Adolescent Unplanned Pregnancy in the Pacific TONGA

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Adolescent Unplanned Pregnancy in the Pacific
TONGA
Christine Linhart, Karen McMillan, Hilary Gorman, Catherine O’Connor,
Michelle O’Connor, Avelina Rokoduru and Telusa Fotu Tu’i’onetoa
Prepared for Pacific Women Shaping Pacific Development Support Unit

Acknowledgements
The research team is deeply grateful and oers heartfelt gratitude to all the participants, but
especially the young women, who were generous and brave enough to share the intimate
details of their experiences and their feelings with the interviewers. These young women
were reflective, insightful, brave and mature beyond their years. We are also very thankful to
the Pacific Women Support Unit and the Pacific Women Working Group, which conducted
the preliminary scoping work and set the project in motion, and the Pacific Women Advisory
Group on Research, which provided feedback. The research team is deeply grateful to the
Talitha Project for its dedication and enthusiasm to so many integral components of this
project. We are also very grateful to the Tonga Family Health Association for its support and
guidance. Ana Baker and Tracey Tupou from the DFAT Post always provided a warm smile,
valuable insights and endless support. Dr Etuini Ma’u, a Tongan-born and raised medical
doctor, worked tirelessly throughout the project to provide insights, understanding and
literature about the Tongan context that added invaluable richness to the information we
collected. Dr Ma’u never asked for anything in return for his time. He simply stated that it was
a sign of his appreciation that our project was doing research ‘with’ Tonga, not ‘on’ Tonga.
This research was funded by the Australian government’s Gender Equality Fund, through
the Pacific Women Shaping Pacific Development (Pacific Women) program.
Chief Investigators: Karen McMillan, Christine Linhart, Catherine O’Connor
Tonga Team Leader: Christine Linhart
Interviewers: Christine Linhart, Vanessa Heleta, Mafi Tupou, Ana Babe Louis Vi, Vika Finau
Translations: Dr Etuini Ma’u, Vanessa Heleta, Ana Babe Louis Vi
The opinions expressed in this document are those of the authors.
No part of this publication may be reproduced, stored, transmitted or photocopied without
the prior permission of the authors.
Please contact Karen McMillan at k.mcmillan@unsw.alumni.com or Christine Linhart at
c.linhart@unsw.edu.com for any further information on the study and the report.
ISBN: 978-0-7334-3926-1
Design and layout by Il Razzo
Suggested citation: Linhart, C., McMillan, K., Gorman, H., O’Connor, C., O’Connor, M.,
Rokoduru, A., & Tu’i’onetoa, T.F. (2020). Adolescent unplanned pregnancy in the Pacific:
Tonga. Sydney: School of Public Health and Community Medicine, UNSW.
Adolescent Unplanned Pregnancy in the Pacific : TONGA

Contents
Executive summary 2
1 Aims and objectives 5
2 Literature review 6
2.1 Adolescent unplanned pregnancy 6
2.2 Adolescent sexual and reproductive health in the Pacific 8
2.3 Abortion in the Pacific 9
3 Methodology 11
3.1 Research design 11
3.2 Ethical approvals 11
3.3 Data collection and analysis 11
3.4 The study in Tonga 12
4 Results and discussion 14
4.1 Experiences of unintended pregnancy and motherhood 14
4.2 Social and structural factors 35
4.3 Knowledge and practices of traditional methods of fertility limitation 36
4.4 Some limitations and considerations from data collection 38
5 Conclusions 40
5.1 Adolescent unplanned pregnancy in Tonga 40
5.2 Regional themes 46
6 Recommendations 48
References 51
1Adolescent Unplanned Pregnancy in the Pacific : TONGA

Executive summary
This research aimed to understand the
contemporary context and realities of
adolescents in Tonga who face unplanned
pregnancy and motherhood. Issues facing
adolescent girls regarding sexual and
reproductive health are implicated in social,
cultural and economic development, and
in human rights imperatives in the region.
Young women in the Pacific navigate
sexual and reproductive decision-making
in increasingly complex social and cultural
contexts, and these realities can only be
adequately understood through investigation
of the lived experiences and perspectives
of the young women and girls themselves.
Inaddition to personal narratives, other
relevant contextual information includes
access to sexual and reproductive
health education and services; access to
contraception; enablers and constraints to
sexual health decision-making and action;
traditional knowledge and practices of
fertility control; and the role of older women
in these matters. Tounderstand the context
and realities in Tonga, face-to-face interviews
were conducted with 15participants
aged 16–19 who had experienced an
unplanned pregnancy; 11 grandmothers
or women aged over 50; and one focus
group discussion with grandmothers or
women aged over 50. Thesample was
non-random and as such it cannot claim,
nor was it intended, to be representative of
all unplanned adolescent pregnancies in
Tonga. All potentially identifying data from
interviews was deleted or altered at the time
of transcription. Pseudonyms have been
used in the results section to protect the
participants’ identities.
Their pregnancy was unexpected for all
of the young participants in this study,
and the first physical symptoms came as
a surprise. Nearly all of the par ticipants
described being frightened and not
knowing what to do when they realised that
they were pregnant. Close friends, aunts,
cousins and grandmothers were the first
people to whom most of the participants
voluntarily disclosed their pregnancy. All
participants said that they were scared to
tell their parents they were pregnant, and
most lied when questioned by their parents
about possible pregnancy. Because they
were scared, most did not confirm their
pregnancy or have any interaction with a
health service until they were around five
months pregnant, and sometimes later.
Knowledge about sexual and reproductive
health and contraception was low among
the young participants. Sources of reliable
information were limited, with many
participants stating that the only things
they knew about sexual and reproductive
health and contraception were what they
had seen on Facebook, on YouTube and in
movies. No participants reported receiving
sex education from parents or senior family
members, nor was there any mention of
sex education or formalised discussion
about sex at school – apart from abstinence
until marriage. Thecoverage of sexual
and reproductive health education through
non-government organisation (NGO)
programs appeared to be patchy and was
compromised by participants’ fears around
confidentiality from the NGO sta if they self-
selected to attend sexual health education
sessions or tried to access contraception.
Condoms were the only contraceptive
method that some of the young participants
were aware of prior to their pregnancy.
While some participants knew that they
could access condoms from certain NGOs,
issues around confidentiality were one of
the biggest barriers to access. Of those
who did mention the use of contraception
(condoms), it was used erratically and
at the sole discretion of their male
partner. Thishighlights the importance
of understanding the way that sexual
relationships are defined among young
people in Tonga and the power relationships
within them. Thefindings from this study
2Adolescent Unplanned Pregnancy in the Pacific : TONGA

show that increased access to condoms,
without also addressing gender equality and
harmful gender dynamics, may have limited
benefit in reducing adolescent unplanned
pregnancy in Tonga. Other methods of
contraception do not preclude condom use
and may give more control to adolescent
girls, including long-acting reversible
contraceptives. Given the older age of many
of the participants’ male sexual partners,
more detailed investigation into the ways that
young people embark on, and establish,
sexual relationships may behelpful.
Decision-making about whether to ‘keep’
the baby or try to abort was often informed
by whatever information the young
participants could find on the internet –
namely, Facebook, Google and YouTube.
Someparticipants also turned to their
close friends and select relatives to discuss
possible abortion, but most often they were
unable to obtain any useful information
from those sources. Mostgirls had heard
that there were ways to abort a pregnancy,
but few were sure of exactly what to do.
Someof the methods to try to abort or
‘drop the baby’ were very dangerous.
One of the most commonly mentioned
methods of abortion was medicines or
pills. However, only one participant could
describe in any detail what these were or
where they could be accessed. Theother
most commonly mentioned method was
drinking ‘blue bleach’. Jumping from high
places, carrying heavy loads, having
sex while pregnant, and drinking strong
tea were perceived methods of abortion
mentioned by several participants. Only
one of our young participants specifically
mentioned ‘traditional’ methods ofabortion.
Some of the young participants had given
their baby for adoption to a family member,
usually a cousin. Theyoung participants’
main motivation for giving their baby for
adoption was to be able to return to school
and complete their studies, but several also
mentioned that it was the best way for their
baby to have a better life.
Most of our young participants described
that the main support they received in being
a mother came from their family. Despite
early anger and disappointment from family
members, most of the young participants
and their babies were still living with their
parents or close relatives. Usually, both the
young mother and the child were being
financially supported by their family. Many of
the young participants spoke about regret for
disobeying their parents and acknowledged
that they had caused a lot of disappointment
by compromising their parents’ schooling
and career aspirations for them. Alot of our
young participants described that when they
gave birth and saw their baby, they had an
overwhelming sense of purpose and love in
their life as a mother. However, this did not
change the aspirations expressed by almost
all the young participants to undertake more
studies and get a job.
The findings from this study indicate the need
for strengthened sexual and reproductive
health education for adolescents in Tonga.
Thiscould be delivered through education
programs in schools, or through community-
based programs such as peer-to-peer and
buddy programs or strengthened early
adolescent girl-focused programs. Sexual
and reproductive health and contraceptive
education for young girls may be more
acceptable if it is delivered to both older
women and girls together, and in a forum
that enables the older women to take some
ownership of the process. Thehosting of
small mother-and-daughter group meetings
or workshops may improve, and begin to
normalise, dialogue between mothers and
their daughters on matters of sex, gender
and relationships. Thefacilitation of such
discussion may also increase the confidence
of both younger and older women to raise or
address these issues in other interpersonal
or family situations and in wider community
fora. Consideration of the use of social
media platforms, such as Facebook
groups, is also recommended to provide
confidential and non-judgemental sexual and
reproductive health education and support.
3Adolescent Unplanned Pregnancy in the Pacific : TONGA

Findings from this study also indicate the
need for improved provision of accessible,
non-judgemental and confidential sexual
and reproductive health services and
commodities for adolescents; a range of
contraceptives available and accessible
to adolescents, including long-acting
reversible contraceptives; more supportive
attitudes by maternity clinic sta towards
young mothers; programs to support
mothers, aunts and grandmothers as
sources of information and suppor t; family
and community projects to challenge
harmful gender dynamics; mentoring for
young mothers and support groups for
young mothers and fathers; support for
young mothers to complete education
and gain employment; and, over the
longer term, repeal of abortion laws
and ratification of the Convention on the
Elimination of all Forms of Discrimination
against Women.
4Adolescent Unplanned Pregnancy in the Pacific : TONGA

1 Aims and objectives
This report presents findings from data
collected in Tonga as part of research
into adolescent unplanned pregnancy in
three Pacific Island States: Tonga, Vanuatu
and Chuuk State. Rates of unplanned
adolescent pregnancy are high in many
Pacific Islands countries. Issues facing
adolescent girls with regard to sexual and
reproductive health are implicated in social,
cultural and economic development, and
in human rights imperatives in the region.
Young women in the Pacific navigate
sexual and reproductive decision-making
in increasingly complex social and cultural
contexts. Thosecontexts do not generally
enable young women to speak openly
about such matters. Inacknowledgement of
this situation, the Pacific Women Advisory
Group on Research identified the need
for research in order to better understand
the experiences of unplanned pregnancy
among young women in the Pacific.
Researchers and stakeholders with an
understanding of adolescent pregnancy in
the Pacific gathered in Suva in July 2018 to
confirm the need and discuss the brief for
the research. Their insights inform the focus
and methodology of this study. Theresearch
was funded by the Australian government’s
Gender Equality Fund through the Pacific
Women Shaping Pacific Development
(Pacific Women) program. Aresearch team
from the University of New South Wales was
contracted to undertake the study.
Data collection at the three sites aimed to
shed light on the contemporary context and
realities of adolescents in Tonga, Vanuatu
and Chuuk State who face unplanned
pregnancy and motherhood. Anaccount
of the lived experiences and perspectives
of the young women and girls themselves
is necessary to gain an adequate grasp
of those realities. Inaddition to personal,
family and relationship stories, the study
enquired into access to sexual and
reproductive health services; enablers and
constraints to decision-making and action;
traditional knowledge and practices of
fertility control; and the role of older women
in these matters.
The research employed in-depth
ethnographic interviews with girls and
young women, aged 16–19 years, who have
experienced unintended pregnancy and
motherhood. Thestudy also investigated
traditional and contemporary knowledge
around fertility limitation practices, including
from the viewpoints of older women,
using face-to-face interview methods and
focus groups with older women. Data
collection was undertaken at three sites
in Tonga, at three sites in Vanuatu, and on
Weno in Chuuk, including in isolated and
mountainous areas.
The findings have direct programmatic
implications for the development of culturally
informed and age-appropriate sexual and
reproductive health, social support and
educational services for adolescent mothers
and young girls. Theneed for such services
is indicated by high teenage fertility rates
(see Table 1, p. 7). Thefindings also oer
insights into the significance of wider health
and social policy and programming for this
group and contribute to a regional evidence
base. Through its methodology, the study
centralises the experiences of, and gives
voice to, the young women themselves, the
wellbeing of whom has human rights and
gender equity implications in the Pacific.
The objectives of the research were:
• to understand the issues associated with
unplanned adolescent pregnancy from
the point of view of young women in
Tonga, Vanuatu and Chuuk State
• to understand the social and structural
factors impacting young women who
experience adolescent pregnancy and
motherhood in Tonga, Vanuatu and
Chuuk State
• to better understand the use of
traditional and other practices of fertility
limitation, especially abortion, in Tonga,
Vanuatu and Chuuk State, and the
impact on the experience of adolescent
pregnancy and motherhood
• to give voice to adolescent girls in
thePacific.
5Adolescent Unplanned Pregnancy in the Pacific : TONGA

2 Literature review
2.1 Adolescent unplanned
pregnancy
Adolescents bear a disproportionate burden
of poor sexual and reproductive health
outcomes in lower- and middle-income
countries (Patton et al., 2016). The2030
Agenda for Sustainable Development
includes 17 Sustainable Development Goals.
Goal 3 on health and wellbeing aims to
‘ensure healthy lives and promote wellbeing
for all at all ages’. Thetarget indicator for
goal 3.7 on sexual reproductive health is a
reduction of adolescent birth rates. Inthe
Pacific, the Moana Declaration of 2013,
as endorsed by Pacific parliamentarians,
focuses on sexual and reproductive health
and acknowledges the need to prevent
unplanned pregnancies and prioritise
sexual and reproductive health services for
adolescents (UNFPA, 2013b).
The adolescent fertility rate among women
aged 15–19 years is far lower in developed
Pacific rim countries such as Australia, with
an estimated 10 births per 1,000 women
aged 15–19 years in 2017 (ABS, 2018), and
New Zealand, with an estimated 15 births
per 1,000 women aged 15–19 years in 2017
(Statistics New Zealand, 2019), compared
to the data provided in Table 1. As indicated
in Table1, Vanuatu has the third-highest
adolescent fertility rate in the region.
Notably, the Federated States of Micronesia
(FSM) has the second-highest maternal
mortality rate after Papua New Guinea.
Adolescent pregnancy and motherhood
can have long-term negative impacts
on the health and social and economic
wellbeing of mother and child (Patton et
al., 2016; Sawyer et al., 2012; UNFPA,
2013b; UNFPA, 2013c). Adolescence is a
time of critical development, as physiology,
cognition, psychology and social
functioning develop rapidly. Unmet need for
contraception, lack of information and lack
of bodily autonomy can lead to unplanned
adolescent pregnancy (UNFPA, 2013a).
Young women tend to bear the burden of
adolescent pregnancy and motherhood,
which can have a long-term negative impact
on their health and social and economic
wellbeing (Patton et al., 2016; Sawyer et
al., 2012; UNFPA, 2013a). Depression,
unsafe abortion, and pregnancy and labour
complications are serious health risks due
to adolescent pregnancy (UNFPA, 2013a),
which is associated with increased risk
of low birth weight, pre-term births and
stillbirths (UNFPA, 2013b).
The impact of adolescent pregnancy
extends beyond that on the individual mother
(Sawyer et al., 2012). Inlow- and middle-
income countries, ‘health inequities related
to social and cultural norms, gender power
imbalance, education and socio-economic
deprivation aect young and unmarried
women in particular’ (Bell et al., 2018, p. 5).
Any stigma and marginalisation associated
with teen motherhood will exacerbate those
impacts. Teenage pregnancy often leads
girls and young women to drop out of
school. It limits income-earning potential
for the mothers and can also limit their
opportunities and choices (UNFPA, 2013a;
Viner et al., 2012). Inthe Pacific, adolescent
fertility and related outcomes have wider
implications for development, as well as
gender equity and human rights imperatives
(Kennedy et al., 2013b; UNFPA, 2013a).
Adolescents are a neglected group in health
and social programming (Bearinger, Sieving,
Ferguson, & Sharma, 2007), and knowledge
on how best to promote adolescent sexual
and reproductive health is patchy (Bell et
al., 2018; O’Connor, 2018). Much of the
critical literature on teenage pregnancy
derives from a Western context and focuses
on clinical services to reduce adolescent
fertility. However, it has been argued that the
health and wellbeing of adolescent mothers
in the Pacific would be better served by
attention to cultural and social features of
the society than by a focus on contraceptive
technologies (McPherson, 2016).
6Adolescent Unplanned Pregnancy in the Pacific : TONGA

