Papua New Guinea: Providing Reproductive Health Care in a Highly Stigmatized Environment

Note: We recorded this episode prior to the leaked document showing the Supreme Courts intent to overturn the right to abortion. While unfortunately we don’t talk about it in the episode we will be recording an emergency episode soon to talk about what happened.

Women and girls in the Pacific region face a variety of barriers to accessing sexual and reproductive healthcare. Geographic isolation, lack of bodily autonomy, and some of the world’s highest rates of sexual and gender-based violence contribute to high maternal mortality, low contraceptive prevalence and pervasive gender inequality. Myths and misconceptions around sex, reproduction and gender norms are rife, creating stigma and further impacting access to SRHR services. Kelly Durrant, External Relations Director at MSI Asia Pacific, speaks to us about addressing some of these challenges.

Papua New Guinea (PNG) is the largest country in the pacific and the third largest island nation globally, home to approximately 9 million people—85% of which live in rural locations. Even before the pandemic, the country battled high rates of tuberculosis, HIV/AIDS, malaria, maternal and child mortality, and inadequate primary healthcare in rural areas. MSI Asia Pacific has worked in Papua New Guinea since 2006, and is the largest – and in many provinces, the only – SRHR provider in the country. Teams of MSI-trained healthcare workers, community mobilizers and educators travel by plane, boat, or jeep to reach remote communities that are often inaccessible by road. In many cases, these outreach visits are the only way that these communities can access high-quality information, counselling and services to meet their sexual and reproductive healthcare needs and chose if and when to have children. Limited exposure to sexual and reproductive health education in tandem with social expectations related to the role of women in society means providers in the country must work to bust myths and address stigma related to contraception. The COVID-19 pandemic has only exacerbated poor health outcomes.

The country also has some of the worst rates of gender-based violence globally, with some statistics estimating that 2 out of 3 women in PNG have experienced gender-based violence, rates of which have been worsened by the pandemic. MSI Asia Pacific works at a government level, community level, and individual level, to advocate for policy change, increase education, confront bias, and better deliver care. Involving faith leaders and men and boys in sexual and reproductive health education (balanced carefully with women and girl’s autonomy to make their own reproductive decisions) de-stigmatizes services.

Links from this episode

MSI Asia Pacific
MSI Asia Pacific on Twitter
MSI Asia Pacific on Facebook
MSI Asia Pacific on Instagram
MSI Asia Pacific Donations

Transcript

Jennie: Welcome to rePROs Fight Back, a podcast where we explore all things reproductive health, rights and justice. I'm your host, Jennie Wetter, and I'll be helping you stay informed around issues like birth control, abortion, sex education and LGBTQ issues and much, much more-- giving you the tools you need to take action and fight back. Okay, let's dive in.

