Public Health Post: “Advancing sexual and reproductive health and rights” to many people sounds like birth control and abortion. How do you define the scope of your work?
Herminia Palacio: A couple of years ago, Guttmacher in partnership with The Lancet medical journal launched the Guttmacher-Lancet Commission, a commission of global experts that produced a wonderful platform of what sexual and reproductive rights really encompasses. It was a sweeping vision, and it was based on human rights for all individuals. This platform includes having bodily integrity, privacy, and personal autonomy. These are concepts that are, actually, also embedded in reproductive justice.
The platform includes very basic human activities: the ability to freely define one’s own sexuality, including sexual orientation and gender identity; the importance of the ability to decide when and if to be sexually active and to derive pleasure in sexual activity; to decide when and if to marry and who to marry; to decide when, and if, and by what means to have a child and to decide how many children to have; and to have access to affordable, quality care over a lifetime, including information and support. That includes the services to terminate a pregnancy. It includes contraception, but it really is much broader. It is grounded in this concept of autonomy to determine one’s sexual and reproductive life.
What kinds of trends have you seen in reproductive health work during your time in this space? Where do you think we’re going?
One of the trends that we’re seeing is enormous engagement from young people. Young people are taking it to the streets to declare what’s important to them and to advocate for policies.
Advocates are starting to understand the overlapping nature of people’s lives. People don’t live just as their reproductive selves; they don’t live just as their racial selves; they don’t live just as their gender selves. They live as all of these things.
We are also seeing that the approach has shifted from the United States exporting expertise to more equitable global partnerships. For example, we are strengthening our partnership with APHRC, the African Population and Health Research Center. We’ve had a longstanding partnership, with knowledge and expertise traveling in both directions, but we are now coming to the table with an even clearer recognition that we have shared expertise that we can learn from each other.
What kinds of things has Guttmacher learned as you’ve shifted from an exporting model to a partnership model?
To be really granular around our research, abortions in the United States are increasingly going to be accessible via medication and self-managed abortion. From a methodological perspective, our research domestically has primarily been about surveying abortion providers, but in-office abortion providers aren’t necessarily always going to be the ones facilitating abortions. In partnership with our international partners, we have developed methods to understand abortion trends by speaking with a trusted confidant. This is the norm of research in countries where you can’t just walk up to an abortion provider and do a survey.
How has the Covid-19 pandemic affected reproductive and sexual health in the US?
At Guttmacher, we found that 34% of women in the US wanted to delay getting pregnant and to have fewer children due to Covid-19. That was the personal impact of facing a pandemic and, in many cases, economic collapse. Simultaneously, 33% of women faced delays in getting contraception or couldn’t get it altogether.
Disasters only amplify pre-existing inequities. Covid is already heightening the severe barriers that people face. Nearly half of Black and Hispanic women wanted to get pregnant later or have fewer children because of the pandemic compared to only about 28% of white women. Almost half of queer women wanted to get pregnant later or wanted fewer children compared with 33% of straight women.
Sexual and reproductive health and rights can’t be put off. People need to be able to love who they’re going to love. They need to be able to decide when and if to become pregnant. They need to be able to decide when and if to terminate a pregnancy. And they need to be able to raise children if they choose to do so in a nurturing and safe environment. The decisions that people are making under these extraordinary circumstances are not just for the here and now. They can affect a generation.
Photo courtesy of Herminia Palacio