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Contraception (September 2006) Adding Value to Reproductive Health Research: Communicating About the Moral Dimensions of ScienceBy: Wayne C. Shields and Beth Jordan
"Now is the time to assertively begin the long-term process that can help define and incorporate our own moral principles into reproductive health education and advocacy work." – Felicia H. Stewart The high-quality reproductive health research regularly featured in this journal is essential for reporting on patient care and generating positive health outcomes. The values associated with the scientific work we do are not well understood by most lay audiences. These audiences, in turn, tend to perceive science and research as remote, even amoral. In the 2004 survey of public perceptions about science by the National Science Foundation, for example, more than half of the respondents agreed that "we depend too much on science and not enough on faith," that "scientific research these days doesn't pay enough attention to the moral values of society," and that "scientific research has created as many problems for society as it has solutions".1 This misperception can affect the incorporation of evidence-based science into health care practice and policy. Improving our ability to explain the values and ethics that underlie humane reproductive health science and policy is especially urgent: reproductive health issues are often at the forefront of policy debate and can be either a strong liability or a critical strength for the entire moderate and pragmatic agenda. As reproductive health professionals, we have a responsibility to participate in communicating the positive and highly moral attributes of our research to the public so that it is easily understood, highly valued and used appropriately to improve health care practice and policy development. To fulfill this responsibility, the Association of Reproductive Health Professionals (ARHP) is launching the Added Values Project, a long-term initiative that was originally initiated by Dr. Felicia H. Stewart, former board chair of ARHP. The long-term goal of this project is to ensure that the positive values associated with reproductive health and science are discussed in every appropriate forum. As envisioned by Dr. Stewart and a working group of clinical researchers, behavioral scientists, health care providers and educators, the project will create solid, well-developed and carefully refined policy concepts featuring language and communication approaches that explain humane reproductive health policy concepts and the values on which they are based. To commemorate her lifetime of commitment to reproductive health, the Added Values Project is dedicated to the memory and vision of Dr. Stewart, who passed away in April. She led the development of an action plan, working closely with the Project's working group, many of the organization's nonprofit colleagues and expert associates, with the goal of redirecting the policy debate away from personal ethics and toward the positive values associated with reproductive health and its scientific basis. To counteract the current incremental weakening of science and reproductive health, ARHP leaders believe that we must communicate their value to individuals first and, second, to society as a whole. As scientists, we must learn to speak the language of nonscientists and appeal to the positive aspects of belief systems outside of our experience to communicate scientific values, to change minds and to affect public policies. Over the course of the past half-century, scientific discovery has advanced reproductive health care in the United States. Scientific evidence has informed health care practice and has contributed significantly to positive health care outcomes. With an increasing emphasis in developing countries on evidence-based health care and a new focus on mentoring of health researchers, science has begun to positively affect health care policies and practices in many of these emerging regions of the world as well, although there is much hard work ahead of us. Reproductive health and biomedical research has led to improved care standards, better diagnostic tools and treatment options to detect and combat disease and increased public education to inform and empower people in making personal health care and life decisions. These advances are more than a product of the research and development that led to their discovery. They come as a result of scientific methodology and principles being applied to the formation of public policy, weaving the daily application of these innovations into the fabric of society. In the United States, this progress has been impeded by the relatively recent and highly alarming politicization of science at all levels of government, impacting a wide array of public policy issues.2 We have witnessed policymakers avoiding scientific evidence in order to distort, suppress or disregard scientific principles and information at unprecedented levels. Instead, many highly publicized - and some lesser-known - cases have relied on political or ideological judgments to guide the formation of public policy.3 This unfortunate trend is not merely the result of overzealous ideologues but indicates a level of indifference among much of the lay public to the importance of science and the policies that directly affect them. For many nonscientists, there is a tendency to view science as a necessary but somewhat remote, dusty and godless venture that has no direct impact on or connection to their everyday lives. Why is this? For too long, we scientists have relied on the principles of science - observation, hypothesis, experimentation, data collection, analysis, theory building, peer review - to make our case, again and again until, we hope, they "get it." Unfortunately, lecturing the public about scientific principles and research outcomes in the desire to convince them about our correctness is a lost enterprise; our intended audiences often consider this approach condescending and patriarchal. If our goal is to change minds, this approach just does not work. Behavioral science theory tells us that most people operate from the screens of their own biases; they are not going to listen to or be swayed by data that contradict their belief systems, regardless of accuracy.4 Worse yet, refusing to participate in communicating the principles and values associated with our work to the public is, at best, short sighted and, at worst, irresponsible. Add to this mixture the problem that reproductive health is often a touchstone for heated political debate and that policies in our arena are a primary target for misunderstanding and scientific assault. Most often, mired in an ethical or ideological framework, reproductive health issues are perceived as either the ultimate progressive defense to preserve Roe v. Wade or a conservative crusade to overturn it. Lost in this highly charged battle is an understanding of the full scope of reproductive health services, its fundamental worth, the science that supports it and the medical experts who administer it. If we are to reverse this course, ARHP leaders believe that the nature, direction and the tone of communicating and advocating reproductive health services and policies must change as well. A truly informed public must be educated on the full range of reproductive health services, the value it adds to their lives and the importance of science in determining reproductive health innovations and policies. This must be done carefully, over time, in recognition of the true diversity of cultures, values and belief systems that make up our societies. An informed and involved public has the best chance to expand the current public debate in the United States and around the world, creating a social context that will ultimately drive the politics behind policymaking. The Added Values Project's first phase involves conducting, collecting and evaluating the values of key groups of Americans. To start with, research will focus on "involved" subgroups of the general public: community leaders, self-identified religious communities, the media, policymakers and other similar groups. Over the next two years, ARHP leaders will train reproductive health experts to speak to lay and professional audiences on key messages that emerge from new and existing values research. In subsequent phases, ARHP leaders also plan to work with organizational colleagues to initiate platforms for ongoing debate and discussion about reproductive health values. Since our field will be experiencing unprecedented change over the next two decades, we will need clear opportunities to explore medical ethics, the appropriate applications of new technologies, the incorporation of new ways of learning, changing cultural norms and other key issues. ARHP is planning to follow Dr. Stewart's lead to proactively address these life-altering concerns for the next decade and beyond. Wayne C. Shields Beth Jordan References
Used with permission from Elsevier, Inc. |
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