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The Indonesian delegation was very active <strong>in</strong> ICPD. 9That conference did not spell <strong>the</strong> end of <strong>the</strong> national FPprogramme <strong>in</strong> Indonesia but it did pose a difficult dilemmafor BKKBN. BKKBN had been set up as a st<strong>and</strong>-aloneagency with<strong>in</strong> <strong>the</strong> central government <strong>in</strong> order to take <strong>the</strong>lead on population control. If FP was now to be seen asessentially a health <strong>and</strong> gender issue, such a perspectivewould imply h<strong>and</strong><strong>in</strong>g over responsibility for FP policy to<strong>the</strong> M<strong>in</strong>istry of Health; after all, it was always governmen<strong>the</strong>alth personnel <strong>and</strong> public health facilities which wereactually deliver<strong>in</strong>g <strong>the</strong> public FP services. BKKBN wasclearly reluctant to do this. Without a radically new mission,BKKBN would be stuck <strong>in</strong>stitutionally <strong>in</strong> an impossibleposition: it could not move forward <strong>and</strong> wholeheartedlyembrace ICPD because that would require acknowledg<strong>in</strong>gthat FP is first <strong>and</strong> foremost a matter of RH <strong>and</strong> <strong>the</strong>reforebelonged logically to <strong>the</strong> mission of <strong>the</strong> M<strong>in</strong>istry of Health,<strong>and</strong> it could not move backwards towards <strong>the</strong> directionof population control because that would require us<strong>in</strong>glanguage no one else wanted to speak anymore <strong>and</strong> <strong>the</strong>orig<strong>in</strong>al “population problem” had mostly been resolved by<strong>the</strong>n anyway. Institutionally BKKBN was stuck between<strong>the</strong> proverbial rock <strong>and</strong> a hard place. 10In short BKKBN chose not to redef<strong>in</strong>e its central vision<strong>and</strong> mission explicitly <strong>in</strong> terms of ICPD (i.e., <strong>in</strong> terms ofpromot<strong>in</strong>g reproductive rights <strong>and</strong> reproductive health)even though it had adopted specific elements from ICPD.As a result nei<strong>the</strong>r <strong>the</strong> goals of <strong>the</strong> government’s FPprogramme nor <strong>the</strong> explicit contributions of BKKBN to<strong>the</strong> country’s development objectives are def<strong>in</strong>ed todaywith <strong>the</strong> same clarity <strong>and</strong> conviction that <strong>the</strong>y had beendur<strong>in</strong>g <strong>the</strong> 1970s <strong>and</strong> 1980s. An <strong>in</strong>creas<strong>in</strong>g number ofreproductive health advocates <strong>and</strong> fem<strong>in</strong>ists have come toregard BKKBN now as be<strong>in</strong>g “beh<strong>in</strong>d <strong>the</strong> curve” <strong>in</strong> mattersof RH <strong>and</strong> FP (for example, see Juliantoro, 2000).Millennium Development Goals <strong>and</strong>numerical targetsAt <strong>the</strong> same time, <strong>the</strong> victory of women’s RH advocatesat <strong>the</strong> Cairo conference did not translate <strong>in</strong>to all <strong>the</strong>promised results ei<strong>the</strong>r, <strong>and</strong> <strong>in</strong>ternational fund<strong>in</strong>g forimplement<strong>in</strong>g <strong>the</strong> Programme of Action subsequently fellfar short of expectations (Sch<strong>in</strong>dlmayr, 1999; PopulationAction <strong>International</strong>, 2005). When 189 member statesadopted <strong>the</strong> United Nations Millennium Declaration<strong>in</strong> September 2000 with <strong>the</strong> commitment to “mak<strong>in</strong>g<strong>the</strong> right to development a reality for everyone” <strong>and</strong>“creat[<strong>in</strong>g] an environment – at <strong>the</strong> national <strong>and</strong> globallevels alike – which is conducive to development <strong>and</strong> <strong>the</strong>elim<strong>in</strong>ation of poverty” (United Nations, 2000), <strong>the</strong>y didnot <strong>in</strong>clude RH as an one of <strong>the</strong> Millennium DevelopmentGoals or one of its targets, even though <strong>the</strong> Declarationwas be<strong>in</strong>g promoted as an explicit culm<strong>in</strong>ation of <strong>the</strong>sequence of United Nations conferences held dur<strong>in</strong>g <strong>the</strong>1990s, <strong>in</strong>clud<strong>in</strong>g ICPD. The omission was deliberate <strong>and</strong>calculated (Bernste<strong>in</strong>, 2005; Crossette, 2005).UNFPA, <strong>the</strong> United Nations