28 March 2018 Senate Foreign Affairs Defence and Trade References Committee [email protected] Re: Senate Foreign Affairs Defence and Trade References Committee Inquiry into the United Nations Sustainable Development Goals Dear Sir/Madam, Thank you for the opportunity to provide a written submission to the Senate Foreign Affairs Defence and Trade References Committee Inquiry into the United Nations Sustainable Development Goals (SDG). Family Planning NSW is the leading reproductive and sexual health (RSH) agency in Australia with over 90-year’s history and an in-depth understanding of where Australia sits in terms of key RSH goals outlined in the agenda. Family Planning NSW provides RSH services, professional education and training, and research and evaluation in Australia, focusing in NSW. We are DFAT accredited and provide international development activities in RSH across the Indo-Pacific region. The Pacific has some of the worst RSH indicators globally, with high rates of unintended and teenage pregnancies, sexual violence and unacceptably high rates of cervical cancer deaths. Our international projects closely align with the United Nations’ SDGs and in particular: • Goal 3: Ensure healthy lives and promote well-being for all at all ages • Goal 5: Achieve gender equality and empower all women and girls Across Australia, there is a lack of national co-ordination on key RSH issues and no recognised national data collection on related 2030 RSH agenda indicators. Available evidence indicates that vulnerable populations including Aboriginal and Torres Strait Islander people, young people, culturally and linguistically diverse people, people with disability and those living in rural or remote areas are left behind the general population on key RSH action items. These facts present ample opportunity to respond and prioritise improvements in this area. Our submission spans key targets and we are delighted to provide this submission via your online portal and cc’d here. I would welcome any inquiries you may have and have no requirement for any part of this submission to be kept confidential. Kind regards Adj. Prof. Ann Brassil CEO Family Planning NSW Sustainable Development Goal 3 – Good Health and Well-Being 3.7 By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes. The unmet need for family planning remains unacceptably high, especially in disadvantaged populations and in under- developed and developing countries, including in the Pacific region. In the Solomon Islands, for example, population increases are expected to outstrip food and water supply within ten years. Neighboring Papua New Guinea is experiencing similar critical sustainability issues in relation to its current population projections. These parts of the Indo-Pacific are faced with limited and unreliable contraceptive supply, with some of the most under-resourced reproductive health services in the world. A. The understanding and awareness of the SDG across the Australian Government and in the wider Australian community; In Australia both within government and the wider community there is good understanding and awareness of the importance of access to family planning and contraception for overall health and wellbeing and there is broad access to sexual and reproductive healthcare. Sixty-eight per cent of partnered women in Australia used contraception in 2015 (i).This proportion has remained relatively stable over the past 20 years and is consistent with other more developed countries. There has been a rise in the prevalence of contraceptive use in less developed (44% to 53%) and least developed countries (21% to 63%) over the same period (i). B. the potential costs, benefits and opportunities for Australia in the domestic implementation of the SDG; Reproductive and sexual health and rights save lives, empower women and lift women and their families out of poverty. Family planning is one of the most cost-effective investments in global health and development. Every one dollar invested in reproductive health generates up to 120 times its value in economic and social benefits (ii). This includes reductions in unintended pregnancy and maternal and infant mortality, improved health and wellbeing, increased educational attainment for women and children, and greater female labour force participation. Australia has good quality reproductive health services, however, there is a significant opportunity to improve access for high need populations including Indigenous communities which have lower use and access rates to contraception than the broader community (iii). C. What governance structures and accountability measures are required at the national, state and local levels of government to ensure an integrated approach to implementing the SDG that is both meaningful and achieves real outcomes; There are significant gaps in knowledge regarding contraceptive prevalence and choices in Australia, including methods and products used, and how this varies by geographic, social and other factors. The National Aboriginal and Torres Strait Islander Health Survey (NATSIHS), conducted by the ABS in 2012, found 49.4 per cent of Indigenous women reported currently using contraception (iii). This is lower than the national average of 60 per cent who were currently using contraception as reported in the HILDA 2015 survey (iv). Facilitating greater education about, as well as access to, contraception among Indigenous and other priority populations is crucial to reducing rates of unintended pregnancy, reducing maternal and infant mortality, and thus increasing educational attainment and increasing labour force participation. These are critical in ‘closing the gap’ in Aboriginal and Torres Strait Islander health and well-being, as well as that of other priority populations including youth, culturally and linguistically diverse populations, people living with disability, lesbian, gay, bisexual, transgender and intersex (LGBTI) people and people from rural and remote communities. 2 D. How can performance against the SDG be monitored and communicated in a way that engages government, businesses and the public and allows effective review of Australia’s performance by civil society; In Australia, a consistent, national approach to the collection of data on contraceptive use, either through routine data collection and reporting by Medicare, or through regular, population-based survey research, is required to provide the level of information needed to ensure a robust understanding of our immediate priorities in RSH, supported by effective health service provision and cost-effective policy in this area. Internationally, the populations of the Pacific Island nations are very small, which means that sales of contraceptives will never be large on any world standard. The pressing impact of this is that both the corporate (including pharmaceutical companies) and significant international donors do not focus on the Pacific as they cannot achieve the requirements of their business models for economies of scale and size in achieving a significant return on investment. While many industries stand to gain from a population with good RSH and rights, such as Australia itself, those companies and services reaping the profits are not those working at the forefront of RSH. It is therefore beholden on governments, including the Australian Government, to provide the safety-net so that Pacific Island nations can access goods and services at the level of developed nations and therefore develop the capability to compete on the world stage. E. What SDG are currently being addressed by Australia’s Official Development Assistance (ODA) program? A greater unmet need for family planning can be seen among less developed (16%) and least developed countries (22%). Globally, 214 million women and girls have an unmet need for modern contraception (v), and more than 800 women and girls die every day from preventable pregnancy and childbirth-related causes (vi). Australia’s investment in family planning within the aid program has halved between 2013/14 and 2015/16 to AUD 23.7 million; accounting for just 0.6% of ODA. Australia’s commitment to family planning now falls far below global comparisons (vii). We urge the Australian Government to increase this investment to AUD $50 million per annum for family planning assistance. Disbursement of these funds should not just focus on big multilateral organisations, but include significant allocations to NGOs and civil society who have a proven track record on the ground to provide capacity-building of service providers at the country level. We call for a broad multi-country commitment, investing in aid and development organisations that focus on communities in the Pacific. Communities across the Pacific are at crisis point with rapidly growing populations .Unsurprisingly, these communities have concomitant high levels of maternal and infant mortality, lower levels of educational attainment, lower levels of sustainable workforce participation and limited and unreliable access to RSH services, including family planning and contraception (viii). G. How countries in the Indo-Pacific are responding to implementing the SDG, and which of the SDG have been prioritised by countries receiving Australia’s ODA, and how these priorities could be incorporated into Australia’s ODA program; To implement sustainable change in the