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Impact of family plann<strong>in</strong>g <strong>and</strong> futureprojectionsTFR <strong>in</strong> Nepal decl<strong>in</strong>ed from 6.3 <strong>in</strong> 1976 to 3.1 <strong>in</strong> <strong>the</strong>period 2003-2005. The average annual l<strong>in</strong>ear decl<strong>in</strong>e frommid-1999 to mid-2004 was 0.2 children per woman, while<strong>the</strong> comparable figures <strong>in</strong> <strong>the</strong> earlier years were more orless 0.1 children per woman. This reveals that <strong>the</strong> pace offertility decl<strong>in</strong>e after 2000 was faster than <strong>in</strong> <strong>the</strong> decades of<strong>the</strong> 1980s <strong>and</strong> 1990s.Impact of contraception on fertilityreductionResearch conducted by Ross <strong>and</strong> Frankenberg (1993),tak<strong>in</strong>g data from 100 develop<strong>in</strong>g countries, revealed thata 15 per cent <strong>in</strong>crease <strong>in</strong> CPR is generally associated witha one-child decl<strong>in</strong>e <strong>in</strong> TFR. In Nepal, Karki <strong>and</strong> Krishna(2008) found a strong correlation between TFR <strong>and</strong> CPR(coefficient = –0.955), which was significant at <strong>the</strong> 0.01level. They also ran a l<strong>in</strong>ear regression (Y = a + b X ) ofTFRs <strong>and</strong> CPRs <strong>and</strong> found <strong>the</strong> follow<strong>in</strong>g equation:TFR = 6.648 + (– 0.068) * CPR (r2 = 0.955)Us<strong>in</strong>g this equation with Nepalese data, we have predictedTFR for each year from 1976 to 2006 (see Table 19).The predicted TFR for 2006 was 3.4 while <strong>the</strong> observedTFR was 3.1. The predicted TFR for Nepal <strong>in</strong> 2006would be 6.648 assum<strong>in</strong>g no contraceptive use (<strong>the</strong> valueof constant). Thus, <strong>the</strong> <strong>in</strong>crease <strong>in</strong> contraceptive useexpla<strong>in</strong>s roughly 96.5 per cent of <strong>the</strong> decl<strong>in</strong>e <strong>in</strong> fertility.This implies that o<strong>the</strong>r proximate determ<strong>in</strong>ants of fertility,such as post-partum amenorrhoea, abortion <strong>and</strong> marriage,have had very little effect <strong>in</strong> reduc<strong>in</strong>g fertility. Thus, us<strong>in</strong>gNepalese data, a 14.1 per cent <strong>in</strong>crease <strong>in</strong> contraceptive useis associated with a one-child decl<strong>in</strong>e <strong>in</strong> TFR. Assum<strong>in</strong>gthat o<strong>the</strong>r proximate determ<strong>in</strong>ants of fertility rema<strong>in</strong> stableat <strong>the</strong> current level, Nepal, <strong>the</strong>refore, needs to achieve 63-65 per cent CPR to reach replacement-level fertility (2.1births per woman).Future projection of contraceptiveprevalence rateCPR must <strong>in</strong>crease <strong>in</strong> <strong>the</strong> future <strong>in</strong> Nepal, but <strong>the</strong> paceof <strong>in</strong>crease will depend upon several factors, <strong>in</strong>clud<strong>in</strong>gwomen’s education, employment <strong>and</strong> <strong>the</strong> national familyplann<strong>in</strong>g programme. A fur<strong>the</strong>r expansion of dem<strong>and</strong> forfamily plann<strong>in</strong>g is likely for two reasons. First, <strong>the</strong> onsetof <strong>the</strong> fertility transition <strong>in</strong> rural areas, especially among<strong>the</strong> most vulnerable, poorest, Muslims <strong>and</strong> Dalits, has notbeen actually <strong>in</strong>itiated, while for o<strong>the</strong>r social groups <strong>the</strong>transition has not yet been completed. Second, Nepal’shigh population growth rate <strong>in</strong> <strong>the</strong> past means that <strong>the</strong>number of women enter<strong>in</strong>g <strong>the</strong> reproductive age groupwill rise for a few decades.Methodology:Global, regional <strong>and</strong> country projections <strong>and</strong> figures forCPR <strong>and</strong> <strong>the</strong> proportion of women <strong>in</strong> union are availablefrom robust sources, such as <strong>the</strong> United Nations (1999)<strong>and</strong> <strong>the</strong> Futures Group (Morel<strong>and</strong> et al., 2010). TheFutures Group projection was carried out by employ<strong>in</strong>gSPECTRUM software, i.e., DEMPROJ for populationprojections, <strong>and</strong> FAMPLN for projection of familyplann<strong>in</strong>g, <strong>in</strong>clud<strong>in</strong>g o<strong>the</strong>r proximate determ<strong>in</strong>ants offertility. The authors used <strong>the</strong> basel<strong>in</strong>e <strong>in</strong>formation from<strong>the</strong> recent Demographic <strong>and</strong> Health Survey of <strong>the</strong> country<strong>in</strong> question. In <strong>the</strong> case of Nepal, <strong>the</strong> authors used datafrom NDHS 2001. CPR was estimated for all women ofreproductive age us<strong>in</strong>g any methods, <strong>in</strong>clud<strong>in</strong>g traditionalmethods, not only for married women or women <strong>in</strong> union.For projection of <strong>the</strong> percentage of women <strong>in</strong> union, <strong>the</strong>authors assumed that marriage <strong>and</strong> union patterns wouldbe <strong>in</strong>fluenced by level of education <strong>and</strong> be taken <strong>in</strong>toaccount.The projection of CPR shows that CPR of Nepal would be54 per cent by 2015, 70 per cent by 2025 <strong>and</strong> 80 per centby 2035. It is projected that CPR will rema<strong>in</strong> at 80 percent from 2035 to 2050. It should be noted that <strong>the</strong> annuall<strong>in</strong>ear <strong>in</strong>crease <strong>in</strong> CPR is 0.60 per cent between 2001 <strong>and</strong>2005; 1.7 per cent between 2005 <strong>and</strong> 2010; <strong>and</strong> that it willbe 1.64 per cent from 2010 to 2030. Therefore, accord<strong>in</strong>gto <strong>the</strong>se projections, Nepal will not reach its target of 67per cent CPR by 2015, which is needed to achieve Target5b of <strong>the</strong> Millennium Development Goals.On <strong>the</strong> o<strong>the</strong>r h<strong>and</strong>, <strong>the</strong> proportion of women <strong>in</strong> union isprojected to decl<strong>in</strong>e l<strong>in</strong>early <strong>in</strong> each of <strong>the</strong> successive years.The proportion of women <strong>in</strong> union was projected to be 77per cent <strong>in</strong> 2005, which would decl<strong>in</strong>e to 71 per cent by2020, to 66 per cent by 2035 <strong>and</strong> to 63 per cent by 2050.RecommendationsThe follow<strong>in</strong>g recommendations have emerged from <strong>the</strong>present assessment:1. Improve <strong>the</strong> quality of familyplann<strong>in</strong>g services:Improve <strong>the</strong> quality of family plann<strong>in</strong>g counsell<strong>in</strong>g bytra<strong>in</strong><strong>in</strong>g health-care providers <strong>and</strong> volunteers to addressmisconceptions <strong>and</strong> mis<strong>in</strong>formation of providers <strong>and</strong>clients. Monitor counsell<strong>in</strong>g practices periodically.2. Increase access to family plann<strong>in</strong>gservices:194
Exp<strong>and</strong> utilization of satellite services for a broaderrange of family plann<strong>in</strong>g services, such as implants <strong>and</strong>IUD, added to voluntary surgical contraception services.Increase <strong>the</strong> number of service delivery po<strong>in</strong>ts, <strong>in</strong>clud<strong>in</strong>gimprov<strong>in</strong>g physical facilities at <strong>the</strong> sub-health post level.Create family plann<strong>in</strong>g counsellor positions at all levels <strong>in</strong><strong>the</strong> government health system to improve access to familyplann<strong>in</strong>g.3. Increase <strong>in</strong>tegration of familyplann<strong>in</strong>g services <strong>in</strong>to o<strong>the</strong>r areas:Increase <strong>in</strong>tegration of FP counsell<strong>in</strong>g <strong>in</strong>to post-partum,safe abortion, safe mo<strong>the</strong>rhood, HIV, STI, child heal<strong>the</strong>tc., services. Increase <strong>in</strong>tegration of FP <strong>in</strong>formation <strong>in</strong>tosocial <strong>and</strong> economic development <strong>in</strong>itiatives.4. Streng<strong>the</strong>n coord<strong>in</strong>ation:Female Community Health Volunteers should be <strong>in</strong>cluded<strong>in</strong> district-level coord<strong>in</strong>ation committees. Refocus familyplann<strong>in</strong>g <strong>in</strong> <strong>the</strong> district-level coord<strong>in</strong>ation committeeagenda. Increase coord<strong>in</strong>ation of large NGOs <strong>and</strong>MoHP to make service delivery more efficient. Increasecommunication of new policies with <strong>the</strong> general population<strong>and</strong> key stakeholders.5. Improve monitor<strong>in</strong>g <strong>and</strong> evaluation:Improve <strong>and</strong> <strong>in</strong>crease rout<strong>in</strong>e monitor<strong>in</strong>g, evaluation <strong>and</strong>supervision of <strong>in</strong>tegration of FP with o<strong>the</strong>r RH services(post-partum, safe mo<strong>the</strong>rhood, safe abortion, HIV etc.)<strong>and</strong> basic health-care services, availability of methods, <strong>and</strong>service providers at health delivery sites <strong>and</strong> <strong>the</strong> VillageDevelopment Committee level.6. Increase/improve human resources:Mobilize health workers, especially doctors <strong>in</strong> rural<strong>and</strong> remote areas. Review current <strong>in</strong>centives for tra<strong>in</strong>edhealth personnel <strong>in</strong> remote areas to <strong>in</strong>crease retention<strong>and</strong> motivate <strong>the</strong>m to serve <strong>the</strong> people <strong>in</strong> those areas.Increase education <strong>and</strong> tra<strong>in</strong><strong>in</strong>g at medical schools <strong>and</strong>among health providers on all FP methods, especially forlong-act<strong>in</strong>g reversible contraceptive methods. M<strong>in</strong>imizedisruption <strong>and</strong> discont<strong>in</strong>uation of services associatedwith staff transfers, through periodic