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Socio-cultural challenges tofamily plann<strong>in</strong>gThe dem<strong>and</strong> for <strong>and</strong> supply ofchildrenLarge family size as a cultural normThe decl<strong>in</strong>e <strong>in</strong> <strong>in</strong>fant <strong>and</strong> child mortality rates from <strong>the</strong> laten<strong>in</strong>eteenth <strong>and</strong> early twentieth century <strong>in</strong>creased <strong>the</strong> supplyof children likely to survive to adulthood, thus <strong>in</strong>creas<strong>in</strong>g<strong>the</strong> <strong>in</strong>centive to employ fertility controls with<strong>in</strong> marriage.The ab<strong>and</strong>onment of customary practices that had limitedfertility <strong>in</strong> <strong>the</strong> pre-contact period also contributed to an<strong>in</strong>creas<strong>in</strong>g potential supply of surviv<strong>in</strong>g children. Thereis no evidence to support <strong>the</strong> proposition that any <strong>Pacific</strong>isl<strong>and</strong> culture sought to produce as many children as wasphysiologically possible for a woman to bear, or as manyas “God provided”. In areas where <strong>in</strong>ter-tribal warfarewas endemic <strong>the</strong>re was a belief that <strong>the</strong>re is “strength <strong>in</strong>numbers”, <strong>and</strong> <strong>the</strong>se beliefs persist today <strong>in</strong> some areas(Pataki-Schweitzer, 1996). In pre-contact times, however,pregnancy <strong>and</strong> childhood were well understood by bothwomen <strong>and</strong> men to carry risks to health <strong>and</strong> life, thuswomen were disposed to avoid excessive childbear<strong>in</strong>g bywhatever means were available. From a male perspective,contact with women was potentially debilitat<strong>in</strong>g <strong>in</strong> any case,<strong>and</strong> mak<strong>in</strong>g women pregnant was considered “work”. 27Missionary teach<strong>in</strong>g did not stress large families as such butra<strong>the</strong>r that <strong>the</strong> decision on <strong>the</strong> number of children that awoman would bear was not hers to make but ra<strong>the</strong>r God’s.Interference with God’s will <strong>in</strong> such matters was s<strong>in</strong>ful.In those areas that had experienced a massive <strong>in</strong>crease<strong>in</strong> mortality follow<strong>in</strong>g <strong>the</strong> <strong>in</strong>troduction of unfamiliar<strong>in</strong>fectious diseases, missionary views were functional<strong>in</strong> ensur<strong>in</strong>g that such decimated populations recovered<strong>the</strong>ir numbers. However pronatalist attitudes rema<strong>in</strong>edstrong for several generations afterwards, long after futurepopulation growth <strong>and</strong> cultural survival had been assured.However, <strong>the</strong>re is a wide range of evidence that suggeststhat a family of three or four children is still generallypreferred among <strong>Pacific</strong> peoples, who cont<strong>in</strong>ue to live <strong>in</strong> <strong>the</strong>rural village universe, <strong>and</strong> this accounts for <strong>the</strong> low level of“unmet need” for family plann<strong>in</strong>g <strong>in</strong> some countries. In someareas it is still believed that a man is not fully mature <strong>and</strong>qualified to participate as a full member of <strong>the</strong> communityuntil he has produced three children. The possibility thatsome of <strong>the</strong>se children may f<strong>in</strong>d employment overseas or<strong>in</strong> local towns eases <strong>the</strong> resource constra<strong>in</strong>ts that operated<strong>in</strong> earlier times when l<strong>and</strong>-tenure systems limited accessto l<strong>and</strong> beyond that owned by k<strong>in</strong> groups. As is apparentfrom <strong>the</strong> current low levels of fertility <strong>in</strong> such territoriesas French Polynesia, New Caledonia <strong>and</strong> <strong>the</strong> Nor<strong>the</strong>rnMariana Isl<strong>and</strong>s, however, high fertility is no longer anecessary component of <strong>the</strong> <strong>Pacific</strong> isl<strong>and</strong>s way of life.However, such low fertility countries <strong>and</strong> territories alsohave state-funded social security arrangements that providepeople with an <strong>in</strong>come <strong>in</strong> <strong>the</strong>ir old age, thus reduc<strong>in</strong>g <strong>the</strong>need for <strong>the</strong>m to rely on children for f<strong>in</strong>ancial support afterretirement. As already mentioned, not all of those <strong>Pacific</strong>societies that have access to overseas labour markets havepersistently high fertility. The case of Indo-Fijians proves<strong>the</strong> po<strong>in</strong>t, although this group is unique <strong>in</strong> <strong>the</strong> <strong>Pacific</strong> <strong>in</strong>hav<strong>in</strong>g very limited access to l<strong>and</strong> resources. Indo-Fijianshave rapidly reduced <strong>the</strong>ir average family size <strong>in</strong> order totake advantage of opportunities to educate <strong>the</strong>ir childrenfor overseas employment.Sexuality of adolescents <strong>and</strong> youngpeopleIn most <strong>Pacific</strong> cultures, young people between <strong>the</strong> ageof