A Methodology for Investigating and Addressing Sexual and Reproductive Health Inequities in the Sustainable Development Agenda

Abstract

Background: Countries are committed to the international agenda and essential to achieving sexual and reproductive health goal is their capability to integrate equity lens in structural social determinants framing of inequalities. The aim is to propose comprehensive practical methodology which can alert countries to the injustice of sexual and reproductive health inequalities and provide tool to guide evidence-based policies and actions. Method: The methodology was founded on literature review. This was followed by consultation meetings and workshops to drive scientific output. Finally, the methodology was applied on data in five Arab countries to illustrate its relevance. Results: There are five contributions made. First, integrating equity lens to conceptual framing of sexual and reproductive health inequalities. Second, operationalizing the framework by articulating comprehensive list of indicators, adding distribution of gender norms, and choosing two inequality measures (index of dissimilarity and concentration index redistribution need) to allow for assessment of magnitude and comparisons. Third, illustrating the responsiveness of the health system and its relative contribution as social determinant of health. Fourth, demonstrating unfairness of root social structures and of social configurations of sexual and reproductive health. Finally, using the decomposition analysis and six questions to identify entry points for actions and responsibilities. Conclusion: the proposed methodology provides countries clear way to assess severity and fairness of health-related conditions and not specifically sexual and reproductive inequalities. It offers an ethical urgency for addressing health inequities and guidance to main stream fairness in the full package of national policies.