Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697636630542.pdf (Australia)
16 July 2020 For the attention of: Committee Secretary Joint Standing Committee on Foreign Affairs, Defence and Trade PO Box 6021 Parliament House Canberra ACT 260 Report prepared and submitted by: Melbourne Children’s Global Health 50 Flemington Road Parkville Victoria 3052 Contact: Professor Andrew Steer and Professor Kim Mulholland, Melbourne Children’s Global Health RE: Inquiry into the human rights of women and girls in the Pacific Melbourne Children’s Global Health Melbourne Children’s Global Health aims to reduce inequity and improve child and adolescent health in disadvantaged populations globally.
We will achieve this through partnerships in research, public health, education and advocacy.

Melbourne Children’s Global Health brings together global health at the Melbourne Children’s – an initiative of the Murdoch Children’s Research Institute, Department of Paediatrics at The University of Melbourne and The Royal Children’s Hospital, Melbourne.
In this submission we draw on the research and technical inputs of Melbourne Children’s Global Health in Pacific Island Countries, with a focus on preventing domestic, family and sexual violence and achieving the fundamental human right to health and wellbeing for women and girls.

Introduction Gender inequality has significant impacts on the human rights of women and girls living in the Pacific islands.
Children and adolescents in this region face particular challenges due to high levels of household, institutional and societal gender inequality.1 Girls and young women can be disadvantaged by lack of representation in many aspects of society and pervasive gender roles persist, which has broad implications for their health, educational, and social and economic outcomes.
Although the aim of this inquiry is to focus on the human rights of women and girls, it is important to acknowledge that gender norms can also have harmful impacts on boys.1 In the Pacific, violence against women is common, and attitudes which support and perpetuate violence are widespread.
Almost half of women aged over 15 years in Vanuatu (44%) report having experienced intimate partner violence in the last twelve months, with high rates also reported in the Kiribati (36.1%), Papua New Guinea (33.7%), Timor-Leste (31.5%) and Solomon Islands (25.4%).2 Inquiry into the human rights of women and girls in the PacificSubmission 27 There is strong evidence that domestic and family violence can impact the development and mental health of children, including low self-esteem, anxiety, depression and trauma.
Evidence suggests that these effects can occur, even where children do not directly experience or witness family violence that is occurring.
Growing evidence from low- and middle-income countries shows the co-occurrence of intimate partner violence and child abuse.3 Physical and sexual violence against adolescent girls aged 15-19 years in Pacific Island countries is common, with 35.8% of adolescent girls in Vanuatu experiencing violence since the age of 15 years and 14% of adolescent girls ever experiencing sexual violence, in Papua New Guinea the rates are 27.6% and 12.2% respectively and in Timor-Leste 30% and 2%, respectively.
However, data on the rates of violence against children under 15 years is limited.

One study reported a prevalence of 5.7% of sexual abuse in children aged 14 years or younger attending a provincial hospital in Papua New Guinea, the majority of these children were female (83%).4 Children with disabilities are a sub-group at particular risk of child maltreatment.
A meta-analysis of international studies showed that they were 3.7 times more likely to be victims of any type of violence, 3.6 times more likely to be victims of physical abuse and 2.9 times more likely to be victims of sexual abuse.
Children with mental or intellectual disabilities are 3.1, 4.6, and 4.3 times more like to victims of physical violence, sexual violence, and emotional abuse respectively.5 Child marriage is still common in the region, with the highest rates of early union in the Solomon Islands (21.3%) and Vanuatu (21.4%).1 This harmful practice can limit access to further education and expose girls to sexual and physical violence.
High rates of adolescent pregnancies across the region are linked to poverty, unequal gender roles and relations, and gender-based violence.1 Across the region, the need for access to modern contractive methods remains unmet, for example, with only 39% of married women in Samoa being satisfied with the level of access they have to family planning.

Low levels of antenatal care for pregnant women in parts of the region are further disadvantages to women.
There is limited data on the prevalence of sexually transmitted infection (STIs) from the small Pacific Island states.

The Pacific has some of the highest rates of human papillomavirus (HPV) infection; cervical cancer is the most common cancer and the leading cause of cancer-related deaths in Fiji.6 In the Pacific few countries have national cervical cancer screening policies and none have a comprehensive national screening programme.
Human papillomavirus (HPV) vaccination programmes have been implemented in Cook Islands, Fiji, Federated States of Micronesia, Kiribati, Palau and Republic of Marshall Islands.
Recent evidence has also found high prevalence of other STIs in women including Chlamydia trachomatis and Neisseria gonorrhoeae in the Solomon Islands (20% and 5.1%, respectively) and in Fiji (33.9% and 9.4% respectively).7,8 Chlamydia and gonorrhoeae are the cause of pelvic inflammatory disease (PID), ectopic pregnancy, infertility and adverse birth outcomes.

