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that of <strong>the</strong> national average, while unmet need for familyplann<strong>in</strong>g <strong>and</strong> TFR each is 1.5 times higher than that of<strong>the</strong> national average figures. Hill Dalit 3 have <strong>the</strong> secondhighest TFR (4.0) <strong>and</strong> have a CPR of only 37 per cent<strong>and</strong> unmet need for family plann<strong>in</strong>g of 34 per cent. Forthis group, CRP is still 0.8 times <strong>the</strong> national average <strong>and</strong>unmet need for family plann<strong>in</strong>g is 1.4 times higher than <strong>the</strong>national average. The Tarai Dalit have a TFR of 3.8, withCPR be<strong>in</strong>g 50 per cent <strong>and</strong> a much lower unmet need forfamily plann<strong>in</strong>g (18%). Hill Chhetri 4 have almost <strong>the</strong> samelevel of TFR, CPR <strong>and</strong> unmet need for family plann<strong>in</strong>gas <strong>the</strong> national averages. Hill Brahman 5 have TFR below<strong>the</strong> national average, with slightly higher unmet need forfamily plann<strong>in</strong>g <strong>and</strong> CPR. Hill/Mounta<strong>in</strong> Janajati 6 stillhave a TFR of 3.1 while <strong>the</strong>ir CPR <strong>and</strong> unmet need forfamily plann<strong>in</strong>g are 41 <strong>and</strong> 31 per cent, respectively.PovertyHousehold wealth is clearly associated with CPR <strong>and</strong> TFR.As household wealth <strong>in</strong>creases, CPR also <strong>in</strong>creases <strong>and</strong>vice versa. There is a wide gap <strong>in</strong> CPR between <strong>the</strong> top <strong>and</strong>bottom household wealth qu<strong>in</strong>tiles. A similar relationshipis observed between <strong>the</strong> wealth qu<strong>in</strong>tile <strong>and</strong> total fertilityrate. TFR of <strong>the</strong> bottom wealth qu<strong>in</strong>tile is 4.7; that of <strong>the</strong>second wealth qu<strong>in</strong>tile is 3.6. TFR is below replacementlevelfertility <strong>in</strong> <strong>the</strong> top wealth qu<strong>in</strong>tile. The overall unmetneed for family plann<strong>in</strong>g is also <strong>in</strong>versely associated with<strong>the</strong> wealth qu<strong>in</strong>tile of <strong>the</strong> households, suggest<strong>in</strong>g that <strong>the</strong>poorer is <strong>the</strong> household, <strong>the</strong> higher is <strong>the</strong> unmet need forfamily plann<strong>in</strong>g <strong>and</strong> vice versa.Adolescents <strong>and</strong> young womenEarly marriage <strong>and</strong> childbear<strong>in</strong>g rema<strong>in</strong> prevalent <strong>in</strong> Nepal.Although <strong>the</strong> legal age at marriage <strong>in</strong> Nepal is 18 years withparental consent <strong>and</strong> 20 years without such consent, <strong>the</strong>nationwide median age at marriage for women is just over17 years (2006 NDHS). Women’s median age at marriage<strong>in</strong> Nepal <strong>in</strong>creased from 16.4 years <strong>in</strong> 1991 to 17.2 years <strong>in</strong>2006. Median age at first birth <strong>in</strong>creased slightly from 19.8years to 19.9 years between 1996 (<strong>the</strong> earliest year withdata) <strong>and</strong> 2006. As of 2006, 18.5 per cent of women aged15-19 had begun childbear<strong>in</strong>g. These ages differ <strong>in</strong> rural<strong>and</strong> urban areas. The median age at marriage for women<strong>in</strong> urban areas tends to be about a year later than thosewomen <strong>in</strong> rural areas. Median age at childbirth is alsoslightly higher <strong>in</strong> urban areas than rural areas but only byabout half a year.Table 10 shows age-adjusted fertility rates, CPR <strong>and</strong>unmet need for adolescents <strong>and</strong> young women. The highestneed for family plann<strong>in</strong>g services are for adolescents <strong>and</strong>young women. Among <strong>the</strong> late adolescents (15-19 years),<strong>the</strong> age-specific fertility rate (ASFR) is very high (98 per1,000 women), while <strong>the</strong>ir use of contraception is just16 per cent <strong>and</strong> unmet need for family plann<strong>in</strong>g is veryhigh (38%). For this age group, unmet need for spac<strong>in</strong>gis very high. In <strong>the</strong> case of young women (20-24 years),ASFR is very high (234 per 1,000 women). On <strong>the</strong> o<strong>the</strong>rh<strong>and</strong>, <strong>the</strong>ir CPR is 31 per cent <strong>and</strong> unmet need for familyplann<strong>in</strong>g services 33 per cent.Accord<strong>in</strong>g to key stakeholder <strong>in</strong>terviews, reproductivehealth programmes <strong>in</strong>corporat<strong>in</strong>g adolescents arenot adequate. Although <strong>the</strong> government has removedpolicies that restrict adolescents from access<strong>in</strong>g familyplann<strong>in</strong>g services, o<strong>the</strong>r barriers to <strong>the</strong>ir use exist, such as<strong>in</strong>adequate sex education <strong>in</strong> schools, shame <strong>and</strong> negativeperceptions of unmarried women us<strong>in</strong>g contraception,lack of youth-friendly family plann<strong>in</strong>g services <strong>and</strong> lack oftarget<strong>in</strong>g adolescents <strong>in</strong> family plann<strong>in</strong>g efforts. Currentgovernmental efforts are aimed at improv<strong>in</strong>g sexual <strong>and</strong>reproductive health education <strong>in</strong> schools; at <strong>the</strong> NGOlevel, programmes are target<strong>in</strong>g adolescents <strong>in</strong> terms of<strong>in</strong>formation <strong>and</strong> services.Negative connotation of term “familyplann<strong>in</strong>g”Accord<strong>in</strong>g to MoHP et al. (2006) <strong>and</strong> key stakeholders,<strong>the</strong> term “family plann<strong>in</strong>g” (pariwar niyojan <strong>in</strong> <strong>the</strong> Nepalilanguage) has negative connotations so <strong>the</strong> government iswork<strong>in</strong>g on emphasiz<strong>in</strong>g a more positive term "byawasthitpariwar" (well-planned family) <strong>in</strong>stead.Underst<strong>and</strong><strong>in</strong>g <strong>the</strong> currentsituationGovernance of family plann<strong>in</strong>g/reproductive healthMoHP formulates, plans, monitors, supervises <strong>and</strong>evaluates basic health <strong>and</strong> family plann<strong>in</strong>g policies <strong>and</strong>programmes <strong>in</strong> <strong>the</strong> country. Under <strong>the</strong> M<strong>in</strong>istry, <strong>the</strong>Department of Health Services works as an implement<strong>in</strong>gagency. Under that department, <strong>the</strong>re are seven divisions.Among <strong>the</strong>m, <strong>the</strong> <strong>Family</strong> Health Division is responsiblefor implement<strong>in</strong>g reproductive health strategies <strong>and</strong>programmes, <strong>and</strong> <strong>the</strong> Logistics Management Divisionis responsible for <strong>the</strong> procurement, warehous<strong>in</strong>g <strong>and</strong>distribution of reproductive health commodities, <strong>in</strong>clud<strong>in</strong>gsupplies <strong>and</strong> equipment.Coord<strong>in</strong>ation mechanisms exist at <strong>the</strong> national (National<strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> Sub-committee) <strong>and</strong> district (ReproductiveCoord<strong>in</strong>ation Committee) levels for <strong>the</strong> purpose of revis<strong>in</strong>gfamily plann<strong>in</strong>g programmes <strong>and</strong> activities. Members of <strong>the</strong>national sub-committee <strong>in</strong>clude <strong>in</strong>ternational developmentagencies <strong>and</strong> service delivery partners, <strong>and</strong> members of <strong>the</strong>district committee <strong>in</strong>clude civil society organizations <strong>and</strong>184
TableTable10<strong>in</strong>ternational NGOs. Accord<strong>in</strong>g to <strong>the</strong> director-generalof FPAN, district committees are located <strong>in</strong> only 45districts. Although committees at <strong>the</strong> national <strong>and</strong> districtlevels have been established, <strong>the</strong>re reportedly is overlap <strong>in</strong><strong>the</strong> work between government agencies <strong>and</strong> NGOs, <strong>and</strong><strong>the</strong>re is no effective mechanism to follow-up whe<strong>the</strong>r <strong>the</strong>recommendations forwarded by such committees are met.In addition, one key stakeholder stated that, ow<strong>in</strong>g to <strong>the</strong>low priority of family plann<strong>in</strong>g <strong>in</strong> Nepal, <strong>the</strong> committeesare not effective because, at <strong>the</strong> district level, <strong>the</strong> committeefocuses on