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Jennie: Welcome to this week's episode of rePROs Fight Back. I'm your host, Jennie Wetter, and my pronouns are she/her. So y'all, I hope you enjoyed last week's episode. I was really nervous sharing that. I had a lot of anxiety for that to being my first time to share my story publicly, but you know what, I'm really glad I did it. And as much as I had nerves about published and putting it out there and, and sharing my story widely, I'm really proud out of myself that I did it. So-- growth, right? So good. And speaking of growth, I think I've talked about this on the podcast before, but I really struggle with the word expert and seeing myself as an expert on anything. I don't know why it is one of those words I really struggle with. And like, when someone's like, you're an expert on this, like I have this like internal cringe and, and I just, I can't claim it. So the wildest thing happened last week. I was talking to someone about an issue and I was like, well, yeah, because I'm an expert in this. And like I paused in that moment and was like, wow. I, I think that's the first time I've like, claimed that for myself. That's wild. I, I mean, it lasted for all of two seconds. I definitely still dunno that… I'm still not comfortable with that word. I, I'm not really sure what…I don't know if it's just imposter syndrome or something about the word expert that I just don't see it in myself. And I think I might have talked about this on the podcast, but I'm not sure, I was doing some coaching around podcasts and this came up and I talked about having a really hard time I'm with it. And they're like, well, maybe it's just the word and let's try to find a different word. And so the one we came up with was maven. So I am more comfortable saying I'm a sexual reproductive health and rights maven than a sexual reproductive health and rights expert. I don't know why, it's just expert doesn't sit well with me. I gotta work on it still, but for the first time I did claim it on my own and I consider that progress. But because that was a big week of milestones, right? So I decided self-care was important last weekend. And so I did fun things. I watched the Princess Bride-- y'all I don't know what the last time I saw that was, but it made me so happy. I just love that movie and could probably recite the whole thing by heart. And it just made me so happy to watch it again. I hadn't seen it in so long. I'm reading a couple good books and it was just delightful. Oh. And I did baking, it was a friend's birthday and she really loves my sour dough english muffins. And so I was gonna make some for her the previous weekend, but I had recently, I mean, I guess not that recently, a couple months ago, I killed my starter. So I had to start a brand new one and it took longer than expected to get going. So when I went to make my sourdough English muffins for her birthday, they weren't, it was not alive enough yet. So it took a whole ‘nother week to get it going, but it got it going. And I made wonderful sour dough english muffins for her and had enough left over for me for breakfast for the week. And it made me happy having those for breakfast. So, you know, a win-win I think those are my big highlights, nothing too, too exciting.

Jennie: I think with that, we'll turn to this week's episode. And, you know, since the pandemic, I haven't been able to take advantage of, I used to have a lot of guests on who were working in countries around the world, and I was able to talk to groups that I work with on a day to day basis, bringing in experts for testimony or for, for any number of reasons and, and having them on the podcast to talk about their work in whatever country. And, and that's something I've really missed during the pandemic. So I am so excited for this week's episode. I have Kelly Durrant with MSI Asia Pacific on talking about reproductive healthcare in Papua New Guinea. And I'm so excited to be back talking to someone who is doing the work on the ground and somewhere abroad. And I'm very excited to be sharing that. So I hope you enjoy my conversation with Kelly talking about her work in Papua New Guinea. Hi Kelly. Thank you so much for being here today.

Kelly: Thanks for having me.

Jennie: Before we get started. Do you want to take a quick second and introduce yourself and include your pronouns?

Kelly: Sure. My name's Kelly. I'm the External Relations Director at MSI Asia Pacific, and my pronouns are she and her.

Jennie: Wonderful. I am really excited to talk to you. I feel like with the pandemic, the podcast has ended up being a lot more domestic than we were pre-pandemic. I was used to be able to take advantage of people, traveling into the states and do interviews with, and talk about things happening in other countries so much more. So I'm so excited to be able to do that today.

Kelly: Yeah. Great. I'm really excited to talk to you because it's a great opportunity to be able to talk about the Pacific region, which I think doesn't get a lot of airtime in many other global conversations. So it's a really great chance to be able to talk about some of the challenges that we face in this region.

Jennie: Yeah. So maybe that's like place to is like a little bit of background. So I think there may be some parts that people are aware of, but maybe not have a really good understanding. I know when we first were talking about things we could talk about in this interview, we talked about maybe Papua New Guinea. And so, I think that's something that people probably don't have a lot of information of like what sexual and reproductive health looks like there, or women's equality or anything like that. So maybe we just start there before we talk about what's being done.

Kelly: Sure. That sounds like a great idea. But before we do that, if it's okay with you, I'd like to just take one second to acknowledge the traditional owners of the land where I'm speaking from today. This is something we like to do in Australia. So I'm calling in from the [land of the Wurundjeri nation]. So I'd like to pay my respects to elders past, present, and future, and just acknowledge the continuation of cultural, spiritual, and educational practices of aboriginal peoples.

Jennie: Thank you.

