Family Planning in Asia and the Pacific - International Council on ...
Family Planning in Asia and the Pacific - International Council on ...
Family Planning in Asia and the Pacific - International Council on ...
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plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>in</str<strong>on</strong>g>formati<strong>on</strong>, counsell<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>and</str<strong>on</strong>g> services couldbe <str<strong>on</strong>g>in</str<strong>on</strong>g>troduced al<strong>on</strong>g <str<strong>on</strong>g>the</str<strong>on</strong>g> c<strong>on</strong>t<str<strong>on</strong>g>in</str<strong>on</strong>g>uum of sexual health<str<strong>on</strong>g>and</str<strong>on</strong>g> reproductive care should be utilized; C<strong>on</strong>traceptive security would be achieved whennati<strong>on</strong>al <str<strong>on</strong>g>and</str<strong>on</strong>g> subnati<strong>on</strong>al budgets <str<strong>on</strong>g>in</str<strong>on</strong>g>cluded earmarksfor essential medic<str<strong>on</strong>g>in</str<strong>on</strong>g>es, <str<strong>on</strong>g>in</str<strong>on</strong>g>clud<str<strong>on</strong>g>in</str<strong>on</strong>g>g c<strong>on</strong>traceptives; Of <str<strong>on</strong>g>the</str<strong>on</strong>g> 47 governments <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> <str<strong>on</strong>g>Asia</str<strong>on</strong>g>n regi<strong>on</strong>, 17 of <str<strong>on</strong>g>the</str<strong>on</strong>g>mdid not directly support c<strong>on</strong>traceptive access. Effortsneeded to be made to c<strong>on</strong>v<str<strong>on</strong>g>in</str<strong>on</strong>g>ce those governments of<str<strong>on</strong>g>the</str<strong>on</strong>g> value of mak<str<strong>on</strong>g>in</str<strong>on</strong>g>g such <str<strong>on</strong>g>in</str<strong>on</strong>g>vestments.Fertility <str<strong>on</strong>g>and</str<strong>on</strong>g> family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> <str<strong>on</strong>g>Pacific</str<strong>on</strong>g> byDr. Geoffrey Hayes, Development C<strong>on</strong>sultant, NewZeal<str<strong>on</strong>g>and</str<strong>on</strong>g>The presentati<strong>on</strong> was based <strong>on</strong> an analysis of recentlyc<strong>on</strong>ducted Demographic <str<strong>on</strong>g>and</str<strong>on</strong>g> Health Surveys (DHS) topresent <str<strong>on</strong>g>the</str<strong>on</strong>g> situati<strong>on</strong> of unmet need for family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g<str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> <str<strong>on</strong>g>Pacific</str<strong>on</strong>g>. The study revealed some comm<strong>on</strong>characteristics across <str<strong>on</strong>g>the</str<strong>on</strong>g> <str<strong>on</strong>g>Pacific</str<strong>on</strong>g> regi<strong>on</strong> but also greatvariati<strong>on</strong>, which made it difficult to generalize.The comparative study assessed whe<str<strong>on</strong>g>the</str<strong>on</strong>g>r <str<strong>on</strong>g>the</str<strong>on</strong>g> fertilitytransiti<strong>on</strong> had stalled <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> <str<strong>on</strong>g>Pacific</str<strong>on</strong>g> isl<str<strong>on</strong>g>and</str<strong>on</strong>g> countries <str<strong>on</strong>g>and</str<strong>on</strong>g>territories <str<strong>on</strong>g>and</str<strong>on</strong>g> if so, what were some of its causes. Theresearch suggested that fertility transiti<strong>on</strong> had stalled <str<strong>on</strong>g>in</str<strong>on</strong>g>some countries, but not all. A review of l<strong>on</strong>g-term fertilitychange showed a slow fertility