Health of Adolescents in

(1)

F

iji is an island nation in the South Pacific. Its population consists of 56.8% Fijians, 37.5% Indians and a minority of other Pacific islanders, Chinese and Europeans.¹ The country has a slow population growth rate because of relatively low levels of fertility and a high level of emigration. Fiji is one of the most developed of the Pacific island economies, although its volatile political situation may have had some adverse impact on the economy. Fiji also has a good standard of health and fares well among the other Pacific island nations.² POPULATION

Based on the 2007 Census, the adolescent population aged 10–

19 accounted for 19.3% (161 902) of the total population in Fiji.³ (Table 1)

Table 1: Number and percentage of young people by age and sex, Fiji, 2007

(years)Age Male Female Total

Number (%) of

Total Pop Number (%) of

Total Pop Number (%) of Total

Pop

10–14 42 369 5.1% 40 015 4.8% 82 384 9.8%

15–19 40 818 4.9% 38 700 4.6% 79 518 9.5%

20–24 41 325 4.9% 39 027 4.7% 80 352 9.6%

Total 124 512 14.9% 117 742 14.1% 242 254 28.9%

Source: Fiji National Census of Population 2007, Fiji Islands Bureau of Statistics.

EDUCATION

Legislation: The Compulsory Education Regulation of the Education Act states that all children of compulsory school age (6–15 years) in Fiji shall have compulsory education.⁴

1 Fiji National Census of Population 2007. Fiji Island Bureau of Statistics.

[Updated 29 September 2010, cited 7 October 2010.] Available from:

http://www.statsfiji.gov.fj

2 Western Pacific Country Health Information Profiles: 2010 Revision. Fiji:

Country Profile. Manila, Philippines: World Health Organization Regional Office for the Western Pacific. [Cited 15 May 2011.] Available from:

http://www.wpro.who.int/internet/files/hin/CHIPS2010.pdf

3 Fiji National Census of Population 2007. Fiji Island Bureau of Statistics.

[Updated 29 September 2010, cited 7October 2010.] Available from:

http://www.statsfiji.gov.fj

4 Fiji country report. United Nations Educational, Scientific and Cultural Organization. [Cited 10 October 2010.] Available from: http://www.

unesco.org/education/wef/countryreports/fiji/rapport_2_1.html

Area: 18 333 sq km^a

Population (2007 Census): 837 271^b

Rural-Urban population, 2009: 48.5%/51.5%^c Crude birth rate/Crude death rate, 2009:

20.6 per thousand/7.5 per thousand^a

Annual population growth rate, 2009: 1.3%^a Human Development Index (HDI), 2010: 0.669 (Rank: 86 of 169 countries)^d

Human Poverty Index (HPI-1): 21.2%

(Rank: 79th of 135 countries)^e

Gross National Income per capita (PPP int. US$):

US$ 4530^f

Incidence of poverty using differentiated values for the Basic Needs Poverty Line (2008–2009): 31%^g

School enrolment: In 2008, the net enrolment ratio (NER) for primary level education was 89% (90% for boys and 89%

for girls)⁵ and, the gross enrolment ratio for secondary level education was 81% (78% for boys and 84% for girls).⁶ The gross enrolment ratio for tertiary level education (ISCED 5 and 6) was 15% in 2005 (14% for boys and 17%

for girls).⁷ The survival rate to grade 5 was 92% based on 2007 figures.⁸

Gender parity index (GPI): The GPI for primary level enrolment was 0.99 in 2008⁹;

5 Fiji: UIS Statistics in Brief. United Nations Educational, Scientific and Cultural Organization Institute for Statistics. [Cited 15 May 2011.] Available from: http://stats.uis.unesco.org/unesco/

TableViewer/document.aspx?ReportId=121&IF_Language=eng&BR_

Country=2420&BR_Region=40515

6 Table 5: Enrolment ratios by ISCED level. Data Centre, United Nations Educational, Scientific and Cultural Organization Institute for Statistics.

[Cited 29 October 2010.] Available from: http://stats.uis.unesco.org/

unesco/TableViewer/tableView.aspx?ReportId=182

7 Table 14: Tertiary Indicators. Data Centre, United Nations Educational, Scientific and Cultural Organization Institute for Statistics. [Cited 29 October 2010.] Available from: http://stats.uis.unesco.org/unesco/

TableViewer/tableView.aspx?ReportId=167

8 Fiji. UIS Statistics in brief. United Nations Educational, Scientific and Cultural Organization Institute for Statistics. [Cited 20 November 2010.] Available from: http://stats.uis.unesco.org/unesco/

TableViewer/document.aspx?ReportId=121&IF_Language=eng&BR_

Country=2420&BR_Region=40515

9 Table 5: Enrolment ratios by ISCED level. Data Centre, United Nations Educational, Scientific and Cultural Organization Institute for Statistics.

