This is the abstract presentation of Michelle O'Connor, which took place as part of the third session of #APCRSHR10 #Virtual on the theme of "Sexual and reproductive health and rights in the Pacific" | more details are online at www.bit.ly/apcrshr10virtual3 Thanks

1. School of Public Health and Community Medicine
Tiko Bulabula: Fiji Adolescent Sexual
and Reproductive Well-Being Study
Dr Michelle O’Connor, UNSW Australia
Dr Patrick Rawstorne, UNSW, Australia
Dr Husna Razee, UNSW, Australia

2. Rationale
1. 1/10 Fijians aged 15 – 19 years
2. Well-being in relation to sex and relationships is not clearly defined.
3. There is no tool to comprehensively measure adolescent sexual and
reproductive well-being.
4. Inadequate knowledge of the meaning and drivers of adolescent sexual
and reproductive well-being in Fiji

3. Research Questions
1. What does adolescent sexual and reproductive well-being mean in Fiji?
2. How is adolescent sexual and reproductive well-being shaped by socio-
cultural and structural factors in Fiji?
3. What are Fijian adolescents’ experiences of sexual and reproductive
wellbeing and how do these differ by different adolescent populations?
4. How can adolescent sexual and reproductive well-being be improved in Fiji?

5. QUALITATIVE
FINDINGS

6. • Love, intimacy, pleasure, confidence, self efficacy, self esteem
• Condom-less sex = expression of love, intimacy and pleasure
Positive thoughts and feelings

7. Social acceptance – conforming to socio-cultural
expectations
They [adolescents] hardly come after condom…They may be afraid
to take contraceptives because of the stigma in the community,
you know Fijian mentality. They hear “somebody hey that one is
taking…”, people gossiping about the ladies. Louisa, an iTaukei
health worker in a rural area

8. Gender dynamics
For us in the Fijian culture, if you don’t do it [have sex] you are not
man enough, so you have to do it. Paul an iTaukei boy
‘if a girl she’s never been kissing a boy, she is healthy’. Jenny, an
iTaukei girl from a rural area

9. Being equipped to engage in health seeking
behaviours and having access to SRH services
We need more information at school because we don’t get to do this
stuff at school because people feel ashamed of saying all this
stuff.
Josefa iTaukei boy urban area

10. Supportive social relationships
The person is always there for a friend whom we need most of the
time, mostly when we are down. Georgia, a young person
identifying as transgender

11. QUANTIATIVE
PHASE

12. Positive emotions and thoughts
Statements
Strongly
disagree
Disagree a
lot
Disagree
a little
Do not
agree or
disagree
Agree
a little
Agree
a lot
Strongly
agree
Don’t
know/not
applicable
1. When I think about having a sexual
relationship now or in the future, I feel
happy.
2. At times when I think about having a
sexual relationship I want I feel
ashamed.
3. I feel positive I can have the
relationship I want.
4. At times I have felt afraid that
someone will touch me in a way which
makes me feel uncomfortable.
Example of scale items

13. Participant characteristics
Characteristic Number of participants
Male 121
Female 75
iTaukei 82
Fijian of Indian Descent 88
Other ethnicity 26
Heterosexual 148
Lesbian, Gay, Bisexual or Transgender 18
Don’t know their sexual orientation 29
Christian 108
Hindu 37
Muslim 16
Other religion or no religion 24

14. QUANTIATIVE
FINDINGS

15. Factors and internal consistency reliability

16. • Mean score 5.
• Heterosexual participants scored significantly better than those who didn’t
know their sexual identity
• Those who had heard of STIs were significantly more likely than those who had
not to report perceiving they had opportunities and confidence to access SRH
services and information.
Perceived opportunities and confidence to access
SRH services and information

17. • mean score of 5
• Heterosexual and LGBT participants scored better on positivity and optimism
than those who reported they did not know their sexual identity.
• Those who had heard of sexually transmitted infections, HIV or answered all
HIV knowledge questions correctly scored significantly higher than those who
hadn’t heard of them/answered questions correctly.
Positivity and optimism about current and/or
future intimate relationships

18. Sense of supportive community and belonging
• Mean score of 5
• Heterosexual participants scored significantly better than those who
did not know their sexual identity

19. • mean score of 3 (reverse)
• Females scored significantly worse than males
• Fijians of Indian descent scored significantly better than iTaukei and ‘other
ethnicities’.
Experiencing difficult emotions about oneself and
sexual situation

20. • mean score of 3 (reverse scale)
• Males scored significantly higher than females, indicating they had greater
concerns about the consequences of violating social taboos
• Heterosexual participants reported significantly less concern about the social
and emotional consequences of violating social norms than LGBT and the
participants who did not know their sexual identity.
Concern about the social and emotional
consequences of violating social taboos

21. • Overall mean score of 5
• Those who did not know their sexual identity scored significantly worse on
overall ASRW than heterosexuals and LGBT participants
• Those who had heard of STIs scored better on overall ASRW compared to
those who had not heard of STIs
Overall Adolescent Sexual and Reproductive
Well-Being

22. • 77% heard of STIs and 88% heard of HIV
• 53% used contraceptives to prevent pregnancy, 18% took non-medical actions
29% took no action to prevent pregnancy
• 12% accessed an SRH service in the past 12 months
• 46% received SRH information and services from an outreach worker or peer
educator within the last 12 months
Health Seeking Practices

23. • Of all participants, 8% reported they had experienced forced sexual
intercourse or had been forced into other sexual acts.
• LGBT youth (28%) were found to be significantly more likely to have
experienced forced sex than heterosexual identifying youth (5%), and those
who did not know their sexual identity (7%)
Forced sex

24. Scale implications
1. Scale shows positive signs of validity and reliability.
2. Scale requires testing on further populations.
3. Potential instrument to measure population level adolescent sexual and
reproductive well-being
4. Social-cultural, political and structural factors to be considered when
implementing the scale
5. Offers a conceptual framework of adolescent sexual and reproductive well-
being

25. Fiji Adolescent Sexual and Reproductive
Well-Being Framework
Positivity and
optimism
about
current/future
intimate
relationships
Sense of
supportive
community
and belonging
Agency over
sexual
practices and
relationship
choices
Perceived
opportunities
and confidence
to access SRH
services and
information
Emotional
resilience
Enactment of
behaviours to
attain the
highest
standard
health for the
individual
Structures, Society, Religion and Culture

26. Key Recommendations
1. Strengths-based approaches used to empower youth and community to
address potentially harmful social norms and barriers to discussing sexuality,
relationships and sexual health.
2. ASRW intervention targeted to vulnerable populations including LGBT, those
who don’t know their sexual identity, girls and boys.
3. Greater focus on programs to build emotional resilience/mental support.
4. Greater focus on programs which address sexual consent, agency and
violence
5. Health campaigns which recognise the role of pleasure and intimacy as
drivers of sexual practices, especially condom-less sex

27. Key Recommendations
5. Health campaigns which recognise the role of pleasure and intimacy as drivers
of sexual practices, especially condom-less sex
6. Health workers trained and supported to provide confidential services
7. Expand peer education - teaching emotional resilience techniques, navigation
of health system, access to contraceptives, STI and pregnancy tests and sexual
assault support
8.SRH Outreach services maintained and strengthened

28. All the participants, The Fiji Ministry of Health and Medical Services, supervisors,
the Pacific Community, research assistants and the advisory group.
Vinaka vaka levu