Global Poverty Research Group

Reproductive health and well-being

Overview

Increasing evidence is available to suggest that globally reproductive health problems account for a heavy burden of ill-health as well as preventable mortality and therefore represent a significant component of the lack of well-being in developing countries. Yet to date, for a number of reasons there has been insufficient dialogue between advocates or researchers of reproductive health and those within the wider development domain. Historical focus on reducing population growth has been the main area of interface between these two fields. Only recently has there been international recognition of the importance of maternal mortality as the health indicator with greatest discrepancy between North and South and a move away from promoting population policies to reduce fertility and instead towards policies which recognise the contribution of reproductive health to development (DeJong 2000).

Prevailing international emphasis on promoting cost-effective evidence-based interventions through health sector reform programmes may not adequately address reproductive health problems (Allotey and Reidpath 2002; Hill 2002). Moreover, these recommendations are based on the dominant disciplinary approaches to public health (reflected for example in World Bank 1993) of epidemiology and health economics. Unidisciplinary approaches to reproductive health such as these, or of other social science fields such as anthropology and sociology have important contributions to make to understanding the determinants and implications of poor reproductive health but none on its own is sufficient. A multidisciplinary approach is needed which addresses the social, cultural and economic contexts which produce risk and vulnerability to poor reproductive health, and which aims to understand the contribution of social relations and social differentiation to individual health outcomes.

The capabilities approach (as developed by Sen 1990, Nussbaum 2000 and others) may be particularly helpful to analyse reproductive health but to date there has been no attempt to do so. As Robeyns (2002) has noted, capabilities are ethically individualistic but not ontologically so – that is, they allow for the importance of social relations, care, cultural norms etc. In this sense this framework is likely to be particularly helpful in analysing reproductive health which inherently addresses relational processes of sexuality and reproduction. Moreover, this approach is able to address doings and beings in market as well as non-market settings (Robeyns 2002) – again a positive feature for analysing health outcomes which are not necessarily improved by addressing income, poverty or health care in isolation of broader contextual parameters.

Nonetheless, there are a number of evident challenges in applying this framework to reproductive health, a field in which health problems are often stigmatised, denied and invisible (in the sense of being very private). Moreover, the need to integrate cultural values and subjective notions of well-being to understand local meanings and implications of poor reproductive health may mitigate against the kind of “informed universalism” that Nussbaum (2000) espouses.

Thus the overarching research question that this component of the research programme would address is: How useful is the capabilities approach in analysing comparisons in reproductive health across countries and individuals?

Proposed Research

Year One:

Research on methodological approaches to applying capabilities framework to reproductive health including review of main theoretical literature on this framework and available literature on “operationalising” capabilities, particularly in fields pertaining to gender equity. Research would explore the contribution of quantitative and qualitative approaches to reproductive health, as well as those of social sciences, epidemiology and health policy as well as the contribution of development ethics and political philosophy.

Year Two:

Research of a more conceptual/theoretical nature on reproductive health as a capability delving in more depth to the debates within the above disciplines. The aim would be to develop a framework for comparing reproductive health determinants and outcomes across individuals and countries. Regional focus on Middle East through review of relevant literature.

Year Three:

Empirically based research based on secondary data (no budget for primary research). Using Demographic and Health Surveys and Pan Arab Project for Child Survival surveys as well as existing research on reproductive health in the Middle East, this research would aim to apply the above framework to analyse differences in reproductive health within the region (such as those between richer/poorer, conservative/less conservative countries for example).

Year Four:

Policy-related research using the outcomes of the previous year’s research to explore the implications for health sector reform, sector-wide approaches to the health sector and linkages between reproductive health and broader social development.

Year Five:(and into Year 6)

Consolidation of research to date and proposal of further research agenda. Potential for cross-regional comparisons.

Note that this work plan is expected to be modified as the research proceeds and is therefore only indicative of research directions.

Bibliography

Allotey, P. and Reidpath, D. (2002) “Objectivity in Priority Setting Tools: Context and the DALY” Reproductive Health Matters Vol 10, No. 20, pp 38-46.

Hill, P. (2002) “Between Intent and Achievement in Sector-Wide Aproaches: Staking Claim for Reproductive Health” Reproductive Health Matters Vol 10, No. 20, pp. 29 - 37

DeJong, Jocelyn (2000) “The Role and Limitations of the Cairo International Conference on Population and Development.” Social Science and Medicine 51 : 941-953, 2000

Nussbaum, Martha (2000) Women and Human Development: the Capabilities Approach (Cambridge: Cambridge University Press)

Robeyns, Ingrid (2002) Sen’s Capability Approach and Gender Inequality” Presented at Von Hugel Institute, Cambridge University September 2002.

Sen, A.K. (1990) “Development as Capability Expansion” in Keith Griffin and John Knight (Eds.) Human Development and the International Development Strategy for the 1990s, Macmillan.

World Bank (1993) Investing in health. World Development Report. Washington, D.C.

Reseachers to contact for this project

Jocelyn DeJong