Women's Voices, Women's Lives: The Impact Of Family Planning

Lessons Learned From the Research Process

Throughout the Women's Studies Project -- from planning, through research, to dissemination -- the WSP has sought to involve researchers, policy-makers/providers and women's health advocates. Each of these groups has an interest in women's reproductive health, and the WSP encouraged the active participation of these "stakeholders" in all phases of the research process. This participatory and inclusive research process was labor-intensive and expensive. However, WSP staff believe it enhanced the quality of the research by ensuring that the projects were locally owned. Following are lessons learned from the WSP, which may be applicable to future research projects on women.

The research agenda should be locally defined, with input from the triangle of researchers, policy-makers/providers and women's advocates. This approach helped foster communication among these three key groups; helped ensure that the concerns of women, the primary users of contraceptive services, were heard and incorporated into the research agenda; and established a basis for practical utilization of research results to improve policies and services. Before research began, WSP staff sought to determine local interests by conducting in-country needs assessments to identify the concerns of diverse groups. Needs assessments became the basis for the WSP request for proposals, in-country research concepts and individual subprojects.

To strengthen the local network of researchers, policy-makers and providers, and women's advocates, the WSP established In-country Advisory Committees (IACs) in each emphasis country. This proved an effective mechanism for initiating and monitoring the progress of research and played a key role in determining how study results would be disseminated to improve services and policies. These advisory groups were involved in all phases of WSP-supported research, from study selection to dissemination of findings. While this was advantageous, it also proved to be costly to establish and maintain* One way to economize in the future might for a single In-country Advisory Committee to serve multiple donors, thus expanding the IAC's scope of work beyond that of one project.

In-country secretariats were effective liaisons between local researchers and WSP staff. In their role as local program managers, secretariats ensured that the goals outlined in the study protocols were met, that the IAC meetings were held regularly and were well-organized, that local concerns were addressed at IAC meetings, and that information dissemination plans were developed for local audiences. For example, the Philippines secretariat coordinated workshops on proposal writing, qualitative methods, data analysis and information dissemination. The Egypt and Indonesia secretariats organized national meetings to disseminate research results.

Women's advocates should be involved throughout the research process to ensure that the research project incorporates women's voices and reflects their concerns. Women's advocates can be involved in many ways in the research process, including advising on the scope and content of the research agenda, advising on study procedures, disseminating study results, and suggesting ways in which study results can be used to improve policies and programs. In the Philippines, for example, women's advocates helped identify sources of services that family planning clients might need, such as legal or social services. This information was included in a handout given to study participants by interviewers. Women's advocates also provided gender training to interviewers in one Philippines study.

Multiple research methods provide a fuller understanding of women's perspectives. Integration of qualitative and quantitative methods often yields richer insights into women's experiences than the sole use of only one approach. In the WSP, both quantitative and qualitative approaches were important.

Since qualitative methods were new to many of the field investigators working with the WSP, technical assistance from FHI staff was especially important. This included help with focus group guidelines, instruction on use of text-based computer software as well as compilation of a manual on qualitative approaches, and assistance on integration of qualitative and quantitative results in final reports. In Bolivia, for example, FHI staff provided training in the use of Ethnograph software for analysis of qualitative data.

Study participants' confidentiality must be paramount. Explicit attention must be given to the protection of study participants' confidentiality and informed consent in social science studies. Whereas risks in a biomedical study may include physical risks (i.e., adverse reactions to drugs), the potential risks for participants in social science studies are typically emotional, social or economic. For example, an individual's reputation may suffer if others learn about domestic conflict, an out-of-wedlock birth or financial troubles.

Social scientists need to make greater efforts to ensure participant confidentiality, to inform study participants of risks (if any), and to ensure that study participants have given their informed consent to participate in the research process. This includes ethics training for interviewers and other study staff, including clerks who handle confidential questionnaires or transcripts.

Information dissemination should be part of the research plan and budget, not an afterthought. The impact of study results will be greater if information dissemination is considered early in the research process and planned in collaboration with researchers. By working together to develop reports, presentations and other materials, researchers and communications professionals can ensure greater accuracy in dissemination of scientific findings.

In addition to technical assistance on research methods, the WSP offered technical assistance in information dissemination. Many researchers had experience publishing in professional journals and giving talks to professional audiences but had not previously disseminated results to other stakeholders in reproductive health, such as women's advocates, family planning clients, employers, and community leaders. Researchers also had not routinely worked with the news media, which can be a key source of information for contraceptive users and potential users. WSP staff helped in-country colleagues design and publish newsletters, press releases and short summaries of studies. Staff assisted colleagues in Egypt and Zimbabwe in developing comprehensive strategies for communicating study results both to technical and non-technical audiences.

Study participants are an important audience for dissemination of research results. To enhance opportunities for study participants to benefit from their experience, they should be considered an important audience for research findings. To share findings with participants while respecting their confidentiality is critical. One option used by colleagues in Zimbabwe, the Philippines and Egypt was to disseminate results through community workshops rather than to individual study participants.

The WSP is making a concerted effort to share findings with study participants and has encouraged colleagues to pursue creative avenues for dissemination to this group. An example is Jamaica, where copies of the case study on a program for adolescent mothers were distributed to focus group participants. In Zimbabwe, plans are being made to discuss study results on the "Today's Woman" national television program, and audience members will include residents of communities where studies were conducted. In Bolivia, street theater has been used to disseminate study findings. In Egypt, researchers are considering disseminating study results at local immunization centers, which are well attended.

Sharing findings not only benefits study participants, but can benefit researchers as well. Inviting community members to offer comments can provide further valuable insight for investigators into the meaning of data and can validate study results.

* Costs included domestic and international travel, honoraria, meals and meeting space, and the considerable time spent in selecting dates, inviting participants, and arranging for presentations at the meetings.

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