Family Planning in Asia and the Pacific - International Council on ...

More documents

Recommendations

Info

family plann<strong>in</strong>g programme to attempt to change familysize preferences. ICPD championed <strong>in</strong>dividual sovereigntyover family size decisions <strong>and</strong> promoted <strong>in</strong>dividual needsover demographic targets 23 . This would appear to rule out<strong>the</strong> promotion of small families <strong>in</strong> general by governments,<strong>in</strong>clud<strong>in</strong>g family plann<strong>in</strong>g workers. However, familyplann<strong>in</strong>g workers obviously have a role to play <strong>in</strong> promot<strong>in</strong>g<strong>the</strong> concept of birth spac<strong>in</strong>g <strong>in</strong> <strong>the</strong> <strong>in</strong>terest of ma<strong>in</strong>ta<strong>in</strong><strong>in</strong>g<strong>the</strong> health of mo<strong>the</strong>rs <strong>and</strong> children. As Bhushan (1997)po<strong>in</strong>ted out, however, <strong>the</strong>re is someth<strong>in</strong>g of a paradox <strong>in</strong><strong>the</strong> concept of unmet need: “[O]<strong>the</strong>r th<strong>in</strong>gs be<strong>in</strong>g equal,<strong>in</strong>crease <strong>in</strong> contraceptive use decreases unmet need,whereas <strong>in</strong>crease <strong>in</strong> potential dem<strong>and</strong> <strong>in</strong>creases unmetneed”. Thus, <strong>the</strong> effort to promote child-spac<strong>in</strong>g amongwomen who do not already have an unmet need for spac<strong>in</strong>gwill <strong>in</strong>crease unmet need by <strong>in</strong>creas<strong>in</strong>g potential dem<strong>and</strong>– unless <strong>the</strong> additional unmet need created is immediatelycompensated for by an <strong>in</strong>crease <strong>in</strong> contraceptive use.This essentially br<strong>in</strong>gs <strong>the</strong> issue back to <strong>the</strong> reasons whywomen who currently have an unmet need do not <strong>in</strong>tendto use contraception <strong>in</strong> <strong>the</strong> future. An <strong>in</strong>crease <strong>in</strong> dem<strong>and</strong>without address<strong>in</strong>g current health concerns might beconsidered counterproductive 24 .AccessIn situations such as those found <strong>in</strong> Papua New Gu<strong>in</strong>ea,where a large component of unmet need is related to lackof knowledge <strong>and</strong> lack of access, <strong>the</strong> policy implications areclearer. As noted previously, <strong>in</strong> <strong>the</strong> 2006 DHS of PapuaNew Gu<strong>in</strong>ea, 43.4 per cent of currently married womenwho said that <strong>the</strong>y did not <strong>in</strong>tend to use contraception<strong>in</strong> <strong>the</strong> future <strong>in</strong>dicated that <strong>the</strong>y had no knowledge of amethod of contraception, as compared with 14.4 per centwho mentioned some form of opposition <strong>and</strong> 13.8 percent who mentioned fear of side effects. Clearly, <strong>in</strong> PapuaNew Gu<strong>in</strong>ea <strong>the</strong>re is a need to exp<strong>and</strong> knowledge of familyplann<strong>in</strong>g, but, as already noted, exp<strong>and</strong><strong>in</strong>g knowledge hasto go h<strong>and</strong> <strong>in</strong> h<strong>and</strong> with <strong>in</strong>creas<strong>in</strong>g services <strong>and</strong> supplies,as well as address<strong>in</strong>g opposition <strong>and</strong> side effects. It wouldappear that <strong>the</strong> reverse is also true: exp<strong>and</strong><strong>in</strong>g supplies<strong>and</strong> services without improv<strong>in</strong>g <strong>the</strong> quality of couples’<strong>and</strong> <strong>in</strong>dividuals’ knowledge about methods would notnecessarily <strong>in</strong>crease contraceptive use.Target<strong>in</strong>g specific groups with anunmet needBecause fertility preferences change