New Zealand Parliamentarians Group on Population and Development Submission


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New Zealand Parliamentarians Group on Population and Development Submission

  1. 1.                       NZ  Parliamentarians’  Group  on  Population  and  Development   Open  Hearing:  Adolescent  Sexual  and  Reproductive  Health  and   Rights  in  the  Pacific     11  June  2012         Submission     Burnet  Institute  on  behalf  of  the     Women’s  and  Children’s  Health  Knowledge  Hub            Submission  prepared  by:    Dr  Elissa  Kennedy  Principal  for  Maternal  and  Child  Health  Centre  for  International  Health  Burnet  Institute  NZPPD  Open  Hearing  Submission  –  Burnet  Institute   1  
  2. 2.    Table  of  Contents    1.  Full  contact  details ............................................................................................. 2  2.  Introduction....................................................................................................... 3  3.  Executive  summary ............................................................................................ 4  4.  Recommendations  and  supporting  information ................................................. 5   4.1     The  need  to  address  adolescent  pregnancy...........................................................5   4.2     Effective  approaches  to  address  adolescent  pregnancy  in  the  Pacific .......6   4.2.1   Increase  development  assistance  for  adolescent  SRH.......................................................... 6   4.2.2     Ensure  adolescents  are  explicitly  addressed  in  reproductive  health  and  population  policy. 7   4.2.3     Improve  the  availability  and  use  of  strategic  information ................................................... 7   4.2.4     Support  efforts  to  create  an  enabling  environment............................................................. 8   4.2.5     Improve  access  to  comprehensive  SRH  information,  including  prevention  of  pregnancy.... 8   4.2.6   Strengthen  health  systems  to  provide  youth  friendly  health  services .................................. 9  5.  References ....................................................................................................... 11      1.  Full  contact  details    1.1 Dr  Elissa  Kennedy   Principal  for  Maternal  and  Child  Health   Centre  for  International  Health   Burnet  Institute   85  Commercial  Rd,  Melbourne,  VIC,  Australia  3004   Phone:  +61  3  9282  2119   Fax:  +61  3  9282  2144   Email:      NZPPD  Open  Hearing  Submission  –  Burnet  Institute   2  
  3. 3.  2.  Introduction    2.1 The   Burnet   Institute,   on   behalf   of   the   Women’s   and   Children’s   Health   Knowledge   Hub,  welcomes  the  opportunity  to  make  this  submission  to  the  NZ  Parliamentarians’   Group   on   Population   and   Development   Open   Hearing   on   Adolescent   Sexual   and   Reproductive  Health  and  Rights  in  the  Pacific.    2.2 The  Burnet  Institute  is  a  leading  Australian-­‐based  medical  research  and  public  health   institute   seeking   to   achieve   better   health   for   poor   and   vulnerable   communities   through   research,   education   and   public   health.   Through   the   Centre   for   International   Health  (CIH)  Burnet  has  full  accreditation  with  AusAID  as  a  health  development  non-­‐ government   organisation   (NGO).     CIH’s   health   priorities   include   women’s   and   children’s   heath   (including   adolescent   health),   HIV   and   sexual   health,   infectious   diseases  and  health  systems  strengthening.      2.3 In   addition   to   its   office   in   Melbourne,   CIH   has   a   strong   presence   in   Asia   and   the   Pacific  with  country  offices  in  Papua  New  Guinea,  Indonesia,  Myanmar,  Lao  PDR  and   China   (Beijing   and   Lhasa)   and   projects   implemented   through   local   partners   in   Sri   Lanka,  Timor-­‐Leste  and  Vanuatu.    2.4 The  Women’s  and  Children’s  Health  Knowledge  Hub  (WCH  Hub)  is  an  AusAID  funded   partnership  between  the  Burnet  Institute,  the  Centre  for  International  Child  Health   at  the  University  of  Melbourne  and  Menzies  School  of  Health  Research.      2.5 The   WCH   Hub   draws   on   regional   expertise   to   improve   the   effectiveness   of   aid   for   women’s   and   children’s   health,   with   an   emphasis   on   contributing   to   equitable   progress   towards   Millennium   Development   Goals   1,   4,   and   5   –   to   reduce   poverty,   improve   maternal   and   child   health,   and   ensure   universal   access   to   reproductive   health.   