[Cited 29 October 2010.] Available from: http://stats.uis.unesco.org/

unesco/TableViewer/tableView.aspx?ReportId=182

Health of Adolescents in

Fiji

(2)

1.10 for secondary level enrolment in 2006¹⁰; and 1.20 in 2005 for tertiary level enrolment.¹¹

ECONOMICS

Legislation: The minimum legal age of employment in Fiji is 15 years.¹² Those aged 15–18 may not enter into an employment contract except in an occupation approved by the district or labour officer as not being harmful to their moral or physical development.¹³

Labour force participation: Census data from 2007 showed that 9.5% of adolescents aged 10–14 and 23.5% of those aged 15–19 were in the labour force. A higher proportion of rural adolescents were in the labour force compared with their urban counterparts and a higher proportion of male adolescents were in the labour force than females.¹⁴ (Table 2) Underage employment: A large proportion of adolescents aged 10–14 in the labour force were rural Fijian males (5066) who had dropped out of school after grade 8 and had engaged in subsistence activities. Young children under the age of 15 worked as shoeshine boys, wheelbarrow boys and bottle collectors.¹⁵

10 Ibid.

11 Table 14: Tertiary Indicators. Data Centre, United Nations Educational, Scientific and Cultural Organization Institute for Statistics. [Cited 29 October 2010.] Available from: http://stats.uis.unesco.org/unesco/

TableViewer/tableView.aspx?ReportId=167

12 Employment Relations Law 2007. Ministry of Labour, Fiji. [Cited 1 December 2010.] Available from: http://labour.gov.fj/bills/ER.pdf 13 National Labor Profile: Fiji. Industrial and Employment Relations

Department, International Labour Organization, 2006. [Cited 9 October 2010.] Available from: http://www.ilo.org/public/english/dialogue/ifpdial/

info/national/fiji.htm

14 2007 Population Census: Labor force by age and urban & rural. Fiji Islands Bureau of Statistics. [Cited 1 December 2010.] Available from:

http://www.statsfiji.gov.fj/Key%20Stats/Population/2.13Labourforc%20 by%20geograph%20sector%20census2007.pdf

15 2007 Census of Population and Housing: Labour force, employment and unemployment. Release 2 – Labour force. (27 February 2009).

Fiji Islands Bureau of Statistics. [Updated 27 February 2009, cited 1 December 2010.] Available from: http://www.statsfiji.gov.fj/Census2007/

Release%202%20-%20Labour%20Force.pdf

Unemployment: The unemployment rate in Fiji increased from 3.7% in 1996 to 8.6% in 2007.¹⁶ According to the 1996 census, unemployment was highest among adolescents aged 15–19 with 14.8% of males and 23.4% of females being unemployed. Among youth aged 20–24, unemployment was 9.2% among males and 13.1% among females. Youth with a post-secondary education had the highest unemployment rates at 18.5% among males and 28.2% among females compared with unemployment rates of 3.5% among males and 5.3% among females with only a primary education.¹⁷ Emigration: A large number of Fijians, a high percentage of whom are Indo-Fijians, has been emigrating to Australia, New Zealand and North America for the past four decades.¹⁸ Among all age groups, women aged 15–24 were most mobile, with 12%–15% of them being emigrants compared with 8%

of men in the same age group.¹⁹ SEXUAL AND REPRODUCTIVE HEALTH

Legislation: (i) The Crime Decree of 2009 states that it is a summary offence if “he or she unlawfully and carnally knows or attempts to have unlawful carnal knowledge of any person being of or above the age of 13 years and under the age of 16 years”.²⁰ (ii) The Marriage Act (Amendment) Decree 2009 states that any person may contract a valid marriage if he

16 Ibid.

17 Distribution of unemployment by age and sex, 1996. Fiji Island Bureau of Statistics. [Cited 1 December 2010.] Available from: http://www.fijichris.

gov.fj/readstatistics.aspx?StatsID=23

18 Migration Issues in the Asia Pacific-Fiji. Asia Pacific Migration Research Network. [Cited 7 October 2010.] Available from: http://www.unesco.

org/most/apmrnwp6.htm

19 Fiji’s international migration in the context of human development:

gender trends, motivations and strategies. Economic and Social Commission for Asia and the Pacific. 18 August 2003, Bangkok, Thailand.

20 Crimes Decree 2009 (Decree No. 44 of 2009). Republic of the Fiji Islands Government Gazette, vol. 10, No. 95, Published by Authority of the Fiji Government [Updated 5 November 2009, cited 12 January 2011.]

