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<strong>in</strong> CPR. Likewise, contraceptive use behaviour <strong>in</strong> Maldivesis quite different from <strong>the</strong> patterns commonly observedelsewhere. For example, contraceptive prevalence <strong>in</strong>Maldives decreased while education was <strong>in</strong>creas<strong>in</strong>g: useof modern methods was recorded at 36 per cent amongwomen with no education; among women who had receivededucation beyond secondary school, <strong>the</strong> figure stood at21 per cent. Much of <strong>the</strong> differential is attributed to <strong>the</strong>higher reliance on female sterilization among women withno education. Interest<strong>in</strong>gly, while use of <strong>the</strong> pill decl<strong>in</strong>edwith <strong>in</strong>creas<strong>in</strong>g education, condom use <strong>in</strong>creased with<strong>in</strong>creas<strong>in</strong>g education. Unlike many o<strong>the</strong>r countries, <strong>the</strong>differences <strong>in</strong> contraceptive prevalence by wealth statusor urban-rural residence are not substantial (MOHF-MDHS, 2009).Adolescent sexual <strong>and</strong> reproductivehealth <strong>and</strong> access to contraceptivesMaldives does not have an explicit policy on access tocontraceptives among adolescents, youth <strong>and</strong> unmarriedcouples/<strong>in</strong>dividuals. As a result, a large number ofadolescents do not have access to FP services despiteevidence show<strong>in</strong>g this group’s <strong>in</strong>creased sexual activity <strong>and</strong>risky behaviour.Several surveys <strong>and</strong> reports have shown <strong>in</strong>creasedvulnerability of Maldivian adolescents <strong>and</strong> youth to riskybehaviours (Narcotics Control Board, 2003; M<strong>in</strong>istry ofYouth <strong>and</strong> Sports, 2005; UNDP <strong>and</strong> MOH, 2008; <strong>and</strong>President’s Office, 2009). A rapid situation assessment ofdrug abuse <strong>in</strong> Maldives (Narcotics Control Board, 2003)reported that, by age 21, 75 per cent of youth have had atleast one sexual experience. Many of <strong>the</strong>se sexual encounterswere unprotected, mak<strong>in</strong>g <strong>the</strong>m <strong>the</strong> most at-risk group forrapid transmission of HIV/AIDS. A situational analysisof adolescents (M<strong>in</strong>istry of Youth <strong>and</strong> Sports, 2005)showed that only about 40 per cent of adolescents livedwith <strong>the</strong>ir parents. Approximately 27 per cent of youthaged 10-14 are not liv<strong>in</strong>g with <strong>the</strong>ir biological parents. Thepossible impacts of this situation are limited opportunities<strong>and</strong> stunted life skills development. The same study notedthat 14 per cent of males <strong>and</strong> 5 per cent of females under<strong>the</strong> age of 18 admitted to be<strong>in</strong>g sexually active. With accessto condoms for unmarried adolescents rema<strong>in</strong><strong>in</strong>g a barrier,many of <strong>the</strong>se young people did not use condoms.A fur<strong>the</strong>r study noted that, even though <strong>the</strong> Indira G<strong>and</strong>hiMemorial Hospital distributes condoms free of cost, manypotential users do not obta<strong>in</strong> <strong>the</strong>m from <strong>the</strong> hospital,preferr<strong>in</strong>g <strong>in</strong>stead to buy <strong>the</strong>ir supplies from pharmaciesfor <strong>the</strong> sake of confidentiality <strong>and</strong> br<strong>and</strong> availability (Ajmal,2003). The same study noted that, of <strong>the</strong> total buyers, only6 per cent were adolescents, a figure which pharmacistsacknowledge is below <strong>the</strong> actual number of users.Maldives conducted <strong>the</strong> first ever Demographic <strong>and</strong>Health Survey (DHS) <strong>in</strong> 2008/09. Prelim<strong>in</strong>ary