puberty <strong>and</strong> early adulthood were given considerablefreedom to experiment <strong>in</strong> matters of sex <strong>and</strong> sexuality,although <strong>the</strong>re is much variation across <strong>and</strong> with<strong>in</strong> cultures.A very widespread belief, remnants of which exist today, isthat a young woman will become pregnant only if she hasrepeated <strong>in</strong>tercourse with <strong>the</strong> same partner. Switch<strong>in</strong>g ofpartners, it was believed, would ensure that a pregnancywould not occur. In Tahiti (<strong>in</strong> French Polynesia), well <strong>in</strong>to<strong>the</strong> modern era, mo<strong>the</strong>rs advised <strong>the</strong>ir daughters not tostay with one boyfriend for this reason (Levy, 1973). It isalso not uncommon for young men to prefer to marry awoman who has already given birth as visible proof thatshe is fertile, thus guarantee<strong>in</strong>g additional children.Adolescent sexuality, however, rema<strong>in</strong>s a highly contestedarea <strong>in</strong> <strong>the</strong> <strong>Pacific</strong> <strong>and</strong> attitudes are chang<strong>in</strong>g very slowly.The view that sexuality education <strong>and</strong> <strong>the</strong> supply ofcontraceptives to young, unmarried people will leadto promiscuity result<strong>in</strong>g <strong>in</strong> unwanted pregnancy <strong>and</strong>br<strong>in</strong>g shame to <strong>the</strong> family is still widespread. In <strong>the</strong><strong>Pacific</strong>, adolescent pregnancy generally occurs outsidemarriage, unlike <strong>in</strong> Africa or India where teenage birthsresult primarily from early age of marriage. Where oldergatekeepers, <strong>in</strong>clud<strong>in</strong>g public health nurses <strong>and</strong> privatepharmacy staff, believe that access to contraceptives by<strong>the</strong> unmarried is contrary to <strong>the</strong> moral order of society,adolescents will have difficulty practis<strong>in</strong>g safe sex <strong>and</strong>avoid<strong>in</strong>g unwanted pregnancy.Gender <strong>and</strong> family relationsGender equality is far from be<strong>in</strong>g achieved <strong>in</strong> <strong>the</strong> <strong>Pacific</strong>,although it is not clear to what extent <strong>the</strong> current statusof gender relations affects fertility levels, <strong>the</strong> use ofcontraception <strong>and</strong> <strong>the</strong> unmet need for family plann<strong>in</strong>g.96
In general, opposition from husb<strong>and</strong>s is not cited bywomen as a major cause of <strong>the</strong>ir unwill<strong>in</strong>gness to usecontraception. However, <strong>the</strong> prevalence of gender-basedviolence is very high <strong>in</strong> those countries where researchhas been conducted, <strong>and</strong> it is likely that coercive sexualrelations results <strong>in</strong> unwanted pregnancy.Socio-cultural research on male attitudes towardscontraception <strong>and</strong> family plann<strong>in</strong>g <strong>in</strong> <strong>the</strong> <strong>Pacific</strong> is limited;thus, more such research is needed.Conclusions <strong>and</strong>recommendationsConclusionsThis paper has reviewed recent micro- <strong>and</strong> macrolevelevidence of relationships between fertility trends,contraceptive prevalence <strong>and</strong> unmet need for familyplann<strong>in</strong>g <strong>in</strong> <strong>Pacific</strong> isl<strong>and</strong> countries. The ma<strong>in</strong> conclusionsfrom this analysis are as follows.There is evidence that <strong>the</strong> fertility transition has“stalled” <strong>in</strong> several <strong>Pacific</strong> isl<strong>and</strong> countries. The totalfertility rate is currently about 4.0 <strong>in</strong> 9 countries <strong>and</strong> <strong>in</strong>some of <strong>the</strong>se countries fertility has hardly changed forover a decade or even longer. However, <strong>in</strong> several o<strong>the</strong>rcountries <strong>and</strong> territories, fertility decl<strong>in</strong>e has cont<strong>in</strong>uedunabated. With <strong>the</strong> exception of Fiji, <strong>the</strong> countries thathave experienced an un<strong>in</strong>terrupted fertility transitionto <strong>the</strong> replacement or near-replacement level are thosethat are <strong>in</strong> some form of political dependency withmetropolitan states 28 . The particular features of <strong>the</strong>sepolitical l<strong>in</strong>ks that are conducive to fertility decl<strong>in</strong>ehave not been exam<strong>in</strong>ed <strong>in</strong> this study, but it is probablethat a comb<strong>in</strong>ation of higher per capita <strong>in</strong>comes, <strong>the</strong>availability of private medical care <strong>and</strong> health <strong>in</strong>surance,higher levels of education <strong>and</strong> greater formal labourforce participation among women are key factors. 