Millennium Project <strong>and</strong>o<strong>the</strong>r stakeholders cont<strong>in</strong>ued to argue <strong>the</strong> case thatpopulation <strong>and</strong> RH policy are essential elements ofsuccessful strategies to eradicate <strong>in</strong>come poverty <strong>and</strong>atta<strong>in</strong> o<strong>the</strong>r MDGs. At <strong>the</strong> High-Level Plenary Meet<strong>in</strong>gof <strong>the</strong> 60th session of <strong>the</strong> General Assembly (2005 WorldSummit) <strong>in</strong> September 2005, <strong>the</strong> ICPD goal of universalaccess to RH by 2015 was reaffirmed, <strong>and</strong> it was agreedthat this goal should be <strong>in</strong>tegrated <strong>in</strong>to “strategies to atta<strong>in</strong><strong>the</strong> <strong>in</strong>ternationally agreed development goals, <strong>in</strong>clud<strong>in</strong>gthose conta<strong>in</strong>ed <strong>in</strong> <strong>the</strong> Millennium Declaration, aimed atreduc<strong>in</strong>g maternal mortality, improv<strong>in</strong>g maternal health,reduc<strong>in</strong>g child mortality, promot<strong>in</strong>g gender equality,combat<strong>in</strong>g HIV/AIDS <strong>and</strong> eradicat<strong>in</strong>g poverty” (UnitedNations, 2005: para 57(g)). There is irony <strong>in</strong> see<strong>in</strong>g FP<strong>and</strong> RH once aga<strong>in</strong> tied to development goals expressed asnumerical targets. The danger is that programme managerswill be rewarded more for meet<strong>in</strong>g <strong>the</strong> numerical targetsthan for br<strong>in</strong>g<strong>in</strong>g about <strong>the</strong> substantive changes that <strong>the</strong>numbers are meant to <strong>in</strong>dicate. 11A review of current underst<strong>and</strong><strong>in</strong>g of <strong>the</strong> l<strong>in</strong>kagesamong population, RH <strong>and</strong> poverty confirms that <strong>the</strong>sefactors are causally <strong>in</strong>terrelated <strong>in</strong> significant ways, <strong>and</strong>that population <strong>and</strong> RH can <strong>and</strong> do have impacts onpoverty status, even though our underst<strong>and</strong><strong>in</strong>g of all <strong>the</strong>specific mechanisms <strong>in</strong>volved is still far from complete(Hayes, 2005). Practical measures, <strong>the</strong>refore, to eradicatepoverty need to take population matters <strong>in</strong>to account,<strong>and</strong> improv<strong>in</strong>g RH is important if <strong>the</strong>y are to be effective.However, whe<strong>the</strong>r <strong>the</strong> target-driven approach of MDGs is<strong>the</strong> best way to accomplish this is ano<strong>the</strong>r question (Reddy<strong>and</strong> Heaty, 2008).The challenge for central <strong>and</strong> prov<strong>in</strong>cial-level FPpolicymakers is to negotiate performance targets fordistricts which fairly measure substantive improvements<strong>in</strong> FP/RH services, <strong>and</strong> which do not serve to distort<strong>the</strong> <strong>in</strong>centive structure of FP <strong>and</strong> RH workers so as toreward <strong>the</strong>m for reach<strong>in</strong>g easily measurable yet essentiallysuperficial changes ra<strong>the</strong>r than reach<strong>in</strong>g more substantialgoals.DecentralizationEffective 1 January 2004, most of BKKBN’s authority foradm<strong>in</strong>ister<strong>in</strong>g <strong>the</strong> programme was transferred to more than420 “autonomous” districts (kabupaten) <strong>and</strong> municipalities(kota), <strong>and</strong> much of its responsibility for develop<strong>in</strong>g FPpolicy is now shared with regional governments. 12 When itbecame clear <strong>in</strong> early 2002 that BKKBN would be obligedto decentralize, <strong>the</strong> agency made a concerted effort to ensure234
that <strong>the</strong> transfer of authority would go smoothly <strong>and</strong> thataccess to FP services would not suffer unduly. BKKBNadvocated with local government authorities to ensure thata suitable <strong>in</strong>stitutional home would be provided for <strong>the</strong> FPprogramme <strong>in</strong> <strong>the</strong> respective districts/municipalities afterdecentralization. It developed, <strong>in</strong> consultation with regionalgovernments <strong>and</strong> <strong>the</strong> M<strong>in</strong>istry of Home Affairs, a list of“essential” family plann<strong>in</strong>g services which districts wouldbe obligated by law to provide, toge<strong>the</strong>r with associatedperformance <strong>in</strong>dicators to be used for monitor<strong>in</strong>g. BKKBNalso