Mind the Gap: Understanding Differences Between Sexual and Reproductive Health-Related Legal Frameworks on Paper and in Practice

Abstract

IntroductionUNFPA recently developed a composite indicator to assess sexual and reproductive health (SRH)-related laws as part of the Sustainable Development Goals monitoring framework (Indicator 5.6.2). However, there is still little understanding of how best to ensure a supportive SRH-related legal framework can improve SRH outcomes. This research draws on country case studies (Colombia, Malawi, Uruguay, Zambia) to provide more generalizable lessons on the processes by which these laws are translated into practice and their impact on lived realities.MethodsPeer-reviewed and gray literature on laws and policies related to maternity care, contraception, sexuality education, HIV and HPV was reviewed. Key informant interviews were carried out with 8–16 people in each country, including representatives of government, civil society and academia to understand factors affecting implementation of relevant laws and policies. Findings were thematically analyzed by country and contextualized within each country's score on Indicator 5.6.2 and relevant SRH outcome data.FindingsAcross these countries, some common organizational steps help move from laws on paper to impacting people's lives including budget allocation, development of technical guidance, health worker training, population awareness creation and demand generation. It is also important to address sociocultural challenges such as entrenched inequalities, conservative cultural and religious beliefs and the potential existence of customary law. Challenges can be encountered across all these steps and can vary based on the area of SRH: implementation of laws to reduce maternal mortality is generally less controversial than laws around abortion, often making the latter harder to implement. Local specificities in structures, systems and cultures bring opportunities and challenges, highlighting the need for tailored actions.DiscussionA legal framework supportive to SRH is critical, particularly in the face of backlash against sexual and reproductive rights, but alone it is insufficient. Understanding that a generic pathway exists for moving laws into practice is a critical starting point for exploring the specificities of each national context as a way of identifying entry points for action. These findings can be used to inform advocacy and monitoring to help ensure that the potential benefits of supportive SRH-related laws can be realized in these four countries and around the world.

Why a good law is not always good enough: a global review of restrictions to supportive laws for sexual and reproductive health and rights

“…Other settings may already have supportive legislation, and legal reform could more usefully focus on removing restrictions within said laws. In contexts that have a supportive law with no restrictions, efforts can focus on implementation and accountability, which are critical 5 24…”

“…In contexts that have a supportive law with no restrictions, efforts can focus on implementation and accountability, which are critical. 5 24 …”

“…Finally, the survey data only provide insight into the existence and partial content of laws, precluding any investigation of their implementation, which is essential for translating law to improved health outcomes. 5 Future research could seek to combine information on legal guarantees and their associated restrictions with data on the implementation of these guarantees to better illustrate the impact of restrictions within law.…”

“…In this context, a supportive law refers to a specific law or regulation designed to ensure access to SRHR 5. For example, Zambia’s Bill of Rights includes a commitment that ‘the state shall ensure the availability to maternal healthcare’ 6.…”

“…In this context, a supportive law refers to a specific law or regulation designed to ensure access to SRHR. 5 For example, Zambia’s Bill of Rights includes a commitment that ‘the state shall ensure the availability to maternal healthcare’. 6 However, even where a specific service is legally available, there may be restrictions in the law regarding who can access it that exclude, for example, minors or women who have not secured spousal consent.…”