Note: In this blog series, we aim to provide an overview of key areas within sexual and reproductive health, but the posts will not include all elements of this broad topic. We also acknowledge that these posts talk about gender in a binary way, as there is currently limited data on these topics specific to nonbinary and trans people.
As summarized in the last two posts in this series, many health and healthcare disparities currently exist in abortion access, contraception access, gynecological care, maternal and infant mortality, and STI prevalence in Massachusetts. These disparities affect lower income, immigrant and BIPOC women the most. Working towards combating these issues is no easy feat, and will be a long, multi-step journey. In this post, I will highlight some research and evaluation priorities and approaches that could help us better understand the underlying issues and identify strategies for improving sexual and reproductive health (SRH) equity.
One priority would be to work with affected communities to understand their level of knowledge about SRH procedures and resources, and to understand their SRH medical care experiences and perceptions. For both of these research areas, qualitative data collection approaches would yield rich information, and this could take the form of in-person interviews or focus groups. In-person would be ideal because there is likely a lot of stigma around talking about SRH, and it may be easier for participants to feel comfortable answering questions if they know they are face to face with an interviewer. However, surveys could also be a solid second option as long as translation and literacy needs are met for both participants and researchers. Participant recruitment could happen through local community organizations, churches, schools, etc., or through specific clinics, practices or hospitals.
To understand participants’ level of SRH knowledge, we would recommend asking them about their current understanding of specific SRH topics, such as cervical cancer screening. Additional questions could focus on how, where and when they learned this information; whether they feel that it is enough information, or if they would want more information; health-seeking behaviors; their health outcomes related to the specific topics at hand; and preferred/ best ways of learning about new SRH information. This would allow us to see where the gaps in education/knowledge/resource distribution are for communities and the effect that these gaps have on participants’ health/health seeking behaviors. From there we could think about potential ways to fill those gaps.
To understand participants’ experiences with and perception of their SRH medical care, depending on the focus of the data collection, inquiry could focus on all or one of the types of SRH medical care they currently receive, with questions about every aspect of their SRH medical care, including: how they found out about their clinic/practice/hospital, how they started working with their specific provider(s), how they made appointments, their experience during appointments and with their provider, format of appointments, if and how they access patient portals, and so on. For each aspect, in addition to asking them about general processes, we could ask them to reflect on what they thought worked well and what they would want to see improved. This would allow us to learn where participants have difficulties with their care (e.g., language, culture, technology, background knowledge), where participants don’t receive culturally competent care, and where participants face discrimination, among other topics. For certain disparities, such as maternal mortality, we could talk to women of all different races about their healthcare experiences during the prenatal and postpartum periods and compare the data to learn more about what parts of the process lead to racial disparities in SRH care.
In addition to learning directly from patients and community members in need of or receiving services, it is important to do research with healthcare providers about their healthcare practices, particularly about how they provide healthcare to specific populations, if they have any training on working with patients of different cultures, and where they see opportunities for change. This data can be compared with patient data to further elucidate gaps and potential solutions.
The learnings from this kind of research could be used to inform community organizations, churches, schools, and other institutions about how to better support their community members with SRH information and resources, and could also help healthcare providers and leaders identify ways to change their healthcare practices and training models. Interventions and change efforts could then be rigorously evaluated so that successes can be built upon, replicated, or adapted to new settings. SRH disparities are just as important as other health disparities, and we need to do our part as researchers and evaluators towards combating and eliminating them.