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Vanuatu

Articles by Vanuatu

Clinic staff in front of the clinic
10 January 2024

Vanuatu: A Regional Leader in Cervical Cancer Elimination

The Western Pacific region bears a quarter of the world's cervical cancer cases. And inequalities persist within the region. Vanuatu women are seven times more likely to die of cervical cancer than Australians. A year and a half ago, the Minderoo Foundation's Collaborate Against Cancer initiative decided to take the lead on this public health issue and founded the Elimination of Cervical Cancer in the Western Pacific (ECCWP) project. By doing so, Vanuatu became the first country in the Pacific to adopt a strategy for the elimination of cervical cancer.

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When getting to the hospital is difficult, Vanuatu mobile outreach can save lives

In the mountains of Kumera on Tanna Island, Vanuatu, the village women of Kamahaul normally spend over 10,000 Vatu ($83 USD) to travel to the nearest hospital.  It takes an hour to travel up the steep, rugged, tire-track terrain by car, but it takes two hours by foot - the normal form of commute for villagers.  Alani*, a 22-year-old mother of three, said that after Tropical Cyclones Kevin and Judy hit Vanuatu in March 2023, it has been even harder to travel to the hospital.  “After the cyclone, my crops were destroyed. I usually take my kids with me to the market and sell produce but after the cyclone, I do not have any money. If I have to go to the hospital for my 3-month injectable [contraceptive], I spend 5,000 Vatu one way, then 500 for medicine at hospital then I pay 5,000 Vatu to come back.” This is equivalent to over 100 AUD, which is unaffordable for most people like Alani.   Village spokesperson, Jimmy, said that the community is grateful for the Vanuatu Family Health Association (VFHA) as they are the first medical team to visit the remote community.  “I feel sorry for our mamas, they must spend so much money just to get medicine,” he said. “In our village, we have a lot of young single mothers and most of the time, trucks refuse to come up here because of the bad road. They must walk for two hours just to get to the main road, sometimes whilst pregnant, holding bags and their many children. This is why I invited VFHA to come here, so women don’t have to spend so much money and time just to get health services.”  The outreach programme was part of VFHA’s humanitarian response to the cyclone.  “We’ve been overwhelmed by the testimonies of hardships shared by the women in this community,” said Kalowi Kaltapangm VFHA Programme Manager. “Girls and women should not be paying over 100 AUD just to have access to sexual reproductive health services – it is not right. We thank Australia through DFAT for allowing us to reach more people post-disaster.”  Jimmy added that the community is grateful for the VFHA visit and hopes they set up a clinic in Kumera.  “After Tropical Cyclones Judy and Kevin, we lost about 21 homes across the communities here and most of the food crops are gone. If you travel further, you will still see some families still in tents. People are still rebuilding their lives and it's hard to rebuild if women fall pregnant again.’  The VFHA response team reached a total of 21 communities and more than 3,000 beneficiaries across Tafea Province. This included mobile outreach to 15 communities on Tanna Island, three communities on Futuna and three communities in Aneityum.   

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Sex: changing minds and winning hearts in Tanna, Vanuatu

“Very traditional.” These two words are often used to describe the people of Tanna in Vanuatu, one of the most populated islands in the small country in the Pacific.  Between 1 and 5 March 2023, the Vanuatu islands were hit by two consecutive Category 4 cyclones (“Judy” and “Kevin”) with widespread damage to the northwest and northeastern islands. Authorities report that some 250,000 people were affected, representing more than 80 per cent of the population.  Since 28 March, The Vanuatu Family Health Association (VFHA) has been conducting their humanitarian response on Tanna. Team Leader, Enneth Ilaisa, said that they are very surprised by their breakthrough with communities - especially with the men.   “Tanna is known to be very traditional, even in the past it was almost impossible get access to these communities to talk about sex, but now it is slowly changing, and we are surprised. In our recent field visits, we have seen men step forward bringing their wives and even their daughters to get family planning!” says Ilaisa.  Levi, a 47-year-old father, said that he brought his daughter to the VFHA site to get Jadelle [a long-acting contraceptive] because he does not want his daughter to fall pregnant.  “After the cyclones, I saw pregnant mothers walking to the hospitals for check-ups and I told myself that I do not want that for my daughter. I do not want her to suffer if the boy runs away. Some men were talking about VFHA, and I was surprised that even though most were hesitant to get family planning for their daughters because it meant that they were able to have sex, they also did not want their daughters to suffer,” says Levi.   Ilaisa added that they have seen more men step forward due to their work with community chiefs to ensure men attend the information sessions.  “We talk to the men too, we educate them. Then after they go to nakamal (a traditional meeting place in Vanuatu used for gatherings and ceremonies), they tell all the men about what they learnt. I believe because people are still recovering from the cyclones, men have seen the firsthand challenges of women getting pregnant and the hardships of looking after a pregnant woman when you have lost everything after a cyclone. “  31-year-old Rose, from Kumera, said that she is surprised her husband advocated for her to get family planning.   “I can’t thank VFHA enough, my husband, who previously accused me of cheating when I told him I wanted to get family planning, is the same man who now wants me to get family planning. I thank VFHA for also speaking to the men as they are usually the problem when it comes to family planning!” says Rose.  VFHA Programme Manager, Kalowi Kaltapang thanked his hardworking humanitarian team for their perseverance in breaking down barriers of sex in communities, but most importantly, the great support from DFAT in funding the humanitarian response.  “It's always been tricky to engage men in these spaces, but I thank DFAT, IPPF and the hardworking VFHA humanitarian team, who are steadfast in their mission to ensure that everyone has access to SRH services.”    