One   of   the   key   thematic   priorities   of   the   WCH   Hub   is   to   ensure   universal   access   to   sexual   and   reproductive   health   for   adolescents.   This   work   has   included   research   activities   to   identify   current   needs,   barriers,   effective   approaches   and   knowledge  gaps  in  the  Pacific.      2.7   Burnet   Institute   is   also   a   founding   member   of   the   Australian   Sexual   and   Reproductive   Health   and   Rights   Consortium,   a   collaboration   with   Marie   Stopes   International   Australia,   CARE   Australia,   Plan   Australia   and   International   Women’s   Development   Agency.   The   Consortium   seeks   to   ensure   Australian   non-­‐government   organisations  are  able  to  position  reproductive  health  as  a  priority  within  the  global   health  and  development  agenda.    NZPPD  Open  Hearing  Submission  –  Burnet  Institute   3  
  4. 4.  3.  Executive  summary    3.1   A   significant   and   growing   proportion   of   the   Pacific   population   is   made   up   of   adolescents   aged   10-­‐19   years.   Adolescents   suffer   a   disproportionate   burden   of   poor   sexual  and  reproductive  health  (SRH),  including  high  rates  of  early  and  unintended   pregnancy,   with   significant   health   and   socio-­‐economic   consequences   for   themselves,   their   families   and   communities.   Addressing   adolescent   pregnancy   and   improving  access  to  family  planning  information  and  services  need  to  be  prioritised   (Recommendation  1).    3.2   Increased   and   long-­‐term   financial   commitment   for   family   planning   in   the   Pacific   is   needed,   with   funding   specifically   allocated   to   adolescent   SRH.   Greater   funding   for   non-­‐government   and   civil   society   organisations   who   provide   the   bulk   of   SRH   information   and   services   for   adolescents   in   the   Pacific   is   also   required   (Recommendation  2).    3.3   Adolescents  do  not  automatically  benefit  from  policies  and  programs  aimed  at  the   general   population.   There   is   need   for   advocacy   and   support   to   ensure   that   adolescent   pregnancy   and   access   to   family   planning   is   explicitly   addressed   in   national   reproductive   health   and   population   policies   and   is   integrated   with   other   youth  policies  (Recommendation  3).    3.4   There   is   an   urgent   need   for   further   research   to   better   understand   adolescents’   family   planning   knowledge,   attitudes,   practices,   preferences   and   socio-­‐cultural   context  to  inform  policies  and  programs.  Advocacy  and  support  are  needed  to  build   local   research   capacity,   strengthen   health   information   systems,   and   ensure   adequate  funding  for  program  research  and  evaluation  (Recommendation  4).      3.5   Advocacy   and   support   are   required   for   multi-­‐sectoral   approaches   to   create   a   supportive  environment  for  adolescent  SRH.  Consideration  needs  to  be  given  to  the   legislative   and   policy   environment   (including   age   of   marriage,   gender-­‐based   violence,   restrictions   on   contraceptive   access   and   abortion);   access   to   free   and   compulsory   education   for   all   adolescents   and   removal   of   policies   that   prevent   pregnant   adolescents   and   mothers   completing   education;   and   support   for   evaluation   of   programs   that   aim   to   address   community   attitudes   and   norms   (Recommendation  5).    3.6   Adolescents   require   access   to   comprehensive   SRH   information,   including   information   about   preventing   early   and   unintended   pregnancy.   Advocacy   and   support  are  needed  to  facilitate  the  scale-­‐up  of  evidence-­‐based  sexuality  education   in   schools,   peer   education   programs   to   reach   out-­‐of-­‐school   adolescents,   and   for   further  research  into  the  potential  of  mass  media  and  communication  technologies   (Recommendation  6).    3.7   Pacific  governments  should  be  supported  to  develop  and  implement  guidelines  for   youth-­‐friendly   health   services.   Non-­‐government   and   civil   society   organisations   currently   providing   a   high   standard   of   youth-­‐friendly   sexual   and   reproductive   health   services  should  continue  to  be  engaged  and  supported  (Recommendation  7).  NZPPD  Open  Hearing  Submission  –  Burnet  Institute   4  
