Moving ahead together, on a foundation of rights-based evidence

Challenge and change, reflections from the outgoing Editor-in-Chief

Almost a year ago to this day, SRHM published an editorial on the implications of COVID-19 on sexual and reproductive health and rights.¹ Sadly, many of the speculated negative effects have come to fruition. We are seeing a repetition of history, including global pandemic responses of “blaming, exploitation of social divisions and government deployment of authority”.² There is bickering over COVID-19 vaccinations between rich nations and pharmaceutical corporations, while less developed nations and those experiencing political unrest continue to struggle to deal with the effects of the pandemic with little hope of initiating mass vaccination campaigns any time soon. Reports of racial abuse and unrest abound in the daily news.

As many have predicted, sexual violence has been a particularly salient topic. On International Women’s Day this year, the 8th March, women all over the world called for greater efforts to end gender-based violence.³ The evidence linking intimate partner violence and COVID-19 lockdown is mounting, with reports, government statistics and domestic abuse helplines from around the world confirming apprehensions at the start of the pandemic.^4,5 In her paper published in SRHM this year, Suga provides some insights from Japan into the response to domestic violence during COVID-19.⁶ In other work, sexual violence against girls in school is eloquently discussed in a legal case from Ecuador,⁷ while in our 2021 South Asia Region issue, Pitre and Lingam scrutinise the changes in sexual violence laws in India and warn against the simplistic use of legal instruments to solve social concerns which are complex and multi-faceted.⁸

There is much strife to overcome and many challenges to face. SRHM’s vision statement, formulated some years ago, is perhaps even more relevant today than ever before.

“A world in which sexual and reproductive health and rights are recognised as fundamental human rights and matters of social justice; and in which sexual and reproductive health needs are addressed and rights of people fully respected, protected and fulfilled, without discrimination of any kind.”

The disruptions of today’s world, with continuing poverty, powerlessness and intolerance, are all well-known threats to the achievement of sexual and reproductive health and rights globally.⁹ The enormity of attaining such a reality, not least from the perspective of having an evidence base to inform a roadmap toward the vision, cannot be overstated.

A human rights foundation for public health has been evolving for some decades,¹⁰ is being put into practice in various areas and is endorsed by international organisations including the World Health Organization.^11,12 Yet, public health did not historically stem from these foundations and for the jobbing public health practitioner or researcher at the front face, full understanding and assimilation of so-called rights thinking or rights-informed research, is perhaps not quite as fully formed as it might be. At SRHM, we would like to see change for the better and feel we can play a role in closing the gaps, strengthening the amalgamation of public health and rights-based frameworks, to advance the progress of rights-based evidence for sexual and reproductive health. The article we published this year by Gruskin and colleagues¹³ starts us on a journey toward how to integrate human rights into sexual and reproductive health research. As part of our “more than a journal” activities, we are also working in partnership to improve approaches for how rights-based research is conducted (see http://www.srhm.org/south-asia-regional-hub/). We will be building on our emphasis in publishing work which has a strong rights base, irrespective of whether the work belongs to epidemiological, anthropological, social science, legal, political science, or other disciplines.

Our vision statement also underscores the need for moving forward together, with synergy and continuity across what we call the “journal” and “more than a journal” activities. The journal fosters the publication of papers relevant to our vision, while “more than a journal” creates dialogue, capacity, partnerships and other spaces that improve research for policy and practice, grounded in rights-based thinking and action. Today, we live and breathe this essential connection and our daily work would not be what it is without the continual back and forth of each component feeding into the other. We do not feel we can achieve our vision without this.

The time is now right for me to hand over the journal to the care of a new, reconfigured editorial team, augmented by the appointment of an executive editor and two new senior editors. I believe that great organisations are founded and sustained on exceptional teamwork and SRHM’s decision to move to this team structure brings the journal toward a future where our strengths lie in working together and collaboration. In the words of Helen Keller, “Alone we can do so little, together we can do so much”.

Moving ahead, message from the incoming Executive Editor

As I come into the new editorial team, the world continues to try to manage the COVID-19 pandemic. COVID-19, while having restricted movements and worlds in some senses, has forced examination of the bigger picture. The exacerbation of inequalities and complex relationships between sexual and reproductive health and rights, gender, social, economic, political and health systems factors have been brought into sharp focus.

In the COVID-19 era, women have faced even greater barriers to access time-sensitive services such as abortion and contraceptive services, maternal health has suffered in many cases, gender-based violence has intensified and whilst all children have suffered, school closures are likely to have had particularly negative consequences for girls in terms of exploitation, pregnancy and early marriage.^14–16 Capturing the consequences through robust and rights-informed research will be crucial and we have kept open our call for papers on sexual and reproductive health and rights in the era of COVID-19.

Future efforts to ensure learning for the sustainability and resilience of health systems and emergency preparedness and planning must have sexual and reproductive health and rights at the centre.¹⁷ As Clark & Gruending highlighted in our issue on Universal Health Coverage, the vulnerability of services for sexual and reproductive health and rights has been made all too evident and “building back better” will require strong political will and leadership.¹⁸ The pandemic has also perhaps hastened trends in health and rights service provision which can create opportunities, including through the expanded use of online consultations and self-care. In 2021 our special issue on “Self-care interventions and rights-based access” promises to explore scaling-up of self-care interventions with a specific focus on the needs and rights of vulnerable populations.

SRHM has often pointed to the impact of political change and power on sexual and reproductive health and rights.¹⁶ A recent review of public policy and health in the Trump era highlights well the negative impact that change in political leadership can have on sexual and reproductive health and rights domestically and globally.¹⁹ We watch while the US enters a new era with the welcomed axing of the “Global Gag Rule”. Ever political, sexual and reproductive health and rights remain vulnerable. It is to be seen how countries respond post-COVID-19, whether there is greater appreciation of global interdependencies and the value of public health systems underpinned by a rights-based approach, or in fact countries become more inward looking to tackle significant domestic social and economic challenges, and whether public health remits are broadened or narrowed with a focus on health protection.

From the journal perspective I am conscious that research funding and agendas will also be reflective of broader political change. The recent announcement that planned cuts to Official Development Assistance funding by the UK government will lead to a £120 million shortfall in research funding for 2021–2022 again shows the fragility of support. It is particularly disappointing when through recent years the research landscape had taken steps to foster the multidisciplinary perspectives required to adequately consider and improve sexual and reproductive health and rights. Funding had also come with greater recognition and conditionality on the nature of partnerships between researchers and others in the global North and global South. The withdrawal of funds that had already been committed now risks undermining the very basis of those partnerships.

Although conscious of external forces that can impact research in all countries, I know that sexual and reproductive health and rights research and advocacy communities will respond irrespective of the challenge, which is part of what makes this role exciting. The journal will reflect and strive to support the principles and ethos of SRHM, thinking about what we can practically do to promote diversity and inclusivity for contributors, uphold ethical standards in research and attend to the nature of partnerships. We know that the impact on researchers during COVID-19 has been gendered; having greatest negative impact on research outputs for those with caring and other responsibilities. It feels like a time when journals should be reflective of their role, seeking to support authors in need of support and ensuring the publication of robust evidence and diverse perspectives to inform change.