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Vanuatu cyclone response: The mental health toll on humanitarian providers

Girls and women from nearby villages flock to mobile health clinics set up by the Vanuatu Family Health Association (VFHA). The response team from VFHA consists mostly of women, who have already been away from their families for over six weeks. Team Leader, Enneth Ilaisa, mentally prepares her team for the long day ahead.  The 12-member team, consisting of nine women and three men, have been conducting community outreach on Tanna Island, Vanuatu since 28 March 2023, as part of their humanitarian response to Tropical Cyclones Judy and Kevin, which tore through Vanuatu.   “Our team consists of nine mothers who have left their families to provide these essential services to vulnerable communities. When people visit us, we must put on a happy face to make them feel welcome but sometimes it gets hard,” says Ilaisa.  Ilaisa said that the women in the medical team have been away from their homes for so long that their husbands would sometimes be overwhelmed with looking after the children and often would call the women on the team ‘selfish’ for choosing to leave their families.  Sexual and reproductive health nurse, Cindy Mahi, said she sometimes feels bad for leaving her partner alone to look after the children. When she sees clients with their children, she says she feels homesick.  “I call my family every morning, and sometimes my husband complains about me being away – and it really hurts, especially if I hear my children in the background asking when I will be back. I feel so guilty sometimes as a mother!” says Mahi.  Ilaisa added that the stress from leaving their families is compounded by an intense working environment delivering vital sexual and reproductive healthcare to remote communities.  “Our work is such that we leave our accommodation before sunrise and return after sunset. People are very tired and sometimes we are so busy helping clients that we often work through lunch to ensure we help everyone,” says Ilaisa.  Mahi said that these are things people don’t see when they come to receive services.  “When women come to see us for help, we put on a warm smile, but they do not know about the hardships we face. They do not see what is running at the back of our mind.”   Ilaisa said when it comes to the mental health of the team, she ensures she is creating a safe space where her team members can openly share.  “I offer counselling to them, and I encourage them to share the important work that they do in the field with their husbands, so they know exactly what they do. I sit there and listen to them and sometimes we cry together.”  Ilaisa said that apart from counselling, she encourages the mothers to practice self-care by taking the weekend off and making sure they take adequate breaks throughout the day.  “I tell them, if you feel you need to take a break in the middle of work – do it! When we debrief after our field work, we share the numbers of women who received SRH services, and the feeling of accomplishment is what makes our work worthwhile. When we hear these numbers it reminds us of our purpose, it reminds us of why we are here, and for a second, our family problems fade away because we know we are serving a purpose greater than ourselves.” 

SPRINT
26 April 2022

SPRINT: Sexual and reproductive health in crisis and post-crisis situations

  The SPRINT Initiative provides one of the most important aspects of humanitarian assistance that is often forgotten when disaster and conflicts strike: access to essential life-saving sexual and reproductive health services. We build capacity of humanitarian workers to deliver essential life-saving sexual and reproductive health services in crisis and post-crisis situations through the delivery of the Minimum Initial Service Package (MISP) for reproductive health in emergencies.   Through funding from the Australian Government's Department of Foreign Affairs and Trade (DFAT), our SPRINT Initiative has brought sexual and reproductive health to the humanitarian agenda, increased capacity and responded to a number of humanitarian emergencies. Australia has funded the SPRINT initiative since 2007. Since then, the SPRINT initiative has responded to 105 humanitarian crises and worked with partners in 99 countries. SPRINT has reached over 1,138,175 people, delivering 2,133,141 crucial SRH services, and continues to respond to ongoing emergencies. In each priority country, we work with an IPPF Member Association to coordinate and implement life-saving sexual and reproductive activities. Through these partnerships, SPRINT helps strengthen the enabling environment, improve national capacity and provide lifesaving services during times of crisis. You can read more about IPPF Humanitarian’s Programme here. Australia's location in the Indo-Pacific provides DFAT with a unique perspective on humanitarian action. Australia is committed to helping partner governments manage crisis response themselves. This is done through building the capacity of the national government and civil society to be able to respond to disaster. DFAT also works with experienced international partners to prepare for and respond to disasters, including other donors, United Nations agencies, the International Red Cross and Red Crescent Movement and non-government organisations.          

Nurse Leias Obed attending to a patient
02 June 2020

Cyclone Harold response: A 'hidden agenda'?

Leias Obed is a registered nurse working with the Vanuatu Family Health Association (VFHA). She’s part of the Emergency Medical Team operating out of Pangi in south Pentecost, as part of the Cyclone Harold response, which hit in April 2020. We caught up with her there. Sexual and reproductive health is a "hidden agenda", she said, putting a positive spin on the phrase. Women often have to hide their sexual and reproductive health issues and concerns, for fear of stigmatization, or even coercion and violence. By joining the relief effort as part of larger joint medical teams capable of addressing numerous concerns for both men and women, the VHFA staff are able to use the opportunities presented to contact potential clients discreetly and without putting them at risk. Informal exposure to skilled medical staff and counsellors is often enough to initiate a process that results in better, more manageable living conditions for women and their families. Unaware of their own pregnancy “We came to central Pentecost,” said Leias, “and we came across many issues affecting women and girls, but it's like I mentioned, it's a 'hidden agenda'. One thing that we found out is that many women have large numbers of children and their spacing is too close together. But they don't see it as a problem. It's not a problem for them." “Some women who became pregnant during the disaster weren't even aware of their status, but when they came to see us, we have pregnancy tests, and when we test them, they're positive. They're pregnant, and a lot of them have family planning needs.” “Their communities are a long long way from accessing facilities like [these] clinics. We go there and we help them understand, about implants that last five years. A lot of them didn't really understand. They didn't know, it but their main issue is family planning.” Information and education for all “During a response we're more concentrated on the issues facing women right now but it's clear there's a need for us to come back. We must come back so that people can come to understand: What exactly is family planning? Why is it important to use contraceptive treatments? “They really don't understand well at all about family planning products.” The information and education process needs to reach everyone, though: “It would be good if we came back. We come back and present small workshops to fathers, chiefs and to communities at large. To young girls, to mothers so they can come to understand.” There’s a need to follow through, she says. “Family planning is an individual right. We won't force anyone to take it. But there's a need. The more we stay with them, the more we explain, then they can begin to change their mind-set. Then they can freely choose to take family planning.”

