SEXUAL AND REPRODUCTIVE HEALTH ACTION PLAN SEXUAL HEALTH CONFERENCE CHRISTCHURCH 2017
WHERE IS THE SRH PLAN UP TO? New enthusiastic MoH steering group Phase one: developing draft complete Phase two: Authorising, getting ownership and leadership Phase three: Lift off! Publishing and beginning
Priority Groups Young people particularly Māori & Pacific and those living in high deprivation Women living in high deprivation Young people at risk of sexual violence Young people living in care, attending alternative education or teen parenting units Gay and bisexual men Sexuality and gender diverse communities Sex workers Migrants refugees and people of diverse cultures People living with HIV People living in rural or remote communities People who have drug or alcohol addictions People living with disabilities
Structure of the plan Healthy young people and communities Comprehensive sexuality education Sexual violence and rape culture Addressing stigma and discrimination Great health care Reproductive health STIs and HIV Sexuality and gender diverse communities Sexual violence Research and surveillance
Rate of birth per 1,000 women Rate of births per 1,000 women Birth rates by ethnicity and deprivation Rate of births per 1,000 15-19 year old women by deprivation and ethnicity, 2015 Rate of births per 1,000 15-44 year old women by deprivation and ethnicity, 2015 80 120 70 60 50 1 (Least Deprived) 2 100 80 1 (Least Deprived) 2 40 60 3 30 3 40 4 20 10 4 20 5 (Most deprived) 0 Māori Pacific Asian Other 5 (Most deprived) 0 Māori Pacific Asian Other
Percent Planning status of most recent pregnancy in past 5 years 80 70 60 50 40 30 20 10 0 68.6 55 50.1 33.1 29.7 20.2 22.5 11.9 8.9 Planned Ambivalent Unplanned Age group 16-24 25-34 35-44 DRAFT: PLEASE DO NOT CIRCULATE
Termination of pregnancy by contraceptive use Percentage using no contraception by age Percentage of abortions by contraception used None 11% 5% 13% under 20 20-24 9% 4% 2% Condoms Combined oral contraceptives Progesterone only contraceptives 17% 25-29 Natural family planning 25% 29% 30-34 35-39 25% 57% Emergency contraception 1% Intra-Uterine contraceptive device without hormones 1% Depo provera injections 1% 40 and over Intra-Uterine contraceptive device with hormones 0%
New contraceptive access budget initiative 67% of the pregnancies of women with drug or alcohol addictions, and 70% of pregnancies of those on a welfare benefit were unplanned. Provide low cost access to reproductive health consultations for low income women Provide free insertions for long acting reversible contraception - IUDs and Jadelle sub dermal implants Develop national consensus contraceptive guidelines and training Undertake focus groups with target groups of low income women including young women, Maori, Pacific, Asian to inform guidelines and training
HIV
HEALTHY YOUTH AND COMMUNITIES SOCIAL DETERMINANTS OF SEXUAL HEALTH AND WELL BEING Comprehensive sexuality education parents, schools and social media Safety from stigma and discrimination and sexual violence sexuality and gender diverse communities, people living with HIV and other STIs, sex workers Sexual well being and safety from sexual violence rape culture pornography STRATEGIES Cross sector and cross govt collaboration Safety at school school based health promotion
Highly positive effects Decreased numbers of sexual partners Delay in first sex Regular use of contraception Reduced unprotected sex SEXUALITY EDUCATION Increased use of condoms, ability to negotiate use of condoms and talk with partners about preventing pregnancy and STIs
SO Work with education sector to encourage whole school approach, good policy development Work to support parents Develop social media BUT Little curriculum time Low priority Little professional development release time Teaching varies Whole school approach needed
SEXUAL VIOLENCE IS COMMON Sexual assault 24% women 6% men - Maori women 29% Sexual abuse 30% of girls and 9% of boys before age 16 Unwanted sexual touching 20% females and 9% males (10,000 13-17yo) 53% girls and 71% boys told no-one Outcomes likely to have other sexual assault, self blame, self medication, PTSD, no safe place (i) NZ Crime and safety Survey 2014 (ii) Youth 2012 (iii) Dunedin Multidisciplinary Health and Development Research
What fuels high rates of sexual violence? RAPE CULTURE Victim blaming shame, silence, inaction Sexualisation and objectification of females Gendered attitudes (audio clip) Pornography the new sex education 2017 46% males and 19% females viewing weekly; 39% males view daily 15-29 Content models male dominance and aggression towards women, and female submission
Percent (%) Young LGBT school experience +mental health Rates of bullying in 2012 Suicidality 100% 100 80% 80 60% 60 40% 40 20% 20 0% Afraid someone Not gone to school will hurt/bother you a least once in the at school last month - afraid someone will hurt/bother you Bullied at school weekly or more often Has been hit or Feels safe at physically harmed school (all or most in last 12 months of the time) 0 Friend attempted suicide Suicidal ideation Family member Plan to kill myself Attempted suicide attempted suicide Opposite-sex attracted Same/both sex attracted Opposite-sex attracted Same/both-sex attracted
STIGMA AND DISCRIMINATION Very poor mental health outcomes for LGBTIQ Associated with hostile environment rather than intrinsic
Workshop LIKES: LINKS: AMEND: ADD: PARTICIPATE/KEEP INFORMED