Bending the Arc to [Reproductive] Justice: Person-Centered Approaches to Contraceptive Access Metrics

Reproductive wellbeing requires the ability to prevent, continue and/or end a pregnancy, in line with one’s desires, values, and preferences. For many people, use of contraception is key to reproductive wellbeing. Currently, there is no way to describe whether individuals’ contraceptive needs—as they define them—are being met at the population-level. Without capturing this important aspect of contraceptive use and access, our ability to monitor contraceptive access and to design policy and programmatic strategies to increase access in ways that are person-centered and attend to the needs of under-resourced populations—particularly those communities most subjected to reproductive oppression—is severely constrained. Further, without accurate person-centered data, current efforts to expand contraceptive access may perpetuate contraceptive coercion and reproductive injustice. This paper will provide a brief history of global contraceptive surveillance measures, or the systematic collection, analysis, and interpretation of data related to family planning, essential to public health program planning, evaluation, and policy development. Next, we provide an overview of foundational frameworks that inform the development of person-centered surveillance strategies for measuring contraceptive use and access, including reproductive justice. Then, we explain a stakeholder-engaged process to develop person-centered metrics of contraceptive access in the U.S. Through this process, we sought to disrupt normative practices that perpetuate epistemic injustice in measurement, by engaging and compensating a diverse group of stakeholders as co-researchers. Stakeholders represented diverse sectors, academic training, professional and lived experiences, and positionalities. Finally, we provide a comparison of two metrics using nationally representative data: use of preferred contraceptive method, a metric we developed and refined; and use of effective contraceptive methods, an existing population-level metric used in the U.S. Healthy People 2030 public health goals. Our analysis shows that conventional metrics presume that millions of people who do not want to use contraception are potential users while simultaneously excluding millions who want to use contraception but are not considered to be “sexually active.” Our analysis shows that person-centered approaches to measurement are feasible, improve upon conventional approaches by centering self-defined contraceptive needs, and offer the opportunity to concretely ground contraceptive access in reproductive justice.