resultsof <strong>the</strong> survey <strong>in</strong>dicated that knowledge (heard) of HIV/AIDS is almost universal among <strong>the</strong> Maldivian population(MOHF, 2009). More significantly, after receipt of <strong>the</strong> firstever <strong>in</strong>put for HIV/AIDS received from <strong>the</strong> Global Fund,<strong>the</strong> country’s first biological <strong>and</strong> behavioural survey wasconducted among <strong>the</strong> five most at-risk groups (seafarers,men hav<strong>in</strong>g sex with men (MSM), adolescent youth,commercial sex workers (CSWs) <strong>and</strong> <strong>in</strong>ject<strong>in</strong>g drug users,which showed that Maldivian youths are vulnerable toHIV/AIDS.The survey report noted that unprotected sex withmultiple partners is prevalent among <strong>the</strong> high-risk groups<strong>and</strong> that <strong>the</strong> shar<strong>in</strong>g of unsterilized needles <strong>and</strong> syr<strong>in</strong>gesis common among <strong>in</strong>ject<strong>in</strong>g drug users. The study alsofound risky behaviours among <strong>the</strong> 15-17-year-old <strong>and</strong>older age groups: buy<strong>in</strong>g <strong>and</strong> sell<strong>in</strong>g of sex; sex with nonregularpartners; premarital sex; group sex; <strong>and</strong> <strong>in</strong>ject<strong>in</strong>gdrugs. However, <strong>the</strong>se behaviours are not consistent with<strong>the</strong> self-perception of risk. The majority of respondentsbelieved <strong>the</strong>y would not get HIV from such behaviours.Some 3-6 per cent believed that <strong>the</strong>ir religion alone wouldprotect <strong>the</strong>m from HIV (UNDP <strong>and</strong> MOH, 2008). Youthseek<strong>in</strong>g counsell<strong>in</strong>g services are <strong>in</strong>creas<strong>in</strong>g 1 but <strong>the</strong> servicesare limited ma<strong>in</strong>ly to Malé. In 2009, Maldives participated<strong>in</strong> <strong>the</strong> Global School-based Student Health Survey, whichsubstantiated some of <strong>the</strong> f<strong>in</strong>d<strong>in</strong>gs of <strong>the</strong> above-mentionedsurveys <strong>and</strong> studies. The Survey found that <strong>the</strong> prevalenceof alcohol use among school students was 6.7 per cent.Alcohol use among boys was 9.1, whereas for girl students,it was 4.2 per cent. Among those who used alcohol, 66 percent of <strong>the</strong>m had used it prior to turn<strong>in</strong>g 14 years of age(Education Development Center <strong>and</strong> WHO, 2009).To address <strong>the</strong> sexual <strong>and</strong> reproductive health (SRH) careneeds of adolescents, UNFPA has been support<strong>in</strong>g <strong>the</strong><strong>in</strong>tegration of population <strong>and</strong> life skills education activities<strong>in</strong>to school curricula. However, <strong>the</strong> <strong>in</strong>troduction of thoseactivities has rema<strong>in</strong>ed modest <strong>and</strong> conf<strong>in</strong>ed mostly to <strong>the</strong>Malé area. The modules <strong>and</strong> tra<strong>in</strong><strong>in</strong>g have been very muchappreciated but ow<strong>in</strong>g to lack of support it has not beenpossible to reach out to <strong>the</strong> most vulnerable populationgroups – out-of-school adolescents <strong>and</strong> youth.To fill <strong>in</strong> <strong>the</strong> gaps <strong>in</strong> SRH services for adolescents <strong>and</strong>youth, particularly out-of-school youth, UNFPA <strong>and</strong>WHO jo<strong>in</strong>ed h<strong>and</strong>s to establish <strong>the</strong> Youth Health Café<strong>in</strong> Malé, which was a step forward <strong>in</strong> creat<strong>in</strong>g a conduciveenvironment for improv<strong>in</strong>g adolescents’ access to SRHservices. However, <strong>the</strong> <strong>in</strong>itiative did not produce <strong>the</strong>required momentum for a number of reasons. “Ownership”of <strong>the</strong> programme was lack<strong>in</strong>g. Institutionally, <strong>the</strong> Café ishoused <strong>in</strong> <strong>and</strong> run by <strong>the</strong> M<strong>in</strong>istry of Youth <strong>and</strong> Sports,but <strong>the</strong> services were to be provided <strong>and</strong> coord<strong>in</strong>ated162
