Reproductive health: A candid conversation with Martha Brady

As Martha Brady sees it, reproductive health is more than family planning.

“We should be thinking about women’s health more broadly, across the life cycle,” says Martha, the new director of PATH’s Reproductive Health program.

In her view, reproductive health encompasses the rights of individuals to make decisions concerning their own sexual activity and reproduction, free from discrimination, coercion, and violence. An integrated approach, she says, includes attention to contraception, cervical cancer, sexually transmitted infections, the right for women to decide if and when they want to become mothers, and gender-based violence prevention and care services.

Before joining PATH in November 2016, Martha served as director of the Expanding Contraceptive Choice Program at the Population Council where she led efforts to build access to multipurpose prevention technologies, microbicides, and other reproductive health technologies that could be used around the globe. At the same time, Martha was also working on adolescent health and development. These experiences inform the way she thinks about her work.

“In my travels working in some of the poorest and most remote areas of the world, I am struck by the ingenuity of people to create and manage with very little; necessity is the mother of invention,” says Martha. “I think that’s relevant to PATH, because we talk about how innovation can happen anywhere. The resourcefulness of women in even the most difficult environments never ceases to amaze me.”

When Martha first joined the field 30 years ago, there were only a handful of contraceptives available: condoms, diaphragms, cervical caps, spermicides, Copper T intrauterine devices (IUDs), oral pills, injectables, and early formulation of implantable contraceptives. In fact, just a few years earlier, three family planning researchers had founded PATH to ensure that women and men around the world had access to high-quality condoms, birth control pills, IUDs, and other modern forms of contraception. New methods have since entered the market—a broader range (and lower doses) of oral contraceptive pills, the vaginal ring, emergency contraception, and second-generation IUDs and implantable contraception. But even as the number and types of contraceptives have grown, the field is still far from achieving its goal.

“The range of contraceptive options is there, at least in principle. But access and availability remain limited in many low- and middle-income countries,” says Martha. “That’s the struggle that still remains—how to ensure access to the hardest to reach and most vulnerable communities in all parts of the world—that is the unfinished agenda.”

For Martha, the future of reproductive health will require innovation, not only in the form of new products, but also with new service delivery models—how we reach women, particularly young women, and deliver high-quality reproductive health services wherever they live.

“When you provide women with accurate information, training, and social support, they can do amazing things,” says Martha.

She sees that guiding principle throughout PATH’s portfolio of reproductive health products. For example, Sayana® Press injectable contraceptive; the Woman’s Condom; SILCS diaphragm, a one-size-fits-most device that works as a nonhormonal contraceptive barrier; and our work around cervical and breast cancer. These are all examples of interventions that enable self-care, empowering girls and women to transform their own health.

PATH’s Reproductive Health program is committed to comprehensive and integrated care that places women at the center, she says, while recognizing the critical role that male partners, providers, and health systems play.

“Unlike many public health programs, in reproductive health we’re not trying to eliminate, eradicate, or cure,” she explains. “Instead we should talk about building health assets—providing the right information, the right set of technologies, and the right constellation of services that help women reach their reproductive health goals.”

While traditional public health programs look for patterns of disease and seek to fill gaps in care, a “health assets” approach applies a positive view, identifying and building on strengths and resources.

Sayana Press is one such example. Instead of women coming to a clinic for family planning, the three-month injectable contraceptive can be administered by community health workers or even through self-injection. Both approaches increase women’s control and access to family planning.

“Through the range of reproductive health products PATH has developed or championed, there’s one common thread,” says Martha. “All of them—whether it’s our work on a diaphragm, a female condom, or Sayana Press—all are helping women to take control into their own hands.”

Martha is a big fan of using data to increase impact.

“It’s about the diversity of women, the diversity of reproductive health needs, and the diversity of contexts. That sounds simple, but all too often program implementers fail to take this diversity into account when designing interventions,” says Martha. “I’ve worked a lot on adolescent health issues and I am quick to point out that adolescents are not one big homogeneous group of people. Are we talking about males or females? Are they in school, or out of school? Are they married? Are they sexually active yet or not? In planning and designing programs, we need to break down the data by key characteristics in order to reach different groups of people and have the greatest impact.”

Martha believes that analyzing data in this way will become increasingly important as the field tackles remaining challenges. To optimize investments, practitioners and stakeholders will need to apply a multifaceted gender lens to the collection and use of health data.

“That’s the only way you can really understand disparities—disparities in access and in health outcomes,” explains Martha. “Once you can do that, you can say who you are reaching and who you are not—and only then can you truly address pockets of inequity.”

She thinks back to when the field first began to separate HIV data into distinct groups, by gender and age cohorts, in sub-Saharan Africa. Researchers and HIV experts began to recognize the disproportionate impact of the epidemic on adolescent girls and young women. Without this level of detail, she says, the global health field would not have been able to address the increase in HIV infection rates among women in the comprehensive manner it has. Increasingly, the global health community is embracing interventions that address the biological, social, behavioral, economic, and structural factors that contribute to the spread of HIV, such as the low social value of women and gender-based violence.

But even as the demographics and landscape for global reproductive health change, a few things have remained constant, says Martha: “There are at least three things that we know empower women. One is the access to and control of economic resources. Another is education. And the third is the ability of women to regulate their fertility, meaning that they can decide when, how, and if they have children. That’s important for women everywhere—for women in Seattle as well as in Senegal.”

Sayana Press and Depo-Provera are registered trademarks of Pfizer Inc. Uniject is a trademark of BD.