Siân L. Curtis
Ph.D., Research Associate Professor, Maternal and Child Health
scurtis@email.unc.edu
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Curtis is a statistical demographer whose research and administrative efforts have focused on monitoring and evaluation of global population and health programs and family planning and reproductive health.
Curtis is a statistical demographer whose research and administrative efforts have focused on monitoring and evaluation of global population and health programs and family planning and reproductive health. As the past Director of the MEASURE Evaluation Project (from 2002-12), she provided technical direction and leadership to a portfolio of over 150 individual monitoring and evaluation activities in over 30 countries. Curtis continues to play an important role in the MEASURE Evaluation Project as a Senior Evaluation Specialist with responsibilities for designing and leading evaluations related to international health and food security projects. She has particular expertise in the design and analysis of complex surveys and previously worked as a senior analyst with the Demographic and Health Survey Project at Macro International.
Curtis conducted pioneering work on contraceptive use dynamics using the DHS contraceptive calendar data in the 1990s and early 2000s. More recent work on contraceptive use dynamics includes a 2011 paper in which Curtis and colleagues used DHS data from six countries to demonstrate that many women who discontinue contraception for reasons other than getting pregnant report a subsequent birth as intended. A smaller but non-trivial percentage of women who report a contraceptive failure also report the subsequent birth as intended. These findings contribute to a growing body of literature on the complexity and importance of fertility preferences in understanding contraceptive use dynamics. Current work on contraceptive use dynamics focuses on the role of quality of care in contraceptive use dynamics, the quality of contraceptive history data, and use of long acting and permanent methods of contraception.
Another current body of research focuses on maternal and reproductive health in Bangladesh. Curtis recently completed two impact evaluation studies of maternal and reproductive health programs in Bangladesh. In a paper published in 2016, she and colleagues examine trends in equity in use of maternal health services in urban and rural areas of Bangladesh using data from the 2010 Bangladesh Maternal Mortality and Morbidity Survey (BMMS) and show that equity in use of maternal health services is improving in urban areas but not in rural areas. Curtis is a member of a multi-partner team providing technical assistance for the 2016 BMMS and conducting an associated maternal morbidity validation study. This validation study aims to assess the reliability of common survey questions on self-reported symptoms of obstetric fistula and pelvic organ prolapse and to use these estimates of reliability to adjust national survey-based estimates of these conditions from the 2016 BMMS. Curtis is also currently collaborating with Bangladeshi colleagues on a number of other program-oriented analyses to inform reproductive health programming in Bangladesh.
Curtis's research also includes methodological work on measurement issues related to monitoring and evaluating global health programs. Curtis and colleagues use the 2010 BMMS data in a three country comparative study to examine experience using verbal autopsy methods to measure maternal mortality. The majority of countries in which maternal mortality is high lack good quality vital registration systems so alternative methods for measuring maternal mortality are needed to monitor progress in reducing deaths from maternal causes. This work demonstrates that verbal autopsy methods can be used with a variety of platforms to obtain estimates of maternal mortality but highlights considerations for different platform options. Another methodological paper explored the implications of facility sampling and geographic displacement of cluster location to protect confidentiality for spatial linking of facility-based and population-based surveys for evaluation analyses. The analysis showed that facility sampling produced larger misclassification errors than cluster displacement, occasionally underestimating access to services by large amounts. The researchers recommend against linking independent facility samples and household clusters at low levels of geographic disaggregation. This work is relevant to current discussions on the measurement of effective coverage in the context of global goals for universal health coverage.
Curtis has experience conducting evaluations in areas outside of reproductive health and in conducting different types of evaluations. Recently completed impact evaluations include an impact evaluation of gendered outcomes of a groundnut value chain intervention to improve food security in Zambia and two impact evaluations related to TB programs in Ukraine. In Zambia, the evaluation found that interventions to increase commercialization of the groundnut value chain did not displace women from that value chain. In Ukraine the two evaluations demonstrated that a social support intervention for TB patients at high risk of treatment default was successful in improving treatment outcomes, and that efforts to improve integration of TB and HIV services were successful in improving some outcomes for co-infected patients. Another area of ongoing work explores approaches to evaluating portfolios of projects that aim collectively to increase contraceptive use to inform ongoing portfolio management. This work is drawing on methods for complexity aware evaluation and from systems science.