CLAIMING HEALTHY FUTURES PMA in partnership with the FMA and the FSM

1. CLAIMING HEALTHY FUTURES PMA in partnership with the FMA and the FSM Challenges to Women’s Health in the Pacific Wame Baravilala UNFPA Pacific Sub-Regional Office

2. Determinants of Women’s Health • Biological characteristcs • Girls biologically tougher than boys • Women shoulder the burden of reproduction • Range of social factors • Boys are favoured in some societies – nutrition, education, access to health • Decision making, acess to resources in male hands • Education, income, urban-vs-rural divide • In many societies women shoulder the burden of production

3. :Gains in Women’s Health in the Pacific • Increasing life expectancy (better diet, water supply; education, immunisation; fewer deaths from infections) • Reduction in maternal deaths in most countries as more women are delivered by skilled attendants • Greater availability of contraceptives but uptake has yet to catch up • Screening for and treatment of non communicable diseases (NCDs) • Some screening for and treatment of cancers

4. Main women’s health concerns (1) Non-communicable diseases and obesity: • Significant and increasing obesity in the region, which is amongst the highest in the world; • Diabetes, heart disease, high blood pressure; • Shortening life expectancy, causing major disability; • Poor compliance with dietary requirements and drug treatment; • Multiple complications in pregnancy; • Behaviour change needs to start in childhood: urgent action required!

5. Prevalence of NCD Risk Factors among 25-64 Age Group by Gender in 4 PICs

6. Main women’s health concerns (2) Cancers affecting women: • High rates of cervical cancer (an STI), linkage between obesity and breast cancer; • Poorly developed cancer prevention awareness amongst women reflecting the general low status of Pacific women; • HPV vaccination offering hope; major price reduction • Very few PICs have fully functioning cancer detection programmes: • Where they do exist: poorly funded/equipped, poor registration systems, poor follow-up; • Rudimentary cancer treatment services available.

7. Female population and estimates of incidence and mortality for cervical cancer in the Pacific

8. Main women’s health concerns (3) Violence against women: • Three national representative studies show high levels of (severe) VAW – including sexual violence • Great interest in other countries for similar studies; 2 countries to issue reports shortly, 5 others due to undertake the study • Women reporting VAW to health workers is extremely rare, but may present with another health complaint; • Most PICs health systems are not addressing VAW; those that do are not sensitive/comprehensive/ competent; • PNG has now created a GBV position in DOH • Low awareness of the health consequences of VAW • VAW not integrated into health professions training

9. Main women’s health concerns (4) Infectious diseases: STIs: increasing, particularly amongst young people; world’s highest prevalence in pregnant women age 19-25, reflects low awareness and low condom use; female condom use in some PICs negligible HIV: is predominately a STI; married women are “passive” victims; PNG generalized epidemic; again low condom use. Double sexual standards (self protection) for girls/women increasing susceptibility Malaria: affects many women and children in Melanesia, increased risk from anaemia in pregnancy; treated bed-nets is effective prevention and becoming more common.

10. Main women’s health concerns (5) Reproductive health: • Maternal illness and maternal deaths unchanged overall for the region – most countries improving, some countries regressing; • Inequity and inequality of services to women/unmarried persons/women with disabilities/rural; • Unplanned pregnancies: no solution in sight; • Low use of modern contraceptives (married/unmarried), despite being freely available from UNFPA; and • Reproductive cancers.

11. Women’s access to health services is constrained by: Social-cultural issues • Low personal health seeking behaviour; • Women put themselves and their health last; • Male dominant cultures and cultural restriction for women to access health care from male doctors and nurses; • Partners control over women’s movements; and • Low education and health awareness of women.

12. Women’s access to health services is constrained by: The health system • Highly centralized health system: urban based, variable quality; • High costs associated with travel to health facility and consultation, drugs and others; • Government-run health services insufficiently funded in some countries; disproportionate amount of the health budget allocated to hospital and curative services; • Preventative services, including screening for cancers, non-communicable diseases, STIs and other conditions either do not exist or are very poorly resourced; • Health services are not women-friendly/gender-responsive; • Health professionals not gender sensitive, nor client-oriented.

13. Women’s access to health services is constrained by: The setup of Reproductive Health services • Often funding of sexual and RH services, including FP, is left to development partners - not considered a high priority; • RH services mainly cater for married women; focusing mainly on safe motherhood; • Unmarried women, young people and men are marginalized; • RH services do not cater comprehensively for violence against women (VAW); • Cancer prevention, detection and management services is grossly inadequate: e.g. Breast and cervical and ovarian cancers are significant causes of ailment and death. The above reflects the general low status of women in the Pacific

14. Contraceptive Prevalence Rate Selected PICs

15. Unmet Need for Family Planning • Is the desire to limit or postpone childbearing but not using any modern method • Demographic Health Surveys reveal Pacific data

16. Accelerating progress: Regional Strategy There needs to be a bold, new approach, in order to effectively address women’s health issues • A Regional Strategy for Women’s Health needs to be developed by gender and health partners in collaboration with stakeholders; • The Regional Strategy should be on the agenda at the next Pacific Ministers of Health Meeting, to be followed by endorsement by the Forum Leaders (or MSG); • This strategy should be within the framework of women’s rights; • All PICs should allocate a percentage of national health budget for women’s health; • Development partners can be asked to assist; • Review of progress made after 5 years by Pacific women’s organizations and health ministries.

17. Thank You Danyabaad, Vinaka Wame Baravilala UNFPA Pacific Sub-regional Office baravilala@unfpa.org