Why has the United States of America not Ratified the United Nations Convention on the Rights of the Child? The veto fulcrum as a new health policy analysis framework

The United Nations Convention on the Rights of the Child (CRC) enshrines health as a human right among other rights for children, the fulfillment of which can be advanced by each member state legally endorsing the principles through ratification of the Convention. The most rapidly and widely ratified human rights treaty in history, only the United States of America of all of the UN state parties has not ratified the CRC. This study aimed to determine the reason(s) the CRC has not been ratified by the USA. Method design involved a mapping literature search and in-depth interviews with key stakeholders in the fields of global health, child rights, health policy, and US law. Implementing Walt and Gilsons health policy triangle to systematize themes into content, context, processes, and actors as opposition or proponents of ratification, finds the literature favors ratification of the CRC. Critically, published literature focuses on pros and cons of ratification of the CRC, rather than reasons why the US has not ratified. Interview informants further expanded themes to elucidate how the history of opposition actors and processes has led to a chilling effect and a status quo of non- ratification, which has become increasingly challenging to overcome. Drawing on Tsebelis veto player theory to explain the status quo and introducing a new policy analysis framework of a veto fulcrum reveals that within the process of ratification, single powerful actors at a veto fulcrum have made undemocratic decisions, obstructing CRC ratification. By investigating American non-ratification of the CRC this research has forged a new policy framework, the veto fulcrum, which examines political systems where political actors - who might even be democratically elected - as veto players have extraordinary power to make executive decisions against public opinion, and against good health policy.