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

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TableTable7skewed distribution of health-care professionals <strong>in</strong> Nepal(see Table 7). Almost 70 per cent of doctors, 40 per centof nurses <strong>and</strong> auxiliary nurse midwives <strong>and</strong> 64 per cent ofretail pharmacies are located <strong>in</strong> <strong>the</strong> central developmentregion, especially <strong>in</strong> <strong>the</strong> Kathm<strong>and</strong>u Valley, even thoughthis development region accounts for only 35 per cent of<strong>the</strong> total population of Nepal. Next to <strong>the</strong> central region,<strong>the</strong> eastern region has 14 per cent of doctors, 23 per centof nurses <strong>and</strong> auxiliary nurse midwives <strong>and</strong> 17 per cent ofretail pharmacies; it accounts for 23 per cent of Nepal’spopulation. The third largest share of health professionalsis <strong>in</strong> <strong>the</strong> western region: 11 per cent of doctors, 26 per centof nurses <strong>and</strong> auxiliary nurse midwives <strong>and</strong> 13 per cent ofretail pharmacies are located <strong>in</strong> this region, which accountsfor 20 per cent of <strong>the</strong> country’s population. It is <strong>the</strong> midwestern<strong>and</strong> far-western regions that share <strong>the</strong> lowestnumber of health professionals. While <strong>the</strong> mid-westernregion accounts for 12 per cent of Nepal’s population, itsshares <strong>in</strong> doctors, nurses <strong>and</strong> auxiliary nurse midwives <strong>and</strong>retail pharmacies are 3, 8 <strong>and</strong> 4 per cent, respectively. Thefar-western region has <strong>the</strong> lowest proportion of doctors(2%), nurses <strong>and</strong> auxiliary nurse midwives (3%) <strong>and</strong> retailpharmacies (3%), even though it accounts for 10 per centof <strong>the</strong> country’s total population.A shortage of female doctors <strong>and</strong> health workers, especially<strong>in</strong> <strong>the</strong> rural <strong>and</strong> most <strong>in</strong>accessible areas, is a major barrier to<strong>the</strong> use of high-quality family plann<strong>in</strong>g services. In Nepal,women <strong>and</strong> girls are often shy to make dem<strong>and</strong>s on, orshare <strong>the</strong>ir reproductive health problems with, male healthworkers. As stated above, this is a particularly importantbarrier to <strong>the</strong> use of IUDs.One of <strong>the</strong> <strong>in</strong>dicators to assess services reach<strong>in</strong>g people is<strong>the</strong> time taken to reach a source of contraception for thosewho were us<strong>in</strong>g a contraceptive method. Data reveal that<strong>the</strong> time taken to reach a source for contraceptives may notbe a major concern <strong>in</strong> terms of quality of care. The mediantime to reach a source for a contraceptive method (for pills,<strong>in</strong>jectables <strong>and</strong> condoms) is 30 m<strong>in</strong>utes (2001 NDHS).Method choice“The current method mix is a reflection of currentavailability, not about client choice”, accord<strong>in</strong>g to VictorLara of PSI Nepal.Clients have limited contraceptive choices <strong>in</strong> rural <strong>and</strong>remote areas, as reflected <strong>in</strong> <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> ProgrammeEffort Index scores. This is measured by <strong>the</strong> percentageof <strong>the</strong> population hav<strong>in</strong>g ready <strong>and</strong> easy access to eachmethod, namely male sterilization, female sterilization,pills, <strong>in</strong>jectables, condoms, diaphragm <strong>and</strong> spermicide,<strong>in</strong>trauter<strong>in</strong>e device <strong>and</strong> safe abortion. The methodavailability score <strong>in</strong> Nepal <strong>in</strong>creased from 50 <strong>in</strong> 2004 to 62<strong>in</strong> 2006, which shows that choice of method has <strong>in</strong>creasedbut still rema<strong>in</strong>s a challenge. A full range of contraceptiveshas yet to be available <strong>in</strong> rural <strong>and</strong> remote areas, amongpoor <strong>and</strong> disadvantaged groups, <strong>and</strong> adolescents <strong>and</strong>young women. Currently, private sector agencies providehigh-quality family plann<strong>in</strong>g services; however, <strong>the</strong>irservice outlets are limited to urban areas <strong>and</strong> district-levelfacilities.There are a number of issues <strong>in</strong> remote areas, for example,many rural outreach health facilities do not provide IUDsor implants because of <strong>the</strong> shortage of tra<strong>in</strong>ed healthpersonnel, but voluntary surgical contraceptive services areprovided <strong>in</strong> mobile camps, so sterilization is very accessiblefor people <strong>in</strong> <strong>the</strong>se regions. A