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where family plann<strong>in</strong>g service delivery became <strong>the</strong> focus ofattention. Thus <strong>in</strong> August 1989, <strong>the</strong> function of populationpolicy formulation <strong>and</strong> implementation was assigned to <strong>the</strong>M<strong>in</strong>istry of Health. As a result, <strong>the</strong> Population Divisionof <strong>the</strong> M<strong>in</strong>istry of Plan Implementation was moved to<strong>the</strong> M<strong>in</strong>istry of Health with <strong>the</strong> same functions <strong>and</strong>responsibilities as previously. With this move, populationpolicy formulation, IEC strategy implementation <strong>and</strong>family plann<strong>in</strong>g service delivery came under <strong>the</strong> purviewof one m<strong>in</strong>istry, namely <strong>the</strong> M<strong>in</strong>istry of Health.Thus <strong>the</strong> M<strong>in</strong>istry of Health took over <strong>the</strong> overallcoord<strong>in</strong>ation <strong>and</strong> management of <strong>the</strong> national populationprogramme. The Population Division, be<strong>in</strong>g placeddirectly under <strong>the</strong> Secretary, M<strong>in</strong>istry of Health, assumedgreater responsibility <strong>in</strong> population policy plann<strong>in</strong>g <strong>and</strong>coord<strong>in</strong>ation of <strong>the</strong> national programme.The responsibility for implement<strong>in</strong>g <strong>the</strong> family plann<strong>in</strong>gservice delivery activities cont<strong>in</strong>ued to be vested <strong>in</strong> <strong>the</strong><strong>Family</strong> Health Bureau. Unmet need for family plann<strong>in</strong>g<strong>in</strong> 1987 was 12 per cent. Thus meet<strong>in</strong>g <strong>the</strong> dem<strong>and</strong> forfamily plann<strong>in</strong>g became a key service delivery issue,which was addressed by improv<strong>in</strong>g field supervision <strong>and</strong>streng<strong>the</strong>n<strong>in</strong>g IEC activities.In 1991, for <strong>the</strong> first time <strong>the</strong> government set a target ofachiev<strong>in</strong>g replacement-level fertility by <strong>the</strong> year 2000 <strong>in</strong>its policy statement on population, which was approvedTableby <strong>the</strong> National Health <strong>Council</strong> chaired by <strong>the</strong> PrimeM<strong>in</strong>ister. Fur<strong>the</strong>r, <strong>the</strong> government streng<strong>the</strong>ned itscentral policy plann<strong>in</strong>g, monitor<strong>in</strong>g <strong>and</strong> implementationagencies, namely <strong>the</strong> National Coord<strong>in</strong>at<strong>in</strong>g <strong>Council</strong> onPopulation, chaired by <strong>the</strong> Secretary, M<strong>in</strong>istry of Health;<strong>the</strong> Population Division; <strong>and</strong> <strong>the</strong> <strong>Family</strong> Health Bureau.Thus by 1993, family plann<strong>in</strong>g <strong>and</strong> reproductive <strong>in</strong>dicatorsshowed fur<strong>the</strong>r improvement (Table 3).The Post-<strong>International</strong> Conference onPopulation <strong>and</strong> Development phaseIn 1994, Sri Lanka along with 179 o<strong>the</strong>r countries, wasa signatory to <strong>the</strong> adoption of <strong>the</strong> Programme of Actionon Population <strong>and</strong> Development at ICPD held <strong>in</strong> Cairo.It was considered one of <strong>the</strong> most significant globalconferences held <strong>in</strong> <strong>the</strong> twenty-first century. The adoptionof <strong>the</strong> broad-based concept of reproductive health atICPD by <strong>the</strong> <strong>in</strong>ternational community was a l<strong>and</strong>markachievement.Sri Lanka adopted a number of <strong>in</strong>itiatives respond<strong>in</strong>g to<strong>the</strong> ICPD Programme of Action. An important <strong>in</strong>itiativewas <strong>the</strong> formulation of <strong>the</strong> Population <strong>and</strong> ReproductiveHealth Policy <strong>in</strong> 1998 <strong>and</strong> <strong>the</strong> subsequent developmentof <strong>the</strong> Action Plan based on that Policy. In addition, <strong>the</strong>Advocacy Strategy was also developed for <strong>the</strong> promotionof population <strong>and</strong> reproductive health activities. ThePopulation Division of <strong>the</strong> M<strong>in</strong>istry of Health playedTable4222
