A critical policy analysis of the national sexual health strategy for Malta and Gozo

Abstract

Malta's new National Sexual Health Strategy exists within a sociocultural context that is post-colonial, Catholic, and shaped by the political behaviours of Malta's microstate nature. While several wins exist, there remains a concerted lack of community-guided and stakeholder-driven input, and little state accountability. Notably, the value of participant-led policymaking and participatory approaches have been championed as preferred methods of informing global health policy.

This study aimed to analyse the Strategy against the views of professional stakeholders in Malta using two research questions: To what extent does Malta's new sexual health strategy reflect international standards and best practices in sexual and reproductive health policy? How do key professional stakeholders in Malta perceive the strategy's effectiveness in theory and potential for implementation?

An intra-paradigm qualitative mixed-methods analysis was performed. A conceptual framework was tailor-made for this study, marrying policy analysis frameworks with thematic analysis of semistructured interviews. Kingdon's 'Multiple Streams Framework' and Bacchi's 'What Does The Problem Represent Approach' were used to analyse policy, and what this says about state interests. Interviews highlighted stakeholder perspectives including unmet needs and community sentiments.

The Strategy identifies key challenges including STIs, contraceptive access, and CSE. Biomedical and service-based solutions are prioritised, however there is a noted silence on abortion, migrant health, and church-state-private education (presenting a selective framing of SRHR). While improving on its 2010 iteration, it fails to consider rights-based approaches to reproductive health, including intersectionality. When compared to more expansive sexual health definitions and exemplary policy, there remain opportunities for further exploration and research, and the need for actionable measures with clear responsible parties and accountability frameworks. These findings support literature on participant-driven policy approaches.