Population Health
Tasmanian
Sexual and Reproductive Health
Strategic Framework
2013 - 2016
May 2013
1
Introduction
The Tasmanian Sexual and Reproductive Health Strategic Framework 2013 - 2016 provides guidance for
coordinated action to improve the sexual and reproductive health of Tasmanians.
Developed collaboratively by a range of organisations and services, the Framework describes a shared
goal, a shared systems approach and a shared commitment.
It builds on work to-date with a view towards innovative action to pre-empt and respond to future
challenges and needs.
The Framework also comprises, within a broad definition of sexual and reproductive health, part of the
Tasmanian response to the suite of five Commonwealth Government national strategies to reduce the
transmission of sexually transmissible infections and blood borne viruses as well as the morbidity,
mortality and personal and social impacts they cause.
The five focus areas of the Framework identify systems points where organisations within their own
operations and across their partnerships, can strengthen their efforts for the ultimate benefit of individual
clients and whole communities.
The priority outcomes reflect the ongoing importance of health promotion work driving prevention of
illness as well as the clinical work centred on disease screening, testing and treatment.
The Framework also highlights the need for increased action that recognises and responds to the social
determinants of health. This is a significant challenge facing organisations, services, other sectors and the
whole Tasmanian community. However, the realisation of health equity – removing avoidable and unfair
barriers that compromise sexual and reproductive health and wellbeing for vulnerable groups and
communities – is crucial to the Framework achieving the shared goal of improved health and wellbeing for
everyone.
Resulting from the collaboration of many stakeholder organisations and services, the Tasmanian Sexual and
reproductive Health Strategic Framework 2013-2016 shows the way forward for all Tasmanians to further
experience better sexual and reproductive health, respectful relationships, informed reproductive choice
and the celebration of sexual and gender diversity.
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The Strategic Context
The Tasmanian Sexual and Reproductive Health Strategic Framework 2013 - 2016 has been developed to
complement existing national and state activity. Such activity includes:
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the five national strategies responding to sexually transmitted infections and blood borne viruses, and
most specifically the Second National Sexually Transmissible Infections Strategy 2010-2013
National Women’s Health Policy 2010
National Male Health Policy 2010
Our Children Our Young People Our Future The Agenda for Children and Young People 2011
Hepatitis and HIV – An Agenda for Action
Working in Health Promoting Ways: A Strategic Framework for DHHS 2009-2012
Making Choices Two Action Plan 2012-2015.
A background paper Developing a Sexual and Reproductive Health Strategic Framework for Tasmania was the
foundation document for consultation, along with the Second National Sexually Transmissible Infections
Strategy 2010-2013, and the Promoting Sexual Health and Wellbeing Health Promotion Action Guide. The Time
for a National Sexual and Reproductive Health Strategy for Australia Background Paper 2008 aided the initial
discussion that shaped the content of the Framework.
The priority outcomes, focus areas and proposed actions detailed in the Framework have been developed
from research evidence, consultation outcomes and the expert advice of the Tasmanian Sexual and
Reproductive Health Strategic Framework Collaborative Group.
A Collaborative and Consultative Approach
The Tasmanian Sexual and Reproductive Health Strategic Framework Collaborative Group was established
in 2011 to guide and inform the Framework’s development and to provide expert advice in consultation
processes.
The Collaborative Group is chaired by Population Health, Department of Health and Human Services
(DHHS) and comprises representation from stakeholders including:
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Family Planning Tasmania
Hobart Women’s Health Centre
Scarlet Alliance
TasCAHRD
Tasmanian Branch, Public Health Association of Australia
The Link Youth Health Service
Working It Out
Department of Education
Correctional Health, DHHS
Population Health Epidemiology Unit, DHHS
Population Health Equity Unit, DHHS
Public and Environmental Health Service, DHHS
Sexual Health Services, DHHS.
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Progressing the Framework
The Tasmanian Sexual and Reproductive Health Strategic Framework 2013-2016 guides action that is
coordinated, collaborative and responsive to identified and evidenced need. It provides direction for
current and future initiatives, and a strategic intent against which organisations and services can test their
own activity. It also encourages partnerships that contribute to a shared goal for improved sexual and
reproductive health of the Tasmanian community.
