Section 1 Introduction
1. Sexual health in Scotland is poor. Sexually transmitted infections, such as chlamydia, are widespread and increasing, while teenage conceptions are amongst the highest in Western Europe. Thus, for example, reports of chlamydia in people aged under 25, rose from 6488 in 2002 to 9066 in 2003, an increase of 39% 1. In people aged over 25, reports of chlamydia rose from 3043 in 2002 to 4160 in 2003, an increase of 36% 1. Scotland's rate of births in the 15-19 year-old age group in 1998 was 30.6 per 1000. This compares with rates of 6.2 in the Netherlands, 8.1 in Denmark and 9.3 in France 2. Scotland-wide indicators published by NHS Quality Improvement Scotland 3 show that teenagers in the most deprived areas are three times more likely to become pregnant than their counterparts in the most affluent parts of the country.
2. Promoting positive sexual health is thus a key public health challenge for the Scottish Executive. Sexual health is not just the absence of disease but includes an intricate range of ethical, moral, cultural and social issues. Improving sexual health requires a holistic approach that incorporates the personal, social, emotional and spiritual, as well as the physical, aspects of sexuality. That is why the Partnership Agreement promised that a national sexual health strategy would be developed and implemented. This strategy fulfils that undertaking. It has been prepared in the light of an extensive consultation carried out on draft proposals prepared by a multi-sectoral Expert Reference Group, led by Professor Phil Hanlon. Their remit was:
"To draw up a National Sexual Health Strategy for Scotland, with particular reference to measures:
- to reduce unintended pregnancies and sexually transmitted infections;
- to enhance the provision of sexual health services; and
- to promote a broad understanding of sexual health and sexual relationships that encompasses emotions, attitudes and social context."
3. We have taken account of the draft proposals prepared by the Expert Reference Group and considered carefully the responses to the consultation. As a result the overarching aims of this strategy are:
- to improve the quality, range, consistency, accessibility and cohesion of sexual health services from primary care to specialist genitourinary medicine services, in line with the principles of providing services which are safe, local and appropriate;
- to support everyone in Scotland, including those who face discrimination due to their life circumstances or their gender, race or ethnicity, religion or faith, sexual orientation, disability or age, to acquire and maintain the knowledge, skills and values necessary for good sexual health and wellbeing; and
- to positively influence the cultural and social factors that impact on sexual health.
4. The strategy endorses the World Health Organization definition of sexual health as:
"A state of physical, emotional, mental and social wellbeing related to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sex experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled."
5. The strategy therefore takes as its starting point:
- the values of respect for self and others, mutuality, trust and love;
- committed and stable relationships, characterised by these values, are the right setting for sexual relationships;
- abstinence is a legitimate choice for any person and delayed sexual activity is a positive choice for those who are not ready to form mature, stable and loving relationships;
- an acceptance of the diversity of beliefs, values and moralities to be found across Scotland, the affirmation that every individual is equally valued, and that a person's needs should be impartially addressed;
- equity 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 opportunities 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 discrimination, abuse, violence or coercion as advocated by the World Health Organization.
6. A particular aim, in the implementation phase, will be to ensure an inclusive approach - in line with the current UK equalities legislative framework - which fully recognises the need to address issues of equity and diversity and the very personal nature of the subject.
7. This document is both a strategy and a practical plan for action. It works its way systematically through what we must do to:
- promote respect and responsibility ( Section 2);
- prevent sexually transmitted infections and unplanned pregnancy through education, service provision and support ( Section 3); and
- provide better sexual health services which are safe, local and appropriate ( Section 4).
8. It then lays out a practical plan for highlighting what can be done by all relevant groups including the Scottish Executive, health boards, local authorities, parents, faith groups, voluntary groups and others.