New Zealand Parliamentarians Group on Population and Development Presentation


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New Zealand Parliamentarians Group on Population and Development, Open Hearing on adolescent sexual and reproductive health rights in the Pacific. Elissa Kennedy, 11 June 2012

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  • Burnet Institute is a medical research and public health NGO. We have offices in 6 countries and ongoing health programs and research projects through out the Pacific, Asia and parts of Africa
  • Burnet is also a collaborating partner of Compass– an AusAID initiative to improve the effectiveness of aid for WCHKey focus has been ensuring adolescents’ access to SRH – particularly in the Pacific
  • The largest cohort of adolescents the world has ever experienced are about to enter their sexual and reproductive yearsThe Pacific is no exception. With over 2 million people aged between 10-19 years almost 1 in 5 people in the Pacific is an adolescentThis growing population of young people present a number of challenges, but also an important opportunityInvesting in these 2 million adolescents who are the future leaders, parliamentarians, workforce and parents is critical if health and development goals are to be realisedAdolescents are not only the future, they are also part of the current generation and ensuring their sexual and reproductive health is a fundamental human right
  • Adolescence is a time when many young people commence sexual activity. In the Pacific up to 65% of girls and 72% of boys aged 15-19 have ever had sexMany adolescents are ill-equipped for this transition having inadequate knowledge and skills and lacking access to the information and services they need. Subsequently adolescents suffer a disproportionate burden of poor sexual and reproductive health.
  • This includes early and unintended pregnancyAs many as 1 in 4 girls aged 15-19 are already mothers or a pregnantAdolescent pregnancy occurs in the context of low contraceptive use – with less than 20% of girls and half of boys having ever used an effective method of contraception – including condoms
  • While information about unmarried adolescents is scarce, up to 50% of married girls have an unmet need for family planning, meaning that they would like to avoid pregnancy but are not using a method of contraceptionSubsequently many adolescent pregnancies are mistimed or unwanted
  • Adolescent pregnancy, intended or unintended, has significant consequences for young people, their children and communitiesConditions related to pregnancy and childbirth are the leading case of death of girls aged 15-19 globally, and girls under the age of 19 are up to 5 times more likely to die than adult womenTheir infants also twice as likely to die on the first month of life and children at higher risk of poor health, education and socio-economic outcomesMany pregnant adolescent girls and sometimes their partners are forced to cut short their education, diminishing their potential for economic, social and political participationThis contributes to a cycle of poor health, poverty, gender inequality and disadvantage that can span generations and hampers progress towards sustainable developmentThe determinants of adolescent pregnancy are complex and so our responses need to be comprehensive
  • Reducing adolescent fertility rates is a MDG target. Birth rates to adolescents are relatively high in a number of countries and higher than the average for developing regions. Importantly, adolescent fertility rates have seen little decline in the past 15 years and have increased in some settings. Recognising the health and development imperatives, greater priority needs to be given to addressing early and unintended pregnancy in this region
  • Globally, funding for family planning has fallen well below that required to meet needsThe Pacific has not been immune with insufficient and unreliable funding contributing to slow progress towards reducing unmet need for family planning, including among adolescentsThe is a great need for increased and long-term financial investment in reproductive health, including family planning, while ensuring funds are also directed to adolescent-specific policies and programs.In the Pacific, less than 0.03% of ODA for the region has been for family planningInsufficient and unreliable funding has hampered efforts to reduce unmet need – including for adolescents(Recommended that AusAID needs to commit 15% of health funding to family planning)
  • Adolescents do not automatically benefit from policies targeting the general populationThey face unique barriers to accessing SRH information and services, which results in poorer access and poorer health outcomesAdolescents are less likely to have heard FP messages in the media or to have discussed family planning with a health worker and they also have low rates of utilisation of health services, including for family planningThere is a need to support the development of policies that specifically address the needs of adolescents, including prevention of pregnancy, and that these are integrated with other youth policiesThese barriers include:socio-cultural norms and taboosSkills and attitudes of health workersFinancialAccess to commodities and facilitiesLack of knoweldge
  • Good policy should draw on good evidenceHowever there is still much that we don’t know about adolescent pregnancy and its prevention in the PacificA review of Demographic and Health Surveys conducted by Burnet highlighted that national level surveys inadequately report information about adolescents, particularly unmarried adolescentsAdvocacy and support are required to endure that both married and unmarried adolescents are included in reproductive health surveys and that data are disaggregated to show outcomes for adolescentsThere is also a need to strengthen health information systems so they better capture information about adolescents’ access to and use of servicesWe also need to continue strengthening local research capacity and support Pacific-based research to better understand the determinants of adolescent pregnancy and identify effective interventions
  • In 2010 Burnet and WSB conducted a study in Vanuatu to explore the barriers adolescents face accessing sexual and reproductive health information and services and how they thought these could be overcomeThe most significant barriers related to the lack of a supportive environment and reflected not only factors at the community level but also a need to consider the legal and policy environment and how it impacts on adolescent sexual and reproductive healthKey considerations include the provision of free and compulsory education for girls and boys, efforts to combat early marriage and gender-based violence, addressing regulations or policies that restrict unmarried young people’s access to contraception, and considering how highly restrictive abortion laws may disproportionately impact on young peopleAdditionally there is need to support the implementation and evaluation of programs that aim to address socio-cultural norms and build community support and skills to address early pregnancyPolicies, legislation and regulation that impact on adolescents SRH and access need to be addressed:Early marriageGBVAccess to family planningParental consentConsideration of the impact of highly restrictive abortion lawsVanuatu study identified socio-cultural taboos as the biggest barrier to accessing information and services. Need to support and evaluate programs that aim to address community norms and attitudes to create a more supportive environment
  • Many young people lack comprehensive knowledge about pregnancy and family planning. One of the key findings of the 2010 study in Vanuatu was that young people consider information about pregnancy prevention very important but they currently receive insufficient information compared with that for STIs and HIVThey also identified schools as a preferred but underutilised source of information. We know from international studies that school-based sexuality education is effective in improving knowledge, skills and behaviour and so there is a need to support the scale-up of comprehensive and skills-based programs in this regionWe also need to ensure that information reaches out-of-school adolescentsPeer educators were identified by young people in Vanuatu as preferred sources of information because they are approachable, trusted and able to give reliable information. Reviews of peer education programs globally have demonstrated a positive impact on knowledge and behaviours, potential to reach large numbers of young people, and may help to address socio-cultural norms and taboos. Greater support for peer education programs and their evaluation is needed in this regionAdditionally there is increasing interest in the potential of mass media, social media and other communication technologies and a need to support further research into these programs
  • Finally, support is required to make health services, including contraceptive services, more accessible to young peopleWe asked adolescents in Vanuatu what they thought were the features of a youth friendly health services. Having a youth only clinic separate to adult services was the least important feature which means there is much that can be done to make existing services more youth friendly – particularly in settings were stand alone clinics are not feasibleOne of the key features is to ensure health workers have the skills to deal sensitively and effectively with adolescents and that all health services are able to ensure confidentiality and privacyThere is need to support governments to develop national youth friendly health service guidelines based on local research, and to increase support for NGO who currently provide the gold standard in stand alone youth clinics and may be better placed to reach marginalised young people
  • There are great health, human rights and development imperatives for addressing adolescent pregnancy in the Pacific. A comprehensive, multi-pronged and multisectoral approach is required if we are to ensure the health and well being not only of this current generation of adolescents but for their communities and the generations to come.
  • New Zealand Parliamentarians Group on Population and Development Presentation

