Methodology

This project embraces a highly innovative approach to advancing knowledge that is collaborative, synergistic, interdisciplinary, and multi-sited.  By centering ethnography as a form of knowledge production, we move beyond narrow statistical estimates of the availability of misoprostol in hospitals and pharmacies to illuminate multiple pathways through which misoprostol is available to some consumers, patients, health workers, and health facilities, and not others.  

Into Women’s Hands/Entre Les Mains Des Femmes fosters South-South and North-South capacity building and resource sharing at the level of the university.  We center the role of national universities in Burkina Faso and Senegal in the conduct of ethnographic research and dissemination of results in academic, professional, and community arenas.  Each component of the research process occurs collaboratively, including the elaboration of project budgets, training of research assistants, the design and pretesting of research instruments, the collection and analysis of data, and the publication and presentation of results.  We meet regularly via Zoom and in person to discuss fieldwork, data analysis, and to plan next steps.  All team members have access to project documents through a virtual platform. Project investigators have access to online scholarly resources through Brandeis University Library. The project equips the investigators’ units with resources to support research such as reading material, subscriptions to academic journals, computers, and Nvivo software for data analysis.  Additionally, we advocate for the integration of research workshops and seminars into existing course offerings, and other forms of support for graduate students, beyond the life of the project.  

Our project is composed of three teams.  One of the principal investigators is located at Brandeis University in Waltham, Massachusetts and works virtually and in person with the teams in Burkina Faso and Senegal. The teams at l'Université Joseph Ki-Zerbo in Ouagadougou and l'Université Cheikh Anta Diop in Dakar are each composed of the principal investigator and three graduate research assistants.  In both teams, one of the assistants is the designated project coordinator, and works closely with the principal investigator to administer the project. The project coordinators manage the process of research approval with national authorities, schedule and delegate fieldwork activities, and coordinate data analysis on Nvivo. 

In June 2024, both teams attended a retreat in person (for the first time!) in Dakar, Senegal.  In addition to reviewing data collection and analysis, we discussed the dissemination of results.   We reviewed examples of policy briefs, and the assistants worked in teams to develop drafts.  Additionally, the assistants shared updates on their Masters theses and doctoral projects and received feedback from their peers and from the project investigators. Three of the assistants are actively using project data to write proposals and Master theses on misoprostol, unplanned pregnancy and abortion.

Please scroll down for descriptions of our data collection methods.

One of the key objectives of this project is to prepare future leaders in ethnographic research.  To this end, we engage in continuous training, supervision, and mentorship of our assistants in data collection and analysis and project management. Our training approach draws on the expertise of Burkinabé and Senegalese scholars with extensive experience in research on sexual and reproductive health, including Dr. Cheikh Ibrahima Niang (Université Cheikh Anta Diop), Dr. Ramatou Ouédraogo (African Population and Health Research Center), and Dr. Fatoumata Ouattara and Dr. Seydou Drabo (Institut de Recherche pour le Développement).  More specifically, the principal investigators:

  • Provide classroom and hands-on training in ethnographic research, including conducting literature reviews, research ethics, direct observation, interviews, mystery client studies, coding qualitative data, and use of Nvivo; 

  • Accompany assistants on research activities, including interviews, observations and introductory visits. We review our objectives in advance of the activities and then discuss strengths and areas for improvement after the activities;  

  • Read and provide line-by-line feedback on interview transcripts and field notes; 

  • Review the database with the assistants and discuss dimensions of our research questions that require additional data collection; and 

  • Meet regularly with the assistants to discuss and revise our list of codes, and to find solutions for technical challenges encountered while using Nvivo software.  

Mystery Client Studies

Mystery client studies are used to assess the quality of health care from the perspective of the patient or client. By blinding the researcher’s identity, these studies aim to replicate, as realistically as possible, interactions between health care workers and patients or clients. This information can then be used to improve health care delivery.

Although research highlights the growing significance of misoprostol and other medications as a method of abortion in middle- and low-income countries, little is known about how vendors instruct clients to use the drug, how much they charge for the drug, and how they instruct patients to respond to side effects or complications. These practices may influence not only women’s access to misoprostol, but also their health outcomes related to using the medication. Mystery client studies of misoprostol have been conducted in several countries, including Bangladesh, Colombia, the Democratic Republic of Congo, Ghana, India, Indonesia, Mexico, Tanzania, and Zambia.

We are conducting mystery client studies of misoprostol in pharmacies and with on-line vendors in Burkina Faso and Senegal. These studies will offer important insight into the real life practices and experiences of vendors and consumers when it comes to the sale of misoprostol.

Mystery Client Studies In-Person Virtual Total
Burkina Faso151944
Senegal292241

Interviews

We are conducting in-depth interviews to explore practices, experiences, and opinions related to the use, procurement, distribution, sale, and availability of misoprostol. Our sample includes include women or men who have used or intend to use misoprostol; health workers; informal drug sellers; wholesale drug distributors, Ministry of Health officials; law enforcement personnel; and many others.

Interviewees Burkina Faso Senegal
Women/men who have used or intend to use misoprostol and other...1621
Health workers (doctors, midwives, nurses, pharmacists)2219
Health workers (doctors, midwives, nurses, pharmacists)191
Community-based health workers (matrons, community members)34
Informal drug sellers02
National and international NGO workers912
Employees of drug wholesalers04
Members of professional associations (doctors, pharmacists)13
Ministry of Health officials (national, regional)20
Agents of the National Supply Pharmacy/central medical store02
Customary, religious and community leaders53
Law enforcement officers (judges, police, gendarmes)52
Key people1
Parliamentarians/Legislators31
Total8674

Observations

We are conducting direct observation of the use, storage, and sale of misoprostol in health facilities, pharmacies, and informal stores. Where possible, we will also review formal records of the use, storage, and sale of misoprostol. Observation sites include :

  • 16 public health facilities: 8 in Burkina Faso and 8 in Senegal;

  • 8 private clinics and medical offices: 4 in Burkina Faso and 4 in Senegal;

  • Private pharmacies: 2 in Burkina Faso and 2 in Senegal;

  • 8 informal stores or markets: 4 in Burkina Faso and 4 in Senegal.

We will also observe 8 social marketing activities involving misoprostol: 4 in Burkina Faso and 4 in Senegal conducted by national and international NGOs.

Completed Observations Burkina Faso Senegal Total
Government Health Facilities
University/regional hospital224
Health center (district level)224
Health post224
Health hut224
Private or NGO Health Care Facilities
Private clinic/hospital224
Private medical practice224
Pharmacies and Drug Shops/Markets
Pharmacies224
Informal drug shops268
Social Marketing Activities
NGOs distributors448