managed to secure central government funds to enableit to cont<strong>in</strong>ue furnish<strong>in</strong>g subsidized contraceptives (<strong>and</strong>some o<strong>the</strong>r supports) to districts on request.BKKBN fur<strong>the</strong>r negotiated a favourable <strong>in</strong>stitutionalarrangement with <strong>the</strong> government whereby <strong>the</strong> BKKBNprov<strong>in</strong>cial offices could stay “vertical” under <strong>the</strong> directcontrol of BKKBN at <strong>the</strong> central level (at least <strong>in</strong> <strong>the</strong> shortterm) ra<strong>the</strong>r than be part of <strong>the</strong> adm<strong>in</strong>istrative apparatuscontrolled by <strong>the</strong> prov<strong>in</strong>cial governor. 13 O<strong>the</strong>r proactive<strong>in</strong>itiatives <strong>in</strong>cluded develop<strong>in</strong>g an early warn<strong>in</strong>g <strong>and</strong> rapidresponse system, so that even if (as seemed <strong>in</strong>evitable)rout<strong>in</strong>e monitor<strong>in</strong>g systems faltered <strong>in</strong> <strong>the</strong> early stagesof decentralization, BKKBN <strong>and</strong> o<strong>the</strong>r stakeholderscould still obta<strong>in</strong> some basic <strong>in</strong>formation on how <strong>the</strong>programme was perform<strong>in</strong>g from a national perspective,<strong>and</strong> could identify emerg<strong>in</strong>g problems quickly <strong>and</strong> work<strong>in</strong> partnership with districts to overcome <strong>the</strong>m. BKKBNprepared for decentralization with arguably more care <strong>and</strong>deliberation than any o<strong>the</strong>r government agency <strong>in</strong>volvedwith <strong>the</strong> delivery of public services.Follow<strong>in</strong>g decentralization FP programme officials atall government levels now face new challenges regard<strong>in</strong>g<strong>the</strong> sourc<strong>in</strong>g of resources, <strong>the</strong> plann<strong>in</strong>g of programmeactivities, recruit<strong>in</strong>g <strong>and</strong> manag<strong>in</strong>g personnel, def<strong>in</strong><strong>in</strong>g <strong>the</strong>scope of <strong>the</strong>ir authority for policy formulation, establish<strong>in</strong>g<strong>the</strong> need for advocacy, foster<strong>in</strong>g good relations with o<strong>the</strong>rgovernmental <strong>and</strong> non-governmental units, report<strong>in</strong>g onperformance <strong>and</strong> f<strong>in</strong>ances, <strong>and</strong> determ<strong>in</strong><strong>in</strong>g how <strong>the</strong>irown performance would be evaluated. It is important torecognize that decentralization <strong>in</strong> Indonesia <strong>in</strong>volves bothadm<strong>in</strong>istrative <strong>and</strong> political dimensions, so FP programmeofficials could not resolve all <strong>the</strong> adm<strong>in</strong>istrative issues<strong>in</strong>volved before politicians resolved outst<strong>and</strong><strong>in</strong>g issuesregard<strong>in</strong>g <strong>the</strong> distribution of authority across <strong>the</strong> central,prov<strong>in</strong>cial <strong>and</strong> district levels of government.Much of <strong>the</strong> technical assistance offered to BKKBN (<strong>and</strong><strong>the</strong> M<strong>in</strong>istry of Health) has tended to focus on technicalissues as if <strong>the</strong> political issues had already been resolved.Sometimes <strong>the</strong> “form follows function” adage is <strong>in</strong>cludedwith <strong>the</strong> advice offered. This assumes that <strong>the</strong> functionsare already well def<strong>in</strong>ed, but often <strong>the</strong>y are not. Even if<strong>the</strong>y were, <strong>in</strong>stitutions <strong>in</strong> <strong>the</strong> real world never adapt tofunctional requirements alone – every <strong>in</strong>stitution has itsown traditions, <strong>and</strong> those with power are able to <strong>in</strong>fluenceprocesses of change <strong>in</strong> ways more favourable to <strong>the</strong>mselves;<strong>in</strong>stitutional reform is always path-dependent. Sometimestechnical assistance has been offered to help def<strong>in</strong>e <strong>the</strong>functions; however, as should be clear by now, this is partlya political process, not a simple technical matter. In o<strong>the</strong>rwords, problems fac<strong>in</strong>g <strong>the</strong> FP programme brought aboutby decentralization that often seem to outsiders to lend<strong>the</strong>mselves to technical solutions <strong>in</strong> fact often have anirreducible