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Ceremony for the recipients of GIAN grants in 2005

Measuring Equity for Reproductive Health Services

The project will be conducted in collaboration with several institutions:

WHO/Department of Reproductive Health and Research (RHR), Geneva , Switzerland
Geneva Foundation for Medical Education and Research (GFMER), Geneva, Switzerland
 Faculty of Psychology and Educational Sciences, Geneva University (FPSE), Geneva, Switzerland
the London School of Hygiene and Tropical Medicine (LSHTM), London, UK
the University College London (UCL), London, UK
the University of Western Cape (UWC) - South Africa

and supported by the Geneva International Academic Network (GIAN-RUIG)


Countries have committed themselves to attainment of "universal access to reproductive health for all by 2015" in 1994 at the International Conference on Population and Development (ICPD). However, most literature shows unequal use of reproductive health services by population sub-groups. It is increasingly recognized that achieving international goals and targets related to reproductive health and development is difficult without addressing inequalities in women’s receiving services. This requires rigorous evaluation of equity of services – examining and explaining sources of inequalities. Equity in health is broadly defined as the elimination of  “avoidable, unfair and unjust differences” in health. More precise definitions focusing on health services define equity in terms of utilization as the equal treatment of individuals with equal need. A variety of factors at user or health systems level influence women’s use of services. The effects of these are modified by the wider context within which health systems function and by other societal influences. It is necessary to develop a means by which complexities of the setting can be captured, in a standard format: 150%">.

Aims and Objectives

To investigate and explain sources of inequalities among population subgroups in a set of indicators of reproductive health service use by women (attendance at birth by skilled health personnel, contraceptive use and knowledge of HIV related prevention practices) in Eastern Cape Province of South Africa.

The research questions are:

  • Do women’s (i)attendance at birth by skilled health personnel, (ii) contraceptive use, and (iii) knowledge on HIV/AIDS prevention practices vary according to their region of residence, urban/non-urban residence, economic status and ethnicity?
  • Do identified variations in above indicators persist after controlling for need and other relevant factors?
  • To what extent variations are associated with supply side/health-system factors?


The study will use a combination of qualitative and quantitative research methods that will complement each other.

1) Systematic review

A systematic review of the literature on the factors influencing use of services and qualitative methods will be used to inform the design of the main study instrument - a questionnaire for a cross-sectional community-based survey. The systematic review will be performed according to an a priori protocol.

2) Prospective field study

The second part of the project will include a household survey of women of reproductive age, face-to-face interviews and focus group discussions.  The field work will be first conducted in South Africa with the possibility to extend to other countries.


The project has received ethical clearance from the relevant review boards.


The systematic review is currently being conducted. The field work is planned to start end 2005 and data collection will be over 24 months.


  • Whitehead M. The concepts and principles of equity in health. International Journal of Health Services 1992;22:429-445
  • Mooney GH. Equity in health care: confronting the confusion. Effective Health Care 1983;1:179-185
  • Measuring access to reproductive health services. Summary report of a WHO and UNFPA technical consultation, 2-3 December 2003 . WHO/RHR/04.07. 2004. Geneva, WHO.

Text: Regina Kulier & Lale Say