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Situation Analysis of Children in the Pacific Island Countries © United Nations Children’S Fund (UNICEF), Pacific Office

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Situation Analysis of Children in the Pacific Island Countries © United Nations Children’S Fund (UNICEF), Pacific Office Situation Analysis of Children in the Pacific Island Countries © United Nations Children’s Fund (UNICEF), Pacific Office December 2017 This report was written by Kirsten Anderson, Ruth Barnes, Awaz Raoof and Carolyn Hamilton, with the assistance of Laura Mertsching, Jorun Arndt, Karin Frode, Safya Benniche and Kristiana Papi. Maurice Dunaiski contributed to the chapters on Health and WASH. Further revision to the Child Protection chapter was done by Shelley Casey. The report was commissioned by UNICEF Pacific, which engaged Coram International, at Coram Children’s Legal Centre, to finalise 14 Situation Analyses and a regional overview of Pacific Island Countries: the Cook Islands, the Federated States of Micronesia, Fiji, Kiribati, the Marshall Islands, Nauru, Niue, Palau, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu and Vanuatu. In-country data collection was implemented in the Federated States of Micronesia, Fiji and Solomon Islands. UNICEF Pacific is a multi-country office based in Fiji, with country offices in Vanuatu, Kiribati and Solomon Islands. UNICEF Pacific promotes the rights and wellbeing of every child in the 14 Pacific Island Countries, which are home to around 1.2 million children and youth, living on more than 660 islands and atolls stretching across 17.2 million square kilometres of the Pacific Ocean. The Situational Analyses were managed by a Steering Committee within UNICEF Pacific and UNICEF EAPRO, whose members included: Andrew Colin Parker; Gerda Binder (EAPRO); Iosefo Volau; Laisani Petersen; Lemuel Fyodor Villamar; Maria Carmelita Francois; Settasak Akanimart; Stanley Gwavuya (Vice Chair), Stephanie Kleschnitzki (EAPRO); Uma Palaniappan; Vathinee Jitjaturunt (Chair) and Waqairapoa Tikoisuva. The contents of the report do not necessarily reflect the policies or views of UNICEF. UNICEF accepts no responsibility for error. Any part of this publication may be freely reproduced with appropriate acknowledgement. Suggested citation. United Nations Children’s Fund, Situation Analysis of Children in the Pacific Island Countries, UNICEF, Suva, 2017 Cover Image: ©UNICEF/UN0249117/Alcock Situation Analysis of Children in the Pacific Island Countries 2 Situation Analysis of Children in the Pacific Island Countries Table of Contents Executive Summary .................................................................................................................. 6 Acronyms ................................................................................................................................. 12 1. Introduction .................................................................................................................. 15 1.1. Purpose and scope ................................................................................................. 15 1.2. Conceptual framework ........................................................................................... 16 1.3. Methods and limitations ........................................................................................ 18 1.4. Governance and validation .................................................................................... 19 2. Context .......................................................................................................................... 20 2.1. Geography and demographics ............................................................................... 20 2.2. Climate and disaster risks ...................................................................................... 22 2.2.1. Natural disaster risks .................................................................................... 22 2.2.2. Climate change............................................................................................. 28 2.3. Government and political context ........................................................................... 29 2.4. Socio-economic context ......................................................................................... 30 2.5. Legislative and policy frameworks ......................................................................... 37 3. Health and nutrition ..................................................................................................... 41 3.1. Child mortality ........................................................................................................ 42 3.1.1. Under-5 mortality ........................................................................................ 43 3.1.2. Infant mortality ............................................................................................ 45 3.1.3. Neonatal mortality ....................................................................................... 45 3.1.4. Disparities within countries ......................................................................... 46 3.1.5. Immediate causes of child mortality ........................................................... 47 3.1.6. Underlying causes of child mortality ........................................................... 48 3.2. Child health, immunization and communicable diseases ....................................... 48 3.3. Maternal health ...................................................................................................... 54 3.4. Violence against women and girls .......................................................................... 58 3.5. Adolescent health .................................................................................................. 58 3.5.1. Fertility and contraceptive use .................................................................... 58 3.5.2. HIV/AIDS and sexually transmitted infections ............................................. 61 3.5.3. Substance abuse......................................................................................... 62 3.5.4. Mental health .............................................................................................. 65 3.6. Nutrition ................................................................................................................. 68 3.6.1. Child stunting and wasting .......................................................................... 69 3.6.2. Anaemia ...................................................................................................... 71 3.6.3. Low birth weight and underweight ............................................................. 72 3.6.4. Obesity ....................................................................................................... 73 3.6.5. Breastfeeding .............................................................................................. 77 Table of Contents 3 3.7. Key barriers and bottlenecks .................................................................................. 79 3.7.1. Transportation ............................................................................................. 80 3.7.2. Climate and disaster risks ........................................................................... 80 3.7.3. Data availability ........................................................................................... 81 3.7.4. Misperceptions and socio-religious norms ................................................. 82 3.7.5. Gender norms ............................................................................................. 82 3.7.6. Health financing .......................................................................................... 82 3.7.7. Health workforce......................................................................................... 87 3.7.8. Equitable service delivery ........................................................................... 88 4. Water, Sanitation and Hygiene .................................................................................... 90 4.1. Access to improved water sources ........................................................................ 91 4.2. Access to improved sanitation facilities ................................................................. 94 4.3. Hygiene practices ................................................................................................... 99 4.4. WASH in Schools .................................................................................................. 101 4.5. Menstrual hygiene management ..........................................................................103 4.6. WASH access for children with disabilities ...........................................................104 4.7. Barriers and bottlenecks ........................................................................................104 4.7.1. Geography ..................................................................................................105 4.7.2. Financing ....................................................................................................105 4.7.3. Human resources .......................................................................................106 4.7.4. Climate and disaster risks ..........................................................................106 4.7.5. Equity .........................................................................................................107 4.7.6. Gender norms ............................................................................................108 4.7.7. Community awareness ..............................................................................108 4.7.8. Conflict and land disputes ..........................................................................109
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