Table 1: Reproductive health indicators for Pacific Island countries1
Adolescent
fertility rate
(births per 1,000
women
15–19 years)
Total fertility rate
(births per 1,000
women
15–49 years)
Unmet family
planning rate
(percentage of
women
15–49 years)
Contraceptive
prevalence rate
(percentage of
women
15–49years)
Maternal
mortality ratio
(per 100,000
women
15–44years)
Cooks 67.7
(2009–13)*
2.7
(2009–13)* –48
(2001–05)*
0
(2008–12)*
FSM 44
(2010)*
3.5
(2010)*
44
(2002)*
40
(2009)*
140.6
(2016)2
Fiji323.1
(2015–17)
2.9
(2015–17)
20
(2000)*
38.4
(2013)*
14
(2015–17)
Kiribati 49
(2010)*
3.9
(2010)*
28
(2009)*
22.3
(2009)*
90
(2015)4
RMI 85
(2011)*
3.4
(2011)*
2.4
(2009)*
16
(2010)*
105
(2007–11)*
Nauru 94.3
(2011–13)*
3.9
(2011–13)*
23.5
(2007)*
25.1
(2007)*
0
(2011–13)*
Niue519.9
(2007–11)*
2.7
(1987–2016) –22.6
(2001)*
0
(1996–2016)
Palau 27
(2015)*
2.2
(2015)* –22.3
(2010)*
0
(2010)*
PNG668
(2016–18)
4.2
(2016–18)
25.9
(2016–18)
36.7
(2016–18)
215
(2015)7
Samoa856
(2010–14)
5.1
(2010–14)
34.8
(2010–14)
15.3
(2010–14)
51
(2015)9
Solomon
Islands
77
(2015)*
4.4
(2015)*
34.7
(2015)*
29.3
(2015)*
114
(2015)10
Tokelau 29.8
(2006–11)*
2.1
(2015)* –––
Tonga 31.9
(2016)*
4.1
(2009–12)*
25.2
(2012)*
28.4
(2012)*
124
(2015)11
Tuvalu 28
(2012)*
3
(2012–16)*
24.2
(2007)*
31
(2007)
0
(2010)*
Vanuatu 81
(2013)*
4.2
(2013)*
24.2
(2013)*
47
(2013)*
78
(2015)12
1 Up-to-date data is not available for all countries. Statistics marked with an * have been sourced from SPC, National Minimum
Development Indicators. Retrieved from http://www.spc.int/nmdi/maternal_health. Other sources are footnoted.
2 Source: Government of Federated States of Micronesia (FSM). (2017).Title V 2018 MCH Block Grant Application and 2016
Annual Report. Palikir, Pohnpei: Department of Health and Social Aairs, FSM National Government. Retrieved from
https://mchb.tvisdata.hrsa.gov/uploadedfiles/StateSubmittedFiles/2018/FM/FM_TitleV_PrintVersion.pdf.
3 Unless marked with an *, the source of the Fiji statistics is Fiji Bureau of Statistics (FBoS), Registrar General’s Oce
(Ministry of Justice, CRO) & Ministry of Health & Medical Ser vices (MoHMS). (2019). Republic of Fiji Vital Statistics Report
2012–2017. Retrieved from https://www.statsfiji.gov.fj/index.php/statistics/social-statistics/vital-statistics-report.
4 Retrieved from https://pacificdata.org/dashboard/sdg-3-good-health-and-well-being.
5 Unless marked with an *, the source of the Niue statistics is Statistics and Immigration Oce Ministry of Finance and Planning
Government of Niue. (2018). Niue Vital Statistics Report 2012–2016. Retrieved from http://beta.sdd.spc.int/media/212.
6 Unless otherwise indicated, the source for the Papua New Guinea statistics is National Statistical Oce (NSO) [Papua
New Guinea] and ICF. (2019). Papua New Guinea Demographic and Health Survey 2016–18: Key Indicators Report. Port
Moresby, PNG, and Rockville, Maryland, USA: NSO and ICF.
7 Retrieved from https://pacificdata.org/dashboard/sdg-3-good-health-and-well-being.
8 Unless marked with an *, the source of the Samoa statistics is Samoa Bureau of Statistics & Ministry of Health. (2015).
Samoa Demographic and Health Survey 2014. Retrieved from https://www.sbs.gov.ws/digi/Samoa%20DHS%202014.pdf.
9 Retrieved from https://pacificdata.org/dashboard/sdg-3-good-health-and-well-being.
10 Retrieved from https://pacificdata.org/dashboard/sdg-3-good-health-and-well-being.
11 Retrieved from https://pacificdata.org/dashboard/sdg-3-good-health-and-well-being.
12 Retrieved from https://pacificdata.org/dashboard/sdg-3-good-health-and-well-being.
7Adolescent Unplanned Pregnancy in the Pacific : TONGA

2.2 Adolescent sexual and
reproductive health in the
Pacific
There is some data on various aspects of
sexual and reproductive health in some
Pacific Island countries, but the amount that
focuses on young people is limited. Within
the literature on sexual and reproductive
health and adolescent pregnancy, cultural
taboos surrounding sexuality and the shame
associated with the discussion of sex is a
common theme. These taboos discourage
communication about sex in families,
schools and churches. Consequently,
adolescents tend to have limited knowledge
about sex and sexuality and limited access
to sexual and reproductive health services
(Jenkins &Buchanan-Aruwafu, 2006;
O’Connor, 2018). Theimpact of such taboos
is also highly gendered.
In the Solomon Islands, taboos about
the discussion of sex are strong and act
as a barrier to discussing sex in certain
contexts. These taboos also serve as
a barrier in the provision of sexual and
reproductive health services (Buchanan-
Aruwafu, Maebiru, &Aruwafu, 2003;
Raman, Nicholls, Pitakaka, Gapirongo,
&Hou, 2015). Buchanan-Aruwafu, Maebiru
and Aruwafu (2003) highlighted how
discussion of sexuality is regulated through
gendered social norms, with shame and
gossip playing a key role. Yet, young
Solomon Islanders in Auki have developed
indirect ways of speaking about sex and
sexuality by using slang and metaphors.
Similarly, in Papua New Guinea, the
shame surrounding pregnancy outside
of marriage, and gossip that focuses on
the young mothers rather than the fathers,
directs the blame for unplanned pregnancy
on young women (Kelly et al., 2010).
Research on unmet need for contraception
and knowledge and attitudes towards
contraception and sexual education has
been conducted in Fiji; however, few of these
studies focus on adolescents (seeLincoln,
Mohammadnezhad, &Rokoduru, 2017;
Naidu, Heller, Koroi, Deakin, &Gayaneshwar,
2017; Naz, 2014; Varani-Norton, 2014).
One study that focused on the outcomes
of adolescent pregnancy in Suva, Fiji,
found that teenage pregnancy, as in other
countries, tends to be high risk and that
health interventions should be tailored for
young women to reduce adverse health
outcomes, including perinatal death (Mahe,
Khan, Mohammadnezhad, Salusalu,
&Rokoduru, 2018).
Recent Fijian data highlighted the role
of emotions in adolescent sexual and
reproductive decision-making, calling for
greater attention to the subjective views and
understandings of adolescents themselves
and to the socio-cultural and structural
environments that shape them (O’Connor,
Rawstorne, Devi, Iniakwala, &Razee,
2018). It was found that adolescents
place emphasis on confidence, resilience
and access to services, yet adolescent
iTaukei women’s priorities diverged from
this norm in that their priorities focused on
preventing shame and preserving their
sexual reputation (O’Connor, 2018). At the
same time, adolescent women desired
agency and freedom in relation to sexual
and reproductive wellbeing (O’Connor et
al., 2018).
Because they do not require a doctor’s
prescription, condoms are often the easiest
contraceptive for young people to first
access. Inwriting about factors related to
condom use among young people in Tonga
and Vanuatu, McMillan and Worth (2011)
pointed to a mismatch between condom
knowledge and condom use practice and
in doing so stressed the role that wider
socio-cultural factors – rather than simply
knowledge – have on condom use. They
noted the way in which the importance of
shame regulated behaviour and limited not
only access to condoms but also their use:
condom use was associated with casual
sex and promiscuity and most young
Tongan women interviewed expressed
resistance to condom use in order to
uphold a respectable feminine identity
(McMillan &Worth, 2011).
8Adolescent Unplanned Pregnancy in the Pacific : TONGA

Research among adolescents in Vanuatu
also suggests that socio-cultural norms
and taboos are the most significant barrier
to youth accessing sexual and reproductive
health services (Family Planning New
Zealand, 2019; Kennedy et al., 2014).
Information for adolescents has tended to
focus on sexually transmissible infections
(STI) and HIV, while young people have
indicated a preference for more information
about pregnancy, condom use, puberty,
sexuality and relationships (Kennedy et al.,
2014). Similarly, research among young
Cook Islanders found that they had little
knowledge of pregnancy and prevention
of STI and that they want knowledge and
communication skills, particularly about
contraception and teenage pregnancy, to
enhance their understanding and decision-
making related to sexuality (Futter-Puati,
2017). Thefindings have been utilised to
develop a needs-led Cook Islands sexuality
and relationships education resource (see
Futter-Puati, 2017).
A study focused on experiences of
teenage pregnancy in the Cook Islands
found that participants reacted to learning
they were pregnant with denial and fear.
Abortion emerged as a key theme, with all
participants having considered abortion
but none able to obtain one (White, Mann,
&Larkan, 2017). Thisstudy found that the
cultural importance of motherhood meant
that these young women also had positive
feelings about motherhood (White, Mann,
&Larkan, 2018). Inthe Pacific, children are
valued for their contribution to the family
as a source of labour and social support.
Thefamily structure includes children who
have been informally adopted and accepted
as part of the family, often but not always
adopted from the extended family (Farran
&Corrin, 2019). Farran and Corrin (2019)
noted that high rates of teenage pregnancy
mean that there are also high rates of
informal interfamily adoption, but incomplete
data makes it dicult to assess the scale of
adoption of babies of teenage mothers.
Knowledge about the social and structural
elements that frame adolescent decision-
making around sex and reproduction in
other Pacific Island societies is currently
limited. Mostdata on adolescent
pregnancy in the Pacific is quantitative,
providing little purchase on factors
impacting high rates, or experiences and
range of consequences, of adolescent
pregnancy.1 Furthermore, while traditional
healers are an acknowledged part of
the informal health system in the Pacific
(Kennedy et al., 2013a), there is no data
on traditional methods of fertility limitation,
nor on the role of traditional knowledge in
fertility decisions (Kennedy et al., 2013a;
Kennedy et al., 2014).
2.3 Abortion in the Pacific
Globally, it is estimated that, among
15–19-year-old women, 3.2 million unsafe
abortions take place in developing
countries each year (Shah &Ahman, 2012).
Thestigma surrounding abortion, laws
that make abortion illegal, a lack of youth-
friendly services, and the constrained
agency of young women act as barriers
to adolescent women and girls accessing
safe abortion services (IPPF, 2014).
Little is known about women’s experiences
of fertility limitation in the Pacific. Jolly
(2002) noted that some women in the
Pacific still use indigenous methods of
herbal medicines, massage and other
means, as well as biomedical preparations,
to induce abortion and that little research
has been done on abortion practices in
the contemporary Pacific. Research on
abortion in the Pacific context is needed
to better understand practices and links
to maternal mortality (FPI &SPC, 2009).
As noted by Chetty and Faleatua (2015),
access to information about sexual and
reproductive health, as well as contraceptive
1 Bell et al. (2018) describe plans to undertake
qualitative research focused on the social context and
the lived experiences of pregnancy for young women
and young men to inform the development of youth-
specific health promotion responses to pregnancy in
Papua New Guinea.
9Adolescent Unplanned Pregnancy in the Pacific : TONGA

commodities, is dicult and access to
safe abortion is simply not an option for
adolescents in the Pacific. TheInternational
Planned Parenthood Federation has
put forth a set of promising practices to
strengthen abortion service provision to
young women that includes integration
with other youth programs; increasing sta
commitment; focusing on confidentiality
and autonomy; utilising a harm reduction
model; understanding consent laws; peer
promotion; applying a buddy system;
advocacy by example; and social media
and mobile outreach (IPPF, 2014).
There is limited documentation of
unplanned pregnancy and abortion in
Papua New Guinea (seeSanga, Costa,
&Mola, 2010; Vallely et al., 2014). With
an estimated 733 maternal deaths per
100,000 live births, Papua New Guinea
has an extremely high rate of maternal
mortality (NSO-PNG, 2009). Astudy that
examined 21 maternal deaths at Goroka
General Hospital between 2005 and 2008
found that 10 deaths (48%) were due to
sepsis after birth or following induced
abortion. Of the three deaths of women
under the age of 19 years, all were due
to complications from unsafe induced
abortions (Sanga et al., 2010). Thestudy
documented the case of a 17-year-old girl
who was single, sexually active and facing
an unplanned pregnancy. She had never
sought contraception, as she thought that
it was only available to married women.
Thegirl obtained herbs traditionally used to
induce abortion because she felt that her
relatives would not accept her pregnancy
and because she wanted to continue
her education. She died of sepsis three
weeks after she attempted to induce an
abortion (Sanga et al., 2010). Similarly,
another study in Papua New Guinea found
that women who induced abortion were
significantly more likely to be younger,
single and studying, with a pregnancy that
was unplanned and unwanted, compared
to women who had a spontaneous abortion
(Vallely et al., 2014). Thestudy reported
women inducing abortion by misoprostol
(50%), physical means (22%), traditional
herbs (11%), cultural beliefs/sorcery (7%)
and other means (9%) (Vallely et al., 2014).
A 2015 study conducted by the Vanuatu
Family Health Association focused on
induced abortion inVanuatu, examining
attitudes and practices of communities and
key informants (health providers, herbalists,
chiefs and legal representatives). Thestudy
respondents cited consumption of lemon
fruit, kastom medicine, vigorous exercise,
inserting objects into the uterus and taking
contraceptive pills as being methods to
induce abortion (Tao, Ssenabulya, &Van
Dora, 2015). Respondents from urban
areas suggested that the reasons why a
woman might have an abortion included
fear of parents or others finding out (14%);
insucient resources (10%); continuing
career/school (7%); incest (5%); rape
(4%); too many children (2%); and other
reasons (7%) (Tao, Ssenabulya, &Van Dora,
2015). Astudy on recent family planning
in rural Vanuatu found that when abortion
arose during discussions on unplanned
pregnancy, the dominant perception was
that it was morally wrong. In-depth interviews
were conducted with 12 women, with one
woman noting that she had terminated her
own pregnancy and another describing
her unsuccessful attempt to access an
abortion (Family Planning New Zealand,
2019). While discussing the scenario of
unintended pregnancy among Fijian youth,
some participants said they would keep the
pregnancy asecret and they would consider
seeking an abortion, despite accessibility to
safe abortion being limited (O’Connor, 2018).
Context-specific strategies are necessary
to create an enabling environment for
adolescent sexual and reproductive health
and the wellbeing of adolescent mothers in
the Pacific (Kennedy et al., 2013a). These
strategies must be informed by the lived
experiences of young women. Yet research
on the topic seldom includes the voices of
adolescent mothers themselves (Barcelos
&Gubrium, 2014; Mann, Cardona, &
Gómez, 2015).
10 Adolescent Unplanned Pregnancy in the Pacific : TONGA