    1. 1. Adolescent sexual and reproductivehealth and rights in the PacificNZ Parliamentarians’ Group on Population and DevelopmentOpen Hearing11 June 2012Dr Elissa
    2. 2.
    3. 3. ‘An age of opportunity’ PICT population (2010) 75+ 70-74 65-69 60-64 55-59 50-54 Age group 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 -800,000 -600,000 -400,000 -200,000 0 200,000 400,000 600,000 800,000 Female Population MaleSource: SPC 2011
    4. 4. Sexual debut during adolescence is common Percentage of 15-19 year olds who have ever had sex 80 70 60 50 40 % 30 Female Male 20 10 0 Photo: WHO/Kolmodin Kiribati Marshall Nauru Papua Solomon Tuvalu Islands New Islands GuineaSource: Selected DHS reports 2006-2009
    5. 5. Up to 1 in 4 girls aged 15-19 in the Pacifichave commenced childbearing Photo: C. Vaughan
    6. 6. Many adolescent pregnancies areunintended Percentage of pregnancies to girls aged <20 that were unintended100% 80% 60% Wanted 40% Mistimed or unwanted 20% 0% Kiribati Marshall Nauru Samoa Solomon Tuvalu Islands IslandsSource: Selected DHS reports
    7. 7. Adolescent pregnancy has significant health and socio- economic implications for: • Young people • Their children • Their communities “The school stopped me from attending classes and said I could not return …..” 17 year old pregnant girl, Fiji (UNFPA)Photo: C. Vaughan
    8. 8. 1. Prioritise the prevention adolescent pregnancy Adolescent fertility rate (births per 1000 women aged 15-19)160140120100 80 Previous 10-14 60 years 40 Current 20 0 Kiribati Marshall Nauru Papua Samoa Solomon Tuvalu Vanuatu Islands New Islands GuineaSource: Selected DHS and Census reports
    9. 9. 2. Increase financial commitment to reproductive health, including family planning $2.5 billion global funding shortfall for family planning (2007) Source: Guttmacher 2008
    10. 10. 3. Ensure policies explicitly address adolescent pregnancy• Adolescents do not automatically benefit from national policies aimed at the general population• They face particular barriers to accessing information and care• They have poorer access to sexual and reproductive health information and services than adults Photo: T. Jarrett
    11. 11. 4. Improve the availability and use of strategic information Photo: C. MorganPhoto: D. Humphreys
    12. 12. 5. Support efforts to create an enabling environment for adolescents“Communities don’t talk about There is a need to consider:these issues to young people….”Adolescent girl, Vanuatu (Burnet/WSB) • The legal and policy environment: – Free and compulsory education – Early marriage – Gender-based violence – Access to contraception – Abortion laws • Socio-cultural norms and attitudesPhoto: Wan Smolbag Theatre
    13. 13. 6. Increase access to comprehensive sexual and reproductive health information – including the prevention of pregnancy “(Young people need) more awareness on how to avoid pregnancy until you are mature…” Adolescent girl, Vanuatu (Burnet/WSB) Photos: Wan Smolbag TheatrePhoto: D. Humphreys
    14. 14. 7. Strengthen health systems to provide youth friendly health services“We want health services for young people”Adolescent boy, Vanuatu (Burnet/WSB)Key features of a youth friendly health service:• Skilled health workers• Confidentiality and privacy• Free services and reliable supply of commodities Photo: Wan Smolbag Theatre
    15. 15. Recommendations1. Prioritise prevention of adolescent pregnancy1. Increase financial commitment to reproductive health and family planning1. Ensure policies explicitly address adolescent pregnancy1. Improve the availability and use of strategic information1. Support efforts to create an enabling environment for adolescents Photo: D. Humphreys1. Increase access to comprehensive SRH information1. Strengthen health systems to provide youth friendly health services