Beyond risk factors to lived experiences: young women's experiences of health in Papua New Guinea.

INTRODUCTION The health of young women in rural Papua New Guinea (PNG) is often examined using individual-based risk factors which are decontextualized from the social and cultural relationships within which women's lives are embedded. Understanding the health meanings and perceptions of rural PNG women is important for bridging the gap between current health program delivery and the real needs of women. The objective of this study was to explore the health perceptions of rural PNG young women and to identify points in the lifespan where support may be required. METHODS Thirty-three young women aged between 15 and 29 years were involved in the research. Multiple data collection methods were used within interpretive qualitative methodology and these included in-depth interviews, focus group discussions, photo narrative and ranking exercises. The study was conducted in a rural community in the Wosera district of the East Sepik Province of PNG from mid-2005 to early 2006. Following a community meeting and targeted awareness about the project to female youth, purposive and snowball sampling was used to recruit young women aged 15-24 years. The mean age of participants was 21 years. Single and married participants, unmarried mothers, school leavers and current school attendees were represented. Informed consent was obtained prior to the sharing of women's narratives. Data were categorized and analysed for emerging themes and cross checked with participants for verification. RESULTS Young women viewed their health in the context of their social and cultural world and in terms of their wider life experiences. The main theme uncovered young women's strong desires for independence. Young women depended on their parents for emotional support and material possessions, and positive parental support provided young women with the opportunity to move towards independence. Freedom from economic constraints was identified as important for autonomy, and having money was discussed as a requisite for good health. Young women discussed that building healthy relationships was integral to health. For single young women this was connected with having the freedom to spend time with friends and boyfriends. Married young women noted that their health was related to the quality of their marital and familial relationships and the level of support available to meet the demands of new roles and responsibilities. CONCLUSIONS The young women's narratives document the importance of the connection between the diverse health needs of young women and the social and cultural environment in which they live. The role of connectedness with family, friends and community in young women's lives is an important issue and can provide opportunities for the delivery of culturally appropriate support to young women in response to key transitional points in their health experiences. Health practitioners and policy-makers in PNG need to reconsider their assumptions underlying women's health programs and interventions in rural areas, and broaden their perspective of health to recognise the ways in which women's personal experiences influence health.