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Beyond Acceptability: Users' Perspectives on Contraception BEYOND ACCEPTABILITY: USERS’ PERSPECTIVES ON CONTRACEPTION ACCEPTABILITY: BEYOND REPRODUCTIVE HEALTH MATTERS MATTERS REPRODUCTIVE HEALTH Beyond Acceptability: Users’ Perspectives on Contraception Reproductive Health Matters for the World Health Organization CONTRIBUTORS Marge Berer is editor of Reproductive Health several women’s health reports for the Amster- Matters; author and editor of Women and dam-based Women’s Health Action Foundation. HIV/AIDS: An International Resource Book; chair of the Gender Advisory Panel, UNDP/UNFPA/ Lori Heise co-directs the Health and Develop- WHO/World Bank Special Programme of ment Policy Project, a research and advocacy Research, Development and Research Training organisation in Washington DC that works to in Human Reproduction, Geneva; and is on the integrate gender and social justice into advisory committee of the reproductive rights international health policy and practice. research project, International Community of Women Living with HIV/AIDS, in London. Evelyn Landry is director, knowledge manage- ment, AVSC International, New York, and has Jane Cottingham is technical officer for conducted research on voluntarism, counselling Women’s Perspectives and Gender Issues, and client perspectives for improving service UNDP/UNFPA/WHO/World Bank Special Pro- delivery in sub-Saharan Africa, Latin America gramme of Research, Development and Research and Asia. Victoria Ward is senior evaluation Training in Human Reproduction in Geneva. specialist, International Planned Parenthood From 1974 to 1989 she founded and built up ISIS, a Federation Western Hemisphere Region, New women’s international information and com- York. Her work has focused on improving munication service, where she co-authored and research and evaluation capacity in service edited publications on women’s health and delivery agencies in the areas of reproductive development, and ran international workshops. health, family planning, safe abortion and reduction of maternal mortality. She is also Charlotte Ellertson is a program associate, adjunct professor, Columbia University School Population Council, New York. Her work focuses of Public Health, New York. on reproductive health technology, including emergency contraception, medical abortion and TK Sundari Ravindran is co-editor of Repro- microbicides. Beverly Winikoff is director of ductive Health Matters and an activist-researcher reproductive health, and a senior medical on women’s health and reproductive health and associate, Population Council, New York. Her rights. She is honorary executive director of work focuses on women-centred approaches to Rural Women’s Social Education Centre, a medical and surgical abortion, breastfeeding, grassroots women’s organisation in Tamil Nadu, safe motherhood and STDs. India. Sumathy S Rao is a public health and health education expert and founder of the Meg Gready was a volunteer with the Women’s Centre for Health Education and Development, Health Project, Johannesburg at the time the an NGO in Madras, India. paper published here was written. Barbara Klugman is director of the Women’s Health Sunanda Ray is a public health doctor working Project. Emelda Boikanyo founded and runs a at South Staffordshire Health Authority, Britain. Well Woman Centre in Mabopane, South Africa. She lives in Zimbabwe, and did this paper as a Helen Rees is director, Reproductive Health research fellow, Zimbabwe AIDS Prevention Research Unit, Department of Obstetrics and Project, University of Zimbabwe Medical School Gynaecology, Health Sciences Faculty, (ZAPP-UZ). She was a founder member of the University of South Africa, and Makhosazana Women and AIDS Support Network, Zimbabwe Xaba is deputy director of the Women’s Health (WASN). Caroline Maposhere is a research Project, Johannesburg. nurse with ZAPP-UZ and also an active member of WASN. They have both worked extensively on Anita Hardon currently works at the Medical reproductive health issues and are long-time Anthropology Unit, University of Amsterdam, advocates for women’s health and sexuality where she also coordinates the international rights in Zimbabwe. action-research network on Gender, Repro- ductive Health and Population Policies (GRHPP). She has published widely, and has contributed to ii READERS AND ADVISORS Soledad Sánchez is a psychologist and coor- We thank the following readers and advisors for dinator of the Social Sciences Unit at the Instituto their contribution to this publication: Chileno de Medicina Reproductiva (ICMER) in Rashidah Abdullah, Bencha Yoddunnern-Attig, Santiago, Chile. Claudia Araya is a psychologist. Regina Maria Barbosa, Toni Belfield, Walli Marcia Tijero is a sociologist. Soledad Díaz is Bounds, Aysen Bulut, Christopher Castle, Cordia a