It's all about choice

The MDGs hope to address global development issues with specified targets and indicators which measures nations' progress. The goals seek to eradicate extreme poverty and hunger (MDG1), achieve universal primary education (MDG2), promote gender equality and empower women (MDG3), reduce child mortality (MDG4), improve maternal health and increase universal access to reproductive health (MDG5), combat AIDS, malaria and other diseases (MDG6), ensure environmental sustainability (MDG7) and to develop a global partnership for development (MDG8).

Globally-speaking, we have reasons to celebrate - maternal and child mortality have dropped, a record number of children are enrolled at primary school level with the number of girls equalling the boys for the first time, statistics point to a halving of the global extreme poverty rate, some two billion more people have gained access to safe drinking water and so forth.

Basic-needs poverty in Fiji fell from 40 per cent in 2002-03 to 35 per cent in 2008-09. However, in Fiji, the incidence of poverty or hardship is markedly higher in the rural areas compared to the urban centres. Available data indicate that poverty rates in FSM, Samoa, Tonga and Tuvalu have increased.

In the Pacific, according to the 2012 Pacific Regional MDGs Tracking Report published by the Forum Secretariat, the region's progress is "slow and uneven". The report also reveals significant variation between countries and sub-regions, however.

Melanesia (excluding PNG) has mixed progress on all the MDG goals except MDG goal 4. Low levels of child and infant mortality in Fiji, the second most populous country, as well as in Vanuatu, the fourth most populous Pacific Island country, underpin positive results in MDG 4.

Polynesia is doing well considering it's on-track progress status for four goals MDG2, MDG4, MDG5 and MDG7 while Micronesia is not on-track for any of the goals - it has an off-track status on MDG1 and a mixed progress status for the remaining goals.

The Cook Islands and Niue are definitely on-track to achieve the MDGs. The report notes the three years remaining until the 2015 deadline. Leaders and other stakeholders are aware of the general interventions that need to be employed and as per the Cook Islands communiqué (2012) have agreed to support specific focus for the "final push".

For the United Nations Population Fund (UNFPA), MDG5, of all the MDGs, reflects the closest the development areas governments have mandated us to work in. It is two-pronged; MDG5a aims to reduce, by three-quarters between 1990 and 2015, the maternal health ratio and MDG5b aims for universal access to reproductive health by 2015.

When reproductive health is discussed, a key aspect of this field is voluntary family planning which is the provision of appropriate services to support individuals and couples' decision on the number of children they want and their spacing (or indeed to support their decision not to have children if they choose) . To access reproductive health, for example, is to be able to acquire modern contraceptives when one needs to or be able to receive quality antenatal care.

Studies have shown that if women can space and decide the number of children they want, this vastly improves their chances of having safe pregnancies and deliveries, being in good health and having the luxury of time and energy to focus on the wellbeing of their families and by extension, their communities and countries.

These points were reiterated during the recent inaugural Conference on Repositioning Family Planning in Fiji, held in Viseisei Village in Vuda, which included young people and village-based health workers.

UNFPA reproductive health adviser Dr Wame Baravilala discussed among other factors, how the limited discussion of family planning may be one of the challenges when one speaks of progress in reducing maternal mortality and ensuring universal access to reproductive health.

The lack of discussion on family planning may be attributed to cultural and/or religious considerations that frown on serious, albeit frank, discussions over anything remotely linked to sex. The phrase "family planning" may also be a barrier in itself, we acknowledge that people may take "family" and "planning" literally and thus exclude themselves from reproductive services because despite being sexually-active, they do not necessarily have a family.

This open discussion may also contribute to Fiji's static uptake of contraceptives - the contraceptive prevalence rate (CPR) or use in Fiji has stagnated in the last 20 years. Records, however, do not always reflect those who access reproductive health services from private practitioners.

Discussions on the benefits of family planning need to be done openly in our villages, a participant from Bua at the meeting said, particularly its links to the cycle of poverty, for example. Family planning is not about control, it is about choice: smaller numbers of children mean more family resources for a good start in life for children, a better chance at higher education and so on.

While access to reproductive health services is important, the quality of these services is just as important. Studies have shown that the greater the options in terms of contraceptives, the greater the likelihood of people considering these methods.

Findings of a study in the Nadi-Lautoka corridor which was shared at the Viseisei meeting affirmed that a lot of unmarried young women who were sexually-active continued to fear contraceptives because of myths that, for example, contraceptives would prevent them from getting pregnant when they eventually wanted to start a family. This is not true.

There may also be a need to ensure that reproductive health services can be accessed from alternative points, not just the health facilities. Underlining the provision of adequate and quality reproductive health services, however, is the need for women, men and young persons to be well-informed but above all, to be assured of confidentiality.

As we count down to the 2015 deadline for achieving the MDGs, let us not dwell on skeptics who lament "it is too late" but rather focus on what we can do to increase social, political and financial support for voluntary family planning.

• This is part of a series of columns provided for publication to Fiji's largest national daily newspaper, The Fiji Times, fortnightly.