through time, it hasbeen argued (Casterl<strong>in</strong>e <strong>and</strong> S<strong>in</strong>d<strong>in</strong>g, 2000) that <strong>in</strong>dividualscan move <strong>in</strong> <strong>and</strong> out of <strong>the</strong> state of unmet need, mak<strong>in</strong>g itimpossible to monitor which <strong>in</strong>dividuals have an unmetneed at a specific po<strong>in</strong>t <strong>in</strong> time. These authors argue thatit is <strong>in</strong>appropriate to expect health <strong>and</strong> family plann<strong>in</strong>gworkers to monitor <strong>the</strong> fertility preferences of <strong>in</strong>dividuals.The approach <strong>the</strong>y advocate is for programme managersto “be well <strong>in</strong>formed about <strong>the</strong> societal-specific causes ofunmet need <strong>and</strong>, accord<strong>in</strong>gly, develop <strong>in</strong>terventions toovercome those obstacles”. However, <strong>the</strong>y also acknowledgethat <strong>the</strong> socio-economic characteristics of persons withunmet need may be more stable than <strong>the</strong> status of specific<strong>in</strong>dividuals whose circumstances change through time.Accord<strong>in</strong>gly, <strong>the</strong>re is a case for develop<strong>in</strong>g programmesthat are aimed at those groups that are more likely to havean unmet need than o<strong>the</strong>r groups.Until recent DHS were conducted <strong>in</strong> <strong>the</strong> <strong>Pacific</strong>, it wouldhave been reasonable to assume that women liv<strong>in</strong>g <strong>in</strong> rural<strong>and</strong> remote areas would be much more likely to have anunmet need for family plann<strong>in</strong>g than women liv<strong>in</strong>g <strong>in</strong>urban centres. In <strong>the</strong> <strong>Pacific</strong> <strong>the</strong> term “rural” residence oftenimplies outer-isl<strong>and</strong>s that suffer from costly <strong>and</strong> <strong>in</strong>frequenttransport, poor health services (<strong>in</strong>clud<strong>in</strong>g difficulties <strong>in</strong>reta<strong>in</strong><strong>in</strong>g staff <strong>and</strong> keep<strong>in</strong>g stocks of medic<strong>in</strong>e up to date).However DHS results <strong>in</strong>dicate that <strong>the</strong>re is no strictdeterm<strong>in</strong>ism between rural <strong>and</strong> urban residence <strong>in</strong> crosscountrycomparison, whe<strong>the</strong>r <strong>the</strong> <strong>in</strong>dicator employed isCPR or <strong>the</strong> percentage of women with an unmet need. Asalready noted, <strong>in</strong> some countries unmet need is higher <strong>in</strong>urban areas than <strong>in</strong> rural areas <strong>and</strong> this is also true of CPR.In some countries <strong>the</strong>re is little difference. It is notable that<strong>in</strong> <strong>the</strong> two countries with <strong>the</strong> highest unmet need (PapuaNew Gu<strong>in</strong>ea <strong>and</strong> Samoa), <strong>the</strong>re is no apparent differencebetween rural <strong>and</strong> urban areas 25 .On <strong>the</strong> basis of such data, it is not possible to say thatfamily plann<strong>in</strong>g programmes are generally weaker <strong>in</strong> ruralthan urban areas. The only possible generalization from<strong>the</strong> data is that each country is different <strong>and</strong> programmesneed to be tailored to specific national circumstances.As with rural-urban differences, it would have beenreasonable on logical grounds to assume that <strong>the</strong> moreeducated women would have lower unmet need <strong>and</strong>higher contraceptive use. This expectation arises from <strong>the</strong>probability that <strong>the</strong> more educated women would havemore knowledge of family plann<strong>in</strong>g methods <strong>and</strong> be morelikely employed <strong>in</strong> paid work outside <strong>the</strong> home. However<strong>the</strong> association between education <strong>and</strong> reproductivebehaviour was already questioned <strong>in</strong> earlier KAP studiesconducted <strong>in</strong> <strong>the</strong> <strong>Pacific</strong>. The 1995 KAP study carriedout <strong>in</strong> Vanuatu found that unmet need for effective familyplann<strong>in</strong>g among currently married (or <strong>in</strong> union) womenwas 49.1 per cent for women with college or universityeducation <strong>and</strong> 49.7 per cent for women who had “no92
