Reproductive power matters: aligning actions with values in global family planning.

Abstract

The COVID-19 pandemic has exposed and compounded existing inequities, with disparities in full recovery from the disease and death affected by geographic, racial, social, and economic status. In the area of sexual and reproductive health, and particularly for adolescents in the global South, school closures have reduced access to comprehensive sexuality education, and lockdowns and disruptions in access to family planning (FP) services have led to increases in sexual harassment, gender-based violence, and unwanted pregnancies. These facts, as well as the occurrence of gross imbalances in access to vaccines, catastrophic losses in income, and increased hunger, have inspired a re-examination of the models of development that have failed so many, with more and more global health actors waking up to what justice activists and scholars have been pointing out for many years – that health cannot be extracted from the economic, social, and political context in which it is produced, or inhibited. Leaders like Loretta J. Ross and Dazon Dixon Diallo from the Reproductive Justice movement in the United States have long called for this realignment, but the emergence of these concepts in the broader global health discourse is more recent and needs to be nurtured. In addition to the latest report from the High-level Commission on the Nairobi Summit on ICPD +25, this rethinking has included a call from Donald Berwick, a leading authority on health care quality and improvement, for the health community to collectively turn our focus to the “moral determinants of health” – in other words, to actions that are truly aligned with our values to improve human health and well-being. This call is rooted in the reality that efforts to improve health and well-being have illogically and drastically underinvested in addressing societal and structural factors, despite robust evidence that circumstances outside of health care are largely responsible for health and well-being. What does this mean for those working in global sexual and reproductive health and rights (SRHR) and FP? Fortunately, we have a history to draw on. From the Alma Ata Declaration of 1978 to the 1994 International Conference on Population and Development (ICPD), to the 2000 ICESCR Article 12 General Comment No. 14 and, most recently, the Nairobi Summit on ICPD + 25, the global health community has come together in the past to set out a vision that centres people and their rights to participate in the health decisions that affect them and to determine their own reproductive futures. Over the years there have been remarkable gains; we have moved from a primary focus on population issues and fertility to one grounded in the rights of individuals to control their bodies and attain reproductive health and well-being, but we are yet to fully achieve this vision. Progress has been impeded in part by a failure to fully articulate, commit to and operationalise these values. FP programming is still often framed around a notion of supply and demand that juxtaposes ensuring adequate availability of contraceptive services and supplies with generating interest and demand for those services. This frame, with its prescriptive expectation that people should COMMENTARY