Melissa Parke (Fremantle, Australian Labor Party) Share this | Hansard source

Last Monday, 8 March, was International Women’s Day, an opportunity to reflect on the progress of the world’s women, particularly as measured against the Millennium Development Goals, because many of the MDGs are aimed at improving the health and education prospects of women and girls. In examining progress on the MDGs, I was disturbed to discover that Australia’s closest neighbour, Papua New Guinea, is currently off track to meet any of the MDGs by 2015. Some of the worst statistics in the world involve PNG women. These numbers are deteriorating rather than improving.

In particular, the maternal mortality rate in PNG has doubled since 1996, with a woman in PNG being 242 times more likely to die from pregnancy or childbirth related complications than an Australian woman. Because of the dependence of infants and young children on their mothers, there is a direct correlation between the high rate of maternal mortality and the high rate of child mortality in PNG. The situation of women and children is rendered more perilous by the high rate of domestic violence in PNG, with 75 per cent of women and children exposed to domestic violence, including sexual violence in the home. Up to 50 per cent of girls are at risk of becoming involved in sex work or being internally trafficked. Thirty percent of children are vulnerable to HIV infection due to factors such as violence, abuse, exploitation and poverty.

I had the opportunity to learn about some of these issues at close range when I visited PNG two weeks ago in my role as Chair of the UNICEF Parliamentary Association and as the guest of UNICEF Australia. Accompanied by UNICEF PNG representative Dr Bertrand Desmoulins and Anna Dekker from UNICEF Australia, I visited health, education and community facilities in Goroka, in the eastern highlands, as well as in the capital, Port Moresby. The Goroka General Hospital was built in 1960 for a population of 60,000. It is now catering for a population of 500,000. With support from UNICEF and the Clinton Foundation, the hospital renovated an existing building to become an antenatal ward, providing space and privacy for mothers to receive antenatal services, including counselling and HIV-AIDS testing and treatment. Some of the pregnant women we saw at the clinic had come from far away to visit the hospital. These women are among the mere 22 per cent of PNG women who access antenatal care. Transport is one of the main problems in PNG, with access to most places in the highlands being by air only, and the very few roads that exist are of extremely poor quality. A UNICEF funded waiting house has been established so that HIV-positive women from remote areas who are about to give birth have a place to stay in the days before they give birth. However, at this stage there is no waiting house for women who are not HIV-positive.

If we think we have a problem finding enough doctors in Australia, PNG, with a population of six million people, has only around 250 trained physicians. Approximately 10 medical students graduate each year and some of them do not stay in PNG once they are qualified. There is also a severe shortage of skilled midwives. In a submission to a parliamentary inquiry last year, World Vision contrasted the situation in PNG, where midwifery education has dwindled over the last two decades and maternal mortality has increased, with the situation in the Solomon Islands, which has been able to reduce its maternal mortality rate by prioritising midwifery training.

The Port Moresby General Hospital delivers over 11,000 babies each year in an overcrowded, rundown and understaffed women’s section. It was noted by Jo Chandler in a powerful Sydney Morning Herald article published on 7 September last year that pregnant women who find their way there are:

… among the luckiest in the country … The floors are crowded with women waiting and babies because there are not enough beds. They sometimes deliver on the floor because of a lack of staff and beds … But at least they have access to doctors and midwives—albeit in chronically short supply—and lifesaving drugs. Many more of their sisters labour unaided at home. Of PNG’s 200,000 births a year … 120,000 are unsupervised.

The article quotes Dr Glen Moa, a PNG professor who said:

Those 120,000 are taking their chances in a dirty house, on a dirt floor, with no skilled attendants, no equipment, no capacity to get somewhere if something bad happens. And they die.