Vanuatu - IPPF/Alana Holmberg
16 August 2018

World Humanitarian Day: The view from Vanuatu

In the ten months since the Monaro Volcano on the tiny island of Ambae, in Vanuatu, became active, every conceivable surface on the island has been covered by a thick layer of ash.  Volcanic ash is acidic, so it severely affects the crops many people rely on for their daily sustenance. The air becomes thick, making breathing labored and difficult. The water becomes contaminated, making it undrinkable.  The first temporary evacuation, back in September last year, relocated residents to a nearby island for one month. Only a few months after they returned the volcanic activity worsened again, and a few weeks ago, the government declared another mandatory evacuation.  Uncertain futures on the island IPPF’s partner on the ground, the Vanuatu Family Health Association, was on Ambae delivering emergency sexual and reproductive healthcare to evacuees during this time. This is their second humanitarian response to the island, having previously responded late last year.  Find out more about sexual health during humanitarian crises Having to relocate both internally and externally, living in evacuation centres, and an uncertain future all impact the sexual and reproductive health needs of a population. On Ambae, many women reported wanting to stop or delay their pregnancies until their futures were more certain.  Other women reported feeling less safe in general due to there being less people on the island.  Our humanitarian response team conducted mobile health clinics on Ambae, providing much-needed contraception and other sexual and reproductive health services.  Humanitarian workers going above & beyond Of the 11,500 original inhabitants of Ambae, thousands of people remained in their coastal homes or evacuation centres, and 4,000 people had registered to be relocated to nearby Maewo Island by the government.  Our team travelled with the evacuees on the ship, even providing impromptu medical care en route. Now they are on their “second home” on Maewo, our teams will continue their outreach to the thousands of new arrivals.  Our humanitarian workers are truly amazing and will do what it takes to provide services to people in need.  On remote Pacific islands, this often means travelling by small plane, boat, vehicle and foot, all the time with the medical supplies. Once the team arrive at a community, they set up mobile health clinics in classrooms or community halls, and deliver education sessions under trees.  This week, in the lead up to World Humanitarian Day on the 19 August, we want to thank our teams on the ground who go above and beyond.  Stories from Ambae’s women IPPF spoke to some of the outgoing residents of Ambae Island to find out about some of the health challenges they were facing as they left their homes.  Rosina, a 29-year-old mum of five, is one of them: "Five children is enough. I have never used family planning, but I know about it. I want to take it but my husband refuses to let me take the pill or the five-year stick. He says if I go on family planning then maybe I will go see other men instead of him. Many men on this island are like that. They need to be educated."  "When my husband and I discuss family planning, he disagrees. He says I know once you are on the pill or take other injectables you won’t think of me as your husband. I tell him, ‘but I am young, and I want to protect me. Then I can care for our kids, look after them properly’. I don’t know how to convince him. It’s really hard." 19-year-old Annie is pregnant with her first child: "We planned for this baby. I always wanted to have a baby. I feel good to have a baby, I’m excited. My husband is excited too." "I know what family planning is. I have heard of the pill and other methods. My grandfather told me that you [the Vanuatu Family Health Association] were here today. I haven’t received any antenatal care yet, but I knew I was pregnant. A nurse checked my baby, and she said the baby is healthy. She gave me some medication for the baby. Seeing the clinic today has saved me time.  The volcano makes me feel bad, it’s scary. I want to leave Ambae... It’s much harder being pregnant now. I want my baby to have a good future." Providing sexual and reproductive healthcare during emergencies is vital – find out why.

Delivering supplies to Vanuatu
19 December 2017

Emergency care in the most disaster-prone country in the world

“All I do is sit and cry with my children. I want family planning so bad. I’ve known about it, but I have never managed to get it,” says Esther, 31, sitting in the tiny village on the island of Ambae, in Vanuatu. On her lap is her youngest child, Elijah. Next to her on the mat is her two-year-old child, Stewart. Running around outside her modest house are her four other children - George, 12, James, 10, Steven, 8, and Judith, 6. Esther lives on the Manaro Voui volcano in Vanuatu - where sudden recent seismic activity causes it to belch toxic fumes. Esther’s husband is barely home. Her second youngest, Stewart, has a disability and cannot walk. Her youngest, Elijah, was born one week before the family were forced to evacuate to another island. Entire island evacuated On her own, Esther packed up their home and safely brought her children to the evacuation centre. This was the first time that an entire island population had been evacuated in the Pacific Region. Once the threat level was decreased and the population returned, the Vanuatu Family Health Association, through the International Planned Parenthood Federation, commenced a humanitarian response with mobile health clinics and awareness sessions. The services available through the clinics included pregnancy and delivery support, contraceptives such as condoms, injectables, implants and emergency contraceptives, and screening and management of sexually transmitted infections.   Often the communities were in areas that were impassable by road, so the VHFA response team - which included nurses and midwives - travelled by boat and foot with their medical supplies to reach those closest to the crater. Esther lived in one of those villages, evident by the smoke constantly billowing out of the crater in the near distance. Raising six children alone was already difficult for Esther but her life was made even harder during and after the evacuation. Emergency situations are particularly unsafe for women and children, who are more likely to die during an emergency than men. Transmission rates of sexually transmitted infections - including HIV - increase during an emergency, as does sexual violence and maternal deaths. Esther desperately wanted access to long term contraceptives. The nearest clinic for her is a two-hour way away, almost impossible with six children in tow. When the Vanuatu Family Health Association arrived at her village they were able to counsel her about her contraceptive options, and return the following week to give Esther a five-year contraceptive implant. Increased sexual literacy ‘Mothers do everything in Vanuatu, so having a smaller family makes it easier to move around in emergencies,’ says Julie Aru, a nurse working with VHFA during their humanitarian response. This is particularly important in Vanuatu, which according to the World Risk Index, is the most disaster-prone country in the world. ‘But the biggest issue is isolation. Mothers do not have access to family planning even in stable times,” says Julie. “The second issue is ‘kastom’ - religious and cultural beliefs – which sometimes don’t allow women access to family planning. We are working to change this.” Whilst emergencies create immense challenges, they also provide opportunities for organisations like the Vanuatu Family Health Association to reach remote communities such as Esther’s, to increase sexual literary rates, and to provide women with reproductive choices. By the end of the response, VHFA had reached over 1,600 people across the southern part of Ambae Island with sexual and reproductive health care and information, and 480 dignity kits were distributed on North and East Ambae.

