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

Population Activities (UNFPA) for assistance <strong>in</strong> order toestablish a broad base for <strong>the</strong> population programme. Thusit took two decades from 1953 to 1973 for family plann<strong>in</strong>gto take root <strong>and</strong> become an acceptable programme. Thefact that it was possible to overcome various social <strong>and</strong>organizational barriers <strong>and</strong> become an <strong>in</strong>strument ofsocial change is undoubtedly of great significance. Theimplementation strategy was essentially designed toprovide family plann<strong>in</strong>g services through <strong>the</strong> establishedmaternal <strong>and</strong> child health (MCH) cl<strong>in</strong>ic network. Thehealth centres provid<strong>in</strong>g MCH care more than doubleddur<strong>in</strong>g <strong>the</strong> period 1953-1973 <strong>and</strong> <strong>the</strong> proportion of birthsattended by tra<strong>in</strong>ed health personnel at delivery <strong>in</strong>creasedfrom 46 to 90 per cent dur<strong>in</strong>g <strong>the</strong> same period.As many population <strong>in</strong>formation, education <strong>and</strong>communication (IEC) activities were implementedby o<strong>the</strong>r government agencies outside <strong>the</strong> M<strong>in</strong>istry ofHealth, <strong>in</strong> 1974 a Steer<strong>in</strong>g Committee was establishedto coord<strong>in</strong>ate <strong>the</strong> national population programme; it waschaired by <strong>the</strong> Secretary, M<strong>in</strong>istry of Plan Implementation.i In 1975, when <strong>the</strong> first fertility survey <strong>in</strong> <strong>the</strong> countrywas carried out, <strong>the</strong> contraceptive prevalence rate (CPR)was estimated at 34 per cent <strong>and</strong> of those practis<strong>in</strong>gcontraception <strong>the</strong> prevalence of modern methods was 20per cent. The maternal mortality ratio was down to 100per 100,000 live births <strong>and</strong> <strong>the</strong> <strong>in</strong>fant mortality rate was45.1 per 1,000 live births (Table 1).Progressive phase, 1975-1985In 1977, <strong>the</strong> government policy on population was clearlystated <strong>in</strong> <strong>the</strong> so-called Throne Speech of <strong>the</strong> government. Itnoted <strong>the</strong> need to streng<strong>the</strong>n cl<strong>in</strong>ical contraceptive services<strong>and</strong> provide f<strong>in</strong>ancial <strong>in</strong>ducements to those who voluntarilyaccept sterilization as a method of contraception.TableIn May 1979, <strong>the</strong> government <strong>in</strong>troduced for <strong>the</strong> firsttime f<strong>in</strong>ancial <strong>in</strong>centives to medical teams that carried outsterilizations. This scheme was extended to new acceptorsof sterilization from January 1980. The ma<strong>in</strong> purposeof provid<strong>in</strong>g f<strong>in</strong>ancial <strong>in</strong>ducements was to meet out-ofpocketexpenditure of clients, such as loss of daily wages<strong>and</strong> transport costs. Fur<strong>the</strong>rmore, medical officers whoperformed a large number of sterilizations were awardedcertificates <strong>and</strong> some were sent on study tours abroad tostudy programmes <strong>in</strong> o<strong>the</strong>r countries.The programme received greater visibility through IECactivities organized by <strong>the</strong> government <strong>and</strong> NGOs. Thegovernment also recognized <strong>the</strong> role that NGOs could play<strong>in</strong> supplement<strong>in</strong>g <strong>the</strong> national programme <strong>and</strong> encouraged<strong>the</strong>m all.In 1979, <strong>the</strong> Population Division was created <strong>in</strong> <strong>the</strong> M<strong>in</strong>istryof Plan Implementation with a view to evaluate currentpopulation policies <strong>and</strong>, where necessary, to formulate newpolicies; establish mechanisms for <strong>in</strong>tegrat<strong>in</strong>g populationfactors <strong>in</strong>to development plann<strong>in</strong>g; coord<strong>in</strong>ate <strong>and</strong> monitor<strong>the</strong> national population programme; <strong>and</strong> undertake <strong>and</strong>subcontract policy-oriented research. At <strong>the</strong> subnationallevel, District Population Committees were established,with <strong>the</strong> District Secretary appo<strong>in</strong>ted as <strong>the</strong> chairperson, tocoord<strong>in</strong>ate population activities at <strong>the</strong> district level. In 1982,<strong>the</strong> President of Sri Lanka appo<strong>in</strong>ted <strong>the</strong> ParliamentaryAdvisory Committee on Population (PACP) to advise <strong>the</strong>government on appropriate policies <strong>in</strong> respect of population<strong>and</strong> family plann<strong>in</strong>g. In 1983, <strong>the</strong> National Coord<strong>in</strong>at<strong>in</strong>gCommittee on Population (NCCP) was established tocoord<strong>in</strong>ate <strong>the</strong> national programme, with <strong>the</strong> M<strong>in</strong>isterof Health serv<strong>in</strong>g as <strong>the</strong> chairperson, <strong>and</strong> <strong>the</strong> Secretary,M<strong>in</strong>istry of Plan Implementation, act<strong>in</strong>g as its secretary.The Population Division functioned as <strong>the</strong> secretariat forboth PACP <strong>and</strong> NCCP.Table1220