a key role <strong>in</strong> <strong>the</strong> development of <strong>the</strong>se three policydocuments. O<strong>the</strong>r <strong>in</strong>itiatives were <strong>the</strong> paradigm shift froma focus on family plann<strong>in</strong>g to a broader holistic approachto reproductive health <strong>and</strong> <strong>the</strong> <strong>in</strong>clusion of o<strong>the</strong>r agencies,such as <strong>the</strong> National Cancer Control Programme <strong>and</strong><strong>the</strong> STD/AIDS Control Programme, <strong>in</strong>to <strong>the</strong> nationalpopulation <strong>and</strong> reproductive health programme.The structure of <strong>the</strong> national population <strong>and</strong> reproductivehealth programme took <strong>the</strong> shape of a pyramid. At <strong>the</strong> apexwas <strong>the</strong> national policy on population <strong>and</strong> reproductivehealth. At <strong>the</strong> next level was <strong>the</strong> advocacy programmeaimed at parliamentarians, women’s groups <strong>and</strong> mediapersonnel. At <strong>the</strong> next level were <strong>the</strong> IEC activitiesimplemented by relevant government agencies <strong>and</strong> NGOs<strong>and</strong> <strong>the</strong> reproductive health programme for school childrenimplemented by <strong>the</strong> M<strong>in</strong>istry of Education. What followednext at <strong>the</strong> base was <strong>the</strong> largest programme, namely <strong>the</strong>reproductive health <strong>and</strong> family plann<strong>in</strong>g services.The maternal <strong>and</strong> child health <strong>and</strong> family plann<strong>in</strong>g serviceswere broad based <strong>in</strong> order to <strong>in</strong>clude o<strong>the</strong>r elements ofreproductive health through a network of already exist<strong>in</strong>gprimary health-care facilities. A life cycle approach towomen’s reproductive health was adopted. Diagnosis <strong>and</strong>treatment for sexually transmitted diseases (STDs) amongpregnant women was <strong>in</strong>tegrated with <strong>the</strong> maternal <strong>and</strong>child health <strong>and</strong> family plann<strong>in</strong>g services.In 1996, <strong>the</strong> <strong>Family</strong> Health Bureau established WellWomen’s Cl<strong>in</strong>ics <strong>in</strong> subdivisional health areas for <strong>the</strong>screen<strong>in</strong>g of breast <strong>and</strong> cervical cancer <strong>and</strong> detection ofhypertension <strong>and</strong> diabetes among women over 35 yearsof age. There was a renewed commitment to reproductivehealth <strong>in</strong>formation, counsell<strong>in</strong>g <strong>and</strong> health-care servicesfor adolescents with <strong>the</strong> development of a health policyfor adolescents. In 2008, <strong>the</strong> <strong>Family</strong> Health Bureauformulated <strong>the</strong> National Maternal <strong>and</strong> Child HealthPolicy, provid<strong>in</strong>g strategic directions to meet some of <strong>the</strong>important challenges <strong>in</strong> <strong>the</strong> national reproductive health(RH) programme. The government also took action tofur<strong>the</strong>r streng<strong>the</strong>n <strong>the</strong> National STD/AIDS <strong>and</strong> CancerControl programmes. These <strong>in</strong>itiatives have resulted <strong>in</strong> an<strong>in</strong>crease <strong>in</strong> screen<strong>in</strong>g, diagnosis <strong>and</strong> treatment. As a result,Sri Lanka has rema<strong>in</strong>ed a low prevalence country withregard to HIV/AIDS despite <strong>the</strong> relatively large numberof cases be<strong>in</strong>g reported <strong>in</strong> neighbour<strong>in</strong>g South India.The <strong>in</strong>cidence of breast <strong>and</strong> cervical cancers has <strong>in</strong> recentyears <strong>in</strong>creased due to better screen<strong>in</strong>g through <strong>the</strong> WellWomen’s Cl<strong>in</strong>ics.The <strong>Family</strong> Health Bureau functions <strong>in</strong> close collaborationwith <strong>the</strong> National Cancer Control Programme <strong>and</strong> <strong>the</strong>National STD/AIDS Control Programme. The <strong>Family</strong>Health Bureau undertakes <strong>in</strong>-service tra<strong>in</strong><strong>in</strong>g of healthpersonnel <strong>in</strong> RH; offers technical assistance <strong>in</strong> programmemanagement <strong>and</strong> service delivery; conducts relevantresearch to streng<strong>the</strong>n service delivery; <strong>and</strong> monitors <strong>and</strong>evaluates <strong>the</strong> service delivery programme. The Bureau isalso responsible for <strong>the</strong> procurement <strong>and</strong> distribution ofcontraceptives, equipment <strong>and</strong> o<strong>the</strong>r supplies needed for<strong>the</strong> RH programme.In <strong>the</strong> delivery of RH services, <strong>the</strong> Bureau cont<strong>in</strong>ues toutilize <strong>the</strong> well-developed health <strong>in</strong>frastructure consist<strong>in</strong>gof a network of medical <strong>in</strong>stitutions <strong>and</strong> health units.The Health Units are responsible for preventive <strong>and</strong>promotional aspects of health, <strong>in</strong>clud<strong>in</strong>g domiciliary RHservices. There are more than 300 Health Unit areas withpopulations rang<strong>in</strong>g from 40,000 to 60,000. The HealthUnit areas are managed by Medical Officers of Healthalso referred to as Divisional Directors of Health Services(DDHS). Each DDHS is supported by a team of publichealth