Project description

Medicamentalia-Contraceptives is a cross-border journalistic investigation on birth control access and barriers. We have combined data journalism with on-the-ground reporting (in The Gambia, México, Senegal and Israel) to tell the stories of the women behind the statistics, to gather their opinions about birth control access and their freedom to decide about their bodies.

Why have we carried out this investigation? Because family planning – women choosing if they want to have children, when and how – is a right, but 12 of every 100 sexually active women between the ages of 15 and 49 can not exercise it. We have analyzed the data and listened to many of them in different countries to know first-hand what hinders their ability to choose in their context, from fear to side effects, sexism, beliefs and impositions of third parties. We exposed and proved that, although women suffer unmet needs in all kinds of countries, from the United States to Albania, in the least developed countries this rate doubles the global average. Additionally, during our work we became aware to what degree religion continues to be a barrier to birth control. It can interfere with a gynecological consultation in Israel, a purchase in a pharmacy in Mexico or an imam-supervised sex education class in Senegal. Although the three main monotheistic religions permit contraceptives in some cases, a woman’s freedom of choice comes second to mens’ interpretation of scripture. We tried to shine a plain, accurate and unbiased light on this very sensitive topic.

We wanted to go far beyond the data, so we produced a 6:50’ video in which women from 11 countries talk about contraception, barriers, side effects and about who makes the decision; a data-based long feature, with several multimedia and interactive assets that analyse how women exercise this right and how side effects, misogyny, beliefs, and outsiders interfere with it, combined with the human stories in an integrated narrative; and a long-form report about the different interpretations and levels of acceptance of the three main monotheistic religions towards contraceptives and the right of women to decide about their pregnancies.

Our work targets women communities around the world that are facing barriers to exercise their right to plan their pregnancies, along with experts and change-making organizations who can leverage the new data in their efforts. Medicamentalia – Contraceptives has been very recently published, but it is reaching a broad audience thanks to a network of media partners which are publishing its stories and findings. It aimed not only to reach a general audience (through publishers like Civio [Spain], El Diario[Spain], La Sexta TV [Spain], Ojo Público [Peru], and soon Correti!v [Germany], MO* Mag [Belgium] and One World Magazine [Netherlands]), but also also to engage the scientific community and health specialists (through EuroScientist [UK] as publisher).

What makes this project innovative?

We have leveraged storytelling narratives and technologies to craft an engaging and informative online reading experience. Multimedia-supported, the main investigative article has been designed as a guided tour: the infographics (treemaps, geographic maps) evolve to point out the key insights while the reader scroll down the article. This is emphasized in mobile devices, with all the content being responsive since its first conception.

As location is obviously central to our story, we used geolocation to push readers deeper into data. Both the first visualisation and the interactive app (“See it their way”) at the end of the article, where we offer specific data for each country, use readers’ IP addresses to get a rough sense of their location, and the information displayed changes depending on where the reader is based. With this feature, we wanted to cut out unnecessary steps between readers and the data they want.

Furthermore, this app not only displays information such as the percentage of women who use birth control methods in every country or the main barrier to family planning women face there. In countries where more data is available (check out Zimbabwe), reader can filter by “urban or rural zone”, “age”, “education” and “income”, offering additional in-depth insights.

Medicamentalia – Contraceptives also includes a medium-length video that takes the story beyond the data and makes the complex issue more engaging and human.

All the data, visualizations and articles are Creative Commons. By making it embeddable by other media organizations and sharing the database, we encourage others to keep digging with a local scope (as Ojo Público, in Peru, has recently done) or embedding the whole microsite (as eldiario.es and EuroScientist did). Partners can co-design their own deliverables and adapt the investigation to their audiences. This openness makes Medicamentalia - Contraceptives a crowd-sourced investigation with an evergreen approach.

What was the impact of your project? How did you measure it?

Creating broader public awareness for this global issue will help people to be more conscious of it. The investigation addresses UN’s Sustainable Development Goal 5 (gender equality), in particular 5.1 and 5.7 (ensuring universal access to sexual and reproductive health and rights). Also Goals 3 and 1, that aims to ensure universal access to sexual and reproductive health-care services, including family planning, information and education, and integration of reproductive health into national strategies.
For Medicamentalia – Contraceptives, we have transformed diverse worldwide data sources into a global map of contraceptive usage and country-specific insights. This huge amount of information is also being broadly shared to support the work of international family planning initiatives and organisations, which fight for affordable and accessible contraceptives in some of the countries we reported from the ground. During the investigation, experts told us they found our journalistic approach very necessary in order to better communicate the issue, and that they could make good use of our materials and investigations.

