What did you study at LSHTM? What drew you to LSHTM?

I studied the MSc in Public Health for Development at LSHTM from 2018-2019, following two degrees in sociology.

A medical sociology course coupled with a summer research internship initially kindled my fascination with public health as I learnt how being healthy was about more than just biological factors and was shaped by social, economic, and historical circumstances – otherwise known as the social determinants of health.

After my master’s in sociology, I began working in public health research on a breadth of issues such as analysing elderly health policy; assessing state preparedness for the Sustainable Development Goals (SDGs); and the links between air pollution and health. I felt a graduate degree in public health would help me streamline my interests and enable me to link my training in social sciences to public health, so I applied for the MSc in Public Health for Development at LSHTM.

Given this was my second master’s degree, I was keen on looking for programmes that could be tailored to my interests rather than a general degree. The MSc in Public Health for Development is unique in its placement of public health within the larger context of development, the diverse cohort it attracts and the training it provides to those who plan to work in low- and middle-income countries (LMICs) and focus on development, as I planned to.

What was your summer project? Who did you work with?

Prior to joining LSHTM, I consulted briefly on the qualitative research analysis of reproductive health decision-making among married adolescent girls in two Indian states. Respondents included adolescent girls who had delayed pregnancy and those who had given birth to at least one child. Between the two sets of respondents, the presence of an accredited social health activist (ASHA) differed starkly. ASHAs – frontline community health workers whose role includes providing family planning counselling and access to contraceptives - typically featured in the experiences of those who had already given birth.  As ASHAs receive incentive-based payments for promoting contraception, this is often as viewed as the obvious reason behind the skew in service provision.

My summer project initially set out to explore if incentive payments had an influence on the work done by ASHAs, particularly on the most used modern contraceptive method in India: female sterilisation. In consultation with my supervisor, Professor Loveday Penn-Kekana, I refined the research question to understand why female sterilisation, a permanent method of contraception, was so widely used in India. Professor Penn-Kekana helped me design my research in a way that I could explore this topic in-depth, while keeping in mind the time limitations of a summer project and my interest in primary data collection. In the end, I interviewed key informants to understand policy perspectives and analysed secondary ethnographic data with ASHAs to understand ground-level perspectives.

What were the main findings of your summer project?

In the 1990s, official Indian policy language shifted to emphasise individuals’ reproductive health, rights and choices, and has continued to reaffirm this in global policy commitments and development agendas. India has also made substantial strides since such as lowered fertility, declining population growth rates and improved maternal health.

However, if appears that the policy shift hasn’t translated into widespread implementation, as many continue to rely upon female sterilisation (67% of married women aged 15-49 years) and are sterilised at younger ages (median age: 25.7 years). This suggests a continuing negotiation between achieving population stabilisation and upholding reproductive rights. Historical factors and social norms may have situated female sterilisation as the primary method to achieve demographic goals.

There also appear to be differing discourses at the policy and implementation levels that help illustrate the role that female sterilisation plays in Indian family planning: wide-ranging choices of contraception vs. the default choice (sterilisation); encouraging male participation vs. low male sterilisations; target-free family planning programmes vs. expected levels of achievements; and rights-based approaches vs population control. The summer project transformed into a larger inquiry into reproductive health and rights, population control and how policies can manifest in programme implementation in India.

How did you go about publishing your summer project?

While I had worked in research, I had no prior experience of publishing my work. I had worked on reports and co-authored white papers but none of those experiences compare to writing a peer-reviewed journal article.

I had planned to publish the paper and discussed it with Professor Penn-Kekana. When I saw that Sexual and Reproductive Health Matters – a journal I read regularly – put out a call for its South Asia regional issue, it was the nudge I needed to get started. The call and the geographic focus aligned very well with my summer project and the regional issue had waived the article publication charges to encourage authors based in LMICs to publish which was another incentive.

I shared a first draft with Professor Penn-Kekana who kindly offered suggestions on how to tailor it to the journal and issue. I went through one major revision based on peer reviews and a few rounds of minor revisions based on the editor’s comments. I typically took the lead in addressing and responding to revisions but was grateful knowing my supervisor was available if I needed support or advice.

What advice would you give to current MSc students completing their summer projects who may be interested in publishing?

• If this is your first ever attempt at publishing research, request guidance from those with experience. My supervisor provided me with invaluable support, encouragement and guidance. It might be helpful to chat with friends and colleagues too.
• Be proactive about getting it published. It is rather easy to get caught up in life and work. That said, I do think some time away from the dissertation is helpful to gain a fresh perspective.
• Subscribe to listservs and journal alerts to keep track of calls for papers.  
• If you’re responding to a particular call for papers, tailor your work accordingly. The article doesn’t need to have the same depth, detail or word count as your summer project but work on incorporating feedback from your markers.
• Read articles previously published by the journal you want to target to gain a better understanding of the work they look for.
• Where there are article publication or processing charges (APCs), write to the editors requesting an APC waiver as this work had received no funding and was done when you were a student.
• Be patient – it takes a long time! I submitted my summer project in October 2019, submitted to the journal in March 2021, and published in June 2022. 

What are you doing now you’ve finished your MSc? What does that entail?

The first year of the pandemic afforded remote working possibilities which meant I was able to take on two very different consultancies, immediately after graduating. I consulted on qualitative research analysis within studies on women’s groups and health intervention and community engagement initiatives to improve women’s access to health insurance at the Population Council, New Delhi.

I also documented strategies within a WHO-led project to support 19 countries in ensuring continued access and coverage to Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) services during the COVID-19 pandemic.

In December 2021, I joined the Population Council in New Delhi as a Technical Specialist and continue to work on qualitative research studies on women’s health and health systems in India.

How has your time at LSHTM helped you get to where you are today?

LSHTM, and the MSc in Public Health for Development in particular, helped me find a language for the public health work that I do. The LSHTM network of friends, colleagues, and teachers is a very generous one and the School is recognised for its high-quality teaching which is well respected in the job market.  

What three words sum up your time at LSHTM?

Community, diversity, memorable.

Publication

Sivaram, S., Singh, S. & Penn-Kekana, L. (2022). Understanding the role of female sterilisation in Indian family planning through qualitative analysis: perspectives from above and below. Sexual and Reproductive Health Matters, 29 (2). https://www.tandfonline.com/doi/full/10.1080/26410397.2022.2080166