y <strong>the</strong> M<strong>in</strong>istry of Health <strong>and</strong> <strong>Family</strong>. Lack of sectoralcoord<strong>in</strong>ation between agencies is ano<strong>the</strong>r reason. Given<strong>the</strong> prevail<strong>in</strong>g socio-political situation, consensus <strong>and</strong>coord<strong>in</strong>ation among all parties to improve SRH amongadolescents <strong>and</strong> youth is critically important.Likewise, UNFPA also partnered with WHO <strong>and</strong> <strong>the</strong>United Nations Children’s Fund (UNICEF) to improveaccess to services for victims of gender-based violence,with <strong>the</strong> establishment of <strong>the</strong> <strong>Family</strong> Protection Unitwith<strong>in</strong> <strong>the</strong> Indira G<strong>and</strong>hi Memorial Hospital under <strong>the</strong>supervision of a gynaecologist. Despite <strong>the</strong> potential of <strong>the</strong>unit to serve as <strong>the</strong> nodal agency to h<strong>and</strong>le cases of sexualabuse of children, teenage pregnancy <strong>and</strong> gender-basedviolence – a third of women <strong>in</strong> Maldives are reported tobe victims of gender-based violence (M<strong>in</strong>istry of Gender<strong>and</strong> <strong>Family</strong>, 2007) – lack of coord<strong>in</strong>ation among severalagencies, namely <strong>the</strong> M<strong>in</strong>istry of Health <strong>and</strong> <strong>Family</strong>, childprotection section with<strong>in</strong> <strong>the</strong> M<strong>in</strong>istry of Gender <strong>and</strong><strong>Family</strong> Welfare, police <strong>and</strong> o<strong>the</strong>r welfare agencies, hashampered <strong>the</strong> smooth function<strong>in</strong>g of <strong>the</strong> unit.Promotion of condoms as a means fordual protectionDespite critical evidence demonstrat<strong>in</strong>g <strong>the</strong> value ofpromot<strong>in</strong>g condoms as a means for “dual protection”, <strong>the</strong>government’s response has been lukewarm. A policy ondual protection <strong>and</strong> <strong>in</strong>tegration <strong>in</strong>to <strong>the</strong> RH commoditylist has yet to be formulated. Maldives’ successiveattempts to secure support from <strong>the</strong> Global Fund toFight AIDS, Tuberculosis <strong>and</strong> Malaria culm<strong>in</strong>ated <strong>in</strong>support for its HIV/AIDS programme, with UNDP as<strong>the</strong> pr<strong>in</strong>cipal recipient <strong>in</strong> 2006. Under <strong>the</strong> programme, aseries of exploratory <strong>and</strong> behavioural research activitieshave been carried out target<strong>in</strong>g <strong>the</strong> most at-risk groups.The programme has also been support<strong>in</strong>g syndromatictreatment of reproductive tract <strong>in</strong>fections <strong>and</strong> STIs <strong>in</strong><strong>the</strong> country. Table 4 shows <strong>the</strong> types of STI servicesprovided under <strong>the</strong> Global Fund-supported HIV/AIDSprogramme. STIs are a major <strong>and</strong> hidden RH problem <strong>in</strong>Maldives.The NGO sectorThe NGO sector <strong>in</strong> Maldives has been historically weak.Before <strong>the</strong> advent of multiparty democracy <strong>in</strong> 2008,only two to three national NGOs of importance were<strong>in</strong> existence. The Society for Health <strong>and</strong> Education hasrema<strong>in</strong>ed at <strong>the</strong> forefront of population activities <strong>in</strong> <strong>the</strong>country. UNFPA has provided <strong>the</strong> Society with support<strong>in</strong> order to assist <strong>the</strong> government <strong>in</strong> reach<strong>in</strong>g out tomarg<strong>in</strong>alized communities. The Society runs counsell<strong>in</strong>gcentres for adolescents, ma<strong>in</strong>ly premarital youth, offer<strong>in</strong>g<strong>the</strong>m counsell<strong>in</strong>g <strong>and</strong> referral services but not free access tocontraceptives. The Society also runs some youth-relatedactivities under <strong>the</strong> Global Fund-supported HIV/AIDSprogramme. Apart from furnish<strong>in</strong>g counsell<strong>in</strong>g support,<strong>the</strong> Society also runs an FP cl<strong>in</strong>ic, but it does not provideunmarried adolescents with free access to contraceptives;<strong>in</strong>stead it provides emergency contraceptives to victimsof sexual violence <strong>in</strong> consultation with guardians of <strong>the</strong>victims.There are a few o<strong>the</strong>r NGOs which are becom<strong>in</strong>g popular<strong>in</strong> <strong>the</strong> country, such as Journey, Maanfa-centre for <strong>the</strong>elderly population, <strong>and</strong> Mo<strong>the</strong>rs aga<strong>in</strong>st Drugs. Journeywas formed by a group of recover<strong>in</strong>g addicts for <strong>the</strong>purpose of help<strong>in</strong>g o<strong>the</strong>r addicts ma<strong>in</strong>ta<strong>in</strong> <strong>the</strong>ir recovery<strong>and</strong> to raise public awareness about drug addiction <strong>and</strong>related issues; it has played a critical role <strong>in</strong> <strong>the</strong> activitiesof <strong>the</strong> Global Fund.NGO Capacity <strong>and</strong> Needs Assessment, which waspublished <strong>in</strong> 2009 by <strong>the</strong> Raajje Foundation, <strong>the</strong> AustralianGovernment <strong>and</strong> UNDP, found that among somegovernment <strong>in</strong>stitutions <strong>the</strong>re is little underst<strong>and</strong><strong>in</strong>g of<strong>and</strong> support for mean<strong>in</strong>gfully <strong>in</strong>volv<strong>in</strong>g <strong>and</strong> collaborat<strong>in</strong>gwith NGOs <strong>and</strong> civil society. The exist<strong>in</strong>g AssociationsAct <strong>and</strong> its regulations need to be revised <strong>in</strong> order toimprove participation by <strong>in</strong>dependent <strong>and</strong> diverse civilsociety actors. The report fur<strong>the</strong>r noted that <strong>the</strong> capacityof NGOs is low ow<strong>in</strong>g to <strong>the</strong> low level of fund<strong>in</strong>g <strong>the</strong>yreceive <strong>and</strong> <strong>the</strong> <strong>in</strong>adequate human resources that run <strong>the</strong>m,as <strong>the</strong>y are managed mostly by volunteers.TableTable2DescriptionPatients with sexually transmitted <strong>in</strong>fections provided services through Global Fund-supported HIV/AIDS projects <strong>and</strong> programmeNumber of health-care providers tra<strong>in</strong>ed <strong>in</strong>diagnosis <strong>and</strong> cl<strong>in</strong>ical management of STIsNumber of STI cases treated at health-carefacilitiesBy August 2009 By June 2010Target Achieved Target Achieved248 253 261 316200 1619 1,702 2,587Source: UNDP/Global Fund to Fight AIDS, Tuberculosis <strong>and</strong> Malaria, 2010. Data furnished by UNDP/Global Fund ProgrammeManager.163
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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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in urban (67%) tha
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Page 166 and 167: Figure1980s and ex
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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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