Working towards gender equality in rural Timor-Leste and Papua New Guinea: community health survey

The centrality of gender equality for sustainable human development is well recognised and reflected in the Sustainable Development Goals (SDGs), however in many countries in the Pacific region gender inequality is widespread. Working with men and boys presents an important opportunity to address gender inequality. A ‘Men’s Health Project’ was implemented in rural districts in Timor-Leste and Papua New Guinea (PNG) in 2014-17, which aimed to promote gender equality and improve sexual and reproductive health and maternal and child health outcomes by actively engaging men. Community surveys were undertaken in each community before and after project implementation to enable a greater understanding of men’s knowledge and attitudes at these different time points. This paper reports findings from the more recent surveys with 400 men in Timor-Leste in 2016 and 243 men in PNG in 2017, in order to provide a ‘snapshot’ of the situation in these rural communities at this time. In both countries, the vast majority of men reported that the husband makes the major decisions in the household (80% in Timor-Leste and 84% in PNG). In Timor-Leste, 5% of respondents felt it was okay for a husband to beat his wife, with 13% reporting this in PNG. Findings suggest that meeting SDGs 3 and 5 will require ongoing and concerted efforts in Timor-Leste and PNG.

Mothers and sisters: educators of sexual health information among young Niue women born in New Zealand

ABSTRACT: Background: For many Pacific youth in New Zealand, discussing sexual health topics with their parents or families remains a highly sensitive subject that is uncomfortable and culturally challenging. These conversations are even more difficult for young Pacific females who are expected to show modest and virtuous behaviours. The aim of this paper is to describe the role of mothers and sisters in conveying sexual and reproductive health information among young Niue women born in New Zealand. Methods: Twenty Niue young women took part in semi-structured qualitative interviews. The young women needed to be of Niue descent, born in New Zealand, living in Auckland and aged between 16-24 years. Findings: This study highlighted the influential role of mothers – both Island born, and New Zealand born – within the home, with mothers identified as being more likely to be involved raising and educating daughters around sexual health. The young women firmly believed mothers were their first teachers and were better placed to lead such sensitive discussions. Interestingly, the findings also drew attention to the role of sisters in the dissemination and search for sexual health information, with many of the participants reporting sisters as important positive influences. Conclusion: This research provides important findings on the role of Niue women – both mothers and sisters – who have been identified as a key source and educator of sexual health information. These findings have significant relevance for Niue women and the potential for intergenerational discussions to take place, ensuring young Niue females are informed with adequate information and advice to make informed sexual health decisions.

Impact of an empowerment program on young mothers in Ba Province, Fiji

Background: Disempowerment is both a cause and effect of unplanned pregnancies in young girls and women. An “Empowerment of Disadvantaged Young Mothers” program was implemented between January 2017 and March 2018 in western Viti Levu, Fiji, to improve young mothers’ knowledge of reproductive health, chance of employment, self-reliance and agency. Aim: To evaluate the outcomes of the “Empowerment of Disadvantaged Young Mothers” program implemented by the Viseisei Sai Health Centre, Lautoka, Fiji. Methods: This is a mixed method retrospective study using quantitative and qualitative data from project records. Findings: There were 89 participants in the program who resided across 22 communities. Almost 75% reported not using a contraceptive as the reason for their unplanned pregnancy. Analysis of pre- and post-program assessment found increases in the number of mothers employed (5.6% vs 27.3%; p=<0.001), registered with National Employment Centre (14.7% vs 47%; p=0.002) and accessing a Pap smear (27.3% vs 60.6%; p=0.003). A third of the participants described feeling “motivated”, “empowered”, “inspired” or “increased confidence” to achieve their original career or educational goals as a result of attending the training. Most reported that the workshops had changed their perspective and given them new hope for their future, with a “reduced sense of isolation” in finding a support network. Conclusion: This empowerment project made substantial increases in the rates of employment and uptake of reproductive health and support services amongst the young mothers, as well as an overall decrease in sense of isolation and improvement in social wellbeing. They felt more “empowered” and “motivated” to make positive changes in their lives to enhance their financial independence and improve quality of life for themselves and their children.

