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

likely to use contraception than younger, lower-paritywomen. There also appears to be an association betweencontraceptive use <strong>and</strong> contact with a health facility.The unmet need for family plann<strong>in</strong>g ranges from a lowof about 8 per cent <strong>in</strong> Marshall Isl<strong>and</strong>s <strong>and</strong> SolomonIsl<strong>and</strong>s to a high of 46 per cent <strong>in</strong> Samoa. Papua NewGu<strong>in</strong>ea is also at <strong>the</strong> high end of <strong>the</strong> range at 44 percent. Ow<strong>in</strong>g to <strong>the</strong> omission of some categories ofunmet need <strong>in</strong> <strong>the</strong> Papua New Gu<strong>in</strong>ea DHS, it is highlylikely that this country has <strong>the</strong> highest level of unmetneed among all those countries that have had a DHS <strong>in</strong>recent years.The determ<strong>in</strong>ants of unmet need for family plann<strong>in</strong>gvary considerably between countries but, o<strong>the</strong>r than<strong>in</strong> Papua New Gu<strong>in</strong>ea, lack of access, <strong>in</strong>clud<strong>in</strong>g lack ofknowledge <strong>and</strong> <strong>in</strong>ability to obta<strong>in</strong> services <strong>and</strong> supplies,is not <strong>the</strong> primary cause. The primary cause of unmetneed is “unwill<strong>in</strong>gness” to use <strong>the</strong> available methods ofcontraception. Unwill<strong>in</strong>gness to use contraception arisesfrom various types of “opposition”, ei<strong>the</strong>r for religiousor personal reasons or worries about side effects <strong>and</strong>o<strong>the</strong>r health concerns. Concerns about side effects <strong>and</strong><strong>the</strong> health risks associated with contraception are <strong>the</strong>s<strong>in</strong>gle-most important cause of unmet need <strong>in</strong> mostcountries. There is little doubt that such concerns areexacerbated <strong>in</strong> small village communities <strong>in</strong> which faceto-facecommunication dom<strong>in</strong>ates social relations 31 .Although <strong>the</strong> relationship is far from l<strong>in</strong>ear – <strong>in</strong> somecountries <strong>in</strong>verse – women with little or no educationtend to have higher levels of unmet need. The highestlevel of unmet need among any group <strong>in</strong> <strong>the</strong> countrieshav<strong>in</strong>g had a DHS was found among Samoan womenwith a primary or lower level of education (55%).The absence of close associations between socioeconomicfactors at ei<strong>the</strong>r <strong>the</strong> macro- or microlevels<strong>and</strong> contraceptive use, fertility levels <strong>and</strong> unmet needsuggests that <strong>the</strong> primary obstacle to <strong>in</strong>creased use offamily plann<strong>in</strong>g <strong>and</strong> <strong>the</strong> reduction of unmet need lies <strong>in</strong><strong>the</strong> socio-cultural systems of <strong>Pacific</strong> societies. Fur<strong>the</strong>rspecification of <strong>the</strong> precise nature of <strong>the</strong>se socioculturalfactors would require more detailed researchus<strong>in</strong>g qualitative methods ra<strong>the</strong>r than fixed-responsesurveys.RecommendationsHealth <strong>in</strong>formation systems should be redesigned tocapture all services dispens<strong>in</strong>g contraceptives, <strong>in</strong>clud<strong>in</strong>gboth public <strong>and</strong> private health services, <strong>in</strong> order toprovide a more accurate <strong>and</strong> complete measure ofcontraceptive use. The use of a dedicated reproductivehealth survey <strong>in</strong> selected countries should be employed<strong>in</strong> order to verify contraceptive use patterns <strong>and</strong> <strong>the</strong>irdeterm<strong>in</strong>ants.Fur<strong>the</strong>r analysis of DHS data should be undertaken tomore precisely identify <strong>the</strong> determ<strong>in</strong>ants of unmet needfor family plann<strong>in</strong>g <strong>and</strong> to resolve counter-<strong>in</strong>tuitivesurvey results. Such research needs to determ<strong>in</strong>e, amongo<strong>the</strong>r th<strong>in</strong>gs, whe<strong>the</strong>r concern about “side effects” arisesfrom personal experience or from second-h<strong>and</strong> reports.The socio-cultural obstacles to contraceptive useamong young, unmarried people (adolescents) <strong>and</strong>older women, both of which groups have special needs,should be reviewed.Qualitative studies should be conducted us<strong>in</strong>gappropriate methods, such as focus groups <strong>and</strong> <strong>in</strong>tensive<strong>in</strong>terviews, to determ<strong>in</strong>e <strong>the</strong> basis for opposition to <strong>the</strong>use of family plann<strong>in</strong>g. Such studies should measure<strong>the</strong> impact of reference groups with<strong>in</strong> <strong>the</strong> community,op<strong>in</strong>ion leaders <strong>and</strong> <strong>in</strong>fluential persons.Fur<strong>the</strong>r research should be conducted <strong>in</strong>to problems ofaccess <strong>in</strong> rural areas <strong>in</strong> those countries <strong>in</strong> which DHSresults suggest that unmet need is unaffected by urbanruralresidence.Qualitative studies should be conducted to developapproaches to family plann<strong>in</strong>g education for poor, <strong>and</strong>poorly educated, or illiterate women.Wherever possible, primary health services (asrecommended by <strong>the</strong> Eighth Meet<strong>in</strong>g of M<strong>in</strong>istersof Health for <strong>the</strong> <strong>Pacific</strong> Isl<strong>and</strong> Countries (WorldHealth Organization, 2010) ) should be streng<strong>the</strong>ned,particularly <strong>in</strong> rural areas, <strong>in</strong>clud<strong>in</strong>g <strong>the</strong> provision of<strong>in</strong>centives for health personnel to work <strong>in</strong> remote areas.It should be ensured that family plann<strong>in</strong>g servicesrema<strong>in</strong> free of cost.Cont<strong>in</strong>ue <strong>and</strong> if necessary exp<strong>and</strong> tra<strong>in</strong><strong>in</strong>g programmesfor reproductive health nurses to improve <strong>the</strong> qualityof counsell<strong>in</strong>g furnished to clients prior to adopt<strong>in</strong>g acontraceptive method.The central role of family plann<strong>in</strong>g <strong>in</strong> reproductivehealth programmes should be re<strong>in</strong>forced <strong>in</strong> policies <strong>and</strong>programmes.Efforts should be cont<strong>in</strong>ued to ensure that all servicedelivery po<strong>in</strong>ts have available <strong>the</strong> widest practicablechoice of contraceptive methods <strong>and</strong> that reproductivehealth nurses have <strong>the</strong> skills to provide comprehensive<strong>and</strong> accurate counsell<strong>in</strong>g.On a country-by-country basis greater use of outreach,<strong>in</strong>clud<strong>in</strong>g home visits, should be considered particularlyto follow up on women with health concerns. Methodsto encourage more frequent visits to health facilitiesshould be explored.Efforts to improve reproductive health commoditysecurity should be cont<strong>in</strong>ued <strong>and</strong> <strong>in</strong>tensified throughtra<strong>in</strong><strong>in</strong>g <strong>in</strong> logistics, <strong>in</strong>ventory management, warehous<strong>in</strong>getc.98