The maternal death rate in PNG is 733 per 100,000 live births, which is similar to maternal mortality rates in sub-Saharan Africa. In Australia the figure is eight per 100,000 or 21.5 per 100,000 for Indigenous women. In PNG 50 per cent of maternal deaths are due to infections or bleeding to death after delivery, while 20 per cent are due to an underlying disease that is aggravated by pregnancy such as malaria, iron deficiency, hepatitis, tuberculosis and heart disease. For every woman who dies in pregnancy or childbirth another 30 become significantly disabled, many for life. The saddest aspect of these statistics is that almost all of these deaths and disabilities are preventable. That World Health Organisation recommends that there be 2.3 health workers per 1,000 people in order to reduce maternal and child mortality. However in PNG there are only 0.6 health workers per 1,000 people.

As noted in the PNG Ministerial Taskforce on Maternal Health:

… the sheer absence of adequately trained, maintained and supervised staff and facilities is the most substantial barrier to progress when discussing maternal death and disability in PNG … Countries with the lowest proportions of skilled health attendants at birth, lowest use of contraceptives and the weakest health systems have the highest number of maternal deaths.

When we were at the Port Moresby Hospital we attended a medical class given by Professor Bediako Amoa, Coordinator of Obgyn Services. He asked me to pass on to my parliamentary colleagues the message:

Next door to Australia there are people who don’t have everything Australians have. So many of our mothers are dying unnecessarily.

The current review of the PNG Treaty on Development Cooperation as informed by the PNG partnership for development is a timely opportunity for Australia to strengthen support for maternal health initiatives in PNG, and particularly for us to support the recommendations from the PNG Ministerial Taskforce on Maternal Health.

Some of these recommendations involve evidence based health interventions to address maternal health revolving around three core strategies: comprehensive integrated reproductive health services with an emphasis on strong family planning services; skilled care for all pregnant women by trained providers with strong midwifery skills during pregnancy and especially during childbirth—that is, supervised delivery; and skilled emergency obstetric care for women and infants with life-threatening complications, supported by timely referral. Other task force recommendations involve addressing systems problems in the health sector and emphasising the important role of education in reducing maternal health problems.

As noted by the task force, the devastating rate of maternal mortality in PNG is a result of a number of factors, not least of which is the second-class status of women in that country. It found:

… gender issues cannot be separated from health issues … maternal mortality is an indicator of disparity and inequity between men and women and its extent a sign of women’s place in society and their access to social, health and nutrition services and to economic opportunities.

The health interventions to address maternal mortality I mentioned above in terms of family planning services, supervised delivery and access to obstetric care are necessary and urgent but they are not sufficient. Empowerment of women in PNG society is another critical step to reducing maternal mortality.

UNICEF is supporting a number of education and training programs in PNG that are aimed at redressing the inequity between men and women. For instance, the Okiufa Primary School outside of Goroka is what is referred to by UNICEF as a ‘child friendly school’. Given the low rate—only 40 per cent—of enrolment of children in schools in rural areas and the even lower rate of girls’ enrolment, the main objective of this program is to raise awareness of the importance of girls’ education. We visited some of the school clubs and saw boys and girls participating equally in sewing, cooking and arts and crafts classes, which are helping to breakdown gender stereotypes.

We visited the Asaroyufa village court operating in one of Goroka’s eight districts. With UNICEF support, village court officials—including magistrates, women and young people—were trained in human rights and women’s and children’s rights. We heard some incredible stories from women about how the village court is now concerned with protecting their interests, whereas formerly the rights of women and children were not known and were therefore ignored.

In Port Moresby we visited a family support centre, one of five such centres in PNG which aim to ensure that women and children experiencing family and sexual violence can access a one-stop service providing a comprehensive package of medical, legal, psychosocial and case management services. There are plans to roll out 17 more centres across the country in the next two years with UNICEF Australia’s support. Improving the status and lives of women in PNG society through such measures as the child-friendly school program, the village court human rights training and the family support centres for victims of domestic violence are vital incremental steps that, together with the necessary health interventions, will assist in reducing maternal mortality. They are also part of the solution to other deep challenges existing in this complex country. I would like to thank the staff of UNICEF Australia and the UNICEF PNG country office for organising this trip and for making it so worthwhile. The UNICEF programs to improve maternal and child health and to empower women and girls—many of which are joint projects with AusAID, the PNG government and other partners—give great reason for hope for the future of PNG.

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