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Research ArticleOpen Access

Improving measures of access to legal abortion: A validation study triangulating multiple data sources to assess a global indicator

Caitlin R. Williams1, Paula Vázquez2, Carolina Nigri3, Richard M. Adanu4, Delia A. B. Bandoh5, Mabel Berrueta3, Suchandrima Chakraborty6, Jewel Gausman7, Ernest Kenu5, Nizamuddin Khan6, Ana Langer7, Magdalene A. Odikro5, Sowmya Ramesh6, Niranjan Saggurti6, Verónica Pingray3, R. Rima Jolivet7*

1Institute for Clinical Effectiveness and Health Policy (Instituto de Efectividad Clínica y Sanitaria (IECS)), Buenos Aires, Argentina; Department of Maternal & Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America

2Institute for Clinical Effectiveness and Health Policy (Instituto de Efectividad Clínica y Sanitaria (IECS)), Buenos Aires, Argentina; Department of Health Science, Kinesiology, and Rehabilitation, Universidad Nacional de La Matanza, Buenos Aires, Argentina

3Institute for Clinical Effectiveness and Health Policy (Instituto de Efectividad Clínica y Sanitaria (IECS)), Buenos Aires, Argentina

4Department of Population, Family, and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana

5Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Greater Accra, Ghana

6Population Council, New Delhi, India

7Department of Global Health and Population, Women and Health Initiative, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America

* Correspondence: rjolivet@hsph.harvard.edu

PLOS ONE — Volume 18, Issue 1 (2023-01)

Abstract

BackgroundGlobal mechanisms have been established to monitor and facilitate state accountability regarding the legal status of abortion. However, there is little evidence describing whether these mechanisms capture accurate data. Moreover, it is uncertain whether the “legal status of abortion” is a valid proxy measure for access to safe abortion, pursuant to the global goals of reducing preventable maternal mortality and advancing reproductive rights. Therefore, this study sought to assess the accuracy of reported monitoring data, and to determine whether evidence supports the consistent application of domestic law by health care professionals such that legality of abortion functions as a valid indicator of access.Methods and findingsWe conducted a validation study using three countries as illustrative case examples: Argentina, Ghana, and India. We compared data reported by two global monitoring mechanisms (Countdown to 2030 and the Global Abortion Policies Database) against domestic source documents collected through in-depth policy review. We then surveyed health care professionals authorized to perform abortions about their knowledge of abortion law in their countries and their personal attitudes and practices regarding provision of legal abortion. We compared professionals’ responses to the domestic legal frameworks described in the source documents to establish whether professionals consistently applied the law as written.This analysis revealed weaknesses in the criterion validity and construct validity of the “legal status of abortion” indicator. We detected discrepancies between data reported by the global monitoring and accountability mechanisms and the domestic policy reviews, even though all referenced the same source documents. Further, provider surveys unearthed important context-specific barriers to legal abortion not captured by the indicator, including conscientious objection and imposition of restrictions at the provider’s discretion.ConclusionsTaken together, these findings denote weaknesses in the indicator “legal status of abortion” as a proxy for access to safe abortion, as well as inaccuracies in data reported to global monitoring mechanisms. This information provides important groundwork for strengthening indicators for monitoring access to abortion and for renewed advocacy to assure abortion rights worldwide.

Cite This Article

Williams, C., Vázquez, P., Nigri, C., Adanu, R., Bandoh, D., Berrueta, M., Chakraborty, S., Gausman, J., Kenu, E., Khan, N., Langer, A., Odikro, M., Ramesh, S., Saggurti, N., Pingray, V., Jolivet, R. (2023). Improving measures of access to legal abortion: A validation study triangulating multiple data sources to assess a global indicator. PLOS ONE, 18(1), online. https://doi.org/10.1371/journal.pone.0280411

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