Melissa Parke (Fremantle, Australian Labor Party) Share this | Link to 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.

Mal Washer (Moore, Liberal Party) Share this | Link to this | Hansard source

First, I would like to congratulate the member for Fremantle for bringing the attention of the Committee to the important issue of maternal and child health in Papua New Guinea. Congratulations. Last Monday, 8 March, was International Women’s Day. For the last 35 years, the United Nations have celebrated women’s achievements on this day without regard to divisions, whether they are national, economic, linguistic, cultural, economic or political. It is a day when nations look back at the struggles and accomplishments, and also, most importantly, look forward to future opportunities for women worldwide.

This year’s theme, ‘Equal rights, equal opportunities: Progress for all’, highlights the fundamental principle that gender equality and women’s empowerment are essential if we are to achieve the Millennium Development Goals. Goal 5 is to reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio and achieve universal access to reproductive health by 2015. Sadly, there has been little progress in this being achieved. In 1990 in the developing world as a whole, there were 480 maternal deaths per 100,000 births. Fifteen years later in 2005, there were 450 maternal deaths per 100,000 births. Each year, 536,000 women and girls die as a result of complications during pregnancy; 99 per cent of these deaths occur in developing countries. Improved access to family planning is critical—40 per cent of pregnancies are unplanned. In poorer countries in Africa and the Asia-Pacific, 40 per cent of maternal deaths would be eliminated if contraceptive needs were met and there would be a 20 per cent reduction in deaths in children under five years of age if women could use contraception to space their births by two years or more. Countries that have lower fertility rates spend substantially more on the health and education of children than those with higher fertility rates.

The Papua New Guinea Department of Health Ministerial Task Force on Maternal Health are to be commended for their recommendations to address the current maternal health status of about 300 deaths per 100,000 live births. In light of our commitment to the Millennium Development Goals, the Australian government must support the Papua New Guinea government in the implementation of these recommendations. These recommendations include the implementation of universal free primary education, strengthening of access and coverage of quality voluntary family service provisions for all Papua New Guineans; access for every woman to supervised delivery by a trained health care provider by 2030; and access for all women to comprehensive obstetric care, and quality emergency obstetric care if required. It is very sad that most women die in the first 24 hours after childbirth from haemorrhage or infection.

Progress towards the goals is currently threatened by slow economic growth, diminished resources and fewer trade opportunities. However, donor nations must not reduce their aid. Our population globally is currently 6.9 billion and by conservative UN estimates it will be 9.15 billion by 2050. We currently have the largest generation ever entering reproductive age. It is critical that we stabilise our populations if any of the goals such as environmental sustainability and reduction of hunger and poverty are to be achieved. The only way that we can do this is by enabling equality and empowerment for women. Nations that implement measures to help address this issue, such as Papua New Guinea, must be supported. We must remember that we are not isolated from these issues, as poverty, population growth and the adverse effects of climate change will exert significant pressure on worldwide migration.

Our commitment to the global partnership embodied in the Millennium Declaration and in achieving the goals must remain strong. As UN Secretary-General Ban Ki-moon said:

Gender equality and women’s empowerment are fundamental to the global mission of the United Nations to achieve equal rights and dignity for all … But equality for women and girls is also an economic and social imperative. Until women and girls are liberated from poverty and injustice, all our goals—peace, security and sustainable development—stand in jeopardy.

I commend this excellent motion to the committee.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

The House of Representatives Standing Committee on Health and Ageing is currently finalising a report into regional health issues jointly affecting Australia and the South Pacific. As part of that inquiry, in October last year the committee visited PNG. This followed a visit to the Torres Strait Islands, where we looked at the health issues that exist there and also the Torres Strait Treaty. We looked at PNG from the Australian side.

When we visited PNG, we learnt of the problems that were being experienced in that society. The government figures showed that it was highly unlikely that the millennium goals would be reached, particularly millennium goals 4 and 5, which are addressed in the member for Fremantle’s motion. It highlighted that there had been some examples of progress in both countries but that there was still a long way to go. I was pleased to hear the member for Fremantle identify the role of women within the society as being one issue that does impact on the millennium goals that we are looking at here.

When we were in PNG we spent time in Port Moresby and Daru. We then visited the treaty villages, where we could see the support that the women had during childbirth and the children during their early childhood. We could compare that to the support that was available for those people living in the Torres Strait Islands, some 10 minutes away by boat. You could understand why people in PNG would invariably cross to Australia if they could in cases of extreme health crises.

It is important to note that PNG has one of the most rugged terrains in the world. Only three per cent of the roads are sealed, and often air transport or banana boat is the only mode of transport. It is very difficult to get from one place to another. Forty per cent of the population live in poverty and 80 per cent live in hard-to-reach areas, as the committee discovered during its visit to PNG. The maternal mortality rate is 733 per 100,000, making it the second-highest maternal mortality rate in Asia-Pacific region—second only to Afghanistan. About 53 per cent of mothers receive delivery assistance from health professionals, nine per cent from doctors and 40 per cent from nurses. The 53 per cent is a break-up of those figures.