medical doctor, member of the board of Chu, Nel Druce, Christopher J Elias, Anibal directors of ICMER and consultant for several Fau´ndes, Jacqueline Darroch Forrest, Dianne international agencies. All of them are re- Forte, Odile Frank, Sarah Hawkes, Shireen searchers, members of an interdisciplinary team Jejeeboy, Raju Khanna, Lisa Koonin, Paul Van working in family planning and reproductive Look, Purnima Mane, Karla Meursing, Karen health at ICMER. Newman, Bert Pelto, Ann Reeler, Mala Ramana- than, Sunanda Ray, Karin Ringheim, Joke Rachel Snow was associate professor, Depart- Schijvers, Sagari Singh, Isabel de Zoyza, Leela ment of Tropical Hygiene and Public Health, Visaria, Geoffrey Waites. Harvard School of Public Health, Cambridge MA, USA, when this research was carried out. She is now at the Department of Tropical Hygiene and Public Health, University of Heidel- berg Medical School, Germany. Sandra García is a doctoral candidate at the Harvard School of Public Health and research affiliate with the Federación Mexicana de Asociaciones Privadas de Salud y Desarrollo Comunitario (FEMAP), in Ciudad Juarez, Mexico. Nazo Kureshy is a research coordinator, Department of Com- munity Health Sciences, Aga Khan University in Karachi, Pakistan. Ritu Sadana is a doctoral candidate at the Harvard School of Public Health and a consultant with WHO Europe. Sagari Singh is a reproductive health consultant based in New Delhi, India. Mercedes Becerra- Valdivia is a doctoral candidate at the Harvard School of Public Health. Star Lancaster is a reproductive health consultant based in Lexington MA, USA. Mamorena Mafokeng is a research associate, Department of Com- munity Health, University of Cape Town, South Africa. Margaret Hoffman is lecturer, Depart- ment of Community Health, University of Cape Town, South Africa. Iain Aitken is lecturer on international health, Department of Population and International Health, Harvard School of Public Health. Joan Walsh is a life sciences graduate with considerable career experience of reproductive health issues, having worked in human cyto- genetics, cancer research and subfertility/ reproductive technology services. She is cur- rently health policy/research officer at the UK Family Planning Association in London. iii INTRODUCTION Beyond Acceptability: Users’ Perspectives on Contraception Jane Cottingham HAT makes people choose a particular development, provision and use of fertility contraceptive? Researchers have been regulation methods. The UNDP/UNFPA/WHO/ Wtrying to answer this question for a long World Bank Special Programme of Research, time, as the extensive body of literature relating Development and Research Training in Human to this topic testifies. For scientists working to Reproduction in Geneva is following a strategy develop new contraceptive methods and which includes stimulating dialogue with improve existing ones, knowing the perspectives women’s health groups on different aspects of its of those who may eventually use the methods work, ensuring the participation of women’s ought to help in making decisions about which health groups as representatives on its scientific scientific leads to pursue and which to abandon. and policymaking committees, and seeking For those working in reproductive health policy advice on gender issues from its Gender and programmes, it is important to know what Advisory Panel. That strategy includes defining users of health services like or do not like about the kind of social science research that is needed the services, as a contribution towards im- to address unanswered questions in the area of proving them. For users and potential users of people’s perspectives on fertility regulation contraception, articulating their needs provides technology and services, so that these can be an opportunity to influence research as well as improved, enabling people to better manage service delivery. And for potential users, their fertility. learning of users’ perspectives would help them assess the appropriateness of the various methods for themselves. Scientific meeting In the context of improving women’s As part of this work, the Special Programme reproductive health, defined and elaborated by hosted a scientific consultation3 to examine the International Conference on Population and research into women’s and men’s perspectives, Development (ICPD)1 the agencies and and to allow an exchange of information and institutions involved in developing fertility experiences on different approaches to research regulation technology are increasingly being that are currently being used and explored.4 called upon to take into account the views and The purpose of the meeting was to review the experiences of the users and potential users of knowledge that exists on users’ perspectives, the that technology,
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