On 11 June 2012, the New Zealand Parliamentarians' Group on Population and Development held an Open Hearing on ‘Adolescent Sexual and Reproductive Health and Rights in the Pacific’. Modelled like a select committee, its purpose was to increase understanding of, support for, and investment in adolescent sexual and reproductive health and rights in the Pacific. Written submissions were received from a wide range of stakeholders, twelve of whom were selected to submit orally at the Open Hearing.
Background
In the Pacific region, 56% of the population is under the age of 25. Living across 20,000 islands and in 22 Pacific Island Countries and Territories (PICTs), adolescents in the Pacific share a disproportionate burden of poor sexual and reproductive health. The diversity in culture, language and ethnicities across the 22 PICTs as well as within countries require locally driven solutions.
Key facts
| • | It is estimated that 650,000 women have an unmet need for family planning in the Pacific. | ||||
| • | A 2006 study of young people aged 15–24 in Samoa, Vanuatu and the Solomon Islands showed that about two thirds of young people were sexually active, with the median age at first sex 16 years. | ||||
| • | Fewer than 20% of girls aged 15–19 and less than half of adolescent boys in the Pacific report having ever used a modern method of contraception. | ||||
| • | Studies in the Solomon Islands, Kiribati, Papua New Guinea and Vanuatu found that over 60% of women had experienced physical and/or sexual violence. | ||||
| • | A 2011 survey of men who have sex with men in Fiji found that 48% of respondents had been verbally abused and 28% had been physically abused in the last 12 months. | ||||
Comprehensive sexuality education
The majority of sexuality education in the Pacific is taught from a traditionally conservative and often religious perspective where abstinence is predominant. Many PICTs do not have sexuality education within their national school curricula. There are many peer education programmes provided by NGOs in Pacific countries, but these are focused in urban settings, leaving those in rural communities and informal settlements with few options.
Gender equality
Data in some countries shows up to two thirds of women reporting having experienced physical and/or sexual abuse from an intimate partner. Actions to further gender equality in the Pacific should include: promoting safe and supportive school environments for young women; increasing political representation of women; establishing legislation, policies and institutions to protect the rights of women and girls; recognising young women as key stakeholders; increasing funding and support for programmes linking SRHR and women's empowerment; focusing on young women and girls in sexual and reproductive health initiatives and policy.
Preliminary research shows that the introduction of an MSM character in a successful Vanuatu-based TV series has contributed to a reduction in stigma and discrimination against MSM and is helping to increase self-efficacy and a sense of empowerment among MSM.
Sexual orientation and gender identity
Young people with diverse sexual orientations and gender identities face discrimination and stigma from a wide range of sources, something which must be addressed in order to ensure all young people are able to enjoy safe and satisfying sex lives.
Stigma and discrimination create a barrier between MSM and TG people accessing sexual and reproductive health information and services as it makes them less willing to visit clinics and other health organisations, forces them underground and out of sight, and contributes to their (and therefore their community's) vulnerability to HIV and STIs. It also causes great distress and harm to individuals as it can lead to family break-ups, abuse, harassment, rejection, and sexual and physical violence. This can cause depression, self-destructive behaviour, and suicide.
To counter negative attitudes, an MSM character was recently introduced into the storyline of Vanuatu-based Wan Smolbag Theatre's very successful TV series Love Patrol, broadcast all over the Pacific. According to preliminary research on the impact of this, it has contributed to a reduction in stigma and discrimination against MSM and is helping to increase self-efficacy and a sense of empowerment among MSM.
Access to youth friendly services
Young people in the Pacific can be reluctant to visit health clinics for treatment and advice for fear of embarrassment, fear that their family will find out, or a misinformed fear of being sexually abused during examination and treatment for STIs. As a result, many young people in the Pacific resort to using traditional medication as a treatment option for STIs.
Culture and religion
Religion plays an important role in most Pacific Island communities, and church leaders – who are mostly male – are very influential. Religious values and beliefs largely disapprove of sex outside marriage, making sex a taboo subject not to be discussed openly. Culture should be used as a tool to promote sexual and reproductive rights, and consulting community and religious leaders prior to engaging with communities is important as their support is critical to positive change. Though some leaders can be resistant, many are very supportive when presented with high quality statistics and strong evidence that these issues are already affecting their communities. Community leadership structures vary significantly. In Papua New Guinea, for example, church leaders are the most influential on the coast, while chiefs are the most important in the highlands.
Democracy and militarisation
As a result of the military presence in the region, in particular the Regional Assistance Mission to the Solomon Islands and the military regime in Fiji, civil and political rights are diminished, in particular freedom of media and information. In times of crisis, systems that protect women break down or are removed, and increased stresses heighten rates of gender-based and sexual violence. A new law in Fiji, by which unmarried young women who get pregnant in the military stand to lose their jobs, illustrates the special concerns for women in the armed services.
Access to safe abortion
Most Pacific countries have very restrictive abortion laws and as such, women (usually young women) are forced to seek methods that lie outside the safety of a surgery or clinic, such as traditional abortifacients. Research and data around unsafe abortion in PICTs is virtually non-existent. In Papua New Guinea, for example, which has the highest maternal mortality rate in the Pacific, many hospital admissions are diagnosed as “incomplete abortion/miscarriage” but then go unrecorded in official hospital records. Some NGOs provide counselling and post-abortion care, but are forced to do so surreptitiously as the service itself is illegal. As a result, many Pacific women die from infection and sepsis associated with incomplete abortion. According to anecdotal evidence, many of these are young women and adolescents.
Resourcing, government budgets, donor country agendas
While there has been a minimal increase in development assistance for reproductive health, funding for family planning has fallen to less than US$1 million per year in the past decade, compared with US$31 million spent on HIV programmes.
Adolescence is an “invisible age group”, often not specifically targeted in health programmes. In Papua New Guinea, for example, National Health Plans do not specify statistics on adolescents in reporting, and adolescent SRHR strategies are often limited to “increasing knowledge and education”, with no plans for adolescent SRH service delivery or the initiation of youth friendly services.
Recommendations
Three overarching recommendations were accepted by Pacific parliamentarians, the New Zealand Parliamentary Group on Population and Development Executive and key regional stakeholders:
| • | That a country-specific structure be established in each country which links MPS and SRHR organisations so that supportive political leaders can advance an SRHR agenda with a particular focus on adolescents and youth; | ||||
| • | That these structures be actively linked to international and regional networks for technical support purposes; | ||||
| • | That each country develop their own programme for advancing the SRHR agenda, with each structure engaging with community leaders as appropriate (e.g. tribal, church, civil society) and with particular focus on adolescents and youth. | ||||
A series of further actions on youth engagement, access to services and commodities, education, legislative reform, political prioritisation, resource, research and data were agreed.
Directly following the hearing, Hon. Maere Tekanene, the Minister for Education of Kiribati, has started the process of implementing CSE into the school curriculum and strengthening the delivery of sexuality education through informal education opportunities. Parliamentarian Hon. Douglas Ete has called for a parliamentary inquiry into the status of adolescent sexual and reproductive health in the Solomon Islands.
Young people at Solomon Islands Parenting Association youth, health and social centre look at HIV prevention materials
