needs tracking

A tragedy that needs tracking

THE unavailability of contraception and reproductive health care for both men and women is the cause of ongoing and major tragedy in the Pacific.

Each year hundreds and hundreds of Pacific women die in childbirth. They leave behind them children who have to grow up without a mother and husbands who have to shoulder the bur den of parenthood alone.

Similarly, a rapidly growing number of teenagers are finding themselves heading down the path to single parenthood - a path that leads to poverty and lack of future life chances for both mother and child.

Much of this trauma need not have occurred if contraception had been available to those who wanted it.

But that is a much more difficult task than one might think, especially in these times of economic reform and public service

‘right sizing’.

In general. Pacific governments are very committed to solv ing these problems, not just because of the immense tragedy they cause, but also because rapid population growth is one of the biggest threats to the economic well-being of Pacific nations.

Since the International Conference on Population and Development (ICPD) in Cairo in 1994, Pacific governments have been taking a much more sophisticated approach to these issues. Reproductive heath is seen as an issue that goes well beyond the old-style maternal and child health programmes.

It takes in the concerns and responsibilities of men as well as women, and of adolescents, and it recognises that one of the most effective ways of addressing the toll of death and injury caused by women having too many children is to improve the education and status of women and girls.

At the same time, the threat of deadly sexually transmitted diseases such as HIV7AIDS, and the very successful preventative health campaigns that have been waged against them, have rev olutionised debate and education programmes on issues such as

contraception.

Ten years ago, many people would have choked on their com flakes if they had seen a word such as “condom” appearing in their morning paper.

Now it is not all that unusual and contraception and repro ductive health are accepted as legitimate subjects of discussion.

But still women die having children they would not have had

* if contraception had been available. » It is Melanesia that suffers most in this regard. In Papua New * Guinea, 930 women die for per 100,000 live births and UNICEF » says that for each woman who does not survive, another 30 incur * “injuries, infections or disabilities which are usually untreated J and unspoken of and which are often humiliating, and painful, * debilitating and lifelong”. » In Vanuatu, 280 women die per 100,000 live births. Even in * Samoa where the toll, at 35 per 100,000 live births, is much I lower, the death rate is still too high - much higher, for instance, \ than the rate in Australia of just nine deaths per 100,000 live

I births.

* Much of the problem in Melanesia comes down to the cost of * providing services in isolated areas. * In those same areas, governments are struggling to provide » any health service and when they do, all the necessary medicines I are not always available on dispensary shelves. Providing contraception to those who need it is even more \ tricky. Often the nurses staffing aid posts are male, perhaps even * a relative, or friend of one’s father or husband. * Discussing intimate details with them can be impossible, and * cultural taboos or other sensitivities make asking for contracep ’ tion very difficult.

I Many of these problems would be simply solved with more money, something the developing countries promised at the 1 ICPD conference in Cairo but have not delivered. » 1 The United States has cut all its funding to the United Nations Family Planning Agency (UNFPA) the lead agency on these issues, over a dispute about resuming operations in China.

Australia, too, has cut its funding to a range of bodies includ ing UNFPA (cut by 50 per cent), the International Planned Parenthood Federation (IPPF) and the International Union for the Scientific Study of Population.

All Australian funding to the Population Council and the World Health Organisation’s Human Reproduction programme has been abolished.

The most important commitment at Cairo, however, was one by developed nations to spend 0.7 per cent of their annual bud get on aid and four per cent of that on population and reproduc tive health programmes.

For young people wanting access to contraception, the prob lems of their mothers are multiplied, particularly when it comes to finding services in which they feel comfortable to ask for advice.

Concern about providing contraceptives to unmarried people remains among some politicians, bureaucrats and health work ers. Perhaps it is because of this, that the excellent education campaigns now running on reproductive health in most Pacific countries have not always been followed up with the availability of contraceptives themselves.

Community attitudes are changing, especially among mothers who realise the way young people lead their lives has changed and would much rather see their daughters protected from unwanted pregnancies and sexually transmitted diseases.

This month, Health Ministers from around the world will meet at the Hague, in the Netherlands, to review progress since the Cairo conference and map out a plan for the next five years.

More money and some concrete plans to get contraceptives to people who need it are what is needed. ■

Jemima Garrett

Sydney