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.

We are also committed to training future leaders in health research. The project investigators provide graduate students at Université Cheikh Anta Diop and Université Joseph Ki-Zerbo with classroom and hands-on training in ethnographic research. 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). We also engage in continuous mentorship of our assistants in data collection and analysis and program management. 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. 

See below for descriptions of our data collection strategies!

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

 

Burkina Faso

Senegal

 

 

Region 1

Region 2

Region 1

Region 2

Total

Pharmacies

12

12

12

12

48

On-line Vendors

20

 

20

 

40

 


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.


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.

Projected Interviews, Burkina Faso and Senegal

Interviewees

Burkina Faso

Senegal

Women or men who have used or intend to use misoprostol

17

20

Health workers in public health facilities

15

20

Health workers in private health facilities

8

5

Community-based health workers

7

7

Informal drug sellers

3

5

National and international NGO actors

12

7

Employees of drug wholesalers

2

3

Members of professional associations and orders

4

3

Ministry of Health officials

6

6

Agents of the National Pharmacy of Supply / central purchasing

1

3

Customary, religious and community leaders

6

3

Law enforcement officers

5

3

Parliamentarians/Legislators

2

3

Total

88

88

 

Sites for Observation

 

Burkina Faso

Senegal

 

 

Region 1

Region 2

Region 3

Region 1

Region 2

Region 3

Total

Government Health Facilities

University/regional hospital

1

1

 

1

1

 

4

Health center (district level)

1

1

 

1

1

 

4

Health post

1

1

 

1

1

 

4

Health hut

1

1

 

1

1

 

4

Private or NGO health care facilities

Private clinic/hospital

1

1

 

1

1

 

4

Private medical practice

1

1

 

1

1

 

4

Pharmacies and drug shops/markets

Pharmacies

1

1

 

1

1

 

4

Informal drug shops

2

 

2

2

1

1

8

 

Social marketing activities (NGOs, distributors)

2

2

 

2

2

 

8