Mapping and assessing sexual and reproductive health policy changes over time in Colombia: measuring their impact on pregnancy terminations

Abstract

Sexual and reproductive health and rights policies (SRHRPs) and their association with reproductive and non-reproductive behavior require precise theoretical and methodological frames. By studying the case of Colombia, we move forward with a comprehensive framework that considers simultaneously multiple SRHRP conceptualizations and their impacts over time on induced pregnancy terminations (IPT). With a mixed-method approach, we first map the evolution of SRHRPs and then analyze their direct and indirect effects on IPTs, using the provision of contraceptive methods by the government, female use of contraceptive methods, and conversations with health professionals in a mediation approach. We build a unique data set from more than 2100 policy documents, and then use data on 81,760 women (20–40 years) from four waves (2000–2015) of Colombia’s Demographic and Health Surveys. We find that SRHRPs are directly associated with an 18% reduction in reported IPTs. Associations between these variables are explained by the increased use of modern contraceptive methods (6%), and the government’s provision of those contraceptive methods (13%). Studies interested in the impact of SRHRPs need to consider not only the direct effects of legal changes on abortion outcomes but also show changes over time may operate through different sub-programs embedded in these policies, such as access to contraceptive methods and family planning. This will add further nuances to how SRHRPs are both multilayered and implemented.