IDP camp in Yemen, served by IPPF
17 May 2017

Humanitarian crises are not temporary, nor are sexual and reproductive health needs

Women and girls are disproportionately affected in humanitarian crises and face multiple sexual and reproductive health challenges in these contexts. IPPF has been providing much needed support to vulnerable communities through our global federation of member associations, who provide contextualised, timely and tailored interventions drawing on local partners' knowledge and expertise. However, recent shifts in the global political landscape are concerning and threaten to undermine IPPF's mission and impact on the ground. We live in a time when crises, whether brought on by human causes or natural disaster, have displaced more people than at any point since the Second World War. The needs of those driven from their homes are not transitory. Refugees now find themselves facing impermanent conditions for an average of 20 years. They must resort to living in temporary shelters or makeshift accommodation, and their refugee status often leaves them ineligible to access public healthcare and education. The UN reports there are more than 125 million people worldwide in need of humanitarian assistance. Of those, a quarter are women and girls between the ages of 15 and 49. And one in five of these women and girls is likely to be pregnant. A woman who has been forced to flee is particularly vulnerable. More than 60% of maternal deaths take place in humanitarian and fragile contexts, according to the UN Population Fund (UNFPA). At least half of these women’s lives could easily be saved. And yet women and girls affected by humanitarian crises face other risks too. A breakdown in civil order following disasters consistently increases the occurrence of sexual violence, exposure to sexually transmitted infections including HIV, and unintended pregnancies. After the 2015 cyclone in the Pacific Island nation of Vanuatu, a counselling centre recorded a 300% spike in gender-based violence referrals. Likewise, a study with Syrian refugee women displaced by conflict found that more than 50% experienced reproductive tract infections, almost a third had experienced gender-based violence, and the majority had not sought medical care. IPPF is at the forefront of delivering life-saving services. Our sexual and reproductive health program in crisis and post-crisis situations (SPRINT), established in 2007 and supported by the Australian Government, has ensured access to essential sexual and reproductive health services for women, men and children in times of crisis. Under the banner of our new IPPF Humanitarian division, the SPRINT initiative is now part of a global movement that seeks to provide all those affected by crises worldwide with dignity, protection and care. As a federation of 142 locally-owned but globally connected member associations, IPPF has a unique model for providing these vital humanitarian services. Our focus on valuing local solutions means our responses are rapid and sustainable. We see it as vital to be on the ground before, during, and after crises. Member associations work to mitigate against sexual and reproductive health (SRH) issues ahead of a crisis to reduce negative impacts, and remain afterward to assist communities to recover and rebuild their lives. When Cyclone Winston struck Fiji in February last year, IPPF’s local member association, the Reproductive and Family Health Association of Fiji (RFHAF), was already preparing to mobilise teams of volunteers and health staff. Initially, sexual and reproductive health was not prioritised at a national level, thus the first challenge was to convince the Government of Fiji and lead agencies of the critical importance of including sexual and reproductive health issues in the response. With support from IPPF and SPRINT personnel, RFHAF successfully advocated with the government to include reproductive health concerns into the post-cyclone needs assessment, and supported the Government in carrying this assessment out. Coordination and collaboration was critical as the damage was across an extensive area on several islands. Working in partnership with the Ministry of Health (MoH), UNFPA, Red Cross Society and local non-government agencies, RFHAF provided SRH care to remote areas identified as being worst hit by the cyclone. Colleagues from SPRINT and RFHAF split into three teams, moving into the field simultaneously to conduct 37 mobile medical missions to reach women and girls, with vulnerable pregnant women and new mothers prioritised. Comprehensive follow up beyond the initial response post-cyclone was a particular challenge for an organisation of just 11 staff. To address this, RFHAF leveraged their existing partnership with the MoH to facilitate training and handover of SRH service provision to district nurses and sub-divisional health centres, once these facilities were again operational. The response in Fiji utilised the Minimum Initial Service Package for Reproductive Health, which IPPF helped to pioneer. Commonly referred to as ‘the MISP’, the package is a series of priority life-saving interventions that IPPF seek to implement as soon as possible following a crisis.

IPPF Humanitarian - Australian Aid logos

Supporting women during humanitarian crisis

The Australian Parliamentary Group on Population and Development (APGPD) welcomes the commitment by the Australian Government to continue funding the International Planned Parenthood Federation’s work with women during humanitarian crises. Over 800 women and girls are dying every day from complications in pregnancy and childbirth. Three in five preventable maternal deaths occur in conflict, displacement and natural disasters. When disasters hit we must not forget women still need access to safe birthing spaces, family planning services, and protection against sexual violence. Since commencing in 2007 the IPPF SPRINT (Sexual and Reproductive Health Program in Crisis and Post-Crisis Settings) initiative has supported over 890,000 people through times of disaster including in Fiji, Nepal and Vanuatu. The APGPD is pleased to see the Australian Government continuing to support women in accessing sexual and reproductive health services. While other countries are pulling back and leaving women and children vulnerable it is vital Australia continues to show global leadership focused on gender equality. Access to reproductive health services is a key component of women’s empowerment, with better health outcomes leading to better education and economic outcomes for all. The Australian Parliamentary Group on Population and Development (APGPD) is a cross-party group of parliamentarians who work collaboratively to champion sexual and reproductive health and rights, gender equality and women’s empowerment globally. The APGPD was established in 1995 as part of a global network of parliamentary groups and is a member of the Asian Forum of Parliamentarians on Population and Development.

