Towards contraceptive autonomy: Examining actors' inclusion of adolescent migrant girls' voices in responses to humanitarian crises. A case study of Venezuelan migrants in Colombia

Abstract

The Reproductive Justice (RJ) movement seeks to address inequalities and combat oppression by combining sexual and reproductive health rights (SRHR) and social justice. Contraceptive autonomy, as an essential component of RJ, is understood as an individual's right to make and actualise their contraceptive choices (Senderowicz, 2020). The study introduces The Scale of Voice, a framework that identifies modalities of consideration and inclusion in contraceptive care decision-making, drawing from and contributing to the literature on RJ and youth participation models. The Scale of Voice framework examines state and non-state actors’ use of mechanisms relating to key pillars of voice: intersectionality, participation, and opportunities to (not) use a variety of contraceptives and the implications for contraception autonomy. Empirically, the study utilises quantitative health utilisation data obtained from records of both state and non-state actors, alongside survey responses. This is triangulated with data from interviews conducted during fieldwork in Bogotá, Colombia, in March 2022 with adolescent migrant girls and key informants at various levels of decision-making and design implementation.
Applying The Scale of Voice, I reveal a pattern of constrained agency where structural factors curtail their ability to make fully informed and autonomous choices regarding contraceptive methods. First, responses put in place by state and non-state actors overlook the intersectional reproductive realities of Venezuelan adolescent migrant girls (as shaped by gender, age, and migration), doing little to address inequalities in access and service utilisation. Secondly, those actors do not provide sustainable mechanisms of participation and feedback by which adolescent girls can share decision-making power. In addition, opportunities to use, or not use, a variety of contraceptive methods were shaped by short-term, one-off interventions and did not promote a variety of methods, nor the ability to change or discontinue using long-term methods. Instead, actors emphasised short-term, ‘emergency’ responses characterised by risk aversion, disease management, and access to resources. Finally, I claim that it is imperative to avoid nonautonomous contraceptive care, which has negative effects on the development of girls and the societies in which they live. Instead, this thesis advocates for a transformative shift in responses, urging the creation of autonomy-enhancing conditions for marginalised groups in accordance with the principles of RJ.

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Identifiers

ORCID for Hannah Louise Hall: orcid.org/0000-0003-1141-8747

ORCID for Pia Riggirozzi: orcid.org/0000-0001-5809-890X

ORCID for Amos Channon: orcid.org/0000-0003-4855-0418

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