Acknowledgments: This work was conducted in collaboration with NORC at the University of Chicago. It was supported by a research grant from a foundation focused on education and health issues.

Introduction

The Endline Statewide Survey of Women of Reproductive Age in Delaware and Maryland was designed and conducted to support evaluation of the Delaware Contraceptive Access Now (DelCAN) initiative. The survey was administered to a probability sample of women aged 18 to 44 in Delaware and Maryland to measure the reproductive health experiences of women. It was fielded by NORC at the University of Chicago from February to October 2021. Eligible respondents were women aged 18-44 residing in households. The design and administration of this “Endline” survey followed that of the “Baseline” survey fielded by NORC at the University of Chicago from November 2016 through March 2017. The Baseline survey’s methodology is described in a separate Methodological Report:
View / Download Baseline Survey Methodology Report

The design of the Baseline survey instrument is described on the Survey page

Questions in the Endline Survey were added or changed on topics of: (1) experience of the Covid-19 epidemic; (2) desired contraceptive features; (3) desired contraception; (4) sterilization regret; (5) experience of pressure to initiate and to continue LARC use; and (6) abortion. The new questions were developed or changed as follows:

Question Sources

Whenever possible, question text and response items were obtained from existing surveys (see Baseline Survey documentation, Table 1, at the bottom of the Survey page). Basing question text and response items on existing surveys allows for estimates to be comparable with those from other surveys and takes advantage of the development and testing process used by those surveys. The construction of new items and changes to existing items is described immediately below.

(1) Experience of the Covid-19 epidemic

One complete question was added [source: adapted from the Guttmacher Survey of Reproductive Health Experiences]:

In the past year, has the COVID-19 (coronavirus) pandemic affected you in any of the following ways?

Two other questions had COVID-19 response options added:

Why didn’t you get health care for yourself?

Please check all that apply.

1. I was concerned about exposure to COVID-19.
2. The place I usually go was closed because of COVID-19.
3. . . .
4. . . .

and

In the PAST 12 MONTHS, did you leave a job or school because…? Please check all that apply

1. COVID-19 (Coronavirus)
2. . . .
3. . . .

(2) Desired contraceptive features [source: adapted from the National Survey of Reproductive and Contraceptive Knowledge and Lessard et al. 2012]

How important are each of the following characteristics to you in deciding which birth control method to use?

(3) Desired contraception [adapted from The Texas Postpartum Contraception Study, Potter, Coleman-Minahan, et al. (2017)]

If you could use any birth control method you wanted, what method(s) would you use?

What is the main reason you are not currently using the birth control method you want to use?

(4) Sterilization regret [source: NSFG]

Two questions were added:

In what month and year did you have the tubal sterilization or “Essure” operation?

As things look to you now, if your tubal sterilization could be reversed safely, would you want to have it reversed?

Additionally, a question was rephrased and had its set of response options revised:

Have you had a female sterilizing operation such as tubal sterilization (also called getting “getting your tubes tied” or having a “tubal ligation”), “Essure” (a sterilization method where women have a small coil inserted inside her fallopian tubes) or another operation (such as a hysterectomy) that makes you currently unable to get pregnant?

Yes, “tubal ligation,” “tubes tied,” or “Essure”

Yes, hysterectomy or another operation, so unable to get pregnant

(5) Experience of pressure to initiate and to continue LARC use.

Questions of when inserted or removed [source: NSFG]:

(After a ‘yes’ response to the questions ever-use of IUD/implant)

If yes, in what month and year did you last have an IUD [Implant] inserted? If you cannot remember exactly, please give your best estimate.

If yes, if you are no longer using that IUD, in what month and year did you have it removed or was it expelled? If you cannot remember exactly, please give your best estimate.

Questions of experience of pressure when inserted or removed [Source: adapted from “Opening doors” survey; see Becker & Tsui 2008]:

If yes, did you ever feel pressured by a medical provider to keep in the IUD [Implant] that you were last using or are still using?

(After the question on ever-use of IUD/implant)

(After the question on current use of IUD/implant)

If yes, how much pressure did you feel from a medical provider to have the IUD [implant] inserted?

If no, did you ever feel pressure from a medical provider to use an IUD [implant] when you would have rather used another method or no method at all?

If yes, thinking about the most recent time that you felt pressure from a medical provider to use an IUD [implant], how much pressure did you feel?

(6) Abortion

As in the Baseline survey, the Endline survey used an indirect question method called the “list experiment” (Moseson et al. 2017). In the list that contained abortion item in the Baseline survey it asked whether the respondent had ever had an abortion. In the Endline survey, the abortion item instead asked whether the respondent “Had an abortion (ended a pregnancy on purpose) in the past 5 years.” Five years corresponds both to the approximate period of the DelCAN Initiative (see our Summary) and the approximate number of years since the Baseline survey.

Questionnaire Instrument and Translation

All questions were originally written in English. The instrument was translated into Spanish by an organization that NORC contracts with to translate their materials.

View / Download Appendix A: Endline Survey of Women (English and Spanish)

View / Download Endline Methodology Report

Appendix B: Mailing Materials

View / Download a copy of this Introduction page