Youth SRHR in the Pacific: deserving urgent attention.

Covering over 29 million square kilometres of ocean, the Pacific region is characterised by diversity. The region's 22 countries and territories speak over one-third of the world's languages. Its 9.6 million people live in vastly different environments: from tiny coral atolls to expansive, forested mountain interiors. Out of 182 countries, the 2009 UNDP Human Development Report rates several Pacific Island countries as experiencing medium levels of development. Papua New Guinea (PNG) is the lowest at 148, sitting alongside Haiti. The Solomon Islands is at 135, alongside the Congo. Samoa is the highest at 94 "with Tonga at 99 and Fiji at 108. In general, women experience a lower status than men across Pacific countries, with the Pacific having the lowest number of female parliamentarians in the world. Pacific people are increasingly urbanised and predominantly young, "with 56% of the population under the age of 24 years. (2)

It is these young people who are the future of our region, and who need improved sexual and reproductive health (SRH) services. We have made progress in meeting these needs. Access to antenatal care has improved, skilled attendance at births has increased, vaccination coverage (3) has expanded and in some countries, maternal deaths have reduced. Legislation affirming, promoting and protecting women's rights have been passed in some countries. Greater attention is being paid to some SRH issues, particularly HIV.

A good deal of work has been done to ensure that young people can visit youth-friendly information and services. The Adolescent Health and Development programme, across 10 Pacific Island Countries, has been working for several years to promote youth-friendly services. Similarly, provision of sexuality and relationships education in skills has been the subject of efforts across several Pacific Island governments, with support from various development agencies.

But to ensure our young people can enjoy safe and healthy sexual and reproductive lives, and make the most of life's opportunities, we need to do more. We know this because not only do young people tell us, but also because the statistics indicate this. A study of young people aged 15-24 years of age in Samoa, Vanuatu and the Solomon Islands showed that about two thirds of young people were sexually active, with the median age at first sex 16 years, with a range of 10 to 23 years. (4) However, this study showed that condom use is generally low, with one third of young people having used a condom with their casual partner in the last 12 months but only 12% using a condom consistently with their casual partners. Condom use at first sex ranges from 15% in the Solomon Islands to 24% in Samoa. The use of modern contraceptives amongst women aged between 15-48 years ranges from 18% in Kiribati to 24% in PNG to a high of 64% in the Northern Mariana Islands. (5)

Related to this situation of generally low contraceptive use, unintended teenage pregnancy across the Pacific is high, in some cases, amongst the highest in the world. In the Marshall Islands, the rate of births per 1,000 teenage women is 138. In Papua New Guinea it is 65, while in Tuvalu it is 42.6 Similarly, sexually transmitted infections are high in young people: a 2005 study revealed a prevalence of chlamydia in under-25 year-old pregnant women of 40.7% in Samoa and 34% in Fiji. (4)

There are many reasons for these statistics. Attitudes and beliefs that young people should not be sexually active until married, and a lack of policy and legislative attention to young people's rights and gender inequality, contribute to underfunded and unsupported sexual and reproductive health services and information. Violence is also a major concern in relation to SRH. While boys in particular, and some men, experience sexual coercion and violence, it is by far women and girls who predominantly survive the trauma of violence. A study in Samoa (2007) found that 46% of women had experienced physical and/ or sexual violence. Similar studies in the Solomon Islands (2009) found that the percentage of women who experience violence is 64%, while in Kiribati (2009) it is 68% of women. (7) This violence has severe impact on a girl's sexual and reproductive health and rights across her lifespan, and her ability to enjoy opportunities she would otherwise be able to.

All these statistics point to the need for quality, confidential, non-judgemental information and services for young people, including contraception and safe abortion. These activities need to be supported by comprehensive, evidence-based sexuality and relationships education. Parents, teachers, politicians and health care professionals need to recognise, and be supported to recognise, that adolescence is a time of transition for young people and that exploring sexuality and sexual intimacy is an important part of this transition.

We must draw inspiration and encouragement from the achievements we have already made, to garner us for the five years to 2015. Our progress proves to us that we are able to address challenging issues, so let us spare no effort to make expanded rights, choices and opportunities the legacy of the ICPD PoA in the Pacific and all across the globe. Our people are entitled to nothing less, especially our young people. Our future depends on it.

Endnotes

(1) More information can be found in A Measure of the Future at www.fpi.org.nz This study amalgamates primary data from DHS, Censuses and other sources. Not all Pacific Island Countries have the same data available, which is why this publication is generally referred to rather than primary data sources, so that data from across the region can be provided.

(2) Secretariat of the Pacific Community. 2009. Pacific Island Populations: Estimates and Projections of Demographic Indicators for Selected Years. Noumea, New Caledonia.

(3) UNFPA, UNICEF, WHO. 2009. Maternal Health in the Pacific. Wellington, NZ: UN Health Agencies' Submission to the NZ Parliamentarians' Group on Population and Development (NZPPD).p.1.

(4) WHO. 2006. Second Generation Surveillance Surveys of HIV Other STTs and Risk Behaviours in Six Pacific Island Countries. Geneva, Switzerland: World Health (Organisation. pp. 20-25.

(5) Family Planning International, Secretariat of the Pacific Community, Population Action International. 2009. A Measure of the Future: Women's Sexual and Reproductive Risk Index for the Pacific 2009. Family Planning International. p 22. (Data from years 2000--2008.)

(6) A Measure of the Future ,p 22. (Data from years 1996-2007.)

(7) A Measure of the Future, p 30.

By Joanna Spratt, Director of International Development (at the time of writing), Family Planning in New Zealand.

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