Moving the public health practice of sexual and reproductive health forward
In the first blog post, I discussed the issues within the contraceptive care context, namely that access to high-quality contraceptive services, including the full range of methods and excluding bias and coercion, was limited. Central to this argument is the understanding that many states and payors can and do cover the cost of contraception but that this access is not always applied equally. In the U.S., people identifying as Black, Indigenous, people of color (BIPOC), those who are queer and/or trans, youth, people with low incomes and limited resources, including those using public health insurance, continue to experience gaps in contraceptive services/barriers in access to contraception. Additionally, we cannot examine this issue in isolation; instead, we should view the matter of sexual and reproductive health inequity in the context of a global public health system rooted in structural oppression and violence (Blog #2). Therefore, in the final blog post in this series on reproductive and contraceptive coercion and public health, I use a newer framework that redefines reproductive and sexual health equity to represent steps that move us closer to health and well-being for all.
Reproductive and Sexual Health Equity Framework
In response to the ongoing focus in public health to reduce unintended and teen pregnancy, researchers, clinician scholars, and reproductive justice advocates proposed a new paradigm for achieving better sexual and reproductive health outcomes: the Reproductive and Sexual Health Equity framework. The creators aimed to make the framework structurally informed, including race-conscious, and reassert that the goal of health attainment is not simply to avoid morbidity or mortality but to thrive. Additionally, a dominant narrative focuses on changing individuals' behaviors, which some may view as the primary determinant of poor health, rather than the environments where they live, work, access care, and care for themselves, their families, and communities. Likely across one's reproductive life course, they will need to access various health services and resources to attain or maintain health. Creating a better set of systems and practices can ensure public health is responsive to people's needs when the need arises. Further, with attention to structural oppression, we can begin to address the underlying causes of why people may not be able to attain health at all. Here, we start with reproductive and sexual health but offer this example to advance all facets of health and well-being.
Shifting the cultures of medicine and public health is important for ensuring that everyone has an opportunity to achieve overall health and well-being, including reproductive and sexual wellness. By using structurally informed frameworks and centering individuals and communities in public health we can help mitigate persistent health inequities.