By: Michael Huarachi
Last week we sat down and had a discussion with Jenny Friedler, senior director for the Digital Product Lab of Planned Parenthood Federation of America. Friedler described the purpose of the digital product being launched recently to assist people in achieving more comprehensive and often interactive reproductive health care. The product was an app that people can download to serve them many purposes from keeping track of their menstrual cycles, to planning and preparing or avoiding a pregnancy, to monitoring physical and emotional symptoms associated with contraception modalities and or days during the menstrual cycle. In addition to the self-tracking features associated with the app, Friedler took note to mention the educational aspect of the digital tool as well. People were given access to more thorough and accurate information about methods of contraception, biological facts of menstruation, and other resources that connected individuals who downloaded the app to their device the ability to learn more about their bodies, and the choices available to them.
Unfortunately, many people are not aware of the services available to them and/or have limited access to services throughout the United States. Each state has various restrictions that govern access to full and comprehensive reproductive health care, not just abortion services. Some states seek to fully criminalize reproductive health services, and in the interim, have built enormous boundaries against people who seek to take control of their bodies and govern their own health.
Limited access to services isn’t the only barrier to seeking reproductive health services. Research conducted on women attending a family planning clinic in Bangalore, India also suggests the lack of awareness of emergency contraception and medical abortion in women in the community from both rural and tribal cites.(1) This study calls into attention the need for more education to be disseminated about the various methods of contraception and the need for increased awareness to vulnerable communities in rural areas that have more burdensome obstacles when seeking reproductive health services. Further, additional research suggests cultural differences in assessing the predictors of contraceptive use and demand for family planning services in Punjab province of Pakistan. Azmat and colleagues note there is between a 32-41% unmet need for contraception, and that more than one fifth of the women studied across the districts expressed interest in using quality, long-term family planning services in the future – if they were readily available to them.2 Cultural differences also account for women’s lack of negotiating reproductive health choices due to some cultures regarding the husband or other male family members as the key decision makers when seeking family planning health care services.
Societies that include resource-constrained settings, as in India and Kenya, have shown marketed differences among women seeking sexual and reproductive health services. Haghparast-Bidgoli and colleagues studied these areas and their research has also demonstrated that restrictive environments and access to reproductive health services lie heavily and disproportionately on the poorest women. The results in this research show that women in lower income households spend a higher percentage of their income on seeking care, compared to households with higher incomes.(3) Women in low-income households in India spent twice as much on seeking SRH services, while women in Kenya spent up to ten times as much in SRH services than their respective higher income counterparts. Indeed, vulnerable women around the world suffer the heaviest burdens when seeking SRH services.
Thinking back on Friedler’s presentation, a reproductive health app that addresses the burdens that women from various cultural backgrounds face would be supremely beneficial. While eavesdropping on a question that one of my classmates asked Friedler after her information session, we came to learn that the app is only available in the English language at the moment. Of course, due to time constraints, and pressures to roll out the app on two device formats (IOS & Andriod), the primary language was tantamount on getting the app out there first in it’s most basic form- the English version. However, the research I’ve reviewed demonstrated a need for the same information to be accessible not just across languages but across cultures as well. Friedler did mention that the organization intends on working on a Spanish-language version, but that it would take some time because of the intricacies and nuances of another language needed to be included in the wording, formatting, and design of the app altogether changing the basic version to a tailored version for various communities.
I understand the need from women across languages and cultures in a country that prides itself on being a ‘melting pot’. All in all, it’s a fantastic resource that is beginning to take shape for women across the country, especially in areas of the country that seek to criminalize abortion services and limit reproductive services in resource depleted areas, or areas where people come from low socioeconomic backgrounds.
