Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694818641811.pdf (Australia)
22nd May 2015 Joint Standing Committee on Foreign Affairs, Defence and Trade jscfadt@aph.gov.au Thank you for the opportunity to make a submission to the Inquiry into the Human Rights Issues Confronting Women and Girls in the Indian Ocean-Asia Pacific Region.

Our comments have been made in the context of our work in the region.
For further information, please contact Jodi McKay, Director Communications Government and Community Affairs, Family Planning NSW Attachment: submission Submission by Family Planning NSW: National Aboriginal and Torres Strait Islander Health Plan 1 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 56 About Family Planning NSW Family Planning NSW is a leading provider of reproductive and sexual health services in Australia.
We are experts on contraception, pregnancy options, sexually transmissible infections, sexuality and sexual function, menstruation, menopause, common gynaecological and vaginal problems, cervical screening, breast awareness and men’s health.

We deliver clinical services from five fixed clinics and use innovative partnerships to deliver services in other key locations with more than 28,000 client visits annually.
We provide information and health promotion activities, as well as education and training for doctors, nurses, teachers and other health, education and welfare professionals.

We deliver best practice education and training in reproductive and sexual health.

Our work builds the capacity of doctors, nurses, teachers and other health, education and welfare professionals to deliver quality reproductive and sexual health services in communities across NSW.
We understand the importance of capacity building and equipping local people with skills and knowledge to meet the needs of rural and remote communities and vulnerable populations.
Our work is evidence-based, and shaped by our research through the Family Planning NSW Sydney Centre for Reproductive and Sexual Health Research, our published clinical practice handbooks on reproductive and sexual health, our nationally recognised data and evaluation unit and validated through our own extensive clinical practice.
Submission by Family Planning NSW 2 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 56 Our international work Our international work is focused on increasing access to quality health and education services with an emphasis on saving lives and achieving a long term impact on marginalised communities.

Our current international work includes projects in Papua New Guinea, Timor Leste, Fiji, and Vanuatu.
We have recently completed projects in Cook Islands, Solomon Islands, Tonga, Tuvalu and Samoa.

We work in partnership with local NGOs and health services to address areas of reproductive and sexual health need, such as high rates of cervical cancer mortality in the Pacific.

Our projects are focused on supporting the achievement of the Millennium Development Goals, in particular MDG5b, (increasing universal access to reproductive health).
Our work aims to reduce maternal mortality, prevent unwanted pregnancies, reduce the rate of sexually transmissible infections (including HIV), empower women and girls to exercise their sexual and reproductive rights through greater decision-making powers, build a more sustainable world for all women, men and young people regardless of gender, sexual orientation, or social and economic status.
We achieve this through capacity building local NGOs to provide high quality family planning services including clinical services, community education, resource development and professional education.

Emphasis is also placed on improving the monitoring and evaluation of all of our project work, implementing child protection training and supporting our NGO partners to improve financial management and governance.
We comply with the Australian Council for International Development (ACFID) Code of Conduct, adherence to which is monitored by an independent Code of Conduct Committee elected from the NGO community.

Our voluntary adherence to the Code of Conduct demonstrates our commitment to ethical practice and public accountability.
Submission by Family Planning NSW 3 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 56 Enhancing the sexual and reproductive rights of women and girls Gender inequality prevails in the region due to practices that are cultural, religious and traditional.

There is also poor political and legal redress of these issues.
This power imbalance means women and girls are denied their right to live free from violence, to choose relationships, to decide when and how many children to have, and to access health services in a timely manner.

As a result, women and girls face an increased risk of maternal death or disability, a high rate of unintended pregnancy, gynecological disorders and sexually transmissible infections.
Some women and girls, such as those with disability, face even greater levels of discrimination and denial of their rights with higher rates of violence and poorer health outcomes.

Barriers to sexual and reproductive rights There are many barriers to women and girls achieving their sexual and reproductive health rights.

1.
1.

Men are the decision makers in all aspects of life and at all levels of society, and therefore women may not be given the option to use contraception to manage family size and birth spacing.

They may not be able to attend medical appointments for serious reproductive health issues or negotiate or even consent to safe sex.