decl<str<strong>on</strong>g>in</str<strong>on</strong>g>e. It was noted thatsome countries <str<strong>on</strong>g>in</str<strong>on</strong>g>itially presented rapid fertility decl<str<strong>on</strong>g>in</str<strong>on</strong>g>e;however, that was followed by a layer<str<strong>on</strong>g>in</str<strong>on</strong>g>g off.An analysis of family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g programmes <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g><str<strong>on</strong>g>Pacific</str<strong>on</strong>g> showed a relati<strong>on</strong>ship between fertility transiti<strong>on</strong><str<strong>on</strong>g>and</str<strong>on</strong>g> family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g programmes. Some programmesstalled, reversed or slowed down, <str<strong>on</strong>g>the</str<strong>on</strong>g> effect of whichwas evident <str<strong>on</strong>g>in</str<strong>on</strong>g> fertility <str<strong>on</strong>g>and</str<strong>on</strong>g> c<strong>on</strong>traceptive prevalence ratefigures. Kiribati was highlighted as an example where <str<strong>on</strong>g>the</str<strong>on</strong>g>total fertility rate (TFR) was over 6 children per woman<str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> 1960s; <str<strong>on</strong>g>the</str<strong>on</strong>g> country experienced a rapid decl<str<strong>on</strong>g>in</str<strong>on</strong>g>e <str<strong>on</strong>g>in</str<strong>on</strong>g>fertility, which co<str<strong>on</strong>g>in</str<strong>on</strong>g>cided with <str<strong>on</strong>g>the</str<strong>on</strong>g> <str<strong>on</strong>g>in</str<strong>on</strong>g>itiati<strong>on</strong> of <str<strong>on</strong>g>the</str<strong>on</strong>g> familyplann<str<strong>on</strong>g>in</str<strong>on</strong>g>g programme, to a TFR of 4; yet TFR rema<str<strong>on</strong>g>in</str<strong>on</strong>g>edat that level for 20 years.An analysis of c<strong>on</strong>traceptive prevalence rate (CPR)trends <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> regi<strong>on</strong> showed a trend upwards <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> caseof Fiji, Papua New Gu<str<strong>on</strong>g>in</str<strong>on</strong>g>ea <str<strong>on</strong>g>and</str<strong>on</strong>g> Solom<strong>on</strong> Isl<str<strong>on</strong>g>and</str<strong>on</strong>g>s, somego<str<strong>on</strong>g>in</str<strong>on</strong>g>g up <str<strong>on</strong>g>and</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g>n stall<str<strong>on</strong>g>in</str<strong>on</strong>g>g as <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> case <str<strong>on</strong>g>in</str<strong>on</strong>g> Vanuatu, <str<strong>on</strong>g>the</str<strong>on</strong>g>Federated States of Micr<strong>on</strong>esia <str<strong>on</strong>g>and</str<strong>on</strong>g> Kiribati, <str<strong>on</strong>g>and</str<strong>on</strong>g> o<str<strong>on</strong>g>the</str<strong>on</strong>g>rsdecl<str<strong>on</strong>g>in</str<strong>on</strong>g><str<strong>on</strong>g>in</str<strong>on</strong>g>g as <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> case of Cook Isl<str<strong>on</strong>g>and</str<strong>on</strong>g>s, Samoa <str<strong>on</strong>g>and</str<strong>on</strong>g>T<strong>on</strong>ga. Generally, <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> <str<strong>on</strong>g>Pacific</str<strong>on</strong>g>, CPR did not get muchabove 40 per cent. The presentati<strong>on</strong> addressed some of<str<strong>on</strong>g>the</str<strong>on</strong>g> reas<strong>on</strong>s <str<strong>on</strong>g>and</str<strong>on</strong>g> relati<strong>on</strong>ships <str<strong>on</strong>g>in</str<strong>on</strong>g> that