There are lots of survey-based studies on abortion in countries where abortion is illegal—the problem is not so much getting it through an ethics board as the reliability of the results. You could alternatively measure using hospitalisations for incomplete abortion as a proxy—you won’t be able to identify the exact magnitude of the problem or the change since an unknown proportion of these are from miscarriages (some have tried to estimate the ‘natural’ miscarriage presentation rate, but I think these estimates are obviously unreliable), but you could see if there is a change and whether it is a big or small change, since the miscarriage rate should remain relatively constant. It would need a big enough sample size though.
Hey Callum practically wise on the ground here I would be like 70 percent sure that it would be impossible to meaningfully assess abortion reduction and a study endpoint
An anonymous survey based study is a lot easier ethics wise than a big RCT, I think it would be a struggle to get through ethics approval in Uganda here—again I have a bit of experience with ethics board but could be wrong. For better or worse (I think worse) ethics boards are understandably often tighter on RCTs than other study forms.
There are lots of survey-based studies on abortion in countries where abortion is illegal—the problem is not so much getting it through an ethics board as the reliability of the results. You could alternatively measure using hospitalisations for incomplete abortion as a proxy—you won’t be able to identify the exact magnitude of the problem or the change since an unknown proportion of these are from miscarriages (some have tried to estimate the ‘natural’ miscarriage presentation rate, but I think these estimates are obviously unreliable), but you could see if there is a change and whether it is a big or small change, since the miscarriage rate should remain relatively constant. It would need a big enough sample size though.
Hey Callum practically wise on the ground here I would be like 70 percent sure that it would be impossible to meaningfully assess abortion reduction and a study endpoint
An anonymous survey based study is a lot easier ethics wise than a big RCT, I think it would be a struggle to get through ethics approval in Uganda here—again I have a bit of experience with ethics board but could be wrong. For better or worse (I think worse) ethics boards are understandably often tighter on RCTs than other study forms.
Thanks Nick. I have come across quite a lot of abortion surveys in countries with restrictive laws. Here is one from Uganda: https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0002340#sec007 I agree entirely that the results are likely not to be very reliable, but I think that is the bigger problem; less so the lack of ethics approval.