Evaluation of Community Health Workers’ Upskilling Training in Maternal and Newborn Care at Mount Hagen in Western Highlands Province, Papua New Guinea

Background: Community Health Workers (CHWs) in Western highlands Province were given a 6-month CHW upskilling training to enable them to provide essential maternal-newborn care, do timely referral of high risk clients and refer emergencies to hospital. Five trainings were conducted over the five year period. Forty seven (47) CHWs were upskilled over that five year period. Aim: To evaluate the effectiveness of the CHW Upskilling Training during 2012 – 2016. Methods: A post-training assessment was conducted by direct observations of the CHWs and the Officer in Charges (OICs) at their workplaces. Assessors observed the application of knowledge and skills and determined if there were improvements in the health facilities. Purposeful discussions were carried out to elicit qualitative feedback from CHWs OICs of the health facilities. Findings: The findings were impressive. The organisation of health facilities improved with specific schedules made for priority reproductive and maternal health services. The recording of maternal and newborn care services indicated great improvement. The ANC, family planning and labour ward registers indicated the kinds of services provided including management of life-threatening conditions. Records show reduced maternal and newborn deaths. Records also show reduced unnecessary referrals. Conclusions: The CHW Up skilling Training Program is an effective intervention to improve reproductive health and maternal-newborn services in remote areas of Papua New Guinea, particularly where there are no midwives, or higher category health care providers. It has contributed to improved maternal-newborn survival. Recommendations: The evaluation recommends that the CHW Upskilling Training should reach more CHWs to fill in gaps in health facilities where there are no midwives or doctor. In Papua New Guinea, the CHWs Upskilling program in maternal and newborn care is recommended for all CHWs.

Fertility preference of pregnant women attending the Colonial War Memorial Hospital (CWMH) Antenatal Clinic, Suva, Fiji Islands, 2015

Background: There are more than two hundred million women in developing countries of childbearing age who do not use modern contraceptives but wish to avoid pregnancy. The Total Fertility Rate (TFR) in Fiji remains moderately high at 2.6 children per woman. This survey was conducted to identify the fertility preferences of pregnant women attending the Colonial War Memorial Hospital (CWMH) Antenatal Clinic, in Suva, Fiji Islands. Methods: This descriptive cross-sectional study was conducted among 2,203 pregnant women who attended the antenatal clinic of CWMH in Suva between May 2014 and December 2015. A self-administered questionnaire was used to collect the data. Using purposive sampling, those who met the study inclusion criteria were asked to answer the questionnaire. The collected data was analysed using SPSS and descriptive statistical analysis and the results are shown in tables and graph format. Results: The majority of participants were aged 20 to 24 years old (36.3%) and more than two thirds of them were married (88.1%). Ninety-one percent of the participant’s partners were employed and 58.3% of them were living together for 0 to 4 years. Fifty one percent were 20 to 24 years at the time of first sexual intercourse. The best spacing time to wait between pregnancies was reported to be 3 years (37.4%), followed by 2 years (27.3%) and 4 years (12.8%). One third of participants (34.5%) preferred to have one child after this pregnancy. A majority of participants were planning to have 3 to 4 children (48.6%) when they were nulliparas. Importantly 50.3% of women did not want any more children after this pregnancy highlighting an unmet contraception need. Conclusion: The results of the study highlighted the fertility preference of pregnant women in Fiji and the factors affecting it. This study will give insights to decision makers to develop interventions based on the influencing factors which can affect promoting family planning among Fijian women.

Prevalence and characteristics of caesarean section (CS) among pregnant women who delivered at the Colonial War Memorial Hospital (CWMH) Suva, Fiji, 2016