3 Methodology
3.1 Research design
This research addresses methodological
and empirical gaps in knowledge about
unplanned adolescent pregnancy in Tonga,
Vanuatu and Chuuk State. Thefindings
are intended to inform the development
of targeted health and social policy and
programming; raise the profile of young
women’s voices; and, consequently, help
further human rights and gender equity in
the Pacific.
The study was designed to produce
ethnographic data on issues associated
with adolescent unplanned pregnancy
and motherhood in Tonga, Vanuatu and
Chuuk State. Ethnographic methods
produce detailed or ‘thick’ (Geertz, 1973)
description and prioritise the subjective
realities of the research participants
(Glaser &Strauss, 1967), characteristics
that are important when we seek a
nuanced understanding of factors aecting
decision-making and underpinning
behaviours, and the meanings of actions
and events in the lives of participants.
Ethnographic methods are increasingly
used in development research (see van
Donge, 2006) and in public health and
service user research (Stahler &Cohen,
2000; Ratner, 1993).
Qualitative in-depth face-to-face interviews
were conducted with young women
(16–19 years old) who had experienced
unintended pregnancy in Tonga, Vanuatu
and Chuuk State. Thecollection of
personal story data enabled the mapping
of issues related to adolescent unplanned
pregnancy and motherhood, as they
have played out in the lives of 63 young
Pacific women. Inacknowledgement of
the ongoing cultural importance and use
of traditional medicines in many Pacific
countries, the study includes enquiries
into traditional as well as contemporary
means of fertility control and the role
and viewpoints of older women in those
three countries. Focus group discussions
are highly eective means of revealing
accepted group norms. Because of this,
focus group discussions collect a dierent
type of information than can be garnered
from private interviews, and the opinions
and views expressed in these discussions
may even be at odds with the personal
beliefs and experiences of the individuals
who are part of that group.
3.2 Ethical approvals
Prior to the commencement of fieldwork,
applications were submitted and approvals
were obtained from the UNSW Human
Subjects Ethics Committee, UNSW
Australia, the FSM Department of Health
and Social Aairs Institutional Review
Board, the Tongan Government and the
Ethics Committee of the Ministry of Public
Health Vanuatu.
3.3 Data collection and analysis
The study aimed to produce nuanced
accounts of a range of factors impacting
on the experiences of unplanned
adolescent pregnancy and motherhood,
and to explore the key thematic areas.
Data was collected through 20–25 face-
to-face interviews in each country with
participants 16–19 years old who had had
an unintended pregnancy. Participants
were recruited through convenience and
snowball sampling. Interviews followed the
General Interview Guide method and were
conversational in style. Interviewers first
asked the young participants to tell their
own story. Further open-ended questions
enquired into how the participant
managed unintended pregnancy and
motherhood; the consequences of the
pregnancy; access to information on
fertility control; access to and use of both
traditional and contemporary knowledge
around fertility control; and enablers and
barriers to decision-making and action.
11Adolescent Unplanned Pregnancy in the Pacific : TONGA

Interviewswere voluntary and all
participants were provided with verbal
and written information about the study
and gave verbal and written consent
to be interviewed. Interviews generally
took approximately 30 minutes and most
interviews were recorded. Themajority
of interviews were conducted in the
participants’ first language by local
research assistants who had been
trained for this project. Asmaller number
were conducted in English by a chief
investigator. Thetraining of research
assistants focused on the aims of the
data collection; principles and practice
of qualitative data collection; ethical
considerations when collecting data on
sensitive subjects; and child protection
during research. Allresearch assistants,
interviewers and translators engaged on
this study signed a strict confidentiality
agreement prior to beginning any work on
the project.
A total of 94 face-to-face interviews and five
focus group discussions were conducted
in Tonga, Vanuatu and Chuuk State during
June and July 2019. These included:
• 63 face-to-face interviews with
16–19-year-old young women who had
experienced unplanned pregnancy
• 31 interviews with women who were over
50 years of age or grandmothers
• five focus group discussions with
women who were over 50 years of age
or grandmothers.
Interviewers debriefed with a chief
investigator following each interview.
In each country, local Pacific women
interviewers were trained and employed.
Thedata collection documents and
instruments, as well as the interview
contents, were discussed constantly with
those interviewers. Pacific early career
(academic) researchers were involved in
the analysis of data.
3.4 The study in Tonga
Tonga has a population of 100,651 spread
across four main island groups, with the
majority (74%) residing on Tongatapu (Tonga
Statistics Department, 2017). Thefour
main island groups are Tongatapu, Vava’u,
Hapa’ai and the Niuas. Tonga has a young
population, with 56percent under the age
of 24 (UNFPA, 2015). Theadolescent fertility
rate was estimated to be 32 per 1,000
women age 15–19 years in 2016. Tonga is
the only Pacific Island country that has not
ratified the Convention on the Elimination of
all Forms of Discrimination against Women.2
Abortion is illegal in Tonga, but there is a
limited number of cases reported of women
presenting to health centres for post-
abortion care (UNFPA, 2015). ANational
Study on Domestic Violence against
Women in Tonga conducted in 2009 found
that 33percent of ever-partnered women
reported experiencing violence in their
lifetime and 13percent had experienced it
during the last 12 months (Ma’a Fafine mo e
Famili, 2012).
Data collection for the Tonga study took
place during July 2019. Four local research
assistants received intensive training and
were engaged to work on the data collection.
Integral logistical support for recruitment
and data collection was provided by the
Talitha Project and the Tonga Family Health
Association. Both organisations facilitated
contact with young women aged 16–19
years who had experienced an unplanned
pregnancy and with older women who
were grandmothers or aged 50years and
above. Participants were known to these
organisations because they were planning
to access, or had accessed, the services
they oer. TheTalitha Project is an NGO
committed to empowering young women
aged 10–24 years to make informed
decisions through informal education, life
skills and development programs. TheTonga
Family Health Association supplies family
planning, maternal and child health support,
and fertility and counselling assistance.
2 Palau has signed but not ratified the Convention.
12 Adolescent Unplanned Pregnancy in the Pacific : TONGA

Participant recruitment for the study in Tonga
was approximately 30percent through
the Talitha Project, 30percent through
the Tonga Family Health Association, and
40percent through participants’ ‘friends of
friends’ who had not had any contact with
either of those organisations.
Data was collected from three sites in
Tonga: Tongatapu, Vava’u and Ha’apai.
Intotal, 26 face-to-face interviews and one
focus group discussion were conducted
in Tonga. All data collection documents,
including the Participant Information
Sheets and Consent Forms, were
translated from English to Tongan. There
were six interviews conducted in English
and 18 in Tongan. Intwo interviews,
the participant requested to under take
the interview in English but changed
to Tongan during the interview. Signed
consent was gained for all interviews;
oral consent was also recorded. All of
the participants agreed to have their
interview recorded. InTongatapu, six
face-to-face interviews were conducted
with 16–19-year-olds and two face-
to-face interviews were conducted
with grandmothers or women over 50.
InVava’u, six face-to-face interviews were
conducted with 16–19-year-olds and seven
face-to-face interviews were conducted
with grandmothers or women over 50.
InHa’apai, three face-to-face interviews
were conducted with 16–19-year-olds, two
face-to-face interviews were conducted
with grandmothers or women over 50,
and one focus group was held with four
older women. Only one focus group was
conducted in Tonga, as the older women
recruited to the study overwhelmingly
expressed a preference to conduct their
interviews privately with the interviewer.
All interviews conducted in Tongan
were translated into English by a native
Tongan speaker fluent in English. Those
translations were then checked against
the original audio files and verified by a
second translator. All potentially identifying
data was deleted or altered at the time
of transcription. Inthe results section,
pseudonyms have been used to protect
the participants’ identities. Translated
and transcribed files were coded by at
least two dierent researchers and code
categories were generated independently.
Code identification was attentive to the
dominant themes that emerged from the
interviews, as well as topics laid out in
the Terms of Reference for the project.
Initial data sets were compared for each
category, final codes were confirmed, and
coding trees were created. As the interview
numbers were relatively small, all coding
was done manually. Thismanual method
has the advantage of facilitating a high
level of familiarity with the transcripts and
allowing the consideration of the interviews
as individual cases as well as in data
fragments. Thetopic headings that appear
in the report reflect the data-derived codes
for the study in Tonga.
13Adolescent Unplanned Pregnancy in the Pacific : TONGA

4 Results and discussion
4.1 Experiences of unintended
pregnancy and motherhood
This study is grounded in young
women’s experiences of pregnancy and
motherhood. While the results presented
here highlight experiences that were
common among the participants in our
study sample, we also present and discuss
divergent experiences.
In the following section, data on key topic
areas is described and summarised.
Particular attention is paid to the range of
experiences and views expressed, as well
as to commonalities. There is a heavy focus
on the use of direct quotations in order to
give strong voice to the participants. All
names have been changed and the names
assigned to the quotations are not the
participants’ real names.
This study sample is non-random and as
such it cannot claim, nor was it intended,
to be representative of all unplanned
adolescent pregnancies in Tonga.
Throughout the reporting of results,
words such as ‘a few,’ ‘some’ and ‘many’
are used instead of exact numbers.
Theresultant imprecision is deliberate
and intended to prevent misinterpretation
or misrepresentation of the data.
Documentation of exact numbers or
percentages of participants who reported
the same experience, circumstance,
practice or belief could otherwise be
taken to suggest, erroneously, that such
percentages are generalisable to the
wider population.
4.1.1 Reactions to unintended
pregnancy
Their pregnancy was unexpected for all the
young participants in this study, and the
first physical symptoms came as a surprise.
Nearly all our participants described being
frightened and not knowing what to do when
they realised that they were pregnant. Close
friends, aunts, cousins and grandmothers
were the first people to whom most of the
study participants voluntarily disclosed their
pregnancy. All of our young participants said
that they were scared to tell their parents
they were pregnant, and most lied when
questioned by their parents about possible
pregnancy. Because the girls were scared,
most did not confirm their pregnancy or
have any interaction with a health service
until they were four or five months pregnant,
sometimes even later. Reactions to
unintended pregnancy are described in the
accounts of these young women.
Early in Angela’s pregnancy, her closest
friend noticed her vomiting at school.
They both assumed that Angela must be
pregnant but did not tell anyone else. Later
in the pregnancy, Angela’s mother noticed
that something was dierent. She was the
person who arranged for Angela to see a
health service:
My mother noticed there was something
dierent [faikehe] and asked if anything
had happened. But I lied to her and
said no. My mum didn’t believe me
because she saw Iwas dierent, so she
spoke to her cousin at the hospital and
arranged for me to be seen, and we
found I was five months pregnant.
(Angela, pregnant at 16, Tongatapu)3
3 Pseudonyms have been used to protect the
participants’ identities.
14 Adolescent Unplanned Pregnancy in the Pacific : TONGA

Brooke suspected that she was pregnant
when she started to experience symptoms,
but she did not tell anyone. When questioned
by her mother, she lied:
… I didn’t know that I was pregnant.
Ikind of have a feeling that I was
because the food and my lunch, I used
to eat them and it’s not like before. Isee
there’s changes and dierence. When
I have my lunch with my friends they
would eat, and I don’t like that food
anymore. Ikept touching my stomach
and I wonder if I’m pregnant when I
have this feeling like morning sickness
and those things … my mum told me,
‘You never told me you needed some
pads. You haven’t got your period or
anything?’ Then I said umm no, no.
It’sjust something. I’m not pregnant.
(Brooke, pregnant at 18, Tongatapu)
Heather mistook her pregnancy symptoms
for an illness that she had previously
experienced and did not use a pregnancy
test until she was six months pregnant:
While I was working, I started to feel
weird craving and stu. But I actually
had a sickness like that before, but
that time I haven’t had sex yet, so I
thought it was the same sickness that
I had. When I was six months, I got
the pregnancy test. That was the time
Ifound out I was pregnant. And my
belly was not growing and stu, so I
didn’t really know I was pregnant until I
had my pregnancy test at six months.
(Heather, pregnant at 18, Vava’u)
Cara suspected that she was pregnant
when she started to have symptoms, but
told only her cousin. She hid the pregnancy
from her grandparents and older sister, with
whom she was living, until she was seven
months pregnant. At that time, she had her
first interaction with a health service:
I knew it myself, when I missed my
period, sleeping a lot, vomiting, not
feeling well and losing appetite. That’s
how I knew I was pregnant … I didn’t
go to the hospital because Iwas
scared my grandparents and big sister
would know. And I didn’t tell them that
something had happened to me … I just
told them when I’m almost due because
I hid it… Wearing loose clothes. Plus,
my stomach was not really big.
(Cara, pregnant at 17, Tongatapu)
Debra’s parents noticed that something
was dierent. But, even after being told
by doctors at the hospital that she was
pregnant, Debra lied to her parents and
said that she wasn’t:
… it gets to a time my skirt didn’t fit
anymore over my belly and my mother
asked if something is wrong and I told
her no … my mother asked me if I
already have my period and I said no
because she is the one who does the
washing. Then she told me we should
go with my father to the hospital and
have a check-up, and the doctor told me
to come in alone for my examination, so
my father waited outside. Ifound out I’m
pregnant and came to my father and
told him something else. Ilied to him
because I was scared.
(Debra, pregnant at 17, Tongatapu)
15Adolescent Unplanned Pregnancy in the Pacific : TONGA

Fran’s aunty helped her get a pregnancy
test and confirm her pregnancy after Fran
noticed her tummy growing. Fran did not
want to tell her parents:
Probably around October I started not
having my period, but I didn’t even
think I was pregnant. Ithought it was
just nothing. Istarted vomiting. Istarted
having those pregnant symptoms and
then maybe around January my tummy
started to grow and then I went to get a
pregnancy test and, yes, it was positive.
That’s the time I knew I was pregnant.
(Fran, pregnant at 17, Tongatapu)
Georgia’s grandmother took her to the
hospital for a pregnancy test. Georgia
recounts her feeling when the doctor
confirmed that she was pregnant and
asked to speak with her parents:
I was crying that day. ’Cause it’s all my
fault, I didn’t tell it to my parents. And the
first moment that the doctor told me that
he wants to talk with my parents. That’s
the first time I can’t hold my tears, when
I heard that the doctor is going to be
telling my parents that I’m pregnant.
(Georgia, pregnant at 18, Vava’u)
Heather’s best friends and cousins knew
about her pregnancy and encouraged her
to tell her parents:
My best friends and my cousins.
Theyknew about it, like how I felt. Ihad
a cousin who’s a single mum, so I
asked her for help. All she told me is to
tell my parents. They’re the only ones
that could help me. It was really hard.
(Heather, pregnant at 18, Vava’u)
Ingrid described her feelings about finding
out that she was pregnant:
… when I started sleeping with him.
When I did this, I started having regrets,
I felt like Ilost something, and I would
sit and think if only I’d listened to
my parents none of this would have
happened. When I got pregnant, I didn’t
blame my mother, I blamed myself, it’s
my fault.
(Ingrid, pregnant at 18, Vava’u)
Mary’s biggest concern when she found
out that she was pregnant was how she
would support herself and her baby:
I just felt scared … I was scared of
what I would do with the baby because
I’m still young, I don’t have a job, what
will I look after the baby with and what
my parents would think, like if they
would chase me from home.
(Mary, pregnant at 18, Ha’apai)
16 Adolescent Unplanned Pregnancy in the Pacific : TONGA

4.1.2 Knowledge underpinning
decision-making
Knowledge about contraception and sexual
and reproductive health was low among
this group of young women. Themajority
of interviewees stated that they knew
they could become pregnant from having
unprotected sex, but for some reason did
not think they would become pregnant
when they were having unprotected sex
with the father of their baby. Sources of
reliable information about sexual and
reproductive health and contraception
were limited, with many participants
stating that the only things they knew about
these topics were what they had seen on
Facebook, on YouTube and in movies.
Some of the young participants were
aware of contraception and where they
may be able to access it, but said that
issues around confidentiality were the
biggest barriers. Cara stated that she did
not access contraception because she was
scared of the nurses:
I didn’t think of using that [condoms]
because I was scared in case I might
go to the hospital and ask for it and the
nurses will ask me why I’m asking for it.
(Cara, pregnant at 17, Tongatapu)
Heather did not want to access condoms
from Tonga Family Health, as her cousin
worked there:
It’s hard, because I know this is the only
place where we could get them for free.
But since she is my cousin, I couldn’t …
She might tell my mum.
(Heather, pregnant at 18, Vava’u)
Of the young participants who did
mention the use of contraception (almost
exclusively condoms), it was used
erratically at the sole discretion of their
male partner. Theyoung participants did
not mention having any role in negotiating
the use of contraception:
I never knew anything. It was him
who usually got those condoms and
I don’t know where he bought it from
or anything. He bought it but he never
wanted to use it … when he’s mad he’s
going to do it, like he’s not going to use
a condom.
(Fran, pregnant at 17, Tongatapu)
When we did it, he told me that he
didn’t feel comfortable when he used
it [a condom], and we didn’t use it
anymore.
(Josie, pregnant at 16, Vava’u)
When we were dating, he used to
come with things like that [condoms]
… He told me it’s for protection but
after a time we didn’t use the condom
anymore, maybe that is why Ideveloped
this problem [palopalema]. When I got
pregnant and I told him, he told me he
got me pregnant on purpose in case I
have another man.
(Debra, pregnant at 17, Tongatapu)
17Adolescent Unplanned Pregnancy in the Pacific : TONGA

