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UNFPA Pacific, Port Vila, Vanuatu (March 26, 2015) - Katherine Silas grimaces but one is not entirely sure if it is in response to pain or merely the sight of the needle being used to implant the long-term contraceptive, jadelle, a week after Cyclone Pam wrought havoc on the Pacific island nation of Vanuatu on the night of March 13.

The nurse, Julienne Aru continuously speaks to her quietly in the local Bislama language as she expertly teases the contraceptive under Ms Silas' skin, all the while explaining the process.

The demand for sexual and reproductive health-related services after Cyclone Pam had increased so much for the Vanuatu Family Health Association that the office in which Ms Aru, the association programme manager, was working out of had to be converted into the third consultation room.

Ms Aru who was part of the United Nations Population Fund (UNFPA) jadelle insertion training in October 2014 found herself pitching in to meet the demand; jadelle, Ms Aru explains has become popular among ni-Vanuatu women because of its long-term duration (five years).

"Life blong me," Ms Silas says emphatically why she opted for family planning, describing a largely absent father of her three children. For five years since 2008, she had been going to the hospital for depo-provera injections, a three-month contraceptive, albeit his disapproval.

"He helps only sometimes but did not want me to take contraceptives," the Tanna native who lives and works in Port Vila explained. Family planning options were explained to Ms Silas by Port Vila Central Hospital staff after the birth of her first child, Tinet who is now 8 years old.

When she became pregnant again barely a year later, she took matters into her own hands and began taking pills and depo-provera on the quite. She became pregnant again in 2014 with her youngest.

"He (the father of her children) has been away almost three months now on the cruise ship he works on and not a single phone call and sometimes I pay for everything," Ms Silas, a domestic help, said.

The issue of partners or husbands disapproving of family planning is widespread and both women agree it is not so much about the myths that surround it but rather emotional: Ms Silas for example says the father of her children suspects her of sleeping with other men if she had no fear of pregnancy.

"But I want a good future for my children. I want to buy a piece of land so my children can have something. Taking this option now (jadelle) is so much better because for five years, I don't have to worry about forgetting to take my pill or that is it the third month and I need to go for my stick (injectable depo-provera)," Ms Silas said.

Since the beginning of 2015, Ms Aru says she has already performed 14 jadelle implants; her colleagues are likely to have performed more. Ms Aru said since being given a vehicle by UNFPA in 2014, awareness and outreach has increased.

"The UNFPA gave us a vehicle that has proven most useful in terms of awareness and the increase in the number of people who come in, even just for information is obvious after these outreach activities," Ms Ari said.

The UNFPA Pacific Sub-Regional Office also pays for a position of a Family Planning and Youth Sexual and Reproductive Health Specialist, Claire Davies, from the New Zealand Volunteers Abroad Scheme.

Ms Aru said since beginning her term with the VFHA at the end of last year, Ms Davies has been instrumental is strengthening their capacity and relationship with the Vanuatu Government pharmaceutical arm.

Most of the nakamals, kava bars which are across Port Vila city and its peripheral settlements, now have condom dispensers.

"From feedback both before and after Cyclone Pam, I know we are providing services that people want, some come here just to avoid the long queues at the hospital," Ms Aru said.

"We know that a mobile clinic is critical at a time like this; having just opened our services we decided just to offer free services for now, which has been very much taken advantage of; we hope that some funding from the response to Cyclone Pam will allow us to actually go out."

A UNFPA team arrived in Vanuatu on March 22 to contribute to the rehabilitation response to Cyclone Pam, working with the Government of Vanuatu, civil society and the Office for the Coordination of Humanitarian Affairs Since.

UNFPA has since agreed to a collaborative framework of complementary programming with more than 20 non-government organizations (NGOs) through the umbrella body Vanuatu Association of NGOS, VANGO; this is apart from its financial commitment and the provision of commodities like reproductive health and dignity kits.

On March 28, the team distributed 46 kits in the village of Fresh Wind Ohlem working with the Ministry for Health and the Vanuatu Women's Center. Dignity kits with hygiene supplies are prepared for women in humanitarian situations, the impact of which is experienced differently by women and girls though their needs are not usually prioritized in national responses.

A 2012 study on the prevalence of violence against in Vanuatu reported 60 per cent intiminate partner violence and 48 per cent non-partner violence. Gender-based violence (GBV) can be exacerbated in emergency evacuation centers and host-family accommodation.

"The people of Vanuatu are proving once again how resilient they are after a cyclone destroyed 5 of the 6 island provinces in the archipelago, UNFPA reached out to partner community-based organizations and helped them to mobilize an emergency response plan for their communities. This includes maternal health outreach, adolescent reproductive health programming and GBV prevention and response initiatives," Maha Muna, UNFPA Pacific Gender Adviser said.

"Young people are stepping up and participating in the longer term needs assessments in their communities and they have begun volunteer outreach to help clear the destruction and rebuild lives."

Reproductive health kits which were airfreighted in on March 28 will replenish the stock at damaged hospitals and health centers, to ensure support for emergency obstetric care, antenatal care and post-natal care services.

Activities the UNFPA has been involved in for the Cyclone Pam response include:

  • The production of a Flash Appeal to raise almost $30m for emergency relief and mobilization of a United Nations (UN) emergency relief funding (CERF) of $225,000 for reproductive health and protection programmes, reflected in the Flash Appeal;
  • Reconnected with community-based organizations to develop outreach programmes of reproductive health services and protection messages to women and youth, and working with vibrant women's machinery to ensure that the humanitarian relief remains responsive to women and girls;
  • Organized a campaign to distribute Dignity Kits to pregnant and lactating women, as well as women who access Vanuatu Women's Center crisis services; and 
  • Advocating for the reopening of markets for women to enable them to sell garden crops and earn money for children to return to school, buy household supplies and pay for healthcare.