OFFICE OF THE OMBUDSMAN, SAMOA Samoa’s Second Universal Periodic Review 32. From the Survey, three areas of concern relating to healthcare were identified: the affordability of health care56; the accessibility of health care57; and the quality of health care.58 Recommendation 22: That the Samoan Government address quality issues and the accessibility gap for rural and remote areas, and Government to address the community’s perception of affordability of health care through health literacy campaigns. 33. Sexual and reproductive health is a particular area of concern in Samoa, and a number of issues must be addressed at local and national levels: teenage pregnancy59; the high prevalence of sexually transmitted infections (STIs)60; availability of termination of pregnancy resulting from unlawful acts 61; and the need for family planning and comprehensive sexuality education (CSE).62 Recommendation 23: That the Samoan Government expand awareness raising programs for families to combat negative social and cultural attitudes towards teenage pregnancy; Recommendation 24: That the Samoan Government, in consultation with the NHRI, launch public health campaigns around safe sex, in particular addressing acceptance of contraceptive use at political, religious and traditional leadership levels. Recommendation 25: That the Samoan Government financially support NGOs working with victims of rape and incest. Recommendation 26: That the Samoan Government implement CSE in accordance with United Nations Population Fund’s Operational Guidance in order to empower young people to protect their health wellbeing and dignity. Recommendation 27: That the Samoan Government consider the serious plight of, and viable medical options for, victims who fall pregnant from unlawful sexual acts. Only 25% of the Survey respondents found health care affordable - NHRI, ‘State of Human Rights Report 2015’, p 49. Less than a third of the Survey respondents could access their nearest medical facility within 30 minutes. Note 56. 58 60% of the Survey respondents found the quality of healthcare to be unsatisfactory and there was widespread concern regarding the availability of physicians. In the most recent survey conducted there were only 48 doctors and 185 nurses and midwives per 100,000 people. Note 56, p 50. 59 The CEDAW Committee voiced serious concerns over the high rate of teenage pregnancies and the fact that existing sex education programs are insufficient in bringing attention to all aspects of prevention. According to the Ministry of Health the adolescent birth rate for 15-19 year olds is 39 births per 1000 women. Note 56, p 53. 60 According to a 2008 survey, 32.8% of the population have at least one STI. Note 56, p 52. 61 The majority of Survey participants (60%) agreed there should be better access to birth control. Under the Crimes Act 2013 abortion is still illegal and according to the Samoa Family Health Association 36 women sought unsafe abortions for unwanted pregnancies in 2014. Note 56, p 54. 62 In this regard, we commend the Samoa Family Health Association’s UPR submission to the Council and ask that its recommendations for youth regarding access to family planning, contraceptives and termination of pregnancy be adopted and extended to women. 56 57 12