Research brief: Asking about identity may disrupt perpetuate stigma

Introduction: People whose identity or experiences have historically been marginalized, such as people living with disabilities, people living in internally displaced persons camps, Lesbian, Gay, Bisexual, Trans, and Queer individuals (LGBTQ+), adolescents, and sex workers, face increased barriers to accessing health care, including abortion care. In contexts where these identities or experiences are criminalized, individuals may be further marginalized from care for fear facing prosecution. Research must both identify the barriers faced by these populations along with ways to better support them. This requires first identifying these populations by asking them about their identities and experiences, a process that can both perpetuate stigma and generate mistrust. On the other hand, asking could intentionally signal to communities that services are open to supporting them.

Study description: Abortion hotlines Generation Initiative for Women and Youth Network (GIWYN) in Nigeria and Trust for Indigenous Culture and Health (TICAH) in Kenya identified different populations they felt were underrepresented in their caller base and who they wanted to ensure could access the comprehensive sexual and reproductive health and abortion information offer through their hotlines. GIWYN selected sex workers, LBGTQ+ individuals, and people living in internally displaced persons (IDP) camps, and TICAH selected sex workers, people living with disabilities, and adolescents. We conducted 16 key informant interviews with people comprising or serving these communities to better understand the barriers these populations experience in accessing SRH and abortion services and their recommendations for improving outreach from the hotlines. Specifically, interviewers asked participants how the hotlines could ask about individuals’ identities and/or experiences in a sensitive and appropriate way to measure the number of callers from each population and evaluate the recommended outreach strategies. Interviews were recorded and professionally transcribed and analyzed thematically.