Blueprint For Sexual And Reproductive Health, Rights, And Justice

autonomy, dignity, health and wellbeing, andeconomic security. Every individual must haveunimpeded access to abortion care – regardlessof where they live, how much money they have,their insurance, their age, or if they decide toself-manage their abortion. Indeed, a right ismerely theoretical when care is inaccessible orunaffordable. Federal lawmakers must enactpolicies that guarantee abortion access across thecountry. This includes passing legislation to ensurecoverage for abortion in private and governmentfunded insurance plans and programs and endingthe Hyde Amendment, which withholds abortioncoverage (except in the limited cases of rape, incest,and life endangerment) from those qualified andenrolled in Medicaid, as well as related restrictionson abortion coverage. Lawmakers must also reducebarriers to medication abortion and decriminalizeself-managed abortions. Likewise, the U.S. shouldsupport the decriminalization of abortion worldwideand use multilateral spaces to promote normativeguidance urging the decriminalization of abortion.Furthermore, Congress must end the HelmsAmendment, which unjustly restricts federal globalfunding from covering abortion care. Pregnancy care must be expanded andimproved. Access to respectful, high-quality,holistic pregnancy-related health services is notonly a fundamental human right, it leads to betterhealth outcomes for both pregnant individualsand children. Federal policymakers must requirepublic and private insurance plans to have a robustnetwork of reproductive health providers andprovide comprehensive coverage of pregnancyrelated health care (including postpartum care);ensure individuals can enroll in and retain theirinsurance coverage when they become pregnant;furnish states with the resources they need toBlueprint for Sexual and Reproductive Health, Rights, and Justiceprovide comprehensive medical treatment topregnant and postpartum individuals withsubstance abuse disorders and/or mental healthconditions; and encourage states not to criminalizepregnant individuals who suffer from substanceabuse disorders. Federal policymakers must alsoensure that all individuals have paid sick time andfamily and medical leave so that new parents canrecover from childbirth and parents can care fortheir children and themselves. Guaranteed access to qualified sexual andreproductive health care providers. Health careproviders are an important component to ensuringthat individuals have the care, information, andservices they need to care for their sexual andreproductive health. It is critical that policymakersbolster public programs that help deliver sexualand reproductive health care services such as theTitle X Family Planning Program, Medicaid,and the international family planning program.In particular, the federal government must endharmful policies that restrict access to providers,including existing domestic and global “gag”restrictions that block providers from participatingin programs or furnishing comprehensive care topatients. Policymakers must also create policiesand programs that provide financial incentives toa larger and more diverse network of health carepractitioners to enter into and remain in the fieldof providing sexual and reproductive health care.Furthermore, federal lawmakers must implementpolicies and practices to ensure there is a sufficientworkforce to meet patient demand, includingraising reimbursement rates and program fundingfor sexual and reproductive health care and takingaction to end violence and harassment againstsexual and reproductive health care providers,patients, and staff.Page 5

