title: Are Sexual and Reproductive Health Policies Designed for All? Vulnerable Groups in Policy Documents of Four European Countries and Their Involvement in Policy Development.
abstract: BACKGROUND
  Health policies are important instruments for improving population health. However, experience suggests that policies designed for the whole population do not always benefit the most vulnerable. Participation of vulnerable groups in the policy-making process provides an opportunity for them to influence decisions related to their health, and also to exercise their rights. This paper presents the findings from a study that explored how vulnerable groups and principles of human rights are incorporated into national sexual and reproductive health (SRH) policies of 4 selected countries (Spain, Scotland, Republic of Moldova, and Ukraine). It also aimed at discussing the involvement of vulnerable groups in SRH policy development from the perspective of policy-makers.
  
  
  METHODS
  Literature review, health policy analysis and 5 semi-structured interviews with policy-makers were carried out in this study. Content analysis of SRH policies was performed using the EquiFrame analytical framework.
  
  
  RESULTS
  The study revealed that vulnerable groups and core principles of human rights are differently addressed in SRH policies within 4 studied countries. The opinions of policy-makers on the importance of mentioning vulnerable groups in policy documents and the way they ought to be mentioned varied, but they agreed that a clear definition of vulnerability, practical examples, and evidences on health status of these groups have to be included. In addition, different approaches to vulnerable group's involvement in policy development were identified during the interviews and the range of obstacles to this process was discussed by respondents.
  
  
  CONCLUSIONS
  Incorporation of vulnerable groups in the SRH policies and their involvement in policy development were found to be important in addressing SRH of these groups and providing an opportunity for them to advocate for equal access to healthcare and exercise their rights. Future research on this topic should include representatives of vulnerable communities which could help to build a dialogue and present the problem from multiple perspectives.
authors.affiliation: International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium.
authors.forename: Olena
authors.initials: O
authors.lastname: Ivanova
authors.affiliation: Faculty of Health and Medical Sciences, Institute of Public Health, Department of International Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Tania
authors.initials: T
authors.lastname: Dræbel
authors.affiliation: School of Global Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Siri
authors.initials: S
authors.lastname: Tellier
mesh_terms: D003256:Community Participation; D006291:Health Policy; D006806:Human Rights; D006801:Humans; D008966:Moldova; D011050:Policy Making; D036301:Qualitative Research; D060728:Reproductive Health; D034121:Reproductive Health Services; D012606:Scotland; D013030:Spain; D014455:Ukraine; D035862:Vulnerable Populations
keywords: Europe; Health Policy; Participation; Policy Development; Sexual and Reproductive Health (SRH); Vulnerable Groups