Making women and girls visible: Gender data for decision making

To coincide with the International Family Planning Conference in Thailand, we spoke with Anju Malhotra of the Johns Hopkins University Bloomberg School of Public Health about how data can inform and accelerate gender equality

A Maasai woman in Kenya carries her baby.
A Maasai woman in Kenya carries her baby.

Monitoring and accelerating progress towards the Sustainable Development Goals, including gender equality and access to family planning, requires overcoming three crucial data-related challenges, experts say.

The first is a lack of gender-relevant indicators – there is still no agreement on the indicators that should to be tracked to fully understand the impact of gender inequality. The second is the gaps in gender data – even when indicators have been identified, the right data is not always being collected. And finally, there is a lack of quality and comparability of data across countries.

Filling in these gaps could help experts better understand progress in gender equality and the SDGs, including increasing access to and use of modern family planning.

Exemplars News spoke with Anju Malhotra, professor at the Johns Hopkins University Bloomberg School of Public Health and currently seconded to the Global Financing Facility at the World Bank, about the new discussions, tools, and efforts to try to close these gaps – many of which are being discussed at this week's International Conference on Family Planning in Thailand. Malhotra is notably part of a new partnership between Johns Hopkins and the Global Financing Facility to equip decision-makers with the gender data they need.

How can the global community use data more effectively to make smart policy and program decisions to advance family planning specifically and gender equality more broadly?

Malhotra: Increasingly, there is the realization that we need to look at data on gender and equity, and reproductive, maternal, and child health for decision making not just for advocacy. This gender data is critical for understanding what is working and what is not working – so we can improve the actual implementation of policies and programs.

We don’t always have good measures to see exactly how we are improving sexual and reproductive health and rights, or gender equality through policies and programming. I think we can make more of a difference by saying, ‘let’s look at the data to see what we’re doing well, and how are we failing.’

That’s part of the reason why Johns Hopkins and the Global Financing Facility at the World Bank joined together to launch Monitoring & Action for Gender and Equity.

What progress has been made?

Malhotra: There’s still a lot of disconnect between how family planning and health programs are run and what feminists and gender advocates want. But there has been progress on two critical fronts. Beyond measuring the number of people accessing family planning, we are also trying to determine if they are getting quality care. Are they getting quality family planning? And, critically, we’re trying to determine what 'quality care' means.

A critical element of quality from a feminist perspective is 'choice.' Do women really have a choice of family planning methods? Are they getting information on the various methods, how they work, what they should expect? It is about informed choice, this is fundamental to women’s lives and rights. We have only been partly successful in building the informed choice concept into our quality-of-care measurement.

What tools are available to help the health leaders wrestling with these questions?

Malhotra: The concept of quality is gaining traction. It is becoming clear that with family planning and with all kinds of health services that poor people, disadvantaged people, people who are marginalized—who are often women—often don’t get quality services. Part of the reason why women don’t access services even when they need them and when they are available, is because they are not treated with consideration and respect. Maybe the providers don’t give women privacy; maybe the facility is not clean or is in disrepair; maybe the contraception method the women prefer is never available; maybe women have to wait four hours to get contraception. Or maybe women have to make a return visit to pick up the contraception when it becomes available. All of this is part of quality of care and it has a huge impact on if and how women access care.

There are a few tools for measuring this including the Method Information Index and Quality of Care Framework. We often use these measures for smaller scale projects and programs. But we need to use them for routine monitoring of larger scale national and subnational programs. And we aren’t there yet. Our facility level data isn’t there yet in tracking quality of care, choice, and respect for women.

This is an area that requires further investment because it can be hard to get women’s perspective on how they are treated. Satisfaction surveys can be problematic, especially because women who are used to getting absolutely nothing and are unaware that they may be entitled to quality care often report satisfaction with very sub-par care. Still, researchers are experimenting on this front, for example by using digital data collection following some days after women have received services so as to allow women to process how they were treated and then share their experience.

Tell us about the initiative you just joined, a partnership between the Global Financing Facility at the World Bank and Johns Hopkins University Bloomberg School of Public Health, called Monitoring & Action for Gender and Equity.

Malhotra: The partnership between the GFF and Johns Hopkins University aims to advance capacity and execution of gender and equity intentional measurement and evaluation at the GFF and its 37 partner countries so that we can see better reproductive, maternal, and child health outcomes. We are starting with a deeper focus on Pakistan, Kenya, and Cote D’Ivoire, but supporting several of the other GFF countries as well.

As I mentioned earlier, a key goal here is not just data and indicator generation, but their use, especially by in-country implementers and decision-makers. We are especially trying to overcome some of the barriers I referenced earlier by providing clarity on which gender indicators to track and how to prioritize robust and uniform data collection that actually simplifies and motivates use of gender data to improve program monitoring and execution.

Most recently, for example, we collaborated with feminist CSOs [civil society organizations] in Kenya to review indicators from the World Bank- and GFF-supported a national health program that is currently concluding. They wanted to use data to be proactive in recommending gender indicators for the next round implementation of the Kenya health program. Our input is helping them to review past performance on key gender measures and prioritize indicators and data going forward. Our review of data and indicators is helping to make their recommendation to the government on priority gender-focused reforms and indicators both strategic and data driven.

What does success look like when you think about gender and data?

Malhotra: Success is when not just the gender people, but all decision makers and the program managers and developers – the people who are doing the leg work to make these programs happen – are routinely using this gender data to evaluate the impact of their programs and make decisions. That’s how data should be used and that’s what matters. Having data out there is just part of it. It is just the first step.

Could you give us an example of a country that used data and it changed the way they thought about the problem or solution.

Malhotra: During my tenure as the head of gender at UNICEF, our maternal and child health lead in Bangladesh really had an 'aha' moment when he absorbed the fact that most of the pregnant adolescent girls he was trying to serve were married. He had been struggling to establish a small-scale initiative of adolescent clubs for girls—something he knew little about— because he equated “adolescent” with being unmarried. But Bangladesh has one of the highest child marriage rates in the world and 45 percent of teenage girls have already become mothers within marriage. The light bulb went on as he realized that he could have a larger impact if he shifted his focus to providing 'girl-friendly' services within the existing MNCH structure which is not set up to serve adolescent girls well.

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