None of the young participants in this
study had discussed sex or contraception
with their parents or older family members.
School sex education was not mentioned
by any of the participants. Decision-
making about whether to ‘keep’ the baby or
try to abort was often informed by whatever
information the young participants could
find on the internet. One participant
explained that she had seen her friends
on Facebook sharing videos about how to
have an abortion, and also videos from the
church about why abortions were a sin.
One participant described being upset
after watching the church anti-abortion
video.4 She said:
… I used to see those videos in
Facebook and YouTube about aborting
the baby. Iusually have those emotions
and I cried. Idon’t know. It was just sad
… I think I remember one that they used
those forceps I guess to pull out the
baby from the … Sometimes I think it’s
the doctor or something. Idon’t know.
Yeah. They pull it out.
(Fran, pregnant at 17, Tongatapu)
Participants also turned to their close
friends and family members to discuss
possible abortion. Often, they were unable
to obtain any information:
There was a girl, my cousin, who I
asked. And she said she hadn’t heard
of any method.
(Georgia, pregnant at 18, Vava’u)
4 This video was considered anti-abortion as the
participant explained that it was a caricature depiction
of a fully grown baby being pulled out of its mother’s
belly by a doctor with over-sized forceps and then
being thrown into a rubbish bin. Theparticipant said
that the video had the church’s name at the end.
Kelly explained that her decision to keep the
baby was based on the following thoughts:
The only thing that comes to my mind
is that it’s not the baby’s fault, it was my
fault and the baby’s father’s, so they
should put the blame on me or him, not
the baby, that’s why Iwanted to keep it.
(Kelly, pregnant at 18, Vava’u)
Tina’s decision to keep the baby was similar:
It’s not good, the baby had no part
in this, it is yourself who was foolish,
but the baby carries the burden even
though they had no part in it.
(Tina, pregnant at 18, Ha’apai)
Some of the participants highlighted that
their decision-making process involved
consideration of their religious views and
beliefs:
I was thinking it’s better to keep it ’cause
it’s a blessing, like how our religion, our
Mormon church see it … It’s not only a
blessing but to abort a baby it’s a big
sin … so that’s what we really believe …
(Tammy, pregnant at 15, Vava’u)
18 Adolescent Unplanned Pregnancy in the Pacific : TONGA

4.1.3 Abortion attempts
Termination of the pregnancy was one of the
first thoughts for many of the participants.
Mostgirls had heard that there were ways
to abort a pregnancy, but few were sure of
exactly what to do. As Cara explained, one
of the reasons she did not tell her family she
was pregnant was because she had hoped
to work out a way to abort the baby before
she needed to tell them:
When I got pregnant, I knew my parents
would be very angry and I would get a
big beating [tā lahi]. Theonly thing that
came to me was to [participant crying]
… I felt and thought to myself that I
wanted to abort [fakatōki] the baby but
I didn’t know how to, that’s why I didn’t
tell my family sooner. And it gets to the
time that I felt like I’m going to give birth
soon then I told them that I’m pregnant.
(Cara, pregnant at 17, Tongatapu)
Some of the participants said that they had
heard there were medicines they could
take to abort a baby, but no one was sure
what the medicines were or where they
could access them. A‘blue bleach’ was
mentioned by many of our younger and
older participants when outlining the ways
they had heard of having an abortion.
None of the young participants said
that they had used the blue bleach, but
mentioned other girls they knew who had:
She said she went and drank the bleach
… she told me it worked.
(Josie, pregnant at 16, Vava’u)
Kelly mentioned that drinking the blue
bleach was a method that she had heard
a lot of girls had used. When asked if it
had worked for these girls, she said she
did not know:
Sometimes if the young mums are not
in a good mood, they going to drink
all of the bleach. They don’t know how
much they want to drink, sometimes
they just drink the whole of the liquid.
(Kelly, pregnant at 18, Vava’u)
Mary explained that she had not tried to
have an abortion, but she had heard of lots
of ways to do it:
The ways of aborting [fakatō tama]
that I have heard from friends and
my relatives is you can take this kind
of pills. And drinking the bleach,
repeatedly jumping from a higher place
and also you can go and sleep with
other men dierent from the baby father
… that can make you lose the baby.
(Mary, pregnant at 18, Ha’apai)
19Adolescent Unplanned Pregnancy in the Pacific : TONGA

Kelly was living with her father when she
found out she was pregnant. Her father
tried to make her have an abortion:
I was so scared of what would happen
if my dad found out … When he found
out he was trying to tell me to abort the
baby. He forced me to take medicine,
he forced me to drink strong tea and
strong coee … When I woke up one
morning he had made it, he told me to
just take the cup and come to his room,
and he told me to sit down beside him
and drink all of it. It tasted like … strong
… dierent … I drank the tea, and he
also told me don’t eat any food from the
morning ’til evening … he just gave me
Panadol, five to six Panadol to take …
maybe two times a day. However, I only
took the medicine one time, and when
he told me to take it the second time, I
rushed to my room and threw it away.
Itexted my mum and told her to call
my dad to tell him to pay my fare and
bring me back home, and that is why
I am here. My mum helped me … It’s
not only my father who told me to abort
the baby. Even my aunty, she also lives
in Fiji, also she was angry at me, she
also told me to abort the baby. When
he gave me all those things and forced
me to take it, I thought, is he a good
father or not? Sometimes I thought, how
would he feel if this was his child? Did
he ever do this to his wife when she was
pregnant? That’s what Iwas thinking
[participant crying].
(Kelly, pregnant at 18, Vava’u)
One of our young participants explained
that early in her pregnancy her boyfriend
told her that they could try and abort the
baby by having sex. She had never heard
of this method of abortion before but was
stressed and scared, so she listened to her
boyfriend and had sex. It did not work.
Ingrid said that her mother scolded her for
doing activities that could cause an abortion:
The truth is, I didn’t know that carrying
heavy things is not good. Iwent and
stayed at one of my sisters’ place and
I didn’t let them know I was pregnant.
Icarried heavy things and I went and
jumped o the wharf when we went
swimming. But when my mother took
me back to live with her because she
already knew I was pregnant, she told
me that was bad. And she told me I’m
heartless because I’m trying to abort
my baby. Isat down and think to myself
maybe it’s god’s plan that I have the
baby, and maybe the truth was I did
try to abort the baby but someone else
was in charge … I don’t know …
(Ingrid, pregnant at 18, Vava’u)
Some of the young participants expressed
that their main motivation for considering an
abortion was because they were so scared
to tell their parents that they were pregnant:
I am so afraid of my father, if he’ll
notice [I’m pregnant], but I know like
doing abortion, even though I was
scared of my father I can’t do it.
(Brooke, pregnant at 18, Tongatapu)
In some situations, the baby’s father
encouraged the young participant to try
and abort the baby. Inothers, it was the
baby’s father who discouraged abortion.
As the participants said:
He didn’t accept it, he told me to abort
the baby.
(Mary, pregnant at 18, Ha’apai)
20 Adolescent Unplanned Pregnancy in the Pacific : TONGA

There was a time I was thinking of
dropping the baby [fakatōki] but the
baby’s father encouraged me and told
me not to drop the baby, to love him
… I told him no I will go and drop the
baby … and it’s like someone came to
my thought and told me not to drop the
baby … and so my thoughts changed
and I didn’t …
(Debra, pregnant at 17, Tongatapu)
Some of the participants objected strongly
to abortion:
… you know I believe that doing
abortion is like just killing a human.
Iwould not do it. Iwould cry, but I won’t
accept it. Ihave heard of it [abortion],
but I don’t know those girls. Isee it
on Facebook where girls would dump
their babies in the rubbish dump and
so on. Idon’t know those girls. Ithink
those girls are not from Tonga though
… When I got pregnant my best friend
suggested that I should abort it. Itold
her no because to me that is murder.
Even my boyfriend told me to get rid of
it because he doesn’t want to look after
it and raise it. But I told him that I will
take care of the baby and he can leave.
(Angela, pregnant at 16, Tongatapu)
Our older participants (grandmothers
and/or women aged 50 years and older)
outlined dierent methods of abortion that
they had heard young girls using:
… because abortion is illegal in Tonga
and so some of them have to keep
that a secret you know … the young
girls like that they go and become
involved in physical exercise or even
carry heavy things, like in laundries
they go and fill up buckets of water
and try to take it because they say that
it will, especially in the like one month
– two month, when the baby hasn’t yet
become a fully completed foetus, so
that’s what I heard. Or they become
involved in sports like basketball so they
jump, and the baby might come out.
And of course, we’ve heard about the
drinking of the bleach … and taking of
unnecessary and irrelevant pills.
(Andrea, 47, Tongatapu)
… there was a girl she got pregnant
when she was still in school and she
drank the bleach. It went wrong or
maybe it was too late when she drank
the bleach, nothing happened but
when she gave birth, her baby was
handicapped, the baby is a big girl now
… she went to primary school … when
she’s about to go to high school they
didn’t let her go to school anymore.
(Candice, 46, Vava’u)
A range of methods was utilised and
described to attempt to induce a
miscarriage. Many of them were dangerous
to the health of the young women.
21Adolescent Unplanned Pregnancy in the Pacific : TONGA

4.1.4 Family attitudes towards the
pregnancy
All our young participants expressed
that they were scared to tell their parents
they were pregnant. Inmost situations,
the parents’ initial reaction was anger,
disappointment and hurt. Several
participants expressed that their fear was
even greater because their parents were
figureheads in their church. However,
in most cases, the parents’ anger
and disappointment changed to love
andsupport.
Angela described the reaction of both
her parents. They were angry, but quickly
highlighted that they would support her
and the baby as best they could. Her
father explicitly told her not to try to ‘get
rid’ of the baby:
My mum comforted me, and I
apologised to her about the lies. She
said it’s okay, it’s just she’s annoyed
about me lying to her … At times, I do
regret not being obedient to my parents
because of what has transpired, so I try
my best now to be obedient … When
my father found out, he was angry. He
sat me down and he asked me all these
questions about what happened to me.
He said that I should have made better
choices because of his role at church.
Thepeople at our church will point a
finger at him not being a better parent
and it sort of embarrassed him. But
then he encouraged me to be brave and
not to try to get rid of the baby because
they will provide everything for my baby,
and it will be their first grandchild.
(Angela, pregnant at 16, Tongatapu)
Brooke described a similar reaction from
her parents and particularly her father, a
church elder:
[I wasn’t afraid] that he would hit me,
he would growl. Iwas the girl that my
father loves the most and trusts me.
Ifeel like I would hurt his feelings.
Ididn’t want to let him know. And plus,
he was kinda … he always goes to
church, you know, like Tongan thing.
Ifeel like he would feel embarrassed
because he was kind of like a Pastor …
When he found out it was just so hard
for him to accept it … I was so afraid to
share with my mum because I’m very
close with her … she was angry but
then after that then she cared about
me. She looked after me to eat healthy
food … I did really get good support
from all of my family and they love me.
Iwas happy. Ifeel that I’m not left alone
or left behind. They care about me and
they were saying, I can’t wait to see that
baby. Iwas so happy when I heard my
dad saying that he will be a grandpa
and also my mum being grandma.
Iwas happy.
(Brooke, pregnant at 18, Tongatapu)
22 Adolescent Unplanned Pregnancy in the Pacific : TONGA

Debra’s experience was similar:
I was scared. Ididn’t know how I would
go talk to my father. Iwas going to tell
him the truth, but I was scared he would
beat me up … So I kept it to myself and
decided to hide it. There was a thought
that came to me not to tell but hide
it until I gave birth … At home I tried
hiding my stomach … but my stomach
was starting to show so I tied my
stomach and my father saw. He didn’t
say anything. The next morning, he
called me and asked ifI’m pregnant, if I
am, I should tell him the truth, it’s better
to tell him straight than me getting into
diculty somewhere. Itold him I’m
sorry and yes, I’m pregnant, and they
took care of me up to the time I gave
birth, and the baby is adopted.
(Debra, pregnant at 17, Tongatapu)
Some participants were so scared to tell
their family that they hid the pregnancy
until as close to their due date as possible
– six to seven months gestation, in some
cases. Cara was living with her older sister
and hid her pregnancy until she was seven
months pregnant:
… we went swimming at the pool one
day and I stood up and my T-shirt was
very tight on my stomach … that day,
I didn’t tell my sister she just saw my
stomach and knew that I’m pregnant …
When we get home my big sister almost
beat me.
(Cara, pregnant at 17, Tongatapu)
Kelly described that her father never
accepted her pregnancy and tried to make
her have an abortion. One year after the
birth of her baby, her father still has not
spoken to her:
When I tested myself, it said that I was
pregnant. Iwas surprised. Icried, and
I was so scared of what would happen
if my dad found out. It’s okay with my
mum, she will understand me, but my
father, he doesn’t like it. When he found
out he was trying to tell me to abort the
baby. He forced me to take medicine, he
forced me to drink strong tea and strong
coee … I have to fix things with my
dad. Ihave to ask him for forgiveness or
that he will accept me and my baby in
this family. But at the moment, he hasn’t
forgiven me yet, he doesn’t want to talk
to me, he just calls and talks to my mum,
my sister and my brother, he hasn’t
asked anything about me.
(Kelly, pregnant at 18, Vava’u)
23Adolescent Unplanned Pregnancy in the Pacific : TONGA

4.1.5 Community attitudes towards the
pregnancy
When most of our young participants found
out that they were pregnant, they feared
that their community would react with
stigma, gossip and exclusion. Thiswas
true in many circumstances, as these
participants said:
… the people at my church were talking
about me and I know they have noticed
my problem [palopalema]. But their
focus was on my parents because my
father is the stewardship of our church.
But my parents are very strong, and
they told me not to be discouraged by
my problem because the people in our
church do not give us any means of
support or buy food or diapers for my
baby. So I just ignore them because
my parents are right. There are some
families who don’t visit us anymore and
some families told me that it will be okay.
My family is good. Even though people
at church talk bad about me Istill attend
church and go home. And I ignore them.
(Angela, pregnant at 16, Tongatapu)
The way they look at us, they already
say that this is the end of our life. And
when she has her baby, her life will
not continue, and she won’t be able to
study or lead a good life.
(Mary, pregnant at 18, Ha’apai)
I know people talked when I was
pregnant, but I didn’t pay attention to
the words and bad things they were
saying about me. If I care about it, I
would be sadder.
(Tina, pregnant at 18, Ha’apai)
Some of our young participants decided
that, despite knowing that there would be
negative attitudes in their community towards
their unplanned pregnancy, they would not
withdraw from their normal socialising:
… for me when I was pregnant, I feel
like this is not something to hide. I’ll
be just the same [name removed –
interviewee referred to herself] and
go out and have fun and be with my
friends. Not staying home and being
locked up and saying I’m pregnant,
people will say that I am this and that.
But sometimes it’s just their imagination,
it’s not what people say but just you
think that they will be like that after that,
but it’s not happening. When there are
social nights, like the religion stu, I go
and enjoy. Be happy.
(Brooke, pregnant at 18, Tongatapu)
24 Adolescent Unplanned Pregnancy in the Pacific : TONGA

