Constructing Access to Reproductive and Sexual Health Services (RSHS) in Small Urban Settings: An Institutional Ethnographic Approach

There has been a significant gap in knowledge about the effects that neoliberal policies and institutional practices have had on women’s access to, and experiences of, reproductive and sexual health services (RSHS) in small Ontario urban communities. Little attention has been paid to how services within these urban centres have adapted and responded to cuts in welfare state and health programs, and the resulting effects of these neoliberal policies and approaches to governance on the community’s cultural and moral climate, as well as the provision of local RSHS and other social services. This paper investigates the potential of institutional ethnography as a method of inquiry for examining how young women’s choices and experiences in accessing community health and social services are shaped, regulated and governed by institutions and policies, and in turn, how these institutions modulate community-based RSHS.

Access to appropriate, timely, and affordable reproductive and sexual health services is essential to the establishment of equity and equality for women. Yet, some of the most vulnerable individuals, such as young women and those who live within the confines of poverty, still experience limited access to appropriate reproductive and sexual health care. This can be particularly pronounced in small urban centres, where there are fewer health and social resources than in the larger cities. My analysis builds on existing research on social determinants of women’s health and explores how the neoliberal erosion of welfare state programs has influenced front-line RSHS within small urban centres, and shaped women’s access to and experiences of those services within these settings.