The Framework supports the continued development of better practice across the five focus areas of
service access; workforce development; collaborative partnerships; research, data and evidence; and
planning for the future. Such a systems approach requires engagement with and commitment from a wide
range of stakeholders to ensure improved sexual and reproductive health can be realised, and most
critically, consolidated as a long term outcome. Action and achievement is likely to be incremental, building
on previous successful work and linked to evolving capacity within and across organisations and sectors.
Lead organisations have nominated within a number of partnership arrangements to progress activity
detailed in the Framework. This approach is in keeping with the collaborative development of the
Framework and also enables stakeholder groups to more effectively and efficiently make use of the
expertise and various resources available.
The Framework identifies many proposed actions to improve the sexual and reproductive health of
Tasmanians. The next step will be to translate and prioritise the identified actions. An annual
implementation plan will complement the Framework and provide further detail including outcomes and
timeframes about how each action will be progressed throughout the life of the Framework. The
Collaborative Group will continue to provide oversight for progressing the activity of the Framework.
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Making Choices Two
Making Choices Two is a complementary area of work that started in 2012 aiming to reduce unplanned
teenage pregnancy in Tasmania. It builds on the previous Making Choices Project and aims to increase the
information and services available to young people. Making Choices Two was established to support existing
work focusing on teenage pregnancy and was also listed as an action area in Our Children Our Young People
Our Future, Tasmania’s Agenda for Children and Young People launched by the Premier in 2011.
The Making Choices Two Taskforce is a subgroup of the broader Tasmanian Sexual and Reproductive Health
Collaborative Group and includes representatives from across government and the community sector. The
role and function of the Taskforce is to:
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coordinate and add support to existing and future initiatives that aim to reduce unplanned teenage
pregnancy
develop a Tasmanian Action Plan to reduce unplanned teenage pregnancy
prioritise the implementation of activities within the Action Plan
promote collaboration and sharing of information across sectors to improve access to programs and
services for young people in relation to sexual and reproductive health
advocate for the needs of young people who are pregnant or parenting.
Reducing unplanned pregnancy, especially among teenagers, is identified as a one of the Framework’s five
priority actions. Many of the potential strategies to address this issue have been documented in the Making
Choices Two Action Plan 2012-2015 and will be implemented by the Making Choices Two Taskforce over
the next two years. The strategies listed below exist as part of the Making Choices Action Plan 2012-2015
but have also been included as proposed actions in the Framework as they are critical in improving the
sexual and reproductive health of younger Tasmanians.
Focus Area
Strategy
Relationships and
Sexuality Education
Support the delivery of relationships and sexuality education in Tasmanian
Schools
Support and advocate for community education initiatives that enable
parents to communicate with their children and teenagers about
relationships and sexuality
Clinical Services for
young people in
secondary colleges
Review youth health services provided through clinics in secondary
colleges
Access to condoms
Increase access to, and use of, condoms with a focus on rural areas
Work towards consistency in policy about condoms being available in
places where young people are located
Excerpt from Making Choices Two Action Plan 2012-2015
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What do we mean by “sexual and
reproductive health”?
Historically, reproductive health and sexual health have largely been considered
separately and within the confines of a clinical perspective. However, “sexual and
reproductive health” has emerged over time as a broadened term that recognises
the overlap of the two and also includes a sociological perspective on the
promotion of individual and community health and wellbeing.
Reproductive health can be described as a state of complete physical, mental and
social wellbeing and not merely the absence of disease or infirmity, in all matters
involving the reproductive system and its functions and processes. Reproductive
health implies people can have a satisfying and safe sex life, have the capacity to
reproduce and the freedom to decide if, when and how often to do so. It also
includes sexual health, which is the enhancement of life and personal relations, and
not merely counselling and care around reproduction and sexually transmitted
diseases (WHO 2002).
