1.
NZ
Parliamentarians’
Group
on
Population
and
Development
Open
Hearing:
Adolescent
Sexual
and
Reproductive
Health
and
Rights
in
the
Pacific
11
June
2012
Submission
Burnet
Institute
on
behalf
of
the
Women’s
and
Children’s
Health
Knowledge
Hub
Submission
prepared
by:
Dr
Elissa
Kennedy
Principal
for
Maternal
and
Child
Health
Centre
for
International
Health
Burnet
Institute
NZPPD
Open
Hearing
Submission
–
Burnet
Institute
1

2.
Table
of
Contents
1.
Full
contact
details ............................................................................................. 2
2.
Introduction....................................................................................................... 3
3.
Executive
summary ............................................................................................ 4
4.
Recommendations
and
supporting
information ................................................. 5
4.1
The
need
to
address
adolescent
pregnancy...........................................................5
4.2
Effective
approaches
to
address
adolescent
pregnancy
in
the
Pacific .......6
4.2.1
Increase
development
assistance
for
adolescent
SRH.......................................................... 6
4.2.2
Ensure
adolescents
are
explicitly
addressed
in
reproductive
health
and
population
policy. 7
4.2.3
Improve
the
availability
and
use
of
strategic
information ................................................... 7
4.2.4
Support
efforts
to
create
an
enabling
environment............................................................. 8
4.2.5
Improve
access
to
comprehensive
SRH
information,
including
prevention
of
pregnancy.... 8
4.2.6
Strengthen
health
systems
to
provide
youth
friendly
health
services .................................. 9
5.
References ....................................................................................................... 11
1.
Full
contact
details
1.1 Dr
Elissa
Kennedy
Principal
for
Maternal
and
Child
Health
Centre
for
International
Health
Burnet
Institute
85
Commercial
Rd,
Melbourne,
VIC,
Australia
3004
Phone:
+61
3
9282
2119
Fax:
+61
3
9282
2144
Email:
elissa@burnet.edu.au
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2

3.
2.
Introduction
2.1 The
Burnet
Institute,
on
behalf
of
the
Women’s
and
Children’s
Health
Knowledge
Hub,
welcomes
the
opportunity
to
make
this
submission
to
the
NZ
Parliamentarians’
Group
on
Population
and
Development
Open
Hearing
on
Adolescent
Sexual
and
Reproductive
Health
and
Rights
in
the
Pacific.
2.2 The
Burnet
Institute
is
a
leading
Australian-­‐based
medical
research
and
public
health
institute
seeking
to
achieve
better
health
for
poor
and
vulnerable
communities
through
research,
education
and
public
health.
Through
the
Centre
for
International
Health
(CIH)
Burnet
has
full
accreditation
with
AusAID
as
a
health
development
non-­‐
government
organisation
(NGO).
CIH’s
health
priorities
include
women’s
and
children’s
heath
(including
adolescent
health),
HIV
and
sexual
health,
infectious
diseases
and
health
systems
strengthening.
2.3 In
addition
to
its
office
in
Melbourne,
CIH
has
a
strong
presence
in
Asia
and
the
Pacific
with
country
offices
in
Papua
New
Guinea,
Indonesia,
Myanmar,
Lao
PDR
and
China
(Beijing
and
Lhasa)
and
projects
implemented
through
local
partners
in
Sri
Lanka,
Timor-­‐Leste
and
Vanuatu.
2.4 The
Women’s
and
Children’s
Health
Knowledge
Hub
(WCH
Hub)
is
an
AusAID
funded
partnership
between
the
Burnet
Institute,
the
Centre
for
International
Child
Health
at
the
University
of
Melbourne
and
Menzies
School
of
Health
Research.
2.5 The
WCH
Hub
draws
on
regional
expertise
to
improve
the
effectiveness
of
aid
for
women’s
and
children’s
health,
with
an
emphasis
on
contributing
to
equitable
progress
towards
Millennium
Development
Goals
1,
4,
and
5
–
to
reduce
poverty,
improve
maternal
and
child
health,
and
ensure
universal
access
to
reproductive
health.
One
of
the
key
thematic
priorities
of
the
WCH
Hub
is
to
ensure
universal
access
to
sexual
and
reproductive
health
for
adolescents.
This
work
has
included
research
activities
to
identify
current
needs,
barriers,
effective
approaches
and
knowledge
gaps
in
the
Pacific.
