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<strong>the</strong> north <strong>and</strong> <strong>the</strong> south regions. Several characteristicscont<strong>in</strong>ue to have a strong <strong>in</strong>fluence on contraceptive use <strong>in</strong><strong>the</strong> north, whereas <strong>the</strong>ir effect <strong>in</strong> <strong>the</strong> south has weakened.For example, <strong>the</strong> odds ratio <strong>in</strong> <strong>the</strong> north <strong>in</strong>creased wi<strong>the</strong>ducation, whereas <strong>the</strong> differences <strong>in</strong> odds ratios amongwomen with no education, primary- or secondary-leveleducation <strong>in</strong> <strong>the</strong> south disappeared. Similarly, <strong>the</strong> effect of<strong>the</strong> number of liv<strong>in</strong>g sons <strong>in</strong> <strong>the</strong> south was much weakerthan <strong>in</strong> <strong>the</strong> north. The odds ratio among women with twoor more liv<strong>in</strong>g sons <strong>in</strong> <strong>the</strong> north was 3.50 (95%CI: 3.03 –4.05) <strong>in</strong> comparison with 1.59 (95%CI: 1.36 – 1.87) <strong>in</strong> <strong>the</strong>south. Urban women <strong>in</strong> <strong>the</strong> north were 30 per cent morelikely to use contraception than rural women, whereasurban women <strong>in</strong> <strong>the</strong> south were 22 per cent less likely touse contraception than rural women.Table 9 shows <strong>the</strong> odds ratio for <strong>the</strong> north compared with<strong>the</strong> south adjusted for various comb<strong>in</strong>ations of respondentcharacteristics <strong>in</strong> 2005/06 <strong>and</strong> 1992/93. Adjust<strong>in</strong>g foreducation only <strong>in</strong> 2005/06 <strong>in</strong>creased <strong>the</strong> odds ratio<strong>in</strong> <strong>the</strong> north from 0.425 to 0.438. This means that, ifwomen <strong>in</strong> <strong>the</strong> north had <strong>the</strong> same education as women <strong>in</strong><strong>the</strong> south, <strong>the</strong> gap <strong>in</strong> contraceptive use between <strong>the</strong> tworegions would decrease. After adjust<strong>in</strong>g for education,employment, residence <strong>and</strong> household wealth, <strong>the</strong> oddsratio for <strong>the</strong> north <strong>in</strong> 2005/06 fur<strong>the</strong>r <strong>in</strong>creased to 0.517.A comparable <strong>in</strong>crease was also observed for 1992/93.This <strong>in</strong>dicates that <strong>the</strong> contraceptive use gap between <strong>the</strong>two regions would decrease fur<strong>the</strong>r if women <strong>in</strong> <strong>the</strong> north<strong>and</strong> south had similar education, employment, residence<strong>and</strong> wealth distributions.In comparison, when adjust<strong>in</strong>g for only <strong>the</strong> number ofliv<strong>in</strong>g sons, <strong>the</strong> odds ratio for <strong>the</strong> north decreased from0.425 to 0.291 <strong>in</strong> 2005/06. This is not a new phenomenon.Adjustment for number of liv<strong>in</strong>g sons <strong>in</strong> 1992/93 decreased<strong>the</strong> odds ratio for <strong>the</strong> north from 0.332 to 0.247. Thismeans that, if women <strong>in</strong> <strong>the</strong> north have <strong>the</strong> same numberof liv<strong>in</strong>g sons as those <strong>in</strong> <strong>the</strong> south, <strong>the</strong> gap <strong>in</strong> contraceptiveuse between <strong>the</strong> two regions would become even wider.This happens because women <strong>in</strong> <strong>the</strong> south have a muchhigher contraceptive prevalence rate than those <strong>in</strong> <strong>the</strong> northfor each category of number of liv<strong>in</strong>g sons. Contraceptiveuse <strong>in</strong> <strong>the</strong> south <strong>in</strong>creases from 36 per cent among womenwith no son to 72 per cent among women with one sonto 85 per cent among women with two or more sons (seeTable 10). The comparative figures for women <strong>in</strong> <strong>the</strong> northare 13 per cent among women with no son, 44 per centamong those with one son <strong>and</strong> 61 per cent among womenwith two or more sons.The decrease between <strong>the</strong> crude odds ratio of 0.425 <strong>and</strong>adjusted odds ratio of 0.406 appears to be due to <strong>the</strong>adjustment made for <strong>the</strong> number of liv<strong>in</strong>g sons. Thismeans that women <strong>in</strong> <strong>the</strong> north have higher contraceptiveuse than would be expected on <strong>the</strong> basis