Kelly: So I'll jump right in then, and just give a bit of an overview of PNG where we have also a land that is steeped in lots and lots of cultural practices and traditional people living quite different lives. And those that many of your listeners would be used to hearing about. So PNG is the third largest island nation globally. It's by far the biggest country in the Pacific and it's home to around 9 million people. So over 85% of the population live in rural and remote locations outside of urban centers. So that makes it one of the most remote and urban countries globally. Most people live in customary communities with strong social groups and subsistence farming, and transport and geography is very complicated. So this is a land that ranges from tropical sort of jungle rainforest type things to quite high mountains. All of the major cities only connected by air. So there's no road. Transport is really complicated. And that, that diversity of landscape also means that the cultural diversity is very unique. There's over 800 languages spoken in PNG and many communities who never really leave their local village. People also say there's numerous groups that are uncontacted people. So people who've never had any contact with the outside world in any way, shape or form. So that makes a really fascinating country, but also really a challenging country to work in in terms of myths, misconceptions, illiteracy, and poverty. So, yeah, let me think, what else… I could mention at the outset. I mean, in terms of general health, there's a lot, there's a lot going on in PNG even before the COVID pandemic. So PNG has very high rates of communicable diseases. So tuberculosis, HIV, malaria. Yeah, very high maternal and child mortality. Primary healthcare at the village level is inadequate and therefore maternal and infant mortality rates are quite high. What else? I mean, in terms of things like maternal mortality, that's an interesting topic in terms of, of what it actually is because one of the biggest challenges working in the Pacific is actually lack of data and lack of knowing what the situation is. So we have a huge range in estimates of what maternal mortality ranges are—they go from 68 per 100,000 to 900. So that can put PNG in, you know, some of the worst statistics globally. And gender equality is a significant challenge as well. So there's systemic violations of women's rights throughout the country in terms of the gender equality index PNG comes in at 161 out of 162 countries globally. So that's not fabulous. And yeah, women's role in society is they don't have a lot of decision making power. There's been very few women politicians or MPS since independence in 1975. Currently after the latest selection, there's no women at all. And that's obviously contributing to gender equality, you know, being a really difficult part of our work.

Jennie: Well, I'm just thinking like everything you've described, like how remote places are, and like having to fly to get places like that's just like a recipe for like not having easy access to healthcare or getting reaching people for services.

Kelly: Yeah. It's definitely really, really challenging. And so some of we have the way that our partners work in PNG is we have outreach teams who go out into those remote and rural communities. And those service providers have a lot of challenges to contend with. So often they will go out for multiday outreach where they're traveling either by boat or in some instances, four-wheel drive. But also they join like flights with government service providers and fly into all remote areas. And then they actually have to stay several days to provide services. So logistically that's really challenging. And I'm sure that your listeners can imagine that when you throw something like COVID into the mix in terms of, you know, transport shutting down and, you know, inability of people to move [within] countries, that's definitely made things even more complicated than it already was. One of the other, I guess, challenges in terms of the geography is also just that people have had limited access to, to education and to other sort of, of exposure to the ideas around sexual and reproductive health. So service providers are really having to start from quite a low base in terms of explaining many of the myths and misconceptions that people have around contraception and, and even the sort of social expectations around the number of children that people should have [related to] the role of women in society in terms of providing children. So there's a lot of education and kind of it all comes down to really some quite basic education and sort of myth busting around lots of the beliefs that people have.

Jennie: And like that's not easy work, right? Like that is not just like a one-off conversation. Like that's something that is like built, you have to build trust and, and it's hard when you're remote. So you're not there all the time to be able to build that relationship.

