The Future of Sexual and Reproductive Health in Kiribati

The Pacific Island nation of Kiribati faces unique challenges in sexual and reproductive health (SRH). Its dispersed geography, limited healthcare resources, and diverse cultural contexts make accessibility to services particularly complex, especially on the outer islands. However, targeted efforts through initiatives like the Kiribati Healthy Families Project (KHFP) have made significant strides in improving family planning (FP) and SRH services.  

Background 

Sexual Wellbeing Aotearoa (SWA) commissioned Future Partners to undertake some research in Kiribati. We were well-placed to do this as Future Partners had undertaken the mid-term review of the KHFP in 2023 and our team (comprising Dr Elisabeth Poppelwell and Dr Mireta Noere) was known and trusted. Their work included interviews in South Tarawa and in two Outer Islands.   

Why Sexual and Reproductive Health matters in Kiribati  

SRH services play a vital role in improving maternal and child well-being, preventing sexually transmitted infections (STIs), and enabling individuals and families to make informed decisions about their reproductive lives. However, the Pacific nation’s infrastructure and geographical dispersion exacerbate the delivery of consistent and high-quality SRH services. 

Challenges in accessing SRH in Kiribati  

• Scattered population: Kiribati consists of 33 atolls, many of which are remote, making it challenging to deliver consistent health services. 

• Cultural diversity: Local traditions and varying religious beliefs often shape attitudes towards modern family planning methods. 

• Resource constraints: A lack of medical supplies, trained staff, and clinic presence on outer islands that limits service reach, as well as high travel costs to these outer islands. 

• Stigma and misinformation: Community surveys reveal prevalent fears and misconceptions about cervical screenings and contraceptive methods. 

Despite these setbacks, tailored approaches to SRH interventions, such as mobile clinics and church-led advocacy, highlight the potential for overcoming barriers.  

The impact of the Kiribati Healthy Families Project  

The KHFP, collaboratively led by the Kiribati Family Health Association (KFHA) and Sexual Wellbeing Aotearoa, and supported by New Zealand’s Ministry of Foreign Affairs and Trade, has proven to be key for effective SRH services. Spanning three phases since 2012, the project has expanded its reach and shown steady progress.  

Highlights of the project  

• Community outreach: Mobile and after-hours clinics reached previously underserved populations, particularly in remote areas. 

• Capacity development: A total of 42 clinicians and 45 health promoters received specialised training, significantly improving healthcare delivery. 

• Advocacy and engagement: Community leaders, including island council mayors and church leaders, have participated in Sexual and Reproductive Health and Rights (SRHR) advocacy meetings, promoting broader acceptance of modern family planning. 

• Youth empowerment: Training initiatives for young volunteers effectively raised awareness about SRH in communities. 

The project’s success is evident in the reported improved attitudes towards SRH and the growing acceptance of family planning methods even in traditional communities. However, stakeholders emphasised the importance of addressing remaining challenges and adapting strategies for future sustainability.  

Learnings and ongoing challenges  

Although the KHFP has championed significant socio-health improvements, several gaps remain that require immediate attention. Challenges identified include: 

1. Service gaps in Outer Islands: The Ministry of Health and Medical Services has nationwide coverage but many stakeholders pointed to the lack of KFHA’s presence in all outer islands, resulting in irregular access to services. noting). 

2. Low cervical screening rates: Fear, embarrassment, and misinformation deter women from undergoing cervical cancer screenings, especially in remote areas. 

3. Supply chain issues: Disruptions to contraceptive supplies hinder consistent service delivery, undermining trust in available healthcare resources. 

4. Cultural barriers: Some communities resist modern family planning methods, promoting traditional approaches instead. 

5. Sustainability risks: KFHA relies heavily on external funding. Delays in funding can disrupt service continuity and erode community trust. 

Strategic priorities for the future  

To ensure sustainable SRH programmes that serve all segments of Kiribati society, KHFP needs to prioritise new strategies and foster stronger collaborations with key stakeholders, including: 

1. Expand Outer Island reach: Establish KFHA hubs on outer islands and schedule regular visits to underserved communities. 

2. Leverage local culture: Work with church and community leaders to tailor SRH messaging in culturally sensitive ways. Encourage the use of community, workplace and church meeting spaces for clinics and workshops. 

3. Improve resource availability: Ensure uninterrupted supplies of contraceptive methods and focus on long-term planning to mitigate delays in financial resources. 

4. Focus on marginalised groups: Expand specialised services for marginalised populations, including LGBTQIA+ individuals and sex workers. 

5. Enhance awareness campaigns: Implement diverse educational approaches, from radio broadcasts to social media platforms, to dispel misinformation and increase engagement. 

6. Train local advocates: Equip volunteers and peer educators with tools to disseminate accurate SRH information, ensuring consistent awareness efforts even during service lags.