Improving measures of access to legal abortion: A validation study triangulating multiple data sources to assess a global indicator
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Date
2023
Journal Title
Journal ISSN
Volume Title
Publisher
PLOS ONE
Abstract
Background
Global 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 findings
We conducted a validation study using three countries as illustrative case examples: Argen tina, 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.
Conclusions
Taken 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.
Description
Research Article
Keywords
Citation
Citation: Williams CR, Va´zquez P, Nigri C, Adanu RM, Bandoh DAB, Berrueta M, et al. (2023) Improving measures of access to legal abortion: A validation study triangulating multiple data sources to assess a global indicator. PLoS ONE 18(1): e0280411. https://doi.org/10.1371/journal. pone.0280411