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

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FigureFigure6Desire to limit childbear<strong>in</strong>g, current use <strong>and</strong> unmet need, by wealth status, 1991-200770605040%3020100PoorestDesire to limit20071991PoorerMiddleRicherRichest70605040%3020100PoorestCurrent use20071991PoorerMiddleRicherRichest504030%20100PoorestUnmet need19912007PoorerMiddleRicherRichestLack of accessWhile access costs are not currently <strong>the</strong> primarydeterm<strong>in</strong>ant of contraceptive use, studies have shownthat <strong>in</strong>creas<strong>in</strong>g service outlets <strong>and</strong> outreach programmescan lead to a reduction <strong>in</strong> unmet need, i.e., <strong>in</strong>creasecontraceptive prevalence (Fikree et al., 2001; Shelton etal., 1999). Data from various national surveys show thataccess to a health or FP facility varies greatly between rural<strong>and</strong> urban areas of Pakistan. Accord<strong>in</strong>g to <strong>the</strong> 1991 DHS,gett<strong>in</strong>g to a reproductive health facility took an average of40 m<strong>in</strong>utes <strong>in</strong> urban areas, while <strong>in</strong> rural areas it took morethan twice that time (96 m<strong>in</strong>utes). By 2001, urban-ruraldisparities <strong>in</strong> <strong>the</strong> availability of RH facilities still rema<strong>in</strong>edsignificant; distance to facilities was 3.4 km <strong>and</strong> 12.6 km<strong>in</strong> urban <strong>and</strong> rural areas, respectively (World Bank, 2009).The 2003 data also show that <strong>the</strong> <strong>in</strong>equality <strong>in</strong> accessrema<strong>in</strong>s strong. S<strong>in</strong>ce rural areas tend to have more poorpeople, it is not surpris<strong>in</strong>g <strong>the</strong>n that <strong>the</strong> figure above showsa negative relationship between wealth <strong>and</strong> distance tonearest FP facility.Quality of servicesThe role of <strong>the</strong> quality of family plann<strong>in</strong>g services <strong>and</strong>methods <strong>in</strong> <strong>the</strong> uptake of contraceptive use demonstratesyet ano<strong>the</strong>r fail<strong>in</strong>g <strong>in</strong> <strong>the</strong> supply of family plann<strong>in</strong>g. Inanalysis of DHS data, Zaidi (2009) found that over time<strong>in</strong>creas<strong>in</strong>g numbers of women had reported fear of sideeffects <strong>and</strong> health concerns as <strong>the</strong>ir primary reason for not<strong>in</strong>tend<strong>in</strong>g to use contraception <strong>in</strong> <strong>the</strong> future (see Figure8). In urban areas, health-related issues have replacedreligious prohibition as <strong>the</strong> most commonly reported nonfertilityreason for not <strong>in</strong>tend<strong>in</strong>g to use a method <strong>in</strong> <strong>the</strong>future. Even <strong>in</strong> rural areas, health-related issues are <strong>the</strong>second most common non-fertility-related reason for not<strong>in</strong>tend<strong>in</strong>g to use contraception. The fear of side effects<strong>and</strong> health concerns are known to be hugely related to <strong>the</strong>quality of services <strong>and</strong> choice of methods available. The<strong>in</strong>crease <strong>in</strong> <strong>the</strong> number of women try<strong>in</strong>g contraception butnot us<strong>in</strong>g it – as demonstrated by <strong>the</strong> difference <strong>in</strong> current<strong>and</strong> ever use – also suggests that health concerns <strong>and</strong>,<strong>the</strong>refore, quality of services are likely to be a significantfactor <strong>in</strong> deterr<strong>in</strong>g contraceptive use.Underst<strong>and</strong><strong>in</strong>g <strong>the</strong> currentsituationSocio-economic factorsEconomic growth but low educationWhile Pakistan has experienced economic growthconsistently s<strong>in</strong>ce its <strong>in</strong>ception, <strong>the</strong> prevalence of smallerfamily norms has yet to fully take place. A possiblereason beh<strong>in</strong>d <strong>the</strong> divergent trends <strong>in</strong> fertility decl<strong>in</strong>e <strong>and</strong>economic growth is that social development has not beencommensurate with economic progress; <strong>in</strong> Pakistan’s case,<strong>the</strong> two are not necessarily