Contraceptive Autonomy: A Mixed-Methods Approach to Developing a Novel Family Planning Measure

Project Summary Contraceptive autonomy – people’s ability to decide for themselves what they want in regard to contraceptive use, and to realize that decision – is essential for reproductive health and wellbeing. The primary goal of this proposal is to develop, refine, and test a contraceptive autonomy indicator that measures the extent to which family planning programs respect and promote free, full, and informed contraceptive decision-making. The longer-term objective of this research is to incorporate a concise survey module for this indicator into existing population-based surveys for routine, standardized, and comparable monitoring across time and place. Improved measurement of contraceptive autonomy can create new health systems incentives for respectful, rights-based family planning. Specific aims of this project include 1) Developing a novel contraceptive autonomy indicator that maximizes information and minimizes respondent burden via formal psychometric analysis of novel survey data from Burkina Faso; 2) Assessing the transportability of “contraceptive autonomy” across diverse sociocultural contexts; and 3) Test and refine the updated autonomy indicator in Nepal and Kenya with cognitive interviews. To meet Aim 1, the PI will use a first-of-its-kind dataset from Burkina Faso with novel survey questions on informed contraceptive decision-making, full access to a broad contraceptive method mix, and free contraceptive choice. To achieve Aims 2 and 3, the PI will collaborate with leading researchers in Nepal and Kenya to collect new data, using semi-structured in-depth and cognitive interviews with a diverse sample of women to understand how notions of autonomy differ across context, and gather pilot data to inform a future multi-site validation study. The goal of the training and career development portion of this grant is to foster the independent research career of Dr. Leigh Senderowicz. Dr. Senderowicz is an emerging scholar of patient-centered family planning and global health metrics. With the guidance of mentors Dr. Daniel Bolt, Dr. Jenny Higgins, Dr. Corinne Rocca and Dr. Claire Wendland, Dr. Senderowicz will pursue a program of training in latent variable modeling, transnational comparative qualitative analysis, survey scale-up and research translation, and professional development at the University of Wisconsin-Madison. These training activities will grow her methodological repertoire and enhance her career as an independent reproductive health scholar. The proposed research is poised to make a substantial impact on global reproductive health, helping to expose reproductive health disparities, and provide new data to inform equitable, person-centered reproductive health programs.