SEX, WOMEN AND THE 21STCENTURY IN PAPUA NEW GUINEA
DAME CAROL KIDU
Thursday March 8 (International Women’s Day)
Pregnancy is the greatest killer of teenage girls in the world. Girls in Papua New Guinea (PNG) are particularly vulnerable as hospital births are rare. Contraception is generally difficult to obtain, especially for unmarried women. Meanwhile, violence against women, including sexual violence, is endemic. Extremely restrictive abortion laws (including a ban on abortion in cases of rape and incest) ensure that young women die regularly from unsafe abortion. Sexually transmitted infections are prevalent with HIV rates increasing steadily. PNG is a devout nation with many denominations. Christianity is an integral part of PNG culture and strongly influences the reproductive health services available to women.
What would improve the situation for PNG women?
Dame Carol Kidu is the only current female member of the Papua New Guinea Parliament. She was born in Queensland and met her PNG husband, the late PNG Chief Justice Sir Buri Kidu, at a school camp. She has spent her adult life in PNG and worked as a teacher before embarking on a political career. Dame Carol won the Port Moresby South Constituency in 1997 and has focused her efforts on supporting women in the community.
TRANSCRIPT: SEX, WOMEN AND 21ST CENTURY IN PAPUA NEW GUINEA
I am extremely honoured to deliver the Pamela Denoon Memorial Lecture 2012. To be honest, my assumption was that Pamela had died as an elderly woman and I was taken by surprise when I googled her name and saw that was not the case. Not only did she die as a young woman but she also left a legacy of a woman before her time. She tackled issues that even now remain marginalised in many societies – she was a voice and an activist for the voiceless. Pamela was born in Toowoomba – a very special town for Buri, my late husband, as he was educated there on a colonial scholarship but like Pamela his life was cut far too short with so much still to do. And for me there is her special connection because of her work and study in Papua New Guinea and later in the Pamela Denoon Trust that provided bursaries for young PNG women to finish their education. I feel highly honoured to be with you here tonight in memory of a truly great woman.
May I begin as is custom by acknowledging the traditional owners of the land of ANU and their elders past and present and may I add my own personal acknowledgement as is my custom when I travel. I am privileged to be here because of many people – DOBI VAGI RAHOBADA- my late mother-in-law and mentor and the people of Pari village and of course the people of Moresby South electorate – my respect and gratitude for their support. It is because of them that I have the privilege to travel and represent Papua New Guinea internationally and I thank them for that support.
You have seen the abstract for my presentation. It is broad and encompasses many aspects of our international commitments to ICPD, CEDAW and the MDGs. Commitments which, at this stage PNG is a long way away from fulfilling and which receive little sustained political traction other than intermittent outbursts of genuine but emotional political rhetoric.
“Pregnancy is the greatest killer of teenage girls in the world. Girls in PNG are particularly vulnerable because hospital births are rare. Contraception is generally difficult to obtain, especially for unmarried women.
Meanwhile GBV, including sexual violence is endemic.
Restrictive abortion laws even in cases of rape and incest, result in women dying from unsafe abortion.
STIs are prevalent with HIV rates increasing steadily.
PNG is a devout nation with many denominations.
Christianity is an integral part of PNG culture and strongly influences the reproductive health services available to women.”
The abstract ends with the focusing question: What would improve the situation for PNG women? I am not a health specialist nor an academic and undoubtedly there are many better qualified people than me in the audience here tonight. However I hope that my presentation will be a catalyst for discussion and action to improve the lives of women in PNG. All I can hope to provide is some snapshots of realities and possibilities for change. My presentation cannot hope to cover the enormity of the topic.
I find it hard to proceed without commenting on the Title of my presentation Sex, Women and the 21stCentury in PNG – I initially found it quite confronting. SEX – SEX?? We don’t talk about that . We pretend it does not happen – and therein lies a fundamental problem. It does happen – regularly , sometimes violently, sometimes in “unnatural ways” according to some perspectives, not always within the confines of a marital relationship but we pretend it does not happen and delude ourselves that if we start talking about such things it will corrupt innocent minds and result in promiscuity and immorality. If we combine the word women in the same sentence as sex – the public mind will tend to think “loose women” or even sex workers.