PRINCIPLE 2:Ensure Discriminatory Barriers in Health Careare EliminatedSexual and reproductive health care cuts across gender, race, age, sexual orientation,disability, economic status, geography, and citizenship. Health care systems in the U.S.and around the world must foster fairness and equity and be respectful and inclusiveof every patient’s full identity. Health systems that do not recognize and respect thediversity of people will shortcut patient care and fail to address complex individualand community needs. While significant progress has been made to improve accessto health care and promote human rights for all, disparities and inequities havegrown both between and within countries, leaving too many communities behind. Bycentering the unique experiences and needs of those most harmed by inequity — nomatter who they are or where they live in the world — U.S. policymakers can make asignificant contribution to promoting health and wellness for all communities.Our vision for how the U.S. eliminates discriminatorybarriers in sexual and reproductive health care includesthe following: Global and domestic health care entitiesand insurance plans must have robust nondiscrimination protections for patients withoutexception. Central to a patient’s autonomy, dignity,and safety is the ability to make their own healthcare decisions in line with their own personalneeds. Health care systems should empowerindividuals to access care that is best for themunimpeded by policies that enable their insuranceplan, hospital, or health care provider to deny themcare, coverage, or referrals on the basis of religiousor moral belief. This is a problem not only in theU.S. but in the global space as well: organizationsthat receive funding to combat HIV globally mayrefuse to provide even basic information, referrals,and services such as abortion, birth control, andgender affirming care without penalty. Federalpolicymakers must ensure that patients comefirst through non-discrimination protections toensure that patients are not refused appropriatereproductive health care services, information,and referrals.Blueprint for Sexual and Reproductive Health, Rights, and Justice Health care entities must be required to ensurethat all individuals can access quality and equitablehealth care no matter their identity or theircircumstances. Health equity and equal accessmust be central to our health care system. We mustprioritize populations that face obstacles in obtainingquality health care from trusted providers, including:immigrants, young people in the U.S. and globalsouth, Native Americans, people of color, andLGBTQ individuals. In particular, immigrants indetention settings should be treated with compassion,dignity, and respect: they should never face sexualviolence while in detention, be shackled during birth,or be denied appropriate reproductive health care,including contraception, abortion, pregnancy care.Likewise, empowering adolescent girls and youthassigned female at birth globally is not possible if theirsexual and reproductive health and rights are notfully addressed; young people cannot meaningfullydetermine their destiny when parental consent andnotification is required for sexual and reproductivehealth care, including abortion. To rectify thesebarriers to health care, policymakers must reform ournation’s health care delivery system and global healthand development approach writ large to ensure allpeople are able to obtain comprehensive, confidential,Page 6

and quality health care from trusted providers in atimely, culturally-competent, and dignified manner. Policymakers must strengthen patient protections,including confidentiality and informed consent.A key component to ending discriminatory healthcare practices is centering the patient and their needswhich must include being responsive to patientpreferences, needs and values, that often vary acrosssex (including sexual orientation and gender identity),parental status, race, ethnicity, community, ability,and immigration status. Additionally, providingcare, free from coercion and implicit or explicit biasis integral to a successful health care framework.Confidentiality and informed consent, among otherpatient protections must be strengthened to ensurepatients are in full control of their medical treatment,planning and care. Policymakers must increase the effectiveness ofU.S. efforts to combat the HIV epidemic globally.In order to end the HIV epidemic globally, theBlueprint for Sexual and Reproductive Health, Rights, and JusticeU.S. must scale up investments in global AIDSprograms and abandon discriminatory policies thatleave critical communities behind. This includesending abstinence-only-until marriage fundingand restrictions on how organizations can engagewith sex workers or advocate or speak about theirhealth and rights. An evidence-informed approachto combating the rise of HIV/AIDS necessitatescomprehensive sexual health education and theengagement and empowerment of key populationsand stakeholders, including young people –especially adolescent girls and young women,sex workers, men who have sex with men, peoplewho inject drugs, transgender, nonbinary, andgender nonconforming persons, and those who areincarcerated. Federal policymakers should promotethe delivery of integrated, rights-based, and nondiscriminatory reproductive health and HIV careto ensure that taxpayer dollars are being used foreffective programming to decrease the transmissionof HIV, care for people who are living with or atrisk of HIV, and uphold the rights of all.Page 7