The greatest cause of mortality is obviously post-partum haemorrhaging and infection. These could be circumvented if proper medical treatment was available. Women are giving birth without supervision or proper medical treatment. They are also giving birth in the most remote areas, which can mean that they do not get the assistance they need.

Australia’s relationship with PNG needs to be strengthened so we can continue to support, encourage and help the PNG government reach the Millennium Development Goals. Otherwise, as I mentioned, I do not think they will be able to reach them by 2015. We need to make an ongoing commitment to our nearest neighbour to give them the support that they need to move forward. We need to ensure that the right medical training and the right resources are available in the country to assist women and children. It is very easy to stand here and say, ‘We have the solution,’ but the solution must come from PNG. We must support the PNG government and do everything we possibly can to turn around the disaster on our doorstep.

Robert Oakeshott (Lyne, Independent) Share this | Link to this | Hansard source

I rise to congratulate the member for Fremantle on this important motion, on a topic that probably does not get the airtime in this place that it deserves. I endorse what I have heard already with regard to the Millennium Development Goals generally and to situations within our region, in particular in PNG. I also want to use my short time to promote a cause that is being raised by many members of parliament, across party lines, who want to see more action from this parliament on the Millennium Development Goals. I will try to build a case, in my four minutes, as to why part of the job description of a local member is to spend time and effort on topics such as this one.

It is chilling to think that, during a five-minute speech, five women somewhere in the world will die because of inadequate maternal health care. If that is not chilling enough to warrant spending time on this topic, let me present the arguments around the Australian sovereign interest and why every single member of parliament should give a damn about topics such as this one. It is a concern to hear people within politics or generally within the community say, ‘We should pull all aid money,’ and at the same time complain about people movement and trafficking throughout our region and the instability this can cause, the problems with health care—maternal health care in particular—violence against women and girls and issues around economic development and poverty, issues that then logically flow on to the various national security issues within our region. These are all direct threats to our national sovereignty. If for no reason other than the self-interest of protecting and promoting the country that we as members of parliament represent, it is critical that we make more mention of, and take more action on, the Millennium Development Goals, the aspirations within them and the practical work being done by so many to try and achieve them.

This is an important motion, particularly if we want fewer people movements and fewer communicable diseases within the region—and the mention of PNG on that particular topic is important when so many in our community still think AIDS is some African thing. AIDS in PNG is an issue of direct threat to health care within Australia. If nothing changes on the ground in PNG, the rate of AIDS and HIV in PNG will outstrip that in any other country in the world. It is as much, if not more, an Asia-Pacific issue as it is an Africa issue. Within the Australian community, some of these stereotypes need to change—and change quickly—because, when they do, pressure can then be applied on executive government to take greater action, to spend more resources and to address some of these issues with the urgency they deserve.

This is important for all local members to be involved with, and I hope that we see more of this. I am involved in a group of 10 Asia-Pacific male MPs working on trying to get into the heads of men within the region on the topic of violence against women and girls. That is chaired by Dr Puka Temu, the Deputy Prime Minister of PNG.. I have full confidence in his ability to steer this region-wide committee to achieve region-wide and national outcomes. That is my little bit. I hope every member does their little bit. If we do, and through motions such as this, we can achieve not only a better nation but also a better region and, ultimately—(Time expired)

Amanda Rishworth (Kingston, Australian Labor Party) Share this | Link to this | Hansard source

I too would like to congratulate the member for Fremantle for bringing this very, very important motion to the attention of the House. I too, with the previous government speaker, the member for Shortland, was an attendee on the House of Representatives committee that looked into some of the health issues in the Pacific region and indeed was one of the members who was able to travel to Papua New Guinea and see some of the health services and some of the work that was being done by the government of PNG and some of the AusAID programs and other NGO programs on the ground.

I am very pleased to speak to this motion. As the previous speaker said, we often do think of some of these big issues as being issues that are far away from us. Indeed, it was only when I travelled up to the Torres Strait that I got a concept of just how close a neighbour PNG is to us. In fact, standing in Saibai, you could see PNG, which was less than three kilometres away. Another example of that was that, when we were on the other side, in PNG, travelling to the treaty villages, you could get Telstra coverage—which is more than some of my electors can get, but that is another story. That highlights just how close the relationship is.

While International Women’s Day is a great opportunity to look at how women across the world are faring, it is important that we are also looking at our own region. I am indeed very pleased that we are looking at our closest neighbour—a neighbour that we have also had a lot of historic links to; a neighbour that I am pleased to see that the government is forging a new relationship with.