Table 2: Labour force participation rate by age and sex, Fiji, 2007

(years)Age Male Female Total Urban Rural

Number LFPR (%)* Number LFPR (%) Number LFPR (%) Number LFPR (%) Number LFPR (%)

10–14 4503 10.6 3296 8.2 7799 9.5 2733 7.0 5066 11.7

15–19 12 077 29.6 6579 17.0 18 656 23.5 7996 18.8 10 660 28.8

20–24 29 381 71.1 17 840 45.7 47 221 58.8 25 665 56.0 21 556 62.5

Total (all

ages) 221 458 51.8 113 329 27.6 334 787 40.0 168 680 39.7 166 107 40.3

Source: 2007 Population Census: Labour force by age and urban and rural. Fiji Islands Bureau of Statistics. [cited 2010 December 1]. Available from: http://www.statsfiji.

gov.fj/Key%20Stats/Population/2.13Labourforc%20by%20geograph%20sector%20census2007.pdf

*LFPR: Labour force participation rate (%) = [No. of persons age i in the labour force/Total no. of persons age i] x 100

(3)

or she is 18 or older.²¹ (iii) The Crime Decree of 2009 states that abortion in Fiji is legal only for health reasons or if the pregnancy is the result of rape or incest.²²

Sexual behaviour: The 2008 Second Generation Surveillance Surveys of HIV, Other STIs and Risk Behaviours in Fiji (2008 SGSS) were composed of five surveys of different population groups, namely (1) antenatal women attending two clinics (Suva and Lautoka), (2) clients of two STI clinics (Suva and Lautoka), (3) tertiary students at three institutions, (4) male seafarers and (5) male military and police. This fact sheet focused on the first three population groups. As these surveys focused on selected population groups in selected sites and have small sample sizes, readers are advised not to draw general conclusions about the national population.

Table 3 provides some insights into the sexual activity and behaviour of respondents who participated in the 2008 SGSS.²³ Commercial or transactional sex: Among the ANC respondents aged 15–49 in 2008 SGSS, 10 women said that they had received money or goods for sex and one said that she had paid for sex. Among tertiary students aged 15–24, 14 male students (9.2%) and one female student (1.6%) had paid money or goods for sex and four male students (2.6%) had received payment or goods.²⁴

Marriage: The figures from 1996 showed that 10.3% of women and 1.8% men aged 15-19 were ever married; the singulate mean age at first marriage for women was 22.9 years and 26.1 years for men.²⁵

Within a certain population group, namely 417 pregnant women aged 15–49 surveyed in 2008 SGSS, 72.7% were currently married.²⁶ Among 303 pregnant women surveyed in SGS between 2004 and 2005, the median age of first marriage was 21.²⁷

21 Fiji Promulgations and Decrees. Pacific Islands Legal Information Institute. [Cited 10 October 2010.] Available from: http://www.paclii.org/

fj/promu/promu_dec/mad2009199/

22 Crimes Decree 2009 (Decree No. 44 of 2009). Republic of the Fiji Islands Government Gazette, vol. 10, No. 95, Published by Authority of the Fiji Government [Updated 5 November 2009, cited 21 January 2011.]

23 Second Generation Surveillance Surveys of HIV, other STIs and Risk Behaviors in Fiji, 2008. [DRAFT] Suva, Fiji: Ministry of Health and World Health Organization.

24 Ibid.

25 World Fertility Report 2003. Department of Economic and Social Affairs, Population Division, United Nations, 2004. [Cited 12 January 2011.] Available from: http://www.un.org/esa/population/publications/

worldfertility/World_Fertility_Report.htm

27 Second Generation Surveillance Surveys of HIV, other STIs and Risk Behaviors in 6 Pacific Island Countries, 2004-2005. World Health Organization Regional Office for the Western Pacific.

Table 3: Findings from 2008 SGSS

STI Clinic Respondents aged 15–49 (106 male and 45 female STI clients using clinics in Suva and Lautoka) 1. Participants who had ever had sex Male: 104 (98.1%)

Female: 40 (88.9%)

2. Mean age at first sex Male: 17.4 years

Female: 19.7 years 3. Mean number of partners in the last 12

months

Male: 3.6 Female: 1.8 4. Respondents aged 15–19 who had first sex

younger than 15 (n=13 males and 2 females)

Males: 4 (30.8%) Females: 0 5. Respondents aged 15–19 who had more than

one partner in last 12 months (n=13 males and 2 females)

Males: 9 (69.2%) Females: 1

(50.0%) 6. Respondents aged 15–19 who had more

than one partner in last 12 months and had used a condom the last time they had sexual intercourse (n=13 males and 2 females)

Males: 0 Females: 1

(50.0%)

7. Men who had ever had sex with men 16 (15.1%) 8. Men who had anal sex in the last 12 months 9 (56.3%)

Antenatal Clinic (ANC) Respondents aged 15–49 (417 pregnant women who visited 2 ANC clinics in

Suva and Lautoka)

1. Mean age at first sex) 20.1±3.1

2. Ever been forced to sex 12 (2.9%)

3. Mean number of partners overall 1.9±1.3 4. Mean number of partners in the last 12

months

1.1±0.4

5. Respondents aged 15–19 who had first sex younger than 15 (n=15)

1 (6.7%)

6. Respondents aged 15–19 who had more than one partner in the last 12 months (n=15)

4 (26.7%)

Tertiary Students aged 15–24 (286 males and 257 females) 1. Percentage of tertiary students aged 15–24

who reported ever having had sex

Males: 180 (62.9%) Females:

65 (25.3%)