  5. 5.  4.  Recommendations  and  supporting  information    4.1     The  need  to  address  adolescent  pregnancy    4.1.1   One   in   five   people   in   the   Pacific   is   an   adolescent   aged   10-­‐19   years.1   These   young   people  are  just  beginning  their  sexual  and  reproductive  lives.  Recent  data  indicates   that   up   to   65%   of   girls,   and   72%   of   boys,   aged   15-­‐19   years   have   ever   had   sex,   with   a   significant   proportion   reporting   sexual   debut   before   the   age   of   15.2-­‐8   Many   are   ill-­‐ prepared   for   this   transition,   lacking   adequate   knowledge   and   access   to   comprehensive   information   and   services.   Subsequently   adolescents   suffer   a   disproportionate   burden   of   poor   sexual   and   reproductive   health   (SRH),   including   early  and  unintended  pregnancy.    4.1.2   Adolescent   fertility   rates   are   high   in   many   Pacific   countries   and   have   seen   little   decline   in   the   past   decade.   Between   8   and   26%   of   girls   aged   15-­‐19   have   already   commenced   childbearing.2-­‐8   In   Marshall   Islands,   births   to   adolescents   account   for   20%   of   all   births.   Adolescent   pregnancy   in   the   Pacific   generally   occurs   outside   of   marriage  and  is  often  unintended.9  In  Solomon  Islands,  Marshall  Islands  and  Nauru   more  than  half  of  all  adolescent  pregnancies  are  mistimed  or  unwanted.2,  5,  6      4.1.3   Adolescent   pregnancy,   intended   or   unintended,   has   significant   implications   for   maternal   and   child   health:   globally,   conditions   related   to   pregnancy   and   childbirth   are  the  leading  cause  of  death  of  girls  aged  15-­‐19  years,  who  are  twice  as  likely  to   die   as   adult   women.   Babies   born   to   adolescent   mothers   are   twice   as   likely   to   die   within  the  first  month  of  life  and  suffer  higher  rates  of  perinatal  morbidity.9-­‐11      4.1.4   While   there   is   paucity   of   data   for   the   Pacific,   globally   between   2   and   4.4   million   adolescents  resort  to  unsafe  abortion  every  year,  accounting  for  around  14%  of  all   unsafe   abortions.   Adolescent   girls   are   more   likely   to   delay   seeking   abortion   and   post-­‐abortion   care,   are   more   likely   to   resort   to   unskilled   providers   and   unsafe   methods  and  suffer  higher  rates  of  complication  and  mortality  than  adults.12,  13    4.1.5   Early   pregnancy   can   have   enormous   socio-­‐economic   consequences.   In   the   Pacific,   pregnant   adolescents   are   often   forced   to   leave   school,   contributing   to   a   cycle   of   poverty,  gender  inequality  and  disadvantage  that  impacts  on  girls,  their  children  and   communities  and  hampers  progress  towards  sustainable  development.14,15,  16      4.1.6   The   determinants   of   adolescent   pregnancy   are   complex   and   relate   to   poor   access   to   information   and   services,   socio-­‐cultural   norms,   gender   inequality,   early   marriage,   sexual  violence  and  coerced  sex,  and  low  socio-­‐economic  status.11      4.1.7   In   2010,   Burnet   Institute,   through   the   WCH   Hub,   conducted   a   qualitative   study   in   partnership   with   Wan   Smolbag   Theatre   to   explore   the   barriers   to   accessing   SRH   information   and   services   experienced   by   adolescents   in   Vanuatu.17   The   major   barriers  reported  included:   • Socio-­‐cultural  norms  and  taboos  regarding  adolescent  sexual  behaviour;     • Judgmental   attitudes,   poor   communication   skills   and   lack   of   confidentiality   among  service  providers;   • Cost  of  transport  and  commodities;   • Unreliable  supply  of  commodities;  NZPPD  Open  Hearing  Submission  –  Burnet  Institute   5  
