Sexual and Reproductive Health and Rights in Italy and Spain: Investigating the Gap between Formal Commitments and Lived Realities through Young Women’s Experiences and Perceptions

This thesis investigates the gap between the formal recognition of Sexual and Reproductive Health and Rights (SRHR) and their implementation in practice in Italy and Spain. Despite broadly similar historical, cultural, and institutional contexts, the two countries diverge in SRHR implementation due to different legal frameworks, institutional dynamics, socio-cultural norms, and political and media discourses, which together influence the availability, accessibility, acceptability, and quality of SRHR services. To examine this gap, the thesis adopts an integrated approach centred on four interconnected dimensions. First, it analyses how SRHR are legally constructed and regulated across international, European, and domestic orders, with particular attention to their fragmented and interpretative nature within international human rights law and the implications this has for state obligations. Second, it develops a socio-political understanding of SRHR as rights whose meaning and legitimacy are shaped through institutional practices, public discourse, and broader cultural narratives. Third, it investigates how SRHR are realised in practice by focusing on lived experiences of access, institutional interaction, autonomy, rights awareness, and perceived barriers as indicators of effective rights implementation. Fourth, it situates these dynamics within a comparative perspective between Italy and Spain to explain how different institutional and socio-cultural configurations generate divergent SRHR outcomes. Methodologically, the research adopts a comparative mixed-methods design combining legal analysis, theoretical development, and empirical investigation. The legal strand examines international, European, and domestic SRHR frameworks in both countries. The theoretical strand develops a conceptual framework grounded in human rights-based approaches and constructivist perspectives to examine how institutions and discourse mediate the implementation of rights. The empirical strand is based on an online questionnaire administered in 2026 to young women aged 18–30 in Italy and Spain, exploring SRHR experiences from 2016 to 2026 regarding access to services, institutional interactions, autonomy, rights awareness, and perceived barriers, and analysed using descriptive statistics and qualitative thematic coding. The analysis is, furthermore, informed by the AAAQ framework (Availability, Accessibility, Acceptability, Quality), the Human Rights-Based Approach (HRBA), Gender-Based Violence (GBV) safety audit methodologies, and the WHO Quality of Care framework. The analysis demonstrates that SRHR implementation cannot be understood as a linear extension of legal recognition, but rather as the outcome of interacting legal, institutional, and socio-narrative processes that condition whether rights are effectively realised. In this sense, by showing how these processes operate differently in Italy and Spain, the thesis explains why formally similar rights regimes generate divergent lived realities, advancing an understanding of SRHR implementation as a structurally mediated and context-dependent process. In doing so, the thesis advances two main contributions. On the one hand, it clarifies how interactions among legal frameworks, institutional practices, and socio-cultural narratives shape the implementation gap in SRHR. On the other hand, it demonstrates the analytical value of combining legal, constructivist, and empirical approaches in comparative SRHR research.