Many women and girls across the Pacific are not able to fully enjoy the good health that is their fundamental human right.
The largest determinant of child health is female literacy.9 Primary school completion rates are improving in the Pacific, and although girls are more likely to be in secondary school education than boys, limited access to sanitation services can be a barrier to attendance for adolescent girls, particularly during menstruation.
Across the Pacific, access to basic sanitation services in schools is variable – 76% of schools in Fiji provide these compared with just 27% of schools in the Marshall Islands.1 While education can be a protective factor, sexual harassment and abuse can also occur within educational settings, within classrooms and school grounds, during travel to and from school and online.10 Violence at school can impact educational participation, particularly for girls.

This context informs the response below.


Inquiry into the human rights of women and girls in the PacificSubmission 27 1.
The role of civil society groups in Pacific Islands in responding practically to domestic, family and sexual violence, and other human rights issues such as gender equality Role of civil society groups and non-government organisations in responding to domestic and family violence Pacific Island countries have ratified the Convention on the Rights of the Child and the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) and most Pacific Island Countries have introduced legislation, policy and formal systems for child safeguarding and the prevention of domestic and family violence.
However, in many Pacific Island countries limited national capacity and resources prevent effective implementation of formal systems.11 In addition, few victim/survivors of violence seek assistance through formal services.12 Thus Crichton-Hill and Olul suggest that ‘responses to family and domestic violence in the Pacific should acknowledge protective factors in Pacific culture and integrate traditional and formal approaches.’13 Traditional processes must be balanced with recognition of the human rights of women and girls.14 In this environment, non-government organisations provide critical community-based initiatives to respond to domestic and family violence including counselling and helplines, case management, community outreach to raise awareness and support women to access formal systems, as well as other integrated services, including cash transfers and income-generating projects.13 Role of NGOs in delivery of primary health care Non-government organisations provide primary health care in partnership with governments in the Pacific.
The World Health Organization Western Pacific Regional Office suggests that non-government and civil society organisations are critical partners in addressing health inequity as providers of primary healthcare.15 Health equity is a priority policy issue in the Western Pacific Region.
Non-government organisations can reach marginalised young women and vulnerable groups that may not have equitable access to health and education services.16 In addition, strategies to prevent domestic, family and sexual violence should be integrated in all services that reach women and girls, particularly health services.2 Health services have an important role in prevention, early response and rehabilitation following trauma.
Role of NGOs in operational research to strengthen evidence for prevention and response to domestic, family and sexual violence Non-government organisations also have a critical role in improving the evidence-base for interventions to prevent domestic, family and sexual violence.
Non-government organisations can incorporate high-quality evaluation of their programs, using robust methodologies that combine both quantitative and qualitative methods to develop a better understanding of the effectiveness of their programs.2 High quality evaluations will strengthen the limited evidence-base for interventions to prevent and respond to violence in low- and middle-income countries.16 2.
The key figures and groups which advance the human rights of women and girls' in the Pacific context A number of non-government organisations, universities and research institutes work with governments, UNICEF and UNFPA to inform policy and implement programs to advance the human rights of women and girls.
A number of local and international NGOs have been recognised for advancing the human rights of women and girls in the Pacific through service provision, community awareness and advocacy including: Save the Children, Child Fund, Empower Pacific, Medical Services Pacific, Fiji Women’s Crisis Centre, Solomon Islands Family Support Centre and the Vanuatu Women’s Centre.12, 14 Universities and research institutes contribute to improve data on the human rights of women and girls and provide technical advice to inform national policies and programming.
This includes measuring violence against women,17 measuring the impact of gender on health and education in the Pacific,1 and estimates of disability and mortality of adolescent girls in the Pacific.18 3.

Engagement of these groups with Australia's Pacific Step-up Australia has a unique and critical leadership role to play in promoting the human rights of women and girls in the Pacific.
DFAT has taken an active role in coordination and collaboration between governments, Inquiry into the human rights of women and girls in the PacificSubmission 27 UN agencies, non-government organisations, universities and research institutes.
DFAT, UNICEF and UNFPA provide the majority of overseas development assistance and support for sexual and reproductive health information and services, and prevention of sexual exploitation and abuse and child protection system strengthening in the Pacific region.14 DFAT has also contributed to raising awareness and strengthening management of child protection and sexual abuse within non-government organisations operating in the Pacific through the requirements within the DFAT Child Protection Policy (2017) and Prevention of Sexual Exploitation, Abuse and Harassment Policy (2019).
However, there is an opportunity for further engagement of these groups with Australia’s Pacific Step-up with further investment in preventing violence against children and adolescents.