2.

Cultural and religious norms do not always support sexual and reproductive health and rights.
For example, unmarried adolescents may not be provided with contraception by health workers who bring their own prejudices and practices to their decision making.

Condoms may not be promoted as a way of preventing STIs including HIV.

3.

Health workers may discriminate against women especially those from marginalised groups due to ignorance, myths, and misinformation.
For example, women living with HIV may not be seen in a clinic because of a perceived risk of infection, or preconceived view about how they acquired the virus.

4.

Sex and sexuality are taboo topics in many communities causing myths and misinformation to flourish, and evidence based information to be ignored.
This results in Submission by Family Planning NSW 4 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 56 uninformed decision making, which has serious health and social consequences for women.

For example, women may not use modern methods of contraception because they believe contraception can cause birth deformities.

Sex education in schools is often limited, not available at all and not evidence informed.

5.
5.

Supply of medical and health equipment such as contraceptive devices is unreliable due to poor resource management and limited health and transport infrastructure.

This results in women not having the opportunity to access family planning services or make choices about their reproductive health.

6.

Poor governance in country, leading to a breakdown in law and order has resulted in women and girls being subjected to high rates of rape and domestic violence.
In some areas in PNG the potential for sexual assault is so great there is anecdotal evidence that women travelling to sell their produce at market have been forced to don female condoms for the trip in an attempt to protect themselves from pregnancy and STIs including HIV if they are attacked.
Submission by Family Planning NSW 5 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 56 Achievements in responding to the sexual and reproductive health and rights of women and girls In delivering sexual and reproductive health programs, Family Planning NSW seeks to uphold the rights of women and girls to have optimal sexual and reproductive health.
In taking this approach, Family Planning NSW aims to not only support women and girls, but also their families and communities.

Family Planning NSW has worked in partnership with a number of in- country Government and Non- Government Organisations (NGOs) across the region to implement projects that impact both directly and indirectly on the sexual and reproductive health and rights of women and girls.
Projects include: • The PNG Clinical Health, Men Programs, Advocacy and Sexual Health Strengthening Project (COMPASS) (2007-2012).

This was a multifaceted project which included four Components and five Outputs Component 1 A Men and Boys program to raise awareness and reduce sexual violence and increase effective decision making.

Component 2 Health worker training for staff of provincial and district health services around STI diagnosis and treatment.
Component 3 Advanced service support which provided an advanced qualification in Sexual and Reproductive Health (post graduate certificate course) developed for and trialled in PNG using open learning mode.

Component 4 Strengthened clinical and management capacity in existing STI referral centres (or alternative centres) and the strengthening of outreach sexual health clinical and related services.
Submission by Family Planning NSW 6 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 56 There has been a significant change in attitude of the health workers towards STI clients and they are now perceived as friendly, helpful and non-judgmental.
In addition to dedicated clinics, the fact that most clinics now have private consulting areas for STI clients (instead of them having to join the public queue on the veranda of the health centre) and the clinics have same sex health workers for STI clients to consult have also been influential factors in the increase in STI presentations.
This is reflected in comments from community women “better….nicer to us and confidential; privacy much better….not sitting on a bench with everyone else when explaining problem to health worker….very public” “Before COMPASS came people had to go to Lae to seek this treatment.” External Evaluators Report for the COMPASS project 2012 • Sexual and reproductive health clinical and community education training to nurses and community outreach workers in Family Health Associations in eight Pacific countries (2013 – 2014).
The project, funded by the International Planned Parenthood Foundation, aimed to build the capacity of family health workers to have the knowledge, skills and attitudes to improve access to services and the quality of the care provided.

Technical skills were enhanced and there was also an emphasis on privacy, confidentiality and women’s rights.

“After the training I went back and did things I did not do before, such as collecting swabs, palpating the abdo and physical examinations.
It is important as now I have more confidence to use these skills.

Before I usually guess it, now when I examine I really get the answer and then I can treat it.

“Many procedures now very clear to me” Nurse, Taro Island Choiseul Province, Solomon Islands • Post Basic Certificate Course in Sexual and Reproductive Health for nurses and health extension officers (2012) in Papua New Guinea.

