Current Context

During the past decade, several changes have taken place in the United States that have affected the delivery of SRH care and understandings of what constitutes quality. This broader context shaped these recommendations. Important considerations include the following:

• Technological advances include new contraceptive methods (for example, vaginal pH modulator gel), modifications to existing contraceptive methods (for example, new doses and formulations of hormonal contraceptives and intrauterine devices), new ways of preventing STIs (for example, pre-exposure prophylaxis for HIV), and more widely adopted service delivery options (for example, online platforms, self-care, and over-the-counter access to oral contraceptives). Existing technologies such as telehealth have also expanded and become more user-friendly.
• Enhanced recognition of long-standing inequities within and beyond the health care realm have influenced what is considered high-quality SRH care. Systemic inequalities have long impeded people’s ability to receive high-quality SRH care, including, but not limited to, contraceptive care. To advance SRHE, entities delivering SRH care are expected to actively attend to and work to redress inequities and to reform systems. These efforts include offering supportive resources such as transportation assistance to increase access to care, addressing provider bias through ongoing and effective anti-bias training and community engagement, and adopting quality measures that reflect the broad range of experiences and needs of diverse people. SRHE also includes acknowledging and accepting that many people prefer to seek care outside of the formal health care system; therefore, it is crucial to empower them with the resources they may need to do this, including accurate information.
• Legal and regulatory changes at the federal, state, and local levels have affected access to SRH care through various mechanisms, including funding, insurance coverage, legal restrictions, public programs, and provider availability. Some of these changes have had the effect of limiting access, whereas others have enhanced access. 

Providers should be attentive to and remain aware of new developments that influence the delivery of highquality SRH care. The Reproductive Health National Training Center (RHNTC) and the Clinical Training Center for Sexual + Reproductive Health (CTC-SRH) offer training on these topics. Other organizations specializing in training on specific health topics covered in this update are listed in the relevant sections. Please refer to the glossary of terms used throughout this update and in the broader SRH field.