  6. 6.   • Poor  geographical  access,  particularly  in  rural  areas;  and   • Lack   of   information   and   knowledge   about   their   own   SRH   needs   and   availability  of  services.    4.1.8   These   barriers   contribute   to   inadequate   knowledge   and   low   contraceptive   use   among   married   and   unmarried   adolescents.   Less   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   (including   condoms).   Between   15   and   52%   of   married   adolescent  girls  have  an  unmet  need  for  family  planning  –  meaning  they  would  like   to   avoid   pregnancy   but   aren’t   currently   using   a   method   of   contraception.   Use   of   modern   contraception   is   lower,   and   unmet   need   higher,   among   adolescent   girls   than  adult  women  aged  over  20.2-­‐8      4.1.9   There  are  significant  opportunities  and  incentives  for  investing  in  efforts  to  prevent   adolescent  pregnancy.  Pacific  populations  are  dominated  by  a  large  and  increasing   youth   bulge,   whose   SRH   impacts   not   only   on   their   own   health   and   well-­‐being   but   that   of   their   families   and   communities.   Delaying   pregnancy   contributes   to   better   health  outcomes  for  women  and  children,  enables  girls  to  complete  education,  may   help   to   address   rapid   population   growth,   and   has   implications   for   sustainable   socio-­‐ economic   development.11,   15,   16   Adolescents   are   the   future   Pacific   parents,   workers   and   leaders   -­‐   investment   in   their   SRH   is   crucial   if   Millennium   Development   Goal   targets,  and  broader  development  goals,  are  to  be  realised.    4.1.10   Recognising   the   critical   importance   of   addressing   adolescent   fertility   and   its   implications   for   sustainable   development   in   the   Pacific,   NZPPD   and   other   stakeholders   must   place   greater   strategic   priority   on   the   prevention   of   adolescent   pregnancy  and  improving  access  to  comprehensive  family  planning  information  and   services  for  young  people  (Recommendation  1).          4.2     Effective  approaches  to  address  adolescent  pregnancy  in  the  Pacific        4.2.1   Increase  development  assistance  for  adolescent  SRH       (Recommendation  2)   Funding   for   reproductive   health   in   the   Pacific   is   currently   inadequate.   While   there   has   been   a   minimal   increase   in   development   assistance   for   reproductive   health,   funding  for  family  planning  has  fallen  in  the  past  decade  to  less  than  US$  1  million   per  year  compared  with  US$  31  million  spent  on  HIV.18  An  increased  and  long-­‐term   financial   commitment   for   family   planning   is   required,   with   funding   specifically   allocated  to  adolescent  SRH  to  reflect  current  needs  and  priorities  in  the  region.   In  addition  to  supporting  governments  and  multilateral  agencies,  greater  funding  is   needed  for  non-­‐government  and  civil  society  organisations  who  currently  provide  a   substantial  proportion  of  SRH  information  and  services  for  adolescents  in  the  Pacific.      NZPPD  Open  Hearing  Submission  –  Burnet  Institute   6  
  7. 7.  4.2.2     Ensure  adolescents  are  explicitly  addressed  in  reproductive  health  and   population  policy       (Recommendation  3)   Adolescents  suffer  a  disproportionate  burden  of  poor  SRH  outcomes  in  the  Pacific,   but   are   often   overlooked   and   underserved   in   reproductive   policy   and   programs.   Adolescents   do   not   automatically   benefit   from   policies   aimed   at   the   general   population.19,   20   They   face   unique   barriers   and   have   particular   SRH   needs   requiring   targeted   responses   that   are   comprehensive,   evidence-­‐informed   and   reflect   international  agreements  on  sexual  and  reproductive  rights.21   NZPPD   and   other   stakeholders   are   in   a   position   to   advocate   for   and   support   the   inclusion   of   adolescents   in   national   reproductive   health   and   population   policies,   ensuring   that   adolescent   pregnancy   and   access   to   family   planning   is   explicitly   addressed  and  is  integrated  with  other  youth  policies.      4.2.3     Improve  the  availability  and  use  of  strategic  information       (Recommendation  4)   Quality   information   is   vital   to   support   evidence-­‐based   policies   and   programs.   Currently,   data   for   adolescent   SRH   in   the   Pacific   are   very   limited.   Routine   health   information  systems  often  fail  to  adequately  capture  or  report  data  for  adolescents   and   lack   adolescent-­‐specific   indicators   that   would   help   inform   effective   interventions.22   A   review   of   Pacific   DHS   and   MICS   reports   conducted   by   Burnet   Institute   in   2009   demonstrated   that   national-­‐level   surveys   are   frequently   limited   by   the   failure   to   report   data   disaggregated   by   age   and   marital   status   to   demonstrate   outcomes   for   unmarried   adolescents,   and   failure   to   collect   data   for   young   adolescents   (10-­‐14   years).23   The   inclusion   of   unmarried   adolescents   in   the   most   recent   Pacific   DHS   is   encouraging,   however   many   important   indicators,   including   those   relevant   to   family   planning,  are  not  reported  for  adolescents.   