personnel compris<strong>in</strong>g one or two Public HealthNurs<strong>in</strong>g Sisters, four to six Public Health Inspectors,one or two Supervis<strong>in</strong>g Public Health Midwives <strong>and</strong> 20-25 Public Health Midwives (PHM). Each health unit issubdivided <strong>in</strong>to PHM areas, which constitute <strong>the</strong> smalles<strong>the</strong>alth area.The Public Health Midwife who is <strong>in</strong>stitutionally tra<strong>in</strong>edis<strong>the</strong> “front l<strong>in</strong>e” health worker provid<strong>in</strong>g <strong>the</strong> communitywith domiciliary RH services. Each PHM has a welldef<strong>in</strong>edarea consist<strong>in</strong>g of a population rang<strong>in</strong>g from2,000 to 4,000 people. Through systematic home visits,PHMs provide pregnant mo<strong>the</strong>rs, <strong>in</strong>fants <strong>and</strong> pre-schoolchildren with care. They also furnish family plann<strong>in</strong>g (FP)services, <strong>in</strong>clud<strong>in</strong>g counsell<strong>in</strong>g <strong>and</strong> <strong>the</strong> distribution ofcontraceptive pills <strong>and</strong> condoms to couples of reproductiveage. In addition, <strong>the</strong>y provide necessary education <strong>and</strong>advice to adolescents on reproductive health when needed<strong>and</strong> educate women on <strong>the</strong> importance of screen<strong>in</strong>g forreproductive organ malignancies, <strong>and</strong> motivate <strong>the</strong>m toattend Well Women’s Cl<strong>in</strong>ics for necessary screen<strong>in</strong>g.PHMs also assist rout<strong>in</strong>ely at <strong>the</strong> area MCH/FP cl<strong>in</strong>ics,which are conducted every two weeks, <strong>the</strong>reby l<strong>in</strong>k<strong>in</strong>g<strong>the</strong> community with <strong>the</strong> <strong>in</strong>stitutional health-care system.Their duties also <strong>in</strong>clude record-keep<strong>in</strong>g, which enables<strong>the</strong>m to plan <strong>and</strong> monitor rout<strong>in</strong>e activities.Despite a slight <strong>in</strong>crease <strong>in</strong> <strong>the</strong> country’s total fertilityrate recently, unmet need for contraception has decl<strong>in</strong>edfrom 12.3 per cent <strong>in</strong> 1987 to 7.3 per cent <strong>in</strong> 2006/07.The fertility rate for women aged 15-19 years has fur<strong>the</strong>rdecl<strong>in</strong>ed from 38 per 1,000 <strong>in</strong> <strong>the</strong> period 1982-1987 to28 <strong>in</strong> 2003-2006. Infant <strong>and</strong> maternal mortality rateshave cont<strong>in</strong>ued to decl<strong>in</strong>e. Although <strong>the</strong> contraceptiveprevalence rate has rema<strong>in</strong>ed about 70 per cent dur<strong>in</strong>g<strong>the</strong> period 2000-2006/07, <strong>the</strong> prevalence of moderntemporary methods has <strong>in</strong>creased from 26.4 to 36.0 percent dur<strong>in</strong>g this period (Table 4).223
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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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assistance from UNFPA and</
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in CPR. Likewise,
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International supp
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in development has
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__________ (2007). Population <stro
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170
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Page 186 and 187: per cent of women reported us<stron
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Page 200 and 201: FigureFigure4Total donor expenditur
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Page 212 and 213: acceptable. From an NGO perspective
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Page 226 and 227: Policy Management.__________ (n.d.,
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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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Page 250 and 251: (Ministry of Healt
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Page 256 and 257: FigureTrends and p
Page 258 and 259: TableTable3Unmet need for contracep
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Page 262 and 263: TableTable8TableTable9Malaysia, abo
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Page 266 and 267: TableTable16births and</str
Page 268 and 269: FigureFigure3TRF54.5Scatter plots o
Page 270 and 271: ReferencesAng, Eng Suan (2007). Stu
Page 272 and 273: Demographic data sheet: population
Page 274 and 275: population size, with just 336,000
Page 276 and 277: NuptialityIn Myanmar nuptiality is
Page 278 and 279: FigureIn Myanmar, birth-spac<strong
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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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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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