of <strong>the</strong> stronger sonpreference <strong>in</strong> <strong>the</strong>se states. This could certa<strong>in</strong>ly be <strong>the</strong> effectof <strong>the</strong> family plann<strong>in</strong>g programme <strong>in</strong> <strong>the</strong>se states becausean adjustment for o<strong>the</strong>r factors would have decreased <strong>the</strong>gap between <strong>the</strong> north <strong>and</strong> <strong>the</strong> south 11 .In brief, <strong>the</strong> gap <strong>in</strong> contraceptive use between <strong>the</strong> north <strong>and</strong><strong>the</strong> south has decreased over <strong>the</strong> years. It would fur<strong>the</strong>rdecrease with improvements <strong>in</strong> such factors as education<strong>and</strong> employment of women. However, <strong>the</strong> progress couldbe hampered by a stronger son preference <strong>in</strong> <strong>the</strong> norththan <strong>in</strong> <strong>the</strong> south.Fertility decl<strong>in</strong>e <strong>in</strong> IndiaPrior to 1971 India’s total fertility rate (TFR) rema<strong>in</strong>edconstant at a high level. The Panel on India constitutedby <strong>the</strong> Committee on Population <strong>and</strong> Demography of <strong>the</strong>United States National Research <strong>Council</strong> estimated TFRat 5.7 births per woman dur<strong>in</strong>g <strong>the</strong> period 1961-1971 <strong>and</strong>at 5.6 dur<strong>in</strong>g <strong>the</strong> period 1970-1972 (Bhat et al., 1984).S<strong>in</strong>ce <strong>the</strong>n TFR decl<strong>in</strong>ed to 2.7 births: by about 2 birthsbetween 1971 <strong>and</strong> 1991 <strong>and</strong> by ano<strong>the</strong>r 0.7 births between1991 <strong>and</strong> 2004. The year 1997 provides a convenientreference po<strong>in</strong>t for assess<strong>in</strong>g <strong>the</strong> pace of fertility decl<strong>in</strong>es<strong>in</strong>ce it marks <strong>the</strong> elim<strong>in</strong>ation of method-specific targets<strong>and</strong> a shift to a broader reproductive health approach. Theaverage annual decl<strong>in</strong>e per year is estimated to be 1.92 percent with <strong>the</strong> target system (dur<strong>in</strong>g <strong>the</strong> period 1971-1997)<strong>in</strong> comparison with 0.50 per cent after <strong>the</strong> elim<strong>in</strong>ation of<strong>the</strong> target system (dur<strong>in</strong>g <strong>the</strong> period 1997-2004). NFHSdata would thus suggest a slowdown <strong>in</strong> fertility decl<strong>in</strong>eafter <strong>the</strong> elim<strong>in</strong>ation of <strong>the</strong> target system. However, TFRestimates from NFHS-2 may be less accurate than TFRestimates from NFHS-1 <strong>and</strong> NFHS-3 because CPR<strong>in</strong>creased by <strong>the</strong> same amount (about 6 percentage po<strong>in</strong>ts)between <strong>the</strong> first two rounds <strong>and</strong> between <strong>the</strong> second <strong>and</strong>third rounds of NFHS (Table 5).The percentage decl<strong>in</strong>e <strong>in</strong> TFR for major states <strong>and</strong>different periods is shown <strong>in</strong> Table 11. S<strong>in</strong>ce 1971, fertilitydecl<strong>in</strong>ed <strong>in</strong> all major states, which reflects <strong>the</strong> importanceof India’s family plann<strong>in</strong>g programme. Fertility decl<strong>in</strong>ed byat least 55 per cent <strong>in</strong> 11 states. Even <strong>in</strong> <strong>the</strong> nor<strong>the</strong>rn states<strong>the</strong> decl<strong>in</strong>e ranged from 34 per cent <strong>in</strong> Bihar to 41 per cent<strong>in</strong> Uttar Pradesh to 50 per cent <strong>in</strong> Madhya Pradesh <strong>and</strong>Rajasthan.Between 1971 <strong>and</strong> 1991, fertility decl<strong>in</strong>e ranged from 25per cent <strong>in</strong> Uttar Pradesh to 56 per cent <strong>in</strong> Kerala. Between1991 <strong>and</strong> 2004, TFR cont<strong>in</strong>ued to decl<strong>in</strong>e <strong>in</strong> all states; <strong>the</strong>percentage decl<strong>in</strong>e <strong>in</strong> TFR dur<strong>in</strong>g <strong>the</strong> period 1991-2004ranged from 4 per cent <strong>in</strong> Kerala <strong>and</strong> 5 per cent <strong>in</strong> Bihar to32 per cent <strong>in</strong> Haryana <strong>and</strong> Punjab. Moreover, TFR dur<strong>in</strong>gthis period decl<strong>in</strong>ed by at least 20 percentage po<strong>in</strong>ts <strong>in</strong> 10of <strong>the</strong> 15 states (see Table 11).144
