Gaps, Challenges and Opportunities
A number of reviews indicate that programmes for adolescent sexual and reproductive health in the Pacific, despite significant investment, have been unequal and fragmented. Some indicate that progress for adolescent sexual and reproductive health and rights (ASRHR), has been ‘limited and patchy’ ( 3,4,7) and therefore fell short of reaching target populations. Innovative approaches in the delivery of ASRH information, education and youth-friendly services have achieved only small scale coverage. The demand for adolescent health services is still relatively low among target populations and therefore available ASRH services are underutilized.
The burden of disease among young Pacific women due to sexual and reproductive health is significantly high. Young women suffer social, economic and health consequences of unplanned pregnancy, gender-based violence and abuse. The risk of maternal deaths and severe pregnancy complications are higher among adolescent women than older women. Young unmarried women who get pregnant often seek abortion. Contraception including emergency contraception is not easily accessible. The levels of unmet need for contraception among Pacific adolescents are generally high (6,9). Adolescents who do not wish to get pregnant and are not using any form of contraception contribute to the unmet need for family planning (11,13).
In PNG, young women are proportionately disadvantaged and have higher rates of HIV infection; they also suffer domestic violence, sexual abuse and discrimination. The prevalence of gender-based violence in the Pacific is one of the highest in the world, exceeding 60% in Fiji, Solomon Islands, Kiribati, Vanuatu and Papua New Guinea. Reproductive health services remain poorly developed in many rural communities because of prevailing influence of conservative political, religious, and cultural factors. Increasing youth unemployment fuels a range of risk taking practices that put them in risky situations – such as alcohol, drugs, unprotected sex, violence and criminal activities. Unprotected sex is the root of problems including: unplanned early pregnancy leading to early motherhood, exposure to risky behavior that increases risk of STI including HIV, and unsafe abortion (6,7).
While progress has been made in achieving improved reproductive health among the general population, interventions targeting adolescents and young people have been slow to achieve a larger scale and coverage. Both supply and demand factors are prevalent. At policy level there has been strong government commitment, but executing and operationalizing this commitment has been weak and poorly resourced. Small scale interventions are not sustainable and inherit difficulties in achieving a wider coverage and in reaching vulnerable groups – those living in remote islands and rural areas, the less educated, and the socially and economically disadvantaged. These groups are less able to exercise their reproductive rights and therefore are more vulnerable to poor health outcomes.
Integration and institutionalization of adolescent health within the existing health services have met with challenges. The intensity of implementation has not been consistent for long-term sustainability. They have been largely small-scale and short-lived. For example peer education, school-based adolescent health curriculum, out of school programmes, NGO-based youth friendly services and other interventions implemented in various Pacific island countries have had mixed results and faced sustainability and continuity challenges.
In September, 2015, world leaders gathered at the UN Headquarters in New York and made history. They adopted the inspiring 2030 Agenda for the Sustainable Development (SDGs), an ambitious blueprint that applies to every nation and aims to leave no one behind (6,7,8). The new 15-year development agenda aims to sustain the gains from the MDGs and to bring together multi-sectoral and multi-level efforts to accelerate development in the spirit of peace, human rights, and poverty reduction. Engaging adolescents is a strong focus of this development agenda (9,10).