2.7
Burnet
Institute
is
also
a
founding
member
of
the
Australian
Sexual
and
Reproductive
Health
and
Rights
Consortium,
a
collaboration
with
Marie
Stopes
International
Australia,
CARE
Australia,
Plan
Australia
and
International
Women’s
Development
Agency.
The
Consortium
seeks
to
ensure
Australian
non-­‐government
organisations
are
able
to
position
reproductive
health
as
a
priority
within
the
global
health
and
development
agenda.
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4.
3.
Executive
summary
3.1
A
significant
and
growing
proportion
of
the
Pacific
population
is
made
up
of
adolescents
aged
10-­‐19
years.
Adolescents
suffer
a
disproportionate
burden
of
poor
sexual
and
reproductive
health
(SRH),
including
high
rates
of
early
and
unintended
pregnancy,
with
significant
health
and
socio-­‐economic
consequences
for
themselves,
their
families
and
communities.
Addressing
adolescent
pregnancy
and
improving
access
to
family
planning
information
and
services
need
to
be
prioritised
(Recommendation
1).
3.2
Increased
and
long-­‐term
financial
commitment
for
family
planning
in
the
Pacific
is
needed,
with
funding
specifically
allocated
to
adolescent
SRH.
Greater
funding
for
non-­‐government
and
civil
society
organisations
who
provide
the
bulk
of
SRH
information
and
services
for
adolescents
in
the
Pacific
is
also
required
(Recommendation
2).
3.3
Adolescents
do
not
automatically
benefit
from
policies
and
programs
aimed
at
the
general
population.
There
is
need
for
advocacy
and
support
to
ensure
that
adolescent
pregnancy
and
access
to
family
planning
is
explicitly
addressed
in
national
reproductive
health
and
population
policies
and
is
integrated
with
other
youth
policies
(Recommendation
3).
3.4
There
is
an
urgent
need
for
further
research
to
better
understand
adolescents’
family
planning
knowledge,
attitudes,
practices,
preferences
and
socio-­‐cultural
context
to
inform
policies
and
programs.
Advocacy
and
support
are
needed
to
build
local
research
capacity,
strengthen
health
information
systems,
and
ensure
adequate
funding
for
program
research
and
evaluation
(Recommendation
4).
3.5
Advocacy
and
support
are
required
for
multi-­‐sectoral
approaches
to
create
a
supportive
environment
for
adolescent
SRH.
Consideration
needs
to
be
given
to
the
legislative
and
policy
environment
(including
age
of
marriage,
gender-­‐based
violence,
restrictions
on
contraceptive
access
and
abortion);
access
to
free
and
compulsory
education
for
all
adolescents
and
removal
of
policies
that
prevent
pregnant
adolescents
and
mothers
completing
education;
and
support
for
evaluation
of
programs
that
aim
to
address
community
attitudes
and
norms
(Recommendation
5).
3.6
Adolescents
require
access
to
comprehensive
SRH
information,
including
information
about
preventing
early
and
unintended
pregnancy.
Advocacy
and
support
are
needed
to
facilitate
the
scale-­‐up
of
evidence-­‐based
sexuality
education
in
schools,
peer
education
programs
to
reach
out-­‐of-­‐school
adolescents,
and
for
further
research
into
the
potential
of
mass
media
and
communication
technologies
(Recommendation
6).
3.7
Pacific
governments
should
be
supported
to
develop
and
implement
guidelines
for
youth-­‐friendly
health
services.
Non-­‐government
and
civil
society
organisations
currently
providing
a
high
standard
of
youth-­‐friendly
sexual
and
reproductive
health
services
should
continue
to
be
engaged
and
supported
(Recommendation
7).
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5.
4.
Recommendations
and
supporting
information
4.1
The
need
to
address
adolescent
pregnancy
4.1.1
One
in
five
people
in
the
Pacific
is
an
adolescent
aged
10-­‐19
years.1
These
young
people
are
just
beginning
their
sexual
and
reproductive
lives.
Recent
data
indicates
that
up
to
65%
of
girls,
and
72%
of
boys,
aged
15-­‐19
years
have
ever
had
sex,
with
a
significant
proportion
reporting
sexual
debut
before
the
age
of
15.2-­‐8
Many
are
ill-­‐
prepared
for
this
transition,
lacking
adequate
knowledge
and
access
to
comprehensive
information
and
services.
Subsequently
adolescents
suffer
a
disproportionate
burden
of
poor
sexual
and
reproductive
health
(SRH),
including
early
and
unintended
pregnancy.
