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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
FigurePills <strong>and</strong> female sterilization have rema<strong>in</strong>ed <strong>the</strong> backboneof <strong>the</strong> modern methods used <strong>in</strong> <strong>the</strong> country. Oral pillsare one of <strong>the</strong> most popular methods of contraception <strong>in</strong>Maldives. Dur<strong>in</strong>g <strong>the</strong> period 1999-2004, pills accountedfor 13 per cent of CPR, as <strong>in</strong>dicated <strong>in</strong> <strong>the</strong> surveys of 1999<strong>and</strong> 2004. The o<strong>the</strong>r modern contraceptive methods whichhave rema<strong>in</strong>ed constant dur<strong>in</strong>g <strong>the</strong> period 1999-2004 were<strong>in</strong>jectables (3%) <strong>and</strong> male sterilization (1%). However,dur<strong>in</strong>g <strong>the</strong> period 2004-2009, <strong>the</strong>re was a significant shift<strong>in</strong> method mix, with <strong>the</strong> use of pills, <strong>in</strong>jectables <strong>and</strong> malesterilization all show<strong>in</strong>g significant percentage decl<strong>in</strong>es. In1999, female sterilization contributed about 10 per cent toCPR. Its contribution decl<strong>in</strong>ed to 7 per cent <strong>in</strong> 2004 but<strong>in</strong>creased to 10.1 per cent <strong>in</strong> 2009. Male condoms are <strong>the</strong>only contraceptive method to show some consistency <strong>in</strong><strong>in</strong>crease across <strong>the</strong> successive survey periods – <strong>in</strong>creas<strong>in</strong>gfrom about 6 per cent <strong>in</strong> 1999 to 9.3 per cent <strong>in</strong> 2009. Theuse of IUDs <strong>in</strong> 1999 doubled to 2 per cent <strong>in</strong> 2004 butdecl<strong>in</strong>ed to 0.8 per cent <strong>in</strong> 2009.Historically, <strong>the</strong> Maldives FP programme has offeredlimited choice of methods because <strong>the</strong> government wasalways sensitive to societal norms. However, despite <strong>the</strong>limited choices of methods on offer, <strong>the</strong> rapid decl<strong>in</strong>e<strong>in</strong> fertility <strong>and</strong> mortality proved that <strong>the</strong> Maldives FPprogramme was successful. None<strong>the</strong>less, <strong>the</strong> governmentcould not ma<strong>in</strong>ta<strong>in</strong> <strong>the</strong> momentum of <strong>the</strong> FP programme.Political reform processes <strong>in</strong>itiated <strong>in</strong> <strong>the</strong> country s<strong>in</strong>cemid-2005 as well as <strong>the</strong> rehabilitation <strong>and</strong> reconstructionprocesses follow<strong>in</strong>g <strong>the</strong> 2004 tsunami were given priority<strong>in</strong> expenditures.Abortion is illegal <strong>in</strong> Maldives <strong>and</strong> is not considered anFP method. Although data on abortions are difficult toobta<strong>in</strong>, partly because people are not will<strong>in</strong>g to discuss thisissue openly ow<strong>in</strong>g to religious reasons, data from <strong>the</strong> RHsurvey of 2004 <strong>and</strong> <strong>the</strong> Biological <strong>and</strong> Behavioural Surveyof 2008 made available by <strong>the</strong> <strong>Family</strong> Protection Unitof <strong>the</strong> Indira G<strong>and</strong>hi Memorial Hospital revealed thatunwanted pregnancies <strong>and</strong> voluntary abortions do happen<strong>in</strong> Malé <strong>and</strong> <strong>in</strong> <strong>the</strong> outer isl<strong>and</strong>s.There are social <strong>and</strong> cultural barriers to <strong>the</strong> promotion<strong>and</strong> acceptance of contraceptives <strong>in</strong> <strong>the</strong> country. As withmany o<strong>the</strong>r countries <strong>in</strong> <strong>the</strong> region, Maldives adopted <strong>the</strong>“cafeteria approach” to <strong>the</strong> promotion of contraceptives;however, it has had limited impact due to sociocultural <strong>and</strong>geographical barriers. Ajmal (2003) considered that somecontraceptive methods such as condoms have been putunder schedule 3 of <strong>the</strong> drugs listed by <strong>the</strong> government,which means that <strong>the</strong>y can be sold only by a pharmacistwhen fill<strong>in</strong>g a prescription. Classification of condoms underschedule 3 of <strong>the</strong> drug list poses a barrier for sexually activepeople to access it as <strong>and</strong> when <strong>the</strong>y need it.Ow<strong>in</strong>g to <strong>the</strong> lack of services providers, <strong>the</strong> governmentwas not able to push methods, such as IUDs <strong>and</strong> implants(Implanon), on a massive scale. In summary, <strong>the</strong> methodmix has rema<strong>in</strong>ed very weak <strong>in</strong> Maldives <strong>and</strong> much needsto be improved <strong>in</strong> that regard.Unlike <strong>in</strong> o<strong>the</strong>r countries <strong>in</strong> <strong>the</strong> region, <strong>the</strong> demographictransition <strong>in</strong> Maldives is unique. The country has achieveda rapid fertility decl<strong>in</strong>e without a commensurate <strong>in</strong>creaseFigure144Population pyramid of Maldives, 2000 <strong>and</strong> 200612108642PillInjectablesCondomFemaleSterilizationMaleSterilizationIUCDImplanon01990 2004 2009Source: Source: MPND, 2007: Population <strong>and</strong> Hous<strong>in</strong>g Census, 2006.161
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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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As far as the supp
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Socio-cultural challenges tofamily
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likely to use contraception than yo
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15 Tests of statistical significanc
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of the South <stro
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104
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Figurewill exceed the</stro
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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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244
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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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292
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294
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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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