In 2017, Australia spent just $1.1 million on programs targeted to prevent violence against children in the Pacific and Timor-Leste, just 0.1% of its overseas development assistance (ODA) spending in these countries.11 4.
The effectiveness of Australian overseas development assistance programs in supporting human rights of women and girls Overall, the evidence for interventions to prevent violence from low- and middle-income countries is limited.2 Further there is limited evidence for effective prevention strategies for children with disabilities, the LGBTQI community and other vulnerable groups.3 However, there is evidence from high- income settings for a number of interventions to prevent violence against women and girls, including those that Australian overseas development assistance has supported.
Evidence-based interventions include:  Child safeguarding and domestic and family violence telephone helplines, supported by an established referral network.2,11,12 Telephone helplines can increase access to reporting and counselling services.
However, in some countries, vulnerable women may not have access to a telephone.12  Counselling services in response to domestic and family violence, delivered as part of comprehensive case management services.12 There is an opportunity for Australia’s ODA to support increased coverage of services for victim/survivor support, particularly in people with disabilities, LGBTQI, sex workers, capacity development for skilled counsellors and the provision of hospital-based specialist counselling services for severe cases, including trauma-focused interventions.16  Programs that engage community leaders and community members to facilitate an enabling environment for women to safely seek assistance.12 However, there is a need for stronger evaluation of some community mobilisation and behaviour change programs that have been implemented in the Pacific.14  Train principals and teachers in the early detection of child abuse, in order to contribute to prevention in the school environment.
 In many settings there is a need for improved co-ordination by strengthening referral pathways and intersectoral collaboration between Ministries of Health, Ministries of Education and child protection institutions, including police and the justice system.
 There are opportunities to increase integration of responses to domestic and family violence and child protection to better address children’s risk and vulnerability.14 There is increasing recognition of the extent of exposure of children to domestic and family violence, the co-occurrence of violence against women with other forms of abuse and evidence of the profound effects of exposure to violence on children’s health and wellbeing.19  Parenting interventions have been shown to be effective in improving both parenting and children’s cognitive and behavioural outcomes, particularly in cases of physical abuse and neglect.2 The outcomes of parenting interventions can be strengthened where provided as part of comprehensive programs including early childhood education.11  Most efforts at reducing intimate partner violence, particularly in high-income countries, have focused on responding to problems as they arise and on supporting survivors, particularly through health and legal services.
However, in all settings, including low- and middle income countries, more Inquiry into the human rights of women and girls in the PacificSubmission 27 efforts are shifting to prevention.
Prevention aims to change the attitudes and norms that reinforce violence against women and girls and promote gender-equity through awareness raising, community mobilization, economic empowerment and group education.2 Effective communication strategies to raise awareness of the prevalence and impact of violence against women and girls should be developed with opinion leaders and traditional communicators.21  Cash-transfer programs.2  Schools can play a critical role in promoting gender equity and a non-violent environment through education programs as part of the curriculum.22 Education programs can include social and emotional learning, bullying prevention, and comprehensive sexuality education.
An example of this is the Connect with Respect: Preventing gender-based violence in schools program commissioned by East Asia Pacific UN Girls’ Education Initiative Network.23 Comprehensive sexual and reproductive health education for adolescents, implemented in the Pacific as ‘life-skills programs’ or ‘family life education’ can address interconnected sexual and reproductive health issues and sexual violence.2 However, there is low coverage of education programs to prevent gender-based violence in some Pacific Island Countries.21 In some settings there is a need to revise the curriculum to address issues for children and adolescents with disabilities, LGBTQI communities and to align with the health needs of adolescents.16  Where sexual and reproductive health programs for adolescents are delivered through peer education, there is limited evidence for peer education as an intervention alone.
Peer education as a component of a more comprehensive programme is likely to be a more effective approach.16  Adolescent-focused sexual and reproductive health services.11 Common barriers for access to health services experienced by adolescents in the Pacific should be addressed including through competency-based training of health providers to address stigma and discrimination, poor communication and counselling skills; improved privacy and confidentiality; and regulatory and service provision barriers that prevent access to certain SRH services.16 5.
Any related matters There is limited data on domestic, family and sexual violence against women and girls in the Pacific.

We support continued investment from Australia’s overseas development assistance in improving data on violence against women and girls and national capacity for data collection, including quantitative data through national reporting systems and qualitative data through surveys, for example, kNOwVAWdata: Measuring Violence against Women in the Asia Pacific.
Improved data and analysis is needed to understand the urgency for improved policy and programs to address domestic, family and sexual violence.

Improved data is also needed on the intersections of violence against children and gender-based violence and in relation to women and girls with disabilities.11 There is also a need for high-quality evidence for interventions to prevent violence in low- and middle-income countries.
In addition, there is limited and low quality data for adolescent health needs in many Pacific Island countries.

This is compounded by the relatively limited nature of the evidence base for interventions to improve adolescent health.

Given the poor quality of evidence for actions to improve adolescent health, programmes should be piloted and evaluated prior to being scaled-up.16 Inquiry into the human rights of women and girls in the PacificSubmission 27 References 1.
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12.Australia’s Department of Foreign Affairs and Trade (2017), Review of Counselling Services in the Pacific Final Report, Pacific Women Shaping Pacific Development.
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Inquiry into the human rights of women and girls in the PacificSubmission 27