4.1.2
Adolescent
fertility
rates
are
high
in
many
Pacific
countries
and
have
seen
little
decline
in
the
past
decade.
Between
8
and
26%
of
girls
aged
15-­‐19
have
already
commenced
childbearing.2-­‐8
In
Marshall
Islands,
births
to
adolescents
account
for
20%
of
all
births.
Adolescent
pregnancy
in
the
Pacific
generally
occurs
outside
of
marriage
and
is
often
unintended.9
In
Solomon
Islands,
Marshall
Islands
and
Nauru
more
than
half
of
all
adolescent
pregnancies
are
mistimed
or
unwanted.2,
5,
6
4.1.3
Adolescent
pregnancy,
intended
or
unintended,
has
significant
implications
for
maternal
and
child
health:
globally,
conditions
related
to
pregnancy
and
childbirth
are
the
leading
cause
of
death
of
girls
aged
15-­‐19
years,
who
are
twice
as
likely
to
die
as
adult
women.
Babies
born
to
adolescent
mothers
are
twice
as
likely
to
die
within
the
first
month
of
life
and
suffer
higher
rates
of
perinatal
morbidity.9-­‐11
4.1.4
While
there
is
paucity
of
data
for
the
Pacific,
globally
between
2
and
4.4
million
adolescents
resort
to
unsafe
abortion
every
year,
accounting
for
around
14%
of
all
unsafe
abortions.
Adolescent
girls
are
more
likely
to
delay
seeking
abortion
and
post-­‐abortion
care,
are
more
likely
to
resort
to
unskilled
providers
and
unsafe
methods
and
suffer
higher
rates
of
complication
and
mortality
than
adults.12,
13
4.1.5
Early
pregnancy
can
have
enormous
socio-­‐economic
consequences.
In
the
Pacific,
pregnant
adolescents
are
often
forced
to
leave
school,
contributing
to
a
cycle
of
poverty,
gender
inequality
and
disadvantage
that
impacts
on
girls,
their
children
and
communities
and
hampers
progress
towards
sustainable
development.14,15,
16
4.1.6
The
determinants
of
adolescent
pregnancy
are
complex
and
relate
to
poor
access
to
information
and
services,
socio-­‐cultural
norms,
gender
inequality,
early
marriage,
sexual
violence
and
coerced
sex,
and
low
socio-­‐economic
status.11
4.1.7
In
2010,
Burnet
Institute,
through
the
WCH
Hub,
conducted
a
qualitative
study
in
partnership
with
Wan
Smolbag
Theatre
to
explore
the
barriers
to
accessing
SRH
information
and
services
experienced
by
adolescents
in
Vanuatu.17
The
major
barriers
reported
included:
• Socio-­‐cultural
norms
and
taboos
regarding
adolescent
sexual
behaviour;
• Judgmental
attitudes,
poor
communication
skills
and
lack
of
confidentiality
among
service
providers;
• Cost
of
transport
and
commodities;
• Unreliable
supply
of
commodities;
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6.
• Poor
geographical
access,
particularly
in
rural
areas;
and
• Lack
of
information
and
knowledge
about
their
own
SRH
needs
and
availability
of
services.
4.1.8
These
barriers
contribute
to
inadequate
knowledge
and
low
contraceptive
use
among
married
and
unmarried
adolescents.
Less
than
20%
of
girls
aged
15-­‐19
and
less
than
half
of
adolescent
boys
in
the
Pacific
report
having
ever
used
a
modern
method
of
contraception
(including
condoms).
Between
15
and
52%
of
married
adolescent
girls
have
an
unmet
need
for
family
planning
–
meaning
they
would
like
to
avoid
pregnancy
but
aren’t
currently
using
a
method
of
contraception.
Use
of
modern
contraception
is
lower,
and
unmet
need
higher,
among
adolescent
girls
than
adult
women
aged
over
20.2-­‐8
4.1.9
There
are
significant
opportunities
and
incentives
for
investing
in
efforts
to
prevent
adolescent
pregnancy.
Pacific
populations
are
dominated
by
a
large
and
increasing
youth
bulge,
whose
SRH
impacts
not
only
on
their
own
health
and
well-­‐being
but
that
of
their
families
and
communities.
Delaying
pregnancy
contributes
to
better
health
outcomes
for
women
and
children,
enables
girls
to
complete
education,
may
help
to
address
rapid
population
growth,
and
has
implications
for
sustainable
socio-­‐
economic
development.11,
15,
16
Adolescents
are
the
future
Pacific
parents,
workers
and
leaders
-­‐
investment
in
their
SRH
is
crucial
if
Millennium
Development
Goal
targets,
and
broader
development
goals,
are
to
be
realised.
