Data come from an existing multi-country project called Performance Monitoring for Action (PMA). PMA conducts annual population-based family planning surveys in several African and Asian countries. PMA uses a multi-stage stratified cluster sampling design with probability proportional to size selection of clusters, which are comprised of approximately 200 households each. Interviewers then map and list all households within selected clusters and randomly sample 35 households per cluster (40 in Lagos, Nigeria). The surveys are conducted regularly in order to track key family planning indicators and sample size determination is based on the sample required to estimate the modern contraceptive rate with a 3 percentage point precision. The sampling design is described in more detail elsewhere [29 ].
In-country partners conducted data collection from April through May 2018 in Nigeria, July through August 2018 in Cote d’Ivoire, and April through June 2018 in Rajasthan. Interviewers residing within or nearby selected clusters conducted surveys in English, Hausa, Igbo, Yoruba, or Pidgin in Nigeria, French in Cote d’Ivoire, and Hindi in Rajasthan. Local dialects were used to improve comprehension when necessary. All females aged 15–49 who were usual residents of or slept the prior night in a selected household were eligible to participate after providing informed consent. In accordance with local ethical approvals, respondents provided verbal informed consent in Nigeria and Cote d’Ivoire and written informed consent in Rajasthan. The Johns Hopkins University Bloomberg School of Public Health provided ethical approval for this study (8308), as did the National Health Research Ethics Committee of Nigeria (NHREC/01/01/2007–02/01/2018C), the Comite National D’ Ethique de la Recherche (CNER) in Cote d’Ivoire (N/Ref: 036–18/MSHP/CNER-kp), and the Indian Institute of Health Management Research (IIHMR) Institutional Review Board for Protection of Human Subjects in Rajasthan (Feb 2018 1).
In the abortion module, interviewers asked women whether they had ever done something to bring back their period at a time when they were worried they were pregnant (i.e. menstrual regulation for the purpose of fertility regulation, which we are simply referring to as menstrual regulation). Researchers’ understanding of this practice and the specific language that captured it emerged during discussions with female data collectors from study areas in Nigeria during the pilot training. The women made a distinction between actions women take when their period is late and they suspect they may be pregnant but have not confirmed it and when a pregnancy is more established or confirmed through a pregnancy test or other pregnancy symptoms. We conducted similar discussions with interviewers and respondents involved in the pilot training in the other study countries and affirmed the importance of asking questions about menstrual regulation in the other contexts as well. We confirmed comprehension and interpretation of this language and the corresponding translations during piloting in each country. The prelude to the abortion module, which included the menstrual regulation questions, framed the content with regards to actions women take when they become pregnant at a time when they cannot or do not want to be pregnant in order to minimize reporting of miscarriage. Interviewers asked about the year of the menstrual regulation, whether the woman did multiple things in the process of regulating her menses, and the method(s) and source(s) used.
In-country partners conducted data collection from April through May 2018 in Nigeria, July through August 2018 in Cote d’Ivoire, and April through June 2018 in Rajasthan. Interviewers residing within or nearby selected clusters conducted surveys in English, Hausa, Igbo, Yoruba, or Pidgin in Nigeria, French in Cote d’Ivoire, and Hindi in Rajasthan. Local dialects were used to improve comprehension when necessary. All females aged 15–49 who were usual residents of or slept the prior night in a selected household were eligible to participate after providing informed consent. In accordance with local ethical approvals, respondents provided verbal informed consent in Nigeria and Cote d’Ivoire and written informed consent in Rajasthan. The Johns Hopkins University Bloomberg School of Public Health provided ethical approval for this study (8308), as did the National Health Research Ethics Committee of Nigeria (NHREC/01/01/2007–02/01/2018C), the Comite National D’ Ethique de la Recherche (CNER) in Cote d’Ivoire (N/Ref: 036–18/MSHP/CNER-kp), and the Indian Institute of Health Management Research (IIHMR) Institutional Review Board for Protection of Human Subjects in Rajasthan (Feb 2018 1).
In the abortion module, interviewers asked women whether they had ever done something to bring back their period at a time when they were worried they were pregnant (i.e. menstrual regulation for the purpose of fertility regulation, which we are simply referring to as menstrual regulation). Researchers’ understanding of this practice and the specific language that captured it emerged during discussions with female data collectors from study areas in Nigeria during the pilot training. The women made a distinction between actions women take when their period is late and they suspect they may be pregnant but have not confirmed it and when a pregnancy is more established or confirmed through a pregnancy test or other pregnancy symptoms. We conducted similar discussions with interviewers and respondents involved in the pilot training in the other study countries and affirmed the importance of asking questions about menstrual regulation in the other contexts as well. We confirmed comprehension and interpretation of this language and the corresponding translations during piloting in each country. The prelude to the abortion module, which included the menstrual regulation questions, framed the content with regards to actions women take when they become pregnant at a time when they cannot or do not want to be pregnant in order to minimize reporting of miscarriage. Interviewers asked about the year of the menstrual regulation, whether the woman did multiple things in the process of regulating her menses, and the method(s) and source(s) used.
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