Makleff Consulting
Specializing in sexual and reproductive health evaluation and research
Presented at American Public Health Association conference in November 2017
The use of a Theory of Change in the development and evaluation of abortion
stigma reduction interventions: two case studies from Latin America
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S Makleff, B Keefe-Oates, E Sa, D Mendoza, F Avila Morales, MA Olaya, F Soto, G Vargas, J Friedman, S Baum
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Organizations around the world have been working to measure abortion stigma and evaluate the effectiveness of stigma-reduction interventions. Given the challenges in measuring this complex social concept and the lack of evidence-based interventions to date, innovative approaches are needed to identify pathways for stigma reduction, and to measure success. This presentation examines the use of Theory of Change (TOC) as an iterative theoretical tool in the design and evaluation of abortion stigma-reduction interventions in clinical settings in Mexico and Colombia.
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In partnership, IPPF/WHR, Ibis Reproductive Health, Mexfam/Mexico and Profamilia/Colombia implemented a study to understand the impact of the abortion counseling model on abortion clients' stigma experiences, and to propose adjustments to the model to further reduce stigma. Each country team created a TOC to articulate the pathways through which interventions might reduce stigma; each TOC identified the rationale and assumptions for each hypothesized pathway, based on legal and social context, academic literature, and input from practitioners and other experts. The TOC served as a reference point throughout the research process: defining research questions, developing research instruments, conducting data analysis, interpreting results, and using the findings to inform interventions.
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This presentation will explain the TOC development process and how it was used throughout the study. Based on our experiences with this approach, we suggest that TOC is particularly well-suited to support collaborative research on topics that are harder to measure or define, which are common in evaluations of social interventions related to abortion stigma and other sexual and reproductive health interventions.