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. 2021 Dec;52(4):513-538.
doi: 10.1111/sifp.12180. Epub 2021 Nov 11.

An Assessment of Third-Party Reporting of Close Ties to Measure Sensitive Behaviors: The Confidante Method to Measure Abortion Incidence in Ethiopia and Uganda

Margaret Giorgio  1 , Elizabeth Sully  1 , Doris W Chiu  1
Affiliations

An Assessment of Third-Party Reporting of Close Ties to Measure Sensitive Behaviors: The Confidante Method to Measure Abortion Incidence in Ethiopia and Uganda

Margaret Giorgio et al. Stud Fam Plann. 2021 Dec.

Abstract

Indirect estimation techniques are important tools for measuring sensitive and stigmatized behaviors. This includes third-party reporting methods, which have become increasingly common in the field of abortion measurement, where direct survey approaches notoriously lead to underreporting. This paper provides the first in-depth assessment of one of the most widely used of these techniques in the field of abortion measurement: the confidante method. We outline six key assumptions behind the confidante method and describe how violations of these assumptions can bias resulting estimates. Using data from modules added to the performance monitoring for action surveys in Uganda and Ethiopia in 2018, we compute one-year abortion incidence estimates using the confidante method. We also perform a validation check, using the method to estimate intrauterine device /implant use. Our results revealed implementation problems in both settings. Several of the method's foundational assumptions were violated, and efforts to adjust for these violations either failed or only partially addressed the resulting bias. Our validation check also failed, resulting in a gross overestimate of intrauterine device/implant use. These results have implications more broadly for the potential biases that can be introduced in using third-party reporting of close ties to measure other sensitive or stigmatized behaviors.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Number of confidantes reported by respondents in Ethiopia and Uganda
FIGURE 2
FIGURE 2
Proportion of respondents self‐reporting abortion who told each confidante about their abortion in Ethiopia and Uganda
FIGURE 3
FIGURE 3
Self‐reported, unadjusted confidante, transmission bias‐adjusted confidante, and AICM one‐year abortion incidence rates per 1,000 women aged 15–49 in Ethiopia and Uganda
FIGURE 4
FIGURE 4
Self‐reported, unadjusted confidante, transmission bias‐adjusted confidante, and DHS estimates of the current prevalence of IUD and implant use in Ethiopia and Uganda
FIGURE 5
FIGURE 5
Proportion of respondents who reported their current IUD or implant used to each confidante in Ethiopia and Uganda
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