NUKU'ALOFA, Tonga - “Now I am confident that I can continue providing this family planning service.” Ms. Lienita Talamai, a family planning service provider in Tonga, is celebrating a new achievement: learning how to insert an intrauterine contraceptive device (IUCD), tiny, but one of the most effective long-term, reversible contraceptive devices.  “When I first provided this service, I was a bit scared,” she recalled. “But, having gone through the [UNFPA] training, I found the procedure very interesting, and actually very easy.”

Health care facilities in Tonga are currently offering IUCD; however, Ms. Lydia Holan, a family planning client, recalls IUCD were previously not easily accessible to her for a long time. “I went to a nearby health facility three times asking for the IUCD method, but no one was available to give the service.  So, I had to ask my cousin who is a nurse where I could get my IUCD from, and she referred me to another place.”

Lienita is happy because she knows that the number of Tongan women like Lydia who face difficulty in accessing family planning services will drop - Lienita is one of 39 health care workers in Tonga who participated in a recent training that UNFPA Pacific provided to improve the coverage and quality of family planning service provision in the country. And as a result of this training, now 100 per cent of the 31 health facilities across Tonga, which is made up of 171 islands, have at least one staff who is fully trained as to how to provide youth-friendly and disability-inclusive family planning services.

“A key accelerator in reducing the undesirably high unmet need for family planning”

This is a ground-breaking step forward in the context of family planning in the Pacific region in general, and in Tonga in particular. Contraception is a key tool for people to achieve life goals and well-being. For the adolescent and youth, avoiding unintended pregnancies increases the likelihood that they can stay in school, advance their education, and improve their economic prospects, so that they can contribute to the socio-economic development of their community and of the country as a whole. And yet, according to the most recent 2019 Tonga Multiple Indicator Cluster Survey (MICS) supported by UNICEF, UNFPA, the Pacific Community (SPC) and the Australian Department of Foreign Affairs and Trade (DFAT), 22.5 per cent of all women in Tonga aged 15-49 have the so-called “unmet need for family planning”— when a woman wants to delay pregnancy or does not want to get pregnant but is not using any contraception - and the adolescent birth rate in Tonga (30 births per 1,000 girls of 15-19 years of age) has increased. 

Young people, and persons with disabilities, in Pacific Island countries and territories often face difficulty in accessing quality family planning services. Often because of misconception, taboos and customary beliefs that they are not, or should not be, sexually active, many of their family members and even health care workers fail to see the necessity to acknowledge the needs of young people and persons with disabilities and to support them to access appropriate family planning services.

“Empowering all cadres of health workers to provide family planning services is a key accelerator in reducing the undesirably high unmet need for family planning in the Pacific,” highlights Dr. Titilola (“Titi”) Duro-Aina, UNFPA Pacific Chief of Health (Sexual and Reproductive Health and Rights Technical Advisor) who led the family planning training in Tonga for Lienita and others.

South-South Cooperation between Tonga and Fiji

The family planning training that Dr. Titi led in October 2022 included a ‘refresher’ course for nine participants who had attended a previous training UNFPA provided in 2021. This time 30 new participants joined, from 29 health facilities and institutions across the country. In addition to learning how to provide counselling on all family planning methods, health workers also gained knowledge and skills from the training on how to provide basic counselling and referrals, attend to specific family planning needs of people living with disabilities, and screen women and girls at risk of gender-based violence. Because of this training, for the first time in the history of Tonga, reproductive health nurses will now be providing Jadelle, a contraceptive implant, in all health facilities.

The training also served as an inspiring example of South-South Cooperation between two Small Island Developing States (SIDS) in the Pacific: Fiji and Tonga. Dr. Merewalesi (“Mere”) Kurulo from the Oxfam clinic in Suva, Fiji, worked with UNFPA Pacific to help roll out the trainings in Tonga. Dr. Mere belongs to a pool of family planning master trainers in Fiji who were trained by UNFPA in 2020 on the new training package to share the knowledge and skills with health workers nation-wide and beyond. 

For mothers’ lives and health

Tonga’s nation-wide achievement accomplished through the training supported by UNFPA Pacific was part of the ‘Transformative Agenda’ programme – a multi-year, multi-country, comprehensive programme funded by Australia’s DFAT that aims at ‘zero unmet need for family planning’ in the Pacific currently implemented in six countries including Tonga, along with Fiji, Kiribati, Samoa, Solomon Islands, and Vanuatu. The programme focuses on human rights and client-centred approaches to family planning, ensuring that family planning services are youth-friendly and disability-inclusive.  

According to the UNFPA-supported 2019 Health Facility Readiness and Service Availability (HFRSA) report - a landmark publication produced also as part of the DFAT-funded Transformative Agenda programme - 97 per cent of health facilities in Tonga provided family planning services already when the assessment was conducted. However, only seven per cent of these facilities were deemed to be providing adolescent- and youth-friendly services according to global standards.
 

Ms. Manafonu Siola’a, Deputy Supervisor of Public Health at Tonga’s Ministry of Health, believes that the series of trainings provided by UNFPA for health care providers across the country will yield many benefits for Tonga. “The training will help Tonga achieve the Sustainable Development Goals, making sure that mothers and babies receive quality health care in a safe environment,” she said. “It will help us ensure that mothers are in good health before having the next baby, avoid having too many babies, and avoid dying during pregnancy or childbirth. Mothers are the foundation of every family. The knowledge and skills that reproductive health care service providers have received from UNFPA’s training will always be needed by the people of Tonga.” 

Explore more stories about how UNFPA Pacific is training health care workers on family planning. 

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