Sexual health can be further described as the existence of a positive and respectful
approach to sexuality and sexual relationships, as well as the possibility of having
pleasurable and safe sexual experiences, free of coercion, discrimination and
violence (WHO 2002). These definitions build on the ICPD Programme of Action
and the Beijing Platform for Action.
In line with these understandings, sexual and reproductive health policy and action
is oriented to support healthy sexual activity and reproductive function, and to
reduce adverse outcomes from sexual and reproductive experiences.
Such policy and action focuses on providing information and education for a health
literate community, gynaecological and obstetric services, contraceptive options,
screening, testing and treatment of disease, and promotion of positive sexual and
reproductive experiences free from violence or discrimination, and unconstrained
by inequity of service.
Understanding sexual and reproductive health in this way helps us to envision and
further realise an inclusive and supported future where all Tasmanians can enjoy
safe, respectful and fulfilling experiences and relationships that sustain themselves,
their families and their communities.
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Sexual and Reproductive Health - Australia and Tasmania
In Australia, where the overall population is among the healthiest in the world, we have unacceptably high
levels of sexual and reproductive ill health. While there are many influences of an individual’s sexual and
reproductive health, social determinants, such as income, employment, housing, education, gender roles,
and access to community resources, all impact heavily on sexual and reproductive health (O’Rourke 2008).
Rates of teenage pregnancy and STIs vary between communities and groups of people and do not impact
on the health of the Australian population evenly. Populations such as young people, Aboriginal people, gay
men and other men who have sex with men and sex workers were all identified as priority populations in
the second National STI Strategy 2010-2013.
By the end of Year 12, 50 per cent of boys and girls have had sexual intercourse, and the average age of
first sexual intercourse is 16 (Smith et al 2009). This often means that people experience 10-20 years of
sexual activity before committing to a life partner, which can increase the risk of unplanned pregnancy and
STIs.
Many young people, especially those in rural areas, lack access to contraception and adequate sexual and
reproductive health information and treatment. Young Tasmanians themselves identify sexual and
reproductive health as one of their primary concerns (Hawkins 2011).
STIs are common in Australia and contribute to a significant level of ill health and long-term complications,
especially chronic pain and infertility. Although the epidemiology differs for each STI, population groups
suffering the greatest burden of notified infection are young people, Aboriginal people and homosexually
active men.
Tasmania has high rates of STIs among the adolescent population with Chlamydia rates exceeding the
national rate during the period 2008-10. Chlamydia occurs more frequently among females than males, and
the age group most affected by chlamydia is the 15 to 24 year old age group (DHHS, 2013).
National estimates by Marie Stopes International (2006) suggests just over half of all Australian women of
reproductive age (15-44 years) have experienced an unplanned pregnancy. Young people are particularly
vulnerable to experiencing an unplanned pregnancy and in 2011 Tasmania recorded the second highest rate
of teenage pregnancy in the Australia (ABS 2012). The highest rates of teenage fertility occur in the most
disadvantaged areas, with young women aged 15–19 in these areas more than six times more likely to give
birth than young women living in the least disadvantaged areas (Tasmanian Government 2013).
Compounding these and other concerns, Tasmania also has poor rates of health literacy when compared
with other states, with more than 60 per cent of people in Tasmanian having inadequate health literacy
(ABS 2006). As the ability to access and understand health information and services is increasingly
recognised as a major determinant of health and wellbeing, achievement of health literacy is emerging as a
significant challenge in the pursuit of better sexual and reproductive health for Tasmanians.
Health literacy is joined by gender, disability, socio-economic status and many other social determinants
that influence sexual and reproductive health for better or worse. These illustrate the continuing need for a
broad, cross sector approach to better understanding and responding to the needs of disadvantaged and
vulnerable groups within a population of increased diversity.
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Tasmanian Sexual and Reproductive Health
Strategic Framework 2013-2016
GOAL
Improved sexual and reproductive health for the Tasmanian community, and especially
for vulnerable populations.
FOCUS AREAS
Service access
Workforce development
Collaborative partnerships
Research, data and evidence
Planning for the future
PRIORITY OUTCOMES
1.
