少，而不是哪些，来减少敏感事件的漏报。我们应用清单实验来衡量“自我管理堕胎”——一个人在临床环境之外自行终止妊娠的任何尝试——由于希望避免判断，这种现象可能在调查中被低估。2015 年，我们对德克萨斯州范围内 790 名育龄妇女的代表性样本进行了一项关于自我管理堕胎的双重清单实验。参与者被问及他们经历过的健康经历中的多少；自我管理堕胎作为一个项目被随机添加到一半的列表中。参与者在有和没有自我管理堕胎的列表之间报告的平均项目数的差异提供了自我管理堕胎的人口水平估计。2017 年，我们对四个州的育龄女性进行了认知访谈，以了解女性如何 (1) 解读列表实验问题格式，以及 (2) 解读有关尝试自我处理堕胎的先前经历的列表项。该列表实验的结果估计，德克萨斯州 8% 的育龄妇女曾经自行堕胎过。这个数字高于预期，因此，研究人员进行了认知访谈，以更好地了解人们如何解读自我管理堕胎的清单实验。一些女性将“独自”解释为“在朋友或家人不知情的情况下”，而不是原意的“没有医疗援助”。清单实验可能减少了自我管理堕胎的漏报情况；然而，清单项目的具体措辞也可能无意中增加了不被视为“自我管理”的堕胎经历的报告。然而，对清单实验的高度参与和理解表明，这种方法作为衡量污名化经历的工具值得进一步探索。