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

assistance from UNFPA <strong>and</strong> WHO, helped to evaluate <strong>the</strong>success of FP <strong>in</strong>terventions, improve service delivery <strong>and</strong>launch specific <strong>in</strong>formation, education <strong>and</strong> communication(IEC) programmes for promot<strong>in</strong>g <strong>the</strong> use of FP. Thesurvey also provided important policy- <strong>and</strong> programmerelevant<strong>in</strong>formation to improve <strong>the</strong> quality of <strong>and</strong> accessto primary health care/RH services <strong>in</strong> <strong>the</strong> country.In 1990, <strong>in</strong> recogniz<strong>in</strong>g <strong>the</strong> limited capacity of <strong>the</strong>government to exp<strong>and</strong> FP <strong>and</strong> child-spac<strong>in</strong>g services,UNFPA supported <strong>the</strong> non-governmental organizationSociety for Health Education under <strong>the</strong> project entitled“Development of Effective Child-spac<strong>in</strong>g Mechanisms<strong>in</strong> Selected Regions <strong>and</strong> Atolls”. That project helped <strong>in</strong>rais<strong>in</strong>g public awareness about population growth, <strong>the</strong>importance of FP, small family size <strong>and</strong> use of FP servicesfor child spac<strong>in</strong>g (UNFPA, 1997). The project ensuredcommunity participation <strong>in</strong> <strong>the</strong> health care of mo<strong>the</strong>rs <strong>and</strong>children <strong>and</strong> promoted <strong>the</strong> concept of volunteerism <strong>in</strong> <strong>the</strong>country. It also helped to streng<strong>the</strong>n national capacity <strong>in</strong><strong>the</strong> field of IEC, <strong>the</strong> backbone for <strong>the</strong> success of any publichealth <strong>in</strong>tervention. UNFPA’s support of <strong>the</strong> Society was<strong>in</strong> recognition of <strong>the</strong> fact that <strong>the</strong> government alone couldnot shoulder <strong>the</strong> entire burden of development <strong>and</strong> thatNGOs <strong>and</strong> civil societies should collaborate <strong>in</strong> reach<strong>in</strong>gout where <strong>the</strong> government is not able to do so (Didi, 1991;<strong>and</strong> Thongthai <strong>and</strong> Didi, 1996).Tra<strong>in</strong><strong>in</strong>g of service providers (Foolhamaas, FHWs <strong>and</strong>CHWs) toge<strong>the</strong>r with isl<strong>and</strong> leaders, through mobilehealth tra<strong>in</strong><strong>in</strong>gs at <strong>the</strong> atoll level, contributed significantly<strong>in</strong> streng<strong>the</strong>n<strong>in</strong>g <strong>the</strong> PHC services of <strong>the</strong> government.Modules covered <strong>the</strong> importance of family health, prevention<strong>and</strong> promotion of reproduction (fertility/<strong>in</strong>fertility),motivation <strong>and</strong> counsell<strong>in</strong>g of couples <strong>and</strong> contribution oflocal elites (isl<strong>and</strong>, atoll leaders) <strong>in</strong> promot<strong>in</strong>g <strong>the</strong> health ofwomen <strong>and</strong> children. Although <strong>the</strong> focus was on FHWs<strong>and</strong> CHWs, <strong>the</strong> project also streng<strong>the</strong>ned <strong>the</strong> capacity<strong>and</strong> skills of medical officers <strong>and</strong> medical supervisors.Provision of <strong>in</strong>ternational consultants, health personnelsuch as nurse-cum-midwives <strong>and</strong> several o<strong>the</strong>r forms oftechnical backstopp<strong>in</strong>g support, <strong>in</strong>clud<strong>in</strong>g United NationsVolunteers, filled <strong>the</strong> human resources gap <strong>in</strong> <strong>the</strong> deliveryof health