Commonwealth Secretariat and Commonwealth Medical Trust high level workshop on Reproductive Health Commodities Security

I am very pleased to welcome Pacific Health Ministers and colleagues, and other workshop participants to Auckland.

I also want to acknowledge the initiative of the Commonwealth Secretariat and Commat in organising this event, and to thank all those whose efforts in various ways have made the meeting possible.

While the meeting is being held in New Zealand, it really is your meeting, focusing on Pacific concerns.

New Zealand will continue to be a strong and committed supporter of the Action Programme agreed to by 179 countries at the International Conference on Population and Development held in Cairo in 1994.

As you all know, the objectives of the ICPD agenda include making sexual and reproductive health care available to all by 2015. The agenda states that gender equity and equality are essential for sustainable sexual and reproductive health policies, and encourages men to be full and responsible partners in sexual and reproductive health and family life.

The agenda also calls for economic, social, and education policies that will help meet ICPD goals, including universal primary education, debt reduction, and women’s access to economic resources.

Examples of New Zealand’s commitment to the ICPD Action Programme include participating in international forums and increasing contributions to the UN Population Fund and the International Planned Parenthood Federation.

We also support sexual and reproductive health programmes in partner countries, and have developed our own sexual and reproductive health policies and programmes, guided by a Sexual and Reproductive Health Strategy. New Zealand recognises the importance of Reproductive Health Commodities Security, which is defined as the secure supply and choice of quality contraceptives and other reproductive health commodities to meet every person’s needs at the right time and in the right place.

RHCS is essential to achieving the goal of universal reproductive health care for all. Quite simply, without reproductive health supplies there can be no action programmes.

Pacific Island countries and territories have a combined population of less than 8.5 million, but have some of the world’s highest population growth rates. High rates of population growth are not new in the Pacific. But what is new is that most Pacific countries now have difficulty coping with further population increases.

In the last decade sustained population growth and economic stagnation have together caused rapid deterioration in the balance between population and resources in much of the region. Obvious signs include rising unemployment rates, especially among school leavers and rural-to-urban migrants, and poverty and overcrowding in urban areas.

Family planning services have been available since the 1950s in some Pacific countries and at least since the 1970s in most. There has been some liberalisation of attitudes to family planning in recent years, but use of services still tends to be low compared to other parts of the world.

A growing awareness of the risk of HIV/AIDS promoted an increase in the use of condoms during the 1990s, and concern about high levels of teenage pregnancy has made use of contraception by adolescents more acceptable in some quarters, but by no means universally.

Relatively little attention has been paid globally to the spread of HIV in the Pacific region.

In recent years the incidence of AIDS in the high-income countries of the Pacific region has been declining, and elsewhere in the region HIV transmission has been limited, at least by world standards.

But the region includes many developing nations that would be poorly equipped to control HIV on a large scale. The reality is that New Zealand’s Pacific neighbours may not be able to escape the widening diffusion of the epidemic indefinitely. The continuing expansion of HIV through much of neighbouring Southeast Asia should serve as a warning signal that we cannot afford to ignore.

Surveillance up to February 2001 as reported by the New Zealand AIDS Epidemiology Group shows an uneven pattern of reported HIV infection in the Pacific region.

The pattern reveals a low cumulative incidence in many smaller Pacific countries, a more moderate incidence in Kiribati, New Zealand and Papua New Guinea, a higher incidence in Australia, French Polynesia, Guam and New Caledonia, and a very high incidence in Hawaii.

These differences between countries may reflect true differences in the incidence of HIV/AIDS, but they may also reflect variation in access to diagnostic tests, effectiveness of public health surveillance and travel patterns.

There are also differences in the evolution of the epidemic among Pacific countries. The proportion of new infections noted since 1996 is just 19 percent in Australia and New Zealand, compared to nearly 80 percent for new infections in other countries of the region.

Poor understanding of potential HIV risks and a low level of social tolerance of HIV infected people may hamper prevention efforts in some Pacific countries.