2. Mean age at first sex Males: 17.3 years

Females: 19.2 years 3. Mean number of partners in the last 12

months

Males: 3.8 Females: 1.5 4. Percentage of tertiary students aged 15–19

who had first sex when younger than 15 (n=103 males and 107 females)

Males: 8 (7.8%) Females: 0

5. Percentage of tertiary students aged 15–19 who had more than one partner in the last 12 months (n=103 males and 107 females)

Males: 33 (32.0%) Females: 5 (4.7%)

6. Percentage of tertiary students who had sex in the last 12 months (Of those who had ever had sex, n=180 males and 65 females)

Males: 152 (84.4%) Females:

61 (93.8%) 7. Male tertiary students aged 15–24 who

reported ever having had sex with men

10 (5.6%)

8. Male tertiary students aged 15–24 who reported having had anal sex with men in the last 12 months (n=10)

4 (40%)

Source: Second Generation Surveillance Surveys of HIV, other STIs and Risk Behaviors in Fiji, 2008. [DRAFT] Suva, Fiji: Ministry of Health and World Health

Organization.

(4)

Condom knowledge and use: According to the Millennium Development Goals Report 2004, young people were said to be embarrassed to seek condoms in pharmacies because of the stigma of being associated with promiscuous and irresponsible behaviour.²⁸

From 2008 SGSS, among the ANC respondents aged 15–49, 93% had heard of a male condom and 49% of a female condom. Of these respondents, 198 (47.5%) had ever used a condom, 11 (2.6%) had used a condom at last sex and 91 (21.8%) at first sex.²⁹

Among STI respondents, 73.5% (n=78) of males and 53.5%

(n=24) of females had ever used a condom; 17.3% of males (n=18) and 22.5% of females (n=9) had used a condom at first sex. Among the tertiary students, 80% of males and 58.5%

of females had ever used a condom and 38% of males and 45% of females had used a condom at first sex. Of those who had sex in the last 12 months, 49.4% of males and 29.5%

of females had used a condom at last sex (commercial or noncommercial).³⁰

Of the nine male STI respondents who had had anal sex with men in the last 12 months, five (55.6%) had used a condom.

Of the four male tertiary students who had had anal sex with men in the last 12 months, three (75.0%) reported using a condom at last sex.³¹

Childbearing: The mean age at childbearing was 24.7 years and that at first birth was 22 years in 2009.³²

Adolescent birth rate: In 2009, there was a total of 987 adolescent (15–19 years old) pregnancies compared with 1186 in 2008.³³ According to the Ministry of Health’s annual reports, the pregnancy rate of adolescents decreased from 8.1 per thousand in 2006 to 6.6 per thousand in 2008; most of these pregnancies were unplanned.³⁴

Sexually Transmitted Infections (STIs): According to the Ministry of Health’s annual reports, the prevalence of STIs among those aged 15–24 decreased from 7.2% in 2007 to

28 Millennium Development Goals: Fiji National Report. National Planning Office, Ministry of Finance and National Planning, 2004.

30 Ibid.

31 Ibid.

32 Fiji: Ministry of Health, Health Information Unit. Information shared through email correspondence between Health Promotion Board, Singapore and Dr Brigitte de Hulsters and Ms Sera Waqa (World Health Organization Office of the Representative for the South Pacific) dated 2 February 2011 after discussion with the Ministry of Health, Fiji.

33 Teenage pregnancies decline. Ministry of Health, Fiji. [Updated 7 December 2010, cited 9 December 2010.] Available from: http://www.

health.gov.fj/news/2010/12/07/teenage-preganacy-declines.html 34 Annual Report 2008. Ministry of Health, Fiji. [Cited 1 December 2010.]

Available from: http://www.health.gov.fj/files/reports/Annual%20 Report%202008.pdf

2.4% in 2008.³⁵ In 2008, a total of 1064 cases of gonorrhoeae and 1004 cases of syphilis were documented.³⁶

Data from 2008 SGSS found that chlamydia prevalence among ANC respondents under 25 years old from both clinics was 37.5%, prevalence of gonorrhoeae was 2.1% and that of syphilis was 5.6%. Among ANC respondents from Lautoka, there was a higher prevalence of chlamydia in women under 25 years old compared with those over 25 years old (37.5%

vs. 20.3%); the prevalence in married women was lower than that in unmarried women (19.4% vs. 42.9%) and those who had only one lifetime partner compared with those with two or more partners (13.8% vs. 38.2%).³⁷

HIV prevalence: By the end of 2009, 333 HIV cases were confirmed in the country -- 23 cases were among children aged 0–9, nine cases were adolescents aged 10–19 and 149 cases were youth aged 20–29. The 20–29 group had the most number of HIV cases. Ethnic Fijians accounted for the majority (81.4%) of the total reported cases. Of these, 88.2%

were infected through heterosexual transmission, 6.6%

through perinatal transmission and 2.4% through homosexual transmission.³⁸

HIV knowledge: Of the tertiary students surveyed in 2008 SGSS, the knowledge of HIV was relatively low. Of the male students aged 15–19, 43 (41.7%) were able to answer all five United Nations General Assembly Special Session (UNGASS) HIV knowledge questions correctly. Of the female students aged 15–19, 59 (55.1%) answered all five questions correctly.³⁹ (Table 4)