Reduced rates of sexually transmissible infections (STIs)
2.
Improved sexual and reproductive health equity in vulnerable populations
3.
Reduced unplanned pregnancy, especially among teenagers
4.
Increased health literacy
5.
Increased access to a full, safe and effective range of reproductive and contraceptive
options
PROPOSED ACTIONS
Proposed actions to achieve each priority outcome are listed on the following pages.
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Priority Outcome 1
Reduced Rates of Sexually Transmissible Infections (STIs)
In reducing STI rates in Tasmania, chlamydia is arguably the most challenging problem. The age group
most affected by chlamydia in Tasmania is the 15 to 24-year-old age group with females affected at a
greater rate than males (DHHS, 2013). For both women and men, the national rates of diagnosis for
chlamydia have increased considerably over the past 10 years.
While affordable and effective treatment is available, barriers exist that make it challenging to bring down
the rates of transmission. Risky sexual behaviour in young people is one such barrier, which may be
affected by alcohol and other drugs, abuse, mental ill health, homelessness, incarceration, access to
condoms, and cultural influences including media, pornography and the sexualisation of children.
Access to education, clinical services and supporting respectful relationships are critical in reducing STIs
and reducing unplanned pregnancy. Young people also need gender specific tools to enable them to make
positive reproductive choices. They also need to experience supportive environments that foster
respectful relationships.
Other barriers which affect a range of population groups include lack of access to appropriate education,
screening programs and treatment options, and inadequate individual and community health literacy to
more fully understand and manage their sexual and reproductive health.
Strategies for addressing sexually transmissible viruses such as Hepatitis B and HIV are described in
‘Hepatitis and HIV, an Agenda for Action 2011-2013’ produced by the Hepatitis and HIV working group,
DHHS.
Focus Area
Proposed Actions
Service access
Increase the number of youth health clinics in colleges – to be progressed
under the Making Choices Two Action Plan
Workforce
development
Support the capacity of Sexual Health Services, DHHS to reduce waiting
times and expand service provision
Collaborative
partnerships
Promote regular STI screening and testing among vulnerable populations
Collaborative
partnerships
Develop and deliver education and resources promoting sexual health and
STI prevention that are age appropriate, gender specific and culturally
sensitive
Research, data
and evidence
Develop strategies to translate the comprehensive chlamydia data gathered
in Tasmania to enable its use in policy and service delivery planning
Planning for
the future
Develop strategies to ensure the Gardasil vaccine is accessible to young
people who may have been missed in-school vaccination programs through
absence or disengagement
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Priority Outcome 2
Improved Sexual and Reproductive Health Equity in Vulnerable Populations
Sexual and reproductive health outcomes are known to be poorer in vulnerable population groups. Many of
these poorer outcomes are attributable, at least in part, to the negative impact of the social determinants
of health and the existence of health inequity – avoidable and unfair barriers that compromise health and
wellbeing.
Identified vulnerable population groups include:
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prison populations
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lesbian, gay, bisexual, intersex and transgender (LGBTI) communities, including non-gay identified
men who have sex with men
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sex workers
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Tasmanian Aboriginal people
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culturally and linguistically diverse populations, including migrants and refugees
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at risk young people including those who are homeless, those in rural areas, those in detention and
those disengaged from the school community
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people living in poverty or with low socio-economic status
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people with low health literacy
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people experiencing mental illness
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people with a disability.
