Why CECA Focuses on SRHW and SRHE
By Jamie Hart and Lisa Stern
Early in CECA’s history (May 2020), CECA convened a technical expert panel (TEP) to explore how federal processes to expand contraceptive access would be different if a sexual and reproductive health equity lens was applied, and how CECA can help make this a reality. Subsequent TEPs, ongoing evidence analyses, and stakeholder conversations have helped us to define and reframe our own goals through a SRHW and SRHE lens and to further develop what steps the field, including the federal government, can take. We offer the following definitions to help clarify concepts integral to this work.
What do SRHW and SRHE mean?
Sexual and reproductive health and wellbeing (SRHW) is a self-defined state, which includes reaching one’s individual sexual and reproductive goals and support from a range of policies, programs, and services.
An SRHW approach requires a ‘whole systems thinking’ and ‘health in all policies’ approach that expands beyond a biomedical model of health to include aspects of life, like economic stability and freedom from discrimination.
Sexual and reproductive health equity (SRHE) 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.
SRHE requires acknowledging and understanding the multidimensional historical context of how inequity has structured the experiences of people with marginalized identities.
Reframing our goals as SRHW and SRHE requires de-siloing clinical services, public health programming, and policy to better reflect how people live and envision their health and wellbeing. Achievement of this reframed approach requires that we understand and redress the root causes of SRH inequities, particularly patriarchy, racism, colonialism, and capitalism.
Asking essential questions about what matters—including which processes, structures, and outcomes are deemed important and thus considered worth funding and measuring— means we must shift away from some frameworks that have traditionally guided sexual and reproductive health work and toward more meaningful ones. This includes reconsidering unintended pregnancy prevention as a goal, and identifying more patient-centered outcomes and recognizing that a spectrum of outcomes may be acceptable to people, dependent on their personal and social context. We must also shift from a traditional family planning framework that primarily invests in preventing pregnancy to meaningful investment of resources to eliminate barriers to those who want or do not want to grow their families, however they see fit. Sexual and reproductive health and maternal and child health are part of the same continuum in people’s lives, and policies and clinical care should reflect this reality.
How does CECA’s work advance SRHW and SRHE?
CECA’s goal is to identify the evidence needed to influence policy, leverage federal executive branch processes, and set the stage for implementation of efforts to expand access to contraception. Our work to advance SRHW and SRHE happens in many concrete ways.
Identifying strategies for leveraging federal processes, described in CECA’s Recommendations for Achieving Universal, Equitable Access to Quality Contraception. SRHW and SRHE are included as principles intended to guide the federal government’s approach to contraceptive access and ensure that all actions and initiatives are consistent, equitable, and aligned. SRHW and SRHE are integrated throughout the four main recommendations, including the urgent call for development of a federal strategy for SRHW.
Improving the conduct and content of policy-relevant research through the steps delineated in CECA’s Priority Roadmap for Policy-Ready Contraceptive Research. Featuring actionable recommendations and equity-informed research principles, the Roadmap positions public and private funders to invest strategically and equitably in policy-ready research, researchers to carry out impactful research projects, and policymakers and advocates to use evidence effectively.
Collaborating with CECA Core Members and stakeholders to further define, develop, and operationalize the SRHW and SRHE concepts. We recently published an article in the Nurse Practitioners in Women’s Health journal, Women’s Healthcare, to describe SRHE and how nurse practitioners can apply this framework to improve research, policy, and clinical practice. We also collaborated with the National Birth Equity Collaborative (NBEC) and the National Family Planning & Reproductive Health Association (NFPRHA) to hold a Congressional briefing on actions that legislators can take to help achieve sexual and reproductive health, wellbeing, and equity for all.
What needs to happen next?
In addition to the steps mentioned above, the SRHW and SRHE frameworks must be further developed and implemented. Frameworks provide an opportunity to ground our work in shared values and evidence and enable transparency and accountability—and must be accompanied by concrete implementation strategies. The following actions will help move this critical work forward:
Fully develop the SRHW and SRHE frameworks by reviewing relevant work to date and engaging a broad range of stakeholders, including communities, government, academia, and the reproductive health, rights, and justice field. The frameworks can then be used by government and the private sector to guide development of implementation and accountability plans.
Continue to make progress on current and emerging efforts to reform policy, research, and clinical practice in accordance with the values and goals of equity and justice. As the frameworks are being developed, equity audits of existing and planned policies and programs are needed to identify and redress the harm and to initiate the steps needed to break down barriers across systems.
Work to develop new measures to better understand SRHW and what interventions can improve it. The University of California, San Francisco (UCSF), NBEC, and CECA are currently collaborating on initial steps to develop a measure of sexual and reproductive wellbeing. Using an equity lens and centering patient voices to develop this measure will help ensure alignment with the Reproductive Justice framing, which prioritizes people’s experience of reproduction in a holistic and comprehensive manner. Continual development of this measure and others will help enrich our understanding of what SRHW means and how we can meaningfully improve it.