Adapting the Abortion Incidence Complications Method to the United States: Measuring the Incidence of Out-of-Facility Abortion Post-Dobbs

Elizabeth A. Sully, Guttmacher Institute
Isabel DoCampo, Guttmacher Institute
Sidney Cech, Guttmacher Institute
Isaac Maddow-Zimet, Guttmacher Institute

Out-of-facility abortion represents an increasingly important option for pregnant people seeking abortion in the United States after the Dobbs decision. However, abortions occurring outside of facility settings are notoriously difficult to measure. In this paper we use a pilot study to assess a medication abortion (MA)-adapted version of the Abortion Incidence Complications Method (AICM), a common indirect method for measuring abortion which employs a multiplier approach to estimate how many abortions occur for every treated abortion complication. We explore three adaptations to the AICM. First, we consider three potential multipliers focused on treatment-seeking, as opposed to complications. Second, drawing on two novel surveys of users and online providers of MA, we compare multipliers estimated from users vs. providers. We assess the stability of the multiplier across respondent demographics, abortion policy environments, and provider types. Third, using historical trends on miscarriage management care from health administrative data, we explore the use of standard facility-based surveys to estimate the share of miscarriage management cases due to out-of-facility abortions. The MA-adapted AICM offers a promising path to estimating the incidence of out-of-facility abortion in the United States, with implications for the measurement of abortion globally in contexts of growing MA use.

Keywords: Data and Methods, Sexual and Reproductive Health and Rights, Family Planning and Contraception

See extended abstract.