Asha: Co-producing abortion knowledge & impact outputs with lay community health intermediaries in India

Lead Research Organisation: London School of Economics & Pol Sci
Department Name: Methodology Institute

Abstract

My research demonstrates the urgent need to account for women's needs and lived realities in abortion care-provision in India. While abortion has been legal since 1971, women continue to encounter barriers to safe services; with the majority of abortions occurring outside of health facilities. I documented women's abortion experiences, illustrating how women's interactions with health workers and the health system involved numerous delays, negotiations and contestations that were underpinned by abortion stigma. My findings demonstrate that lay community health intermediaries (CHIs) like Accredited Social Health Activists (ASHAs) play pivotal roles in women's abortion experiences, enabling or restricting access to a range of abortion-related services, but lack accurate information. I found that their training does not adequately cover abortion-related information or support. Additionally, a highly medicalised approach to abortion persists in training materials and structures, overlooking women's experiences and needs that are shaped by their social and economic environments. Drawing on these data and narratives, I propose using visual methodologies to co-produce impact and scholarly outputs for a range of audiences including academia, and advocacy and policy organisations.

Building on existing relationships, I will work with an organisation that trains ASHAs on abortion-related care provision to design and deliver a novel workshop. In this workshop, I will utilise participatory methods to co-create, with approximately 30-45 ASHAs, a set of visual resources (e.g. zines- booklets created using images, sketches & narratives, used to create communities of practice). I will also investigate the production of audio materials for greater impact.

In order to enable knowledge exchange, I will ensure that these materials are made widely available and remain accessible to a range of groups- e.g. organisations working on sexual and reproductive health and rights (SRHR), policy actors, or institutions that train health workers. I will create and maintain a project website to ensure availability of resources and identify existing channels for dissemination (e.g. National ASHA Mentoring Group or CHW Central). I will also produce a resource on the workshop methodology and process, so it can be adapted for different settings for CHI trainings in India or other contexts. I will use a copyleft licence for these outputs, allowing copying, modification or adaptation for specific local contexts.

One of the core elements of my work is linking academia with policy or advocacy interventions. I am keen to continue building strong partnerships with civil society organisations to ensure my research contributes- directly or indirectly- to policy, advocacy or campaigning efforts at local or community levels. To bring these two different audiences together, I will organise an international workshop to discuss co-produced research and interventions in SRHR.

I am keen to build my academic and research career, aspiring to continue working on crucial social science research questions relating to SRHR and women's health. Towards that, I will be developing two grants for submission to research funders. I will also focus on building my publication record and disseminating my scholarly work. I will, based on the workshop with ASHAs, write one academic article on the methodology I developed and implemented. I will also continue to adapt my PhD research into at least three more articles. I aim to submit these to prestigious journals in my field, building on my previous experience of publishing high-impact articles.

Publications

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Nandagiri R (2020) COVID-19 and Abortion: Making Structural Violence Visible. in International perspectives on sexual and reproductive health