Are Sexual and Reproductive Health Policies Designed for All? Vulnerable Groups in Policy Documents of Four European Countries and Their Involvement in Policy Development.

Olena Ivanova,Tania Dræbel,Siri Tellier

doi:10.15171/ijhpm.2015.148

Abstract

Health policies are important instruments for improving population health. However, experience suggests that policies designed for the whole population do not always benefit the most vulnerable. Participation of vulnerable groups in the policy-making process provides an opportunity for them to influence decisions related to their health, and also to exercise their rights. This paper presents the findings from a study that explored how vulnerable groups and principles of human rights are incorporated into national sexual and reproductive health (SRH) policies of 4 selected countries (Spain, Scotland, Republic of Moldova, and Ukraine). It also aimed at discussing the involvement of vulnerable groups in SRH policy development from the perspective of policy-makers. Literature review, health policy analysis and 5 semi-structured interviews with policy-makers were carried out in this study. Content analysis of SRH policies was performed using the EquiFrame analytical framework. The study revealed that vulnerable groups and core principles of human rights are differently addressed in SRH policies within 4 studied countries. The opinions of policy-makers on the importance of mentioning vulnerable groups in policy documents and the way they ought to be mentioned varied, but they agreed that a clear definition of vulnerability, practical examples, and evidences on health status of these groups have to be included. In addition, different approaches to vulnerable group's involvement in policy development were identified during the interviews and the range of obstacles to this process was discussed by respondents. Incorporation of vulnerable groups in the SRH policies and their involvement in policy development were found to be important in addressing SRH of these groups and providing an opportunity for them to advocate for equal access to healthcare and exercise their rights. Future research on this topic should include representatives of vulnerable communities which could help to build a dialogue and present the problem from multiple perspectives.

Highlights

Strong evidence exists to show the disparities in health status among different population groups and subgroups within and between countries
Implications for public The study findings showed that incorporation of vulnerable groups in the sexual and reproductive health (SRH) policies and their involvement in policy development were found to be important in addressing SRH of these groups and providing an opportunity for them to advocate for equal access to healthcare and exercise their rights
The paper of World Health Organization (WHO) has defined participation as “a process by which people are enabled to become actively and genuinely involved in defining the issues of concern to them, in making decisions about factors that affect their lives, in formulating and implementing policies, in planning, developing, and delivering services and in taking action to achieve change.”[12]. It emphasized that involvement of people, especially representatives of vulnerable communities, in health policy and programs development increases the possibility that their health needs are met, and that these undertakings have a higher chance of success.[12]

Summary

Introduction

Strong evidence exists to show the disparities in health status among different population groups and subgroups within and between countries. Inequities in service provision and access to SRH care still exist in many countries in the WHO European region and many population groups appear to be systematically disadvantaged.[16] The aim of this present study is to explore how vulnerable groups and principles of human rights are incorporated into national SRH policies of 4 selected countries: Spain, Scotland, Republic of Moldova, and Ukraine which represent 2 European Union (EU) members and 2 non-EU members. This paper aims to deeper understand the place of vulnerable groups in SRH policy documents and discuss their involvement in SRH policy development in the studied countries from the perspective of policy-makers

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Conclusion