We should work together on SRH care Here’s why
By Diana Taylor, RNP, PhD, FAAN
Professor Emerita, University of California, San Francisco (UCSF) School of Nursing
Faculty, Research & Evaluation, UCSF Primary Care Initiative
Advancing New Standards in Reproductive Health Program (ANSIRH)
UCSF Bixby Center for Global Reproductive Health
Integrating sexual and reproductive health (SRH) into public health and primary care is one of those vexing problems: complex, multifaceted, and requiring disparate groups to work together to develop strategies and policy activities that align pre-licensure SRH education, continuing professional development, and service delivery for all healthcare professionals within an integrated primary healthcare framework.
Although the integration of SRH practice and education has lagged behind other specialty and population care guidelines such as gerontology, public health, genetics/genomics, and interprofessional practice, there are several global and national recommendations and models in action to guide us.
Over the past 20 years, several national commission reports have focused on the future of health professions education. More recent reports have focused specifically on primary care, public health, population-based health, as well as women’s preventive services, including gender-based services under the 2010 Affordable Care Act. Specific to SRH services, the World Health Organization published standards and core competencies based on a foundation of public health and primary care; and in the United States, a new report out of the RAND Corp. recommends policy interventions to align SRH practice, education, and credentialing to address workforce needs.1-3
SRH care is sometimes narrowly thought of as maternal-child health, family planning, or women’s healthcare. However, to produce optimal health outcomes, many experts believe SRH care should include the reproductive health of men and women throughout their lifespan, and adolescents of both sexes. Under a definition accepted by the World Health Organization and implemented in several national health systems, a minimum package of SRH care would include preconception care, contraception, pregnancy and unplanned pregnancy care, women’s health/common gynecology care, genitourinary conditions of men, assessment of specialty gynecology problems including infertility, and sexual health promotion. These services would be delivered within a system of public health and primary care services accessible to all with a focus on eliminating health disparities.
Looking to global and national models for how to make real and lasting change for what seem to be intractable problems, we now have a roadmap and recommendations for specific actions. These transformative paradigms can move us beyond our current siloed, competitive, and inefficient systems of education and practice. Interprofessional collaboration is today’s buzz term, yet this is what is urgently needed. No one profession can accomplish this alone.
The SRH Workforce Summit brought together a diverse group of organizations and individuals committed to developing and implementing new ways to prepare future clinicians. By expanding skills within the existing workforce in primary care, incorporating SRH into new models of healthcare delivery and reimbursement, and leveraging the existing expertise of SRH health professionals to improve delivery of sexual and reproductive health care, we can bring SRH care into reality for all Americans.
- World Health Organization. Sexual and Reproductive Health Core Competencies in Primary Care: Attitudes, Knowledge, Ethics, Human Rights, Leadership, Management, Teamwork, Community Work, Education, Counselling, Clinical Settings, Service, Provision. Geneva: World Health Organization, 2011. Accessed at: http://bit.ly/12mvyme.
- World Health Organization. The Role of Primary Health-Care Providers in Sexual and Reproductive Health: Results from an Intercountry Survey (Supplement 1). Geneva: World Health Organization, 2011b. Accessed at: http://bit.ly/1abCvIz.
- Auerbach DI., Pearson ML, Taylor D, et al. Nurse Practitioners and Sexual and Reproductive Health Services: An Analysis of Supply and Demand. Santa Monica, CA: RAND Corp., 2012. Accessed at: http://bit.ly/14JewOE.