PRINCIPLE 3:Ensure Research and Innovation Advance Sexual andReproductive Health, Rights, and Justice Now and in the Future.Technology and innovation are transforming the health care landscape. Patients,providers, and policymakers continue to express enthusiasm about the ways in whichtechnology has the capability of making health care more accessible and affordable,which in turn could contribute to reduced health care disparities and improved healthoutcomes. New technologies and research to improve drugs and devices, increasedefficiency and accuracy in data collection, and reforms to health care delivery thatbetter coordinate patient care will also benefit the delivery of sexual and reproductivehealth care. However, given the intimate nature of sexual and reproductive healthcare, it is imperative that policymakers ensure that innovation and advancement inthis area be modeled around the principles of bodily autonomy, health equity andbe patient-centered.Our vision for how the U.S. utilizes research andinnovation to advance sexual and reproductive healthand rights includes the following: Health care system reform and innovation mustprioritize sexual and reproductive health care andhealth equity. Significant efforts have been made toreform our nation’s health care system to meet the“triple aim” of health care: better care, lower costs,and improved health outcomes. As these deliveryreform initiatives continue to develop, it is criticalthat they include sexual and reproductive healthcare to ensure that individuals are able to receive thecomprehensive health care they need from trustedproviders and that health equity be an explicit goalof health care transformation. Likewise, healthdelivery reforms must be based on evidence-basedpolicy rather than politics to ensure that individualsare able to get the services they need and accessthe qualified providers they trust without obstacleor judgment. Indeed, a health care system cannotbe patient-centered and improve health equity ifit does not address all aspects of a patient’s health;reflect the unique ways people access the healthcare system; and receive input from a diverse groupof stakeholders, including communities that haveBlueprint for Sexual and Reproductive Health, Rights, and Justicehistorically had limited access to health care, suchas people of color, individuals with low incomes,immigrants, and LGBTQ individuals. Withinthe history and ongoing existence of reproductivecoercion, particularly among women of color,individuals with low incomes, incarceratedindividuals, and individuals with substanceabuse disorders, as well as with the long-standinginstitutional racism in our health care system, it isvital that health care delivery reform policies thatcenter on sexual and reproductive health care notcoerce or steer individuals into using a particularmethod of contraception or restrict patient access toqualified reproductive health providers. Policymakers must prioritize developmentand broad adoption of delivery system andpayment models that recognize how peopleof reproductive age define quality, value andchoice and how they access comprehensivereproductive and sexual health care. Alternativepayment and clinical care delivery modelsshould view patients and their loved ones asvaluable partners at all levels of care and focuson coordinated patient-centered care deliverythat includes a commitment to care planning.Page 8

Care coordination and continuity should includeappropriate interface with primary and specialtycare. Financial incentives should reward deliveryof high-quality care that is measured by highvalue quality measures, including patient-reportedoutcomes measures and patient experience ofcare measures. Federal policymakers must invest in research anddevelopment to improve sexual and reproductivehealth care. Federal policymakers should workacross sectors to develop and fund fellowshipsand grants for scientists and researchers to studyreproductive health, increase investments in sexualand reproductive health research and development(including contraception, maternal health, andabortion), design new health care delivery platformsthat make it easier for patients to access care, improvedata collection on sexual and reproductive healthcare measures, and provide free and open access tosexual and reproductive health care-related databases,tools, and resources. Similarly, lawmakers should alsoensure that the U.S. collaborates with other countriesto fund, develop, and use global health innovationsin an effort to meet global health goals related tosexual and reproductive health.Blueprint for Sexual and Reproductive Health, Rights, and Justice Policymakers must restore scientific integrity andtransparency to support activities that affect sexualand reproductive health. Sound policies must beinformed by high-quality evidence, and likewise,policy proposals should accurately represent evidence.Unfortunately, in recent years, politicians haveallowed their personal beliefs surrounding sexual andreproductive health to outweigh scientific evidence,resulting in the erosion of federal and state healthprograms and priorities that provide individuals withreproductive health care services. It is imperative thatfederal lawmakers reverse this trend and implementactions to ensure that our country is guided byscience and not politics. The administration mustappoint and Senate should confirm nomineeswho exhibit views and experience consistent withagency missions and who demonstrate respect forand sufficient understanding of relevant science,ensure that federal agencies and other policymakingentities rigorously investigate instances of abuses ofscientific integrity, and that the general public, mediaoutlets, and lawmakers receive scientific and accurateinformation about public health topics (includingsexual and reproductive health care).Page 9