related. First, despite persistenteconomic growth <strong>and</strong> a rapid <strong>in</strong>crease <strong>in</strong> urbanization,<strong>the</strong> majority of Pakistan rema<strong>in</strong>s an agrarian society.Agriculture cont<strong>in</strong>ues to provide more than 40 per centof employment; its proportion has only decreased slightlyfrom 48 to 44 per cent. There has been little change <strong>in</strong> <strong>the</strong>proportion of employment provided by <strong>the</strong> o<strong>the</strong>r sectors,with marg<strong>in</strong>al <strong>in</strong>creases <strong>in</strong> wholesale <strong>and</strong> retail, <strong>and</strong> servicessectors.Second, <strong>the</strong> periods that saw a rise <strong>in</strong> economic growth ratesdid not see substantial progress <strong>in</strong> <strong>the</strong> social sectors <strong>and</strong>vice versa. Educational atta<strong>in</strong>ment saw little improvementover <strong>the</strong> period of <strong>the</strong> fertility transition, with gender<strong>in</strong>equalities <strong>in</strong> education rema<strong>in</strong><strong>in</strong>g high throughout. Itis only very recently that children’s enrolment rates haverisen at <strong>the</strong> primary level from about 49 per cent for boys210
FigureFigure7Non-fertility-related reasons for not <strong>in</strong>tend<strong>in</strong>g to use contraception <strong>in</strong> <strong>the</strong> future, 1991-200714Urban14Rural1212101086420199120078642019912007Husb<strong>and</strong>opposedReligiousprohibitionLack ofknowledgeHealthconcernsHusb<strong>and</strong>opposedReligious Lack ofprohibition knowledgeHealthconcerns<strong>and</strong> 38 per cent for girls <strong>in</strong> <strong>the</strong> 1990s to 59 per cent forboys <strong>and</strong> 52 per cent for girls <strong>in</strong> <strong>the</strong> recent decade. Thereare wide urban-rural disparities: enrolments are 70 percent <strong>in</strong> urban areas, but <strong>the</strong>y still lag far beh<strong>in</strong>d <strong>in</strong> <strong>the</strong> ruralareas. Secondary school enrolments are even lower, notris<strong>in</strong>g beyond 33 per cent even for 10-14-year-old boys.Less than half <strong>the</strong> population (about 47%) cont<strong>in</strong>ue to beilliterate <strong>and</strong> reside <strong>in</strong> rural areas where illiteracy is evenmore severe. Education has been a largely neglected sector<strong>in</strong> past decades <strong>and</strong> few resources have been allocated to ituntil recently.Low participation of women <strong>in</strong> societyMoreover, women’s low mobility <strong>and</strong> autonomy rema<strong>in</strong>obstacles to participation <strong>in</strong> politics, economic life <strong>and</strong>basic access to services. Accord<strong>in</strong>g to <strong>the</strong> Status of Women,Reproductive Health <strong>and</strong> <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> Survey 2003,one <strong>in</strong> three women was not allowed to leave her homealone <strong>and</strong> 42 per cent of women who were able to go tohealth centres on <strong>the</strong>ir own were us<strong>in</strong>g contraceptioncompared with half that proportion, 21 per cent, who werenot allowed to go to <strong>the</strong>se facilities at all. Similarly, <strong>the</strong>proportion of women with high decision-mak<strong>in</strong>g powerwith<strong>in</strong> <strong>the</strong> households us<strong>in</strong>g contraception was twice <strong>the</strong>proportion of women with low decision-mak<strong>in</strong>g powerpractis<strong>in</strong>g family plann<strong>in</strong>g.Women have become more visible <strong>in</strong> Pakistani society; <strong>the</strong>yare certa<strong>in</strong>ly participat<strong>in</strong>g more <strong>in</strong> politics, public life <strong>and</strong>education than ever before, <strong>and</strong> an <strong>in</strong>creas<strong>in</strong>g proportionof women are enter<strong>in</strong>g <strong>the</strong> labour force, especially <strong>in</strong> urbanareas. Yet, it is still questionable whe<strong>the</strong>r this has led to an<strong>in</strong>crease <strong>in</strong> <strong>the</strong>ir status with<strong>in</strong> <strong>the</strong> household <strong>and</strong> with<strong>in</strong>society. Despite <strong>the</strong> recent <strong>in</strong>crease <strong>in</strong> female labour forceparticipation from 13 to 19 per cent over <strong>the</strong> last 18 years,female participation rema<strong>in</strong>s low compared with malelabour force participation, which has rema<strong>in</strong>ed at about71 per cent dur<strong>in</strong>g this period. Pakistan has <strong>the</strong> highestgender gap <strong>in</strong> labour force participation rates among <strong>the</strong>South, East <strong>and</strong> South-East <strong>Asia</strong>n countries (Arif <strong>and</strong>Arooj, 2009).Even <strong>the</strong> m<strong>in</strong>or <strong>in</strong>crease <strong>in</strong> female labour force participationis offset by <strong>the</strong> trends <strong>in</strong> <strong>the</strong> types of work women aretak<strong>in</strong>g up. Trends <strong>in</strong> employment status show that womenare replac<strong>in</strong>g men <strong>in</strong> unpaid <strong>and</strong> agricultural work; <strong>the</strong>proportion of women engaged <strong>in</strong> unpaid family work has<strong>in</strong>creased from 57 to 65 per cent. The proportion of womenwork<strong>in</strong>g <strong>in</strong> <strong>the</strong> agricultural sector is double <strong>the</strong> proportionof men, 75 <strong>and</strong> 37 per cent, respectively. However, <strong>the</strong>small but notable proportions of women who are educated<strong>and</strong> engaged <strong>in</strong> economic activity are likely to comprisean important <strong>in</strong>fluence on women’s empowerment <strong>and</strong>on fertility change. Recent expansion <strong>in</strong> wage work foreducated women <strong>in</strong> rural areas, such as <strong>the</strong> Lady HealthWorker scheme <strong>and</strong> <strong>the</strong> hir<strong>in</strong>g of female teachers <strong>and</strong>paramedics on a contract basis, may be pivotal to fur<strong>the</strong>rchange (Sathar et al., 2007).Explanations for programmeshortcom<strong>in</strong>gsThe Population Policy, <strong>in</strong>itiated <strong>in</strong> 1998 <strong>and</strong> passed <strong>in</strong> 2002by <strong>the</strong> Cab<strong>in</strong>et, may be considered a statement support<strong>in</strong>ga commitment to population issues. The pr<strong>in</strong>ciples werestrong but implementation details were weak. Essentially,elements of <strong>the</strong> policy underscored <strong>the</strong> need for anexpeditious completion of <strong>the</strong> fertility transition, good<strong>in</strong>ter-sectoral l<strong>in</strong>ks <strong>and</strong> <strong>in</strong>tertw<strong>in</strong>ement with developmentprogrammes. Unfortunately, while tackl<strong>in</strong>g <strong>the</strong> fertilitydecl<strong>in</strong>e, not much attention was devoted to how exactlythis would happen <strong>and</strong> <strong>the</strong> resources it would require;once more, much was left to do<strong>in</strong>g th<strong>in</strong>gs <strong>the</strong> way <strong>the</strong>y hadbeen done, with some expansion <strong>in</strong> <strong>the</strong> numbers of outlets<strong>and</strong> workers. Very little attention was given to details of211
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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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the north
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TableTable10Differences between nor
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TableTable11 Total fertility rate <
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End Note1The first camp was success
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152
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154
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Figure1980s and ex
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health care and ed
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Page 256 and 257: FigureTrends and p
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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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TableTable6TableTable7TableTable832
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TableTable11326
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TableTable14TableTable15TableTable1
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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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