4.1.6 Marriage
Conversations and perspectives on
marriage were very mixed in our sample.
Somefamilies questioned our young
participants about the possibility of
marriage:
… ask me questions about who the
father is, and if he ever mentioned to get
married. ’Cause if he really loves me,
he will say it before, if he knew it [that
she was pregnant]. Then I told them he
knew but doesn’t want to get married.
(Brooke, pregnant at 18, Tongatapu)
Kelly’s partner suggested marriage, but
she wanted to mend the situation with her
father first:
When he [the baby’s father] found out
that I was pregnant, he did everything,
he asked me to marry him. When I told
him about my family, he told me, ‘How
about if we run away and get married?’
He wants to take care of me and the
baby. However, … I had to fix everything
before it goes back to a normal life.
(Kelly, pregnant at 18, Vava’u)
In some situations where marriage was
proposed, the young participant declined:
… right now, his family tried to reach us,
me and the baby, for marriage. Inmy
opinion, Idon’t think marriage is the
solution. Just told them to forget about
us, because we don’t really need them
anymore and stu … My parents don’t
want me to be with him again, because
he wasn’t there [when she was pregnant].
(Heather, pregnant at 18, Vava’u)
I had occasional thoughts that it would
be good if we got married … to get
married for the sake of the baby …
but there were other times I thought
the only reason we would be getting
married would be for the baby.
(Georgia, pregnant at 18, Vava’u)
In some situations, the parents disagreed
about the possible marriage of their
daughter. Themain reasons for a parent not
wanting their child to marry was because
they saw marriage as something that would
inhibit their aspirations for their daughter
to return to finish her studies and get a
job when her baby was a bit older. Also, in
some cases, they had a very low opinion of
the father of their daughter’s baby because
he got their daughter pregnant unplanned
and out of wedlock. He was therefore not
a worthy husband for their daughter. As
these participants shared:
When my father arrived, he was furious
when he saw the guy. He called my
mother so they could talk … when they
talked, they spoke about marriage.
Theguy agreed to marry me, but it only
depends on my family’s decision …
Buttalking to my father is a waste of time
because he doesn’t want me to marry
the baby’s father. But my mother wants
me to marry him because of my baby.
(Ebony, pregnant at 17, Tongatapu)
At first my mother told me to marry him,
but my dad disagreed because of study
and stu. Ican’t really do the homework
and stu, and the housewife jobs.
(Heather, pregnant at 18, Vava’u)
25Adolescent Unplanned Pregnancy in the Pacific : TONGA

The boy’s parents asked me if we could
get married, but my mum said no. My
mum said after I gave birth I could go and
find a school and finish my education.
(Tammy, pregnant at 15, Vava’u)
4.1.7 Motherhood
Most of our young participants described
that the main support they received in
being a mother came from their family.
Despite early anger and disappointment
from family members, most of our young
participants and their babies were still
living with their parents or close relatives.
Inmost cases, both the young mother and
the child were being financially supported
by their family:
I have my grandmother, sister and my
cousins, my big sister. Yeah. Them.
They taught me how to become a mum.
(Fran, pregnant at 17, Tongatapu)
Many of our young participants
described that when they gave birth and
saw their baby, their perspective and
emotions changed immediately. As these
participants said:
When I gave birth … once I see her,
I forgot everything [crying]. Iregret
thinking about abortion and stu.
(Heather, pregnant at 18, Vava’u)
I just have that feeling that my child gave
me more strength and it made me not
give up life. It’s one thing that I’m living
for and that’s why I love becoming a
mum. When I had my child, I feel like he
gave my life more meaning, how to live
life, why I’m still living.
(Fran, pregnant at 17, Tongatapu)
When I became a mum, it gives me
compassion towards other young
mums who are going through the same
situation as me. When I see other
people who are like me, I will give them
encouragement to be strong. But so far,
I feel content … My whole pregnancy
was very hard and painful because my
heart was broken, my boyfriend hurt
me a lot. But when I gave birth to my
daughter it changed everything. Iwas
happy to see her. She was all mine. I’m
relieved that the father of my baby and
his family will never have anything to do
with her.
(Angela, pregnant at 16, Tongatapu)
I feel like I have one heart with my son.
That time, I used to hate kids if I see
kids, I don’t like them, but when I gave
birth to my son, I felt special love …
like I felt a real love towards my son.
(Ingrid, pregnant at 18, Vava’u)
Only one of the young mothers in our
sample was not living with her parents.
Shewas living with the parents of the
baby’s father because her family members
all lived abroad. Thebaby’s father did not
live with them. She said:
They [her baby’s paternal
grandparents] asked me if we can stay
together, because of my daughter …
they are nice.
(Cara, pregnant at 17, Tongatapu)
26 Adolescent Unplanned Pregnancy in the Pacific : TONGA

Only one of the participants was
cohabitating with the baby’s father, in her
parent’s house. She described that she
really loved the baby’s father, he had a
good attitude and she felt safe with him.
They had plans to get married soon.
Sometimes financial support was provided
by the father’s family, but this was not
common. One young participant described
that motherhood has been incredibly hard
for her:
It’s hard, very hard. Mostof the time at
night I cry, because sometimes I ask
myself, how can I find other ways to earn
money to support my child, even my
family, because no one in my family has
helped me for support, even my sister,
my brother, they never help, they just stay
home and do all the stu, but never work,
they do not have any work anywhere.
(Kelly, pregnant at 18, Vava’u)
4.1.8 Adoption
Some of the young participants had
given their baby for adoption to a family
member, usually a cousin. Theyoung
participants’ main motivation for giving
their baby for adoption was to be able
to go back to school and complete their
studies. Debra gave her baby for adoption
to her aunt’s daughter when the baby was
three months old:
When I gave birth, my aunty came and
said she will adopt the baby so I can go
back to study because it’s not time for
me … my father didn’t agree, he said
no … But then she [the baby] got sick,
so we went to my aunt’s house with my
baby and slept there so that my aunty
will treat my baby. We stayed there
until she got better, and my aunty went
and bought a stroller and baby bed.
Theytold me when the baby gets better,
I am going back home, my father won’t
have a say … My father was surprised
when I called him to come and he asked
if we are both coming back and I told
him no, only me … my father came and
talked with them. My aunt’s daughter
couldn’t let go of my baby. My father
told them to let us go back with the baby
and we did. Thenext day they arrived
again, they couldn’t leave me alone, and
they begged for the baby to let them
raise her so I could go back to study
and my father told me to let them have
the baby and I told him yes, it’s alright.
So they took her and adopted her.
(Debra, pregnant at 17, Tongatapu)
27Adolescent Unplanned Pregnancy in the Pacific : TONGA

Debra described that she was very sad at
first, but slowly became used to the situation:
That day I wasn’t able to sleep, I cried
and my father woke up at night and
asked me if it was because of my child
and I said yes, I couldn’t stop thinking
about her. Then, after a while, I get used
to it and don’t think about it so much.
(Debra, pregnant at 17, Tongatapu)
Heather gave her baby for adoption to her
cousin when the baby was three months old:
When my parents found out, I have a
cousin who has no child. She asked
for the baby. She lives in the States. So,
I thought that the baby would have a
better life with a dad and a mum, so I
agreed for the adoption.
(Heather, pregnant at 18, Vava’u)
When asked how she now felt about that
decision, Heather responded:
Not sure yet. It’s the only way for a
better life though.
(Heather, pregnant at 18, Vava’u)
Angela also stated that she was considering
giving her 12-month-old baby up for
adoption, so that she can return to school:
Well, I have this plan with my mum.
Her brother who lives in Australia and
married an Australian woman, they have
already written to me and asked if they
can adopt my baby. They say they will
look after the baby and I can return to
school to finish and get a job.
(Angela, pregnant at 16, Tongatapu)
In some circumstances, there was no
explicit mention of adoption, but the young
participants explained that their parents
and relatives were looking after the baby,
or were planning to do so, so that the
young participant could return to school:
My parents and mostly my relatives …
they wanted me to go back to school
and leave the child with them just to
take care and then get a job.
(Fran, pregnant at 17, Tongatapu)
4.1.9 Relationship with father-to-be
About half of the young participants
in this study had met the boy to whom
they became pregnant through a school
function or family friends. Theother half
first met the boy or man to whom they
became pregnant through Facebook.
Someinteractions on Facebook began
through mutual Facebook friends, while
others began by the boy or man sending
a ‘friend request’ to the young girl.At the
time, the girl was a complete stranger to
him, as these participants conveyed:
I met the guy through the internet. Mydad
brought home a mobile phone. He didn’t
wantme to use it, but I did. Iwent into
Facebook, that’s the first time I used a
mobile phone. Iwas still in Form 5. Iwent
into Facebook and I saw the guy’s page
adding me … I accept his friend request.
Ididn’t know he liked me and something
like this would happen. We contacted
each other through this and gets to a time
we agreed to meet in person.
(Ebony, pregnant at 17, Tongatapu)
I met him in Facebook. Afriend of mine
made me introduce myself to him …
and we started chatting.
(Tammy, pregnant at 15, Vava’u)
28 Adolescent Unplanned Pregnancy in the Pacific : TONGA

In the relationships that started through
school functions or at church, the age of
the boys was similar to that of the young
participants. Where the initial interaction
began through Facebook, the boy or man
was usually a few years older. Mostof the
young participants said that they would
sneak away from school or from their house
during the night to meet up with the father
of their baby and would lie to their parents
about where they had been and what they
were doing. As Debra and Fran said:
When we have the big examinations, I
didn’t go to school, I ran away … I left
… I ran away with a guy, that’s how I got
pregnant. When I went back home, my
family didn’t know.
(Debra, pregnant at 17, Tongatapu)
It started when I go to school …
sometimes I sneak out of school and I
go out with the guy … Usually he comes
and picks me up … it was almost three
times a week … He finished school
already … [his age is] about 20 years old
… we met on Facebook.
(Fran, pregnant at 17, Tongatapu)
Angela met the young man to whom she
became pregnant on Facebook. After
chatting through messages for a short
time, he oered to come and pick her up
from a school function. Angela agreed
and they drove to a quiet place to talk.
He asked how old Angela was and she
replied that she was 16years old. He was
23 years old. Soon after, they began a
sexual relationship. Angela said:
… we embarked on a sexual
relationship where my parents thought
I was at school, but little did they know
that my boyfriend would pick me up.
Nearly every night or in the early hours
of the morning I would sneak out
and go to his house and would come
back at dawn. And this is where the
problem started, we had sex many
times. Mymum would give me a hiding
asking where I have been and stu.
However, I would always lie to her.
(Angela, pregnant at 16, Tongatapu)
Cara met the father of her baby at a school
function and would skip school to see him:
… we met at a school function where all
the Wesleyan schools showcase their
handicrafts [the Free Wesleyan Church
Schools bazaar] … and we start dating.
When Igo to school, I always run away
and went to the guy’s place and I start
staying with him. And it was during the
school holiday and I was staying with
my big sister because my parents were
overseas. My sister went to a dinner and I
was texting with the guy and that’s when
I went to him and sleep with him … that’s
how I got pregnant.
(Cara, pregnant at 17, Tongatapu)
29Adolescent Unplanned Pregnancy in the Pacific : TONGA

The fathers showed a varying level of
commitment to our participants when they
became pregnant, with some continuing
to have sexual interactions with other girls
at the same time. Angela’s relationship
with the young man to whom she became
pregnant deteriorated within a few months.
Angela suspected that she was pregnant,
but had not told the father. She said:
I was still with my boyfriend and he didn’t
pay as much attention to me and hurt
me [fakamamahi]. He would see other
girls apart from me and I would see
this and feel hurt [mamahi] but I would
tolerate it and try to ignore it. Afterhe
had sex with them, he would come back
to me. Ihave seen him with my own
eyes, and it hurts me a lot so yeah.
(Angela, pregnant at 16, Tongatapu)
Brooke’s relationship with the father of her
baby was similar:
… the baby’s daddy, he did not care
like what he said before because he
had many girlfriends … He doesn’t tell
me ‘I have a girlfriend’. He told me ‘I
have lots of girlfriends’. Iwas like okay
and I smiled but he doesn’t know the
pain inside me. Ijust smile to try and
show him that I accept it, even though
it’s so hard but I have to … I fall for his
words but not his actions. But then I
realise I keep falling for his words. He
kept telling me that he cares, and he
loves us. But we never see each other
when I was pregnant …
(Brooke, pregnant at 18, Tongatapu)
Fran’s experience was also similar:
I found out he went around with some
other chicks … and I believed it was
best to let him go. And then I just found
out I was pregnant, and I told him about
it. People said despite that fact that
we’d broken up he still has the right to
know about it.
(Fran, pregnant at 17, Tongatapu)
There were mixed reactions from the
fathers when they found out about the
pregnancy, as these participants said:
… my boyfriend had blocked me on
Facebook when he found out about
my pregnancy. He got what he wanted
[long sigh]. His family doesn’t know
anything about me and the baby. But
I’m okay with that … my boyfriend told
me to get rid of it because he doesn’t
want to look after it and raise it. But I
told him that I will take care of the baby
and he can leave, and I will have no
problem finding a father figure for my
baby. So he verbally abused me and
left and I cried because now I know he
only used me, he never loved me…
My whole pregnancy was very hard
and painful because my heart was
broken, my boyfriend hurt me a lot …
Ihaven’t seen my boyfriend ever since
[I was pregnant]. And his family doesn’t
acknowledge me and the baby …
(Angela, pregnant at 16, Tongatapu)
30 Adolescent Unplanned Pregnancy in the Pacific : TONGA

When I told him, he said I was pregnant
to someone else or something like
that. Ijust coped with it. Ilet it be.
And tell him at least I told him that I’m
pregnant and that he’s the father, and
if he doesn’t accept it it’s fine with me
… When I was six or probably seven
months pregnant, he contact back
asking about the baby but I was really
pissed o so Isaid I don’t want him
anymore because he’s probably around
with those girls and I didn’t want him.
(Fran, pregnant at 17, Tongatapu)
Some of the fathers were absent until the
baby was born, at which point they sought
a relationship with their child. Brooke did
not see her baby’s father until the child
was born:
… when I gave birth, I was surprised
that he came to the hospital and looked
for me and the baby … He wanted to let
my family know that he is the father of
the baby and then my mum respected
him because he came up and see us.
Right now he comes once a week, every
Sunday evening and gives me 100 for
the baby and also for me to eat to feed
the baby. We talk … The truth is that
I still love him, but I try so hard not to
show it because he’s not my husband.
I’m a girlfriend. So I keep thinking that if
I love him I show it by taking care of the
baby and all … I can see that the more
I don’t force him he knows what to do.
I’ll just see if he loves us, he will come
home and see us … Me and him there’s
nothing. But for him and the baby
there’s like … he has a feeling and he
comes home and sees the baby.
(Brooke, pregnant at 18, Tongatapu)
Brooke explained that the paternal
grandparents come to visit her sometimes
and they warned her about their son and
his behaviour:
… the mum told me to block her son.
She said I should ignore him. And the
father told me to never believe his son,
he’s a liar.
(Brooke, pregnant at 18, Tongatapu)
Some of the young participant explained
that the baby’s father tried to keep the baby
secret from their friends and new girlfriends.
Brooke mentioned that her baby’s father
never made any posts on Facebook about
their baby and he set his profile status to
‘single’. Brooke was disappointed by this
soshe ‘blocked’ him on Facebook:
… he never posts with the baby or
mention it. Also, his thing is single.
There is no relationship or complication.
(Brooke, pregnant at 18, Tongatapu)
4.1.10 Older women’s views
Some of our young participants talked about
the disappointment from their grandmothers
regarding their unplanned pregnancy:
… my grandmother, she told me to stay
and look after my baby because it’s
my own foolishness/silliness/ignorance
[vale]. She told me not to get pregnant
again …
(Tina, pregnant at 18, Ha’apai)
31Adolescent Unplanned Pregnancy in the Pacific : TONGA

Some of our older women participants
talked of the importance of not scolding
the girls too much, in case it causes them
to have an abortion:
If that mistake happens, we need the full
support of families instead of ridiculing
and scolding and giving those harsh
words and things like that, because
that’s one of the pressures they put them
under, to try to abort and terminate …
(Andrea, 47, Tongatapu)
Andrea outlined that there are specific
situations in which young girls should be
able to access abortion services:
… we don’t encourage that [abortion],
but at the same time I always support
that there are services because we
people are dierent from each other.
Incidents happen like rape, incest.
There should be places young girls
can easily run to and access services
tostop and prevent unwanted
pregnancies and things like that.
(Andrea, 47, Tongatapu)
Andrea also talked about the importance of
educating young people to try and prevent
unplanned pregnancy from happening.
She said:
I think it’s very important for us older
and elderly women to talk to young
women, talk tothem. Having children,
we believe from our Christian faith, is a
gift and blessing from God. At the same
time, they need to be well-cared for, not
just born and abandoned and not cared
for properly. So, it’s very important for
us to sit down and talk nicely with young
couples or young mothers and fathers,
to make good, informed choices …
So,it’s important as men and women to
think properly and make good decisions
instead of just sleeping around and,
‘Ihave a daughter, I have a son’.
(Andrea, 47, Tongatapu)
A few older participants discouraged the
use of contraceptives because of their
side eects, as Candice stated:
For me, using the contraceptives is
bad for us women and also man …
controlling birth is good, but I don’t
believe we should go to the hospital
because a lot of people in our village
and also myself is unhealthy from
using these methods from the hospital
[condoms and injections].
(Candice, 46, Vava’u)
32 Adolescent Unplanned Pregnancy in the Pacific : TONGA

