Inclusion and Equity

Improving the quality of SRH services can lead to improved health outcomes, both directly and through improved patient experiences of care.1 

However, many people have long faced barriers to high-quality SRH care, including inequitable access to information; cost and insurance gaps; unnecessary, inadequate, or biased medical practices; and institutional barriers, such as lack of trained staff.6 Black, indigenous, people of color; lesbian, gay, bisexual, transgender, queer or questioning, and intersex (LGBTQI+) people; people living in poverty; people with disabilities; people with larger bodies; immigrants; and others with (often intersecting) marginalized identities are more likely to face the barriers described above and experience unique systemic barriers to SRH care and discrimination within and beyond the health care system.7, 8, 9, 10  These groups also have a history and continued experiences of reproductive injustices, including forced sterilizations and coercive use of contraception.11, 12

Delivery of high-quality, unbiased SRH care is one critical step in achieving sexual and reproductive health equity (SRHE).8 SRHE is defined as a state in which all people across the range of age, gender, disability, race, and other intersectional identities have what they need to attain their highest level of SRH, including the ability to self-determine and achieve their reproductive goals.1SRHE draws from human rights, health equity, and reproductive justice13 frameworks and requires policies, healthcare systems, and other structures to ensure its advancement.14 

The SRHE framework shaped the development of these recommendations, including through the incorporation of the overarching equity principles that were developed to guide this QFP update (Exhibit 2).1 These principles, detailed further in the methods section, have included the engagement of users of the QFP recommendations and users of SRH services through listening sessions, visioning sessions, and lived experience panels; the use of equity review guides and checklists; and the incorporation of various forms of evidence.

The recommendations aim to support the delivery of inclusive, person-centered care. With this goal in mind, this QFP update uses gender-inclusive language throughout and includes a wider range of methods of family building.15 

• The term “assigned female at birth” (AFAB) is used to describe particular considerations for people who were born with and may or may not currently have a uterus, ovaries, fallopian tubes, vagina, and vulva without connecting this anatomy to the experience of gender identity.16 
• Similarly, the term “assigned male at birth” (AMAB) is used for people who were born with and may or may not currently have a penis and testes without connecting this anatomy to the experience of gender identity. 
•  Because these recommendations apply beyond the formal health care system, the terms “person,” “individual,” “client,” “user,” and “patient” are all used to refer to people who may seek or desire SRH care. 
• Additionally, the term “clinic” is used to define broadly the various types of service sites, health centers, and clinical settings where SRH care is provided.

Exhibit 2: Overarching Equity Principles Guiding Development of QFP