Focus Area
Proposed Actions
Service access
Increase outreach clinics to promote STI testing and treatment in rural
populations
Service access
Increase clinical and counselling support services for transgender and intersex
populations
Workforce
development
Increase the knowledge and skills of mainstream services in regard to sexual
and reproductive health issues for vulnerable populations including Aboriginal
Tasmanians, refugee and migrant populations, LGBTI communities, sex
workers, prison populations and people with disabilities
Collaborative
partnerships
Map health services for older Tasmanians, particularly vulnerable populations
including older Aboriginal Tasmanians, refugee and migrant populations,
LGBTI communities, sex workers, prison populations and people with
disabilities, and develop strategies to increase their awareness and the
dissemination of appropriate sexual and reproductive health information
Research, data
and evidence
Use available evidence showing links between sexual and intimate partner
violence/abuse and poor health outcomes, and assess needs of affected
populations
Planning for the
future
Develop strategies that respond to the sexual and reproductive health needs
of people who have experienced sexual violence, intimate partner violence,
sexual abuse or family violence
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Priority Outcome 3
Reduced Unplanned Pregnancy, Especially Among Teenagers
Despite increased education and availability and use of contraception, unplanned pregnancies will still occur
for a number of reasons. Even when contraception is used it is not 100 per cent effective 100 per cent of
the time. Research suggests at any given time, just over half of all Australian women of reproductive age
(15-44 years) have experienced an unplanned pregnancy (Marie Stopes International 2006).
In Tasmania, rates of unplanned pregnancy within the adolescent age group has been an area of focus for
some years. Teenage birth rates in Tasmania are consistently among the highest in Australia and in 2011
were second only to the Northern Territory (ABS 2012). The highest rates of teenage fertility occur in the
most disadvantaged areas, with young women aged 15–19 in these areas more than six times more likely to
give birth than young women living in the least disadvantaged areas (Tasmanian Government 2013).
Although many teenage births result in positive outcomes for both the mother and child, teenage mothers
are more likely to have poorer health, education and economic outcomes than older mothers. Outcomes
for their children are also poorer.
Much work has happened over the past five years to reduce unplanned teenage pregnancy but this work
need to continue to ensure young people have access to services and the appropriate information and
knowledge to make decisions about their sexual and reproductive health.
Focus Area
Proposed Actions
Collaborative
partnerships
Support the implementation of the key strategies in the Making
Choices Two Action Plan – (relationships and sexuality education,
clinical services in colleges and access to condoms)
Workforce
development
Support the implementation of the Indigenous Early Childhood
Development National Partnership Agreement; focus on increasing
capacity of health workers in Aboriginal organisations in sexual and
reproductive health issues; implement sexual health training of
existing workers; and provide sexual health and relationships
education and promotion to young people
Workforce
development
Advocate for the expansion of clinical capabilities available to nurse
practitioners
Planning for
the future
Develop strategies to actively engage young males in a shared
community dialogue around respectful relationships and parenting,
and young females around aspirations and life goals
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Priority Outcome 4
Increased Health Literacy
Increasing the health literacy of Tasmanians is critical if individuals and communities are to better manage
their sexual and reproductive health for positive outcomes. For young people, educational settings play a
key role in increasing health literacy.
Significant activity has been undertaken nationally in the development of the Australian Curriculum, with
sexual and reproductive health education included in the draft Health and Physical Education Curriculum
from Foundation Year to Grade 10. In Tasmania, the Relationships and Sexuality Education in Government
Schools Strategy 2012-2014 aims to support and enable school communities to provide relationships and
sexuality education that considers developmental processes for every age, with appropriate information
on sexual development, physical development, reproduction, respectful relationships and gender.
Other combinations of population groups and settings that offer opportunities for increasing health
literacy include older persons in supported residential care and in day care environments; people with
disabilities in supported residential care, in day care environments and in workplaces; prisoners; and
Aboriginal, and culturally and linguistically diverse people in culturally sensitive settings.
Focus Area
Proposed Actions
Service access
Support the provision of comprehensive and sequential relationships
and sexuality education for young people in schools and alternative
educational settings. Progressing under the Making Choices Two Action
Plan
Service access
Support sexuality and relationships education targeted to priority
populations including lesbian, gay, bisexual, intersex and transgender
communities, prison populations, sex workers, Aboriginal youth,
culturally and linguistically diverse communities, people who experience
mental ill health, and people with disabilities
Workforce
development
Support capacity building for service providers to support people with
disabilities and to support older people to experience optimised sexual
and reproductive health and wellbeing
Workforce
development
Support the delivery of relationships and sexuality training for teachers,
youth health workers and youth health nurses
Collaborative
partnerships
Increase awareness of the importance of sexual and reproductive health
issues across the lifespan by engaging mainstream health services in
sexual health promotion activity
Collaborative
partnerships
Support capacity building for health services to provide education and
resources for women experiencing midlife/menopause
Collaborative
partnerships
Develop capacity for services to provide age appropriate support to
disadvantaged young parents and their children
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Priority Outcome 5
Increased Access to a Full, Safe and Effective Range of Reproductive and
Contraceptive Options
Central to improved sexual and reproductive health outcomes is ready access to reproductive and
contraceptive choices.