Another issue that the member for Fremantle and other previous speakers mentioned was the millennium goals. I do not think that we can look at millennium goals 4 and 5 and even 6 without addressing the violence against women that is occurring. We heard a lot of stories, and there are a lot of programs. I know that the government are aware of this and are looking at how they might address the violence against women that is happening throughout that society. I think we sometimes try to put violence against women in a different pigeonhole and not in the health pigeonhole, but I do not think we can really address this without looking at gender equality and also violence against women in that country. This issue was raised with us time and time again and it is something that needs to be noted when we are addressing the Millennium Development Goals 4 and 5.

As we heard previously, workforce is another issue that we heard about time and time again. Ensuring that women have access to a health worker when they are having their babies is difficult. This was raised with us especially when we were out in the rural areas and it is an issue that does need to be addressed and does need to be seriously looked at. How do we make sure that workers are trained, that they have the resources that they need and that they also have the support in the local areas where they are working? One thing that we did hear time and time again was that, while there was a health worker allocated to a certain village, they were not adequately supported with housing, so it was very hard for that health worker to continue to do the work that they were doing as they had nowhere to stay. Support for those health workers as well as training up more health workers to ensure that women do have access is incredibly important.

We cannot avoid talking about Millennium Development Goal 6 when it comes to PNG, which is about combating HIV and AIDS, with particular reference to child and maternal mortality. While we were there, we saw some small programs that were very effective at reducing the transmission from mother to child of HIV. This can be done in an effective way, but it does need support and education. That was a very small but inspiring program, which I hope many more mothers and babies in PNG get access to. I have run out of time at this point, so I will finish by commending the motion to the House.

Louise Markus (Greenway, Liberal Party, Shadow Minister for Veterans' Affairs) Share this | Link to this | Hansard source

I rise to support this motion and I thank the member for Fremantle for moving it. I have a particular connection to Papua New Guinea as my husband was born there. He was a PNG national, but he is now an Australian citizen. From my many times in Papua New Guinea with my tambus, my family, I have developed a commitment to that nation and I thank the member for Fremantle for raising these issues. I rise to speak on the work in relation to the Millennium Development Goals that are yet to be achieved in Papua New Guinea, with particular concern for the goals relating to maternal and child health. I have seen firsthand the results and the impact of the lack of services and the reduction in services that are available to women across that nation over the last 20 years. It has deteriorated year by year and with each visit I am extremely dismayed.

Recently, the United Nations Development Program administrator, Miss Helen Clark, visited PNG to launch their second national MDG progress report. Sadly, as the report highlights, Papua New Guinea is currently not on track to meet the Millennium Development Goals in most areas, specifically in the areas of HIV/AIDS, reducing child and maternal mortality and also promoting gender equality. I speak on behalf of the women in that nation as I rise tonight, as I am sure we all do. They have a desire in their hearts to see themselves, their nation and their children rise to achieve their full potential. That is their greatest desire.

Miss Clarke draws attention to the fact that progress towards achieving MDGs is often lagging the most where the needs and the status of women and girls are accorded low priority. As late as the 1960s the national average life expectancy at birth was only about 40 years and the infant and child mortality rate was 134 per thousand live births in PNG. Infant and child mortality started to come down in the 1970s, but progress has slowed considerably in recent years. Some provinces in PNG continue to have very high infant mortality rates of more than 100 per thousand live births, but there are huge disparities in these numbers.

I know, as a result of the lack of medical services for my own family members, that children have not been born alive because they have not had access to what we take for granted in this nation. Health services, mother and child health care, reproduction health, immunisation, preventable diseases, the security situation and the lack of basic infrastructure in some provinces need to be addressed in order to close the large gaps in child mortality. In view of the already stagnating mortality indicators and the enormous new challenges PNG is facing, especially the threat of HIV/AIDS, it is highly unlikely that the global target of reducing child mortality by two-thirds can be achieved by 2015.

Although accurate numbers are not available and recent statistics, as have been mentioned around this room, have varied even among us, some of the figures I have from 1984 are that the national average maternal mortality ratio was an estimated 370 per 100,000 live births. This is far too high. The proportion of pregnant women giving birth under medical supervision is extremely low and has decreased even further in recent years. These are important determinants of maternal and infant mortality.

The extremely large reduction of 75 per cent in maternal mortality by 2015 envisaged under MDG5 is generally considered unlikely to occur in Papua New Guinea. A far more modest national target may be achievable if some drastic and urgent improvements are made in a number of critical areas especially antenatal care attendance, supervised delivery or, more generally, reproductive health and family planning. These two goals are important and direct action can be taken to achieve improvement in these areas. However, improving other areas will also benefit these two specific goals—improvement in education and gender equality, particularly in providing increasing access to all women to education facilities. This will see significant flow-on effects to the improvement of maternal health and child mortality in Papua New Guinea. Access to education is often a choice families must make. They have to choose between the number of children they have and who they can provide education for. It is often the male who gets first priority. I would like to see everything done to encourage every girl in PNG to have access to education. (Time expired)

Ramsey Rowen (the Deputy Speaker):

Order! The time allotted for this debate has expired. The debate is adjourned and the resumption of the debate will be made an order of the day for the next sitting.