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Enhancing Sexual Wellbeing in Scotland: A Sexual Health and Relationships Strategy: Proposal to the Scottish Executive
1 Chair's introduction
1.1 Sex is a positive and fulfilling part of the lives of most people, irrespective of age, culture or faith. Although Scotland, like many Western countries, has become a society saturated with sexual imagery, it remains one that is uncomfortable about discussing sexual matters openly. Scotland is also a country with rising levels of sexually transmitted infections, high rates of unintended or unwanted pregnancies and increasing reports of sex-related violence, abuse, coercion and regret. These poor sexual health outcomes are not inevitable. Other European countries with a demographic profile comparable to that of Scotland have achieved much greater success in changing behaviours and achieving good outcomes.
1.2 An expert Reference Group guided the Project Team in the development of this strategy. Substantial efforts were also made to ensure that this strategy reflects the opinions of those currently working to improve sexual health across Scotland through an engagement exercise. The Minister for Health and Community Care granted additional time to allow this exercise to form part of the strategy development process. It involved engaging with established multi-agency sexual health strategy groups in NHS Boards and other voluntary and statutory parties to learn more about local issues, opportunities and challenges, and their vision for a national strategy. This proved extremely useful and informed the development of the strategy from an early stage.
1.3 Sexual wellbeing is not just about the absence of disease or unintended pregnancy, but encompasses the positive aspects of relationships and sexuality. Improving sexual wellbeing therefore requires a holistic approach that incorporates personal, social, emotional and spiritual, as well as physical, aspects of sexuality. It is important that people have the life skills and values to make choices for themselves, as well as access to technical responses to sexual disease.
1.4 For many people, issues around sex and relationships are founded in and inextricably linked to personal, societal, and faith-based morality. Interpretations of morality, however, vary from individual to individual, society to society and faith to faith. We do not, therefore, feel it is appropriate for this sexual health strategy to arbitrate on such matters. What the sexual health strategy can and must do is:
Recognise and embrace the cultural, ethical and spiritual components which impact on an individual's sexual health;
Encourage and support individuals in developing and maintaining their own sets of moral values;
Develop and promote services which are sensitive to and respectful of the diversity of beliefs, values and moralities which people bring with them.
1.5 A consensus emerged within the Reference Group on the key values informing this strategy. These are:
self-respect and respect for others;
equality of opportunity and access to lifelong learning (including, but not limited to, schools based education) and service provision which fully recognise and address the factors which can undermine such opportunity and access; and
a real and meaningful commitment to promote and reinforce the rights of people to have mutually respectful, happy, healthy and fulfilled sexual relationships free from abuse, violence or coercion.
1.6 This proposed strategy has been informed by international and national evidence, including research specifically commissioned for this purpose by the Health Education Board for Scotland (HEBS) and the Scottish Executive,
1;2;3;4;5 and input from key stakeholders across Scotland. Lessons have also been learned from the other UK countries that have all recently developed sexual health or teenage pregnancy strategies.This strategy has three broad aims:
To influence the cultural and social factors that impact on sexual health;
To support everyone in Scotland to acquire and maintain the knowledge, skills and values necessary for sexual wellbeing; and
To improve the quality, range, consistency, accessibility and integration of sexual health services.
It acknowledges the plurality of Scottish society but recognises the importance of seeking a way forward that is inclusive and shared. It builds on existing good practice but marks the start of a long-term strategic approach to sexual health improvement and proposes a framework to achieve these aims.
Professor Phil Hanlon
Chair, Sexual Health Strategy Reference Group and Project Team
September 2003
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