ADOLESCENT REPRODUCTIVE HEALTH

Background

In 1999 the United Nations Fund for International Partnerships (UNFIP), commonly known as the Turner Foundation, provided US$2.34 million to UNFPA for “Improving Adolescent Reproductive Health in the Pacific Region: A Multi-Island, Multi-Sectoral Approach”.  It has provided adolescent reproductive health activities in the Pacific, based on the development of a comprehensive Regional Adolescent Reproductive Health (ARH) Project Framework. 

The overall goal of the Pacific Regional ARH project is aimed at defining and developing new initiatives to meet the unmet reproductive and sexual health needs of adolescents, especially adolescent girls in the South Pacific region.  The regional initiative has developed an enabling environment for the provision of reproductive health information and services to youth and adolescents.  The project recognised the distinct and diverse interests of young people, and the need to adopt innovative strategies to address ARH issues.  

The project consisted of four key components: (1) In-School Programmes, (2) Out-of-School Programmes, (3) Youth Media Initiatives, and (4) Participation of Religious Groups.    Through these components a number of activities were implemented including integrating ARH into schools, training of school teachers, strengthening school-based clinics, establishing community outreach programmes, establishing and strengthening Youth Centres, extensive use of the media, eliciting support from religious communities, and producting of ARH resources and materials. 

Future Directions 

With some remaining funds under regular resources, the UNFPA Office for the Pacific committed US$400,000 to maintain the project’s momentum and sustain it for another 6 months in 2004.  Given the importance of this project in the Pacific, UNFPA Area Office for the Pacific are currently in the process of seeking donor funds for the project through 2004 and beyond.  The project will continue to be executed by the Secretariat of the Pacific Community and implemented in eight Pacific Island countries: the Federated States of Micronesia, Fiji, Kiribati, Marshall Islands, Samoa, Solomon Islands, Tonga, and Vanuatu.  Tuvalu will continue its activities through secured EU funding.  Given the limited funding resources, the areas of focus for 2004 are restricted to:  

1) Strengthening ASRH Information and Education
2) Providing of ASRH Counselling Services
3) Strengthening ASRH Services in Participating Countries – including a specific focus on adolescent girls
4) Strengthening Project Management at Country and Regional Level  

Regional ARH Issues 

Over the past decade, the population of the Pacific Island Countries (PICs) has been growing steadily at around 2.2% each year.  Total fertility rates average around 4 children per woman.  In particular, the Teenage Fertility Rate in the Pacific ranges from 22 in Tonga to 151 in the Marshall Islands.  Growth is highest in the Micronesian countries, which average 2.7% per year, and lowest in the Polynesian countries where growth averages 1.3% per year.  For instance, population growth rate in the Pacific ranges from 3.6 in the Marshall Islands to –1.8 in the Cook Islands. 

One of the main demographic features of PICs and territories is their very young population base, 20 out of 22 countries and territories have median ages of below 25.  While gender disaggregated statistics reveal gender differences have all but disappeared in primary education enrolment, most women in salary and wage employment are still confined mainly to “traditional” occupations.  At the secondary and tertiary level, fewer girls than boys remain in the system long enough to acquire learn basic vocational skills.  This situation is due to poverty and financial constraints, as well as socio-cultural beliefs and practices. 

Although family ties are weakening as these countries develop modern economies;, the implications of these different family configurations are at the centre of local behaviour and beliefs.  Having a sound understanding of them is important for any serious social and economic policy analysis and formulation.  These considerations are also crucial for policy implementation.  In small communities, where people are known to each other, it is not always possible to obtain Reproductive Sexual Health (RSH) or Family Planning (FP) information without the knowledge of other family members.  This can undermine the right to privacy and rupture the relationship of confidence between service provider and client. 

It is apparent that in order to safeguard privacy and client confidentiality young people must be provided with access to reproductive health services from outlets other than the mainstream health system.  Moreover, adolescents prefer to access RH information and services from Non-Governmental Organisations (NGOs) instead of the mainstream health network.  This is mainly due to the personalised service, privacy and confidentiality, which are accorded to clients at NGO-run clinics.  Young people have remarked, “it is far less likely to run into a family member at a clinic which is run by a youth organisation or an NGO”.  Thus, in order to ensure the availability of RH services to young people, partnerships between youth and health NGOs need to be strengthened.  In addition, in those countries where the infrastructure is available for adequate support and training to enable service delivery to young people, client confidentiality should be assured. 

All across the Pacific, the most important gatekeepers in urban and rural communities are the church and parents. Traditional, political and other community leaders are all sanctioned by religious institutions and the region is characterised by close relationships between church and state.  Although they play an influential role in the PICs they have not been effectively used as advocates for ARH issues. 

The percentage of teen pregnancies and STDs in some PICs is symptomatic of other fundamental and complex problems faced by youth. These include the relative social position of young women, because of economic and cultural patterns, sexual violence against young women, misconceptions about sexuality and a lack of information about contraception and safe sex practices.  Sexuality is a “taboo” subject not easily discussed at home. The little sexuality education that does exit is often taught in the context of biology classes, focusing on the physiological aspects of reproduction rather than addressing the difficult aspects of sexuality and communication about sexual needs and desires. 

Given the taboo nature of the topic, young people, in particular adolescent girls, are facing great difficulties in getting access to reliable information regarding their reproductive rights and health.  Too often, such information is provided in a purely medical setting, outside the social, cultural and economic context in which decisions regarding sexuality and RH are made.