* small, isolated populations make if difficult to provide quality sexual and reproductive health services and information, including family planning
* large youth populations - around half of the population is under the age of 24
* high unintended adolescent pregnancies
* rising prevalence of STIs with poor access to treatment and predominantly syndromic management
* persistent high maternal mortality in some countries
* strong conservative beliefs, particularly around sexual activity and contraception
* high rates of violence against women and children
* a generalised HIV epidemic in Papua New Guinea
* widespread gender inequality and lack of policies to support women and girls
* lack of attention by global donors to Pacific-specific needs.
There is an absence of political will to address some of the difficult sexual and reproductive health issues. In many Pacific Island communities, there is widespread public denial - despite the evidence - that young people engage in sexual activity outside of marriage. Some churches have signaled disapproval of the use of modern contraceptive methods. Several Pacific Island Countries, particularly in Melanesia and Micronesia, will not achieve the Millennium Development Goals without accelerated action.
The Pacific Plan of Action on Reproductive Commodity Security was first adopted by health ministers in 2003. The plan aims to ensure that by 2015 every person in the region will have access to the widest range of reproductive health services and commodities. Most Pacific Island countries have integrated reproductive health services into the primary health care system.
However, many Pacific Island countries still suffer from poor access to sexual and reproductive health information and services, particularly communities on outer islands and in rural areas. Key challenges include:
* a lack of trained health care personnel
* low staff capacity to accurately collect and analyse data, manage supplies and develop policies
* insufficient resources to strengthen quality services.
Key barriers affecting reproductive health supply
* Users across the Pacific still report problems obtaining consistent, quality reproductive health services and information.
* A lack of community awareness on contraception and the importance of family spacing.
* Severe service and information access problems for young people. Conservative cultural and religious beliefs have led to reluctance by young people to visit and be seen near reproductive health clinics.
* A lack of workforce development and training, and few systems in place to manage and retain knowledge.
* Systems for collecting and analyzing information on the supply situation require further improvement.
* In many Pacific Island countries, women remain unable to control their sexual and reproductive health. Male partners sometimes determine contraceptive use and decide which method.
Complex supply chains in the Pacific highlight the urgent need for improved donor coordination and communication. Multilateral agencies, large NGOs and private organisations all procure and provide reproductive health supplies and services in the Pacific. Only a few health ministries across the region have established reproductive health supply budget lines and are working seriously towards reproductive health supplies independence. Most countries remain dependent on donors for commodity supply.
As part of the Pacific Plan of Action, a regional reproductive health supplies warehouse was built in Fiji. Managed by UNFPA, the warehouse now supplies 14 Pacific Island countries with contraceptives. Government ministries receive these supplies at no cost and supplies are dispatched annually.
Reproductive health supply outages are less frequent than previously reported, but are still occurring. Many in-country storage facilities are poorly managed; expired supplies have been dispatched and distributed.
Communication problems are reported between donor agencies sending supplies and the receiving agency in-country. The complex supply chain places an enormous resource strain on small, locally run services, particularly in reporting.
HIV and other sexually transmitted infections (STIs)
Awareness of HIV and AIDS is widespread. However, messages are often based on fear and do not adequately promote prevention, testing and the value of treatment. Despite very low HIV prevalence rates in many Pacific Island countries, regional funding specifically for HIV prevention, care and treatment is higher than funding for general sexual and reproductive health, which includes family planning. 18% of antenatal women under the age of 25 years, tested across five countries in the Pacific, were diagnosed with Chlamydia. As Chlamydia usually causes no symptoms, it is often under-diagnosed and under-treated.
A range of locally branded male condoms are available, but only in simple colours and flavours. Female condoms are not readily available and for some people, they are a preferred alternative to male condoms. In many countries, IUD use is limited by the lack of skilled staff to insert these devices. Vasectomy is not common and rarely available, although this is improving in some countries. Husbands are required to give signed consent for their partner's tubal ligation procedure in many countries. Many health care providers require training on implant provision. Natural fertility methods are not well taught or implemented.
Recommendations to improve sexual and reproductive health and rights in the Pacific
1. Increase training and develop infrastructure to make sexual and reproductive health services youth friendly
2. Integrate HIV and sexual and reproductive health services and information to optimize limited resources
3. Improve data collection and analysis, and find ways to improve knowledge gaps particularly for young people
4. At the country level, health ministries should take all measure to expand the availability of drugs and supplies on the World Health Organization's Interagency List of Essential Medicines for Reproductive Health
5. Improve coordination and communication mechanisms to avoid supply chain problems.
About the research: This information is based on findings from research conducted by Family Planning International (New Zealand) in 2008, drawing on qualitative information on the reproductive health supplies situation in Vanuatu, Kiribati and Tonga. Tapping into civil society networks, the research involved focus group discussions with young women and men, married women, men who have sex with men and sex workers. With a large Pacific youth population, all focus groups included a youth perspective. Key informant interviews were also conducted with government officials, community leaders and health providers to clarify policy and procurement issues. The full report and more detailed recommendations are available from www.fpi.org.nz.