Clinic staff in front of the clinic
10 January 2024

Vanuatu: A Regional Leader in Cervical Cancer Elimination

The Western Pacific region bears a quarter of the world's cervical cancer cases. And inequalities persist within the region. Vanuatu women are seven times more likely to die of cervical cancer than Australians. A year and a half ago, the Minderoo Foundation's Collaborate Against Cancer initiative decided to take the lead on this public health issue and founded the Elimination of Cervical Cancer in the Western Pacific (ECCWP) project. By doing so, Vanuatu became the first country in the Pacific to adopt a strategy for the elimination of cervical cancer.

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When getting to the hospital is difficult, Vanuatu mobile outreach can save lives

In the mountains of Kumera on Tanna Island, Vanuatu, the village women of Kamahaul normally spend over 10,000 Vatu ($83 USD) to travel to the nearest hospital.  It takes an hour to travel up the steep, rugged, tire-track terrain by car, but it takes two hours by foot - the normal form of commute for villagers.  Alani*, a 22-year-old mother of three, said that after Tropical Cyclones Kevin and Judy hit Vanuatu in March 2023, it has been even harder to travel to the hospital.  “After the cyclone, my crops were destroyed. I usually take my kids with me to the market and sell produce but after the cyclone, I do not have any money. If I have to go to the hospital for my 3-month injectable [contraceptive], I spend 5,000 Vatu one way, then 500 for medicine at hospital then I pay 5,000 Vatu to come back.” This is equivalent to over 100 AUD, which is unaffordable for most people like Alani.   Village spokesperson, Jimmy, said that the community is grateful for the Vanuatu Family Health Association (VFHA) as they are the first medical team to visit the remote community.  “I feel sorry for our mamas, they must spend so much money just to get medicine,” he said. “In our village, we have a lot of young single mothers and most of the time, trucks refuse to come up here because of the bad road. They must walk for two hours just to get to the main road, sometimes whilst pregnant, holding bags and their many children. This is why I invited VFHA to come here, so women don’t have to spend so much money and time just to get health services.”  The outreach programme was part of VFHA’s humanitarian response to the cyclone.  “We’ve been overwhelmed by the testimonies of hardships shared by the women in this community,” said Kalowi Kaltapangm VFHA Programme Manager. “Girls and women should not be paying over 100 AUD just to have access to sexual reproductive health services – it is not right. We thank Australia through DFAT for allowing us to reach more people post-disaster.”  Jimmy added that the community is grateful for the VFHA visit and hopes they set up a clinic in Kumera.  “After Tropical Cyclones Judy and Kevin, we lost about 21 homes across the communities here and most of the food crops are gone. If you travel further, you will still see some families still in tents. People are still rebuilding their lives and it's hard to rebuild if women fall pregnant again.’  The VFHA response team reached a total of 21 communities and more than 3,000 beneficiaries across Tafea Province. This included mobile outreach to 15 communities on Tanna Island, three communities on Futuna and three communities in Aneityum.   

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Sex: changing minds and winning hearts in Tanna, Vanuatu

“Very traditional.” These two words are often used to describe the people of Tanna in Vanuatu, one of the most populated islands in the small country in the Pacific.  Between 1 and 5 March 2023, the Vanuatu islands were hit by two consecutive Category 4 cyclones (“Judy” and “Kevin”) with widespread damage to the northwest and northeastern islands. Authorities report that some 250,000 people were affected, representing more than 80 per cent of the population.  Since 28 March, The Vanuatu Family Health Association (VFHA) has been conducting their humanitarian response on Tanna. Team Leader, Enneth Ilaisa, said that they are very surprised by their breakthrough with communities - especially with the men.   “Tanna is known to be very traditional, even in the past it was almost impossible get access to these communities to talk about sex, but now it is slowly changing, and we are surprised. In our recent field visits, we have seen men step forward bringing their wives and even their daughters to get family planning!” says Ilaisa.  Levi, a 47-year-old father, said that he brought his daughter to the VFHA site to get Jadelle [a long-acting contraceptive] because he does not want his daughter to fall pregnant.  “After the cyclones, I saw pregnant mothers walking to the hospitals for check-ups and I told myself that I do not want that for my daughter. I do not want her to suffer if the boy runs away. Some men were talking about VFHA, and I was surprised that even though most were hesitant to get family planning for their daughters because it meant that they were able to have sex, they also did not want their daughters to suffer,” says Levi.   Ilaisa added that they have seen more men step forward due to their work with community chiefs to ensure men attend the information sessions.  “We talk to the men too, we educate them. Then after they go to nakamal (a traditional meeting place in Vanuatu used for gatherings and ceremonies), they tell all the men about what they learnt. I believe because people are still recovering from the cyclones, men have seen the firsthand challenges of women getting pregnant and the hardships of looking after a pregnant woman when you have lost everything after a cyclone. “  31-year-old Rose, from Kumera, said that she is surprised her husband advocated for her to get family planning.   “I can’t thank VFHA enough, my husband, who previously accused me of cheating when I told him I wanted to get family planning, is the same man who now wants me to get family planning. I thank VFHA for also speaking to the men as they are usually the problem when it comes to family planning!” says Rose.  VFHA Programme Manager, Kalowi Kaltapang thanked his hardworking humanitarian team for their perseverance in breaking down barriers of sex in communities, but most importantly, the great support from DFAT in funding the humanitarian response.  “It's always been tricky to engage men in these spaces, but I thank DFAT, IPPF and the hardworking VFHA humanitarian team, who are steadfast in their mission to ensure that everyone has access to SRH services.”    