Kelly: Yeah. I think that is really important. And that's why a lot of the work that we do is trying to work within the existing health system and working with traditional structures and systems to build in ways of talking about things. So for example, PNG is a, it's a highly Christian society, almost a vast majority by far a Christian. And so the church has a huge, plays a huge role in the provision of education and also in the provision of healthcare. So working with those faith leaders and other traditional leaders in communities is really important. And often that is men. So we do a lot of work in engaging men in these conversations, working with them to understand the value of allowing their wives to have fewer children and the benefits that that will have for their community and for their family. And that comes with its own challenges, but actually PNG is a country where we provide vasectomy. And that's been really interesting to sort of see some of the ways that men can come around thinking about these things. So we have an example of, of one of our vasectomy clients who has said “I felt guilty about getting a vasectomy. There are plenty of negative ideas about family planning. People say it will affect your health. Your body might swell up and you might die. Some people believe that implants are evil, connected to the devil I was told I would bring the devil into the community.” And so that is someone who has overcome some of those, that stigma and, you know, those negative views because he has gone on to get a vasectomy. And that's pretty amazing to think that that kind of behavior change and thinking can be brought about, and that person has actually become like a, a mobilizer for our teams. So he actually goes out and tells his story about getting a vasectomy and the benefits that it's had in an effort to encourage others, to, to also look at these services and to assure them that some of these myths and misconceptions are not based on reality.

Jennie: I mean, I can, my guess is that that's a fairly, not common doing that, but that's probably a model that you try and use is people in the community who have been adopters and have overcome the myths, like using them as the, the gateway to talk to others in their community. Because again, when you can't come in all the time, like that community trust is hard to build.

Kelly: Yeah. It's really important that you have those people, but yeah. So getting those people on board is, is a real challenge. And then just working gradually to change mindsets about some of other sort of elements that I guess a lot of people who are working internationally, or even in the US face in terms of people's stigma around adolescent pregnancy or sex outside of marriage. Yeah. The sort of views that people have around who is, isn't deserving of family planning and access to safe abortion services, for example.

Jennie: Yeah. It's um, it's amazing how some of these stories are just like, so universal of like, right, like who deserves the access, like not having youth friendly services or yeah. You know, who should access safe abortion, if it should be allowed at all? Like it's the universality of it is, uh, sad.

Kelly: Yeah, it is. And I think, you know, some, some issues that I think stigma is an issue that is universal and, you know, we could all, I think we can say to some extent that sexual and reproductive health and rights are stigmatized in most environments, but the extent to which different element of other stigmatized [issues], I think varies dramatically. So for sure, I think, you know, in Australia or in the US you, you have, there's still lots of stigma around talking about, I don't know, late term abortions or particular effects or topics that are still highly stigmatized, but there isn't the same kind of stigma around contraception, but in a place like PNG, there's almost stigma around every element of these services. It's really not spoken about in any way, shape or form. The assumptions are very much that sex is not occurring before marriage. There's still lots of assumptions around women's and men's roles and women to a certain extent are seen as men's the property of men. And that means that leaves them very open to sexual and gender-based violence. And PNG has some of the worst rates of sexual and gender-based violence globally. Some estimates say two out three women have experienced that in their lifetime and that's official statistics.

Jennie: That is just to like put that in perspective for the audience, right? Like the global number is one in three. So for PNG to be two and three is really that.

Kelly: Yeah. And there's some other really kind of, you know, statistics that really drive this home. There's a statistic around the number of men who admit that they have raped someone and it's 41% or something. Um, so that's just shocking and also shows the sort of way that, that behavior is being normalized and has kind of become accepted. That that's just what happens. And PNG has a really, you know, not a great reputation in terms of law and order, like it's quite a violent society. There's often clashes in the tribal areas related to different clans around elections. There's often tribal related violence. And that's unfortunately, you know, the downside of these, some of these more traditional practices, but there's, you know, it's changing rapidly and PNG has a very young population. So over half of the population is under the age 24 years old. So that's a real opportunity in terms of accessing people who are yet to kind of decide their views on things, or they're, they're open to change and to, to thinking about different concepts of gender equality or what is, or isn't acceptable around violence, within environment, relationships, et cetera. So that's also something we try and do a lot of work in is engaging young women and men and boys essentially.

Jennie: Well, I feel like we've talked a lot about the obstacles and a lot of the challenges. So maybe let's talk about some of the lessons you've learned and like ways that you have worked to provide the services.

