The Green Agenda of a new Sexual Health Policy
Values are those core beliefs and principles that motivate behaviour, which determine political positions and political identities. The role of issues and proposals is to activate and sometimes change those deeply held values which might inhibit healthy change. And the job of policy strategists should be to determine which values we need to activate to bring various constituencies into a political majority. A change in this direction entails a move towards healthier lifestyles, provided measures are taken with investing in those core beliefs.
According to a statement on common values in EU healthcare systems, values include universality, access to good care, equity and solidarity. These common values should be at the heart of any health policy, whether national or international.
Points to remember
The first point which should be emphasized is the importance of research on the subject of sexual health, especially local research. There are various reports and data concerning sexual health, and thus should be included in the making of a high quality sexual health policy. The same argument applies for any statistics supplied by Genito-Urinary (GU) Clinic. Comparative information supports policy-makers in the development of a thorough sexual health policy. Therefore for the sake of a useful sexual health strategy, the relevant authorities should start seeking information as according to “the 2001/2002 WHO international report on young people’s health states that data for Malta on the incidence of sexual intercourse, mean age and use of contraception are unavailable” (Camilleri-Cassar, 2005).
Central to this debate revolves around definitions. Only a unifying and a congruent sexual health policy can succeed in keeping the people healthy, a policy which is able to define sexual health and related concepts. It is also important to distinguish the different social groups that are affected by the problems of STIs, in relation to the appropriate educational campaigns (more details when discussing sex education).
Current Context of sexual health in Malta
“The first genitourinary (GU) clinic was set up in Malta in January 2000. After 6 years, an audit revealed that only 10% of clients admitted to using a condom regularly. The increasing attendance, as revealed by this audit, reflects a growing demand for the service offered by the GU clinic in Malta” (Schembri & Carabot, 2007). The number of people attending the GU clinic every year exceed the 2000 mark (Micallef, n.d.). The clinic operates in perfect confidentiality and as such it should continue in this manner.
A STIPC (Sexually Transmitted Infections Prevention Committee) was set up in 1999 in an attempt to draft a sexual health policy “in order to be in line with EU suggestions before membership”. This multi-disciplinary committee succeeded in drafting a policy, but it was rejected and re-written. In this second document the word “condoms” were omitted. The STIPC disagreed on the amended policy, and matters have been in a standstill ever since. Since the authorities refuse to comment or clarify the story it may contain inaccuracies; in 2009 there is still the absence of a sexual health policy.
In Malta, the mean age of first sexual intercourse is 21.3 years (Camilleri-Cassar, 2005). Casual sex among young people has increased from 28 % in 2000 to 42% in 2004; despite the high rate of casual sex, the use of condoms remains poor, with 63% indulging in unprotected sex; Only 25% of young women use any form of consistent contraception (Carabot, 2004 as reported in Camilleri-Cassar, 2005).
According to the World Health Organization Regional Office for Europe, by 2005 Malta should have “health research, information and communication systems that better support the acquisition, effective utilization, and dissemination of knowledge to support health for all” (target 19). This statement applies for all types of health services, including sexual health.
Teenage pregnancies in Malta are increasing from 6% in 2005 to 8.5% in 2007 (International Day of families, NSO, 2007; International Day of families, NSO, 2008). This means that in 2007, 8.5% of all live-births in Malta were by mothers under the age of 20.
Aims of a Green Sexual Health Policy
- To promote social justice, equity and human rights, including health and reproductive rights.
- To Challenge the Inequalities in Sexual Health. To date, Malta although a member of the European Union, we have a huge deficit on the civil liberties front. The best approach would be to take into account one issue at a time. When dealing with health-related issues, above everything else the first priority should be given to the value of health. Religious dogmatism is dangerous in this respect because it has the ability to curb any real progress.
- To control the spread of STIs and minimise unwanted teenage pregnancies.
- Create awareness and breaking taboos.
Setting the wheels in motion – How can this be achieved?
A holistic approach should not stop at treating patients at the clinic. It must encompass:
1.) A wide-ranging educational campaign which reaches young people possibly before they start to have sexual intercourse. Moreover, the educational campaign should target a specific part of society to be successful. As a result, for every social group there should by an accompanying sexual health campaign; including young people, immigrants, intravenous drug users (IDU) and the LGBT community.
2.) Progress can be achieved through public consultation with the relevant civil organizations. Moreover this process should be transparent.
3.) Sex Education should not be left to the discretion of individual schools anymore, but rather a national agenda should be implemented. Sex education (also defined as ‘sexuality education’) is an educational or motivational programme which involves the teaching/acquiring of useful knowledge and forming of attitudes, beliefs about sex, and skills of critical issues to make informed choices related to sexual behaviour. This knowledge includes:
- Sexual identity
- Gender roles
- Intimacy and Human relationships
- Body image
- Reproductive health (anatomy and processes)
- Sexual pleasure
- Puberty and Emotional aspect of maturation
- The value of abstinence
- HIV/STIs prevention
- Risky sexual Practices
- Family planning
4.) Raising awareness about STDs in Malta requires open communication between the GU clinic and the public. Any measures aimed to silence government officials on the subject of sexual health should be reported to the relevant European authorities. “In addition to successful management of STIs, the GU clinic would further benefit from a public health campaign aimed at encouraging asymptomatic sexually active individuals to attend for an STI screen, while simultaneously promoting responsible sexual behaviour (Schembri & Carabot, 2007). The hotline for Sexually transmitted diseases is 23266121.
5.) Promote condom use. Although condoms should not be the only solution, it undoubtedly forms part of an integral system. It is better to use a condom correctly than having sexual intercourse without one. Promoting safe sex procedures includes condom use even if this type of behaviour is frowned upon by other institutions. To reiterate previous sentiments in this document, the value of health should be put ahead of any other conservative interests – and any attempt to undermine this notion should not be taken lightly.
6.) Availability of the morning-after pill. It is inadmissible that the only way for a woman to obtain the effect of this drug, is through an overdose of another type of pill. If Malta is trying to become on par with other member states of the European Union, it needs a radical reform in many sectors, including sexual health; and a healthy start would be to make the morning-after pill accessible by making it available at any local pharmacy. Emergency contraceptive pills (ECPs) such as the morning-after pill are considered as medical forms of contraception. However it also infers treating the morning-after pill as any other standard medication empowering the citizen. “Control over one’s body is perhaps the central feminist credo” (Camilleri-Cassar, 2005).
Camilleri-Cassar, F. (2005) Sexual and Reproductive Health and Rights in Malta. Commonwealth People’s Forum.
National Statistics Office (2007). International day of families 2007. Valletta: National Statistics Office.
National Statistics Office (2008). International day of families 2008. Valletta: National Statistics Office.
MaltaMedia News (2008) No ‘condoms’ in national sex health policy draft.
Micallef, G. (n.d.) Mill-A saż-Ż tal-mard sesswali. Found at http://www.l-orizzont.com/news.asp?newsitemid=49566.
Schembri, G. & Carabot, P. (2007). Setting up the first genitourinary clinic in Malta and an audit of the initial performance. [Abstract] Journal of the European Academy of Dermatology and Venereology: JEADV.
World Health Organization Regional Office for Europe http://data.euro.who.int/cisid/?TabID=67