Guest Post: KNŻ’s Take On Malta’s Updated Sexual Health Strategy

A positive and inclusive approach for all

Praiseworthy, like the previous strategy, this strategy aims to support sexual and reproductive health for all, irrespective of sex, age, gender, sexual orientation, socio-economic status, or ethnicity.

It identifies various vulnerable populations who are particularly at risk of poor sexual and reproductive health, often due to unique barriers such as language, cultural differences, non-traditional education, and fear of discrimination. However, the strategy falls short in offering a comprehensive plan to effectively engage with and address the specific needs of these groups. For example, a local study by Dr. Hili (2023) highlighted concerning disparities in maternal health outcomes between Maltese mothers and Sub-Saharan African (SSA) migrants—an ethnic minority group.

Given Malta’s increasingly diverse migrant population, a more focused approach on cultural competence and targeted outreach to non-Maltese communities would significantly enhance inclusivity and equity in sexual healthcare. A broader discussion on decolonising healthcare is also essential. Malta’s medical practices, which draw heavily from the UK’s Beveridge model and contemporary training programmes, should not only focus on addressing outdated medical practices but also on examining the long-lasting effects of colonial-era legislation on our healthcare system today.

Access to specialised genito-urinary (GU) services has improved with ongoing investments aimed at decentralising these services into the community through Health and Wellbeing Clinics, as well as primary and secondary healthcare centres. However, users have identified significant gaps in these services, largely due to a shortage of resources and the absence of interdisciplinary professionals such as gynaecologists, midwives, psychologists, and counsellors.

A particularly notable gap exists in the provision of a fully functioning GU clinic on the island of Gozo. While sexual health and wellbeing services are available at the Victoria Health Clinic, these are offered only once a week on Saturdays for just five hours—an insufficient arrangement to meet the needs of the population. To address this, further resources must be allocated to provide comprehensive and accessible sexual health services for Gozitan residents on a more regular basis.

Additionally, there is an urgent need for an administrative overhaul of the Gender Wellbeing Clinic. The ongoing concerns raised by activists regarding the year-long absence of a specialist psychiatrist overseeing gender-affirming care are particularly troubling. The Health Minister’s response, which cites the difficulty in filling the position without acknowledging the structural issues surrounding healthcare resourcing, is deeply concerning.

Moreover, comparing Malta’s challenges with medico-legal cases in other countries, especially in the context of rising transphobic rhetoric, does not provide meaningful solutions.

Increased resources in the prevention of Sexually Transmitted Infections (STIs)

Increasing the criteria of entitlement for those accessing free anti-retroviral treatment as PEP (post exposure prophylaxis) is a commendable step forward. As KNŻ, we are particularly relieved to see that free PrEP (pre-exposure prophylaxis) will be made available to key populations at risk of contracting HIV.

However, there is uncertainty regarding how these key populations will be identified and how they will be encouraged to seek support. Furthermore, the strategy does not address if or how the limited stock of PEP will be addressed as currently very few pharmacies have a stock of PEP.

Given that PEP must be administered within 72 hours of potential HIV exposure, we strongly recommend that Emergency Departments (ED) be stocked with PEP to ensure immediate access in emergency situations. This would improve timely access to critical treatment and help prevent HIV transmission in urgent scenarios.

Comprehensive Sexuality Education (CSE)

After years of criticism regarding the limited and unregulated nature of Comprehensive Sexuality Education (CSE), this strategy has rightly prioritised the delivery of age-appropriate, evidence-based CSE for children and youth across all educational settings, including state, church, independent schools, and even workplaces.

While the strategy outlines the need for regulation of the Sexual and Relationships Education component within PSCD lessons, it lacks a systematic framework, clear content plan, timelines, implementation strategies, and a comprehensive approach to evaluation.

We recommend expanding the evaluation process to include input from sexual health professionals, NGOs, and other experts through regular consultations, feedback sessions, and collaborative development of educational materials. Additionally, we stress the importance of adhering to evidence-based practices supported by reputable international bodies, while ensuring that reproductive justice and a rights-based approach are central to the curriculum.

Establishing an accountability mechanism to monitor the implementation and progress of CSE will be essential in maintaining consistency and ensuring its success across all educational settings.

Reproductive Health Needs – Contraception

Free access to barrier contraceptives ensures individuals have the necessary resources to practice safe sex, thereby reducing the risk of unintended pregnancies and STIs.