Kelly: Yeah. Okay. So I mean, we, we try and work in at all levels to address the stigma and, and misconceptions. And so that at a high government level, that includes things like advocacy around guidelines. So looking at post-abortion care guidelines, what work we can do with the ministry of health or other government departments to create a more enabling legal and policy environment. Another really important part of our work is a process called values clarification and attitudes, transformation, training, or VCAT for short. And this is a process where we bring together a group of people, often it's our own staff to start with, and that is not opportunity to explore opinions, biases, preconceptions about who should and shouldn't access services and help the service providers to kind of confront their own bias and realize how they can be less judgmental and, and ultimately look at reducing the kind of bias that sometimes service providers can, can show towards young people or, or particular clients, which is then another barrier to services,

Jennie: Right? That's so important. You have like a bad experience when you're young and you might not come back

Kelly: Well, exactly. And even you, if you don't have a bad experience, you hear about you’re your friend has a bad experience and that's a perceived bias that you might not even personally experience, but you have that idea that you will be judged if you go and ask for those services. And another big challenge is that people know each other in PNG as well. So confidentiality is really important and getting service providers to understand that even if their sister's daughter or someone that someone knows to come and get services, that's real, really important that people understand, and that we are providing services in, in a confidential manner so that they can be sure they won't yeah… everyone in their village won't somehow find out that they're sexually active. So that process we have to do even with our own staff, but then we also roll that out, others within the ministry of health. And so we try and ensure that in all of our conversations, we are talking about sexual and reproductive health as a, a public health issue, the health consequences, you know, nobody wants to see maternal mortality rates as high as they are in PNG. And so being able to talk about the ways that our services contribute to people, being able to plan when to get pregnant, to be able to space their pregnancies and those kinds of things, to place that in a framework where we're saying, this is how it's gonna help you achieve the health outcomes you want to achieve. That's a really good way to engage people. So we also look at adressing stigma at the educational level. So we provide family planning, information and awareness sessions in high schools, and also directly to teachers in within those environments, because often they can also present barriers to their students receiving that information, as I'm sure everybody knows. There's very much that, that idea that if you tell people about sex, they will have more sex. So we are constantly having to repeat that message and bring data to show that that's not the case; in PNG there's a lot of people who don't necessarily attend high school. So we also work to try and reach people outside of the formal education center, a system through things like youth corners, youth friendly pop up chat box booths at different locations. Sometimes that's at local festivals or things like that. We try and provide a space where people can ask those questions. And this is not necessarily something that only happens in PNG, but for example, in our program team, or we also find ways to talk to young people without it being so controversial. So we have anemia testing, for example, for young women in Timor, which is a big issue. Anemia is a huge issue in that country, but it's not controversial at all. So we have young women come in to talk about anemia testing, and that gives our service providers a chance to talk about some of these other issues as well. And menstrual health and hygiene is also one of those topics that can be used really effectively as a gateway to other conversations. It's a way to, to talk about sexual and reproductive health organs, or, you know, the, the body and how it works without necessarily going straight into the topics of family planning or abortion. Faith leaders, I think, think I already mentioned that, but that's really important in these contexts. So for example, in PNG, before our outreach teams come to provide services, they try and hold meetings with community and religious leaders. They explain the services that we offer. They take the time to kind of work through the myths and concerns with those leaders initially, before talking to individuals in the community. Sometimes that's as simple as explaining how certain contraceptive methods work and also how some particular methods can be seen as no not being contravened by their religious beliefs. So that can also be a good way to open up that dialogue with those, those leaders.

Jennie: Yeah. I mean, the, the engaging men and boys element is really important in a country like PNG because of the fact that all the leaders are men, but yeah, that, that has to take lots of, of different channels. It seems like there's so many forms of it that needs to happen. I mean, since you talked about gender equality, being such a big issue, like if that really feels like a huge chunk, that extends way beyond just the, the reproductive health parts. I mean, it gets into the gender-based violence parts. And while they're all related, like this seems like an, the audience that really needs ways to find, to work with men and boys.

