October is full of important observances, including Hispanic and Latinx Heritage Month, World Mental Health Day, Indigenous Peoples’ Day and International Day of the Girl Child. Created not only to commemorate diverse identities and experiences but to galvanize, one way in which the ecosystem of contraceptive research, development and introduction can be called to action is to generate inclusive data reflecting the full spectrum of current and potential users.
As we consider the meaning behind International Day of the Girl Child, for example, vital tools that contraceptive innovators could create and wield include gender- and age-inclusive data points. To date, some of the most meaningful numbers illustrating method use and unmet need typically cite "women of reproductive age (15-49)." When it comes to assessing the contraceptive preferences of those who can become pregnant (and we should also look to those championing contraceptive access and options for those who produce sperm), this phrasing fails to include transgender and nonbinary people as well as those under 15 and those over 49 who menstruate. Using only “women” could also be seen as erasing the experiences of girls. Altogether this shrinks our understanding of the contraceptive userbase.
User-centered data is categorically indispensable to the field of sexual and reproductive health and invaluable in demonstrating to funders, policymakers, program managers and fellow innovators the demand for new and improved contraceptive products. We must do more to forward research that comprehensively captures the needs and desires of trans and nonbinary individuals and all gender-expansive people while also avoiding the erasure of youth experiences in particular.
Of course, differing cultural contexts and perspectives on the age of majority may call for nuance. But with:
girls of color having often experienced "adultification" within systems like health care
studies showing menstruation beginning at younger ages—meaning more under 15 may have a need for reproductive health care
the fact that pregnancy can happen after age 49
the lack of contraceptive research centering trans and nonbinary people
it’s critical that we look to data beyond the narrow confines of “women of reproductive age, 15-49.”
An improvement can sometimes be as easy as rephrasing. But while using gender- and age-inclusive language like “people who menstruate” is an important and even imperative step in many cases, there are also times when rewording alone may fail to reflect the available data with accuracy.
Many reports in the family planning and sexual and reproductive health spaces have called out these limitations. The Guttmacher Institute, for example, points to the need for inclusive data generation in Adding It Up: "We use the terms ‘women’ and ‘men’ to match the data available in nationally representative household surveys, although we recognize that not all people have binary gender identities.” Meanwhile, Ibis Reproductive Health has centered trans and nonbinary people in contraceptive research across a number of groundbreaking publications. And organizations like YLabs are supporting and spotlighting youth-driven health innovation.
All current and potential contraceptive users are part of the field’s geography. And measurements are the map. Now we need investment of time and funds in generating the data that can reflect the whole world—so we can know just where we are and see rightly where we’re going.
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