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

<strong>in</strong> development has been through <strong>in</strong>vestments <strong>in</strong> build<strong>in</strong>gsocial capital <strong>and</strong> <strong>in</strong> provid<strong>in</strong>g <strong>the</strong> people with healthservices <strong>and</strong> education. Public expenditure on health <strong>and</strong>education is <strong>the</strong> highest of all: <strong>the</strong> public sector f<strong>in</strong>ances 90per cent of <strong>the</strong> health expenditure <strong>in</strong> <strong>the</strong> country. However,this may not be <strong>the</strong> case <strong>in</strong> <strong>the</strong> future. Vulnerable groups,such as women, adolescents <strong>and</strong> youths, <strong>and</strong> people liv<strong>in</strong>g<strong>in</strong> <strong>the</strong> outer isl<strong>and</strong>s would <strong>the</strong>n be deprived of muchneeded health services.RecommendationsRepackag<strong>in</strong>g of population <strong>and</strong> development issues.Although Maldives has made significant ga<strong>in</strong>s <strong>in</strong> achiev<strong>in</strong>gMDGs relat<strong>in</strong>g to MMR <strong>and</strong> IMR, it has yet to achieve <strong>the</strong>ICPD goal on improv<strong>in</strong>g universal access to RH services,especially among adolescents <strong>and</strong> youth. Likewise, a CPRof 27 per cent for modern methods <strong>and</strong> a seem<strong>in</strong>gly highunmet need estimated to be about 33 per cent (new DHSdata have yet to be analysed) clearly demonstrate <strong>the</strong> needfor promot<strong>in</strong>g SRH rights <strong>and</strong> services <strong>in</strong> <strong>the</strong> country,hence <strong>the</strong> refocus on FP services. UNFPA <strong>and</strong> RHadvocates must repackage <strong>the</strong> programme <strong>and</strong> its messages,capitaliz<strong>in</strong>g on <strong>the</strong> recognition of reproductive rights by<strong>the</strong> government. Emerg<strong>in</strong>g data must be analysed to createevidence to advocate for cont<strong>in</strong>ued relevancy of promot<strong>in</strong>gRH for improv<strong>in</strong>g <strong>the</strong> quality of life for Maldivian men,women <strong>and</strong> adolescents. Innovative approaches must beidentified <strong>and</strong> worked out to suit <strong>the</strong> chang<strong>in</strong>g preferencesof people.Conduct qualitative <strong>and</strong> sociocultural research. There arecritical gaps <strong>in</strong> underst<strong>and</strong><strong>in</strong>g <strong>the</strong> factors underp<strong>in</strong>n<strong>in</strong>g <strong>the</strong>demographic transition <strong>and</strong> Maldives’ success <strong>in</strong> improv<strong>in</strong>gits socio-economic condition. The relatively low CPRof 39 per cent <strong>and</strong> a decl<strong>in</strong>e <strong>in</strong> TFR to 2.1 children perwoman <strong>in</strong> 2006 dem<strong>and</strong> that much more be learned about<strong>the</strong> society’s RH behaviour. What is contribut<strong>in</strong>g to <strong>the</strong>sephenomena? Is it abortion, or <strong>the</strong> high mobility of men, orsecondary sterility, or a high prevalence of RTI/STIs, or acomb<strong>in</strong>ation of <strong>the</strong>se factors? There are several unansweredquestions. Abortion is illegal <strong>in</strong> <strong>the</strong> country, but abortionis believed to be carried out both with<strong>in</strong> <strong>the</strong> country <strong>and</strong>outside. An <strong>in</strong>-depth, sociocultural perspective to helpunderst<strong>and</strong> <strong>the</strong> situation is clearly needed.Improv<strong>in</strong>g <strong>the</strong> contraceptive method mix. Thecontraceptive method mix has rema<strong>in</strong>ed weak <strong>in</strong> Maldives.Future programme efforts must be directed at improv<strong>in</strong>g<strong>the</strong> method mix. For this purpose, tra<strong>in</strong><strong>in</strong>g of serviceproviders on <strong>the</strong> use of methods <strong>and</strong> counsell<strong>in</strong>g is criticallyimportant. Given <strong>the</strong> rise of Islamic fundamentalistelements <strong>in</strong> <strong>the</strong> country, it is likely that <strong>the</strong>re will be strongeropposition to some FP methods than o<strong>the</strong>rs, for example,male sterilization. RH <strong>and</strong> population programmes mustbe developed <strong>and</strong> designed to reflect sensitivity to <strong>the</strong>seissues, <strong>the</strong> chang<strong>in</strong>g priorities of <strong>the</strong> community at large<strong>and</strong> of service providers. FP efforts of Maldives <strong>in</strong> <strong>the</strong>past had been successful, stress<strong>in</strong>g <strong>the</strong> importance of birthspac<strong>in</strong>g for <strong>the</strong> desired number of children. In learn<strong>in</strong>gfrom past experiences, similar programmatic efforts shouldbe directed at utiliz<strong>in</strong>g <strong>the</strong> changed context to promoteSRH <strong>and</strong> <strong>the</strong> reproductive rights of <strong>in</strong>dividuals, <strong>in</strong>form<strong>in</strong>g<strong>the</strong>m about <strong>the</strong> choices of methods <strong>and</strong> <strong>the</strong>ir efficacy. Male<strong>in</strong>volvement <strong>in</strong> FP should be promoted more effectively.Such efforts should also target <strong>the</strong> capacity-build<strong>in</strong>g ofFP service providers by develop<strong>in</strong>g <strong>the</strong>ir skills <strong>in</strong> serviceprovision, of which client counsell<strong>in</strong>g is an <strong>in</strong>tegral part.Advocacy <strong>and</strong> lobby<strong>in</strong>g. There are new actors <strong>in</strong> population<strong>and</strong> development <strong>in</strong> <strong>the</strong> country. There is a new parliament(People’s Majlis), <strong>and</strong> many parliamentarians are young<strong>and</strong> restless. The Islamic party is a coalition partner <strong>and</strong><strong>the</strong> Supreme <strong>Council</strong> for Islamic Affairs has a major roleto play <strong>in</strong> shap<strong>in</strong>g <strong>the</strong> op<strong>in</strong>ions, values <strong>and</strong> behaviour of<strong>the</strong> people. To best utilize <strong>the</strong> opportunities providedby <strong>the</strong> Strategic Action Plan <strong>and</strong> Maldives’ <strong>in</strong>ternationalcommitments, new advocacy materials need to be preparedfor specific target groups at all levels. Tailored exposurevisits of ykey actors from relevant countries (Bangladesh,Indonesia, Iran, Malaysia <strong>and</strong> Pakistan) should be targetedto promote <strong>the</strong> importance of SRH.The Global Fund has successfully utilized <strong>the</strong> Supreme<strong>Council</strong> for Islamic Affairs <strong>in</strong> respect of mak<strong>in</strong>g known<strong>the</strong> benefits of <strong>the</strong> country’s HIV/AIDS programme.Population <strong>and</strong> RH programmes can also benefit fromsuch <strong>in</strong>terventions. Advocacy materials for such purposesmust be grounded <strong>and</strong> evidence-based, <strong>and</strong> <strong>the</strong> evidenceshould come from <strong>the</strong> socio-economic research proposedabove, while DHS <strong>and</strong> BBS could provide fur<strong>the</strong>r evidenceon some of <strong>the</strong> issues. Advocacy tools <strong>and</strong> materials basedon <strong>the</strong>se should be developed <strong>and</strong> used to <strong>in</strong>form <strong>and</strong> lobbyfor relevant policy <strong>and</strong> programmatic changes.Address<strong>in</strong>g <strong>the</strong> sexual <strong>and</strong> reproductive health needs ofadolescents <strong>and</strong> youth. Maldives’ adolescent <strong>and</strong> youthpopulation is sexually active <strong>and</strong> restless. A number ofsociocultural factors – high divorce rate, high unemployment<strong>and</strong> lack of access to RH services <strong>and</strong> <strong>in</strong>formation –have fur<strong>the</strong>r compounded <strong>the</strong> situation. Youth-relatedproblems have worsened <strong>in</strong> densely populated places suchas Malé <strong>and</strong> Addu. Lack of space <strong>and</strong> opportunities forplay<strong>in</strong>g sports <strong>and</strong> enjoy<strong>in</strong>g o<strong>the</strong>r forms of recreationdrives adolescents to seek o<strong>the</strong>r avenues for spend<strong>in</strong>g <strong>the</strong>irfree time. Youth reportedly are be<strong>in</strong>g used by all politicalparties for various purposes. Schools <strong>and</strong> educationalcurricula should be developed that value labour, teach lifeskillseducation <strong>and</strong> are employment-oriented, along withprovid<strong>in</strong>g students with SRH <strong>in</strong>formation <strong>and</strong> services.A multisectoral response to address adolescent RH <strong>and</strong>166