o<strong>the</strong>r reproductive health issues – not on familyplann<strong>in</strong>g. Issues related to restructur<strong>in</strong>g or reprioritiz<strong>in</strong>g<strong>the</strong> national family plann<strong>in</strong>g programme are discussed at<strong>the</strong> national sub-committee meet<strong>in</strong>gs.The <strong>International</strong> Conference onPopulation <strong>and</strong> Development,Millennium Development Goals <strong>and</strong>NepalCommon goals of <strong>the</strong> ICPD Programme of Action <strong>and</strong> <strong>the</strong>Millennium Development Goals <strong>in</strong>clude <strong>in</strong>creas<strong>in</strong>g genderequality, reduc<strong>in</strong>g poverty, improv<strong>in</strong>g maternal health<strong>and</strong> afford<strong>in</strong>g universal access to reproductive health. IfNepal still has a high unmet need for family plann<strong>in</strong>g,low maternal health-care usage, cont<strong>in</strong>ued disparities <strong>in</strong>education <strong>and</strong> <strong>in</strong> age at marriage between men <strong>and</strong> women,<strong>the</strong>n <strong>the</strong> country is at risk of not meet<strong>in</strong>g <strong>the</strong>se goals.Target 5b of <strong>the</strong> MDGs is “Achieve universal access toreproductive health by 2015”. Table 11 below shows <strong>the</strong>four <strong>in</strong>dicators used to measure progress towards achiev<strong>in</strong>gTablethis goal, along with Nepal’s targets for 2015.Political commitment to familyplann<strong>in</strong>g programme<strong>Family</strong> plann<strong>in</strong>g is currently a “Priority One” programmefor <strong>the</strong> government. However key stakeholder <strong>in</strong>terviewssuggested that o<strong>the</strong>r reproductive health programmes, suchas <strong>the</strong> Safe Mo<strong>the</strong>rhood <strong>and</strong> Safe Abortion programmes,are gett<strong>in</strong>g more attention than family plann<strong>in</strong>g. Accord<strong>in</strong>gto representatives from <strong>the</strong> <strong>Family</strong> Health Division, <strong>the</strong>family plann<strong>in</strong>g programme is be<strong>in</strong>g revamped <strong>and</strong> <strong>the</strong>rewere plans to create a specific family plann<strong>in</strong>g policy <strong>in</strong> 2011<strong>in</strong> order to accelerate progress towards reach<strong>in</strong>g <strong>the</strong> targetof 67 per cent CPR by 2015. The <strong>Family</strong> Health Division<strong>and</strong> <strong>the</strong> Department of Health Services are currentlyrevis<strong>in</strong>g <strong>the</strong> National Reproductive Health Strategy. O<strong>the</strong>rkey stakeholders reported that political commitment tofamily plann<strong>in</strong>g is high, but <strong>the</strong>re is difficulty <strong>in</strong> translat<strong>in</strong>g<strong>the</strong> policies <strong>in</strong>to <strong>the</strong> programme <strong>and</strong> practice levels on<strong>the</strong> ground. Accord<strong>in</strong>g to key stakeholders, <strong>the</strong>re is nopolitical or public opposition to family plann<strong>in</strong>g <strong>in</strong> Nepal.For example, an NGO representative stated: “The politicalcommitment is sufficient but <strong>the</strong> context <strong>and</strong> <strong>the</strong> practiceon <strong>the</strong> ground is <strong>the</strong> problem”.Political commitment related tovulnerable groupsTable 13 shows Nepal’s recent policies that relate to familyplann<strong>in</strong>g for marg<strong>in</strong>alized groups.Accord<strong>in</strong>g to key stakeholders, <strong>the</strong> commitment tovulnerable groups is not adequate even though <strong>the</strong>re areTable11185
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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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IntroductionThe use of contraceptiv
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TableTable2Indicators of tra<strong
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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 230 and 231: Population Activities (UNFPA) for a
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Page 238 and 239: Figureeconomic growth durin
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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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