services. Similarly, <strong>the</strong> provision of equipment,boats <strong>and</strong> supplies (contraceptives) streng<strong>the</strong>ned nationalcapacity to attend to emerg<strong>in</strong>g needs. The boats were notonly utilized for UNFPA-supported activities but alsohelped to <strong>in</strong>crease <strong>the</strong> mobility of health-care providerswith<strong>in</strong> isl<strong>and</strong>s <strong>and</strong> atolls (Thongthai <strong>and</strong> Didi, 1996).Khaleel (2001) argued that <strong>the</strong> ma<strong>in</strong> aim of <strong>in</strong>troduc<strong>in</strong>g<strong>and</strong> <strong>in</strong>tegrat<strong>in</strong>g <strong>the</strong> FP programme with<strong>in</strong> <strong>the</strong> MCHservices was among <strong>the</strong> top priority areas necessary toprovide better services for pre- <strong>and</strong> post-natal care as wellas child health. He fur<strong>the</strong>r identified that IEC activitieson population issues, <strong>in</strong>clud<strong>in</strong>g <strong>the</strong> benefits of childspac<strong>in</strong>g, were critical elements <strong>in</strong> Maldives’ FP successes.He noted that <strong>the</strong> IEC strategies played a pivotal role <strong>in</strong>motivat<strong>in</strong>g couples to accept FP as a means to limit <strong>the</strong>irfamily size. For <strong>in</strong>stance, radio, television <strong>and</strong> o<strong>the</strong>r massmedia, such as local newspapers <strong>and</strong> pr<strong>in</strong>ted materials, <strong>and</strong><strong>in</strong>terpersonal communication networks among communityleaders were used to dissem<strong>in</strong>ate <strong>in</strong>formation on FP issues.Tra<strong>in</strong><strong>in</strong>g/orientation regard<strong>in</strong>g RH/FP programmes was<strong>in</strong>troduced for atoll chiefs, department heads <strong>and</strong> religiousleaders. O<strong>the</strong>r relevant activities <strong>in</strong>cluded <strong>the</strong> tra<strong>in</strong><strong>in</strong>g ofcommunity volunteers, such as teachers, women’s groups,isl<strong>and</strong> development committee members <strong>and</strong> youths asmotivators <strong>and</strong> agents of change.Trends <strong>in</strong> method mixDespite <strong>the</strong> remarkable success of <strong>the</strong> FP programme<strong>in</strong> Maldives, not all modern contraceptive methodsare promoted <strong>and</strong> available to <strong>the</strong> population. Table 3provides a breakdown of <strong>the</strong> methods available <strong>and</strong> used,as determ<strong>in</strong>ed by comparative national surveys. WhenCPR was highest at 42 per cent <strong>in</strong> 1999, <strong>the</strong> contributionof traditional methods was also <strong>the</strong> highest (about 9%).The use of modern methods improved only slightly<strong>the</strong>reafter, from 33 per cent <strong>in</strong> 1999 to 34 per cent <strong>in</strong> 2004.Dur<strong>in</strong>g <strong>the</strong> 2004 period, <strong>the</strong> contribution of traditionalmethods decl<strong>in</strong>ed to 5 per cent, while total CPR (<strong>in</strong>clusiveof traditional methods) stood at 39 per cent. Users oftraditional methods were divided almost equally betweentwo methods: periodic abst<strong>in</strong>ence (3%) <strong>and</strong> withdrawal(4%).TableTable3Trends <strong>in</strong> contraceptive method mix, 1999-2009Methods 1999(%) 2004 2009 (%)Modern 33.0 34.0 27.0Traditional 9.0 5.0 7.8Total users 42.0 39.0 34.7Source: M<strong>in</strong>istry of Health, Republic of Maldives, UNFPA, CIET <strong>International</strong>, Reproductive Health Survey 2004, Malé, Maldives,2004, Decision Support Division, M<strong>in</strong>istry of Health <strong>and</strong> <strong>Family</strong>, Demographic Health Survey, 2009, Prelim<strong>in</strong>ary Results.160