4.1.10
Recognising
the
critical
importance
of
addressing
adolescent
fertility
and
its
implications
for
sustainable
development
in
the
Pacific,
NZPPD
and
other
stakeholders
must
place
greater
strategic
priority
on
the
prevention
of
adolescent
pregnancy
and
improving
access
to
comprehensive
family
planning
information
and
services
for
young
people
(Recommendation
1).
4.2
Effective
approaches
to
address
adolescent
pregnancy
in
the
Pacific
4.2.1
Increase
development
assistance
for
adolescent
SRH
(Recommendation
2)
4.2.1.1
Funding
for
reproductive
health
in
the
Pacific
is
currently
inadequate.
While
there
has
been
a
minimal
increase
in
development
assistance
for
reproductive
health,
funding
for
family
planning
has
fallen
in
the
past
decade
to
less
than
US$
1
million
per
year
compared
with
US$
31
million
spent
on
HIV.18
An
increased
and
long-­‐term
financial
commitment
for
family
planning
is
required,
with
funding
specifically
allocated
to
adolescent
SRH
to
reflect
current
needs
and
priorities
in
the
region.
4.2.1.2
In
addition
to
supporting
governments
and
multilateral
agencies,
greater
funding
is
needed
for
non-­‐government
and
civil
society
organisations
who
currently
provide
a
substantial
proportion
of
SRH
information
and
services
for
adolescents
in
the
Pacific.
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7.
4.2.2
Ensure
adolescents
are
explicitly
addressed
in
reproductive
health
and
population
policy
(Recommendation
3)
4.2.2.1
Adolescents
suffer
a
disproportionate
burden
of
poor
SRH
outcomes
in
the
Pacific,
but
are
often
overlooked
and
underserved
in
reproductive
policy
and
programs.
Adolescents
do
not
automatically
benefit
from
policies
aimed
at
the
general
population.19,
20
They
face
unique
barriers
and
have
particular
SRH
needs
requiring
targeted
responses
that
are
comprehensive,
evidence-­‐informed
and
reflect
international
agreements
on
sexual
and
reproductive
rights.21
4.2.2.2
NZPPD
and
other
stakeholders
are
in
a
position
to
advocate
for
and
support
the
inclusion
of
adolescents
in
national
reproductive
health
and
population
policies,
ensuring
that
adolescent
pregnancy
and
access
to
family
planning
is
explicitly
addressed
and
is
integrated
with
other
youth
policies.
4.2.3
Improve
the
availability
and
use
of
strategic
information
(Recommendation
4)
4.2.3.1
Quality
information
is
vital
to
support
evidence-­‐based
policies
and
programs.
Currently,
data
for
adolescent
SRH
in
the
Pacific
are
very
limited.
Routine
health
information
systems
often
fail
to
adequately
capture
or
report
data
for
adolescents
and
lack
adolescent-­‐specific
indicators
that
would
help
inform
effective
interventions.22
4.2.3.2
A
review
of
Pacific
DHS
and
MICS
reports
conducted
by
Burnet
Institute
in
2009
demonstrated
that
national-­‐level
surveys
are
frequently
limited
by
the
failure
to
report
data
disaggregated
by
age
and
marital
status
to
demonstrate
outcomes
for
unmarried
adolescents,
and
failure
to
collect
data
for
young
adolescents
(10-­‐14
years).23
The
inclusion
of
unmarried
adolescents
in
the
most
recent
Pacific
DHS
is
encouraging,
however
many
important
indicators,
including
those
relevant
to
family
planning,
are
not
reported
for
adolescents.
4.2.3.3
Further
research
is
urgently
needed
to
identify
adolescents’
knowledge,
sexual
behaviours,
use
of
contraception,
reasons
for
non-­‐use
and
discontinuation,
contraceptive
preferences
and
socio-­‐cultural
and
other
barriers
to
better
inform
policy
and
programs.
There
is
also
a
great
need
for
data
about
sensitive
but
critical
issues
such
as
abortion.
Support
for
rigorous
evaluation
of
interventions
and
approaches
in
the
Pacific
is
required
to
identify
effective
strategies
for
reducing
early
and
unintended
pregnancy.
4.2.3.4
Advocacy
and
support
are
required
to
strengthen
health
information
systems,
ensure
the
inclusion
of
adolescents
(married
and
unmarried)
in
national-­‐level
surveys,
support
efforts
to
enhance
local
research
capacity
and
to
increase
financial
commitment
for
Pacific-­‐based
research.
