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

Abstract

Background: 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 policymakers. Methods: 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. Results: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. Conclusion: 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. Implications for policy makers• Evidence on health status of vulnerable communities and political commitment are crucial for addressing vulnerable groups in health policies and promote their involvement in the policy development process. • Future research on policy development process and vulnerable groups' involvement should include representatives of vulnerable communities that will help to build a dialogue and present the problem from multiple perspectives.• Clear tools and recommendation on how to include vulnerable groups in sexual and reproductive health (SRH) policies have to be developed through collaboration of various stakeholders. • Moreover, the concept of vulnerability has to be further discussed more in depth, and categorization of groups and populations as "vulnerable" has to be well-founded and unified, in particular in the European context. Implications for publicThe study findings showed that incorporation of vul...

Policies and Processes for Social Inclusion: Using EquiFrame and EquIPP for Policy Dialogue Comment on "Are Sexual and Reproductive Health Policies Designed for All? Vulnerable Groups in Policy Documents of Four European Countries and Their Involvement in Policy Development"

“…3 We welcome application of EquiFrame to sexual and reproductive health polices in Ukraine, Scotland, Moldova, and Spain. 4 Their analysis of these policies highlights important inequities between polices in terms of coverage of Vulnerable Groups, of Core Concepts of human rights and of the quality of commitment to these rights; with the Spanish policy performing best and the Ukrainian policy the worst. In this analysis the authors selected 11 of the 21 Core Concepts within EquiFrame, and 7 of the 12 Vulnerable Groups covered in EquiFrame; while adding 4 additional Vulnerable Groups which they felt were appropriate to their purpose: Lesbian, Gay, Bisexual, Transgender (LGBT), people living with HIV, sex workers, and victims of sexual abuse, gender violence and human trafficking.…”

“…5 We would, therefore, like to encourage other users of EquiFrame to justify the basis on which they select some Core Concepts and not others, some Vulnerable Groups and not others; as well as the rationale and accompanying evidence for the inclusion of additional Vulnerable Groups. Without the provision of a strong rationale and evidence-base (which we appreciate would indeed be available for the additional groups included 4 ), it may be that policies could be found lacking because they fail to address particular additional groups or Core Concepts, when in fact there may be no justifiable…”

Disability Inclusive Development Good Practices: Level of Commitment to Core Concepts of Human Rights

“…It has been used to analyse health, rehabilitation, disability, nutrition, sexual and reproductive health and mental health policies as well as instruments such at the UN CRPD (Andersen & Mannan, 2012;Bedri et al, 2013;Eide, Amin, MacLachlan, Mannan, & Schneider, 2012;Ivanova, Draebel, & Tellier, 2015;Mannan et al, 2013;Meral & Turnbull, 2016;O'Dowd, Mannan, & McVeigh, 2013;Schneider, Eide, Amin, MacLachlan, & Mannan, 2013;Van Rooy et al, 2012). Policy analysis using EquiFrame can provide a platform for evaluating policy revision and development, identifying a policy's strengths and weaknesses in terms of the protection of human rights .…”

“…Other Core Concepts may be more related to administrative principles, for example concepts relating to the implementation and action of policies The Core Concepts mentioned in good practice documents were classified according to which principles they represented. This was then compared to the taxonomy of Core Concepts mentioned in policy documents which had been previously been analysed with EquiFrame in order to compare any differences between policy and practice (Andersen & Mannan, 2012;Bedri et al, 2013;Ivanova et al, 2015;O'Dowd et al, 2013;Van Rooy et al, 2012).…”

In Search of the Third Eye, When the Two Others Are Shamefacedly Shut? Comment on "Are Sexual and Reproductive Health Policies Designed for All? Vulnerable Groups in Policy Documents of Four European Countries and Their Involvement in Policy Development"

“…T he aim of the paper of Ivanova et al 1 was to explore how vulnerable groups and principles of human rights are incorporated into national sexual and reproductive health (SRH) policies of 2 European Member States (Spain and Scotland) and 2 non-European Member States but within the broad European region (Republic of Moldova and Ukraine). The authors analysed SRH policies by applying a very interesting framework.…”