This is particularly advantageous for young people who may lack the financial means to purchase contraception. While the policies outlined in this strategy primarily focus on populations aged 16 and above, in line with the age of consent in Malta, it is important to acknowledge that younger individuals are also exploring sexual behaviours. This creates a significant gap in the policy, leaving these younger individuals vulnerable to potential health risks due to the lack of access to appropriate contraceptive resources.

To further align with past reforms aimed at reducing age-based discrimination and violence, KNŻ strongly recommends removing the age restriction, as this not only contradicts the values of inclusivity upheld by this strategy but also overlooks the pressing need for safer sexual practices.

Recent research indicates that access to contraception does not lead to earlier sexual activity, but rather helps reduce unintended pregnancies and STIs. This approach aligns with international health and rights frameworks, such as those from the World Health Organization (WHO) and the United Nations (UN), which recognise the right of all individuals, regardless of age, to access sexual and reproductive health services.

Reproductive Health Needs – Family Planning

In 2022, Malta recorded the lowest total fertility rate in the EU, with just 1.13 live births per woman, according to recent Eurostat statistics. Given this concerning data, coupled with an increasingly aging population, it is surprising that the strategy does not take a more proactive approach in addressing family planning measures. While the strategy highlights the importance of preventing unplanned pregnancies by addressing barriers to contraceptive access, it unfortunately does not place the same emphasis on the proactive process of planning a pregnancy.

As noted in a local study examining the preparation for parenthood among first-time parents, preconception care plays a crucial role in ensuring optimal physical and mental health. It also provides guidance on necessary lifestyle modifications, all of which contribute to better pregnancy outcomes and a smoother transition to parenthood (Spiteri, 2019). KNŻ recommends that further research be conducted to better understand the underlying factors contributing to Malta’s low fertility rates, followed by the development of a targeted, urgent action plan to address the findings from this research.

Comprehensive Healthcare following Termination
This policy has overlooked the critical issue of access to pre- and post-termination care in Malta, leaving women who self-manage abortions with pills often reluctant to seek medical assistance due to the fear of prosecution. Instances of women being prosecuted for seeking help underscore the urgent need for policy reform to safeguard their health and protect their rights.

Without comprehensive access to appropriate care, these women face significant health risks, and the current legal framework exacerbates their vulnerability. It is essential that the policy is revised to ensure that women have access to safe, confidential, and non-punitive medical support in these circumstances.

Gynecological Conditions and Sexual Health

While the socio-economic and cultural aspects of sexual health are carefully addressed in this strategy, it is concerning that the physiological dimensions of sexual health, particularly gynaecological, andrological, and endocrinological conditions, are largely overlooked.

There is no focus on common gynaecological conditions such as polycystic ovary syndrome (PCOS), endometriosis, fibroids, and chronic pelvic pain. Malta has one of the highest rates of PCOS, yet this crisis was completely ignored reflecting a significant oversight in recognising the broader physiological determinants of sexual and reproductive health. This lack of attention undermines the strategy’s comprehensiveness and its ability to address the full spectrum of sexual health needs.

By failing to prioritise these prevalent conditions, which have profound implications for fertility, sexual function, and overall quality of life, the policy risks perpetuating gaps in care and neglecting a critical aspect of public health.

Concluding notes

The strategy is informed by recent international policies and research on the social determinants of sexual and reproductive health. Whilst this ensures that policy actions are grounded in current data, reflecting the realities and modern needs​, it lacks in local studies, leading to gaps in addressing the nuanced cultural and socio-economic needs of Malta’s. Finally, it is crucial to integrate NGOs and patient representatives into the strategy’s implementation. Their expertise and lived experiences provide invaluable insights that can help ensure policies are not only practical but also equitable.

A forward-thinking, inclusive approach is essential for Malta to effectively address the diverse and evolving needs of its population, ensuring that no group is left behind in the pursuit of better sexual and reproductive health outcomes.

Attending the strategy’s launch and critically examining the proposed policies has been both inspiring and thought-provoking. The need for such a strategy has never been more pressing, as it seeks to address the evolving sexual and reproductive health challenges in our diverse and constantly changing society. With thoughtful reflection, we have developed our official

This article is written by il-Kunsill Nazzjonali taż-Żgħażagħ (KNŻ Malta), which is the national non-partisan non-governmental body representing all youths and youth organisations in Malta and Gozo.

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