Rethinking how reproductive health care quality is measured

study by CUNY ISPH researchers suggests the quality of reproductive health care should be measured from the patient’s perspective, rather than using current measures such as rates of “unintended” pregnancies.

For the study, published last week in BMC Women’s Health, Associate Professors Meredith Manze and Heidi Jones and doctoral candidate Silpa Srinivasulu interviewed 30 women in New York State aged 18-45 who had visited a primary care provider in the last year. They conducted five virtual focus groups and eight in-depth interviews with participants about their ideal clinic interactions when preventing or attempting pregnancy and their perspectives on how to measure the quality of such encounters.

The team found that, whether they were trying to conceive or prevent pregnancy, participants wanted care that was non-judgmental, respectful, and responsive to their needs and preferences. There was considerable support for using the team’s definition of reproductive autonomy to measure quality of care.

Given this support, the authors recommend developing and testing a new metric that assesses patients’ perceptions of reproductive autonomy during clinical encounters. Such an approach moves away from stigmatizing individuals for pregnancy and toward accountability among providers and health systems for delivering high-quality care for all.

“Until we develop metrics to track the quality and effectiveness of reproductive health service delivery beyond reducing ‘unintended’ pregnancies, we will continue to blame ‘poor’ outcomes on individuals who become pregnant, and not on structural facilitators and barriers that empower or impede individuals from exercising reproductive autonomy and leading healthy lives with dignity,” the researchers say.

Manze, M.G., Srinivasulu, S. & Jones, H.E. Patient perspectives of using reproductive autonomy to measure quality of care: a qualitative study. BMC Women’s Health 23, 647 (2023).

About the CUNY SPH
The CUNY Graduate School of Public Health and Health Policy (CUNY SPH) is committed to promoting and sustaining healthier populations in New York City and around the world through excellence in education, research, and service in public health and by advocating for sound policy and practice to advance social justice and improve health outcomes for all.

About the CUNY ISPH
The CUNY Institute for Implementation Science in Population Health (ISPH) was founded on the notion that substantial improvements in population health can be efficiently achieved through better implementation of existing strategies, policies, and interventions across multiple sectors. With that in mind, we study how to translate and scale up evidence-based interventions and policies within clinical and community settings in order to improve population health and reduce health disparities.