Kelly: Yeah. And that's not, that's not something we can do alone as one organization. That's definitely, you know, there's a whole, you know, there's lots of organizations working on these kinds of issues, but, you know, just inviting men to things like to childbirth, those kinds of initial, engaging men in conversations, you know, inviting men to take part in conversations around what contraceptive methods their, their wives or girlfriends might choose to be using. But that on the other hand also needs to be balanced very carefully with ensuring that women who want to use contraception in, in secret, for example, because they are in a domestic violence situation, that they also have the ability to do that. So it is something that we have to balance very carefully. And I mean, there's lots of work that is being done around things like sporting figures can be a really great way to engage men in conversations around different topics. What it means to be a male. It's not necessarily something that focuses on, but I know that other organizations use that. And sporting figures in some of these specific countries really are, you know, they're very well-known leaders in their country. So sometimes changing the attitudes and having those conversations with some of those key individuals be really powerful in terms of getting larger numbers of men and boys to, to think about these topics.

Jennie: Well, the only other thing I was gonna ask, if you had anything you wanted to add, you talked about, you know, being in charge of like the Asian Pacific, if there were any you brought in to more of this, but is there, are there other areas that you wanted to just real quick or…?

Kelly: So from our office in, in Melbourne, we look at, currently look after a program in Cambodia and PNG and Timor. So the, some of the challenges that we see in Timor and PNG are quite similar, Timor is a much smaller country. Its population’s around a million people. So I guess PNG is always seen as, as the example because it's just bigger, you know? Yeah. Everything's amplified. The challenges are amplified, everything's more in P and G but issues are really there in a lot of the Pacific countries, essentially I would need to look up the exact statistic, but I believe it's like lots of, you know, it's something like 16 out of 19 of the worst countries in terms of domestic violence rates are in the Pacific. So that's definitely something that's sort of a challenge for the region. I mean, in terms of MSI as a global organization, we are working in 37 countries globally. So lots of those countries are in Africa and they have a lot of these same challenges. The Asia region has some of the challenges and some very different challenges, but those in the Pacific kind of realm are really, they're really struggling because the health system is, is so rudimentary. And part of that is that they're both, you know, post-colonial, they're, they're setting up their own systems. They're really trying to build their own health workforce. I mean, the workforce is a huge challenge. There's, there's not enough doctors, midwives, nurses. And as I'm sure you can imagine you throw COVID into the mix and you know, you already had these service providers who were dealing with multiple challenges and then to have, I guess the health staff very much distracted with dealing with the sort of latest crisis what's actually really scary for some of these countries is that these ongoing routine services like immunization and maternal and child health really get kind of sidelined or forgotten. And when you have the kind of rates you do of death and disability from these existing conditions, actually the impact of neglecting those services, far exceeds, whatever impact we're seeing from COVID. But I mean, having said that like our service providers in PNG, many of them have had COVID two or three times already. And that's despite the fact that they are they're fully vaccinated. And so that's another challenge that we've had to, to adjust to in the last two years, is that at any given time, lots of our service providers are out of action. So we've really had to kind of bolster the workforce and trying to do that when there's already quite a limited workforce is, is challenging. Actually that's one thing I didn't mention is that MSI Asia Pacific supports the PNG government by implementing their national family planning training program. So that's a great opportunity in terms of our ability to teach staff in PNG the technical elements of IUD insertion and other family planning method provision, but at the same time to be talking about or challenging or increasing knowledge and expertise around some of these other broader issues in terms of stigma, barriers to access and gender inequality. So that can be really helpful.

Jennie: That's really good. Yeah. It helps to have the government programs like fully trained and on these issues. And it seems like, you know, when you're talking about challenges, it was like all the way down to like the individual to all the way up to the government of like getting the acceptance of these issues. So it it's really good to hear that you are able to work with the government.

