Episode 247: Engaging Marginalized Groups is Essential to Achieving Universal Health Coverage

New Security Broadcast

Too often, many in my community are excluded from sexual and reproductive health services, said Ruth Morgan Thomas, co-founder and Global Coordinator of the Global Network of Sex Work Projects, in today’s episode of Friday Podcasts. This episode features highlights from a recent Wilson Center and UNFPA event where Thomas and Zandile Simelane, an HIV Youth Advocate from Eswatini, address the barriers that their respective communities—sex workers and HIV positive youth—face in accessing sexual and reproductive health (SRH) services and universal health coverage (UHC).

Leaving marginalized individuals out of conversations about SRH and UHC heightens the chance that social protections will not fully accommodate their health needs. For individuals engaged in sex work, access to SRH services is an occupational health issue, said Thomas. “It isn’t just sexual and reproductive health. It’s actually about our work and keeping us safe in our work.” Nevertheless, because many governments do not formally recognize sex work, it is excluded from typical social protections, she said.

This lack of protection is compounded by the active criminalization of marginalized groups, including sex workers, LGBTQ+ individuals, and individuals who inject drugs, said Thomas. Criminalization “underpins and exacerbates” the stigma and discrimination that these groups already face, creating barriers that prevent them from accessing other essential health services. The impacts of criminalization are especially damaging because those causing harm – including governments, law enforcement, and health care providers – are often the very individuals and institutions tasked with protecting and caring for marginalized communities, she said.

Adolescents and young people are another key population often left out of conversations about SRH and UHC. Due to cultural norms and individual morals surrounding sexuality, providers are often not welcoming of young people seeking SRH care and may even scold them for engaging in sexual activity, said Simelane. This treatment discourages youth from seeking needed services. As a young Swazi woman, you are treated as a child, even at the health center, she said.

Family planning terminology and the vastness of services under the family planning umbrella can also create barriers for young people. Family planning translates differently to a 16-year-old who isn’t planning for a family and who might need information on HIV testing, but doesn’t know where to access that information, said Simelane. This confusion and lack of youth directed services often “filters” young people out and results in them not seeking needed care, she said.

Social media is a powerful tool to include communities directly in service planning and provision. “Ten years ago, when I tested positive, it dawned upon me that young people are actually on social media,” trying to engage with each other, said Simelane. “So why not bring the information that they need to them on these social media streets?”

Nevertheless, there are huge disparities in access to digital services, particularly for marginalized groups, said Thomas. COVID-19 is exacerbating the effects of this digital divide. Because of this, social media efforts must be paired with on-the-ground work, she said. Whether it’s in the digital or physical space, marginalized and criminalized communities worldwide need to be part of our health response, including sexual and reproductive health, to make universal health coverage a reality, she said.