situati<strong>on</strong>. Primarily,<str<strong>on</strong>g>the</str<strong>on</strong>g> research revealed a weak relati<strong>on</strong>ship between CPR<str<strong>on</strong>g>and</str<strong>on</strong>g> educati<strong>on</strong>. Also, <str<strong>on</strong>g>the</str<strong>on</strong>g> CPR <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> regi<strong>on</strong> seemed t<strong>on</strong>ot be closely associated with rural <str<strong>on</strong>g>and</str<strong>on</strong>g> urban residence;<str<strong>on</strong>g>in</str<strong>on</strong>g> fact, <str<strong>on</strong>g>the</str<strong>on</strong>g>re were some examples of higher CPRlevels <str<strong>on</strong>g>in</str<strong>on</strong>g> rural areas. The research could not present acorrelati<strong>on</strong> between household wealth <str<strong>on</strong>g>and</str<strong>on</strong>g> CPR levels.However, <str<strong>on</strong>g>the</str<strong>on</strong>g>re were relati<strong>on</strong>ships between CPR, age<str<strong>on</strong>g>and</str<strong>on</strong>g> parity, as well as a measure of c<strong>on</strong>necti<strong>on</strong> betweenaccess to health centres or hav<str<strong>on</strong>g>in</str<strong>on</strong>g>g been visited by a familyplann<str<strong>on</strong>g>in</str<strong>on</strong>g>g nurse.The presentati<strong>on</strong> discussed <str<strong>on</strong>g>the</str<strong>on</strong>g> relati<strong>on</strong>ship between keydevelopment <str<strong>on</strong>g>in</str<strong>on</strong>g>dicators, CPR <str<strong>on</strong>g>and</str<strong>on</strong>g> TFR. The researchrevealed a str<strong>on</strong>g relati<strong>on</strong>ship between TFR <str<strong>on</strong>g>and</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g><str<strong>on</strong>g>in</str<strong>on</strong>g>fant mortality rate (IMR). Higher gross domesticproduct did not translate <str<strong>on</strong>g>in</str<strong>on</strong>g>to higher TRF or CPR,which suggested a weak relati<strong>on</strong>ship between <str<strong>on</strong>g>the</str<strong>on</strong>g> two.The research revealed a moderately str<strong>on</strong>g relati<strong>on</strong>shipbetween life expectancy <str<strong>on</strong>g>and</str<strong>on</strong>g> TFR. F<str<strong>on</strong>g>in</str<strong>on</strong>g>ally, researchrevealed a weak relati<strong>on</strong>ship between TFR <str<strong>on</strong>g>and</str<strong>on</strong>g> poverty.Patterns <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> <str<strong>on</strong>g>Pacific</str<strong>on</strong>g> were not <str<strong>on</strong>g>the</str<strong>on</strong>g> same as <str<strong>on</strong>g>in</str<strong>on</strong>g> o<str<strong>on</strong>g>the</str<strong>on</strong>g>rregi<strong>on</strong>s.In terms of unmet need for family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g, <str<strong>on</strong>g>the</str<strong>on</strong>g> <str<strong>on</strong>g>Pacific</str<strong>on</strong>g>regi<strong>on</strong> displayed c<strong>on</strong>siderable variati<strong>on</strong>. Samoa presenteda high percentage of unmet need (just over 40%), whileSolom<strong>on</strong> Isl<str<strong>on</strong>g>and</str<strong>on</strong>g>s presented a low percentage of unmetneed (under 10%). Fur<str<strong>on</strong>g>the</str<strong>on</strong>g>r, c<strong>on</strong>traceptive use variedwidely country by country.The research suggested that <str<strong>on</strong>g>the</str<strong>on</strong>g> <str<strong>on</strong>g>Pacific</str<strong>on</strong>g> isl<str<strong>on</strong>g>and</str<strong>on</strong>g> countriesdid not follow <str<strong>on</strong>g>the</str<strong>on</strong>g> expectati<strong>on</strong> of <str<strong>on</strong>g>the</str<strong>on</strong>g> st<str<strong>on</strong>g>and</str<strong>on</strong>g>arddemographic