CECA's Commitment to Sexual and Reproductive Health Equity in Our Work

By Jamie Hart

As a Black woman living in Washington DC during these turbulent times, I feel pain in both my heart and head. As a historian and public health professional whose now 20-year-old dissertation focused on what I then called “The African American Reproductive Freedom Movement”, I had hoped that the historical injustices faced by Black communities in America would remain in the past. Yet racism remains an ongoing public health crisis.

But I am moved and inspired by the historical and current collective action across the country in support of social justice. I am fortunate to lead a coalition that is dedicated to equity and changing the way federal processes have (or have not) expanded access to contraception for all individuals. While we focus on contraception, we see our work as a part of the broader vision of achieving sexual and reproductive health equity and reproductive quality of life. 

CECA turns evidence into action by identifying existing research and needs from the field, analyzing data and integrating evidence into federal processes, and setting the stage for implementation. On May 7th and 14th, we (virtually) convened 27 thought leaders for a technical expert panel (TEP) to explore (1) how federal processes to expand contraceptive access would be different if a sexual and reproductive health equity lens was applied, and (2) how CECA can help make this integration actionable.

What does “sexual and reproductive health equity (SRHE)” really mean? 

To shape our own definition and develop shared understanding, we explored various organizations’ and government agencies’ definitions of key terms and frameworks like health equity, patient-centeredness, reproductive autonomy, and reproductive justice. TEP participants highlighted the importance of highlighting the important role that systems and structures play in equity, and integrating a sexual health framing to incorporate the perspective and experiences of LGBTQ people, which resulted in the following definition:

Sexual and reproductive health equity means that systems ensure that all people, across the range of age, gender, race, and other intersectional identities, have what they need to attain their highest level of sexual and reproductive health. This includes self-determining and achieving their reproductive goals. Government policy, health care systems, and other structures must value and support everyone fairly and justly.

How can we integrate SRHE in our work?

The lively and insightful conversations at TEP meetings led to the co-creation of the following principles and strategies. 

Principle 1: Existing structures, systems, and processes must be examined and changed

To fundamentally change federal processes to reflect sexual and reproductive health equity, we must reconsider the questions we ask and how we design, measure, interpret, and share the results. As part of this process, we need to redefine “evidence” in a way that emphasizes a broad range of voices, fields, and outcomes and does not reinforce systemic bias. We must also alter structures to enhance collaboration and communication.

Principle 2: Inclusion must be prioritized

We must engage more diverse and new voices in a meaningful way that includes the power to make decisions. This means that professional and expert organizations, academic partners, and the federal government must invite end users and others not traditionally invited from the beginning, rather than as an afterthought. For many, this will be a cultural shift that can be supported by explicit guidance about who should be at the table and how they can be involved during every stage of the process.

Principle 3: Accountability must be built into the system and processes

SRHE means that government policy, health care systems, and other structures value and support everyone fairly and justly; these systems must be held accountable for demonstrating results and effectiveness that centers equity. Guidelines, performance measures, and funding streams can be leveraged to drive equity, for example, through development of clinical guidance that centers the principles of SRHE and aligning patient-centered performance measures with payment.

Principle 4: Language and definitions must follow values         

To ensure people have what they need to attain their highest level of sexual and reproductive health, we must explicitly acknowledge historical context and harms and how they manifest today, be clear in our values and intention, and prioritize alignment between language use and change behavior. Contextualizing our work in history and within the context of people’s lives begins with consistent use of inclusive, equity-focused language and principles that resonate with diverse groups – particularly those historically marginalized such as people of color, adolescents, people with disabilities, and LGBTQ people – and address issues in an intersectional way.

Where do we go from here?

I have been reflecting this week on the continued urgency of this work and the fact that there is so much to do. And I am grateful that we have the energy, commitment, and partners to continue to move forward. 

The integration of SRHE and the conduct of an SRHE expert panel was something that the CECA Conveners – Sue Moskosky, Tanishia Smith, Lisa Stern, and me – had planned from the beginning of CECA. We could never have predicted the expert panel’s timeliness. We are committed to moving the SRHE principles forward in our work together and with our broader group of CECA Core Members and Stakeholders. We will make our values explicit in the decision that we make. For example, while we are focused on contraception for many strategic reasons, we and our partners will continue to weigh the pros, cons, and risks of potentially expanding our focus to other essential aspects of sexual and reproductive health care. When we conduct upcoming expert panels and develop evidence-based recommendations, we will continue to consider and ensure that SRHE principles and diverse voices are driving the process, and define concretely how we measure our progress on this. Lastly, understanding that none of us are neutral, we will continually push each other to overcome the systemic habits of racial and social injustice and to listen, learn and grow from each other. Please join us on this journey!

Jamie Hart, CECA Executive Director