Table 4: Percentage of youth who answered all five UNGASS HIV knowledge questions correctly in 2008 SGSS,

Fiji Age (years) Male (15–19: n=103);

(20–24: n=183)

Female (15–19: n=107);

(20–24: n=150) Number (%) of Total Number (%) of

Total

15–19 43 41.7% 59 55.1%

20–24 99 54.1% 81 54.0%

Source: Second Generation Surveillance Surveys of HIV, other STIs and Risk Behaviors in Fiji, 2008. [DRAFT] Suva, Fiji: Ministry of Health and World Health

Organization.

35 Annual Reports 2005–2008. Ministry of Health. Fiji. [Cited 20 October 2010.] Available from: http://www.health.gov.fj/-annual-reports.html 36 Annual Report 2008. Ministry of Health, Fiji. [Cited 1 December 2010.]

38 National HIV Cumulative Statistics. [Updated 10 February 2010.] World Health Organization Representative Office in the South Pacific.

39 United Nations General Assembly Special Session on HIV/AIDS 2010 Country Progress Report: Fiji Islands. Republic of Fiji Islands. [Cited 1 December 2010.] Available from: http://data.unaids.org/pub/

Report/2010/fiji_2010_country_progress_report_en.pdf

(5)

Among 15 ANC respondents aged 15–19, only two (13.3%) answered all five United Nations General Assembly Special Session HIV knowledge questions correctly. Among 13 STI male respondents aged 15–19, seven (53.9%) answered all five United Nations General Assembly Special Session HIV knowledge questions correctly; and the corresponding figure for STI female respondents aged 15–19 was two (100.0%).⁴⁰ Adolescent-friendly health services: The United Nations Population Fund (UNFPA), the United Nations Children’s Fund and the Secretariat of the Pacific Community (SPC) supported a regional Adolescent Health and Development (AHD) Project which began in 2001. There was a regional project team at SPC and an AHD coordinator in 10 Pacific island countries, including Fiji.⁴¹ The AHD programme has been tasked through the Regional AHD Strategic Plan 2009–2012 to create supportive environments, deepen education through life skills training, strengthen youth-friendly services and enhance project management and delivery.⁴²

The Adolescent Reproductive Health (ARH) Project in Fiji began as a pilot project under the UNFPA-funded national Reproductive Health Programme (1998–2002). In 2003, the Ministry of Health appointed an ARH Project Officer to coordinate the project at headquarters level. ARH is a key component of the national Reproductive Health Programme within the Public Health Programme of the Ministry of Health.⁴³ Some achievements to date include the establishment of youth- friendly adolescent health centres in 12 of the 19 subdivisions to provide basic information and counselling by peer educators.

Nurses also have been trained to integrate youth-friendly services within health centres and clinics. In 2006, a revised Family Life Education (FLE) programme in collaboration with the Ministry of Education was established. The FLE programme aims to formalize a life-skills based curriculum in schools to be taught in an age-appropriate format.⁴⁴

NUTRITIONAL STATUS AND PHYSICAL ACTIVITY

Underweight prevalence: In 2004, the proportion of underweight Indo-Fijian males aged 10-17 was 31.8% and that of male Fijians was 11.3%. The proportion of underweight Indo-Fijian females aged 10-17 was 31.0% and that of female

41 Empower children, says UN. The Fiji Times Online. [Updated 13 October 2008, cited 12 January 2011.] Available from: http://www.fijitimes.com/

story.aspx?id=103284

42 Directors of Public Health to review adolescent health and development.

Secretariat of the Pacific Community. [Updated 18 August 2010, cited 12 January 2011.] Available from: http://www.spc.int/en/component/

content/article/556-directors-of-public-health-to-review-adolescent- health-and-development-.html

43 Adolescent Health. Ministry of Health, Fiji. [Updated 2 April 2010, cited 1 December 2010.] Available from: http://www.health.gov.fj/adolescent-- health.html?page=1

44 Adolescent Health Achievements. Ministry of Health, Fiji. [Updated 2 April 2010, cited 1 December 2010.] Available from: http://www.health.gov.fj/

adolescent--health.html?page=3

Figure 1: Percentage of underweight (<80% NCHS median) adolescents aged 10–17, Fiji, 2004.

Percentage

Male Female Male Female Male Female Fijians Indo-Fijians Others 70%

60%

50%

40%

30%

20%

10%

0%

1993 2004 18.5%

1.3% 12.0%7.0%

57.6%

1.8%

45.4%

1.0%

0.0%

15.0%

21.7%

6.3%

Source: 2004 National Nutrition Survey, Fiji.

Figure 2: Percentage of stunted (<90% NCHS median) adolescents aged 10–17, Fiji, 2004.