Interestingly, Dribe and colleagues demonstrate the similarities of association between socioeconomic status and net fertility during the ‘fertility decline’. The authors note that northwestern Europe and North America, beginning in the late nineteenth century, experienced the beginnings of a ‘fertility decline’, in conjunction with changes in occupational structure and industrialization and urbanization. Women from middle-to-high level occupations began to have less children than women from lower socioeconomic groups. The study emphasized the class-based structure of these societies, and what was most interesting in the study was one exception of the net fertility decline trends: Iceland. Results in this study showed that Iceland had little fertility differentials across socioeconomic groups. Some researchers suggest this is in part due to Iceland having a less pronounced social stratification system and more social equality than the other industrialized countries studied. All of the other countries in the study (Canada, Sweden, Norway and the United States) showed dramatic fertility differentials when controlled for socioeconomic status: women in higher paid occupations having less children than women in lower socioeconomic groups.4 This highlights the trends in the U.S. that suggest that women from higher SES groups have more access to reproductive health services, such as family planning, abortion, and contraception, than do women in lower SES groups.
Studies that have researched racial and ethnic disparities in contraceptive use among women who desire no future children found that Black women were significantly less likely than white or Hispanic women to use any contraception at last intercourse.(5) These findings are consistent with previous literature which documents contraceptive non-use is more common among black than white women, among them a study which examined the risk of unwanted pregnancy in a nationally-representative sample of women aged 35-44 found contraceptive non-useres had three times greater odds of being black.6
The aforementioned research has consistently demonstrated the powerful predictors that socioeconomic status and race are as influencing the health outcomes of women seeking sexual and reproductive health services. Assessing the data, a clear conclusion can be made to suggest the most substantial health disparities exist in women who are often one or a combination of: low-socioeconomic status, in rural communities, and or racially marginalized women. 1,2,4,6 Analyzing the context of negative health disparities in women who seek sexual and reproductive health services is useful when considering the local context of volatile American policies that seek to harm women in the most vulnerable populations. Through a more detailed discussion of the intersection of race, socioeconomic status, and place, we can inspect the consequences of restrictive (and often racialized) sexual and reproductive health-related policies that make abstract the Constitutional right to comprehensive abortion services and contraception methods.
Friedler’s work has provided a great platform to build a more comprehensive and inclusive variety of digital tools to be made available, especially to women in resource restrictive areas and low socioeconomic backgrounds. To download an app doesn’t take much technological knowledge, and it is free.
- Umashankar KM, Dharmavijaya MN, Jayanta Kumar DE, Kala K, Abed GN, Ramadevi. Survey of the attitude to, the knowledge and the practice of contraception and medical abortion in women who attended a family planning clinic. Journal of Clinical and Diagnostic Research. 2013 Mar. 7(3): 493-495. doi: 7860/JCDR/2013/5106.2805.
- Azmat SK, Ali M, Ishaque M, Mustafa G, Hameed W, Khan OF, et al. Assessing predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan: results of a cross-sectional baseline survey. Reproductive Health. 12:25. doi: 10.1186/s12978-015-0016-9.
- Haghparast-Bigdoli H, Pulkki-Brannstrom AM, Lafort Y, Beksinksa M, Rambally L, Roy A, et al. Inequity in costs of seeking sexual and reproductive health services in India and Kenya. International Journal for Equity in Health. 14:84. doi: 10.1186/s12939-015-0216-5.
- Dribe M, Hacker DJ, Scalone F. Socioeconomic status and net fertility during the fertility decline: a comparative analysis of Canada, Iceland, Sweden, Norway and the United States. Population Studies. 2014: 68(2): 135-149. Doi: 1080/00324728.2014.889741.
- Grady CD, Dehlendorf C, Cohen ED, Schwarz EB, Borrero S. Racial and ethnic differences in contraceptive use among women who desire no future children, 2006-2010 National Survey of Family Growth. Contraception. 2015 Mar. 92: 62-70. doi: http://dx.doi.org/10.1016/j.contraception.2015.03.017.
- Upson K, Reed SD, Prager SW, Schiff MA. Factors associated with contraceptive nonuse among US women ages 35-44 years at risk of unwanted pregnancy. Contraception. 2010; 81(5): 427-434.