Reproductive health systems analyses and the reparative reproductive justice approach: a case study of unsafe abortion in Lesotho

Abstract

ABSTRACTHealth systems analyses are touted as mechanisms through which health policy and planning may be implemented. An example is the WHO health systems approach that connects people (needs, rights, perspectives) with services and technologies (equitable access, quality of care, mix of interventions) and with policies and institutional capacities (laws, regulations, human/physical resources, management and financing). The approach is comprehensive and multi-faceted, which is a strength. We argue, however, that health systems analyses should be supplemented with a focus on reproductive justice. Using the WHO health systems approach as an exemplar, we show how the reparative reproductive justice approach outlined by the first author and colleagues assists with outlining comprehensive remedies to the inequities identified in the systems analysis. We argue for attention to remedies at individual and collective, material and symbolic levels. We illustrate our argument using unsafe abortion, legal abortion services and post-abortion care in Lesotho as a case study. We outline the policies, services and people components of abortion in Lesotho using the WHO systems model, followed by a reparative justice analysis of remedies.

Keywords: Sexual health; abortion; reproductive health; reproductive justice; sexual and gender based violence; supportability; systems; unintended pregnancies.