Sexual and Reproductive Justice: A Framework for Improving Access to Care

The 2015 Title X National Grantee Meeting took place in Washington, DC, from August 18-20, and brought together Title X Grantee leaders from across the country to gain and share current information on the provision of high-quality family planning services.  Particularly memorable was the Meeting’s Keynote Speaker, Dr. George Askew, Deputy Commissioner for the Division of Family and Child Health at the New York City Department of Health and Mental Hygiene (NYC DOHMH).  In line with the focus of the Meeting, “Improving Quality, Expanding Access, and Building Sustainability,”Dr. Askew’s presentation focused on the topic of sexual and reproductive justice and access to health care, and how a social justice framework can be used to shape and strengthen the work of family planning providers.

Dr. Askew opened by describing the importance of empowerment when working to engage communities. The goal of an organization should be to involve individuals in communities directly and in a way that respects their needs and contexts.  Dr. Askew went on to provide an overview of the Sexual and Reproductive Justice Framework (SRJ), which is central to this effort. The SRJ Framework defines reproductive rights as human rights, and recognizes the multiple forms of oppression that impact individuals’ decisions about their sexual and reproductive health.  In order to reflect this important framework in practice, it is essential for family planning providers to involve community members directly and in a way that respects their needs and contexts.  Dr. Askew provided an example of a local campaign that was intended to promote the use of Long-Acting Reversible Contraception (LARC). The campaign was initiated without involvement from the community during the planning process, and, before implementation, the community expressed concerns about the potential for coercive promotion of LARC—concerns which stemmed from the historical context of publicly supported programs using contraception to promote discriminatory practices. Dr. Askew used this example to highlight the importance of community engagement at all phases of program development and implementation. Had community members been engaged at the onset of the campaign’s development, the campaign would have been more in line with their needs and context, and, ultimately, more effective.

Using an SRJ Framework to inform efforts to increase access to sexual and reproductive health services entails acknowledging that individuals’ health-related decisions are shaped by where they live, work, and play (i.e., the social determinants of health). Also pivotal is an acknowledgement of the history of coercion in communities of color, which fosters trust between the family planning provider and its clients. Understanding this context and history is central to effective community engagement efforts. 

Dr. Askew found that including the community in the planning process in a genuine way promoted better outcomes, and also helped his staff feel more engaged and secure in the potential success of the campaign.  Strategies the NYC DOHMH has used to involve communities in its work include establishing relationships with advocacy organizations within the community; meeting weekly with SRJ leaders; and hosting strategy meetings with both staff and community groups. Dr. Askew outlined recommendations for other agencies based on the lessons-learned by NYC DOHMH.  First, it is important to engage the community from the onset of any new initiative, looking at both community needs as well as strengths.  Targeted action is needed in order to produce effective change, as is an understanding that health disparities in communities often are rooted in bad policies and historical context.  Most importantly, he emphasized, is that, while this work can be difficult, these strategies are rewarding and necessary for effectively expanding access to reproductive health care services.