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Planning your life with contraception

Finau* had no plans of becoming a mother anytime soon. She was young and still in school. But her life took a turn when she became pregnant unexpectedly and had to temporarily leave school. Finau is one of the many women and girls in Fiji - one in five (1) - who is not using any method of contraception despite not having plans to establish or expand her family.

Family planning enables women to decide when they would like to have children, as well as decide on the size of their family. It preserves the health of women and girls and empowers them to pursue an education, a career and lifetime dreams. It also boosts women's ability to contribute to the economy and, as a result, allows them to invest in the health and education of their children. Family planning has many implications and goes a long way to helping women achieve equity and empowerment in Fiji and the Pacific.

Health workers play a vital role in providing accurate information on family planning options to clients like Finau. But in many instances, they still contend with long-held cultural and/or religious resistance to the uptake of contraception even more so if clients are single women and young people. As a result, women and young people may not seek family planning, increasing the likelihood of unplanned pregnancies. Young people like Finau should have access to accurate information and support to be empowered to make informed choices and prevent unplanned pregnancies.

 


Dr. Brian Guevara
Chief Medical Officer

   Dr. Brian Guevara, Chief Medical Officer for the Obstetrics and Gynaecology Department at the Labasa Hospital in Fiji believes that a rights-based approach to         family   planning should be centred on a woman’s informed choice tailored to her situation.
   “We do our best to inform them of the contraceptive methods available.  However, at the end of the day, we must respect the choice a woman makes with her body.”
 
    Unfortunately, it has not been not uncommon that health workers decide the family planning option for their clients.

 

 

 

 

 

 


Dr. Mere Sigawale
Medical Officer

 Mere Sigawale works as a Medical Officer in the Lautoka SRH Clinic in Fiji.

 
She explains:“Because of our cultural and religious values, some health workers tend to rush through the consultations with adolescents and make choices for them in terms   of family planning.”   

 

 

 

 

Upskilling health workers to reduce the unmet need for family planning

These lingering societal issues with contraception are among the factors causing women like Finau's family planning needs to go unmet, and the Pacific Ministries of Health, UNFPA and the Australian Government are working together to change this.

Ending unmet need for family planning is one of the key results to be achieved by the Sustainable Development Goals’ by 2030. To drive progress toward this result, UNFPA Pacific partners with the Governments of Fiji, Kiribati, Samoa, Solomon Islands, Tonga and Vanuatu to implement the Transformative Agenda programme, with funding from the Australian Government. In collaboration with the governments of these countries, and with support from Family Planning  Australia, one health worker per service delivery point in each country is being trained to provide rights-based, client-centred family planning services to everyone, including youth and people with disabilities.

 

Dr. Jennifer Butler, UNFPA Director and Representative for the Pacific Sub-Region, explains “We work to integrate family planning services into primary health care, so that everyone is able to access the relevant information and services, like contraceptives, allowing them to make informed choices”.

In each country, experienced clinicians are trained as Champion or Master Trainers. The Champion Trainers act as in-country facilitators to train other trainers (Master Trainers) and both – Champion and Master Trainers – will rollout Family Planning training to health workers nationwide. Dr. Guevara was part of the Family Planning Champions training conducted in Fiji.

“The training was a real eye-opener for me, as it brought out the nuances of training health care professionals to deliver family planning services to the community. We then had an opportunity to put our skills into practice by running the Ministry of Health’s Family Planning training of trainers course, which had over twenty participants from all over Fiji. Qualified health professionals then returned to their places of work trained in counselling and dispensing of family planning commodities.”

 

By the end of 2022, services delivery points in the six countries - ranging between 50% in the Solomon Islands and 100% in Samoa and Tonga - will have a trained health worker on  location to provide rights-based and client-centred family planning services.

 

Family planning during crises

Since the Family Planning training, Fiji was hit with two tropical cyclones, Yasa and Ana, in December 2020 and January 2021 respectively. The close interval between these storms caused major damage to infrastructure and put tremendous stress on livelihoods and social structures in the communities exposing women and girls to many risks; particularly in Fiji's Northern division, on the Island of Vanua Levu. In response, UNFPA Pacific, in conjunction with the Fijian Ministry of Health and Medical Services, set up six "Women-Friendly Spaces" to provide a haven for women and adolescents in the affected areas, to rebuild their social networks, receive family planning counselling and supplies, to access antenatal and postnatal care, and to be referred to specialized, gender-based violence services.

Since April 2021 Fiji has also been experiencing a second wave of the COVID-19 and this is putting additional stress on the national health system. Medical emergencies now take greater priority and family planning services risk receiving less emphasis.

Recognizing the stress on the health system in cyclone and COVID-19-affected areas, UNFPA Pacific has trained and deployed 30 retired midwives to establish 3 “Women-Friendly Spaces”, to support emergency field hospitals, and to conduct community outreach with health teams. With the help of the Family Planning Champion Trainers, these retired midwives work to support health workers in ensuring that sexual and reproductive health services are still provided to women, adolescents and youth.  As a result, 5,397 women and young people have received family planning methods, consultation and outreach services between May to July 2021.

“UNFPA Pacific continues to work with governments and partners to prioritize the needs of women and girls of reproductive age to ensure that family planning services remain available during challenging emergencies”, explains Dr. Jennifer Butler.

The retired midwives received updated training and education on current contraception methods, including Long-Acting Reversible Contraception (LARC), to prevent unplanned pregnancies, particularly during crises.  Dr. Guevara was among the people who trained them.

“We trained the retired midwives who were re-engaged to run these Women-Friendly Spaces and updated their knowledge on family planning especially around long-acting reversible methods.”

He explained that the type of LARC has changed since the midwives retired. They have experience with Norplant while the Ministry of Health and Medical Services uses Jadelle more commonly. During the refresher training, Dr. Guevara provided them with practical information to safely dispense Jadelle and other LARC commodities. 

One of the trained midwives is Sister Moapa Nainima, who provided Finau with family planning information and services after she gave birth to her child.

Finau now wants to prevent a second pregnancy and she has selected Depo Provera, which is a short-term, injectable contraceptive that provides three months’ protection, until she is able to receive a long-term implantable contraceptive method.  

“I plan to go back to school and finish my education. I am using Depo Provera now and will have an Implant soon,” said Finau.

The Transformative Agenda programme

The Transformative Agenda programme is a $30 million (AUD) investment by the Government of Australia’s Department of Foreign Affairs and Trade, implemented by UNFPA. The programme seeks to reduce the unmet need for family planning over a 51-month period (2018-2022) in six priority countries: Fiji, Kiribati, Samoa, Solomon Islands, Tonga, and Vanuatu. The programme has three focus areas 1) increasing the supply of family planning information and services, 2) generating demand among the public for family planning information and services, and 3) creating a more conducive environment for people to access family planning information and services. The Family Planning training intervention falls under the first focus area.

 

*Name changed to protect privacy. 

  1. UNFPA (2000). Achieving the MDG’s (Millennium Development Goals) in the Pacific Island Countries: Policies and Strategies in Population and RH (Reproductive Health).