PRINCIPLE 4:Ensure Health, Rights, Justice, and Wellnessfor All Communities.True health and wellness will only be achieved by transforming complex andinterrelated systems and by addressing societal, environmental, and social factorsthat impact people’s health. Fair wages, affordable housing, safe and affordablewater and sanitation, public transportation, paid leave, affordable childcare, andcompassionate immigration policy are all interconnected to the vision to securereproductive autonomy. Sexual and reproductive health, rights, and justice alsorequire the promotion and integration of social determinants of health into theactual provision of health care. Simply put, federal policymakers must workacross sectors, agencies, and stakeholders to address the intersectional issuesthat impact an individual’s ability to have control over their own body, health,and destiny.Our vision for how the U.S. ensures the health, rights,justice and wellness for all communities includesthe following: Policymakers must foster economic opportunity forall families. All individuals deserve to achieve the lifeof their choosing and to adequately care for themselvesand their families. This is impossible, however, withoutthe structures in place to enable individuals to live witheconomic security and safety. Federal policymakersmust create policies that guarantee individuals paid sickdays and paid family and medical leave (which can beused for reproductive health care services), quality andaffordable childcare, secure housing, access to nutritiousfood, high-quality education that is free from schoolviolence, job training, and a livable wage. Policymakers must ensure all communities are freefrom violence. Sexual and reproductive autonomyand justice necessitates that individuals also be able tolive their lives without fear of violence, intimidation,or retribution – regardless of who they are, where theylive, where they come from, their age, or how muchmoney they have. Policymakers must enact laws thatshield individuals from gun violence, sexual violenceand harassment, and race- and gender-based violence.Blueprint for Sexual and Reproductive Health, Rights, and JusticeIn addition, policymakers should guarantee access tocomprehensive health care for survivors of violencewithin the U.S. and globally. Policymakers must support and promote policiesto develop a healthy and safe environment.Every person has the right to a healthy environmentthat is free from toxic chemicals, and has accessibleclean drinking water, wastewater services, safe food,and clean air. Policymakers must aggressively andquickly address the climate crisis and enact policiesthat provide strong regulation and oversight overenvironmental protections, including the regulationof emissions. These policies not only further criticalpublic health goals and ensure that individuals canmaintain their health and the health of their childrenand families, they are also moral imperatives asindividuals can suffer grave health consequences andeven death from unmonitored, unregulated, andunsafe toxins in their environment. Policymakers must promote and ensure integrationof the social determinants of health into theprovision of health care. Improving health outcomesrequires addressing the social determinants ofhealth: the conditions in which people are born,Page 10

grow, live, work, and age. As our nation continuesits efforts to transform the health care system, itmust also invest more resources and funding intomeeting the demands of related issues that impacthealth outcomes such as housing, food access, crime,violence, and education. Federal lawmakers mustcommit to significant financial investment to developan efficient infrastructure that allows individualsto access the care and services they need withoutpenalty, discrimination, or barrier, so they can to livewhole, healthy, and dignified lives. Policymakers must invest in programs thatpromote health and wellbeing and advancegender equity. Our nation has the frameworkfor an infrastructure to provide health care andBlueprint for Sexual and Reproductive Health, Rights, and Justicesocial services to individuals across the country.However, that framework lacks the funding,resources, and strength needed to serve as manypeople as it could in an efficient and timely manner.Federal lawmakers must fully fund the programsthat alre

Blueprint for Sexual and Reproductive Health, Rights, and Justice Page 1 Contents Executive Summary 02 Introduction 15 Principle 1: Ensure that Sexual and Reproductive Health Care is Accessible to All People 17 Promote Comprehensive Access to Sexual and Reproductive Health Services Domestically 18 Use United States Leadership to Advance Sexual and Reproductive Health Globally 24