TableTableAdjusted odds ratios for contraceptive use <strong>in</strong> north as compared with south after controll<strong>in</strong>g for9various characteristics <strong>in</strong> India: 1992/93 <strong>and</strong> 2005/06North compared with southCovariates2005/06 1992/93OR 95% CI OR 95% CIRegion: Crude 0.425 (0.396 - 0.455) 0.332 (0.310 - 0..355)Adjusted AOR AOREducation 0.438 (0.409 - 0.469) 0.374 (0.351 - 0.399)Education + Employment 0.465 (0.434 - 0.499) 0.408 (0.382 - 0.435)Education + Employment + Residence 0.476 (0.443 - 0.511) 0.416 (0.390 - 0.445)Education + Employment + Residence +Wealth0.517 (0.482 - 0.554) 0.449 (0.421 - 0.479)Parity 0.331 (0.305 - 0.359) 0.267 (0.247 - 0.289)# of liv<strong>in</strong>g sons 0.291 (0.268 - 0.315) 0.247 (0.229 - 0.267)# of child deaths 0.417 (0.389 - 0.447) 0.329 (0.307 - 0.352)The tim<strong>in</strong>g <strong>and</strong> pace of fertility decl<strong>in</strong>e varied acrossstates, suggest<strong>in</strong>g <strong>the</strong> importance of state-specific socialsett<strong>in</strong>gs. Fertility decl<strong>in</strong>e started earlier <strong>and</strong> decl<strong>in</strong>ed faster<strong>in</strong> sou<strong>the</strong>rn states that <strong>in</strong>vested <strong>in</strong> health <strong>and</strong> education.In nor<strong>the</strong>rn states that did not <strong>in</strong>vest adequately <strong>in</strong> health<strong>and</strong> education, fertility decl<strong>in</strong>ed later <strong>and</strong> at a slower pace.TFR <strong>in</strong> Kerala <strong>and</strong> Tamil Nadu had already decl<strong>in</strong>ed to4.7 by 1966, even before <strong>the</strong> reorganization of <strong>the</strong> familyplann<strong>in</strong>g programme, <strong>and</strong> reached <strong>the</strong> replacement level by1991 <strong>in</strong> Kerala <strong>and</strong> by 1997 <strong>in</strong> Tamil Nadu.The importance of social sett<strong>in</strong>g for fertility differentialsobserved <strong>in</strong> 2004 is illustrated by a classification of 15major states accord<strong>in</strong>g to <strong>the</strong>ir levels of <strong>in</strong>fant mortality <strong>and</strong>female education. When this is done by us<strong>in</strong>g data fromNFHS-3, we f<strong>in</strong>d that most of <strong>the</strong> states fall on a diagonal(see Table 12). States with a poorer social sett<strong>in</strong>g, i.e., withhigh <strong>in</strong>fant mortality <strong>and</strong> low female education, also havehigh fertility. This group <strong>in</strong>cludes Bihar, Rajasthan, MadhyaPradesh <strong>and</strong> Uttar Pradesh. At <strong>the</strong> o<strong>the</strong>r extreme areKerala <strong>and</strong> Tamil Nadu with TFRs of less than two births.These states also have a good social sett<strong>in</strong>g, i.e., low <strong>in</strong>fantmortality <strong>and</strong> high female education. The rema<strong>in</strong><strong>in</strong>g n<strong>in</strong>emajor states fall <strong>in</strong> between <strong>the</strong>se two extremes. There are afew exceptions. The states of Andhra Pradesh, Karnataka,Maharashtra <strong>and</strong> Punjab have achieved replacement-levelfertility at a slightly higher level of <strong>in</strong>fant mortality or aslightly lower level of female education. However, <strong>the</strong>re isno state with a good social sett<strong>in</strong>g <strong>and</strong> high fertility (for asimilar analysis of <strong>the</strong> NFHS-1 data, see Ja<strong>in</strong>, 1998c).Demographers have been <strong>in</strong>terested for quite a longtime <strong>in</strong> expla<strong>in</strong><strong>in</strong>g <strong>the</strong>se regional differences between <strong>the</strong>north <strong>and</strong> south. Dyson <strong>and</strong> Moore (1983) attributed <strong>the</strong>differences <strong>in</strong> demographic behaviour between <strong>the</strong> north<strong>and</strong> south to differences <strong>in</strong> <strong>the</strong> k<strong>in</strong>ship structure 12 <strong>and</strong>lower female autonomy <strong>in</strong> <strong>the</strong> north. Satia <strong>and</strong> Jejeebhoy(1991) attributed high fertility <strong>and</strong> low contraceptive use<strong>in</strong> <strong>the</strong> north to lower female education, lower economicopportunities for women, higher child mortality <strong>and</strong>deficiencies (limited availability <strong>and</strong> poor quality) <strong>in</strong> <strong>the</strong>implementation of <strong>the</strong> family plann<strong>in</strong>g programme. Earlyfertility transition <strong>in</strong> Kerala is attributed to more equitableachievement <strong>in</strong> female