Further   research   is   urgently   needed   to   identify   adolescents’   knowledge,   sexual   behaviours,   use   of   contraception,   reasons   for   non-­‐use   and   discontinuation,   contraceptive   preferences   and   socio-­‐cultural   and   other   barriers   to   better   inform   policy  and  programs.  There  is  also  a  great  need  for  data  about  sensitive  but  critical   issues   such   as   abortion.   Support   for   rigorous   evaluation   of   interventions   and   approaches   in   the   Pacific   is   required   to   identify   effective   strategies   for   reducing   early  and  unintended  pregnancy.   Advocacy   and   support   are   required   to   strengthen   health   information   systems,   ensure   the   inclusion   of   adolescents   (married   and   unmarried)   in   national-­‐level   surveys,  support  efforts  to  enhance  local  research  capacity  and  to  increase  financial   commitment  for  Pacific-­‐based  research.      NZPPD  Open  Hearing  Submission  –  Burnet  Institute   7  
  8. 8.  4.2.4     Support  efforts  to  create  an  enabling  environment       (Recommendation  5)   The   determinants   of   early   and   unintended   pregnancy   are   multi-­‐factorial,   and   available   evidence   indicates   that   multiple,   concurrent   interventions   are   most   likely   to   be   effective,   including   multi-­‐sectoral   approaches   to   create   a   supportive   environment.   This   includes   increasing   youth   participation   in   policy   and   program   development  and  support  for  youth  development  strategies  to  promote  protective   factors.24,  25   Consideration  of  the  legal  and  policy  environment  and  its  impact  on  adolescents  is   required.   Legislation   to   prevent   marriage   before   18   years   of   age   and   address   gender-­‐based  violence  should  be  enacted  and  enforced.  Legislation  or  policies  that   restrict  adolescents’  access  to  a  full  range  of  SRH  services,  including  restrictions  on   providing  unmarried  young  people  with  contraception,  or  compulsory  requirements   for   parental   or   spousal   consent,   should   be   addressed.26   Policymakers   need   to   also   consider   the   impact   of   highly   restrictive   abortion   laws,   which   may   disproportionately  affect  adolescents.12   In   addition   to   ensuring   free   and   compulsory   education   for   all   adolescents,26   harmful   school   policies   that   prevent   pregnant   adolescents   from   continuing   or   returning   to   education   should   be   removed   and   programs   introduced   to   support   adolescent   mothers  to  complete  education.   Socio-­‐cultural   factors   are   among   the   most   significant   barriers   reported   by   young   people   in   Vanuatu.   There   is   a   need   for   evaluations   of   interventions   that   aim   to   overcome   these   barriers,   including   programs   targeting   parents   and   community   leaders  to  address  socio-­‐cultural  norms  and  attitudes.17      4.2.5     Improve  access  to  comprehensive  SRH  information,  including  prevention  of   pregnancy       (Recommendation  6)   There   is   a   great   need   to   increase   adolescents’   access   to   comprehensive,   age-­‐ appropriate   SRH   information   and   education.   Evidence   suggests   that   such   information   provided   from   an   early   age   can   have   life-­‐long   protective   benefits.27   While  the  majority  of  married  adolescents  in  the  Pacific  have  heard  of  at  least  one   modern   method   of   contraception,   limited   data   indicate   that   comprehensive   knowledge   about   prevention   of   pregnancy   is   poor.28,   29   Research   conducted   by   Burnet   in   Vanuatu   identified   that   while   prevention   of   pregnancy   is   important   to   adolescents,   they   currently   receive   little   information   about   this   compared   with   information  about  sexually  transmitted  infections  and  HIV.17  Compared  with  adults,   adolescent  boys  and  girls  are  less  likely  to  have  heard  family  planning  messages  in   the  media,  and  less  than  25%  of  girls  have  discussed  family  planning  with  a  health   worker.2-­‐8  Research  conducted  by  Burnet  has  highlighted  the  need  to  reach  boys  as   well  as  girls  to  promote  shared  responsibility  for  prevention  of  early  and  unintended   pregnancy.17  NZPPD  Open  Hearing  Submission  –  Burnet  Institute   8  