transiti<strong>on</strong> model. Patterns of reportedc<strong>on</strong>traceptive use <str<strong>on</strong>g>and</str<strong>on</strong>g> unmet need varied so much thatit was necessary to take a country-by-country approach.However, it could be c<strong>on</strong>cluded that uneducatedwomen were less likely than <str<strong>on</strong>g>the</str<strong>on</strong>g>ir educated peers touse c<strong>on</strong>tracepti<strong>on</strong> <str<strong>on</strong>g>and</str<strong>on</strong>g> more likely to have an unmetneed. O<str<strong>on</strong>g>the</str<strong>on</strong>g>r than <str<strong>on</strong>g>in</str<strong>on</strong>g> Papua New Gu<str<strong>on</strong>g>in</str<strong>on</strong>g>ea <str<strong>on</strong>g>and</str<strong>on</strong>g> Solom<strong>on</strong>Isl<str<strong>on</strong>g>and</str<strong>on</strong>g>s, <str<strong>on</strong>g>the</str<strong>on</strong>g> ma<str<strong>on</strong>g>in</str<strong>on</strong>g> reas<strong>on</strong> for unmet need was not accessbut “unwill<str<strong>on</strong>g>in</str<strong>on</strong>g>gness”, which was aris<str<strong>on</strong>g>in</str<strong>on</strong>g>g from fear of sideeffects, health c<strong>on</strong>cerns or some form of socioculturaloppositi<strong>on</strong>. Fur<str<strong>on</strong>g>the</str<strong>on</strong>g>r, adolescents faced <str<strong>on</strong>g>the</str<strong>on</strong>g> largestbarriers to <str<strong>on</strong>g>the</str<strong>on</strong>g> use of c<strong>on</strong>tracepti<strong>on</strong> for socioculturalreas<strong>on</strong>s. In many countries, service providers <str<strong>on</strong>g>in</str<strong>on</strong>g> publichealth facilities were slowly ab<str<strong>on</strong>g>and</str<strong>on</strong>g><strong>on</strong><str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>the</str<strong>on</strong>g>ir moralisticattitude towards adolescent sexuality. The researchshowed that NGOs did much better <str<strong>on</strong>g>in</str<strong>on</strong>g> address<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>the</str<strong>on</strong>g>needs of adolescents.The presentati<strong>on</strong> outl<str<strong>on</strong>g>in</str<strong>on</strong>g>ed a number of measures forgovernments to take <str<strong>on</strong>g>in</str<strong>on</strong>g> order to improve access to<str<strong>on</strong>g>and</str<strong>on</strong>g> use of family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g services, based <strong>on</strong> f<str<strong>on</strong>g>in</str<strong>on</strong>g>d<str<strong>on</strong>g>in</str<strong>on</strong>g>gsfrom <str<strong>on</strong>g>the</str<strong>on</strong>g> research. One key recommendati<strong>on</strong> was toimprove <str<strong>on</strong>g>the</str<strong>on</strong>g> quality, scope <str<strong>on</strong>g>and</str<strong>on</strong>g> accessibility of familyplann<str<strong>on</strong>g>in</str<strong>on</strong>g>g programmes through <str<strong>on</strong>g>the</str<strong>on</strong>g> tra<str<strong>on</strong>g>in</str<strong>on</strong>g><str<strong>on</strong>g>in</str<strong>on</strong>g>g of providers<str<strong>on</strong>g>in</str<strong>on</strong>g> counsell<str<strong>on</strong>g>in</str<strong>on</strong>g>g skills; to streng<str<strong>on</strong>g>the</str<strong>on</strong>g>n primary healthcare, especially <str<strong>on</strong>g>in</str<strong>on</strong>g> rural areas, for a widened choice ofc<strong>on</strong>traceptives; to place more emphasis <strong>on</strong> communityoutreach; as well as to ensure that family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>gservices rema<str<strong>on</strong>g>in</str<strong>on</strong>g>ed free of cost. Also, <str<strong>on</strong>g>the</str<strong>on</strong>g> research revealed14