29Similarly, contraceptive prevalence rates <strong>in</strong> many <strong>Pacific</strong>countries have rema<strong>in</strong>ed below <strong>the</strong> average for <strong>the</strong> lessdeveloped regions of <strong>the</strong> world <strong>and</strong> have <strong>in</strong>creasedat a slow pace or not at all over <strong>the</strong> past decade ormore. In some countries it is likely that official ratesare understated due to <strong>the</strong> exclusion of private healthproviders from health m<strong>in</strong>istry statistics, but surveybasedestimates generally capture all sources of supply.Notwithst<strong>and</strong><strong>in</strong>g <strong>the</strong>se measurement issues, several<strong>Pacific</strong> countries appear to fit a common pattern of rapidtake-up of family plann<strong>in</strong>g on <strong>the</strong> <strong>in</strong>itial establishmentof a programme followed by a plateau that may lastfor many years. This paper has not exam<strong>in</strong>ed <strong>the</strong>historical evidence underly<strong>in</strong>g <strong>the</strong> levell<strong>in</strong>g-off of <strong>the</strong>rate contraceptive use, but it is likely that a comb<strong>in</strong>ationof factors is responsible, <strong>in</strong>clud<strong>in</strong>g <strong>the</strong> follow<strong>in</strong>g:A preference for a family size of 3-4 children as aresult of <strong>the</strong> need for old-age security <strong>in</strong> <strong>the</strong> absenceof alternative sources of supportDissatisfaction with <strong>the</strong> available methods ofcontraception <strong>and</strong> <strong>the</strong> limited range of alternativesActual or perceived side effects, particularly due tohormonal methods <strong>and</strong> IUDsThe <strong>in</strong>fluence of some churches whose doctr<strong>in</strong>es donot allow <strong>in</strong>terference with <strong>the</strong> natural function<strong>in</strong>gof <strong>the</strong> human body, which <strong>in</strong>cludes opposition tosterilization ei<strong>the</strong>r of men or womenIn several Melanesian countries, notably Papua NewGu<strong>in</strong>ea, Solomon Isl<strong>and</strong>s <strong>and</strong> Vanuatu, fertility decl<strong>in</strong>ehas been slow, but <strong>the</strong> use of modern contraception has<strong>in</strong>creased quite steadily over <strong>the</strong> past two decades, evenaga<strong>in</strong>st many obstacles. The slow pace of fertility decl<strong>in</strong>e<strong>in</strong> <strong>the</strong>se countries is related <strong>in</strong> part to <strong>the</strong> slow decl<strong>in</strong>e <strong>in</strong>family size preferences, although <strong>in</strong> Papua New Gu<strong>in</strong>ea,<strong>the</strong> gap between <strong>the</strong> “wanted” TFR (3.0) <strong>and</strong> “actual”TFR (4.4) is now 1.4 children, a significantly smallerlevel than it was 20 years ago. Limited access to healthservices <strong>in</strong> general – <strong>and</strong> reproductive health services <strong>in</strong>particular – is constra<strong>in</strong><strong>in</strong>g <strong>the</strong> use of family plann<strong>in</strong>g<strong>in</strong> that country.The cross-country relationships between fertility<strong>and</strong> socio-economic factors, such as GDP per capita(R2=0.017) 30 , <strong>and</strong> <strong>the</strong> proportion of <strong>the</strong> populationbelow <strong>the</strong> basic needs poverty l<strong>in</strong>e is weak (R2=0.018).Similarly, <strong>the</strong> contraceptive prevalence rate is onlyweakly associated with <strong>the</strong> level of GDP per capita(R2=0.208). TFR shows some association with <strong>in</strong>fantmortality (R2=0.5165), as transition <strong>the</strong>ory wouldpredict.At <strong>the</strong> microlevel, <strong>the</strong> expected relationship between <strong>the</strong>socio-economic status of women <strong>and</strong> contraceptive usewas not found <strong>in</strong> all countries. Although contraceptiveuse rises with education <strong>in</strong> some countries, <strong>in</strong> o<strong>the</strong>rs<strong>the</strong>re is an <strong>in</strong>verse relationship. However, <strong>the</strong> weight ofevidence suggests that women educated to <strong>the</strong> secondarylevel or beyond are more likely to use contraception thanwomen with little or no education.Similarly, rural-urban differences <strong>in</strong> contraceptive useare non-existent <strong>in</strong> some countries, while <strong>in</strong> o<strong>the</strong>rs <strong>the</strong>reverse of expectations is true, with higher contraceptiveuse be<strong>in</strong>g found <strong>in</strong> rural as compared with urban areas.This f<strong>in</strong>d<strong>in</strong>g is anomalous <strong>in</strong> <strong>the</strong> geographical contextof <strong>the</strong> <strong>Pacific</strong>.Contraceptive use is, however, closely l<strong>in</strong>ked to age<strong>and</strong> parity. Women aged 40 <strong>and</strong> older <strong>and</strong> women whoalready have had five or more children are much more97
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Family Pla
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ForewordThe Asia <
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Part 1Part 1Asia <
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Ensuring that <str
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of methods for all, in</str
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and undertake <str
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Report on the Regi
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SESSION 1: Changin
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that improving <st
