A working group comprised of members of the IReSH network operations group developed a response to the consultation on the Healthcare Improvement Scotland Standards for Sexual Health in July 2021.
Given the cross-sector and interdisciplinary nature of IRESH, our aim was to avoid duplicating responses from clinical services and third sector organisations that have specific expertise relevant to individual Standards. We sought to complement this by sharing overarching comments on the draft Standards as a whole. Our main comments on the Standards highlight the need to centre an intersectional approach to sexual health and justice, and to be explicit in naming and responding to the structural inequalities that currently affect sexual health, wellbeing, and justice in Scotland.
We suggest that there is a need to explicitly acknowledge the increasingly hostile environment (exacerbated by the COVID-19 pandemic) in relation to sexual and gender rights, racism, immigration, ableism and increased socio-economic inequalities. These factors directly impact the availability of, and access to, sexual and reproductive health services. This is important because it affects the sexual health and wellbeing of individuals and communities across Scotland, and beyond.
We commend the importance of championing human rights and taking a rights-based approach in the Standards. However, we suggest that this should be expanded beyond the current focus only on young people and emphasised across all the Standards with concrete acknowledgement of, and suggested responses to, the structural barriers to sexual and reproductive justice in other areas of service provision.
We recognise the limits of the Standards in tackling structural social inequalities. However, we suggest that they do not go far enough; neither naming such issues, nor in providing further guidance on addressing inequalities and ongoing discrimination. In our response, we draw attention to examples of where there is an absence of this approach, and where this has potential material consequences for the sexual and reproductive health and wellbeing of communities
In line with participatory engagement principles, we strongly support the need for involvement of key stakeholders (community, third sector, research, clinical) in determining the implementation and monitoring of Standards at a local level. Given the strong emphasis on ‘engagement’, and recognising the diverse ways in which this term is used and applied, we suggest that more explicit reference is made to using local data to inform meaningful engagement work (and links to guidance on community engagement), so that such work does not inadvertently replicate the inequalities that boards seek to address.
We recognise the challenges associated with drafting the updated Sexual Health Standards at a time when there are rapid and ongoing changes in local and national policy and current clinical best practice in the context of COVID-19. We suggest that it may be worth revisiting the current structure of the Standards, which represents a mix of broad areas for improvement (leadership and governance, sexual wellbeing, access etc.), service delivery (STI prevention, detection and management, abortion care etc.) and key populations (young people, GBMSM). In particular, we note that this ‘siloed’ approach, with explicit sections focused on the needs of some key populations (young people and GBMSM), but not others (communities of colour, disabled people, including people with learning difficulties, LGBTQ+ people etc.) could inadvertently lead to further exacerbating inequalities. As such, we suggest that there may be benefits to reframing using an intersectional approach that acknowledges overlapping identities, and intersectional issues that shape availability, access, and experiences of sexual and reproductive healthcare.
As an interdisciplinary network of researchers, health practitioners, third sector organisations and community stakeholders, we welcome the chance to respond to sexual health Standards, and encourage further discussion on how sexual health provision can be central to acknowledging and addressing entrenched structural inequalities that affect us all.