enneth

Vanuatu cyclone response: The mental health toll on humanitarian providers

Girls and women from nearby villages flock to mobile health clinics set up by the Vanuatu Family Health Association (VFHA). The response team from VFHA consists mostly of women, who have already been away from their families for over six weeks. Team Leader, Enneth Ilaisa, mentally prepares her team for the long day ahead.  The 12-member team, consisting of nine women and three men, have been conducting community outreach on Tanna Island, Vanuatu since 28 March 2023, as part of their humanitarian response to Tropical Cyclones Judy and Kevin, which tore through Vanuatu.   “Our team consists of nine mothers who have left their families to provide these essential services to vulnerable communities. When people visit us, we must put on a happy face to make them feel welcome but sometimes it gets hard,” says Ilaisa.  Ilaisa said that the women in the medical team have been away from their homes for so long that their husbands would sometimes be overwhelmed with looking after the children and often would call the women on the team ‘selfish’ for choosing to leave their families.  Sexual and reproductive health nurse, Cindy Mahi, said she sometimes feels bad for leaving her partner alone to look after the children. When she sees clients with their children, she says she feels homesick.  “I call my family every morning, and sometimes my husband complains about me being away – and it really hurts, especially if I hear my children in the background asking when I will be back. I feel so guilty sometimes as a mother!” says Mahi.  Ilaisa added that the stress from leaving their families is compounded by an intense working environment delivering vital sexual and reproductive healthcare to remote communities.  “Our work is such that we leave our accommodation before sunrise and return after sunset. People are very tired and sometimes we are so busy helping clients that we often work through lunch to ensure we help everyone,” says Ilaisa.  Mahi said that these are things people don’t see when they come to receive services.  “When women come to see us for help, we put on a warm smile, but they do not know about the hardships we face. They do not see what is running at the back of our mind.”   Ilaisa said when it comes to the mental health of the team, she ensures she is creating a safe space where her team members can openly share.  “I offer counselling to them, and I encourage them to share the important work that they do in the field with their husbands, so they know exactly what they do. I sit there and listen to them and sometimes we cry together.”  Ilaisa said that apart from counselling, she encourages the mothers to practice self-care by taking the weekend off and making sure they take adequate breaks throughout the day.  “I tell them, if you feel you need to take a break in the middle of work – do it! When we debrief after our field work, we share the numbers of women who received SRH services, and the feeling of accomplishment is what makes our work worthwhile. When we hear these numbers it reminds us of our purpose, it reminds us of why we are here, and for a second, our family problems fade away because we know we are serving a purpose greater than ourselves.” 

SPRINT
26 April 2022

SPRINT: Sexual and reproductive health in crisis and post-crisis situations

  The SPRINT Initiative provides one of the most important aspects of humanitarian assistance that is often forgotten when disaster and conflicts strike: access to essential life-saving sexual and reproductive health services. We build capacity of humanitarian workers to deliver essential life-saving sexual and reproductive health services in crisis and post-crisis situations through the delivery of the Minimum Initial Service Package (MISP) for reproductive health in emergencies.   Through funding from the Australian Government's Department of Foreign Affairs and Trade (DFAT), our SPRINT Initiative has brought sexual and reproductive health to the humanitarian agenda, increased capacity and responded to a number of humanitarian emergencies. Australia has funded the SPRINT initiative since 2007. Since then, the SPRINT initiative has responded to 105 humanitarian crises and worked with partners in 99 countries. SPRINT has reached over 1,138,175 people, delivering 2,133,141 crucial SRH services, and continues to respond to ongoing emergencies. In each priority country, we work with an IPPF Member Association to coordinate and implement life-saving sexual and reproductive activities. Through these partnerships, SPRINT helps strengthen the enabling environment, improve national capacity and provide lifesaving services during times of crisis. You can read more about IPPF Humanitarian’s Programme here. Australia's location in the Indo-Pacific provides DFAT with a unique perspective on humanitarian action. Australia is committed to helping partner governments manage crisis response themselves. This is done through building the capacity of the national government and civil society to be able to respond to disaster. DFAT also works with experienced international partners to prepare for and respond to disasters, including other donors, United Nations agencies, the International Red Cross and Red Crescent Movement and non-government organisations.          

Nurse Leias Obed attending to a patient
02 June 2020

Cyclone Harold response: A 'hidden agenda'?

Leias Obed is a registered nurse working with the Vanuatu Family Health Association (VFHA). She’s part of the Emergency Medical Team operating out of Pangi in south Pentecost, as part of the Cyclone Harold response, which hit in April 2020. We caught up with her there. Sexual and reproductive health is a "hidden agenda", she said, putting a positive spin on the phrase. Women often have to hide their sexual and reproductive health issues and concerns, for fear of stigmatization, or even coercion and violence. By joining the relief effort as part of larger joint medical teams capable of addressing numerous concerns for both men and women, the VHFA staff are able to use the opportunities presented to contact potential clients discreetly and without putting them at risk. Informal exposure to skilled medical staff and counsellors is often enough to initiate a process that results in better, more manageable living conditions for women and their families. Unaware of their own pregnancy “We came to central Pentecost,” said Leias, “and we came across many issues affecting women and girls, but it's like I mentioned, it's a 'hidden agenda'. One thing that we found out is that many women have large numbers of children and their spacing is too close together. But they don't see it as a problem. It's not a problem for them." “Some women who became pregnant during the disaster weren't even aware of their status, but when they came to see us, we have pregnancy tests, and when we test them, they're positive. They're pregnant, and a lot of them have family planning needs.” “Their communities are a long long way from accessing facilities like [these] clinics. We go there and we help them understand, about implants that last five years. A lot of them didn't really understand. They didn't know, it but their main issue is family planning.” Information and education for all “During a response we're more concentrated on the issues facing women right now but it's clear there's a need for us to come back. We must come back so that people can come to understand: What exactly is family planning? Why is it important to use contraceptive treatments? “They really don't understand well at all about family planning products.” The information and education process needs to reach everyone, though: “It would be good if we came back. We come back and present small workshops to fathers, chiefs and to communities at large. To young girls, to mothers so they can come to understand.” There’s a need to follow through, she says. “Family planning is an individual right. We won't force anyone to take it. But there's a need. The more we stay with them, the more we explain, then they can begin to change their mind-set. Then they can freely choose to take family planning.”

