{"id":61856,"date":"2021-07-26T17:44:00","date_gmt":"2021-07-26T21:44:00","guid":{"rendered":"https:\/\/www.psi.org\/?post_type=disc-post&p=61856"},"modified":"2024-05-15T17:56:50","modified_gmt":"2024-05-15T21:56:50","slug":"what-women-want-examining-power-and-agency-within-self-injectables","status":"publish","type":"disc-post","link":"https:\/\/www.psi.org\/fr\/disc-post\/what-women-want-examining-power-and-agency-within-self-injectables\/","title":{"rendered":"WHAT WOMEN WANT: EXAMINING POWER AND AGENCY WITHIN SELF-INJECTABLES"},"content":{"rendered":"\n

BY ALEXANDRINA NAKANWAGI, DELIVERING INNOVATION IN SELF-CARE (DISC) PROJECT LEAD<\/strong><\/p>\n\n\n\n

\u201cIt starts with yourself<\/em>.\u201d\u2014Mom, Kaduna<\/p>\n\n\n\n

Women have self-managed their reproductive health needs for decades, including through the use of contraceptive pills. Contraception has been, and remains, key in women\u2019s ability to pursue life goals, including the goal of becoming a mother if, and when, the time is right. Given the huge unmet need for modern contraceptives, it\u2019s clear that women need options. Where access is constrained, the ability to take home affordable contraceptive coverage (up to a nine-month supply) has been referred to as a potential \u201cgame changer\u201d[1]<\/a> for women who desire contraception.<\/p>\n\n\n\n

As a self-care technological innovation, subcutaneous DMPA (DMPA-SC, or Sayana\u00ae Press) self-injectable offers undeniable benefits to women who want to take more control of their sexual and reproductive health (SRH). Yet, despite a rapidly growing evidence base demonstrating its safety, effectiveness and acceptability, women\u2019s knowledge and use of this method\u2014either self-injected or provider administered\u2014has been slow to take off, and uptake remains low.<\/p>\n\n\n\n

As a woman-centered program, a woman\u2019s power to achieve and to decide for herself is at the core of DISC\u2019s design work. DISC yearns to understand women\u2019s own conceptions of power and agency, and how these relate to their contraceptive use journey. Do women desire full autonomy in their SRH decisions and actions? Is it important for women to enjoy shared decision making with a spouse or partner? Will male partners (and providers) be supportive?<\/em><\/p>\n\n\n\n

WHAT DATA AND INSIGHT GATHERING SHOWS<\/h3>\n\n\n\n

The Demographic and Health Surveys (DHS) ask women about decisions in their healthcare as one metric to gauge women\u2019s power and level of agency within their households. According to the most recent DHS data, the majority of married women in both Nigeria and Uganda made the decision to use contraception jointly with their husband, 66% and 62% respectively. Thirty-one percent of Ugandan women and 23% of Nigerian women made the decision on their own, with the balance indicating that it is mainly the husband\u2019s decision in each country.  <\/p>\n\n\n\n

With this evidence in mind, DISC wanted to develop a clearer understanding of how urban youth and young mothers (Mums) in its catchment areas of Nigeria and Uganda felt. Insight gathering around these women\u2019s preferences and needs revealed a nuanced picture about power and agency. Some felt full ownership over the decision to use contraception. Others felt they could comfortably share contraceptive decision making with a supportive spouse or partner, while still others focus on concealing their contraceptive use for other reasons, such as fear of stigma or marital conflict. Overall, women inherently recognized their power within<\/em> (\u201ca person or group identity\u2019s sense of self-worth, self-awareness, self-knowledge and aspirations, which are also related to agency\u201d) and power to<\/em> (\u201cthe potential of a person or group to form, pursue and realize aspirations for their life and society\u2026[t]his can include education, skills, capabilities and the confidence to exercise them\u201d).[2]<\/a> In practice, however, women\u2019s realization of their power is complex.<\/p>\n\n\n\n

Where Mum segments largely report enjoying shared decision-making with their male partners, they also discussed their intention to act privately on SRH decisions, including termination of pregnancy. Young mothers in particular prioritized broader ambitions, noting that an unintended pregnancy would be a threat to these, and explicitly linking the power to achieve life aspirations with the power to make autonomous SRH decisions.<\/p>\n\n\n\n

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\u201cI might not talk about it again. If he is not giving me an audience, I will do it and protect my life. It is my body anyways. I will inject when he\u2019s not around<\/em>.\u201d \u2014Mom, Kaduna<\/p>\n<\/blockquote>\n\n\n\n

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\u201cBeing a boss lady, I decided to go for family planning to be able to fulfill my goals\u2026\u201d<\/em> \u2014Mom, Oyo<\/p>\n<\/blockquote>\n\n\n\n