Combining the two concepts of women and 21st century is also confronting. A very small and very slowly increasing number of women fit into the category of being women of the 21st century but the large majority of women have no access to the benefits of living in the 21st century. In fact the 1996 UNICEF Situational Analysis of Women and Children asserted that “modernisation” had done little to improve the lot of women in PNG – in fact many women were faced with the difficult task of combining and balancing the expectations of both the old and the new worlds – many women face more burdens with less protection in the interface between tradition and modernity. It is now over a decade since this observation was made but it is still very relevant to the lives of many (probably most) PNG women in 2012.
What would improve the situation for PNG women? The abstract outlines a variety of reproductive health issues confronting women of PNG. They skim the surface of some very confronting realities that cannot be ignored.
The PNG Situation
~ 200,000 pregnancies per year
~ 80,000 (40%) are unplanned at conception
~ 30,000 spontaneous abortions
~ 900 induced abortions per year
~ 1300 women die from pregnancy complications each year (that’s 4 today)
~ 4000 women suffer serious permanent damage from pregnancy complications each year
The 2006 Demographic Health Survey was a wake-up call for PNG. In the decade between the DHSs and with the commitment made to MDG5, one would have expected an improvement in the Maternal Mortality Rate but the reality showed no improvement – in fact the MM rate had worsened considerably and PNG has by far the worst MM rate in the Pacific region and the worst bar one for the whole of Asia Pacific (only Afghanistan is worse than PNG).
PNG Maternal Mortality – 733/100,000 (DHS 2006); 4 Women die a Day; Each 6 six hours a family continues life without a MOTHER and a WIFE (ex Report to Cabinet, mid 2011)
These statistics could not be ignored and resulted in the preparation of a Ministerial Report and Plan of Action on Maternal Health. This resulted in a very targeted policy review, Ministerial reports and action plans with budgeted and time-framed implementation plans.
NDOH action on the Ministerial report has focussed on addressing the structural response issues with the establishment of an emergency response maternal health command post and appointment of a specialist obstetrician to head it. Provincial co-ordinators for maternal health have also been put in place to hopefully track progress at the provincial and district level.
On the more practical side of implementation, AusAID have funded and recruited the eight overseas midwifery tutors and they are hard at work at the 4 midwifery schools (in Madang, UPNG, PAU and Goroka). This will improve the situation for PNG women because MAJOR human resources issues had been identified by the Ministerial Report….not enough nurses or midwives in particular. Many of them are aging and have had little or no in-service training since they graduated and thus can provide only very limited care. Next week when I return to Port Moresby I will be closing one of the midwifery training courses funded by AusAID in this on-going programme to re-vitalise and increase the number of mid-wives and midwifery training schools
To improve the situation for women in PNG, I believe there is a need to personalise the problems more. It is not just about statistics. It’s about people. It’s about real women and their families. It was really only when I started to personalise it that my advocacy became more intense eg If I was a woman in a remote village in PNG I would most likely not be here – also of my three daughters I would be lucky if even one remained out of an eptopic pregnancy and two emergency Caesarians. In the audience?? In Western society, we are so used to safe deliveries and modern medical interventions that we can easily forget the dangers in unsupervised deliveries as was the case for Jodie whose story appeared in our weekend newspaper two weeks ago.
Before coming here I asked Prof Glen Mola the focus question –What will improve the situation for women in PNG? His second prioroity was Supervised birth. Every strategy under the sun must be tried and tried again to convince women to come to health facilites for supervised birth, and to convince health workers that it is their responsibility to encourage ALL pregnant women to do their very best to come to the facility for a supervised birth, and help them to do so by assisting them in working out a delivery plan, and even giving small incentives (like baby bundles to women who come – has been working well in EHP, and assistance with health centre delivery fees and transport costs – about to be trialled in Milne Bay province)
Most likely Jodie’s pregnancy was a planned pregnancy but for PNG women at least 40% of pregnancies are unplanned (and often unwanted). There are three main options to prevent an unwanted pregnancy – abstinence; contraception, abortion. For many PNG women, preventing an unwanted pregnancy is not easy. Let’s look at these three options in a bit more detail.
Can she abstain or negotiate her sexual relations, fertility or condom use ? The inter-relationship between physical violence, population management and family planning cannot be ignored. Gender based violence is very relevant to sexual and reproductive health issues.