Dorothy outlined that she thought
adolescent unplanned pregnancy was
occurring because laws that allowed
parents to punish their children had
changed.5 She suggested that these laws
should be reinstated to address the issue:
I think the reason why these problems
are happening because of the law.
That time, the parents punished their
children and it can stop their children
from getting in trouble. Now, the law
changed, and the children makes
their own choice and the parents can’t
control them anymore … Go back to the
old law. Allow the parents to control and
make decisions for their children until
they are 18, legal age. Let the children
stay under their parents’ control so they
could listen to their parents. That’s the
only way we can prevent this, to get
back the law so the children can listen
to their parents and so these problems
will decrease.
(Dorothy, 42, Ha’apai)
5 Although not explicitly stated by the participant, it
is likely that she was referring to the Tonga Family
Protection Act 2013. Thisis an Act to provide for
greater protection from domestic violence, introduce
protection orders, clarify the duties of the police, and
promote the health, safety and wellbeing of victims of
domestic violence and related matters.
4.1.11 Aspirations: hopes, plans, fears
and regrets
Almost all of the young participants
expressed aspirations to undertake
more studies and get a job. Someof the
participants who did not complete high
school explained that they could go to the
University of the South Pacific campus
in Tonga to finish the high school studies
that they had not completed. As these
participants said:
I wish to complete my studies so I can
get a job and also I want to go overseas
and provide for my family.
(Angela, pregnant at 16, Tongatapu)
That’s what I wish for [to get a job or do
more study], but first I must wait for my
daughter to start school before I start
looking for a job.
(Cara, pregnant at 17, Tongatapu)
I’ve planned that after this I’d go back
to school next year and start to find a
life for me and my child and get a job to
feed him and all those.
(Fran, pregnant at 17, Tongatapu)
Heather had very recently given her baby
for adoption to her cousin in order to focus
on her studies and her future. She said:
I would miss her and everything [her
baby], but I was thinking of furthering my
studies, to get educated more, and just
to work on my career. Because I have a
job now with the government. So, just to
work on myself first before I look further
for a husband or anything, or even date.
(Heather, pregnant at 18, Vava’u)
33Adolescent Unplanned Pregnancy in the Pacific : TONGA

Some of our young participants had
recently graduated from high school
when they found out they were pregnant.
Their pregnancy put a halt to their plans
for their immediate future. Brooke was in
NewZealand with her mother, looking for a
school and a job, when she found out she
was pregnant. She said:
We went to New Zealand because my
mum wanted to help me to get a better
life and go and find a school or get
a job, but then when I was pregnant,
Ihad to come back here because I
can’t stay there.
(Brooke, pregnant at 18, Tongatapu)
When asked how she felt about this
change, Brooke responded:
I don’t know what to say. It’s just a big
change and there’s nothing to do so you
had to go that way and try to deal with
it and focus on it. Iwas trying to focus
on my study, but then I got pregnant, so
I had to focus on the baby before study.
But I was thinking I will continue studying
after giving birth, but first I will try to take
care of my baby then I’ll go do study.
(Brooke, pregnant at 18, Tongatapu)
Some of the young participants’ hopes
for their future were focused on raising
their children and providing them with
opportunities for their lives:
To do my best and raise my daughter
so she will grow up and choose a
dierent path.
(Cara, pregnant at 17, Tongatapu)
Many of the young participants spoke
about regret for disobeying their parents.
They said:
I’m staying home and feeling sad
from what I did. Because I see the big
mistake I made, my parents worked hard
to pay for my school fees, but I ran away
from school. Icried and pray to the Lord
and asked him … [crying] to forgive me
for my sins and everything that I did that
time that hurts my parents …
(Debra, pregnant at 17, Tongatapu)
My goal was to get a job to help my
family. Now I won’t achieve my goal.
Itwon’t happen because of the problem
(palopalema) that happened to me.
(Tina, pregnant at 18, Ha’apai)
Today, I regret it, I regret not listening
to my parent’s advice … they were
very unhappy [lotomamahi] with my
behaviour. Now I feel that I have lost all
the opportunities from my parents. And
I can see it today.
(Ebony, pregnant at 17, Tongatapu)
I told my mother, this is the end. I’m
never going to make the same mistake
Imade. Iwant my life to go back to
what it was like before. Idon’t want my
son to grow up and follow my footsteps.
(Ingrid, pregnant at 18, Vava’u)
I was going to treat it in a dierent way
when I stay with my dad. That’s how I’ll
change everything, change my attitude,
my mind and everything of my future.
(Kelly, pregnant at 18, Vava’u)
34 Adolescent Unplanned Pregnancy in the Pacific : TONGA

4.2 Social and structural factors
This section discusses the social and
structural factors that impact on adolescent
unplanned pregnancy, along with the
experiences and decision-making related to
adolescent unplanned pregnancy, as these
emerged through the interviewee narratives.
4.2.1 Access to education
All of our young participants were
either still in high school or had recently
graduated when they found out they were
pregnant. Those who were still in high
school all left immediately, for a variety
ofreasons.
Angela left school when she had her
pregnancy confirmed at five months
because her mother said that it would be too
embarrassing or shameful for her to stay:
I left school after my first clinic
appointment [at five months pregnant].
Mum said don’t go back to school
as it will be embarrassing/shameful
[fakamā] and will create more problem
[palopalema] for you.
(Angela, pregnant at 16, Tongatapu)
Cara was living in Tonga with her
grandparents when she became pregnant.
She told them that she wanted to leave
school and go and live in Fiji with her older
sister, who was working there. She did not
tell them that this was because she was
pregnant. She said:
I left school when this happened
[pregnancy] and went that month and
stayed in Fiji for two years and I gave
birth there. And I didn’t go to school.
(Cara, pregnant at 17, Tongatapu)
Some of the participants mentioned that
education about sex and contraception
is not discussed at all in school. And the
only time they had discussed it was at
church. Tammy remembers that in church
she was told:
… just get pregnant in the right time when
you get married, and that’s the right time
to have a baby. But for now, no. You just
have to go plan on your education and
finish your missionary or whatever, and
then you get married. Andthen that’s the
right time to get pregnant.
(Tammy, pregnant at 15, Vava’u)
4.2.2 Access to prenatal and post-
pregnancy healthcare
Most of the young participants’ first
interaction with a health facility was to
check or confirm their pregnancy. Almost
always, they were escorted by a parent
or family member who arranged the visit.
Some participants presented within the first
few months of their pregnancy. However, as
many participants were scared and tried to
hide their pregnancy, they did not confirm
their pregnancy or have any interaction with
a health service until they were four or five
months pregnant, sometimes later.
Cara was living with her older sister and
hid her pregnancy from her until she was
seven months pregnant. When her sister
found out, she took Cara to a health clinic.
Cara recalled:
We went to check up and the nurse
asked me why I didn’t come earlier,
and I told her because I was scared of
telling my sister that I’m pregnant.
(Cara, pregnant at 17, Tongatapu)
35Adolescent Unplanned Pregnancy in the Pacific : TONGA

Angela’s mother noticed that something
was dierent and arranged for her to go
to the hospital. Angela was five months
pregnant when the pregnancy was first
confirmed. She said:
My mum cried when the nurse said that
I’m pregnant. Thenurse reassured her
that I’m not the only one who is getting
pregnant young, there’s many young
mums. Thenurse’s concern was that
I continue to attend appointments.
They created a chart for me so always
attended my check-up.
(Angela, pregnant at 16, Tongatapu)
When asked about postnatal care, many
of the participants stated that they had not
been back to a health service since their
baby was born.6 Kelly’s baby was 12months
old. When asked about visits to a health
centre since birth, she stated:
Not yet. She hasn’t been checked for
any health.
(Kelly, pregnant at 18, Vava’u)
6 Unfortunately, these participants were not questioned
further at the time of the inter view to determine if this
also meant that their babies had not received any
routine vaccinations.
4.3 Knowledge and practices
of traditional methods of
fertility limitation
Very few of our young participants made
any mention of traditional methods of
fertility limitation. One participant explained
that she knew of a Tongan medicine called
pua-tonga7 that is used for abortion:
… there is a Tongan medicine, we call
it pua-tonga. They use the leaves, they
smash them, then drink the liquid.
(Kelly, pregnant at 18, Vava’u)
Some stated that they had heard of a juice
for abortion, but did not know anything
about it. Mary said:
I heard that there is a juice that you can
drink but don’t know much about it.
(Mary, pregnant at 18, Ha’apai)
Others had heard of a variety of physical
methods to have an abortion. Tammy said:
I heard about it that you can just wear
a tight-waist thing to just pull it and
squeeze the stomach to be small so it
can kill the baby. My cousin used one
and the baby dropped.
(Tammy, pregnant at 15, Vava’u)
7 Cambie and Brewis (1997), in their book Anti-fertility
plants of the Pacific, outline that ‘pua-tonga’ is
the Tongan name for the flowering plant Fagraea
berteriana A.Gray. They do not outline how the plant
is used in Tonga. However, they cite Briggs (1985),
who states that in Futuna the plant is used as an
abortifacient by ingesting a decoction of scrapings
from the trunk of the tree.
36 Adolescent Unplanned Pregnancy in the Pacific : TONGA

Our older participants were also aware
of some traditional methods of fertility
limitation. Someparticipants were able to
explain the methods in detail, while others
could only give a broad overview. They said:
One method I knew was from a mother
who shared me about her daughter
trying to abort her baby in case her
father knows … her daughter used
this type of grass called matamanu
remember it’s a long leaf and she cut
o the soft part and put inside her.
Thisgirl studied biology in school, and
she knew that there’s water inside that
protects the baby, that if she used this
method to break the water, the baby
will come out. That’s what the mother
shared with me, that she asked her
daughter, and this is what she used
… she was two months pregnant …
the mother just found out her daughter
aborted the baby.
(Barbara, 54, Vava’u)
I just heard that there are some kind of
trees, or plants, that you can drink and
… but I’m not sure. Because people
don’t encourage that since it might
have impacts to on the women’s health.
They’re afraid, otherwise not losing the
baby but can cause harm to the mother.
(Andrea, 47, Tongatapu)
Several older participants specifically
mentioned using the si plant8 to abort a
pregnancy. All explanations were similar,
involving the insertion of the young leaves
of the plant into the vagina.
8 Cambie and Brewis (1997) outline that the ‘si plant’
is the Tongan name for the flowering plant Cordyline
terminalis (L.) Kunth. Several sources of literature note
its use to abort pregnancy in the Pacific, including in
New Caledonia (Rageau, 1957), Vanuatu (Baker, 1928),
Fiji (Seemann, 1862) and Hawaii (Gutmanis, 1979).
Candice shared:
They used the si plant, they take the
softest leaf, if they are still one or two
months and put inside them and that
causes the baby to come out. Isaw
with my own eyes, a woman who was
already pregnant and this method is a
fast method of getting rid of the baby
… the si plant, when you put it inside
you, it’s fast, maybe after few minutes
the baby comes out.
(Candice, 46, Vava’u)
One older participant recalled the use of a
tea for having an abortion:
When I was still in high school …
there was a woman who taught [at the
school]. Iknew she was pregnant to
a teacher and I went to school and I
came back and saw her lying down,
she was still young … she asked me
to go get some water and bring her
food. Iwas wondering what happened
then I found out she was aborting her
baby. When I went to clean her room,
I saw a big bucket and I saw the tea.
She was using the tea, a lot of tea and
she used a piece of cloth, a big one
and put the tea inside and boil some
water and mix with the tea. She told me
everything herself and I also see it with
my own eyes. She drank the tea and
when it start working inside, the blood
automatically comes out … because
the baby was not fully formed …
(Candice, 46, Vava’u)
37Adolescent Unplanned Pregnancy in the Pacific : TONGA

4.4 Some limitations and
considerations from data
collection
The 170-plus islands that make up the
Kingdom of Tonga are spread over
700,000 square kilometres of the South
Pacific Ocean. Whilst the majority of
the population live on the main island of
Tongatapu (74%), followed by the divisional
areas of Vava’u (14%) and then Ha’api
(6%), there are 40 inhabited islands across
the Tongan archipelago (Tonga Statistics
Department, 2017). Data collection in this
study was undertaken in the three most
populous divisions (Tongatapu, Vava’u
and Ha’api) where 94percent of the
population reside; however, it is important
to note that the findings in this study are
limited with regard to how well they can
represent the experience of, and make
recommendations for, adolescent girls all
over Tonga. Thestudy sample was non-
random and as such it cannot claim, nor
was it intended, to be representative of
all unplanned adolescent pregnancies in
Tonga. Inorder to prevent misinterpretation
or misrepresentation of the data, the
results section purposefully includes words
such as ‘a few,’ ‘some’ and ‘many’ instead
of exact numbers.
Participant recruitment was approximately
30percent through the Talitha Project,
30percent through the Tonga Family
Health Association, and 40percent
through participants’ ‘friends of friends’
who had not had any contact with either
organisation. Theyounger and older
participants recruited through the Talitha
Project were made aware of the study
by Talitha Project sta or through word
of mouth, including the circulation of
‘Invitation to Participate in Research’
forms (in English and Tongan). Mostof
the young participants had attended,
or were planning to attend, the Talitha
Projects programs which focus on
empowering girls and young women
aged 10–24 years to gain increased
awareness and control over their bodies
and their lives. None of the young
participants stated that they had attended
any Talitha Project programs prior to
their pregnancy. Younger and older
participants recruited through the Tonga
Family Health Association had recently
attended an outreach clinic or workshop
and received an ‘Invitation to Participate
in Research’ form, or had been given the
form at their house from the community
nurse in their area. All participants in
the study were oered ‘Invitation to
Participate in Research’ forms to give to
friends or neighbours, and forms were
also distributed in local marketplaces.
Theremaining 40percent of participants
were recruited through this method.
All participants contacted the Talitha
Project, Tonga Family Health Association
or the Tonga Team Leader (C. Linhart) to
express their interest to be involved in the
study. All participants were oered the
opportunity to be interviewed in English
by the Tonga Team Leader (C. Linhart),
or in Tongan by trained interviewers from
the Talitha Project or the Tonga Family
Health Association. Therecruitment of
participants from a variety of sources
helped to ensure that the diversity of
experiences of adolescent unplanned
pregnancy in Tonga were captured.
The research team found that while some
young participants were quite tentative
and shy prior to their interview, they
generally opened up quite a lot during the
process of being interviewed, particularly
the participants who were interviewed
by the Tonga in-country Team Leader (C.
Linhart), an Australian born woman aged
in her mid-30s. Ms Linhart conducted
all interviews that were undertaken in
English with the young participants (six
interviews of the total 15 interviews with
young participants). These interviews
were generally longer and included a
greater depth of intimate detail about
the young participants’ experiences
of adolescent unplanned pregnancy,
compared to the interviews undertaken
in Tongan. Apossible reason for this may
38 Adolescent Unplanned Pregnancy in the Pacific : TONGA

be that in addition to reiteration by all
interviewers of the strict confidentiality
of any information participants shared,
Ms Linhart also highlighted at the
beginning of her interviews that she
was a foreigner with no family or long-
term ties in Tonga. At the beginning of
the study, the Tongan members of the
research team described Tonga as a
small country where church, extended
family and community connections are
extensive, and highlighted that ‘most
people know someone that you know’.
Theresearch team were aware that
this may be a barrier to the depth of
detail participants were willing to share
about their experiences, particularly
in the Tongan context where there are
significant legal, cultural and religious
implications to topics raised in the
interviews. It is possible that being alone
with Ms Linhart and her greater level of
perceived anonymity compared to the
Tongan interviewers facilitated a greater
depth of sharing of intimate details of
participants’ experiences. It may also be
that the young participants were more
circumspect in regard to what they would
share with an older interviewer compared
to a younger interviewer, or vice versa.
Theage of the Tongan interviewers
ranged from early 20s to over 50, but
there was no noticeable dierence in the
type or detail of the information given to
the Tongan interviewers.
The main role of focus groups in this
study was to scope older women’s views
towards adolescent unplanned pregnancy
and traditional practices of fertility
limitation, in order to signal the issues that
should be pursued in private interviews,
as well as providing a useful means
of identifying, recruiting and gaining
introduction to – and gauging the interest
of – potential interviewees. InTonga only
one focus group discussion was held
with three participants, as the majority of
older women approached to participate
in a focus group discussion said they
preferred to be interviewed individually.
Given the cultural and religious social
conventions in Tonga which limit the
willingness of both younger and older
women to talk openly about sexual and
reproductive health, contraception and
fertility limitation, it was not unexpected
that the older participants requested to
be interviewed individually.
39Adolescent Unplanned Pregnancy in the Pacific : TONGA

