SHARED RESPONSIBILITY IN PACIFIC REPRODUCTIVE HEALTH

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By Rowena Singh

NOUMEA, New Caledonia (May 31, 2000 – SPC)---"Women's and men's knowledge, attitudes and behavior play an essential role in harmonious family life, reproductive health and decision-making," says Mrs. Dharma Chandra, from the University of the South Pacific (USP)'s Population Studies Program.

"In most developing countries, participation of men in reproductive health in either direct or indirect ways is limited. Reproductive health components, such as family planning, safe motherhood, prenatal and postnatal care and child rearing, are seen as women's responsibilities," Mrs. Chandra added.

There is a large gap between the population rise in the Pacific region, and the availability of services and resources to meet the demands of an increased population. Total population in the region has risen to approximately 7.4 million. Though numbers and growth rates vary from country to country, most are finding it difficult to provide resources demanded by the rapidity of the population rise.

In Tuvalu, about 43 percent of the total population live in the capital, Funafuti, with the average household size being about eight per household. The problems of solid waste production and disposal, overcrowding and limited land for housing and agriculture are some of the major population-related problems affecting Funafuti.

However, population is only one reason why there is an urgent need in the Pacific region for awareness and practice of reproductive health issues.

There is a significant increase in unwanted and teenage pregnancies, sexually transmitted diseases and high-risk sexual behavior in the Pacific region. Since the first report of HIV in the Pacific in 1984, the number of new infections reported each year has risen. In PNG the peak age group infected are those in their twenties, while in Fiji it is the thirty to thirty-nine age group.

The major barrier to positive reproductive health practices is the gender imbalance in the roles and responsibilities of men and women.

A study in Cook Islands, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu, was commissioned by the International Planned Parenthood Foundation (IPPF) to gauge male attitudes, knowledge and practice of family planning across the region.

This research, carried out by Mrs. Dharma Chandra and Mr. Anand Chand of USP, showed that there was a high level of awareness amongst men in certain areas of reproductive health. This information was generally obtained from the media - radio, TV, and newspapers. Some information was gained from friends or peers, as well as from medical sources, particularly for men whose partners visited a family planning center.

However, throughout the Pacific men did not carry their knowledge of reproductive health through to practice. Men did not practice safe sex and were found to have negative attitudes towards use of condoms or vasectomy.

In the Pacific region, men have a poor understanding of the reproductive system. They lack knowledge of sexually transmitted infections (STIs) associated with HIV/AIDS, and were unaware of STIs such as gonorrhea and syphilis and reproductive health-related cancers.

"In the Pacific region there is less male participation in reproductive health," says Dr. Ezekiel Nukuru, Population Advocacy and Reproductive Health, Information and Communication officer at SPC.

Dr. Nukuru stressed that family planning services in most Pacific countries have been directed towards women. Men have not been involved, and preferred their spouses to obtain information.

According to Ms. Shamima Ali, Coordinator of the Fiji Women's Crisis Centre, men are often the ones making decisions on family planning issues.

Violence has been linked with assertion of this control over decision-making processes. A significant percentage of women across the region have also suffered from reproductive health problems as a result of violence such as beatings during pregnancies. Married women especially have shown less ability to negotiate safe sex.

The IPPF study shows that limited detailed knowledge and limited access to information prevent men from practicing positive reproductive health practices and safe sex.

Most men are aware only of a limited number of contraceptive methods. Though the condom was widely known, use of condoms was limited. Vasectomy was the least-known method in many countries. It was not generally promoted. Men also lacked detailed information on the side effects of the different methods.

Although men are aware of family planning, their access to family planning information is limited. Men in rural areas have more problems accessing contraceptive methods and information.

In the Cook Islands men felt shy to be seen visiting the clinic and about talking to clinic staff. They are also shy about providing details required at the clinic.

In Pacific Island countries, some religious beliefs prohibit the use of contraception to control fertility.

Cultural norms in the Pacific also restrict family planning. Large families are desirable for old-age security and for a helping hand in wealth generation. In most Pacific Islands a strong value is placed on children.

Gender and kinship relationships make it difficult for men to discuss family planning topics in the presence of relatives during meetings and workshops. Men's traditional role and their position and status in family and the community do not permit them to discuss or seek information on family planning and contraception.

Men often feel that a woman's traditional and natural role is that of childbearing and child nurturing. Traditional culture and the status of women in the households, together with family planning efforts being directed to women, further enforce this role.

At the moment, the reproductive health services in the Pacific are not adequate, though there have been initiatives in some countries to try and improve on that. These include setting up services and clinics that are specifically for men.

In Fiji, Dr. Neil Sharma has set up the Male Wellness Clinic that provides services for men with problems such as impotence, problems getting erections, advice on available methods of contraception, and the general well being of men.

An SPC (Secretariat of the Pacific Community) reproductive health project gives priority to promoting male participation. The focus of this UNPFA-funded project is advocacy, information, education and communication in reproductive health. It covers seven priority countries: the Solomon Islands, Samoa, Vanuatu, Tuvalu, Kiribati, the Federated States of Micronesia and the Marshall Islands.

Equal participation in reproductive health can only be achieved through a process of evolution, where cultural and social barriers will gradually come down.

Education, both formal and non-formal, is essential. Men with a higher level of education are more likely to be aware of the importance of gender equity, the practice of non-violence and family planning.

For this purpose, theater plays a vital role, as most people respond better to theatre than other mediums, as it does not depend on literacy and encourages interactive discussions.

Coordinated national policies that focus on the broader issues of population and reproductive health incorporating good and comprehensive population and reproductive health strategies for the entire Pacific region are needed. Private sectors, religious organizations and non-government organizations need to work with governments and the wider community to raise awareness, and provide information and services through workshops, programs, theater and other means

The strains on resources through increased population, the risks of unwanted pregnancies, teenage pregnancies, and the potential consequences of STI and HIV/AIDS all show the necessity for men to become equal partners in tackling sexual and reproductive health concerns.

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