Gender Based Violence and Sexual and Reproductive Health crisis in PNG
High rate of family violence Post Courier 17 Feb
PAPUA New Guinea has some of the highest rates of family violence in the world. Case reports represent only a tiny fraction of actual incidents, but limited research shows that; On average; two out of three women have been beaten by their husbands or partners, with the figure rising close to 100 per cent in some areas. This is the highest in any of the 15 studies conducted by World Health Organisation in 10 countries. According to a report on the scale of family and sexual violence in PNG; one in two women have been forced to have sex against her will. Around half the victims of rape presenting for medical attention are under 16 years old, one in three or four is under 12 years old and one in 10 is under eight years old. Seventy five percent of children report that they have lived in homes where violence is endemic, mostly against the mother, 50 per cent of children say they feel unsafe in their neighbour hood at night; and 60 percent of children are estimated to be at risk of sexual violence.
These are very scary statistics – they are not comprehensive and perhaps are not reflective of the diversity of PNG. There is on-going research that is targeted to analyse the diversity of PNG more. This is important because the nature of the GBV should determine the types of interventions in order to reduce the violence
Increased GBV relates also to the uncomfortable interface between tradition and modernity. Traditionally there were protective customs for women at risk of violence and recognised protectors and recognised protectors for women facing an immediate violent situation. These customs have been breaking down but legal interventions to protect women have not successfully filled the vacuum created by the break-down in customs.
New trends of increased violence need new interventions and perhaps one of the most important is the involvement of men in the responses to gender based violence.
Women’s empowerment can sometimes equate to men’s disempowerment and have a backlash effect if men are not actively involved in improving the situation.
Eliminating disempowering language and managing lateral violence in communities are also fundamental to women’s empowerment and advancement. “Basio hereva …… Yu meri tasol….. etc”
What will improve the situation for PNG women? Legal protection is needed and progress has been made with Interim Protection Orders and legal pathways but to be honest they are still not effectively protecting women in spite of a zero tolerance policy announced by a former Police Commissioner. The establishment of special Victims’ Desks at police stations is helping (but reliance on development partner funds is a concern). The Family Protection Bill is ready for Parliament but time has run out in this term of Parliament for its passage. Some excellent work is being done by NGO service providers focusing on men and male advocacy against violence.
Can she access information and health services and an uninterrupted supply of effective contraceptives? Many enthusiastic family planning efforts lack sustainability eg – the condom dispensers are empty in most rural areas. The challenge of ineffective distribution systems, limited access to education and lack of development opportunities is widespread. Meeting the unmet need for family planning services is fundamental to improved reproductive health services for women in PNG. It is also a positive trend that increasingly men are become active participants in the desire to fill this unmet need but the unmarried population and teenagers remain marginalized from services other than in areas that have the services of NGO Family Planning providers such as Marie Stopies, World Vision, Pathfinders.
Prof Mola’s first priority to the focus question of what will improve the situation for women in PNG wascomprehensive nation-wide implementation of Family Planning programs, – at the moment the sort of things which are major impediments to FP access for women are
a. non-functional health facilities, health workers only willing to offer FP in “Tuesday clinics” and not every day as they have been directed to so many times by memos from both NDOH Health Sec and provincial health authorities,
b. erratic supplies,
c. lack of motivation of health staff to talk to every adult person at every health encounter about fertility issues, – particularly mothers in baby clinics
c. focused training on FP service provision (particularly the newer methods, – implants and Loops) and clinic organization; more access to TL and vasectomy in rural areas, – we need to send around teams who can do mutliple procedures in one hit of people who have been lined up by the local health workers – what Asian countries call camps, – is working very well in WHP and EHP
e. Political commitment/involvement – eg Karkar vasectomy program with Pathfinders; Men’s Clinic
The third option for preventing unwanted pregnancies of Abortion remains illegal in Papua New Guinea but is increasing in incidence. Restrictive legal frameworks force the poor to either have too many babies, too close or to resort to unsafe or traditional abortions – both of which endanger the life of the mother and reinforce the poverty cycle.
Elsie’s Story – Where is the “leader”? No matter how many times I relate this story, I can never come to terms with it. I keep imagining if I was Elsie.
• Grade 9 student at a school outside Port Moresby
• Netball carnival in Port Moresby
• Went to disco with other girls
• Picked up by a ‘leader’
• Hid pregnancy from family for 5 months
• Aunts and mother put things inside to cause abortion
• Lost a lot of blood and got infected
Arrived at PMGH shocked and near death and did not tell the ‘full story’
DIED ……As a woman, I ask where is the “leader”? But Elsie not only had to carry all of the shame and blame but also paid the ultimate price of her young life
Where abortion is legal, safe and available, mortality rates from the procedure are very low
The death rate from abortion is hundreds of times higher in the developing nations than in developed regions of the world.