Percentage

10%

8%

6%

4%

2%

0%

1993 2004 5.3%

4.1%

2.4%2.9%

9.8%

3.8% 4.0%

4.9%

0.0%

10.0%

8.7%

0.0%

Figure 3: Percentage of overweight (≥120% NCHS median) adolescents 10–17, Fiji, 2004.

Percentage

35%

30%

25%

20%

15%

10%

5%

0%

1993 2004 7.3%

11.0%13.4%

21.9%

2.9%

13.0%

4.0%

10.2%11.8%

20.0%

26.1%

37.5%

Fijians was 7.0%. Figure 1 shows that the prevalence of underweight adolescents had fallen between 1993 and 2004.⁴⁵ Stunting prevalence: In 2004, the prevalence of stunting in Indo-Fijian male adolescents aged 10–17 was 3.8% and that of male Fijian adolescents was 4.1%. The prevalence of stunting in Indo-Fijian female adolescents aged 10–17 was 4.9% and that of female Fijians was 2.9%.⁴⁶ Figure 2 shows that between 1993 and 2004, stunting prevalence decreased

45 Fiji National Nutrition Survey. 2004. Suva, Fiji: National Food and Nutrition Centre, 2007. [Cited 24 October 2010.] Available from: http://

www.nutrition.gov.fj/reports_1.aspx 46 Ibid.

(6)

among male Fijians and Indo-Fijian adolescents. However, stunting prevalence increased slightly among female Fijians and Indo-Fijians adolescents.

Overweight prevalence: In 2004, the prevalence of overweight in Indo-Fijian male adolescents aged 10–17 was 13.0% and that of male Fijian adolescents was 11.0%. The prevalence of overweight in Indo-Fijian female adolescents was 10.2% and that in Fijian female adolescents was 21.9%.⁴⁷ Figure 3 shows that between 1993 and 2004, the prevalence of overweight had increased.

Anaemia: In 2004, among Fijian adolescents aged 12–14, the prevalence of anaemia was 29.1% (25.4% among males and 32.9% among females) and among Indo-Fijian adolescents, the prevalence of anaemia was 36.9% (29.2% among males and 44.4% among females).⁴⁸

Physical activity: According to the 2004 National Nutrition Survey, the majority (72.7%) of the respondents aged 12–17 reported doing light work; during leisure time, however, 79.4%

of males and 58.6% of females reported vigorous activity levels.⁴⁹ (Tables 5 and 6)

Table 5: Work activity level among adolescents aged 12–17, Fiji, 2004

Sex None Light Moderate Vigorous

Male (n=447)

6 (1.3%)

302 (67.6%)

122 (27.3%)

17 (3.8%) Female

(n=431)

11 (2.6%)

336 (78.0%)

83 (19.3%)

1 (0.2%) Total

(n=878)

17 (1.9%)

638 (72.7%)

205 (23.3%)

18 (2.1%) Source: Fiji National Nutrition Survey. 2004. National Food and Nutrition Centre.

Suva, Fiji. 2007.

Table 6: Leisure time activity among adolescents aged 12–17, Fiji, 2004

Sex None Light Moderate Vigorous

Male (n=447)

5 (1.1%)

52 (11.6%)

35 (7.8%)

355 (79.4%) Female

(n=431)

12 (2.8%)

134 (30.8%)

34 (7.8%)

255 (58.6%) Total

(n=878)

17 (1.9%)

186 (21.1%)

69 (7.8%)

610 (69.2%) Source: Fiji National Nutrition Survey. 2004

Mental health

Suicide: There were 66 adolescent suicides in Fiji in 2008, an increase since during the period 2005-2007 (<50 suicides).⁵⁰

47 Ibid.

48 Ibid.

49 Ibid.

50 Annual Reports 2005–2008. Ministry of Health. Fiji. [Cited 20 October 2010.] Available from: http://www.health.gov.fj/-annual-reports.html

Studies had documented high suicide rates among young Indo-Fijian women. A 2009 fact sheet stated that the overall suicide rate for young women aged 15–24 in Fiji was 38 per hundred thousand.⁵¹ In 2006, the suicide mortality rate was 2.8 per hundred thousand.⁵² Over half of suicides in the country occur in youth, with more females attempting but more males completing suicides.⁵³

SUBSTANCE USE

Legislation: (i) Liquor Act (Amendment) Decree 2009 states that the legal drinking age in Fiji is 18.⁵⁴ (ii) The minimum age to purchase tobacco is 18.⁵⁵

Tobacco use: The 2002 STEPS survey found that the mean age of initiation into smoking was 21.4 years.⁵⁶ From the 2005 Global Youth Tobacco Survey, 13.7% of students aged 13–15 were currently using any tobacco product; 6.9% were currently smoking cigarettes (9.8% of boys and 4.1% of girls). Second- hand smoke exposure was high, with almost half reporting that they had been exposed to smoke at home. Of those who smoked, 87.8% desired to stop and 21.5% usually bought their cigarettes from a store.⁵⁷ (Table 7)

Table 7: Findings from the Fiji Global Youth Tobacco Survey, 2005

Main activity Students aged 13–15

(n=1,946)

Male (%) Female (%) Total (%)

Currently smoked cigarettes 6.7 3.1 5.0

Currently used any tobacco

product other than cigarettes 11.6 10.2 11.5 Exposed to smoke from

others at home during week preceding the survey

- - 47.1

Desired to stop smoking

(among current smokers) - - 88.2

Source: Global Youth Tobacco Survey, Fiji, 2005.

