Making Connections

This summer, I have been working under the guidance of Dr. Sarah Averbach and Dr. Anita Raj of UCSD’s Center on Gender Equity and Health to study measures of contraceptive decision-making and their associations with contraceptive communication and use in rural India. I was both excited and nervous to take on a project within my interest in women’s health, as this was my first experience in this field of research. I worked to prepare by informing myself on sociocultural dynamics, traditions, and other determinants of reproductive health specific to the context of India. As Dr. Averbach wisely explained to us, cultural humility is a lifelong process, and I strove to be mindful of this regardless of whether I traveled internationally or not.

Coming from the world of bench research, my GHAC summer project was a completely new experience for me. Leaving behind my reagents, cells, and graphs, I was introduced to the value of survey questionnaires and statistical analysis.

In the field of global reproductive health, countless studies have sought to design survey-based measures of contraceptive decision-making among women and couples. These are incredibly important to the field, as understanding the process of contraceptive decision-making in relation to contraceptive uptake allows us to assess the factors creating and mitigating unmet need for contraception, a driver of poor maternal and child health outcomes. This then informs us on optimal targets for intervention programming and program quality assessments.

Across country contexts and study designs, numerous measures of contraceptive decision-making exist in the field, but it remains unclear how their utility varies or intersects, and what they truly tell us about decision-making and contraceptive use. Importantly, the most broadly used measures are indicative of who the decision-maker is, while newer measures seek to capture women’s agency in decision-making.

Once I had developed an initial understanding of how decision-making is measured and applied in the field, I worked closely with my mentors to begin our project centered on data from rural Maharashtra, India. We utilized responses from married women across three distinct measures of contraceptive decision-making to determine how outcomes in contraceptive use differed in association with these measures, how closely these measures were related to one another, and what the role of female agency may be in determining contraceptive uptake in this context. It was interesting to observe that female agency, though extremely important to gender equity and personal sovereignty, was not as directly related to contraceptive use as anticipated. This led to informative discussions and postulations regarding how complex and intertwined determinants of contraceptive uptake are. Our work points to the need for development of more comprehensive decision-making measures that account for the many dimensions of the decision-making process and can inform on how to better design and evaluate family planning intervention programs to support both women’s personal goals as well as contraceptive uptake.

Study being conducted in Maharashtra, India (photo was used with signed permission)

In addition to this project, Dr. Raj supported me in turning my initial review of the literature into a brief for the Center on Gender Equity and Health, which is meant to be a report on existing measures of contraceptive decision-making and what the current state of the field is.

Growing interest in the field on measures of decision-making in the past 10 years.
Compiling and assessing existing decision-making measures.

introduction to the field of global women’s health, I became incredibly motivated by how family planning and gender transformative intervention programming is so directly impactful to the lives and health of women across the world and can support gender equity. This experience has definitely confirmed my interest in shaping my future education and career to involve efforts like these and enabled me to take a first step into this realm.

Though I did not travel to India for my research this summer, I did have the opportunity to e-meet the collaborating team in India via Zoom. It has been a privilege to work with international colleagues who have been dedicated to this work for years, and to have been involved in such a motivating project in a growing field.

I am not only grateful to the team I worked with and to GHAC for this incredible opportunity, but also to the program participants whose responses allow us to learn from their lived experiences and without whom these studies are not possible.

As the summer comes to an end, I am energized and impatiently awaiting my future travels to participate in an international clinical rotation during my 4th year.

Looking forward to making connections abroad soon.

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