Family Planning in Asia and the Pacific - International Council on ...
Family Planning in Asia and the Pacific - International Council on ...
Family Planning in Asia and the Pacific - International Council on ...
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school<str<strong>on</strong>g>in</str<strong>on</strong>g>g” (House, 1999a). When all methods (both<str<strong>on</strong>g>in</str<strong>on</strong>g>effective <str<strong>on</strong>g>and</str<strong>on</strong>g> effective) were <str<strong>on</strong>g>in</str<strong>on</strong>g>cluded, unmet need am<strong>on</strong>gwomen with <strong>on</strong>ly primary educati<strong>on</strong> (30.9%) was virtuallyidentical to that of women with some college or universityeducati<strong>on</strong> (30.8%). After look<str<strong>on</strong>g>in</str<strong>on</strong>g>g at several <str<strong>on</strong>g>in</str<strong>on</strong>g>dicators offertility behaviour, House (1999a) c<strong>on</strong>cluded: “… fertilityseems to have a limited resp<strong>on</strong>se to <str<strong>on</strong>g>in</str<strong>on</strong>g>creas<str<strong>on</strong>g>in</str<strong>on</strong>g>g educati<strong>on</strong>at this stage of Vanuatu’s development <str<strong>on</strong>g>and</str<strong>on</strong>g> demographictransiti<strong>on</strong>”. This f<str<strong>on</strong>g>in</str<strong>on</strong>g>d<str<strong>on</strong>g>in</str<strong>on</strong>g>g foreshadowed by more than adecade <str<strong>on</strong>g>the</str<strong>on</strong>g> f<str<strong>on</strong>g>in</str<strong>on</strong>g>d<str<strong>on</strong>g>in</str<strong>on</strong>g>gs of <str<strong>on</strong>g>the</str<strong>on</strong>g> recent DHS <str<strong>on</strong>g>in</str<strong>on</strong>g> seven countries,which produced similar results.To some extent, however, <str<strong>on</strong>g>the</str<strong>on</strong>g> actual associati<strong>on</strong>s betweeneducati<strong>on</strong> <str<strong>on</strong>g>and</str<strong>on</strong>g> unmet need vary between countries. InPapua New Gu<str<strong>on</strong>g>in</str<strong>on</strong>g>ea, women with no educati<strong>on</strong> havemuch higher unmet need than women with sec<strong>on</strong>daryeducati<strong>on</strong>; <str<strong>on</strong>g>in</str<strong>on</strong>g> Samoa, women with <strong>on</strong>ly primary educati<strong>on</strong>have higher unmet need than women with more than asec<strong>on</strong>dary level, so <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g>se countries <str<strong>on</strong>g>the</str<strong>on</strong>g> relati<strong>on</strong>ship is<str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> expected directi<strong>on</strong>. Aga<str<strong>on</strong>g>in</str<strong>on</strong>g>, <str<strong>on</strong>g>the</str<strong>on</strong>g> programme resp<strong>on</strong>sewould have to be tailored to <str<strong>on</strong>g>the</str<strong>on</strong>g> particular circumstancesof each country.The ICPD Programme of Acti<strong>on</strong> recommended that<str<strong>on</strong>g>in</str<strong>on</strong>g> seek<str<strong>on</strong>g>in</str<strong>on</strong>g>g to assess <str<strong>on</strong>g>the</str<strong>on</strong>g> extent of unmet need for goodqualityfamily plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g services, countries should “payparticular attenti<strong>on</strong> to vulnerable <str<strong>on</strong>g>and</str<strong>on</strong>g> underserved groups”.As <str<strong>on</strong>g>the</str<strong>on</strong>g> analysis <str<strong>on</strong>g>in</str<strong>on</strong>g> this paper has shown, DHS do not fullyaccomplish this task <str<strong>on</strong>g>in</str<strong>on</strong>g> all sett<str<strong>on</strong>g>in</str<strong>on</strong>g>gs <str<strong>on</strong>g>and</str<strong>on</strong>g> additi<strong>on</strong>al researchus<str<strong>on</strong>g>in</str<strong>on</strong>g>g both quantitative <str<strong>on</strong>g>and</str<strong>on</strong>g> qualitative methods is needed.There is little doubt, however, that young, unmarriedpeople are both “vulnerable” <str<strong>on</strong>g>and</str<strong>on</strong>g> “underserved”. To someextent this is evident <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> teenage fertility rate, whichis high <str<strong>on</strong>g>in</str<strong>on</strong>g> some countries <str<strong>on</strong>g>and</str<strong>on</strong>g> does not appear to follow<str<strong>on</strong>g>the</str<strong>on</strong>g> general fertility trend. Recourse to illegal aborti<strong>on</strong> byyoung people is ano<str<strong>on</strong>g>the</str<strong>on</strong>g>r <str<strong>on</strong>g>in</str<strong>on</strong>g>dicator, although statistical dataare hard to come by 26 .Commodity securityCommodity security plansReproductive health commodity security (RHCS) hasreceived a great deal of attenti<strong>on</strong> <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> <str<strong>on</strong>g>Pacific</str<strong>on</strong>g> isl<str<strong>on</strong>g>and</str<strong>on</strong>g>sover <str<strong>on</strong>g>the</str<strong>on</strong>g> past decade. In 2003, <str<strong>on</strong>g>Pacific</str<strong>on</strong>g> m<str<strong>on</strong>g>in</str<strong>on</strong>g>isters of healthagreed to <str<strong>on</strong>g>the</str<strong>on</strong>g> Reproductive Health Commodity SecurityPlan of Acti<strong>on</strong> for <str<strong>on</strong>g>the</str<strong>on</strong>g> regi<strong>on</strong>. The Regi<strong>on</strong>al Workshop <strong>on</strong>RHCS was subsequently c<strong>on</strong>ducted <str<strong>on</strong>g>in</str<strong>on</strong>g> 2004 for healthpers<strong>on</strong>nel from <str<strong>on</strong>g>Pacific</str<strong>on</strong>g> isl<str<strong>on</strong>g>and</str<strong>on</strong>g> countries. In 2008, <str<strong>on</strong>g>Pacific</str<strong>on</strong>g>m<str<strong>on</strong>g>in</str<strong>on</strong>g>isters of health endorsed <str<strong>on</strong>g>the</str<strong>on</strong>g> <str<strong>on</strong>g>Pacific</str<strong>on</strong>g> Policy Frameworkfor Achiev<str<strong>on</strong>g>in</str<strong>on</strong>g>g Universal Access to Reproductive HealthServices <str<strong>on</strong>g>and</str<strong>on</strong>g> Commodities. Dur<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>the</str<strong>on</strong>g> period 2005-2008,<str<strong>on</strong>g>the</str<strong>on</strong>g> UNFPA <str<strong>on</strong>g>Pacific</str<strong>on</strong>g> Sub-regi<strong>on</strong>al Office <str<strong>on</strong>g>in</str<strong>on</strong>g> Fiji carried outdetailed assessments of <str<strong>on</strong>g>the</str<strong>on</strong>g> status of reproductive healthcommodity security <str<strong>on</strong>g>in</str<strong>on</strong>g> 10 <str<strong>on</strong>g>Pacific</str<strong>on</strong>g> isl<str<strong>on</strong>g>and</str<strong>on</strong>g> countries. Some of<str<strong>on</strong>g>the</str<strong>on</strong>g>se assessments were follow-ups <strong>on</strong> earlier assessmentsc<strong>on</strong>ducted with<str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> previous five years, thus changesthrough time have also been assessed. Evidence-basedGuidel<str<strong>on</strong>g>in</str<strong>on</strong>g>es <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>Family</str<strong>on</strong>g> <str<strong>on</strong>g>Plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g</str<strong>on</strong>g> for Health Pers<strong>on</strong>nel havealso been prepared for several <str<strong>on</strong>g>Pacific</str<strong>on</strong>g> isl<str<strong>on</strong>g>and</str<strong>on</strong>g> countries,which also cover commodity security <str<strong>on</strong>g>and</str<strong>on</strong>g> related topics.These assessments have been comprehensive, cover<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>the</str<strong>on</strong>g>full range of issues c<strong>on</strong>nected with commodity security,<str<strong>on</strong>g>in</str<strong>on</strong>g>clud<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>the</str<strong>on</strong>g> follow<str<strong>on</strong>g>in</str<strong>on</strong>g>g:Legislative framework <str<strong>on</strong>g>and</str<strong>on</strong>g> its impact <strong>on</strong> c<strong>on</strong>traceptiveavailability <str<strong>on</strong>g>and</str<strong>on</strong>g> quality c<strong>on</strong>trolPolicy framework <str<strong>on</strong>g>and</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> level of politicalcommitmentCoord<str<strong>on</strong>g>in</str<strong>on</strong>g>ati<strong>on</strong> between comp<strong>on</strong>ents of <str<strong>on</strong>g>the</str<strong>on</strong>g> healthsystem, NGOs, <str<strong>on</strong>g>and</str<strong>on</strong>g> o<str<strong>on</strong>g>the</str<strong>on</strong>g>rsLogistical systems for manag<str<strong>on</strong>g>in</str<strong>on</strong>g>g stockMethods of forecast<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>and</str<strong>on</strong>g> mak<str<strong>on</strong>g>in</str<strong>on</strong>g>g procurementarrangementsInclusi<strong>on</strong> of c<strong>on</strong>traceptives <strong>on</strong> “essential drugs list”Ma<str<strong>on</strong>g>in</str<strong>on</strong>g>tenance of records <str<strong>on</strong>g>and</str<strong>on</strong>g> compilati<strong>on</strong> of statisticsSupervisi<strong>on</strong>The quality <str<strong>on</strong>g>and</str<strong>on</strong>g> scope of <str<strong>on</strong>g>the</str<strong>on</strong>g>se assessments is somewhatvariable <str<strong>on</strong>g>and</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g>refore <str<strong>on</strong>g>the</str<strong>on</strong>g> results are not easily summarized.In general, much less attenti<strong>on</strong> has been paid to <str<strong>on</strong>g>the</str<strong>on</strong>g>situati<strong>on</strong> <str<strong>on</strong>g>in</str<strong>on</strong>g> rural areas or outer isl<str<strong>on</strong>g>and</str<strong>on</strong>g>s, ma<str<strong>on</strong>g>in</str<strong>on</strong>g>ly because of<str<strong>on</strong>g>the</str<strong>on</strong>g> lack of, or high costs associated with, transportati<strong>on</strong><str<strong>on</strong>g>and</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> limited amount of time available to <str<strong>on</strong>g>the</str<strong>on</strong>g> assessors.The results of <str<strong>on</strong>g>the</str<strong>on</strong>g>se assessments cannot be discussed <str<strong>on</strong>g>in</str<strong>on</strong>g>detail here, but <str<strong>on</strong>g>the</str<strong>on</strong>g> overall impressi<strong>on</strong> <str<strong>on</strong>g>the</str<strong>on</strong>g>y give is that <str<strong>on</strong>g>the</str<strong>on</strong>g>reare no significant legislative barriers to <str<strong>on</strong>g>the</str<strong>on</strong>g> purchase orsupply of c<strong>on</strong>traceptives <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g>se countries <str<strong>on</strong>g>and</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> overallpolicy stance of governments is positive. Some countriesstill have regulati<strong>on</strong>s <str<strong>on</strong>g>in</str<strong>on</strong>g> place that require a husb<str<strong>on</strong>g>and</str<strong>on</strong>g>’ssignature before a tubal ligati<strong>on</strong> procedure can be carriedout, <str<strong>on</strong>g>and</str<strong>on</strong>g> this requirement is seen by some women to bea c<strong>on</strong>stra<str<strong>on</strong>g>in</str<strong>on</strong>g>t up<strong>on</strong> <str<strong>on</strong>g>the</str<strong>on</strong>g>ir reproductive rights, but suchregulati<strong>on</strong>s are undergo<str<strong>on</strong>g>in</str<strong>on</strong>g>g review. While “stockouts” (asituati<strong>on</strong> which occurs when <str<strong>on</strong>g>the</str<strong>on</strong>g> dem<str<strong>on</strong>g>and</str<strong>on</strong>g> or requirementfor an item cannot be fulfilled from <str<strong>on</strong>g>the</str<strong>on</strong>g> current <str<strong>on</strong>g>in</str<strong>on</strong>g>ventory)are reported <str<strong>on</strong>g>in</str<strong>on</strong>g> most countries, <str<strong>on</strong>g>the</str<strong>on</strong>g>re are no precise figures<strong>on</strong> how frequently <str<strong>on</strong>g>the</str<strong>on</strong>g>se occur <str<strong>on</strong>g>and</str<strong>on</strong>g> to what extent womenare unprotected aga<str<strong>on</strong>g>in</str<strong>on</strong>g>st unwanted pregnancy <str<strong>on</strong>g>and</str<strong>on</strong>g> for howl<strong>on</strong>g. In most countries, c<strong>on</strong>traceptives have been placed<strong>on</strong> <str<strong>on</strong>g>the</str<strong>on</strong>g> “essential medic<str<strong>on</strong>g>in</str<strong>on</strong>g>e list” <str<strong>on</strong>g>in</str<strong>on</strong>g> order to guarantee <str<strong>on</strong>g>the</str<strong>on</strong>g>security of supplies.93