Improving monitoring of sexual, reproductive health, and rights globally

The inclusion of sexual health and reproductive health targets in the Sustainable Development Goals (SDGs) aimed to provide impetus for tracking progress and advocating for sexual health and reproductive health rights for girls and women globally.With a rapidly changing political landscape in many countries, especially the United States, and with regions experiencing prolonged poly-crises, such as in the Middle East and North Africa region, it is imperative to ensure the tools used to monitor progress are valid and adaptable to varying contexts.SDG 5.6.2,defined as the "Number of countries with laws and regulations that guarantee full and equal access to women and men aged 15 years and older to sexual and reproductive health care, information, and education," has potential to address this need.In a new study, Jewel Gausman and colleagues [1] examine the validity of SDG 5.6.2'scurrent method of calculation by using country-level data to compare it to their revised version.This new version offers a potential resolution to 2 main concerns raised in the literature: one, that the indicator is sensitive to the number of barriers and enablers included, and two, that the overall score is a mean of the number of components rather than of the substantive domains [2].The revised formula addresses these challenges by re-expressing barriers as the absence of enablers and by assigning the 4 substantive domains equal weightage.Although this represents progress and an advancement, some issues remain.First, a country with multiple restrictions based on age, marital status, and third-party authorization for emergency contraception, for example, should be assigned a different score compared to a country with only limited restrictions.The revised formula continues to treat the impact of any one of these restrictions equal to the impact of all of them acting simultaneously on access to health care, information, and education.Second, a plural legal system (defined as a legal system in which multiple sources of law coexist) is listed as a barrier in at least 1 component of each section (e.g., Section 1, Component 1).While it is often the case that women fare worse under plural legal systems, it has been noted that they can and have conversely benefited from them by leveraging the operational ambiguity that accompanies the same systems [3].Existence of a plural legal system on its own should be reconsidered as a barrier only when contradictory sexual health and reproductive health laws exist therein.Lastly, financing ought to be considered as a key potential barrier to the availability of the 13 commodities listed in Section 1, Component 2: Maternity Care, Life Saving Commodities.Though a common measure is useful for cross-country comparisons, SDG 5.6.2 is particularly susceptible to between-and within-country variations.Additional guidance to countries on adapting the proposed new measure to local contexts and in certain humanitarian settings could increase its acceptability and application within countries.Below, we share 2 examples of when adaptation may present an improvement and enhance the utility of the measure within countries.