Moving Past a Legacy of Controlling Women: Key Frameworks to Center Women and Girls’ Choice and Agency in Sexual and Reproductive Health Measurement

Abstract

As the global community looks beyond the 2030 Sustainable Development Goals agenda, there is a critical opportunity to refine and elevate indicators focused on sexual and reproductive health and rights (SRHR) and to shift nations away from fertility and contraceptive targets. This commentary presents four key frameworks—drawn from a panel at an International Union for the Scientific Study of Population (IUSSP) meeting focused on SRHR measurements—that offer distinct yet complementary lenses for understanding and measuring reproductive choice and agency. These include the EMERGE Empowerment Framework (focused on measurement and evaluation), Patient‐Centered Care (focused on clinical practice), the Human Rights Framework (focused on policy), and Reproductive Justice (focused on social change). While not an exhaustive list, these frameworks reflect a diversity of disciplinary perspectives and emphasize the importance of grounding reproductive health indicators in concepts of choice and agency. The empowerment framework centers on individual decision‐making and collective action, while person‐centered and rights‐based approaches evaluate how health systems and policies support or constrain that agency. Reproductive justice expands the lens further, highlighting how structural inequalities shape differential access and outcomes across race, class, and other social determinants of health. Together, these frameworks underscore the need for multilevel, intersectional indicators or reproductive agency—spanning individuals, health systems, communities, and policies—to effectively guide and evaluate the impact of reproductive health programs and policies at scale.