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at a hospital would be offered post
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Bounkoung Phichit, Deputy M
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medicines
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Thus, while knowledge of modern met
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Hon. Mr. Malakai Tabar, Chairman, P
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curricula. If the
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dialogue as well as regional <stron
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BackgroundGlobal development effort
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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</
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Page 65 and 66: Nam. Nearly all economies i
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Page 70 and 71: family planning wi
Page 73 and 74: IntroductionFamily
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Page 77 and 78: FigureFigure1Oceania and</s
Page 79 and 80: next 25 years, however, TFR fluctua
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Page 96 and 97: The concept of “unmet need” has
Page 98 and 99: TableTable8Percentage of th
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Page 131 and 132: ConclusionThe Bangladesh Fa
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TableTable10Differences between nor
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TableTable11 Total fertility rate <
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End Note1The first camp was success
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152
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154
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Figure1980s and ex
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health care and ed
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assistance from UNFPA and</
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in CPR. Likewise,
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International supp
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in development has
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__________ (2007). Population <stro
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170
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TableTable2What has the</st
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174
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per cent of women reported us<stron
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is provider bias that such methods
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TableTable7skewed distribution of h
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TableTable8TableTable9182
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that of the nation
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TableTable12 7some policies that ex
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The system guides the</stro
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FigureFigure4Total donor expenditur
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FigureFigureagain
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Impact of family plannin</s
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marketing of contr
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United States Agency for In
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200
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acceptable. From an NGO perspective
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FigureThis trend of limited donor f
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Figureto have the
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FigureFigure5Percentage change <str
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FigureFigure6Desire to limit childb
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coordination betwe
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the 1980s
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Policy Management.__________ (n.d.,
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218
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Population Activities (UNFPA) for a
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where family plannin</stron
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Thus an objective assessment of <st
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226
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Figureeconomic growth durin
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TableTable1TableTable2For spac<stro
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eflect a provider bias (e.g., <stro
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The Indonesian delegation was very
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than in ensur<stro
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in-country <strong
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(Ministry of Healt
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242
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FigureTrends and p
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TableTable3Unmet need for contracep
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TableTable5TableTable6TableTable725
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TableTable8TableTable9Malaysia, abo