Where women felt their family and community did not agree or affirm their decision-making, women may still exercise their power to decide, but conceal it out of a sense of fear of repercussions or disparagement. Urban youth in particular (and some Mums) were more likely to focus on concealing the entirety of the contraceptive user journey\u2014from awareness through continuation and advocacy.<\/p>\n\n\n\n

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\u201cI would love to be secretive whether married or single.\u201d<\/em> \u2014Urban youth, Kaduna<\/p>\n<\/blockquote>\n\n\n\n

DISC\u2019S CREATIVE CAMPAIGN MESSAGING<\/h3>\n\n\n\n

DISC is paying attention, not only to the health system requirements of delivering self-injectable contraception among the basket of family planning options, but to women\u2019s experiences, desires, preferences and needs as expressed through the insights related to self-injection. As women\u2019s experiences of power over, within, and in relation to their use journey are varied, so DISC\u2019s strategy to reach diffuse segments of women is varied as well. One aspect of DISC\u2019s creative campaign messaging uses bold imagery and messaging that affirms some women\u2019s proud and unabashed independence, power and agency in contraceptive decision-making.<\/p>\n\n\n\n

\"When<\/a><\/figure>\n\n\n\n
\"Dream.<\/a><\/figure>\n\n\n\n

This messaging is intended to resonate with those women who will act on their own intentions, planning a use journey that is theirs alone. DISC\u2019s metrics have shown that the \u2018I decide\u2019 and \u2018Yes\u2019 messaging themes perform well on engagement levels (i.e. comments, likes), generating the highest number of reactions across the two countries, as well as amongst the most comments and shares. The \u2018how to self-inject\u2019\/product specific messages perform well on click throughs.<\/p>\n\n\n\n

The campaign additionally acknowledges those women who welcome a partner\u2019s support and engagement in their use journey, as expressed by this Mum from Nigeria: \u201cEmotional support from my husband will go a long way to help me [feel comfortable and informed to use SI]<\/em>\u201d \u2014Mom, Oyo<\/p>\n\n\n\n

\"\"<\/a><\/figure>\n\n\n\n
\"\"<\/a><\/figure>\n\n\n\n

LEARNING AND ADAPTING<\/h3>\n\n\n\n

DISC is tailoring its messaging and strategies, remaining attentive to the fact that women\u2019s needs and user journeys are highly individualized, encompassing varied gender and power dynamics. This openness to learning and adaptive posture will be important to ensure the ongoing relevance of demand generation activities to all women, including those who openly use SI (perhaps with additional support from a husband\/partner\/provider), and those who want to adopt a method completely privately, and on their own. One way that the project is continuing to deepen its understanding of women\u2019s power and agency is by conducting participatory workshops with its target populations in both Nigeria and Uganda. During the workshops, groups of women will use art and theater-based activities, as well as open-ended discussion, to contextualize power, powerlessness and the perceived relationship between reproductive health, contraceptive use and women\u2019s decision-making power in these contexts. The approach will not predetermine what \u2018power\u2019 means but invites participants to determine how this is defined, and what metrics are thereby relevant in relation to contraceptive use and self-managed care. For example, one metric strives to assess whether a woman has as much decision-making power as she wants<\/em>, rather than defaulting to the assumption that making a decision \u2018on one\u2019s own\u2019 always equates with greater power. The selection of more contextually grounded indicators will inform tracking studies that will examine women\u2019s perceptions of their power, voice and agency, explore how these perceptions change over time, as well as whether this translates into uptake of SI as DISC interventions are rolled out.<\/p>\n\n\n\n

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[1]<\/a> Spieler J. 2014.Sayana\u00ae Press: Can it be a \u201cgame changer\u201d for reducing unmet need for family planning?<\/a> Contraception<\/em>. 2014;89(5):335\u2013338.<\/p>\n\n\n\n

[2]<\/a> https:\/\/www.care.org\/wp-content\/uploads\/2020\/05\/working_paper_aas_gt_change_measurement_fa_lowres.pdf<\/a><\/p>\n","protected":false},"featured_media":58160,"template":"","disc-resource-type":[],"disc-language":[2488],"disc-country":[2492,2490,2491],"disc-page-type":[2494],"class_list":["post-61856","disc-post","type-disc-post","status-publish","has-post-thumbnail","hentry","disc-language-english","disc-country-malawi","disc-country-nigeria","disc-country-uganda","disc-page-type-stories-updates"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/disc-post\/61856","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/disc-post"}],"about":[{"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/types\/disc-post"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/media\/58160"}],"wp:attachment":[{"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/media?parent=61856"}],"wp:term":[{"taxonomy":"disc-resource-type","embeddable":true,"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/disc-resource-type?post=61856"},{"taxonomy":"disc-language","embeddable":true,"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/disc-language?post=61856"},{"taxonomy":"disc-country","embeddable":true,"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/disc-country?post=61856"},{"taxonomy":"disc-page-type","embeddable":true,"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/disc-page-type?post=61856"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}