NZPPD
Open
Hearing
Submission
–
Burnet
Institute
7

8.
4.2.4
Support
efforts
to
create
an
enabling
environment
(Recommendation
5)
4.2.4.1
The
determinants
of
early
and
unintended
pregnancy
are
multi-­‐factorial,
and
available
evidence
indicates
that
multiple,
concurrent
interventions
are
most
likely
to
be
effective,
including
multi-­‐sectoral
approaches
to
create
a
supportive
environment.
This
includes
increasing
youth
participation
in
policy
and
program
development
and
support
for
youth
development
strategies
to
promote
protective
factors.24,
25
4.2.4.2
Consideration
of
the
legal
and
policy
environment
and
its
impact
on
adolescents
is
required.
Legislation
to
prevent
marriage
before
18
years
of
age
and
address
gender-­‐based
violence
should
be
enacted
and
enforced.
Legislation
or
policies
that
restrict
adolescents’
access
to
a
full
range
of
SRH
services,
including
restrictions
on
providing
unmarried
young
people
with
contraception,
or
compulsory
requirements
for
parental
or
spousal
consent,
should
be
addressed.26
Policymakers
need
to
also
consider
the
impact
of
highly
restrictive
abortion
laws,
which
may
disproportionately
affect
adolescents.12
4.2.4.3
In
addition
to
ensuring
free
and
compulsory
education
for
all
adolescents,26
harmful
school
policies
that
prevent
pregnant
adolescents
from
continuing
or
returning
to
education
should
be
removed
and
programs
introduced
to
support
adolescent
mothers
to
complete
education.
4.2.4.4
Socio-­‐cultural
factors
are
among
the
most
significant
barriers
reported
by
young
people
in
Vanuatu.
There
is
a
need
for
evaluations
of
interventions
that
aim
to
overcome
these
barriers,
including
programs
targeting
parents
and
community
leaders
to
address
socio-­‐cultural
norms
and
attitudes.17
4.2.5
Improve
access
to
comprehensive
SRH
information,
including
prevention
of
pregnancy
(Recommendation
6)
4.2.5.1
There
is
a
great
need
to
increase
adolescents’
access
to
comprehensive,
age-­‐
appropriate
SRH
information
and
education.
Evidence
suggests
that
such
information
provided
from
an
early
age
can
have
life-­‐long
protective
benefits.27
While
the
majority
of
married
adolescents
in
the
Pacific
have
heard
of
at
least
one
modern
method
of
contraception,
limited
data
indicate
that
comprehensive
knowledge
about
prevention
of
pregnancy
is
poor.28,
29
Research
conducted
by
Burnet
in
Vanuatu
identified
that
while
prevention
of
pregnancy
is
important
to
adolescents,
they
currently
receive
little
information
about
this
compared
with
information
about
sexually
transmitted
infections
and
HIV.17
Compared
with
adults,
adolescent
boys
and
girls
are
less
likely
to
have
heard
family
planning
messages
in
the
media,
and
less
than
25%
of
girls
have
discussed
family
planning
with
a
health
worker.2-­‐8
Research
conducted
by
Burnet
has
highlighted
the
need
to
reach
boys
as
well
as
girls
to
promote
shared
responsibility
for
prevention
of
early
and
unintended
pregnancy.17
NZPPD
Open
Hearing
Submission
–
Burnet
Institute
8

9.
4.2.5.2
Schools
are
an
underutilised
source
of
SRH
information
in
the
Pacific.
There
is
substantial
global
evidence
demonstrating
the
positive
effective
of
comprehensive
school-­‐based
sexuality
education
on
knowledge,
attitudes,
behaviours
and,
to
some
extent,
SRH
outcomes.30
Adolescents
in
Vanuatu
reported
that
they
would
like
to
receive
SRH
through
school,
either
as
part
of
the
standard
curriculum
or
delivered
by
visiting
peer
educators
or
nurses.17
Evidence-­‐based
programs
that
build
life
skills
and
improve
communication
and
decision-­‐making,
such
the
Family
Life
Education
program,
should
be
strengthened
and
scaled-­‐up
through-­‐out
the
region.31
4.2.5.3
Adolescents
in
Vanuatu
identified
peer
educators
and
health
workers
as
preferred
sources
of
information
because
they
were
perceived
to
be
well-­‐trained,
trustworthy
and
able
to
give
correct
information.17
Recent
reviews
have
shown
that
youth
peer
education
programs
in
developing
countries
can
be
effective
in
improving
knowledge,
and,
to
some
extent,
attitudes
and
behaviours
and
have
the
potential
to
reach
large
number
of
young
people.32
33
Opportunities
to
expand
peer
education
programs,
particularly
for
out-­‐of-­‐school
young
people,
should
be
sought
and
these
approaches
rigorously
evaluated
to
identify
impact.