51 Fact sheet on women’s health, Manila, Philippines: World Health Organization Regional Office for the Western Pacific, 2009. [Cited 25 October 2010.] Available from: http://www.wpro.who.int/media_centre/

fact_sheets/fs_20091111.htm

52 Annual Report 2006. Ministry of Health, Fiji. [Cited 1 December 2010.]

53 Roberts G. et al. Attempted Suicide in Western Viti, Fiji. Health Promotion in the Pacific, vol. 14, no. 2, Sept 2007.

54 Liquor Act (Amendment) Decree 2009. Decree No. 13. Republic of Fiji Islands Government Gazette, vol. 10, no. 25, Published by Authority of the Fiji Government. [Updated 20 May 2009, cited 12 January 2011.]

55 Tobacco Control Act 1998 Fiji Government. [Cited 5 October 2010.]

Available from: documents.ag.gov.fj/tableOfAct.pdf

56 Fiji Non-Communicable Diseases STEPswise Risk Factor (NCD STEPS) Survey. Ministry of Health, Fiji, 2002.

57 2005 Global Youth Tobacco Survey. Fact Sheet: Fiji. [Cited 1 December 2010.] Available from: http://www.cdc.gov/tobacco/global/gyts/

factsheets/wpr/2005/Fiji_factsheet.htm

(7)

Alcohol use: The 2004 National Nutrition Survey found that 38.7% of adolescents aged 12–17 drank alcohol. Among these, more males (45.6%) drank compared with females (16.7%). Although the sample size was small, this finding showed that adolescents were consuming alcohol. The mean alcohol intake for male adolescents was 4.27 standard drinks compared with 1.00 standard drink for female adolescents.

Males aged 18–44 had the highest mean intake than any other age groups (7.99 standard drinks). Only six males aged 12–17 reported binge drinking. Because of the small sample size, the prevalence of binge drinking could not be extrapolated.⁵⁸ Results from the 2002 STEPS survey showed that 57.6% of males and 16.5% of females aged 15–24 had ever consumed alcohol. Of these respondents, 42.0% of the males and 7.8%

of the females had consumed alcohol in the past 12 months.

Alcohol-consuming youth had a high average of drinks per drinking day, with 14.8 drinks for males and 7.6 drinks for females. A large proportion (83.5%) of current drinkers in this age group was also binge drinkers (86.2% of male drinkers and 65.4% of female drinkers).⁵⁹

Kava: Kava, or yaqona, is a drink made from the kava plant with mild sedative properties. It is served at traditional functions and recently has become a common social drink.

Surveys have demonstrated a strong association between kava consumption and the use of alcohol and tobacco.⁶⁰ According to the 2004 National Nutrition Survey, among adolescents aged 12–17, 2.2% consumed kava daily (Table 8).⁶¹ Among youth aged 15–24 in the 2002 STEPS survey, 49.4% of males and 26.6% of females who had ever consumed kava reported smoking during or after kava consumption; 37.1% of males and 9.7% of females reported drinking alcohol during or after kava consumption.⁶²

Table 8: Kava consumption among adolescents aged 12–17 by sex, Fiji, 2004

Sex <2 days/

week (%) 2–6 days/

week (%) Daily (%)

Male (n=56) 87.5 8.9 3.6

Female (n=33) 93.9 6.1 0

Total (n=89) 89.9 7.9 2.2

Source: 2004 National Nutrition Survey

www.nutrition.gov.fj/reports_1.aspx

www.nutrition.gov.fj/reports_1.aspx 61 Ibid.

CRIMES, INJURIES AND VIOLENCE

Domestic and sexual abuse: In 2009, a total of 542 cases of child sexual abuse and 170 child physical abuse cases were reported. The most common; form of child sexual abuse was the defilement of girls aged 13-16 (202 of 542 cases). The most common child physical abuse was assault occasioning actual bodily harm (104 of 170 cases).⁶³ (Table 9)

Table 9: Number of child sexual abuse and child physical abuse cases, 2009

Child sexual

abuse Number of

cases Child physical abuse Number of cases Total no. of

cases 542 Total no. of cases 170

Defilement of girl between 13–16 years

202

(37.3%) Assault occasioning

actual bodily harm 104 (61.2%) Indecent

assault 113

(20.8%) Abduction 41

(24.1%)

Rape 85

(15.7%) Common assault 14 (8.2%) Abduction 76

(14.0%) Act with intent to

cause grievous harm 4 (2.4%)

Others 66

(12.2%) Others 7

(4.1%)

Source: Department of Social Welfare. In:. Fiji: 2010 Facts & Figures. Fiji Islands Bureau of Statistics. [cited 1 December 2010]. Available from: http://www.

statsfiji.gov.fj/Releases/FFF2010.pdf

Drowning: In 2009, there were 49 drowning cases, 11 of which were of children under 10 years old four aged 11–17.