education <strong>and</strong> health or socialdevelopment (for additional policy <strong>in</strong>formation, see Nag,1984 <strong>and</strong> Krishnan, 1998). While fertility decl<strong>in</strong>e <strong>in</strong> TamilNadu is attributed to <strong>the</strong> social reform movement of powertransfer to lower caste <strong>in</strong>dividuals <strong>in</strong> <strong>the</strong> 1920s <strong>and</strong> 1930s,<strong>the</strong> movement itself is attributed to <strong>in</strong>creas<strong>in</strong>g literacy <strong>in</strong><strong>the</strong> state (Bhat, 1998). The family plann<strong>in</strong>g programmescerta<strong>in</strong>ly contributed to <strong>the</strong> acceleration of fertility decl<strong>in</strong>eafter reorganization of <strong>the</strong> programme <strong>in</strong> 1966.The experience of fertility decl<strong>in</strong>e <strong>in</strong> India po<strong>in</strong>ts to <strong>the</strong>synergistic effect of social development <strong>and</strong> <strong>the</strong> familyplann<strong>in</strong>g programme. Social development contributed tofertility decl<strong>in</strong>e by creat<strong>in</strong>g a desire for smaller families,while <strong>the</strong> family plann<strong>in</strong>g programme <strong>in</strong>creased accessto fertility-regulat<strong>in</strong>g methods, which helped couplesto transform <strong>the</strong>ir fertility desires <strong>in</strong>to practice. A betterhealth delivery system <strong>in</strong> states such as Kerala <strong>and</strong> TamilNadu also made it easier for <strong>the</strong> family plann<strong>in</strong>g programmeto make services for contraceptives widely available towomen <strong>and</strong> couples. A better education system <strong>in</strong> <strong>the</strong>sestates made it easier for <strong>the</strong> family plann<strong>in</strong>g programme torecruit <strong>the</strong> staff needed to provide such services. Moreover,better education also implied that a higher proportion ofwomen <strong>in</strong> <strong>the</strong>se states were exposed to <strong>the</strong> family plann<strong>in</strong>gmessages propagated by <strong>the</strong> family plann<strong>in</strong>g programmethrough mass media. For example, 57 per cent of women145
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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
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A third observation is that reporte
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TableTable2Current Contraceptive Pr
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Figure(-1.2), Cook Island</
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FigureTableTable3Trends in<
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Nam. Nearly all economies i
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2008 2009% Bilateral % Multilateral
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family planning wi
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IntroductionFamily
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The advent of the
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FigureFigure1Oceania and</s
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next 25 years, however, TFR fluctua
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FigureFigureFigure2Total fertility
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family planning pr
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esponsible for the
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that estimates of CPR for earlier p
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Figuremarried at an older age compa
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As previously mentioned most <stron
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FigureFigure945Relationship between
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The concept of “unmet need” has
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TableTable8Percentage of th
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TableTable9Percentage of reasons fo
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family planning pr
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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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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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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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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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