4.2.5.4
Family
planning
information
delivered
through
mass
media
can
increase
contraceptive
uptake,
but
messages
need
to
be
appropriately
targeted
and
delivered
to
reach
adolescents.26,
34
Adolescents
in
Vanuatu
identified
a
range
of
preferred
sources
of
information
including
print
media,
radio,
television,
community
theatre
and
community
workshops,
but
also
noted
that
current
mass
media
messages
regarding
family
planning
only
target
married
couples.17
Further
research
is
required
to
identify
effective
strategies,
particularly
the
potential
of
social
media
and
communication
technologies.
4.2.6
Strengthen
health
systems
to
provide
youth
friendly
health
services
(Recommendation
7)
4.2.6.1
It
is
well
recognised
that
adolescents
face
multiple
barriers
that
limit
their
access
to
mainstream
health
services,
and
indeed
use
of
SRH
health
services
by
young
people
in
the
Pacific
is
low.35
Youth-­‐friendly
health
services
are
those
that
are
accessible,
acceptable
and
appropriate
for
adolescents
with
limited
research
showing
a
promising
impact
on
service
utilisation.20,
24,
36
4.2.6.2
In
2010,
Burnet
Institute
conducted
a
qualitative
study
of
adolescents’
SRH
service
delivery
preferences
in
Vanuatu.17
The
features
of
a
youth-­‐friendly
health
service
that
were
identified
included
(from
most
important
to
least
important):
• Friendly,
non-­‐judgmental
health
workers;
• Reliable
commodity
supply;
• Free
(affordable)
services
and
commodities;
• Confidentiality;
• Availability
of
male
and
female
staff;
• Convenient
opening
hours;
NZPPD
Open
Hearing
Submission
–
Burnet
Institute
9

10.
• Printed
materials,
television,
peer
educators
and
other
activities
provided
in
the
waiting
room;
• Privacy;
and
• Separate
from
adult
services.
4.2.6.3
These
findings
suggest
that
much
can
be
done
to
make
existing
services,
including
government
services,
more
youth-­‐friendly
–
even
where
it
is
not
feasible
to
provide
stand-­‐alone
youth
clinics.
These
approaches
require
increased
investment
from
government
and
other
stakeholders,
and
engagement
with
young
people
and
communities,
and
should
include:
• Training
for
health
workers
(SRH
needs
and
rights
of
young
people,
confidentiality
and
communication
and
counselling
skills);
• Strengthening
commodity
supply
of
condoms
and
contraceptives,
particularly
in
rural
areas;
• Providing
affordable
services
and
commodities
–
including
free
contraceptives;
• Ensuring
all
facilities
have
a
confidentiality
and
privacy
policy;
and
• Providing
a
separate
waiting
area
or
separate
opening
hours
for
young
people
4.2.6.4
SRH
services
should
be
integrated
with
other
general
health
services
for
young
people
and
other
youth
activities
(such
as
youth
centres)
where
possible
to
reduce
stigma
and
increase
accessibility.20
Consideration
should
also
be
given
to
the
appropriateness
and
feasibility
of
providing
SRH
services
and
contraception
in
school
clinics.
4.2.6.5
Pacific
governments
should
be
supported
to
develop
and
implement
country-­‐
specific
guidelines
for
youth-­‐friendly
health
services
based
on
local
research.
4.2.6.6
Increased
support
is
needed
for
non-­‐government
and
civil
society
organisations
who
currently
provide
high
quality
stand-­‐alone
youth-­‐friendly
health
services
in
the
Pacific37
and
may
be
better
able
to
reach
young
people,
particularly
marginalised
adolescents.
Innovative
models
of
service-­‐delivery
models
and
outreach
services
to
reach
most-­‐at-­‐risk
adolescents
should
also
be
explored.
NZPPD
Open
Hearing
Submission
–
Burnet
Institute
10

11.
5.
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Open
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–
Burnet
Institute
11

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NZPPD
Open
Hearing
Submission
–
Burnet
Institute
12