school<strong>in</strong>g” (House, 1999a). When all methods (both<strong>in</strong>effective <strong>and</strong> effective) were <strong>in</strong>cluded, unmet need amongwomen with only primary education (30.9%) was virtuallyidentical to that of women with some college or universityeducation (30.8%). After look<strong>in</strong>g at several <strong>in</strong>dicators offertility behaviour, House (1999a) concluded: “… fertilityseems to have a limited response to <strong>in</strong>creas<strong>in</strong>g educationat this stage of Vanuatu’s development <strong>and</strong> demographictransition”. This f<strong>in</strong>d<strong>in</strong>g foreshadowed by more than adecade <strong>the</strong> f<strong>in</strong>d<strong>in</strong>gs of <strong>the</strong> recent DHS <strong>in</strong> seven countries,which produced similar results.To some extent, however, <strong>the</strong> actual associations betweeneducation <strong>and</strong> unmet need vary between countries. InPapua New Gu<strong>in</strong>ea, women with no education havemuch higher unmet need than women with secondaryeducation; <strong>in</strong> Samoa, women with only primary educationhave higher unmet need than women with more than asecondary level, so <strong>in</strong> <strong>the</strong>se countries <strong>the</strong> relationship is<strong>in</strong> <strong>the</strong> expected direction. Aga<strong>in</strong>, <strong>the</strong> programme responsewould have to be tailored to <strong>the</strong> particular circumstancesof each country.The ICPD Programme of Action recommended that<strong>in</strong> seek<strong>in</strong>g to assess <strong>the</strong> extent of unmet need for goodqualityfamily plann<strong>in</strong>g services, countries should “payparticular attention to vulnerable <strong>and</strong> underserved groups”.As <strong>the</strong> analysis <strong>in</strong> this paper has shown, DHS do not fullyaccomplish this task <strong>in</strong> all sett<strong>in</strong>gs <strong>and</strong> additional researchus<strong>in</strong>g both quantitative <strong>and</strong> qualitative methods is needed.There is little doubt, however, that young, unmarriedpeople are both “vulnerable” <strong>and</strong> “underserved”. To someextent this is evident <strong>in</strong> <strong>the</strong> teenage fertility rate, whichis high <strong>in</strong> some countries <strong>and</strong> does not appear to follow<strong>the</strong> general fertility trend. Recourse to illegal abortion byyoung people is ano<strong>the</strong>r <strong>in</strong>dicator, although statistical dataare hard to come by 26 .Commodity securityCommodity security plansReproductive health commodity security (RHCS) hasreceived a great deal of attention <strong>in</strong> <strong>the</strong> <strong>Pacific</strong> isl<strong>and</strong>sover <strong>the</strong> past decade. In 2003, <strong>Pacific</strong> m<strong>in</strong>isters of healthagreed to <strong>the</strong> Reproductive Health Commodity SecurityPlan of Action for <strong>the</strong> region. The Regional Workshop onRHCS was subsequently conducted <strong>in</strong> 2004 for healthpersonnel from <strong>Pacific</strong> isl<strong>and</strong> countries. In 2008, <strong>Pacific</strong>m<strong>in</strong>isters of health endorsed <strong>the</strong> <strong>Pacific</strong> Policy Frameworkfor Achiev<strong>in</strong>g Universal Access to Reproductive HealthServices <strong>and</strong> Commodities. Dur<strong>in</strong>g <strong>the</strong> period 2005-2008,<strong>the</strong> UNFPA <strong>Pacific</strong> Sub-regional Office <strong>in</strong> Fiji carried outdetailed assessments of <strong>the</strong> status of reproductive healthcommodity security <strong>in</strong> 10 <strong>Pacific</strong> isl<strong>and</strong> countries. Some of<strong>the</strong>se assessments were follow-ups on earlier assessmentsconducted with<strong>in</strong> <strong>the</strong> previous five years, thus changesthrough time have also been assessed. Evidence-basedGuidel<strong>in</strong>es <strong>in</strong> <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> for Health Personnel havealso been prepared for several <strong>Pacific</strong> isl<strong>and</strong> countries,which also cover commodity security <strong>and</strong> related topics.These assessments have been comprehensive, cover<strong>in</strong>g <strong>the</strong>full range of issues connected with commodity security,<strong>in</strong>clud<strong>in</strong>g <strong>the</strong> follow<strong>in</strong>g:Legislative framework <strong>and</strong> its impact on contraceptiveavailability <strong>and</strong> quality controlPolicy framework <strong>and</strong> <strong>the</strong> level of politicalcommitmentCoord<strong>in</strong>ation between components of <strong>the</strong> healthsystem, NGOs, <strong>and</strong> o<strong>the</strong>rsLogistical systems for manag<strong>in</strong>g stockMethods of forecast<strong>in</strong>g <strong>and</strong> mak<strong>in</strong>g procurementarrangementsInclusion of contraceptives on “essential drugs list”Ma<strong>in</strong>tenance of records <strong>and</strong> compilation of statisticsSupervisionThe quality <strong>and</strong> scope of <strong>the</strong>se assessments is somewhatvariable <strong>and</strong> <strong>the</strong>refore <strong>the</strong> results are not easily summarized.In general, much less attention has been paid to <strong>the</strong>situation <strong>in</strong> rural areas or outer isl<strong>and</strong>s, ma<strong>in</strong>ly because of<strong>the</strong> lack of, or high costs associated with, transportation<strong>and</strong> <strong>the</strong> limited amount of time available to <strong>the</strong> assessors.The results of <strong>the</strong>se assessments cannot be discussed <strong>in</strong>detail here, but <strong>the</strong> overall impression <strong>the</strong>y give is that <strong>the</strong>reare no significant legislative barriers to <strong>the</strong> purchase orsupply of contraceptives <strong>in</strong> <strong>the</strong>se countries <strong>and</strong> <strong>the</strong> overallpolicy stance of governments is positive. Some countriesstill have regulations <strong>in</strong> place that require a husb<strong>and</strong>’ssignature before a tubal ligation procedure can be carriedout, <strong>and</strong> this requirement is seen by some women to bea constra<strong>in</strong>t upon <strong>the</strong>ir reproductive rights, but suchregulations are undergo<strong>in</strong>g review. While “stockouts” (asituation which occurs when <strong>the</strong> dem<strong>and</strong> or requirementfor an item cannot be fulfilled from <strong>the</strong> current <strong>in</strong>ventory)are reported <strong>in</strong> most countries, <strong>the</strong>re are no precise figureson how frequently <strong>the</strong>se occur <strong>and</strong> to what extent womenare unprotected aga<strong>in</strong>st unwanted pregnancy <strong>and</strong> for howlong. In most countries, contraceptives have been placedon <strong>the</strong> “essential medic<strong>in</strong>e list” <strong>in</strong> order to guarantee <strong>the</strong>security of supplies.93
Page 1:
Family Pla
Page 7 and 8:
ForewordThe Asia <
Page 11:
Part 1Part 1Asia <
Page 14 and 15:
Ensuring that <str
Page 16 and 17:
of methods for all, in</str
Page 18 and 19:
and undertake <str
Page 21 and 22:
Report on the Regi
Page 23 and 24:
