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).