World Population Day on 11 July focuses attention on the importance and urgency of population issues, such as population growth, ageing, migration, and urbanisation. The theme for this year’s World Population Day recognises that reproductive health and gender equality are essential in achieving sustainable development and a brighter future. JCU PhD candidate Relmah Harrington is looking to the role the wider community can play in creating a healthier and safer future for maternal and neonatal health outcomes in the Solomon Islands.
As an experienced nurse, midwife, and nurse educator and trainer, Relmah has witnessed first-hand the reproductive healthcare challenges faced by the communities and healthcare workers in her home nation, the Solomon Islands.
Maternal and neonatal mortality, limited access to health services, and high teen pregnancy rates are some of the issues that the she has seen throughout her career. On way of improving outcomes in these areas is through the provision of reproductive health advice and family planning resources.
The availability of such services, however, does not necessarily relate to the number of people using the service. “I didn’t see women come forward very much to access family services,” Relmah says. “We used to give health talks and education talks to them but not many people came forward to take family planning options. I was wondering why women, or men, weren’t coming forward and if there was something I need to know from their perspectives.”
In order to understand the gap between the high-level of family planning knowledge and the uptake rate of family planning services, Relmah decided to combine her experience as a Solomon Islands woman and her time as a nurse and midwife to examine what was happening at the service provision level. “I needed to go back to the other part of me,” she says, “the community member, to see what might work for us in the community and how we can get everyone to be involved so that women can come forward.”
Relmah’s preliminary results suggest that connecting the provision of family planning with community context is key. “We only talk to women when we talk about family planning and not the men,” she says. “In the cultural context, men are the decision makers in the family, and they will have to agree before a woman will accept these resources — we didn’t actually reach the husband.”
Considering the cultural contexts of men and woman is also important when it comes to who is delivering the service. “Men would prefer to deal with a male service provider, but in my remote hospital there was no man in the family planning clinic it was only women. It is like men and boys cannot fit into the service, so we need to make space for them, and involve men in the delivery of family planning.”
The location of the clinic was also an important factor in the uptake of family planning services. “What happened was our family planning clinic in that hospital was a little room attached to the delivery suite,” Relmah says. “The nearby communities in the mountains practice ancestral worship and have a belief that their women could not call near the birthing place. Unless they are birthing it is taboo, so if the building is connected then they can’t come. There is a similar taboo for the men. They believe that they can’t come near the birthing suite, which means they can’t access the family planning clinic. They said if the clinic is a separate building not connected to the birthing suite then they can come there to access family planning resources and advice.”
For Relmah, understanding that a one size fits all approach would not work is key. Health services must meet the community where they are and in their own context. As Relmah points out, cultural values and religious beliefs can play an important role in making family planning more accessible, as opposed to being viewed as an impediment to service delivery and care. “Rather than just blaming culture and religion, if we can also look at facilities and how we actually make the service available to each community it would make a difference to the uptake and provision of family health services,” she says. “The main thing is where the service is located, who is providing the service, and how it is provided.”
While women and their babies are at the forefront of pregnancy and childbirth risk, encouraging the uptake of family planning to improve reproductive health outcomes requires a community approach. “I hope I can change the way that we provide services and change it in a way that suits the context of people who access that particular health centre, so people are able to come forward and utilise the service.”
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