tra<strong>in</strong><strong>in</strong>g of newlyappo<strong>in</strong>ted staff. Increase refresher <strong>and</strong> retra<strong>in</strong><strong>in</strong>g courses.Increase advocacy to motivate health providers to givefamily plann<strong>in</strong>g services.7. Greater impact of Female CommunityHealth Volunteers:Cont<strong>in</strong>ue to tra<strong>in</strong> <strong>and</strong> motivate (through <strong>in</strong>centives <strong>and</strong>awards) Female Community Health Volunteers on accuratecounsell<strong>in</strong>g <strong>and</strong> <strong>in</strong>sure that <strong>the</strong>y have adequate amountsof FP supplies. Improve referral l<strong>in</strong>kages to facilities thatoffer long-act<strong>in</strong>g reversible contraceptive method services.Reorient <strong>the</strong> Volunteers to engage <strong>in</strong> promot<strong>in</strong>g spac<strong>in</strong>gmethods. Increase refresher <strong>and</strong> referral tra<strong>in</strong><strong>in</strong>g. Include<strong>the</strong> Volunteers <strong>in</strong> <strong>the</strong> formulation of family plann<strong>in</strong>gprogrammes. Establish or exp<strong>and</strong> exist<strong>in</strong>g FemaleCommunity Health Volunteer funds <strong>in</strong> every VillageDevelopment Committee <strong>and</strong> properly mobilize <strong>the</strong>m toimprove <strong>the</strong> liv<strong>in</strong>g st<strong>and</strong>ards of <strong>the</strong> Volunteers. Modify <strong>the</strong>Volunteer recruitment methods to meet <strong>the</strong> dem<strong>and</strong> for<strong>the</strong>ir services <strong>in</strong> order to reduce <strong>the</strong>ir burden of work.8. Reach marg<strong>in</strong>alized populations:Prioritize equitable access to family plann<strong>in</strong>g services by<strong>the</strong> donors, government <strong>and</strong> NGOs <strong>in</strong> order to reachmarg<strong>in</strong>alized groups, such as Muslims, Dalits, <strong>the</strong> verypoor <strong>and</strong> undereducated rural people. Community healthworkers <strong>and</strong> volunteers with<strong>in</strong> <strong>the</strong>se groups should betra<strong>in</strong>ed <strong>and</strong> mobilized to exp<strong>and</strong> family plann<strong>in</strong>g education<strong>and</strong> access. Integrate family plann<strong>in</strong>g with socio-economicdevelopment programmes, as well as all health servicesthrough local participation. For example, FP should be<strong>in</strong>corporated with microcredit <strong>and</strong> women’s cooperativeprogrammes, s<strong>in</strong>ce <strong>the</strong>re are more than 1 million womenwho are organized <strong>in</strong> such programmes. Fur<strong>the</strong>r promote<strong>in</strong>formed choice <strong>and</strong> comprehensive FP services below <strong>the</strong>district level.9. Reach migrants:Increase access to <strong>in</strong>formation <strong>and</strong> <strong>in</strong>crease provision ofemergency contraception, easy access to condoms <strong>and</strong>pills for <strong>the</strong> migrant population <strong>and</strong> develop quick referralsystems to enable migrant populations to easily accesscontraception.10. Reach adolescents <strong>and</strong> youth:Increase youth-friendly services at health facilities. Increaseemphasis on sexual <strong>and</strong> reproductive health education,<strong>in</strong>clud<strong>in</strong>g <strong>the</strong> advantages of contraceptive use, <strong>in</strong> schools<strong>and</strong> <strong>in</strong> public communication campaigns, to sensitizeyoung people to <strong>the</strong>se issues.11. Contraceptive commodities:Streaml<strong>in</strong>e <strong>the</strong> procurement procedures <strong>and</strong> developnational capacity <strong>in</strong> <strong>the</strong> area of procurement plann<strong>in</strong>g.Improve warehous<strong>in</strong>g, distribution <strong>and</strong> transportationsystems <strong>in</strong> l<strong>in</strong>e with <strong>the</strong> <strong>in</strong>creas<strong>in</strong>g dem<strong>and</strong> for moresupplies. Explore cost recovery schemes, <strong>and</strong> <strong>in</strong>creaseprivate sector outreach <strong>in</strong> rural areas.12. Increase private sector<strong>in</strong>volvement:Increase role of <strong>the</strong> private sector <strong>in</strong> sell<strong>in</strong>g <strong>and</strong> social195
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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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FigureFigureFigure1Contraceptive pr
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TableTable5Indicators of contracept
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TableTable6Adjusted odds ratios for
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FigureFigure3Contraceptive prevalen
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TableTable7Adjusted and</st
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Page 238 and 239: Figureeconomic growth durin
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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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