Navigating a complex policy landscape : a case study of IVF policy in Malta

Abstract

This dissertation explores the development of In Vitro Fertilisation (IVF) regulation in Malta, as a case study of policymaking on morality politics. This research explores the key policy developments and different stakeholder positions to identify which theories of policymaking can best capture the complex dynamics involved in developing morally contentious policies in Malta. Using a multi-method qualitative case study approach, this study combines document analysis, which outlines the key policy developments on IVF between 1991 and 2022, and the prevailing stakeholder positions, with an abductive thematic analysis of nine semi-structured elite interviews on this policymaking process. Data triangulation was employed to assess which of the identified theories best capture the dynamics of the policymaking process. The findings show that the regulation of IVF in Malta has been a long and gradual process, characterised by disagreements between actors with competing interests and political hesitancy to regulate. The theories underscored political will, institutional structures and stakeholder beliefs as key dynamics that influence policymaking on morality politics. Although the theories of Punctuated Equilibrium, Historical Institutionalism and Discursive Institutionalism capture most of these dynamics, other theories of policymaking provide insights into the role of policy entrepreneurs, subsystem coalitions and narrative development. While this research is limited to the Maltese context, it addresses a notable gap on morality politics and policymaking in Malta. It also contributes to wider research on the IVF policymaking by applying the analysis to a small state context.