Vanuatu - IPPF/Alana Holmberg
16 August 2018

World Humanitarian Day: The view from Vanuatu

In the ten months since the Monaro Volcano on the tiny island of Ambae, in Vanuatu, became active, every conceivable surface on the island has been covered by a thick layer of ash.  Volcanic ash is acidic, so it severely affects the crops many people rely on for their daily sustenance. The air becomes thick, making breathing labored and difficult. The water becomes contaminated, making it undrinkable.  The first temporary evacuation, back in September last year, relocated residents to a nearby island for one month. Only a few months after they returned the volcanic activity worsened again, and a few weeks ago, the government declared another mandatory evacuation.  Uncertain futures on the island IPPF’s partner on the ground, the Vanuatu Family Health Association, was on Ambae delivering emergency sexual and reproductive healthcare to evacuees during this time. This is their second humanitarian response to the island, having previously responded late last year.  Find out more about sexual health during humanitarian crises Having to relocate both internally and externally, living in evacuation centres, and an uncertain future all impact the sexual and reproductive health needs of a population. On Ambae, many women reported wanting to stop or delay their pregnancies until their futures were more certain.  Other women reported feeling less safe in general due to there being less people on the island.  Our humanitarian response team conducted mobile health clinics on Ambae, providing much-needed contraception and other sexual and reproductive health services.  Humanitarian workers going above & beyond Of the 11,500 original inhabitants of Ambae, thousands of people remained in their coastal homes or evacuation centres, and 4,000 people had registered to be relocated to nearby Maewo Island by the government.  Our team travelled with the evacuees on the ship, even providing impromptu medical care en route. Now they are on their “second home” on Maewo, our teams will continue their outreach to the thousands of new arrivals.  Our humanitarian workers are truly amazing and will do what it takes to provide services to people in need.  On remote Pacific islands, this often means travelling by small plane, boat, vehicle and foot, all the time with the medical supplies. Once the team arrive at a community, they set up mobile health clinics in classrooms or community halls, and deliver education sessions under trees.  This week, in the lead up to World Humanitarian Day on the 19 August, we want to thank our teams on the ground who go above and beyond.  Stories from Ambae’s women IPPF spoke to some of the outgoing residents of Ambae Island to find out about some of the health challenges they were facing as they left their homes.  Rosina, a 29-year-old mum of five, is one of them: "Five children is enough. I have never used family planning, but I know about it. I want to take it but my husband refuses to let me take the pill or the five-year stick. He says if I go on family planning then maybe I will go see other men instead of him. Many men on this island are like that. They need to be educated."  "When my husband and I discuss family planning, he disagrees. He says I know once you are on the pill or take other injectables you won’t think of me as your husband. I tell him, ‘but I am young, and I want to protect me. Then I can care for our kids, look after them properly’. I don’t know how to convince him. It’s really hard." 19-year-old Annie is pregnant with her first child: "We planned for this baby. I always wanted to have a baby. I feel good to have a baby, I’m excited. My husband is excited too." "I know what family planning is. I have heard of the pill and other methods. My grandfather told me that you [the Vanuatu Family Health Association] were here today. I haven’t received any antenatal care yet, but I knew I was pregnant. A nurse checked my baby, and she said the baby is healthy. She gave me some medication for the baby. Seeing the clinic today has saved me time.  The volcano makes me feel bad, it’s scary. I want to leave Ambae... It’s much harder being pregnant now. I want my baby to have a good future." Providing sexual and reproductive healthcare during emergencies is vital – find out why.

Delivering supplies to Vanuatu
19 December 2017

Emergency care in the most disaster-prone country in the world

“All I do is sit and cry with my children. I want family planning so bad. I’ve known about it, but I have never managed to get it,” says Esther, 31, sitting in the tiny village on the island of Ambae, in Vanuatu. On her lap is her youngest child, Elijah. Next to her on the mat is her two-year-old child, Stewart. Running around outside her modest house are her four other children - George, 12, James, 10, Steven, 8, and Judith, 6. Esther lives on the Manaro Voui volcano in Vanuatu - where sudden recent seismic activity causes it to belch toxic fumes. Esther’s husband is barely home. Her second youngest, Stewart, has a disability and cannot walk. Her youngest, Elijah, was born one week before the family were forced to evacuate to another island. Entire island evacuated On her own, Esther packed up their home and safely brought her children to the evacuation centre. This was the first time that an entire island population had been evacuated in the Pacific Region. Once the threat level was decreased and the population returned, the Vanuatu Family Health Association, through the International Planned Parenthood Federation, commenced a humanitarian response with mobile health clinics and awareness sessions. The services available through the clinics included pregnancy and delivery support, contraceptives such as condoms, injectables, implants and emergency contraceptives, and screening and management of sexually transmitted infections.   Often the communities were in areas that were impassable by road, so the VHFA response team - which included nurses and midwives - travelled by boat and foot with their medical supplies to reach those closest to the crater. Esther lived in one of those villages, evident by the smoke constantly billowing out of the crater in the near distance. Raising six children alone was already difficult for Esther but her life was made even harder during and after the evacuation. Emergency situations are particularly unsafe for women and children, who are more likely to die during an emergency than men. Transmission rates of sexually transmitted infections - including HIV - increase during an emergency, as does sexual violence and maternal deaths. Esther desperately wanted access to long term contraceptives. The nearest clinic for her is a two-hour way away, almost impossible with six children in tow. When the Vanuatu Family Health Association arrived at her village they were able to counsel her about her contraceptive options, and return the following week to give Esther a five-year contraceptive implant. Increased sexual literacy ‘Mothers do everything in Vanuatu, so having a smaller family makes it easier to move around in emergencies,’ says Julie Aru, a nurse working with VHFA during their humanitarian response. This is particularly important in Vanuatu, which according to the World Risk Index, is the most disaster-prone country in the world. ‘But the biggest issue is isolation. Mothers do not have access to family planning even in stable times,” says Julie. “The second issue is ‘kastom’ - religious and cultural beliefs – which sometimes don’t allow women access to family planning. We are working to change this.” Whilst emergencies create immense challenges, they also provide opportunities for organisations like the Vanuatu Family Health Association to reach remote communities such as Esther’s, to increase sexual literary rates, and to provide women with reproductive choices. By the end of the response, VHFA had reached over 1,600 people across the southern part of Ambae Island with sexual and reproductive health care and information, and 480 dignity kits were distributed on North and East Ambae.

