Aligning Values and Evidence:
Toward a Measure of Sexual and
Reproductive Wellbeing

Learn about the initial SRWB measure work

In this first phase of the work, the Coalition to Expand Contraceptive Access (CECA), National Birth Equity Collaborative (NBEC), and University of San Francisco, Person-Centered Reproductive Health Program (UCSF), along with a diverse working group, set out to align values and evidence, toward a measure of Sexual and Reproductive Wellbeing (SRWB). This collaborative group produced and disseminated a definition of SRWB and developed a strategy to design and validate a measure of SRWB.

Background

Wellbeing is increasingly recognized as a desirable outcome that governments and policy makers should both measure and prioritize. Focusing on and measuring wellbeing moves away from economic measures of societal success to allow decision-makers and funders to consider “what do we really care about? Is it ultimately the wellbeing of citizens?” Yet wellbeing measures and applications have typically not considered sexual and reproductive experiences and health (SREH), nor has wellbeing truly been considered in the sexual and reproductive health field.

Developing an expanded and more inclusive understanding and definition – and ultimately measurement(s) - of SRWB will benefit both those working in sexual and reproductive health (SRH) and those engaged in wellbeing related research and scholarship.

  • From the perspective of SRH, applying the wellbeing framework is consistent with the Reproductive Justice framework, which prioritizes people’s experience of sexuality and reproduction in a holistic and comprehensive manner.

  • With respect to the increasing attention to wellbeing in economics and policy discussions, attention to and measurement of SRWB will provide a mechanism for tracking this important component of lived experience, both in general and in response to policy interventions.

Why is this work important now?

  • Current policies, programs, and measurement strategies are inconsistent with a focus on reproductive autonomy and reproductive justice

  • It is important for us to not reproduce the harms that occurred with previous measurement by keeping values central to and omnipresent in this work

  • We can build on the increasing recognition of the value of prioritizing and measuring wellbeing as a means of determining how well people’s health and social needs are met

Approach

Phase 1 reflects the work completed to date, comprising of two steps: developing the idea and conceptual framework and developing a detailed definition and measurement framework. This work was informed by diverse workgroup input and reviews of the evidence; it also led to enhanced communication, collaboration, and alignment.  

Phase 2 reflects future measure development work and consists of three steps: refining the definition and measurement framework, drafting a preliminary instrument, and testing and refining the instrument and developing recommendations for use. Contingent upon funding, this work will be driven by additional qualitative research and community engagement.

The SRWB team and working group identified and modeled six principles from the outset of this effort. These principles, informed by environmental scanning efforts and expert input, were identified as key to centering justice and equity and ensuring the process is inclusive, values-aligned, evidence-based, and does not reproduce the same harms as prior measurement approaches.

These principles have been used to this point to define SRWB and it is intended for these principles to continue to be modeled as measure development continues.

Equity-Informed Principles to Guide a Measure of SRWB

  1. Center values of RJ and SRHE throughout this process​

  2. Define SRWB “in the eye of the beholder”

  3. Rely on diverse community engagement

  4. Move away from negative definitions and toward a positive framing

  5. Reiterate the importance and unique contribution of holistic measures, like SRWB​

  6. Build from but do not be constrained by previous measurement approaches

Draft SRWB Definition

SRWB is a state of complete physical, mental, and social fulfillment in all matters related to sex and reproduction, free of injustice, oppression, coercion, violence, and stigma and their consequences. This includes having: 

  • Freedom and ability to control, act on, and not act on one’s sexual and reproductive decisions, desires, goals, and identities, including having comprehensive information, services, and supports, and not being hindered or harmed 

  • Holistic and high-quality care for one’s sexuality and reproduction, free of judgement and bias, and coercion, that prioritizes personal needs and desires 

  • Optimal sexual and reproductive outcomes in accordance with one’s needs and desires, including:  

    • Attaining one’s ideal level of sexual and reproductive health  

    • Having the choice of if, when, and how to become a parent, and ability to do so 

    • Having a pleasurable and safe sex life 

Resources

Measurement Development Strategy Report

This report outlines the rationale for a measure of SRWB, the project approach and progress to date, and suggested steps for continued measure development.

Conceptual Model

The SRWB developed a conceptual model of SRWB, informed by input from the workgroup and learnings from the environmental scans and adapted from a socioecological model developed for the Robert Wood Johnson Foundation.