IntroductionIn recent decades we have noted a marked increase in caesarean section (CS) rates in both developed anddeveloping countries. Institutional data indicate a rise in CS rates in Fiji however published data in thisregard is lacking. This study aims to estimate the prevalence and identify the characteristics of CS atColonial War Memorial Hospital (CWMH) in 2016.MethodologyThis is a retrospective audit of 1625 women who underwent CS at CWMH from 1st January 2016 to 31stDecember 2016. A data collection form was developed to collect data from the birth register book. Thedata collected included patients’ demographic characteristics, indication for CS, surgeon hierarchy, andwound check review. Data was analyzed using SPS and the results were presented in tables and graphs.ResultsOf the1625 CS patients who met the study criteria, the majority were I-Taukei (77%; n=1148) and 20-34years old (60%; n=887) and Primigravida (45.5%, n=739). Caesarean delivery was mostly performed bysenior registrar (n=1002; 62%). Of 1625 CS 87.7% (n=1409) were emergency CS and 13.3% (n=216) wereelective CS. Fetal distress was found in 56% (n=911) of all CS cases. , followed by obstructed labour(15.6%) and foetus mal-presentation (13%). More than half of patients (n=537; 59.0%) were considered asnon-reassuring for fetal distress. In obstructed labour group 81.1% (n=223) were first stage obstruction.Breech was most common mal-presentation (n=192; 86%). The results of the study revealed that there wasa high compliance rate (n=1435; 97%) of non-private CS mothers (n 1478) followed at CWMH for awound check following caesarean.ConclusionIn 2016 CWMH recorded it highest rate of CS births and while it just at the newly defineoptimum CS rate, it is part of a rising trend in CS rates in CWMH. In this respect there is aconcern that the majority of CS was done on first time mothers with at least secondary leveleducation, this trend as this would suggest an ongoing trend to increasing CS rates. There is aneed to define fetal distress and arrested labour amongst these women to reduce unnecessary CS.Further studies are needed to explore the impact of this CS rate on hospital budget and resourcesand therefore the implications of a rising trend.

Barriers and enablers for cervical cancer screening in the Pacific: A systematic review of the literature.

Background: Globally cervical cancer is the fourth most common type of cancer in women and in some low-income countries is the most common cancer in women. Papua New Guinea has a particularly concerning incidence of cervical cancer where it ranks first as the leading cause of cancer in females. Screening is a reliable strategy to detect cervical cancer but implementation of screening in Papua New Guinea is poor. The aim of this review is to identify the enablers and barriers for cervical cancer screening in Papua New Guinea. Methods: A systematic search of peer-reviewed literature was conducted using electronic databases; PubMed, Medline, Scopus, CINAHL and Google Scholar. Articles published between 2007 and 2017 that focused on the enablers and barriers to cervical cancer screening were included. Only one study from Papua New Guinea was identified so the search was extended to include other Pacific Island Countries and Low-Income Countries more broadly. Findings: Twenty articles met the inclusion criteria. The main barriers for cervical cancer screening included a lack of women’s knowledge about cervical cancer and screening, a lack of health facilities for screening, diagnosis and treatment, lack of health care worker knowledge and training, cultural beliefs and financial burdens. The main enablers included women having access to education programs, availability of cervical cancer screening services, female friendly environments and health care workers being trained to undertake screening. Conclusions: While the literature highlighted the importance of cervical cancer screening, a range of barriers limits the delivery of this service in low-income country settings. In particular, there is a gap in the knowledge of barriers and enablers within Papua New Guinea and further research in this country is required. Applying the knowledge learned from other low-income countries and gaining a clearer understanding of both the barriers and enablers for cervical cancer screening in the Papua New Guinea context may lead to clear recommendations to improve implementation and uptake of cervical cancer screening.

A qualitative study of Pacific women’s knowledge and awareness of gynaecological cancers in Auckland, New Zealand

Introduction The aim of this paper is to understand knowledge and awareness of gynaecological cancer among Pacific women. The key objectives are to examine the level of awareness Pacific women have about gynaecological cancers, to identify the barriers accessing gynaecological services and to obtain feedback as to what would be the best way of educating and informing Pacific women. Methodology Data was collected through semi structured interviews which took place in Auckland. Twenty Pasifika women were interviewed during 2015-2017. A general inductive approach was used to analyse the data. Ethical approval was granted by the University of Auckland Human Subjects Committee Ethics Reference Number 016670. Findings The definitions of gynaecology varied with many Pacific women never hearing of the term gynaecological cancers. The women identified that their primary sources of information for health and gynaecological health were; personal experiences, relatives that were previously diagnosed, health professionals, pamphlets and posters, school sex education, referrals through the health system, website searches, friends and family. There were a number of barriers to accessing gynaecological services. These included a lack of awareness of services, personal fear, shame, busy schedules, physical examinations, and attitudes, preference for a female doctor, poor health literacy, language difficulties, costs, public health system versus private health system., Participants identified a number of key areas strategies for gynaecological cancers. Their needs to be more information about the types of services that are available, accessing services, community outreach programmes and services, flexible opening hours and culturally appropriate information. Conclusion Given the multi-faceted and complex nature of this project, the recommendations provided are multi-levelled and will require inter-sectoral partnerships for community and education awareness is needed to enhance Pacific women’s access to gynaecological services in New Zealand.