IDP camp in Yemen, served by IPPF
17 May 2017

Humanitarian crises are not temporary, nor are sexual and reproductive health needs

Women and girls are disproportionately affected in humanitarian crises and face multiple sexual and reproductive health challenges in these contexts. IPPF has been providing much needed support to vulnerable communities through our global federation of member associations, who provide contextualised, timely and tailored interventions drawing on local partners' knowledge and expertise. However, recent shifts in the global political landscape are concerning and threaten to undermine IPPF's mission and impact on the ground. We live in a time when crises, whether brought on by human causes or natural disaster, have displaced more people than at any point since the Second World War. The needs of those driven from their homes are not transitory. Refugees now find themselves facing impermanent conditions for an average of 20 years. They must resort to living in temporary shelters or makeshift accommodation, and their refugee status often leaves them ineligible to access public healthcare and education. The UN reports there are more than 125 million people worldwide in need of humanitarian assistance. Of those, a quarter are women and girls between the ages of 15 and 49. And one in five of these women and girls is likely to be pregnant. A woman who has been forced to flee is particularly vulnerable. More than 60% of maternal deaths take place in humanitarian and fragile contexts, according to the UN Population Fund (UNFPA). At least half of these women’s lives could easily be saved. And yet women and girls affected by humanitarian crises face other risks too. A breakdown in civil order following disasters consistently increases the occurrence of sexual violence, exposure to sexually transmitted infections including HIV, and unintended pregnancies. After the 2015 cyclone in the Pacific Island nation of Vanuatu, a counselling centre recorded a 300% spike in gender-based violence referrals. Likewise, a study with Syrian refugee women displaced by conflict found that more than 50% experienced reproductive tract infections, almost a third had experienced gender-based violence, and the majority had not sought medical care. IPPF is at the forefront of delivering life-saving services. Our sexual and reproductive health program in crisis and post-crisis situations (SPRINT), established in 2007 and supported by the Australian Government, has ensured access to essential sexual and reproductive health services for women, men and children in times of crisis. Under the banner of our new IPPF Humanitarian division, the SPRINT initiative is now part of a global movement that seeks to provide all those affected by crises worldwide with dignity, protection and care. As a federation of 142 locally-owned but globally connected member associations, IPPF has a unique model for providing these vital humanitarian services. Our focus on valuing local solutions means our responses are rapid and sustainable. We see it as vital to be on the ground before, during, and after crises. Member associations work to mitigate against sexual and reproductive health (SRH) issues ahead of a crisis to reduce negative impacts, and remain afterward to assist communities to recover and rebuild their lives. When Cyclone Winston struck Fiji in February last year, IPPF’s local member association, the Reproductive and Family Health Association of Fiji (RFHAF), was already preparing to mobilise teams of volunteers and health staff. Initially, sexual and reproductive health was not prioritised at a national level, thus the first challenge was to convince the Government of Fiji and lead agencies of the critical importance of including sexual and reproductive health issues in the response. With support from IPPF and SPRINT personnel, RFHAF successfully advocated with the government to include reproductive health concerns into the post-cyclone needs assessment, and supported the Government in carrying this assessment out. Coordination and collaboration was critical as the damage was across an extensive area on several islands. Working in partnership with the Ministry of Health (MoH), UNFPA, Red Cross Society and local non-government agencies, RFHAF provided SRH care to remote areas identified as being worst hit by the cyclone. Colleagues from SPRINT and RFHAF split into three teams, moving into the field simultaneously to conduct 37 mobile medical missions to reach women and girls, with vulnerable pregnant women and new mothers prioritised. Comprehensive follow up beyond the initial response post-cyclone was a particular challenge for an organisation of just 11 staff. To address this, RFHAF leveraged their existing partnership with the MoH to facilitate training and handover of SRH service provision to district nurses and sub-divisional health centres, once these facilities were again operational. The response in Fiji utilised the Minimum Initial Service Package for Reproductive Health, which IPPF helped to pioneer. Commonly referred to as ‘the MISP’, the package is a series of priority life-saving interventions that IPPF seek to implement as soon as possible following a crisis.

IPPF Humanitarian - Australian Aid logos

Supporting women during humanitarian crisis

The Australian Parliamentary Group on Population and Development (APGPD) welcomes the commitment by the Australian Government to continue funding the International Planned Parenthood Federation’s work with women during humanitarian crises. Over 800 women and girls are dying every day from complications in pregnancy and childbirth. Three in five preventable maternal deaths occur in conflict, displacement and natural disasters. When disasters hit we must not forget women still need access to safe birthing spaces, family planning services, and protection against sexual violence. Since commencing in 2007 the IPPF SPRINT (Sexual and Reproductive Health Program in Crisis and Post-Crisis Settings) initiative has supported over 890,000 people through times of disaster including in Fiji, Nepal and Vanuatu. The APGPD is pleased to see the Australian Government continuing to support women in accessing sexual and reproductive health services. While other countries are pulling back and leaving women and children vulnerable it is vital Australia continues to show global leadership focused on gender equality. Access to reproductive health services is a key component of women’s empowerment, with better health outcomes leading to better education and economic outcomes for all. The Australian Parliamentary Group on Population and Development (APGPD) is a cross-party group of parliamentarians who work collaboratively to champion sexual and reproductive health and rights, gender equality and women’s empowerment globally. The APGPD was established in 1995 as part of a global network of parliamentary groups and is a member of the Asian Forum of Parliamentarians on Population and Development.