5 Conclusions
5.1 Adolescent unplanned
pregnancy in Tonga
Sexual and reproductive health knowledge
among the young participants in this
study was low. Allparticipants stated that
their pregnancy was unexpected and that
the first physical symptoms came as a
surprise. For some, this can be attributed
to avoidance and denial, but others were
genuinely surprised. Mostof the young
participants knew that they could become
pregnant from having unprotected sex,
but for some reason they did not think
they would become pregnant when they
were having unprotected sex with the
father of their baby. Sources of reliable
information about sexual and reproductive
health were limited, with many participants
stating that the only things they knew about
these topics were what they had seen
on Facebook, on YouTube and in movies.
No participants repor ted receiving sex
education from parents or senior family
members, nor was there any mention of
sex education or formalised discussion
about sex at school – apart from
abstinence until marriage. Thecoverage of
sexual and reproductive health education
and access to contraception through
NGO programs appeared to be patchy
and was compromised by participants’
fears around confidentiality from the NGO
sta if they self-selected to attend sexual
health education sessions or tried to
access contraception. Participants also
demonstrated low levels of knowledge and
understanding of contraception. Condoms
were the only contraceptive method that
most of the young participants were aware
of priorto their pregnancy. Studies have
long shown that early adolescent fertility
in particular is associated with low levels
of sexual, reproductive and contraceptive
knowledge (see, for example, Okonofua,
1995). While not particularly surprising or
novel, the recurrence of these findings
here indicates that although these factors
are well known, eorts to date have not
managed to eect significant change in
many parts of the Pacific.
As condoms oer protection from HIV
and some sexually transmitted infections,
they have been the most widely promoted
form of contraception to young people
in the Pacific. Literature on condom use
among young people in Pacific settings
highlights not only barriers to accessing
condoms, but also the strong social,
cultural and religious barriers, including
stigma (McMillan &Worth, 2011). Inthis
study, the young participants also noted
diculties around sustaining condom
use in an ongoing relationship, due to
a lack of autonomy in negotiating the
use of contraception with their male
partner. Thishighlights the importance
of understanding the way that sexual
relationships are defined among
young people in Tonga and the power
relationships within them. Much has been
reported in international literature over the
years on the manner in which adolescents
determine condom use within heterosexual
relationship. Mostof the research has
underscored two dyadic factors associated
with condom use: firstly, power dynamics
between partners, whereby the partner
with more relational power is more likely
to enact their desire to, or not to, use a
condom (Li &Samp, 2019; Woolf &Maisto,
2008; Tschann, Adler, Millstein, Gurvey,
&Ellen, 2002); and secondly, safer sexual
communication, whereby communication
between partners about condom use is the
single most important predictor of condom
use (Li &Samp, 2019; Noar, Carlyle,
&Cole, 2006; Sheeran, Abraham, &Orbell,
1999). Thefindings from this study show
that increased access to condoms may
have limited benefit in reducing adolescent
unplanned pregnancy in Tonga unless
gender equality and harmful gendered
power dynamics are also addressed,
in order to give adolescent girls the
40 Adolescent Unplanned Pregnancy in the Pacific : TONGA

confidence and ability to communicate
and negotiate their desire for condom
use with their sexual partners. Thisis
consistent with the findings of McMillan
and Worth (2011), who highlighted that
in Tonga ‘individual-level approaches to
improving rates of condom use will be
inadequate unless they are informed by
an understanding of the role of identity,
culture and tradition in young people’s
decisions around condom use’ (p. 313).
Other methods of contraception do not
preclude condom use, such as long-acting
reversible contraception, and may give
more control to girls. Given the older age of
many of the participants’ sexual partners,
more detailed investigation into the ways
that young people embark on and establish
sexual relationships may also be helpful.
A few participants mentioned that during
their pregnancy they learned about, and
were oered, a contraceptive implant by
health sta (for insertion after their baby
was born). Several participants were now
using this method for long-term reversible
contraception. No participants mentioned
the emergency contraceptive pill. When
it was described to several participants,
they responded that they had never heard
of it. As all participants in this study were
in some type of ongoing relationship and
having unprotected sex on numerous
occasions when they became pregnant,
knowledge about, or access to, the
emergency contraceptive pill may not
necessarily have been helpful.
While the findings from this study show
that there are adolescent girls in Tonga
who are engaging in sexual relationships
with limited or no access to sexual and
reproductive education or contraception,
there is likely to be community resistance
to the provision of contraceptive access
and sexual and reproductive education to
girls during adolescence. Sex is not a topic
that is easily discussed in Tonga because
of cultural and religious restrictions
(WCCC, 2017) and previous research
has highlighted the influence that social
authorities and adults exert on young
people’s condom use in Tonga (McMillan
&Worth, 2011). Sexual and reproductive
health and contraceptive education for
young girls may be more acceptable if
it is delivered to both older women and
girls together, and in a forum that enables
the older women to take some ownership
of the process. Thehosting of small
mother-and-daughter group meetings or
workshops may improve, and begin to
normalise, dialogue between mothers and
their daughters on matters of sex, gender
and relationships. Improved dialogue
prior to a girl’s pregnancy is desirable.
Thisstudy found that while mothers played
a key role in instigating the first prenatal
health facility visit once they discovered
their daughter’s pregnancy, prior to the
pregnancy mothers played no role in sex
education. Inaddition, fear of parental
anger resulted in participants hiding their
pregnancy and delaying prenatal care.
Thefacilitation of such discussion may also
increase the confidence of both younger
and older women to raise or address these
issues in other interpersonal or family
situations and in wider community fora.
All our young participants expressed
that they were scared to tell their parents
that they were pregnant, and most
lied when questioned by their parents
about possible pregnancy. Several
participants expressed that their fear
was even greater because their parents
were figureheads in their church.
Inmost situations, the parents’ initial
reaction to learning of their daughter’s
pregnancy was anger, disappointment
and hurt. However, the parents’ anger
and disappointment changed to love and
support in most cases. Thisis consistent
with previous findings in Pacific Island
populations where experiences of guilt
and fear during adolescent pregnancy
are common, but family members are
generally accepting once the baby is
born (White, Mann, &Larkin, 2018).
Inthis study, once born the baby was
commonly valued and loved in the family.
41Adolescent Unplanned Pregnancy in the Pacific : TONGA

Even though, with time, most of the
young participants were given love and
support from their parents, their fear
while they were pregnant was significant
and led the young participants to hide
their pregnancy for as long as possible.
Mostdid not confirm their pregnancy or
have any interaction with a health service
until they were five or six months pregnant,
sometimes even later. Inouter island areas,
fear of parents as a barrier to accessing
prenatal care was further exacerbated
because access to a boat, and the cost of
fuel, limited the young participants’ ability
to independently travel to a health facility
on a main island. Inaddition, pregnant
adolescents who are unfamiliar with the
nearest health facility on the main island,
or the town in which it is located, may lack
the confidence or necessary information
to seek assistance there even if they were
able to overcome the transport barriers.
For the young participants who did live on
main islands in close proximity to health
facilities and NGOs oering reproductive
health services, familiarity with these
services often became an actual barrier
to accessing them due to fears about a
lack of confidentiality among the sta.
Confidentiality becomes especially dicult
to maintain when family and service
provider roles overlap. Thiswas particularly
a concern for the young participants
from Vava’u and Ha’apai, due to the
smaller population size and the increased
likelihood of familiarity with NGO and
health service sta. However, confidentiality
was an issue that participants from
Tongatapu also mentioned.
In Tonga, the age of consent (when
an individual is considered legally old
enough to consent to participation in
sexual activity) is 16 years for both men
and women. Statutory rape law is violated
when an individual has consensual sexual
contact with a person under age 16.
Because Tonga does not have a ‘close-
in-age’ exemption, it is possible for two
individuals, both under the age of 16,
whowillingly engage in intercourse to both
be prosecuted for statutory rape, although
this is rare. Similarly, no protections are
reserved for sexual relations in which one
participant is a 15-year-old and the second
is a 16- or 17-year-old. One of the young
participants in this study was 15 years old
when she became pregnant with a man
two years older than her. Because this
study focused on how the girls themselves
explained their situation and experience,
no follow-up questions were asked about
any legal action against the father of
the baby. However, the participant’s own
subjective understanding and framing
of her relationship with her baby’s father
indicated that she perceived that she had
been in a consenting sexual relationship
– even though legal consent was not
possible, given her age. While many of the
other participants outlined that the father
of their baby was several years older than
they were (often aged in their early to mid-
20s), these participants were all aged 16
years or older at the time of their sexual
interactions. No participants in this study
said they were pregnant as a result of
rape, coerced sex or violence. It is possible
that those most traumatising conditions
of conception are also the most secret,
and that this study was unable to capture
the most covert and successfully hidden
adolescent unplanned pregnancies.
Statistics from the Women &Children Crisis
Center (WCCC) in Tonga state that between
2010 and 2016, more than 2,000 cases of
domestic violence, sexual violence and
child abuse were reported and referred
to the Center. Statistics for 2016 included
334 cases of domestic violence; one case
of rape; one case of sexual harassment;
and 46 cases of child abuse. Thistotals
to 382 cases in 2016, similar to the 354
cases in 2010, with annual fluctuations over
the seven-year period (WCCC, 2016). It is
evident that violence against women and
children in Tonga remains a critical issue,
particularly considering that the cases
that present to the WCCC in Tonga do not
represent the full scale of the issue.
42 Adolescent Unplanned Pregnancy in the Pacific : TONGA

Most of the young participants in this study
had heard of ways to abort a pregnancy,
but few were sure of exactly what to do.
Someof the methods to try to abort or
‘drop the baby’ were very dangerous and
posed serious risks to the foetus, as well
as the pregnant woman. No participants
reported problems as a result. However,
it is possible that harms may emerge
later. Several participants outlined
harms that they had heard happened to
other girls who had attempted abortion.
Themost commonly mentioned method
was medicines or pills. However, only
one participant could describe in any
detail what these were or where they
could be accessed. Thisparticipant
had been forced to swallow an overdose
of paracetamol tablets by her father to
try and induce an abortion. Theother
most commonly mentioned method was
drinking ‘blue bleach’. None of the young
participants said that they had used the
blue bleach, but they mentioned other girls
they knew who had done so. Itwas also
mentioned that the blue bleach was very
dangerous and was no longer available
in the supermarket. Jumping from high
places, carrying heavy loads, having sex
while pregnant – in one case, specifically
not with the father of the baby – and
drinking strong tea were methods of
abortion mentioned by participants.
All of the young participants were asked
if they knew any traditional methods of
fertility limitation. Only one participant
was able to respond to this question and
outlined that she had heard that the leaves
of the pua-tonga plant were smashed into
a liquid and drunk to induce an abortion,
although she highlighted that she had not
tried this method herself. Several sources
confirm that pua-tonga is the Tongan name
for the flowering plant Fagraea berteriana
A. Gray (Cambie &Brewis 1997; Motley
2004). Literature on the use of pua-tonga
as an abortifacient however is conflicting,
and there is an absence of literature on
the eectiveness of any abortifacient
properties. Intheir book Anti-fertility plants
of the Pacific, Cambie and Brewis (1997)
list pua-tonga as an anti-fertility plant in
Tonga, but do not outline how the plant is
used, or specific anti-fertility outcomes in
the Tongan context. They do cite Briggs
(1985), who states that in Futuna the plant
is used as an abortifacient by ingesting a
decoction of blended scrapings from the
bark of the tree, mixed with the bark of two
trees in the coee family (Morinda citrifolia L.
and Neonauclea forsteri Merrill). Incontrast,
Whistler (1990) recorded that in Tonga an
infusion of the bark of the pua-tonga plant
is drunk for relief from improperly healed
broken bones and internal injuries. Motley
(2004) states that ‘No recorded poisonings
have been attributed to the consumption of
Fagraea fruits or decoctions made from the
plant parts’ (p. 402) but highlights that by
no means does this verify that unrecorded
deaths have not occurred from improper
consumption. Astudy by Ciganda and
Laborde (2004) of the toxic eects of
commonly used plant infusions for induced
abortion in Uruguay, although not the same
as the plants outlined in this study, identified
cases of significant morbidity and mor tality
following their ingestion. Further focused
research would be required to better
understand the role and outcomes (eective
or otherwise) of the pua-tonga plant in the
limitation of fertility in contemporary Tonga.
Although, as this traditional method was
not commonly considered or used by the
young participants in this study, particularly
compared with the more contemporary
methods of abortion they outlined, the value
of further research may be limited.
Our older participants were familiar with
all of the traditional and non-traditional
methods of abortion outlined by our
younger participants, but also mentioned
two additional methods: a grass called
matamanu that could be inserted into the
vagina to pierce the placental sac, and
the si plant, from which the young leaves
are inserted into the vagina. Cambie and
Brewis (1997) outline that the si plant is
the Tongan name for the flowering plant
Cordyline terminalis (L.) Kunth.
43Adolescent Unplanned Pregnancy in the Pacific : TONGA

Literature on the matamanu grass made
no mention of its role as an abortifacient.
Thisis likely because participants described
it as an instrument or a tool to induce an
abortion by physically piercing the placental
sac, rather than a traditional method
that relied on the chemical properties of
the plant. Incontrast, there was a lot of
literature noting that the si plant was used
as an abortifacient, although none of the
literature confirmed the eectiveness of
any abortifacient properties. Theuse of
the plants leaves to abort a pregnancy has
been noted in New Caledonia (Rageau,
1957), Vanuatu (Baker, 1928), Fiji (Seemann,
1862) and Hawaii (Gutmanis, 1979), but no
literature outlined details of the plant’s use
in the Tongan context. While participants
in this study described that its use as an
abortifacient required inser tion of the
plant’s young leaves into the vagina, other
sources outlined that an infusion made from
the leaves of the plant needed to be drunk
(Blyth, 1887; Gutmanis, 1979). Barnes, Price
and Hughes (1975) were unable to show any
significant anti-fertility eects of the si plant
when solvent extracts of the leaves were fed
to rats. Further focused research is required
to better understand the role and outcomes
(eective or otherwise) of the si plant in the
limitation of fertility in contemporary Tonga,
although the value of this may be limited as
none of the young participants in this study
mentioned the si plant.
Recent global evidence continues to
show that abortions occur as frequently in
countries which have the most restrictive
abortion legislation (banned outright or
allowed only to save the woman’s life) as
they do in countries with the least-restrictive
abortion legislation (allowed without
restriction) (Singh et al. 2018). Thecritical
dierence is that the more restrictive the
legal setting, the higher the proportion of
abortions being under taken using unsafe
methods (Singh et al. 2018);9 with unsafe
abortion a leading cause of maternal
9 An ‘unsafe method’ of abortion is one that does not
use a recommended method and is not undertaken by
a trained provider.
deaths globally (OECD, 2018). Inorder to
safeguard the health, wellbeing and rights
of women and girls who face unwanted
pregnancy in Tonga there is a need for
legislative change that would make safe
low-cost abortion (both pharmaceutical
and surgical) available to women and
girls. Current legislation in Tonga, the
Criminal Oences Act 2016 revision (MoJ,
2016), states that a woman or girl shall
be liable to imprisonment for any period
not exceeding three years if she procures
the means to administer to herself, or
allows someone else to administer to her,
drugs, noxious things or an instrument to
cause a miscarriage. If another person
supplies the woman with the means to
cause a miscarriage, they shall be liable to
imprisonment for any period not exceeding
4 years; and if another person administers
the means to cause a miscarriage to
a woman or girl, they shall be liable to
imprisonment for any period not exceeding
seven years [MoJ, 2016]. While it is highly
improbable that the legislation banning
abortion in Tonga will be repealed in the
short term, there are readily available online
resources through organisations such
as the International Planned Parenthood
Federation (IPPF)10 that could be used in the
short term to increase community support
and political will for legislation repeal by
facilitating evidence-based conversations in
the community around what abortion is, and
the detrimental consequences of unsafe
abortion practices. These resources include
written guides and short educational videos,
such as How to talk about abortion: Arights-
based messaging guide (IPPF, 2018),
How to educate about abortion: A guide
for peer educators, teachers and trainers
(IPPF, 2016), and Youth and abortion:
Keystrategies and promising practices
for increasing young women’s access to
abortion services (IPPF, 2014).
In the Pacific, there is no ocial data on the
scale of, or the harms caused by, unsafe
abortion practices. Advocacy is dicult in
10 The Tonga Family Health Association is the national
member association for the IPPF in Tonga.
44 Adolescent Unplanned Pregnancy in the Pacific : TONGA