SESSION 1: Changin
Page 25 and 26:
that improving <st
Page 31:
at a hospital would be offered post
Page 35:
Bounkoung Phichit, Deputy M
Page 38 and 39:
medicines
Page 40 and 41:
Thus, while knowledge of modern met
Page 42 and 43:
Hon. Mr. Malakai Tabar, Chairman, P
Page 44 and 45:
curricula. If the
Page 47:
dialogue as well as regional <stron
Page 51: BackgroundGlobal development effort
Page 54 and 55: TableTable1EventNational policyYear
Page 56 and 57: A third observation is that reporte
Page 58 and 59: TableTable2Current Contraceptive Pr
Page 60 and 61: Figure(-1.2), Cook Island</
Page 62: FigureTableTable3Trends in<
Page 65 and 66: Nam. Nearly all economies i
Page 67: 2008 2009% Bilateral % Multilateral
Page 70 and 71: family planning wi
Page 73 and 74: IntroductionFamily
Page 75 and 76: The advent of the
Page 77 and 78: FigureFigure1Oceania and</s
Page 79 and 80: next 25 years, however, TFR fluctua
Page 81 and 82: FigureFigureFigure2Total fertility
Page 83 and 84: family planning pr
Page 85 and 86: esponsible for the
Page 87 and 88: that estimates of CPR for earlier p
Page 90 and 91: Figuremarried at an older age compa
Page 92 and 93: As previously mentioned most <stron
Page 94 and 95: FigureFigure945Relationship between
Page 96 and 97: The concept of “unmet need” has
Page 98 and 99: TableTable8Percentage of th
Page 100 and 101: TableTable9Percentage of reasons fo
Page 104 and 105: As far as the supp
Page 106 and 107: Socio-cultural challenges tofamily
Page 108 and 109: likely to use contraception than yo
Page 110 and 111: 15 Tests of statistical significanc
Page 112 and 113: of the South <stro
Page 114 and 115: 104
Page 116: Figurewill exceed the</stro
Page 119 and 120: in urban (67%) tha
Page 121 and 122: ased service delivery poin<
Page 123 and 124: Most FWAs who were recruited two to
Page 125 and 126: are considered, unmet need for effe
Page 127 and 128: Households pay the
Page 129 and 130: Effective public-private partnershi
Page 131 and 132: ConclusionThe Bangladesh Fa
Page 133 and 134: the Family
Page 135 and 136: National Institute for Population R
Page 137 and 138: IndiaIndiaFamily <
Page 139: IntroductionThe use of contraceptiv
Page 142 and 143: TableTable2Indicators of tra<strong
Page 144 and 145: FigureFigureFigure1Contraceptive pr
Page 146 and 147: TableTable5Indicators of contracept
Page 148 and 149: TableTable6Adjusted odds ratios for
Page 150 and 151: FigureFigure3Contraceptive prevalen
Page 152 and 153:
TableTable7Adjusted and</st
Page 154 and 155:
the north
Page 156 and 157:
TableTable10Differences between nor
Page 158 and 159:
TableTable11 Total fertility rate <
Page 160 and 161:
End Note1The first camp was success
Page 162 and 163:
152
Page 164 and 165:
154
Page 166 and 167:
Figure1980s and ex
Page 168 and 169:
health care and ed
Page 170 and 171:
assistance from UNFPA and</
Page 172 and 173:
in CPR. Likewise,
Page 174 and 175:
International supp
Page 176 and 177:
in development has
Page 178 and 179:
__________ (2007). Population <stro
Page 180 and 181:
170
Page 182 and 183:
TableTable2What has the</st
Page 184 and 185:
174
Page 186 and 187:
per cent of women reported us<stron
Page 188 and 189:
is provider bias that such methods
Page 190 and 191:
TableTable7skewed distribution of h
Page 192 and 193:
TableTable8TableTable9182
Page 194 and 195:
that of the nation
Page 196 and 197:
TableTable12 7some policies that ex
Page 198 and 199:
The system guides the</stro
Page 200 and 201:
FigureFigure4Total donor expenditur
Page 202 and 203:
FigureFigureagain
Page 204 and 205:
Impact of family plannin</s
Page 206 and 207:
marketing of contr
Page 208 and 209:
United States Agency for In
Page 210 and 211:
200
Page 212 and 213:
acceptable. From an NGO perspective
Page 214 and 215:
FigureThis trend of limited donor f
Page 216 and 217:
Figureto have the
Page 218 and 219:
FigureFigure5Percentage change <str
Page 220 and 221:
FigureFigure6Desire to limit childb
Page 222 and 223:
coordination betwe
Page 224 and 225:
the 1980s
Page 226 and 227:
Policy Management.__________ (n.d.,