  9. 9.   Schools   are   an   underutilised   source   of   SRH   information   in   the   Pacific.   There   is   substantial   global   evidence   demonstrating   the   positive   effective   of   comprehensive   school-­‐based  sexuality  education  on  knowledge,  attitudes,  behaviours  and,  to  some   extent,   SRH   outcomes.30   Adolescents   in   Vanuatu   reported   that   they   would   like   to   receive   SRH   through   school,   either   as   part   of   the   standard   curriculum   or   delivered   by  visiting  peer  educators  or  nurses.17  Evidence-­‐based  programs  that  build  life  skills   and   improve   communication   and   decision-­‐making,   such   the   Family   Life   Education   program,  should  be  strengthened  and  scaled-­‐up  through-­‐out  the  region.31   Adolescents   in   Vanuatu   identified   peer   educators   and   health   workers   as   preferred   sources   of   information   because   they   were   perceived   to   be   well-­‐trained,   trustworthy   and  able  to  give  correct  information.17  Recent  reviews  have  shown  that  youth  peer   education   programs   in   developing   countries   can   be   effective   in   improving   knowledge,  and,  to  some  extent,  attitudes  and  behaviours  and  have  the  potential  to   reach   large   number   of   young   people.32   33   Opportunities   to   expand   peer   education   programs,   particularly   for   out-­‐of-­‐school   young   people,   should   be   sought   and   these   approaches  rigorously  evaluated  to  identify  impact.   Family   planning   information   delivered   through   mass   media   can   increase   contraceptive   uptake,   but   messages   need   to   be   appropriately   targeted   and   delivered   to   reach   adolescents.26,   34   Adolescents   in   Vanuatu   identified   a   range   of   preferred  sources  of  information  including  print  media,  radio,  television,  community   theatre   and   community   workshops,   but   also   noted   that   current   mass   media   messages  regarding  family  planning  only  target  married  couples.17  Further  research   is  required  to  identify  effective  strategies,  particularly  the  potential  of  social  media   and  communication  technologies.      4.2.6   Strengthen  health  systems  to  provide  youth  friendly  health  services       (Recommendation  7)   It  is  well  recognised  that  adolescents  face  multiple  barriers  that  limit  their  access  to   mainstream  health  services,  and  indeed  use  of  SRH  health  services  by  young  people   in   the   Pacific   is   low.35   Youth-­‐friendly   health   services   are   those   that   are   accessible,   acceptable   and   appropriate   for   adolescents   with   limited   research   showing   a   promising  impact  on  service  utilisation.20,  24,  36   In  2010,  Burnet  Institute  conducted  a  qualitative  study  of  adolescents’  SRH  service   delivery   preferences   in   Vanuatu.17   The   features   of   a   youth-­‐friendly   health   service   that  were  identified  included  (from  most  important  to  least  important):   • Friendly,  non-­‐judgmental  health  workers;   • Reliable  commodity  supply;   • Free  (affordable)  services  and  commodities;   • Confidentiality;   • Availability  of  male  and  female  staff;   • Convenient  opening  hours;  NZPPD  Open  Hearing  Submission  –  Burnet  Institute   9  
  10. 10.   • Printed  materials,  television,  peer  educators  and  other  activities  provided   in  the  waiting  room;   • Privacy;  and   • Separate  from  adult  services.   These   findings   suggest   that   much   can   be   done   to   make   existing   services,   including   government  services,  more  youth-­‐friendly  –  even  where  it  is  not  feasible  to  provide   stand-­‐alone   youth   clinics.   