The course was based on a human rights framework and included a focus on values and attitudes and ethical practice.
A specific module on improving access for people with disability was included in this program.

Submission by Family Planning NSW 7 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 56 The participants were grateful for the professional development opportunity and were keen to tell of their new level of clinical and personal confidence and comfort when dealing with clients.
One graduate commented: “I am using the new learning every day and at my hospital the doctor sometimes asks me to do the counselling and management plan first and then send back to the doctor.” “Clients ask straight away for me by name…..they like their privacy and confidentiality and know that this is how I work now; patients bring new clients to us because they like what we do.” “We (the graduates) now have a good network amongst providers (themselves and their facilitators) in Lae.” Extract from the External Evaluators Report • Men and Boys Behaviour Change programs (2008).
This was a collaboration with national NGOs in both PNG and Timor Leste to develop and implement country programs utilising a peer education model in urban and remote communities with a strong focus on the impact on women and families of male decision making.

The aim of the project was to educate men and boys to work in partnership with women to improve health outcomes and relationships.
The reach and capacity of the program to improve the lives of women and communities has in some cases been unprecedented: In 2009 there were lots of problems in the community before the Men and Boys program started in 2010.

There was a lot of fighting and trouble from armed raskols who came to the market and caused fights and stealing.

There were 21 raskols hiding in the bush, escapees wanted for crimes against communities (stealing, GBH, rape).
The community were really afraid of them...they had guns and other weapons.

The Men and Boy’s program worked with community stakeholders and the raskols heard about the program and got involved.

They wanted to come back to live well in the community after 5 years hiding in the bush.
It took a year to set it up, using networks between Men & Boys Community Based Advocates, Lutheran Health Services, local Police (LHS intervened on the raskols behalf) and finally several of them came out of the bush, laid down their weapons and presented them in a field purposely set up for the ceremony at Braun.

They had a one day health camp that day.. and everyone was happy, the community relieved there was no police retribution just an amnesty with the community.
Now 5 of them work in the community and it is good.

Extract from External Evaluation Report Submission by Family Planning NSW 8 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 56 • Fighting Cervical Cancer: Low resource screening methods.
Family Planning NSW has been working with the Ministry of Health and Family Health Association partners in Fiji since 2011 to pilot visual inspection of the cervix with acetic acid (VIA), a safe and effective low resource method of cervical cancer screening recognised by the World Health Organisation and used in developing countries like Fiji that do not have infrastructure to support population based screening programs.
26 nurses and 13 doctors were trained and local resources were developed to educate women and men about cervical cancer.

More than 3,000 Fijian women received screening.

The program provided immediate cryotherapy treatment to women with detected lesions, a process known as “screen and treat”.

The success of the pilot program has resulted in the Ministry extending VIA and cryotherapy across all divisions of Fiji.
Currently Family Planning NSW is in consultation with stakeholders in other low resource Pacific Island nations to pilot the VIA program.

“One client, a 55 year old woman had never had a Pap smear and was delighted to receive VIA screening.

She said she was surprised how fast the screening took and was delighted with the pleasant approach from the nurses who are also taught to counsel nurses on the procedure and its importance.
`It has given me peace of mind that I can confidently say that I have no symptoms of developing cervical cancer, especially at my age” Extract from the Fiji Health Sector Support Program newsletter, March 2014 • Working at all levels of Government to promote sexual and reproductive health rights in China.
Family Planning NSW is involved in a three year project between the Chinese and Australian Governments to enter into dialogue with the various levels of government in China about human rights in relation to population policy and its implementation.

Led by the Australian Human Rights Commission, the project is part of the Technical Human Rights program established between the Australian and Chinese Governments more than 10 years ago.
This is an opportunity to present good practice in relation to sexual and reproductive health and rights to clinicians, provincial leaders and national government representatives and discuss application in China.

Discussions have been held about the rights of people, mainly women including those from ethnic minority groups and girls, to have confidential private services.

There has been a particular focus on informed decision making.
The rights of women with disability has been one of the priority areas advocated by Family Planning NSW.

Submission by Family Planning NSW 9 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 56