Reproductive Health Capability : Towards a tool to measure inequity in reproductive health. A case study of Colombia

Dodsworth, Emma and Parry, Luke (2021) Reproductive Health Capability : Towards a tool to measure inequity in reproductive health. A case study of Colombia. Masters thesis, Lancaster University.

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Abstract

Despite global improvements in typical reproductive health indicators, inequities in reproductive health are widening within and between sub-populations. To address reproductive health inequity, a theory of justice is required. Reproductive Justice, the most recent development of the reproductive health discourse, provides encouraging insight into the real, intersectional, and socially unjust reproductive oppressions experienced by vulnerable and minority populations. However, Reproductive Justice has limitations - notably it cannot operate as a complete moral theory. It has been argued for an application of Sen's Capability Approach to reproductive health; the theory provides a more realistic assessment of women's reproductive health because it assesses their actual ability to realise valued outcomes. This research supports the application of the capability approach to reproductive health and Reproductive Justice. To measure reproductive health inequity, a conceptual framework entitled: Reproductive Health Capability is developed. Unlike previous work on capability and reproductive health, this project identifies the relevant capabilities a woman requires to be in good reproductive health, as guided by Reproductive Justice and capability literature. These capabilities are universal, instrumental, and intrinsic to reproductive health; a deficit in these capabilities is grounds for injustice. Using data collected from Colombia's 2015 DHS survey, exploratory data analysis is undertaken to translate these capabilities into an empirical multidimensional measure. From this, the potential for the DHS to be re-purposed to measure health justice is assessed. Using this empirical measure, reproductive health capability for women in Colombia is assessed. This project finds a valid and reliable empirical index that captures Reproductive Health Capability for women in Colombia. It finds a novel index of health agency and supports the development of agencyfocused health interventions. Empirical analysis also finds women living in rural and Pacific and Amazon/Orinoco regions, who are indigenous and Afro-Colombian, and with little education have limited capability to reproductive health.