These   approaches   require   increased   investment   from   government   and   other   stakeholders,   and   engagement   with   young   people   and   communities,  and  should  include:     • Training   for   health   workers   (SRH   needs   and   rights   of   young   people,   confidentiality  and  communication  and  counselling  skills);   • Strengthening   commodity   supply   of   condoms   and   contraceptives,   particularly  in  rural  areas;   • Providing   affordable   services   and   commodities   –   including   free   contraceptives;   • Ensuring  all  facilities  have  a  confidentiality  and  privacy  policy;  and   • Providing   a   separate   waiting   area   or   separate   opening   hours   for   young   people   SRH   services   should   be   integrated   with   other   general   health   services   for   young   people  and  other  youth  activities  (such  as  youth  centres)  where  possible  to  reduce   stigma   and   increase   accessibility.20   Consideration   should   also   be   given   to   the   appropriateness  and  feasibility  of  providing  SRH  services  and  contraception  in  school   clinics.   Pacific   governments   should   be   supported   to   develop   and   implement   country-­‐ specific  guidelines  for  youth-­‐friendly  health  services  based  on  local  research.   Increased  support  is  needed  for  non-­‐government  and  civil  society  organisations  who   currently   provide   high   quality   stand-­‐alone   youth-­‐friendly   health   services   in   the   Pacific37   and   may   be   better   able   to   reach   young   people,   particularly   marginalised   adolescents.  Innovative  models  of  service-­‐delivery  models  and  outreach  services  to   reach  most-­‐at-­‐risk  adolescents  should  also  be  explored.    NZPPD  Open  Hearing  Submission  –  Burnet  Institute   10  
  11. 11.  5.  References      1.   SPC.  Youth  population  -­‐  PICT.  Secretariat  of  the  Pacific  Community.  AHD  Section.  2010.  2.   National  Statistics  Office  (SISO),  SPC,  Macro  International:  Solomon  Islands  2006-­‐2007   Demographic  and  Health  Survey.  Noumea:  SPC;  2009.  3.   Ministry  of  Health  (Samoa),  Bureau  of  Statistics  (Samoa),  and  ICF  Macro:  Samoa   Demographic  and  Health  Survey  2009.  Apia,  Samoa:  Ministry  of  Health,  Samoa:  2010.  4.   Central  Statistics  Division  (TCSD),  SPC  and  Macro  International  Inc:  Tuvalu  Demographic  and   Health  Survey.  2007.  5.   Nauru  Bureau  of  Statistics,  SPC  and  Macro  International  Inc:  Nauru  2007  Demographic  and   Health  Survey.  2007.  6.   Economic  Policy,  Planning  and  Statistics  Office  (EPPSO),  SPC  and  Macro  International  Inc:   Republic  of  the  Marshall  Islands  Demographic  and  Health  Survey  2007.  2007.  7.   National  Statistical  Office  Papua  New  Guinea:  Papua  New  Guinea  Demographic  and  Health   Survey  2006:  National  Report.  Port  Moresby:  National  Statistical  Office  Papua  New  Guinea;   2009.  8.   Kiribati  National  Statistics  Office  (KNSO)  and  SPC.  2009.  Kiribati  Demographic  and  Health   Survey.  Secretariat  of  the  Pacific  Community  (SPC),  Noumea;  2010.  9.   WHO:  Adolescent  pregnancy:  unmet  needs  and  undone  deeds.  World  Health  Organisation.   Geneva:  2006.  10.   Patton  GC,  Coffey  C,  Sawyer  SM,  Viner  RM,  Haller  DM,  Bose  K,  et  al.  Global  patterns  of   mortality  in  young  people:  a  systematic  analysis  of  population  health  data.  The  Lancet.   2009;374(9693):881-­‐92.  11.   WHO.  Position  paper  on  mainstreaming  adolescent  pregnancy  in  efforts  to  make  pregnancy   safer.  Department  of  Making  Pregnancy  Safer.  World  Health  Organisation.  Geneva:  2010.  12.   Olukoya  AA,  Kaya  A,  Ferguson  BJ,  AbouZahr  C.  Unsafe  abortion  in  adolescents.  Int  J  Gynaecol   Obstet.  2001  Nov;75(2):137-­‐47.  13.   Shah  I,  Ahman  E.  Age  patterns  of  unsafe  abortion  in  developing  country  regions.  Reprod   Health  Matters.  2004  Nov;12(24  Suppl):9-­‐17.  14.   UNFPA:  Briefing  notes  for  Pacific  Parliamentarians  on  population,  development  and   reproductive  health  issues.  UNFPA  Office  for  the  Pacific.  Suva:  2007.  15.   Greene  M,  Merrick  T:  Poverty  Reduction:  Does  Reproductive  Health  Matter?    In  World  Bank   Human  Development  Network,  ed.  Health,  Nutrition  and  Population  Discussion  Papers.  The   World  Bank.  Washington  DC:  2005.  16.   World  Bank:  Development  and  the  Next  Generation,  World  Development  Report.     International  Bank  for  Reconstruction  and  Development.  Washington,  DC:  2007.  17.   Kennedy  E,  Gray  N  et  al.  Identifying  the  sexual  and  reproductive  health  informaiton  and   service  delivery  preferences  of  adolescents  in  Vanuatu.  Burnet  Institute,  on  behalf  of   Compass:  the  Womens  and  Childrens  Health  Knowledge  Hub.  Melbourne,  Australia;  2010.  18.   OECD  Statistics.  