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

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<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
development needs should be prioritized. Evaluation of<strong>the</strong> <strong>Family</strong> Protection Unit <strong>and</strong> <strong>the</strong> Youth Health Café<strong>and</strong> related recommendations should be used to create anew model of service provision for improv<strong>in</strong>g <strong>the</strong> accessof adolescents <strong>and</strong> youth. The private sector, civil society<strong>and</strong> NGOs should be streng<strong>the</strong>ned <strong>and</strong> encouraged topromote sexual <strong>and</strong> reproductive health <strong>in</strong>formation <strong>and</strong>services for adolescents <strong>in</strong> order to protect <strong>the</strong>m from riskysexual behaviour.Communication <strong>and</strong> behavioural change. Despite universalknowledge of FP devices <strong>and</strong> HIV/AIDS <strong>in</strong> Maldives, useof recommended methods is nom<strong>in</strong>al both for meet<strong>in</strong>g <strong>the</strong>unmet need <strong>and</strong> protection from risky sexual behaviour.The focus of future RH <strong>and</strong> population programmesshould be to identify <strong>the</strong> communication messages neededto change <strong>the</strong> behaviour of people, most importantlyadolescents <strong>and</strong> youth. Peer education <strong>and</strong> role modelscould be used to <strong>in</strong>fluence <strong>the</strong> outcome. Build<strong>in</strong>g upon<strong>the</strong> <strong>in</strong>creas<strong>in</strong>g evidence from various surveys <strong>and</strong> studies,multiple media sources, both electronic <strong>and</strong> pr<strong>in</strong>t, shouldbe engaged <strong>and</strong> encouraged to dissem<strong>in</strong>ate such messagesto reach out to a wider spectrum of adolescents, youth <strong>and</strong><strong>the</strong>ir families.Address<strong>in</strong>g gender disparities <strong>and</strong> gender-based violence.Maldives is less likely to achieve MDGs <strong>in</strong> terms of reduc<strong>in</strong>ggender disparity <strong>and</strong> reduc<strong>in</strong>g violence aga<strong>in</strong>st women. As aliberal Muslim state <strong>in</strong> <strong>the</strong> past, Maldives provided womenwith relative freedom <strong>and</strong> improved <strong>the</strong>ir socio-economicstatus. However, women <strong>in</strong> Maldives suffer from genderbasedviolence. Address<strong>in</strong>g gender-based violence requiresa multi-pronged approach at all levels. The new StrategicAction Plan has some good elements for promot<strong>in</strong>g genderequality <strong>and</strong> empower<strong>in</strong>g women. Development partnersmust cont<strong>in</strong>ue to build on past achievements; while notlos<strong>in</strong>g sight of <strong>the</strong> progress that had been made, <strong>the</strong>y needto focus on what still needs to be done.End Note1 Personal communication with Dr. Mausooma Kamaludd<strong>in</strong>,Director of Sexual <strong>and</strong> Reproductive Health of <strong>the</strong> Society forHealth Education.ReferencesAjmal, Mohamed (2003). Market Research on CondomPrevalence <strong>and</strong> Promotion, 2003. UNFPA, Maldives.Chamara, Anurana et al. (2009). y, f<strong>in</strong>al draft report forWHO <strong>and</strong> Government of Maldives, Colombo:Institute of Health Policy.Chaudhury, Rafiqul H, 1996. A socio-demographicprofile of <strong>the</strong> population of Maldives, <strong>Asia</strong>-<strong>Pacific</strong>Population Journal, vol. 11(4), pp: 3-26.Department of Public Health (DPH)(2008).Reproductive Health Strategy, 2008-2010. M<strong>in</strong>istryof Health.Department of Public Health (DPH) <strong>and</strong> World HealthOrganization (WHO), 2008. Streng<strong>the</strong>n<strong>in</strong>g healthservices through primary health care <strong>in</strong> Maldives.Draft.Didi, Am<strong>in</strong>ath Mohamed (1991). Determ<strong>in</strong>ants ofcontraceptive use patterns <strong>in</strong> Addu Atoll, Maldives.Thesis submitted <strong>in</strong> partial fulfilment of <strong>the</strong>requirements for <strong>the</strong> degree of Master of Arts <strong>in</strong>Population <strong>and</strong> Social Research, Faculty of GraduateStudies, Mahidol University, Salaya, Nakhon Pathom,Thail<strong>and</strong>.Education Development Center <strong>and</strong> World HealthOrganization (WHO) (2009)., Malé: EducationDevelopment Center, M<strong>in</strong>istry of Education <strong>and</strong>WHO, Maldives.Government of Maldives (1994). National Reportfor <strong>the</strong> <strong>International</strong> Conference on Population <strong>and</strong>Development, Malé: Government of <strong>the</strong> Republic ofMaldives.__________ <strong>and</strong> UNFPA (2009). Country Report,Maldives: ICPD+15 <strong>and</strong> Beyond: ProgressAchievements <strong>and</strong> Challenges, 1994-2009.Khaleel, A. (2001). “The role of family plann<strong>in</strong>g<strong>in</strong> reduc<strong>in</strong>g maternal mortality <strong>in</strong> Maldives”,In: Reproductive Health <strong>and</strong> <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong>(Dissertation), Mahidol University, Salaya, NakhonPathom, Thail<strong>and</strong>.M<strong>in</strong>istry of Gender <strong>and</strong> <strong>Family</strong> (2007). A Study onWomen’s Health <strong>and</strong> Life Experiences: A Study Jo<strong>in</strong>tlyConducted by <strong>the</strong> M<strong>in</strong>istry of Gender <strong>and</strong> <strong>Family</strong>, Malé:WHO, UNFPA <strong>and</strong> UNICEF.M<strong>in</strong>istry of Health (MOH)(2006a). Maldives NationalAIDS Policy, Malé: Government of <strong>the</strong> Republic ofMaldives.__________ (2006b). Health Master Plan, 2006-2015: Quality Health Care, Bridg<strong>in</strong>g <strong>the</strong> Gaps, Malé:M<strong>in</strong>istry of Health.__________ <strong>and</strong> WHO (2009). Health F<strong>in</strong>anc<strong>in</strong>g <strong>and</strong>Expenditure Review, a report prepared by Dr. SomilNagpal.M<strong>in</strong>istry of Health <strong>and</strong> <strong>Family</strong> (2009a). MaldivesDemographic <strong>and</strong> Health Survey, Prelim<strong>in</strong>ary Report,Malé: M<strong>in</strong>istry of Health <strong>and</strong> <strong>Family</strong> <strong>and</strong> ICF Macro.__________ (2009b). Maldives Health Statistics, 2009,Malé: M<strong>in</strong>istry of Health <strong>and</strong> <strong>Family</strong>.M<strong>in</strong>istry of <strong>Plann<strong>in</strong>g</strong> <strong>and</strong> National Development(MPND) (2002). Analytical Report: Population <strong>and</strong>Hous<strong>in</strong>g Census of <strong>the</strong> Maldives, 2001, Malé: MPND.__________ (2003). The Official Year Book of <strong>the</strong>Republic of Maldives, Malé: MPND.__________ (2005). Population Policy of <strong>the</strong> Maldives,Work<strong>in</strong>g Document, 2004, Malé: Population Section,MPND.167
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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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ased service delivery poin<
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Most FWAs who were recruited two to
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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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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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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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