Medicamentalia - Contraceptives proves that there is a relationship between GDP of countries and unmet needs for contraception, meaning that the lower the level of income of the country, the higher the unmet need percentage is. As one of the interviewees stated: “Poverty is not just the lack of money, or material, it's also the inability to make choices”. Highlighting how socio-economic inequality impacts access, paying special attention to the contraceptive needs of vulnerable groups such as unmarried young women, poor women and rural women, will surely contribute a broader public debate and evidence-based policies.

Source and methodology

The two main sources of data are the World Contraceptive Use of the Population Division of the United Nations and the Demographic and Health Surveys (DHS) of the United States Agency for International Development (USAID). We have analysed and combined these with other data, such as income levels or family planning difficulties. Both are based on surveys of women.
Use of contraceptives by country:
To find which contraceptives are most common in each country, we have used the 2017 statistics published by the Population Division of the United Nations (UN). We have selected countries with data available from 2007 onward in the World Contraceptive Use 2017 report. For the remaining countries (those with older data), we have used 2015 estimates. This is because that is the only UN source that breaks down the data by method.
In both cases we converted the data from usage as a percentage of the surveyed women to birth control methods as a percentage of women who use any method. The objective was to show more clearly the distribution of methods in each country. If we reported the rates as fractions of all reproductive-age women, countries with low overall birth control usage rates would be swamped by those with higher rates. This follows Family Planning 2020’s calculation.
Global data and unmet needs:
For global usage data (visible in the infographic with the female figures) and the unmet needs by country (the scatterplot) we have used UN estimates published in 2017. For unmet needs we used 2016 data since it is the most recent year with available national income data for comparison. The source for the income data is the World Bank.
Barriers:
The global barrier data cited in the text are from a 2016 Guttmacher Institute report. In our graphics and for the country-level data we use in the application, we needed to use the raw DHS data.
Application:
For the data searching app at the end of the article, where our priority was to offer specific data for each country consulted, we have been able to be more precise. For countries in the DHS, we have used the raw individual survey data (microdata) whenever available, which allows us to analyse birth control methods by income, education, urban or rural, and age. For countries not in the DHS, we use UN data, which does not allow the same analysis. For the percentage of unmet needs, we used real data if survey data was available from 2007 onward. If not, we used estimates. We also looked for news articles published by other media outlets that were covering any local issue related with contraception to include in the application.

Technologies Used

In order to provide additional insights into contraception use by age, education and wealth, we accessed the microdata from US Aid's DHS Program in Stata format for all available countries and surveys. We then developed R code to process the raw data and aggregate it along different dimensions, filtering by the criteria interesting to journalists (e.g. married women, women declaring having unmet needs). The exported aggregation results drive the interactive application at the end of the article.

The website is developed with Jekyll, and uses Javascript and D3.js for the data visualisations. All the code is published online in our Github repository and we published our work as Creative Commons in order to encourage its reuse and increase the impact of the story.

Project members

Civio’s team members in this investigation where: Eva Belmonte (project management, research, creating and analysing databases, reporting in Mexico, The Gambia, and Senegal, writing and editing); Raúl Díaz (website development, interaction design, data analysis and visualisation); María Álvarez del Vayo(research, creating and analysing databases, reporting in Israel and writing); Miguel Ángel Gavilanes (research, creating and analysing databases, reporting in Israel and writing); Javier de Vega (research, writing, editing and communications); David Cabo (data extraction and analysis) and Amir Campos (project management).

Besides Civio’s team, many, many people have contributed to make this investigation possible. Verónica Ramírez, journalist from La Sexta TV (Spain) researched and reported in The Gambia and Senegal. Lucas Laursen, journalist for Scientific American and Resilience Thinking was instrumental in translating and English copy-editing. Giulio Piantadosi, video-producer for El Independiente (Spain) was key to editing the video. Maya Siminovich contributed with video and production in Israel. Pablo Duer contributed with production in Israel. Muna Faye contributed with video and photography in The Gambia. Modou Lamin contributed with fixing and production in The Gambia. Malyka Diagana contributed with video and photography in Senegal.
Many colleagues helped us to reach women for interviews. They were: Carmen Santamaría in Argentina; Alice Campanille in Colombia; Petra Piitulainen in Finland; Elsa Cabria y Ximena Villagrán in Guatemala and Marta Orosz, of Correctiv, in Germany.

Additionally, many experts generously helped us throughout. Jaime Manzano, a pharmacist at Médicos Sin Fronteras, helped us understand the main problems on the ground. Clara Lis, a pharmacist specialised in sexual health and reproductive justice, gave us a masterclass on how women deal with this issue and possible focuses for our investigation. And Bea Hernández helped us to use R to deal with raw USAID DHS data.

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