Query  Wizard  for  International  Development.  Organisation  for  Economic  Co-­‐ operation  and  Development.  Available  at,4:1,1:1,5:3,7:1&q=3:51+4:1+1:1+5:3+7:1+2: 262,240,241,242,243,244,245,246,249,248,247,250,251,231+6:2002,2003,2004,2005,2006,2 007,2008,2009    Accessed  16  April  2012.  19.   UNICEF.  Adolescence  and  age  of  opportunite.  State  of  the  Worlds  Children.  United  Nations   Childrens  Fund,  New  York;  2011.  20.   Tylee  A,  Haller  DM,  Graham  T,  Churchill  R,  Sanci  LA.  Youth-­‐friendly  primary-­‐care  services:   how  are  we  doing  and  what  more  needs  to  be  done?  Lancet.  2007  May  5;369(9572):1565-­‐ 73.  21.   Kennedy  E,  Gray  N,  Azzopardi  P,  Creati  M.  Adolescent  fertility  and  family  planning  in  East   Asia  and  the  Pacific:  a  review  of  DHS  reports.  Reproductive  Health  2011;8:11.  NZPPD  Open  Hearing  Submission  –  Burnet  Institute   11  
  12. 12.  22.   Ekeroma  A.  Building  audit  and  research  capacity  in  the  Pacific  Islands  in  the  area  of   reproductive  healthcare.  Auckland:  Pacific  Womens  Health  Research  and  Development  Unit,   Middlemore  Hospital,  2007.  23.   Gray  N,  Azzopardi  P,  Kennedy  E,  Creati  M,  Willersdorf  E.  Improving  adolescent  reproductive   health  in  Asia  and  the  Pacific:  do  we  have  the  data?  A  review  of  DHS  and  MICS  surveys  in   nine  countries.  Asia-­‐Pacific  Journal  of  Public  Health.  2011  Jul  13  [Epub  ahead  of  print].  24.   Speizer  IS,  Magnani  RJ,  Colvin  CE.  The  effectiveness  of  adolescent  reproductive  health   interventions  in  developing  countries:  a  review  of  the  evidence.  J  Adol  Health  2003;  33:  324– 48.  25.   Oringanje  C,  Meremikwu  MM,  Eko  H,  Esu  E,  Meremikwu  A,  Ehiri  JE.  Interventions  for   preventing  unintended  pregnancies  among  adolescents.  Cochrane  Database  Syst  Rev.   2009(4):CD005215.  26.   Bearinger  LH,  Sieving  RE,  Ferguson  J,  Sharma  V.  Global  perspectives  on  the  sexual  and   reproductive  health  of  adolescents:  patterns,  prevention,  and  potential.  Lancet.  2007  Apr   7;369(9568):1220-­‐31.  27.   Blum  R,  Mmari  K.  Risk  and  protective  factors  affecting  adolescent  reproductive  health  in   developing  countries.  World  Health  Organisation.  Geneva,  2004.  28.   UNFPA.  Adolescent  sexual  and  reproductive  health  situation  analysis  for  Solomon  Islands.  A   review  of  literature  and  projects  1995-­‐2005.  UNFPA  Office  for  the  Pacific,  Suva,  Fiji;  2006.  29.   UNFPA.  Adolescent  sexual  and  reproductive  health  situation  analysis  for  Vanuatu.  A  review   of  literature  and  projects  1995-­‐2005.  UNFPA  Office  for  the  Pacific,  Suva,  Fiji;  2006.  30.   Kirby  D,  Laris  BA,  Rolleri  L.  Impact  of  sex  and  HIV  education  programs  on  sexual  behaviors  of   youth  in  developing  and  developed  countries:  FHI  youth  research  working  paper  no  2.  North   Carolina:  Family  Health  International,  2006:  1–56.  .  31.   SPC  Assessment  report  of  adolescent  sexuality  education  (or  Family  Life  Education)  in  ten   PICTs.  AHD  Section,  Secretariat  of  the  Pacific  Community:  June  28,  2010.  32.   Maticka-­‐Tyndale  E.  Evidence  of  youth  peer  education  success.  In  Adamchak  S.  Youth  Peer   Education  in  Reproductive  Health  and  HIV/AIDS.  Youth  Issues  Paper  7.  Arlington,  VA:  Family   Health  International  (FHI)/YouthNet,  2006.      .  33.   Kim  CR  and  Free  C.  Recent  evaluation  of  the  peer-­‐led  approach  in  adolescent  sexual  health   education:  a  systematic  review.  International  Family  Planning  Perspectives2008;  34(2).  34.   Wakefield  MA,  Loken  B,  Hornik  RC,  Use  of  mass  media  campaigns  to  change  health   behaviour.  The  Lancet.  376(9748):1261–71  (2010).  doi:10.1016/S0140-­‐6736(10)60809-­‐4.  35.   SPC.  Pacific  adolescent  health  and  development  partnerships  expanded.  AHD  Section,   Secretariat  of  the  Pacific  Community,  Suva,  Fiji;  2011.  Available  at­‐about-­‐spc-­‐news/824-­‐pacific-­‐ adolescent-­‐health-­‐and-­‐development-­‐partnerships-­‐expanded.html.  36.   WHO.  Adolescent  friendly  health  services.  An  agenda  for  change.  Department  of  Child  and   Adolescent  Health  and  Development.  World  Health  Organisation,  Geneva;  2002.  37.   SPC.  Youth  friendly  service  clinic  assessment  in  5  Pacific  Island  countries.  AHD  Section,   Secretariat  for  the  Pacific  Community,  Suva,  Fiji.      NZPPD  Open  Hearing  Submission  –  Burnet  Institute   12