Enreca Health > News > Call for papers: Repro...

2010-01-20

Call for papers: Reproductive Health Matters

Reproductive Health Matters 18(36) November 2010
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Theme: Privatisation and commercialisation of sexual and reproductive health services

Submission date: ± 1 March 2010 (negotiable due to late distribution of this call)

The past two decades have seen important growth in private health care all over the globe. Whereas private health care used to be available only to the rich in almost every country, private services of many different kinds are reaching out to more and more patients, including in the poorest countries and among the poor in more affluent societies, some funded through development aid. This is happening across sexual and reproductive health care, from private assisted conception clinics (including in countries with high rates of secondary infertility due to unsafe abortions and unskilled delivery care), to private midwives' cooperatives offering antenatal and delivery care to some women while the majority still deliver at home without a skilled attendant, to small private hospitals and NGO clinics offering abortion and many other reproductive and sexual health services in the absence of public services.

The growth of private health care has been supported above all by the so-called Washington consensus from the 1980s onwards, that free market capitalism is the only economic model to follow and should be applied not only in finance, business and trade, but also to social welfare services and agencies, including health care. This ideology has dominated the development aid policies of the World Bank, other international agencies and most if not all donor governments. Most aggressive have been commercial health corporations (mainly originating in the US) who are tendering for contracts from a growing number of governments to replace or supplement public health services.

The now entrenched situation of mixed public and private health care has been exacerbated by the failure of public health systems in many countries to ensure universal access to health services with a decent quality of care. Once private services have been set up, they can use their "monopoly" position to charge high fees and reduce quality of care in order to keep their costs low. There has also been rapid growth (often with donor funding) of international NGOs which provide a range of reproductive and sexual health services in fee-charging clinics, mainly to high- and middle-income patients. While these may be non-profit organisations and/or charities, they often behave like profit-making/corporate entities in order to compete for patients and finance their own expansion. There are also a growing number of religious-run hospitals and clinics whose anti-choice policies mean they refuse to offer sexual and reproductive health (SRH) services apart perhaps from maternity care, yet they may provide the only health services in their area.

There has also been the phenomenon of the migration of providers and patients into the private health sector, whether on a full-time or part-time basis. Disillusioned, under- and unemployed public health care workers are setting up on their own or in small hospitals and clinics, whether on a non-profit or profit-making basis, in order to increase their income and improve and control their working conditions. Policies supporting formal and informal fees, payments demanded under the table and other out-of-pocket costs, and non-governmental health insurance schemes have all encouraged people, even those with little money to spare, to try the private sector, since they are forced to pay anyway. For the most part, although some SRH health indicators have been improving in middle-income countries due to economic development and a growing middle class, the poor everywhere, especially those living in rural areas, are missing out. The lack of equity in access to health and health care has remained and may even be getting worse following the economic downturn.

These trends have consistently been opposed by those who support universal public health services funded from the public purse, e.g. by a tax-based national insurance system, a return to a primary health care approach, public health systems strengthening, increased education and training to increase the skilled health care workforce, and good salaries and working conditions for health professionals, mid-level providers and other staff.

However, when countries refuse to support their own public system adequately, or are afraid and unwilling to ensure that contested services such as contraception, safe abortion and assisted conception are available in the public sector, especially where fundamentalist opposition to these services is strong, if private clinics step in to offer them, shouldn't those private clinics be supported and even encouraged? On the other hand, there are many unethical practices such as offering monthly antenatal ultrasound scans or ultrasound for sex determination, or promoting cosmetic genital surgery, as a way of taking money from vulnerable women. Many private services are unregulated, even in the most developed countries.

We are seeking papers for this journal issue about what is happening in countries as regards commercialisation and privatisation of sexual and reproductive health services in the context of wider trends.

• What is the current picture in countries for one or more specific SRH services and what does the future hold? Is the public sector being restricted, starved of resources, or falling apart, giving the private sector more space to move into? Are there public sector initiatives to stop or reverse such a decline and are these efforts working?

• Do people cross back and forth between public and private SRH services - what are their pathways? With what outcomes? Who is using private/commercial SRH services and do these people end up in the public sector if there are complications or problems? What about cost issues for patients?

• Are private services actually doing a better job than the public health sector in any areas of SRH care provision, that is, are they achieving better outcomes, providing more and better services with a higher quality of care, or is this a false assumption/perception? Is there any evidence one way or the other?

• Are there innovative public-private projects worth supporting in SRH care (or are there good reasons not to support them even if they are bringing improvements)?

• Are there examples of well-regulated, ethical, inexpensive private SRH services that are improving women's lives and supporting the delivery of SRH care that the public sector cannot or does not provide? Can these be accommodated alongside and reconciled with the public sector?

• What realistic models for 21st century public sector SRH services are worth promoting in the context of today's policies and realities?

Please share this with anyone who may be interested in submitting a paper.
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RHM author and submission guidelines are at: .