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previously mentioned is based on fo
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TableTable16births and</str
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FigureFigure3TRF54.5Scatter plots o
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ReferencesAng, Eng Suan (2007). Stu
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Demographic data sheet: population
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population size, with just 336,000
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NuptialityIn Myanmar nuptiality is
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FigureIn Myanmar, birth-spac<strong
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Scope of coverage and</stro
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FigureIn Myanmar, out of six select
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equirements. The Min</stron
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according to <stro
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Adolescent sexual and</stro
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FigureHIV/AIDS. An HIV-positive wom
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National Population PolicyMyanmar i
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Linkages with o<st
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TableTable4Achievements of Myanmar
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monitoring <strong
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Nay Pyi Taw, 26 October 2010.53 Sit
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TableTableA296
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dispense and adm<s
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(1) I am against a
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FigureFigureFigure3Use of modern co
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FigureFigure7Traditional method use
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Figureprojection, and</stro
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Figure 11 summarizes the</s
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correlating <stron
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Figurethe use of c
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FigureFigure15Sexual behaviour <str
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track the distribu
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Figureservices, which should <stron
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FigureFigureFigure18 Population <st
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National Statistics Office, <strong
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TableTable11326
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TableTable19Laws and</stron
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worker and hours w
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334
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336
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includin</
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TableTable1Contraceptive prevalence
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These results suggest that about 70
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2 The (period) TFR is the</
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346
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FigureThe existence of traditional
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Guinea case by <st
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The establishment of provin
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provide family plannin</str
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Figurelegal requirement nor a condi
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FigureTableTable5TableTable6Figure4
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modern method and
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married or in unio
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Figureolder. Both the</stro
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TableTable15The immediate past Nati
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out that the “ne
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Commodity securitySupply cha<strong
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is able to achieve. In Papua New Gu
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Qualitative assessments by a number
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increasin<
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service delivery poin</stro
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Population: Views from Men
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1545-1730Day 2: December 9Session 2
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Day 3, December 10Session 50830-100
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15Mr. Tong Sithen1
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54Ms. Shadiya IbrahimAssistant Repr
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93Mr. Melkie AntonProject OfficerUn
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131Dr. John P. SkibiakDirectorRepro
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International <str
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