this context and there appears to be a lack
of political will to acknowledge or address
unsafe abortions. Somedata on mortality
and morbidity rates attached to abortion
attempts in Tonga might be collected from
medical records of presentations for medical
care as a result of complications from
miscarriage. However, data from this study
suggests that many young women and girls
will not present at a hospital following self-
induced miscarriage and that hospital data
is likely to significantly underestimate the
scale of clandestine abortions.
Adoption was a frequently discussed topic
among many of the young mothers. Someof
the young participants had given their baby
for adoption to a family member, usually a
cousin. Their main motivation for giving their
baby for adoption was to be able to go back
to school and complete their studies, but
several also mentioned that it was the best
way for a better life for their baby. Insome
circumstances, there was no explicit mention
of adoption, but the young participants
explained that their parents and relatives
were looking after their baby so they could
return to school. Thecurrent education
regulation in Tonga, the Education (schools
and general provisions) Regulations 2002
(Ministry of Education, 2002), does not make
any specific provisions for the inclusion or
exclusion of students who are pregnant.
Thefindings from this study indicate that the
school environment in Tonga was not a place
our young participants felt comfortable to
continue their studies after their pregnancy
was visibly noticeable to others, mainly due
to perceived stigma and shame. Whilst most
of the young participants who left school
during their pregnancy expressed a strong
desire to return to studies as soon as they
were able after the birth of their baby, none
of the participants tried to remain in school
during the middle or late stages of their
pregnancy. Although there is no explicit
exclusionary policy in the national education
regulations regarding pregnant students, the
current schooling system does not appear
to be a particularly supportive environment
during pregnancy. Even in countries
with explicit legislation that supports the
retention of students during pregnancy and
motherhood, significant incongruities have
been identified between policy intentions
to provide a supportive environment for
pregnant and parenting learners, and the
young woman’s lived experience, due to
conservative interpretations of policy, and
negative and moralistic responses from
teachers and peers (Pillow, 2006; Gender
Research and Advocacy Project, 2008;
Ngabaza &Shefer, 2013). Teachers have
themselves highlighted that their ability to
provide a supportive environment within
their classroom is compromised by their
own attitudes, lack of skills and clear
enough guidance on how to do so (Bhana,
Morrell, Shefer, &Ngabaza, 2010). Current
literature highlights that in addition to
overarching legislation to support pregnant
and parenting learners, it is equally as
imperative that education policies include
explicit clarity regarding day-to-day support
and management of pregnant and parenting
learners, including support and training for
teachers (Morrell, Bhana &Shefer, 2012;
Govender, 2012).
Most of our young participants described
that the main support they received in
being a mother came from their family.
Despite early anger and disappointment
from family members, most of the young
participants and their babies were still
living with their parents or close relatives.
Both the young mother and the child were
usually being financially supported by their
family. Many of the young participants
spoke about regret for disobeying their
parents and acknowledged that they
had caused a lot of disappointment by
compromising their parents’ schooling
and career aspirations for them. Alot of
our young participants described that
when they gave birth and saw their baby,
they had an overwhelming sense of
purpose, meaning and love in their life as a
mother. However, this did not change their
aspirations, expressed by almost all of
the young participants, to undertake more
studies and get a job.
45Adolescent Unplanned Pregnancy in the Pacific : TONGA

5.2 Regional themes
The research in Tonga was conducted as
part of a larger study called Adolescent
Unplanned Pregnancy in the Pacific, which
also collected data in Chuuk State and
Vanuatu. Due to the diversity of the social,
cultural, economic and political contexts
that constitute key dierences that cannot
be adequately measured in this study, we
do not attempt any comparisons between
the country findings. We have, however,
identified some of the shared themes and
issues that emerged from the wider set of
data. While we point to common threads,
the findings highlight the distinctiveness of
each country context and the importance
of attention to local specificity in attempts
to address issues raised.
The need to make sexual and reproductive
health services and related resources and
information more accessible to adolescent
girls, including through improvement of
the provision of non-judgemental and
confidential service delivery, was common
in all three countries. Alack of skills –
particularly counselling skills – among
service providers was a significant barrier
to young people’s access to sexual and
reproductive health services in Vanuatu
(Kennedy et al., 2013a). Tovarying
degrees, the issue of service confidentiality
arose in all three countries. Instudies
undertaken across the Pacific region,
concerns about systematic violations of
confidentiality, and a variety of reasons for
this, have been raised (see Butt, 2011).
Studies have also repeatedly identified
the lack of confidentiality as a deterrent
to sexual and reproductive health service
uptake (Jenkins &Buchanan-Aruwafu,
2006; McMillan, 2008; Kennedy et al.,
2013a; O’Connor, 2018).
Data in these reports also highlighted
the need to improve access to reliable
sources of reproductive and sexual health
information for adolescent girls in all three
countries. Thedata also indicated that
dierent means of providing information
are indicated at each site. For example,
the research found that social media was
used heavily by the Tongan interviewees.
Thereliance of young Tongan participants
on social media, as well as the manner
in which it was integrated into their daily
lives, highlights its potential as a platform
from which to make locally specific and
reliable reproductive health, sexuality and
service provider information available
to Tongan girls. However, while social
media was used in Vanuatu, it was not
accessed to the same extent as in Tonga.
InVanuatu, internet and talk time on
mobile and other devices was limited
due to cost. Theparticipants in Chuuk
accessed internet services less frequently
and often could not even be contacted
by text. Therefore, it would be a mistake
to overemphasise the importance and
potential of social-media-based resources
for those areas.
In Tonga, many of the young participants
had met the father of their baby through
social media platforms such as Facebook.
Theways that young people embark
upon, and establish, sexual relationships
appeared to be quite dierent in the three
study countries, with young Tongans
connecting in virtual space; young
Ni-Vanuatu meeting partners through
regular activities, such as work or travel
(for example, on the bus or walking); and
young Chuukese appearing particularly
vulnerable when staying home alone.
The age at which a woman can legally
consent to sex with a male is 16 years
in Tonga (UNESCO, 2013), 15 years in
Vanuatu (UNESCO, 2013), and 18 years
in Chuuk (UNHRC, 2015). Thisstudy
suggests that in all three countries, it
is not uncommon for girls to become
pregnant prior to the legal age of
consent. Although the interviewees
themselves understood their relationships
as being consensual, this indicates a
need for improved understanding of
the dynamics of, and motivations for,
relationships between adolescent girls
and older males in the Pacific.
46 Adolescent Unplanned Pregnancy in the Pacific : TONGA

Babies are highly valued in all three
societies and motherhood may oer girls
not only a respected social role, but also
validation as an adult woman. Other
Pacific research has shown that having
ababy means leaving the group of girls
and joining the adult women (Salomon,
2002). Issues of feminine identity are
deeply imbricated in discourses around
motherhood among all societies and may
be particularly so in Pacific societies.
White and colleagues contended that
motherhood is central to feminine identity
and culturally signals becoming a woman
in the Pacific (White, Mann, &Larkan,
2018). Salomon (2002) used the term
‘obligatory motherhood’ to describe
how motherhood in Kanak societies is
women’s preeminent role. Pacific women’s
organisations have sought to challenge
restrictive notions of Pacific motherhood in
their advocacy work by drawing attention to
the diverse and changing ideals of women
as mothers (George, 2010).
Education appears to be deeply
implicated in feminine aspirations and
ideals. Gendered access to, and average
standards of, education dier between
Pacific countries (Clarke &Azzopardi,
2019) for arange of historical reasons.
Inthis study, the findings from Tonga
suggested a relationship between high
general standards of education and
girls’ expectations of their own lives:
the distinctiveness of the Tongan girls’
aspirational narratives suggests that raising
the educational level of all girls works to
expand and raise girls’ expectations of
self-determination, as well as of attaining
good employment, and of continuing to
train and study despite pregnancy and
young motherhood.
The participants’ narratives show that
traditional gender roles are implicated
in experiences of unplanned pregnancy
in a wide variety of ways. Attention to
expectations and norms around adolescent
sexual relationships and the resultant
impact on adolescent girls will also require
attention to young men and to dominant
notions of masculinity (Ricardo, Barker,
Pulerwitz, &Rocha, 2006).
While there are some cross-cutting issues,
such as a lack of access to sexual and
reproductive health information, there is
no one strategy (such as the use of social
media) that will be best for all Pacific Island
countries. We have outlined and discussed
in detail the most relevant factors for each
country included in this study in each of
the country-specific reports. Programs and
responses must be context specific, and
must take into account the often uneven
distribution of resources across the region,
as well as within countries, if they are to be
acceptable and eective.
47Adolescent Unplanned Pregnancy in the Pacific : TONGA

6 Recommendations
The recommendations are aimed at
policymakers and government ministries
with portfolios that include health,
education, women’s aairs, youth and
child welfare, social services and justice;
civil society organisations working in the
areas of women and children’s wellbeing,
family and child welfare, gender equality,
youth, and sexual and reproductive health;
donors; and regional organisations – all
of which have a role to play in improving
young women’s and girls’ agency in
relation to sexual and reproductive health.
• Facilitate discussions between younger
and older women about sexual and
reproductive health and gender equality.
Young girls had limited knowledge of
sexual and reproductive health and
contraception prior to pregnancy. There
is likely to be community resistance,
however, to the formalised provision
of increased sexual and reproductive
health education and contraceptive
access to girls during adolescence in
Tonga. Amore acceptable method in the
short term may be the delivery of this
information to both older women and girls
together, and in a forum that enables the
older women to take some ownership
of the process. Thehosting of small
mother-and-daughter group meetings
or workshops may improve, and begin
to normalise, dialogue between mothers
and their daughters on matters of sex,
gender and relationships. Thefacilitation
of such discussion may also increase the
confidence of both younger and older
women to raise or address these issues
in other interpersonal or family situations
and in wider community fora.
• Strengthen sexual and reproductive
health education in schools. Sexual and
reproductive health education appears to
be currently non-existent or very minimal
in schools, beyond teaching abstinence
until marriage. Sexual and reproductive
health education in schools should be
reviewed and strengthened with the aim
of ensuring that these topics are covered
adequately in the curriculum and taught
in class. Extensive consultation will be
required with the Ministry of Education
and Training, teaching sta and the
broader school community to promote
the importance and benefits of sexual
and reproductive health education in
schools and gain support before any
new curriculum is introduced. Teachers
are likely to require training in how to
teach such topics, which are traditionally
considered taboo. Alternatively, it may be
preferable for external experts to deliver
programs in schools.
• Utilise social media platforms such
as Facebook and websites to provide
anonymous and timely sexual and
reproductive health education and
support to young people. Social media
was popular among the young Tongans
in this study. Many relied on the internet
for sexual and reproductive health
information. Reliable and Tongan-specific
content made available through the
internet would oer a confidential way
to provide accurate, evidence-based,
accessible and timely information about
sexuality, reproduction, relationships
and parenting, as well as ‘where to go’
guides for care and support.
• Strengthened community programs
designed for adolescent girls and boys
to promote understanding of gender
equality and challenge harmful gender
dynamics. Adolescent girls in Tonga
frequently lack autonomy in negotiating
the use of contraception with their partner.
Thefindings from this study show that
increased access to condoms, without
also addressing gender equality and
harmful gender dynamics, will likely have
limited benefit in reducing adolescent
unplanned pregnancy in Tonga. Several
48 Adolescent Unplanned Pregnancy in the Pacific : TONGA

organisations have run programs which
aim to promote gender equality and
challenge harmful gender dynamics.
They include the Women &Children Crisis
Center, the Talitha Project and the Tonga
Family Health Association. Programs
have included male advocacy training
on ending all forms of violence against
women and girls, gender equality and
women’s human rights, implemented
by the Women & Children Crisis Center.
Another program, My Body! My Rights!,
which is implemented by the Talitha
Project, aims to support adolescent
girls in gaining increased awareness,
rights and control over their bodies and
their lives, and becoming empowered
leaders in their families and communities.
Funding should be allocated to ensure the
consistent and continual development and
delivery of these programs, in addition
to ensuring that they are appropriately
evaluated, including process, impact and
outcome evaluation.
• Strengthen the availability and
accessibility of contraceptives to
adolescents, including evidence-
based and accurate information on
its use and side eects. Arange of
contraceptive options should be made
available without judgement to young
people through a variety of accessible
and confidential sources. As adolescent
girls in Tonga frequently lack autonomy
in negotiating the use of contraception
with their partner, methods that give
more control to girls should be equally
prioritised, particularly long-acting
reversible contraceptives and the
emergency contraceptive pill.
• Strengthened healthcare worker training
on the importance of providing non-
judgemental and confidential sexual
and reproductive health services and
commodities to adolescents. Fear of
judgement and lack of confidentiality
are major access barriers to sexual
and reproductive health services
and commodities, especially for girls.
Pregnant adolescents require confidential
and supportive services in order to
access contraceptive information,
confirm a suspected pregnancy, and
access support regarding decision-
making. Healthcare workers require
strengthened training around the
importance of confidentiality and
impartiality in delivering adolescent
sexual and reproductive health and
wellbeing services, and sensitisation to
the vulnerabilities of adolescent mothers.
• Mentoring for young mothers and
support groups. Young mothers may feel
isolated from friends and social activities
when they have a baby. Support groups
or mothers’ groups were not mentioned
by any of our young participants.
Young mother mentoring programs and
support groups provide young mothers
with practical, emotional and social
support to navigate motherhood and
feel a greater sense of belonging and
acceptance. These groups can also
be used as a way for young mothers
to be educated and reminded about
the best ways to look after their baby,
including the importance and timeliness
of accessing dierent vaccinations and
postnatal check-ups.
• Support young mothers to complete
their education and gain employment.
Many of the young mothers in this study
left high school as soon as they were
visibly pregnant due to a fear of stigma
and shame. Insome cases, the young
participants’ parents encouraged or
instructed them to leave school in order
to reduce the shame they believed
the pregnancy would also bring upon
the family. Increased dialogue in
interpersonal or family situations and
inwider community fora around sex,
gender and relationships may help to
reduce the stigma around adolescent
pregnancy. Teachers also need to be
educated about how to create supportive
environments in their classrooms that
encourage pregnant adolescents to
49Adolescent Unplanned Pregnancy in the Pacific : TONGA

continue their studies for as long as
possible while pregnant, particularly if
they can complete their current year of
study or graduate before they deliver
their baby. Thiswould help mothers to
more easily return to finish their high-
school studies, undertake graduate
studies, and seek employment and a
career. Thecurrent education regulation
in Tonga does not make any specific
provisions for the inclusion or exclusion of
students who are pregnant or parenting.
Regulation amendment to include a
provision which explicitly outlines the
inclusion of pregnant and parenting
students is recommended, in conjunction
with updated education policies which
outline the day-to-day support and
management of pregnant and parenting
learners in the school system, and
support and training for teachers.
• Strengthened gender-based violence
prevention and response programs.
Gender-based violence prevention
and response programs should be
implemented to protect young pregnant
adolescent mothers who may be at risk
of gender-based violence from a male
relative or partner. Thisincludes the
provision of safe houses that support
women, including young mothers and
their children.
• Advocacy for abortion legislation
review and repeal. Thestudy found
that adolescent girls are engaging in
unsafe abortion practices. Advocacy
for abortion legislation review based on
existing research and unsafe abortion
cases presenting at health centres is
required to repeal abortion laws that
endanger women’s health and wellbeing
• Strengthened engagement with
organisations and key members of the
community that have been advocating
for strengthened sexual and reproductive
health education and/or gender equality,
access to contraception, abortion
legislation review and repeal, and
ratification of the Convention on the
Elimination of all Forms of Discrimination
against Women. There are organisations
and key people in the community that
have continued to advocate for these
matters over many years. These include
the Women &Children Crisis Center in
Tonga, the Talitha Project and the Tonga
Family Health Association.
• Ratification of the Convention on
the Elimination of all Forms of
Discrimination against Women.
• Further research as indicated by the
data. Thefindings of this study indicate
a need for further research in a number
of areas, including: investigation into
the ways that adolescent girls in the
Pacific embark on and establish sexual
relationships, including gender power
dynamics and communication in the
negotiation of contraception use; and
documentation of abortion complications
(including morbidity and mortality data
from hospitals).
50 Adolescent Unplanned Pregnancy in the Pacific : TONGA

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