Discussions
Four key action areas are proposed to best promote and protect adolescent sexual and reproductive health in the Pacific. They are complementary and intersecting (14,15) and should involve the participation of young people . Pacific nations have the opportunity to review their current situations, and build national programs based on what interventions work best in their own settings. ASHRHR programmes must develop to become large scale and sustainable. This requires greater attention and investment.
  1. Creating an enabling environment for ASRHR
Children and adolescents spend the greatest amount of time at home and schools; therefore parents and teachers must provide the enabling environment that builds trusting relationship for information sharing, communication, mentoring and counseling (14). Programmes to support parents, guardians and teachers are required. Churches, NGOs and community support groups play a critical role in this process. Programmes should also empower young people so that they can exercise their human rights, with special attention given to younger adolescents, 10-14 years of age.
  1. Comprehensive Sexuality Education (CSE)
    Children and adolescents need to build knowledge, skills and attitudes on gender norms, power imbalances, traditions and practices, respect for people in line with traditional structures. CSE should start as early as the beginning of primary school and integrated into standard school curriculum. This requires that teachers training institutions teach CSE for pre-service teachers while practical arrangements are made for in-service teachers. CSE should reach all adolescents, including the most vulnerable and marginalised (14,15). In countries where primary school enrolment is low, CSE programmes for out-of-school should be developed to engage churches, NGOs and other community-based institutions. CSE should strongly address gender based violence and other forms of violence. This is particularly relevant in the Pacific where the prevalence of gender violence is one of the highest in the world.
  2. Adolescent Health Services and Demand Creation
    Programmes must address both establishing adolescent services and creating demands for services. Increased adolescent uptake of SRH services has been shown to include a combination of training and support of health workers; improving adolescent-friendliness of health facilities; and information outreach through multiple channels (14,15). The relevance of innovative initiatives such as school-based clinics can be explored in schools that will also develop and teach CSE.
  3. ASRHR as an integral part of SDGs programmes
    ASRHR programs must be implemented on a large national scale as part of government programmes within the framework of SDGs. Large-scale programmes can facilitate collaborative work across sectors to gain greater impact. EG: Increased utilization and greater demands for adolescent health services will occur if education and empowerment programmes for change behaviours are also implemented. Small scale and short-term projects are not sustainable and investing in such should be avoided (14,15).
In summary the key action areas outlined above should link sexuality education and reproductive health (SRH) services; build awareness, acceptance, and support for youth-friendly SRH education and services; and address gender inequality in terms of beliefs, attitudes, and norms; and target early adolescents, where appropriate. Implementers should adopt some key principles for improved results such as: adolescent-focused, political support, community participation, multi-sectoral engagement, partnerships, results-based and working towards sustainability.