Those aged under 10 and above 45 registered the most number of drowning cases in 2009.⁶⁴

LIST OF LEGISLATION AND CONVENTIONS THAT IMPACT ADOLESCENT HEALTH AND WELFARE

Employment

• Employment Relations Promulgation, 2007

Education

• Compulsory Education Regulation of the Education Act, 1997

• Education Act, 1978 Welfare

• Family Law Act, 2003

• Juveniles Act (Amendment), 1997

63 Department of Social Welfare. In:. Fiji: 2010 Facts & Figures. Fiji Islands Bureau of Statistics. [Cited 1 December 2010.] Available from: http://

www.statsfiji.gov.fj/Releases/FFF2010.pdf

64 Fiji: 2010 Facts & Figures. Fiji Islands Bureau of Statistics. [Cited 1 December 2010.] Available from: http://www.statsfiji.gov.fj/Releases/

FFF2010.pdf

(8)

Sources:

a. Fiji: 2010 Facts & Figures. Fiji Islands Bureau of Statistics. [Cited 1 December 2010.] Available from: http://www.statsfiji.gov.fj/Releases/FFF2010.pdf b. Fiji National Census of Population 2007. Fiji Island Bureau of Statistics. [Updated 29 September 2010, cited 7October 2010.] Available from: http://

www.statsfiji.gov.fj

c. Fiji: Country Health Information Profile. Manila, Philippines: World Health Organization Regional Office for the Western Pacific Health Databank, 2010 Revision. [Cited 29 November 2010.] Available from: http://www.wpro.who.int/NR/rdonlyres/B2027DE2-19D1-456B-B057-EDEE6A94C64F/0/11finalF IJtab2010.pdf

d. Human Development Report 2010. New York: United Nations Development Programme. [Cited 7 November 2010.] Available from: http://hdr.undp.org/

en/reports/global/hdr2010/chapters/en/

e. Human Development Report 2009. Human and Income Poverty: Fiji. United Nations Development Programme. [Cited 15 May 2011.] Available from:

http://hdrstats.undp.org/en/indicators/97.html

f. Gross national income per capita 2009, Atlas method and PPP. World Development Indicators Database, World Bank. [Updated 4 April 2011, cited 15 May 2011.] Available from: http://siteresources.worldbank.org/DATASTATISTICS/Resources/GNIPC.pdf

g. Poverty Indicators. Fiji Islands Bureau of Statistics. [Cited 1 December 2010.] Available from: http://www.statsfiji.gov.fj/Social/poverty_indicators.htm Sexual and Reproductive Health

• Crimes Decree, 2009

• Marriage Act (Amendment) Decree, 2009

Mental Health

• Mental Health Treatment Act, 1975

Substance Use

• Liquor Act (Amendment) Decree, 2009

• Ministry of Education, Science & Technology School Code of Ethics, 2005

• Illicit Drug Control Act, 2004

• Tobacco Control Act, 1998

• Substance Abuse Advisory Council Act, 1998 Crimes, Injuries & Violence

• Crime Decree, 2009

• Domestic Violence Decree, 2009

Conventions

• World Health Organization Framework Convention on Tobacco Control, 2003

• International Labor Organization’s (ILO) Convention No. 138 on Minimum Age for Admission to Employment, 2003

• ILO’s Convention No. 182 on Worst Forms of Child Labour, 2002

• Convention to Eliminate All Forms of Discrimination Against Women, 1995

• Convention on the Rights of the Child, 1993

GOVERNMENT RESPONSES

Note: This is not meant to be a comprehensive list of all relevant government initiatives.

Economic

• National Strategic Development Plan 2007–2011

• The Sustainable Economic and Empowerment Development Strategy 2008–2010

Health

• National Noncommunicable Diseases Prevention and Control Strategic Plan 2010–2014

• Ministry of Health Strategic Plan 2007–2011

Sexual & Reproductive Health

• Adolescent Reproductive Health (ARH) Project

• Safe Motherhood Programme STIs & HIV/AIDS

• National HIV Strategic Plan 2007–2011

Nutrition and Physical Activity

• Fiji Food and Nutrition Policy, 2008

• National Food and Nutrition Centre

• School canteen based guidelines for improvement in nutrition of school children

Mental Health

• Suicide Prevention Policy, 2008

• National Mental Health and the Suicide Prevention Strategic Plan 2005–2008

Substance Use

• Tobacco Control Enforcement Strategic Plan 2007–2011

• School Drug Use Policy

Crimes, Injuries & Violence

• Road Safety Action Plan

• Women’s Plan of Action 2010–2019