Article Text

Original research
Interviewer effects on abortion reporting: a multilevel analysis of household survey responses in Côte d’Ivoire, Nigeria and Rajasthan, India
  1. Katy Footman
  1. Social Policy, The London School of Economics and Political Science, London, UK
  1. Correspondence to Katy Footman; k.footman{at}


Objectives The analysis aimed to assess the scale of interviewer effects on abortion survey responses, to compare interviewer effects between different question wordings and between direct and indirect approaches, and to identify interviewer and interview characteristics that explain interviewer effects on abortion reporting.

Setting 2018 Performance Monitoring for Action nationally representative household surveys from Côte d’Ivoire, Nigeria and Rajasthan, India.

Participants Survey data from 20 016 interviews with reproductive age (15–49) women, selected using multistage stratified cluster sampling. Data from self-administered interviewer surveys and from a sample of health service delivery points that serve the female survey participants were also included.

Primary outcome measures Outcomes were the respondent’s own experience of ever ‘removing a pregnancy’, their closest confidante’s experience of pregnancy removal and the respondent’s own experience of period regulation.

Results Substantial interviewer effects were observed, ranging from 7% in Côte d’Ivoire to 24% in Nigeria for pregnancy removal. Interviewer effects for survey questions that were designed to ask about abortion in a less stigmatising way were either similar to (9%–26% for confidante-reporting) or higher than (17%–32% for a question about period regulation) the pregnancy removal question. Interviewer and interview characteristics associated with abortion reporting included respondent–interviewer familiarity, the language of interview and the interviewer’s comfort asking questions about abortion.

Conclusion This study highlights that questions designed to be less stigmatising may increase interviewer effects due to lower comprehension among respondents. Further work is needed to assess question wordings for different contexts. Selecting and training interviewers to ensure comfort asking questions about abortion is important for reproductive health surveys. Challenges for the use of ‘insider’ interviewers and the management of surveys in countries with high linguistic diversity are also identified.

  • demography
  • statistics & research methods
  • reproductive medicine
  • public health

Data availability statement

Data are available in a public, open access repository. PMA survey datasets can be requested through the PMA website:

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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Data availability statement

Data are available in a public, open access repository. PMA survey datasets can be requested through the PMA website:

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  • Contributors This analysis was conceptualised and conducted and the manuscript was written by the sole author (KF), who is responsible for the overall content as the guarantor.

  • Funding The UK Economic and Social Research Council funded this analysis as part of a 1+3 doctoral grant (F79676A). The PMA abortion module was funded by an Anonymous Donor.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.