Reliable, inclusive data help advocates and decision-makers better serve communities that have been marginalized in health care. This January 25, Women’s Health Research Day champions the importance of representation in the evidence used to inform health policies and programs. Research on gender, access to services, and the intersection of race, sexuality, income, age, immigration status and other identities is essential for shaping evidence-based sexual and reproductive health decision-making. Ahead of the day, we’re sharing our latest global findings and insights.
New research published in Global Public Health, developed in collaboration with colleagues from BRAC University and the London School of Economics and Political Science, explores how displaced Rohingya women living in Cox’s Bazar, Bangladesh, understand and experience pregnancy termination in this humanitarian setting. With findings from a 2022 community-based household survey of 1,173 women of reproductive age across four camps, the study examines women’s awareness of available services, their understanding of relevant laws in Bangladesh, their attitudes toward pregnancy termination, and reported experiences of pregnancy termination since displacement.
Key findings:
- In Bangladesh, menstrual regulation (restoring menses without first confirming pregnancy) is legally available on demand up to 12 weeks after a woman’s last menstrual period, yet while 92% of respondents knew facilities provide pregnancy termination, far fewer understood gestational limits.
- Respondents believed menstrual regulation can only be provided under certain conditions, and nearly all stated that a husband’s consent should be necessary, even though these are not requirements.
- One in five respondents reported knowing someone who had terminated a pregnancy since arriving in the camps.
“Our findings show a disconnect between the legal availability of menstrual regulation and how women understand their eligibility for care in this humanitarian context,” says Ann M. Moore, principal research scientist and lead author. “Accurate information is critical to safe access to pregnancy termination services, particularly when displacement involves moving from settings with limited services to those where safe services are available.”
Why How We Measure Contraceptive Need Matters for Policy and Funding
The measurement frameworks we use influence how people’s needs are understood, with real implications for policy and funding decisions. In a new policy analysis, Guttmacher experts and researchers explain the shift to a more precise way of measuring contraceptive need, called unmet demand. Based on the recent Adding It Up report, the analysis explores this new measure and discusses why the change matters.
Key findings:
- Traditional measures of contraceptive need focus on modern method use among people who want to avoid pregnancy, often missing differences in preferences, intentions, and access.
- The updated Adding It Up framework introduces unmet demand, a person-centered measure based on whether individuals intend to or are open to using contraception, now or in the future.
- Unmet demand centers on people’s own stated contraceptive intentions, rather than assuming who is in need. This emphasis makes it a more rights-based, person-centered strategic guide for identifying gaps in contraceptive care and prioritizing resources.
“When we measure contraceptive need in ways that center people’s preferences, we get data that are more meaningful for policy and funding decisions,” says Jessica Rosenberg, research associate and co-author. “Through this approach, unmet demand provides a stronger foundation for analysis and comparison.”
Rethinking the “Intention to Use” Indicator in Family Planning
In a recent Studies in Family Planning special issue, a commentary co-authored by Elizabeth Sully, Guttmacher’s director of international research, alongside colleagues Jamaica Corker, Ilene S. Speizer, Jean Christophe Fotso, and Niranjan Saggurti, examines the “intention to use” (ITU) contraception indicator, a longstanding measure in family planning (FP) programs.
Key findings:
- Despite being positioned as part of the shift toward person-centered measurement, ITU falls short of truly person-centered criteria—it asks what women think they might do rather than explicitly capturing their preferences or assessing whether their needs have been met.
- The authors argue that while ITU offers advantages over older measures like “unmet need,” it should be a transitional measure, not an endpoint.
- Relying on ITU alone risks prioritizing “low-hanging fruit” (i.e., women already open to contraception) and slowing investment in better measures that more meaningfully reflect people’s contraceptive realities.
“The ITU indicator provides insight into women’s contraceptive plans, but it only tells part of the story,” says Elizabeth Sully, Guttmacher’s director of international research. “Used alone, it risks narrowing our focus to modern method uptake just when the field is trying to expand measurement to capture the full complexity of people's contraceptive decision-making."
New Evidence on Pharmacy-Based Medication Abortion in Ethiopia
New research published in BJOG, conducted in partnership with the St. Paul Institute for Reproductive Health and Rights (SPIRHR), examines the quality of medication abortion (MA) services provided to mystery clients—trained individuals posing as clients rather than real service seekers—at pharmacies and drugstores in Addis Ababa, Ethiopia, where provision of MA medications without a prescription is not currently permitted.
Key findings:
- Most mystery clients reported respectful and confidential treatment, and two-thirds received correct instructions on how to use MA medications—an essential component of high-quality abortion care. However, fewer than half were informed about potential complications or where to seek emergency care (if needed).
- Although nearly all MA medications sold were unexpired, packaged in aluminum and of a known brand, affordability emerged as a major barrier to access.
“Supporting SPIRHR and drawing on their expertise regarding abortion access in Addis Ababa, our research shows that pharmacies and drugstores serve as a key piece of the abortion care ecosystem,” says Alice F. Cartwright, Guttmacher senior research scientist and co-author. “Supporting staff training and implementing policies to ensure consistent medication supply can improve equitable access to care. This evidence can also inform efforts in similar settings to strengthen how abortion services are managed and expanded effectively.”