Where Evidence Meets Policy—and Politics

Mar 26, 2014, 9:00 AM

Annik Sorhaindo, MSc, is a senior program researcher with the Population Council’s Reproductive Health Program in Mexico. A 1997 alumna of the Robert Wood Johnson Foundation-funded Project L/EARN initiative, she conducts research to provide evidence that helps inform government policy. This post reports on her work.

Fifty-five percent of all pregnancies in Mexico are unplanned.

That dramatic statistic, from a report by the Guttmacher Institute, can be mapped to the limited access women have to contraception.

“Many women can’t readily obtain contraceptive methods,” says Annik Sorhaindo. As part of a five-organization alliance working to improve reproductive health in the world’s 11th most populous country, the council directs research and analysis for the effort.

“My work focuses on answering research questions: Which occurrences in daily life impact women’s decisions about contraception? What are the impediments to preventing teen pregnancy? What are the challenges to using contraception post-abortion?”

Sorhaindo is quick to note that the council stays above the political fray. “We do the research and interpret the results, and the advocacy organizations address the politics,” she says.

Who Controls Reproductive Health?

As with its northern neighbor, “the politics” in Mexico is a labyrinthine mix of legislation, socioeconomics, and religion.

Reproductive rights are central to numerous international conventions signed by Mexico’s government. Yet access to contraception remains scarce, most notably for women from disadvantaged social and economic backgrounds.

The status of safe abortion is especially convoluted. In Mexico City—a “federal district” that falls under the jurisdiction of Mexico’s 31 federated states but has autonomy over certain laws—abortion in the first trimester has been legal since 2007. It is restricted in all other states except in cases of rape; additionally, 25 states allow termination to save the life of a pregnant woman, and 12 if the pregnancy poses a severe risk to a woman’s health. Abortion stigma is prevalent, especially in areas where it is legally restricted.

The challenges are made more complex, Sorhaindo says, by widespread poverty and the powerful presence of the Catholic Church, which opposes contraception and abortion in any circumstance.

“It’s in Mexico’s constitution to have separation between church and state, but that separation is often ignored,” she explains. “Legislators seek the church’s input, and the church constantly intervenes in decisions about reproductive health.”

“The unavailability of abortion in the overwhelming majority of the country has consequences for women’s health, including high maternal morbidity and maternal mortality,” she adds.

Finding a Community

Sorhaindo’s interest in reproductive health took root at Project L/EARN. The intensive 10-week internship offers hands-on experience in health services research for qualified students, who are trained in multidisciplinary research under the guidance of faculty mentors. “It helped me develop skills as an undergraduate that surpassed those of many graduate students,” she says.

The support and exposure she discovered through Project L/EARN also became a marking point, she adds. Before her internship, Sorhaindo says, she felt unhappy and out of place as a pre-med student at Rutgers University. “I was lost in a sea of 50,000 students.”

Being part of an underrepresented population deepened her sense of isolation and disconnection. “At the time, there were real issues of segregation among the students. As part of a disadvantaged group, you’re already receiving messages that you don’t matter. It’s hard to feel that you have value, regardless of your abilities.”

At L/EARN, she found a community. “I was doing well. People praised me. Professors cared about and advocated for me. It was a different world.”

“The program gave me social capital,” she concludes. “It showed me that I do matter, I can belong—and I have the skills to back that up.”

Research Based on Need

Project L/EARN also introduced Sorhaindo to the Population Council, where she has completed several tours of duty. Her current research with the council focuses on post-abortion contraception in Mexico.

Woven into Mexico City’s law decriminalizing abortion is a requirement that women must be offered contraceptive counseling after terminating a pregnancy. The council’s study, which will follow its subjects over 12 months, will ascertain how women perceive the counseling, and whether or not they adopt—and continue to use—the contraception methods offered. The research considers a variety of methods, taking into account social context, personal lives, and economic hindrances.

“The work we do is very pragmatic, and the majority of our research is based on need,” she says. “Seven years on, there’s no data in Mexico on contraception use post-abortion, and the city wants to know what it can do to improve its services and reduce repeat unwanted pregnancies.”

A recently completed randomized controlled trial examined outcomes of medical abortion (through pills) delivered by nurses rather than doctors. “We found that they’re on par with doctors,” she notes. “We can now tell the Mexico City government that it could double its capacity to deliver safe medical abortion by allowing nurses to do it.”

Other studies have looked at child marriage in Central America and sex education. Projects awaiting funding include a set of six studies examining different aspects of abortion, and an investigation of health provider respect for maternity care.

In the meantime, Sorhaindo is clear about the limits of her work.

“The underpinning of all the challenges here is poverty and inequality,” she says. “Unfortunately, we don’t have the resources to confront those bigger structural issues.”

“I’d like to have a culture of respecting women’s rights, which naturally would have implications for their health,” she adds. “But that’s a harder battle. So right now, we focus on reproductive health.”

Learn more about Project L/EARN.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.