Kelly: Yeah. But it's gonna be a long path. I mean, the types of misconceptions that we have, like already, there was things about IUDs being the mark of the devil or a microchip that's being inserted to allow foreign bodies to monitor and control you. And there's also a lot of stigma around, um, vaccinations of any type. So in having COVID vaccination rollout programs has increased the kind of stigma that we've already been seeing for some of our program. Yeah. There's also the same stigma that you have with it. I said before around family planning, being the expectation is that that is just for married women and men. But part of the process of, of trying to challenge those ideas is to kind of havimg conversations around situations that are happening. So in PNG last year, there was a, a young woman who died from taking misiprostol alone, not under medical supervision, she'd accessed it. Nobody really knows how, but quite possibly from a pharmacy or somewhere that wasn't regulated. And so that's someone died. And so having those conversations about what are the things that have contributed to that, to of that death, you know, it's that lack of information. It's the fact that as a young woman, she didn't feel she could go to anybody to ask for information or services. So really looking at what systems are contributing to those outcomes and also what sort of the use and misconceptions lead to those terrible outcomes.

Jennie: Okay. So as we wrap up, we always like to end with action items, and I know this one, maybe a little different, but is there anything our audience can do to, I don't know if it's raise awareness or, or, or help around these issues.

Kelly: So in terms of what your audience can do, I mean, donations to support our work is always welcome either to the Asia Pacific region or also across any of the other areas where MSI works globally. In the Asia Pacific region, 91 cents of every dollar donated goes directly to our programs in the Asia Pacific. So this is really quite an excellent impact compared to many other organizations. And with just $25 a year, you can provide contraception for a woman in PNG that can protect her from an unplanned pregnancy. Obviously not everybody is in a position to support financially. So my message would be to converse around this region. So often the Pacific is really left out of global conversations at UN and other events. We really struggle to get a presence. So learning more about the region, more about the challenges that the region faces, raising awareness about the, and about the issues. Yeah. I mean, COVID is decimating the health systems and impacting foreign aid spending around the world. So anything that your listeners can do to support that work, to make sure it doesn't get forgotten during this time is really important.

Jennie: Yes. That has been kinda the eternal struggle, right? Is COVID taking up so much of the attention. I mean, as it should, because it is a major pandemic, but like all these other priorities still exist and cannot be neglected.

Kelly: And I think that's really, the thing is it's just amped so much around gender inequality and really pushed these struggling health systems that weren't universal to begin with. They just pushed to the brink. And in many cases, they're really collapsing under the strain of it because COVID exacerbated it. Right? Like we've definitely seen increased gender-based violence. Yeah. And I'm sure you've probably talked about that in terms of UNFPA's global statistics before, but you know, we are seeing that those curfews and all the methods that we've had to combat the COVID pandemic vitally, so have really put a lot of women in really different situations and has increased for example, gender-based violence. And if you think about that as increasing from a base of two out of three in PNG, that's pretty scary. Yeah. I also think that it's gonna take time for us to really see the hard statistics around increases to the other indicators, such as maternal mortality. There are some indications that maternal mortality has increased in PNG, but we won't really be able to see that until the next census.

Jennie: Well, Kelly, thank you so much. It was one wonderful talking to you today.

Kelly: Thank you for having me. It was great to talk to you.

Jennie: Okay. Y'all I hope you enjoyed my conversation with Kelly. I'm so glad I was able to do it. Like I said, I really loved talking to people, working in places around the world about their programs. And I am so, so excited we were able to talk about what is happening in Papua New Guinea. Like she said, it's something we don't hear about a lot. And there were some really big issues happening there that really were worth a conversation. So I hope y'all enjoyed it.

Jennie: Thanks for listening everyone. And we'll see you on our next episode of RePROS Fight Back. For more information, including show notes from this episode and previous episodes, please visit our website at reprosfightback.com. You can also find us on Facebook and Twitter at RePROS Fight Back, or on Instagram at reprosfb. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

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