recent study <strong>in</strong> 40 ruraldistricts by <strong>the</strong> Nepal family health programme foundthat 68 per cent of Female Community Health Volunteershad pills on h<strong>and</strong> <strong>in</strong> <strong>the</strong> previous month <strong>and</strong> 80 per centhad condoms on h<strong>and</strong> Nepal <strong>Family</strong> Health Program II<strong>and</strong> New ERA , 2010) This <strong>in</strong>dicates that those volunteersdo not always have <strong>the</strong>se two methods on h<strong>and</strong>, <strong>the</strong>rebylimit<strong>in</strong>g <strong>the</strong> access of <strong>the</strong>ir clients to contraception. Thisrestricted choice of contraceptive methods has constra<strong>in</strong>ed<strong>the</strong> opportunity of <strong>in</strong>dividual couples to obta<strong>in</strong> a method180
that suits <strong>the</strong>ir needs, result<strong>in</strong>g <strong>in</strong> a low level of contraceptiveprevalence, especially among <strong>the</strong> poor, disadvantaged <strong>and</strong>remote rural areas <strong>in</strong> Nepal (for district-level CPR, seeTable 8 below).Accord<strong>in</strong>g to key stakeholder <strong>in</strong>terviews, method choice islimited by availability, especially <strong>in</strong> rural areas, counsellorsare not adequately tra<strong>in</strong>ed or <strong>in</strong>formed of all options, <strong>and</strong>clients are not adequately <strong>in</strong>formed so <strong>the</strong>y are not able todem<strong>and</strong> what method is best for <strong>the</strong>m.O<strong>the</strong>r challenges of <strong>the</strong> nationalfamily plann<strong>in</strong>g programmeO<strong>the</strong>r challenges fac<strong>in</strong>g <strong>the</strong> national family plann<strong>in</strong>gprogramme <strong>in</strong>clude: political <strong>in</strong>stability; difficulttopography; coord<strong>in</strong>ation issues between <strong>the</strong> government,NGOs <strong>and</strong> donors; <strong>and</strong> socio-cultural practices.Political <strong>in</strong>stabilityVarious sources reported that, due to <strong>the</strong> political <strong>in</strong>stability<strong>and</strong> conflict <strong>in</strong> <strong>the</strong> late 1990s <strong>and</strong> early 2000s, it was difficultto focus on family plann<strong>in</strong>g when even basic health needswere not be<strong>in</strong>g met. Resources have been directed towardsrestor<strong>in</strong>g peace <strong>and</strong> security <strong>and</strong> rebuild<strong>in</strong>g <strong>in</strong>frastructurefollow<strong>in</strong>g <strong>the</strong> conflict, leav<strong>in</strong>g little for health programmes(FPAN, 2010). Political transformation from a monarchialsystem to a democracy (begun <strong>in</strong> 2008) is tak<strong>in</strong>g longerthan expected as a new constitution still has not yet beencompleted (<strong>the</strong> deadl<strong>in</strong>e had been set for May 2010). Thissituation has caused delays <strong>in</strong> budget allocation. Ano<strong>the</strong>rexample of how political <strong>in</strong>stability has adversely affectedfamily plann<strong>in</strong>g is that, <strong>in</strong> FY 2001/2002, voluntarysurgical contraception camps could not be conducted <strong>in</strong>32 districts for security reasons (MoHP et al., 2006). Inaddition, <strong>the</strong> conflict could have reduced <strong>the</strong> number ofacceptors of contraception, such as young males who weredisplaced <strong>and</strong> young women felt threatened <strong>in</strong> try<strong>in</strong>g to181
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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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are considered, unmet need for effe
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Households pay the
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Effective public-private partnershi
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ConclusionThe Bangladesh Fa
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the Family
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National Institute for Population R
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IndiaIndiaFamily <
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Page 166 and 167: Figure1980s and ex
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Page 186 and 187: per cent of women reported us<stron
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Page 212 and 213: acceptable. From an NGO perspective
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Page 230 and 231: Population Activities (UNFPA) for a
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Page 238 and 239: 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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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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