Demographics are a key factor. Almost 20 percent of the Pacific region’s population are adolescents, and in some countries the figure is much higher. According to the UN Population Fund, adolescents are engaging in high levels of unprotected sexual activity leaving them exposed to the risk of unplanned and unwanted pregnancy, contracting STIs, and the transmission of HIV/AIDS.

New Zealand is involved in helping Pacific countries address sexual and reproductive health issues through regional, multilateral and bilateral Overseas Development Assistance programmes.

Over and above the annual contributions NZAID makes to multilateral agencies in the sexual and reproductive health area, we fund several agency-driven projects in the Pacific and various bilateral programmes in countries like Vanuatu, Kiribati and Papua New Guinea. New Zealand continues to engage in international meetings on sexual and reproductive health issues in support of Pacific Island interests. On occasion we have funded the attendance of other Pacific representatives at those meetings, including the particularly significant United Nations General Assembly Special Session on HIV/AIDS in June 2001.

The importance of this workshop in helping bring about full implementation of the ICPD Program of Action in the Pacific region cannot be underestimated. Developing a RHCS Call to Action for the Pacific region will be crucial.

At the Bangkok Regional ESCAP meeting on Population and Poverty last month, the countries of the Pacific, with 20 others, re-affirmed their commitment to the ICPD Plan of Action, recognising that its implementation is the sovereign right of each country.

A number of Pacific delegations have also played a lead role in developing their own regional plans of action.

In doing so, they have recognised that population development and poverty are closely interrelated, and that achieving sustained economic growth and a balance between population, resources and environment are essential to improve quality of life.

The Bangkok plan of action stated: “The countries that have been most successful in reducing poverty are also those that have done the most in reducing high levels of population growth, and balancing population and development dynamics as well as meeting reproductive health needs”.

The future of Pacific countries, particularly those with youthful populations, depends to a large extent on the decisions made by their young people, especially in relation to the number and spacing of children.

The Bangkok conference recognised that, ‘under-developed and island developing countries should be given special attention in a co-ordinated and sustained manner’, and New Zealand is committed to this approach.

Governments and societies in the region need to ensure they provide comprehensive, integrated reproductive health care. This will require funding, political will, and appropriate infrastructure.

Clearly, strengths and weaknesses vary from one country to the next. Partners need to work together to support a national strategy designed by each country to meet commodity requirements.

If training and technical assistance in building national capacity is tailored to the needs of each country, this should enable national programmes to forecast their requirements more accurately, and strengthen their capacity to obtain finance and to create strong and secure supply systems.

Improved advocacy at national levels is needed to promote development of more efficient and sustainable long-term finance strategies to meet national reproductive health commodity needs. Successful advocacy would help make RHCS a priority.

As I said at the UNGASS meeting in New York, the HIV/AIDS virus does not care about religion, or the colour of a person’s skin, or about ideology or political sensibilities.

But politicians must care about AIDS and all sexual and reproductive health issues. As political leaders, our fundamental responsibility is to provide leadership.

It is vital our region mobilises before it is too late. It is a big challenge to overcome many religious and cultural taboos that frustrate attempts to inform and empower people about sexual and reproductive health.

It is also far from easy to create the conditions that make it possible to talk to people about sexuality issues openly and honestly. That is why evidence shows that women are more reluctant to access family planning services when they live in small communities.

Nonetheless, it is a vital task and we should not be intimidated by it.

We must also work within the sometimes poorly developed civil and public health infrastructures that dominate the region and place particular emphasis on governments working with non-government to fill the void or understanding.

Hiding behind traditional taboos about prostitution, sex before marriage, use of condoms, and sexual orientation, will doom many thousands of our young people and allow the spread of HIV/AIDS and other STIs to accelerate.

Honesty is the only answer. It is up to us as Health Ministers to take the lead. That is what I’m sure all of us want to see this workshop achieve.

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