Adolescent Reproductive Health : Issues and Challenges in the Pacific

Dr. Praema Raghavan-Gilbert, Adviser on Reproductive Health and Gender

Introduction

The Pacific is unique in that it is a region characterized by young populations ranging from 18% in Cook Islands to 25% in FSM (1994 Census) with all the inherent problems embedded in this characterisation – high dependency ratio, rapidly changing socio-cultural values & norms, ever rising aspirations of the young for education, skills training and employment. The loss of traditional family role models and parental guidance in sexual behaviour and sexual behaviour modeling has also contributed to loosening of attitudes to premarital and unsafe sex. The sexual behaviour of adolescents is modelled increasingly now after their peers, and not their parents and elders.

Regional organisations and national governments are cognizant of the consequences of these changes. MOH and NGO service statistics indicate rising levels of teenage pregnancy, sexually transmitted diseases (including Hepatitis B, HIV/AIDS), suicides, botched abortions, and abandoned newborn babies. About 15% of all deliveries in the Pacific Island Countries between 1990 and 1994 were to adolescent mothers, 60% of whom were unmarried (UNFPA/CST Sectoral Review, 1996).

ADOLESCENT MOTHERS BY COUNTRY AND YEAR

Source: [Katoanga, S.F. UNFPA/CST]
*Source: [Watson (WHO), 1997:5]
**Source: Ministries of Health Reports

The picture is depressing for all who work in adolescent health care because in the future of the youth of the Pacific is invested the future of all the Pacific Island Countries.

Issues

In the past, adolescents were largely neglected in both health and family planning programmes. This is partly explained by the fact that in many societies adolescents are not considered sexual beings until marriage. Another factor in this systemic neglect is the unfounded fear that providing information and services would encourage premarital sexual activity. As a result, unmarried adolescents have been denied access to services by law or written or verbal policy. And yet, young people’s reproductive health needs require urgent consideration, as indicated by recent global trends.

Young people need comprehensive information and access to services and to have the right to privacy, confidentiality and respect. When young people have access to private and confidential services, it has been demonstrated that they are better able to protect themselves against sexually transmitted diseases (STDs), avoid unwanted pregnancy, care for their reproductive health and take advantage of educational and other opportunities that will affect their lifelong well-being. Fear that access to information and services will lead to greater sexual activity among youth, has not been supported by numerous studies.

Actions taken during adolescence can affect a person’s life opportunities, behavioural patterns and health. The loss of human capital in the next generation of Pacific Islanders through the abrupt and premature curtailment of educational and employment opportunities, aspirations, chronic ill health and premature death is enormous. From a national perspective, these exposures to health risks are costly. There are expenditures directly associated with both childbearing and disease, and indirect costs incurred when the full potential of the individual is not realized. Moreover, early childbearing generally leads to higher lifetime fertility for the individual women and to a reduction in the time-span between generations. Governments and civil society cannot continue to ignore these losses citing custom, religion and taboo as the impeding factors.

Biologically, socio-culturally and economically the adolescents of today are different from the youth of 30 years ago. Their bodies mature earlier, they marry later, have increased opportunities for opposite – sex interactions and relationships, the ‘outing’ of homosexuality and a greater tolerance in society of sexual preferences, the globalization and influence of role models projected throughout the media, and increasing difficulty in finding good jobs in a market with moving targets. Adolescents also live in a more dangerous world with deadly and debilitating diseases like HIV/AIDS, Hepatitis B and Herpes.

Adolescents have a diversity of personal and health needs. These vary with their special life situations e.g. marital status, sexual activity status, single motherhood, experience of abuse and rape, street children, commercial sex workers and adolescents with special educational and physical needs and diseases. All have needs that must be approached in different ways. It is therefore important to understand adolescent sexual and reproductive health in the context of the individual’s overall life situation. There are no generic solutions.

The role of the proximal social influences such as parents’ attitudes to sexuality, marital and child rearing behaviour, religious and educational and work experience of parents, and the attitude of peers to premarital sex, contraception and safe sex practices must be considered in programme design.

The distal social influences related to the prevailing youth culture, adult and media models of sexual behaviour, and the social institutions of school, religion and law are important formative environments that cannot be excluded in programmes designed to reach adolescents. A holistic understanding of ARH needs is essential for successful programmes.

Challenges in Adolescent Reproductive Health

Healthy adolescent development is undermined by factors in the social environment. These include poverty and unemployment, gender discrimination, and the impact of social changes on familial and cultural support systems. While programming for adolescent health cannot directly focus on the inequities present in countries, these conditions represent real constraints to improving the health and welfare of youth. The attitudes and behaviours that health programmes seek to influence often arise from other socio-economic influences. For this reason, adolescent reproductive health programming must be integrated with all aspects of social development.

There is a lack of formal knowledge through research about adolescence in the Pacific and therefore about the needs of the different groups. Without this information, it is difficult to design effective programmes to reach all adolescents, except through their active involvement Little is known, except for anecdotal information about relationships with their parents and elders in societies where traditions and customs are fast evolving as in the Pacific Island Countries. Commonly held myths and misconceptions, both generic and specific to the Pacific culture about sexuality will need to be addressed. The role, level and quality of communication in the Pacific between the adolescents, parents, church and school will need to be better understood and addressed in information and counselling services. Male involvement and responsibility for safe and healthy sexual behaviour and attitudes will need to be studied.

The judgmental attitudes of the service providers and the provision of adolescent friendly services within existing health structures will need to be assessed and addressed as should the design and implementation of youth friendly service delivery points.

A group discussion during the Programme Management Workshop

In many countries, governments will need to demonstrate commitment to the ICPD PoA on Adolescent Reproductive Health by legislation and policy changes which clearly state that adolescents are entitled to Adolescent Reproductive Health information and services both as a human right and as a commitment to investing in their human capital. Since little is known through research on the complexity of issues facing adolescent reproductive health behaviour in PICs, it is crucial that young people be involved throughout the different phases of programming from needs assessment to evaluation. Advocacy efforts to convert and recruit influential members of the community to push for a multi-sectoral approach to link education, employment and health of the adolescence of the PICs must be unrelenting.