Page 228 and 229:
218
Page 230 and 231:
Population Activities (UNFPA) for a
Page 232 and 233:
where family plannin</stron
Page 234 and 235:
Thus an objective assessment of <st
Page 236 and 237:
226
Page 238 and 239:
Figureeconomic growth durin
Page 240 and 241:
TableTable1TableTable2For spac<stro
Page 242 and 243:
eflect a provider bias (e.g., <stro
Page 244 and 245:
The Indonesian delegation was very
Page 246 and 247:
than in ensur<stro
Page 248 and 249:
in-country <strong
Page 250 and 251:
(Ministry of Healt
Page 252 and 253:
242
Page 254 and 255:
244
Page 256 and 257:
FigureTrends and p
Page 258 and 259:
TableTable3Unmet need for contracep
Page 260 and 261:
TableTable5TableTable6TableTable725
Page 262 and 263:
TableTable8TableTable9Malaysia, abo
Page 264 and 265:
previously mentioned is based on fo
Page 266 and 267:
TableTable16births and</str
Page 268 and 269:
FigureFigure3TRF54.5Scatter plots o
Page 270 and 271:
ReferencesAng, Eng Suan (2007). Stu
Page 272 and 273:
Demographic data sheet: population
Page 274 and 275:
population size, with just 336,000
Page 276 and 277:
NuptialityIn Myanmar nuptiality is
Page 278 and 279:
FigureIn Myanmar, birth-spac<strong
Page 280 and 281:
Scope of coverage and</stro
Page 282 and 283:
FigureIn Myanmar, out of six select
Page 284 and 285:
equirements. The Min</stron
Page 286 and 287:
according to <stro
Page 288 and 289:
Adolescent sexual and</stro
Page 290 and 291:
FigureHIV/AIDS. An HIV-positive wom
Page 292 and 293:
National Population PolicyMyanmar i
Page 294 and 295:
Linkages with o<st
Page 296 and 297:
TableTable4Achievements of Myanmar
Page 298 and 299:
monitoring <strong
Page 300 and 301:
Nay Pyi Taw, 26 October 2010.53 Sit
Page 302 and 303:
292
Page 304 and 305:
294
Page 306 and 307:
TableTableA296
Page 308 and 309:
dispense and adm<s
Page 310 and 311:
(1) I am against a
Page 312 and 313:
FigureFigureFigure3Use of modern co
Page 314 and 315:
FigureFigure7Traditional method use
Page 316 and 317:
Figureprojection, and</stro
Page 318 and 319:
Figure 11 summarizes the</s
Page 320 and 321:
correlating <stron
Page 322 and 323:
Figurethe use of c
Page 324 and 325:
FigureFigure15Sexual behaviour <str
Page 326 and 327:
track the distribu
Page 328 and 329:
Figureservices, which should <stron
Page 330 and 331:
FigureFigureFigure18 Population <st
Page 332 and 333:
National Statistics Office, <strong
Page 334 and 335:
Page 336 and 337:
TableTable11326
Page 338 and 339:
Page 340 and 341:
TableTable19Laws and</stron
Page 342 and 343:
worker and hours w
Page 344 and 345:
334
Page 346 and 347:
336
Page 348 and 349:
includin</
Page 350 and 351:
TableTable1Contraceptive prevalence
Page 352 and 353:
These results suggest that about 70
Page 354 and 355:
2 The (period) TFR is the</
Page 356 and 357:
346
Page 358 and 359:
FigureThe existence of traditional
Page 360 and 361:
Guinea case by <st
Page 362 and 363:
The establishment of provin
Page 364 and 365:
provide family plannin</str
Page 366 and 367:
Figurelegal requirement nor a condi
Page 368 and 369:
FigureTableTable5TableTable6Figure4
Page 370 and 371:
modern method and
Page 372 and 373:
married or in unio
Page 374 and 375:
Figureolder. Both the</stro
Page 376 and 377:
TableTable15The immediate past Nati
Page 378 and 379:
out that the “ne
Page 380 and 381:
Commodity securitySupply cha<strong
Page 382 and 383:
is able to achieve. In Papua New Gu
Page 384 and 385:
Qualitative assessments by a number
Page 386 and 387:
increasin<
Page 388 and 389:
service delivery poin</stro
Page 390 and 391:
Population: Views from Men
Page 392 and 393:
1545-1730Day 2: December 9Session 2
Page 394 and 395:
Day 3, December 10Session 50830-100
Page 396 and 397:
15Mr. Tong Sithen1
Page 398 and 399:
54Ms. Shadiya IbrahimAssistant Repr
Page 400 and 401:
93Mr. Melkie AntonProject OfficerUn
Page 402 and 403:
131Dr. John P. SkibiakDirectorRepro
Page 404:
International <str
show all

Family Planning in Asia and the Pacific - International Council on ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?