For women, in particular, full management and control of their fertility is critical both across their lifespan
and to their experience of various life events.
While Tasmanians are in general adequately supported by fertility and pregnancy support services,
barriers exist to accessing contraception, including emergency contraception and pregnancy termination
services.
These barriers are often more significant for young people; Aboriginal people; people in rural areas;
people who are financially disadvantaged; people from culturally and linguistically diverse backgrounds;
people who are homeless; people who are lesbian, gay, bisexual, transgender or intersex, people with
disabilities; and people with mental ill health.
Focus Area
Service access
Proposed Actions
Explore opportunities to increase access to termination of pregnancy
services, particularly for women who are financially and/or
geographically disadvantaged and examine opportunities for expanding
pregnancy termination services into the public health system or
commissioning private clinics
Service access
Increase awareness of access issues and availability of contraception,
including emergency contraception, among pharmacists in rural areas
for people in their local communities
Service access
Explore options and advocate for increase access to assisted
reproductive and in vitro fertilisation services for people who are
financially disadvantaged
Workforce
development
Support the development and delivery of training for general
practitioners, pharmacists and other primary health workers in issues of
consent, confidentiality and effective co-management with clients and
consumers about their sexual and reproductive health
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The Way Forward
The Tasmanian Sexual and Reproductive Health Strategic Framework 2013-2016 provides a clear and
consistent set of actions to improve the sexual and reproductive health outcomes for all Tasmanians.
Progressing the actions contained in the Framework will depend on the collaboration and commitment of
government and non-government service providers.
Some strategies are currently under development while other actions such as improving access to
termination services need considerable legislative and policy change before access can be improved. There
are actions that clearly fall within the remit of a particular agency and other actions will need the
development of partnerships to share resources. There are also actions within the Framework named in
the Making Choices Two Action Plan and will continue to be implemented by the Making Choices Two
Taskforce with reports back to the Collaborative Group.
The next steps in realising the goal of the Framework will be the prioritisation of actions by the
Collaborative Group and the development of an annual implementation plan to progress work. The
implementation plan will include detailed information for each action including timeframes, lead agency
responsibility and key deliverables. The first implementation plan will be developed by June 2013 and
implementation will be driven and monitored by the Collaborative Group.
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References
Australian Bureau of Statistics (2012) Births Australia 2011, Canberra Australia
Australian Bureau of Statistics (2006) Health Literacy Australia, Canberra Australia
DHHS (2013), Health Indicators Tasmania Unpublished data
Hawkins, C (2011) The Rural Reality for Young People Living on the West Coast of Tasmania, TigerHawke
Consulting
Marie Stopes International, (2006) What women want when faced with an unplanned pregnancy
O’Rouke, K, (2008) Time for a National sexual and reproductive health strategy for Australia, Background paper
Smith A, Agius P, Mitchell A, Barrett C, Pitts, M. (2009) Secondary students and sexual health 2008: Results of the
4th National Survey of Australian Secondary Students. Australian Research Centre in Sex, Health and Society, La
Trobe University: Melbourne.
Tasmanian Government (2013) Kids Come First Update: Selected Outcomes for Children and Young People in
Tasmania, Tasmania
World Health Organization (2006) Defining sexual Health: Report of a Technical Consultation on Sexual Health
20-31 January 2002, Geneva
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Population Health Equity
Population Health
Department of Health and Human Services
GPO Box 125, Hobart 7001
Ph: 1800 671 738
Published May 2013
Copyright State of Tasmania 2013