The PNG Law relating to abortion: Criminal Code sections 225 – 228.
• An inherited, pre-independence law
• Derived from
– The Colonial Law of Papua 1901
– In turn derived from Colonial Law of Queensland 1870
– In turn derived from UK Law of 1861!!!
UK and QLD have changed their laws
We still have the pre-colonial 1861 Law
Our 1861 Law states “Abortions are illegal unless they are performed for the
‘preservation of the mother’s life’” But……… PNG Law is subject to interpretation by our Courts. There is almost no case Law on abortion in PNG, so it is likely our judges would follow English Law precedent
A 1982 Legal opinion from the PNG State Solicitor states that an abortion would be considered legal if :“doctors have an honest belief that the termination of the pregnancy is necessary to preserve the woman from serious danger to her life or physical or mental health…..”
This 1982 legal opinion is used by some private clinics to assist women seeking termination of pregnancy but it is expensive and thus marginalises the poor to have to resort to unsafe abortions.
Some NGO reproductive health service providers such as MSI do provide medical terminations at a very affordable rate but no public health facilities offers safe abortion services and legal reform is unlikely in the present political climate. Perhaps the most that could be hoped for in legal reform would be to allow legal abortions in public health facilities in cases of rape and incest.
The archaic legal situation combined with church teachings based on 14th century doctrine combine like a death sentence for women in 21st Century in PNG
What do doctors think??? A limited survey in 2011 of doctors involved in maternal health care revealed that
– 80% thought that access to abortion was still very difficult for women
– 65% thought that less than 10% of doctors responded to womens’ requests for abortion
– 9 of the doctors indicated that they had only started responding to women’s requests recently
– All doctors thought that there were many more abortion requests and abortions being performed in recent years
As a legislator and the only female in Parliament, I am ashamed that I have not attempted to bring legal reform in this area. My work in politically spearheading attempts for legal reform relevant to the management of the HIV epidemic became so polarized and homophobic that the reference group on HIV and the Law which I established asked me not to venture into the area of abortion. Legal reform is the ideal but without legal reform, it is imperative to still ensure that services are available when needed so that young girls and women like Elsie do not die.
Elsie’s story also illustrates the fact that young girls (and boys) have almost no access to client-friendly health services (teenagers remain almost invisible to the health system. There are no age-aggregated data kept that we can use to describe the current status for teenage health). . PNG needs an external evaluation of teen health (including sexual and reproductive health) so that a proper plan for young people’s health can be made
One area of sexual and reproductive health that has focused on young people is the response to the HIV epidemic. And it is the church health services that have spearheaded PNG’s response to HIV, particularly at the community and service provision level. Many Christian health workers differentiate between the doctrinal approach to HIV and the pastoral/practical approach, in order to balance their religious beliefs and the practical need to effectively address HIV and sexual health.
Doctrinally, biblical teachings are concretely against extramarital sexual behaviour and the use of condoms; yet in the diverse pastoral work and social work of churches and faith-based organisations, many Christian health workers justified condom promotion by seeing that it is a necessary step to save lives, which is also an important Christian principle.
To sum up:
The Health Department and Ministry have made policy responses to our Maternal health crisis BUT that alone is not enough
Political commitment and effective partnerships must be actively encouraged and strengthened to create a genuinely unified and integrated health service for PNG
Importance of integrated partnerships diagram.
Importance of community ownership and community preparedness.
Lots of work still needed in this area to institutionalise new Integrated Community Development policy of PNG and for government to genuinely take an integrated approach – break down the departmental silos
Political involvement is essential and need for awareness raising is critical. I have facilitated the establishment of two organisations to focus on integrated partnerships.
PNG PGPD in 2008 and SMALL PNG in 2010.
SMALL PNG to become the secretariat to PNG PG PD
Making it happen – Canoe cartoon – power politics destroys development efforts
What are we going to do? Cartoon. Thank you for being involved by attending this Pamela Denoon Memorial Lecture and following her example of choosing to be involved.
These young women are part of the lucky minority with access to services – our challenge is to reach the large majority of women marginalised from services whose lives are at risk.
On behalf of the women of PNG I thank all of you for your attention. I stand before you as 0.9% of the Parliament of PNG. One woman, 108 men. And that is the most fundamental of all challenges facing the women of PNG.
What would improve the situation for PNG women?
Give them equal opportunity to have their voices heard in all decision-making bodies in Papua New Guinea