political component <strong>and</strong> <strong>the</strong>refore need to beapproached as governance issues.The grow<strong>in</strong>g dem<strong>and</strong> for goodgovernanceAlthough <strong>the</strong>re is little agreement on an exact def<strong>in</strong>ition of“good governance” as promoted by <strong>in</strong>ternational agencies<strong>and</strong> donors (for example, see Jenk<strong>in</strong>s <strong>and</strong> Plowden,2006), <strong>the</strong>re is broad agreement that certa<strong>in</strong> items, suchas freedom of speech, political party organization, publicaccountability of governments, transparency <strong>in</strong> politicaldecision-mak<strong>in</strong>g <strong>and</strong> an <strong>in</strong>dependent judiciary, are all keycomponents of a “healthy” democracy. Institutionaliz<strong>in</strong>g<strong>the</strong>se items systemically can also make sectors, <strong>in</strong>clud<strong>in</strong>ghealth <strong>and</strong> FP, more responsive to local communities’ needs<strong>and</strong> aspirations.At <strong>the</strong> programme level, <strong>in</strong>troduc<strong>in</strong>g such elements asaccountability <strong>and</strong> transparency is relatively easy, <strong>and</strong> thoseelements engender local participation <strong>in</strong>, <strong>and</strong> ownershipof, <strong>the</strong> programme. Good governance <strong>in</strong> this sense is animportant part of <strong>the</strong> ICPD Programme of Action. An<strong>in</strong>itial obstacle, usually short-lived, is that <strong>in</strong> <strong>the</strong> early stagesfew officials or members of <strong>the</strong> public are familiar with <strong>the</strong>senotions, <strong>and</strong> <strong>the</strong> mechanisms <strong>in</strong>troduced tend to be weak<strong>and</strong> <strong>in</strong>nocuous: “accountability” is simply a “suggestionsbox” placed at a service delivery po<strong>in</strong>t, for example. Goodgovernance depends crucially on <strong>the</strong> development ofstrong civil society <strong>in</strong>stitutions, not just on an efficientstate apparatus, <strong>and</strong> programme managers might not see itas <strong>the</strong>ir responsibility to foster this. Indonesian NGOs are<strong>in</strong>creas<strong>in</strong>gly effective <strong>in</strong> promot<strong>in</strong>g good governance. Goodgovernance <strong>and</strong> strong civil society <strong>in</strong>stitutions are neededto check that key “pr<strong>in</strong>cipals” <strong>in</strong> <strong>the</strong> state apparatus at alllevels do <strong>in</strong>deed serve <strong>the</strong> public <strong>in</strong>terest <strong>and</strong> that servicesare responsive to <strong>the</strong> population’s needs <strong>and</strong> aspirations.BKKBN has supported some good governance <strong>in</strong>itiatives– for example, support<strong>in</strong>g local NGOs <strong>in</strong> <strong>the</strong>ir watchdogfunctions – but <strong>the</strong>y could show much more leadership <strong>in</strong>promot<strong>in</strong>g good governance <strong>in</strong> <strong>the</strong> FP programme. To dateBKKBN <strong>in</strong>vests far more energy <strong>in</strong> protect<strong>in</strong>g <strong>the</strong> legalstatus of FP <strong>in</strong> government decrees <strong>and</strong> development plans235
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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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TableTable2What has the</st
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174
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per cent of women reported us<stron
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is provider bias that such methods
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TableTable7skewed distribution of h
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TableTable8TableTable9182
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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
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Page 262 and 263: TableTable8TableTable9Malaysia, abo
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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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Page 282 and 283: FigureIn Myanmar, out of six select
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Page 286 and 287: according to <stro
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Page 290 and 291: FigureHIV/AIDS. An HIV-positive wom
Page 292 and 293: 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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