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plann<strong>in</strong>g <strong>in</strong>formation, counsell<strong>in</strong>g <strong>and</strong> services couldbe <strong>in</strong>troduced along <strong>the</strong> cont<strong>in</strong>uum of sexual health<strong>and</strong> reproductive care should be utilized; Contraceptive security would be achieved whennational <strong>and</strong> subnational budgets <strong>in</strong>cluded earmarksfor essential medic<strong>in</strong>es, <strong>in</strong>clud<strong>in</strong>g contraceptives; Of <strong>the</strong> 47 governments <strong>in</strong> <strong>the</strong> <strong>Asia</strong>n region, 17 of <strong>the</strong>mdid not directly support contraceptive access. Effortsneeded to be made to conv<strong>in</strong>ce those governments of<strong>the</strong> value of mak<strong>in</strong>g such <strong>in</strong>vestments.Fertility <strong>and</strong> family plann<strong>in</strong>g <strong>in</strong> <strong>the</strong> <strong>Pacific</strong> byDr. Geoffrey Hayes, Development Consultant, NewZeal<strong>and</strong>The presentation was based on an analysis of recentlyconducted Demographic <strong>and</strong> Health Surveys (DHS) topresent <strong>the</strong> situation of unmet need for family plann<strong>in</strong>g<strong>in</strong> <strong>the</strong> <strong>Pacific</strong>. The study revealed some commoncharacteristics across <strong>the</strong> <strong>Pacific</strong> region but also greatvariation, which made it difficult to generalize.The comparative study assessed whe<strong>the</strong>r <strong>the</strong> fertilitytransition had stalled <strong>in</strong> <strong>the</strong> <strong>Pacific</strong> isl<strong>and</strong> countries <strong>and</strong>territories <strong>and</strong> if so, what were some of its causes. Theresearch suggested that fertility transition had stalled <strong>in</strong>some countries, but not all. A review of long-term fertilitychange showed a slow fertility decl<strong>in</strong>e. It was noted thatsome countries <strong>in</strong>itially presented rapid fertility decl<strong>in</strong>e;however, that was followed by a layer<strong>in</strong>g off.An analysis of family plann<strong>in</strong>g programmes <strong>in</strong> <strong>the</strong><strong>Pacific</strong> showed a relationship between fertility transition<strong>and</strong> family plann<strong>in</strong>g programmes. Some programmesstalled, reversed or slowed down, <strong>the</strong> effect of whichwas evident <strong>in</strong> fertility <strong>and</strong> contraceptive prevalence ratefigures. Kiribati was highlighted as an example where <strong>the</strong>total fertility rate (TFR) was over 6 children per woman<strong>in</strong> <strong>the</strong> 1960s; <strong>the</strong> country experienced a rapid decl<strong>in</strong>e <strong>in</strong>fertility, which co<strong>in</strong>cided with <strong>the</strong> <strong>in</strong>itiation of <strong>the</strong> familyplann<strong>in</strong>g programme, to a TFR of 4; yet TFR rema<strong>in</strong>edat that level for 20 years.An analysis of contraceptive prevalence rate (CPR)trends <strong>in</strong> <strong>the</strong> region showed a trend upwards <strong>in</strong> <strong>the</strong> caseof Fiji, Papua New Gu<strong>in</strong>ea <strong>and</strong> Solomon Isl<strong>and</strong>s, somego<strong>in</strong>g up <strong>and</strong> <strong>the</strong>n stall<strong>in</strong>g as <strong>in</strong> <strong>the</strong> case <strong>in</strong> Vanuatu, <strong>the</strong>Federated States of Micronesia <strong>and</strong> Kiribati, <strong>and</strong> o<strong>the</strong>rsdecl<strong>in</strong><strong>in</strong>g as <strong>in</strong> <strong>the</strong> case of Cook Isl<strong>and</strong>s, Samoa <strong>and</strong>Tonga. Generally, <strong>in</strong> <strong>the</strong> <strong>Pacific</strong>, CPR did not get muchabove 40 per cent. The presentation addressed some of<strong>the</strong> reasons <strong>and</strong> relationships <strong>in</strong> that situation. Primarily,<strong>the</strong> research revealed a weak relationship between CPR<strong>and</strong> education. Also, <strong>the</strong> CPR <strong>in</strong> <strong>the</strong> region seemed tonot be closely associated with rural <strong>and</strong> urban residence;<strong>in</strong> fact, <strong>the</strong>re were some examples of higher CPRlevels <strong>in</strong> rural areas. The research could not present acorrelation between household wealth <strong>and</strong> CPR levels.However, <strong>the</strong>re were relationships between CPR, age<strong>and</strong> parity, as well as a measure of connection betweenaccess to health centres or hav<strong>in</strong>g been visited by a familyplann<strong>in</strong>g nurse.The presentation discussed <strong>the</strong> relationship between keydevelopment <strong>in</strong>dicators, CPR <strong>and</strong> TFR. The researchrevealed a strong relationship between TFR <strong>and</strong> <strong>the</strong><strong>in</strong>fant mortality rate (IMR). Higher gross domesticproduct did not translate <strong>in</strong>to higher TRF or CPR,which suggested a weak relationship between <strong>the</strong> two.The research revealed a moderately strong relationshipbetween life expectancy <strong>and</strong> TFR. F<strong>in</strong>ally, researchrevealed a weak relationship between TFR <strong>and</strong> poverty.Patterns <strong>in</strong> <strong>the</strong> <strong>Pacific</strong> were not <strong>the</strong> same as <strong>in</strong> o<strong>the</strong>rregions.In terms of unmet need for family plann<strong>in</strong>g, <strong>the</strong> <strong>Pacific</strong>region displayed considerable variation. Samoa presenteda high percentage of unmet need (just over 40%), whileSolomon Isl<strong>and</strong>s presented a low percentage of unmetneed (under 10%). Fur<strong>the</strong>r, contraceptive use variedwidely country by country.The research suggested that <strong>the</strong> <strong>Pacific</strong> isl<strong>and</strong> countriesdid not follow <strong>the</strong> expectation of <strong>the</strong> st<strong>and</strong>arddemographic transition model. Patterns of reportedcontraceptive use <strong>and</strong> unmet need varied so much thatit was necessary to take a country-by-country approach.However, it could be concluded that uneducatedwomen were less likely than <strong>the</strong>ir educated peers touse contraception <strong>and</strong> more likely to have an unmetneed. O<strong>the</strong>r than <strong>in</strong> Papua New Gu<strong>in</strong>ea <strong>and</strong> SolomonIsl<strong>and</strong>s, <strong>the</strong> ma<strong>in</strong> reason for unmet need was not accessbut “unwill<strong>in</strong>gness”, which was aris<strong>in</strong>g from fear of sideeffects, health concerns or some form of socioculturalopposition. Fur<strong>the</strong>r, adolescents faced <strong>the</strong> largestbarriers to <strong>the</strong> use of contraception for socioculturalreasons. In many countries, service providers <strong>in</strong> publichealth facilities were slowly ab<strong>and</strong>on<strong>in</strong>g <strong>the</strong>ir moralisticattitude towards adolescent sexuality. The researchshowed that NGOs did much better <strong>in</strong> address<strong>in</strong>g <strong>the</strong>needs of adolescents.The presentation outl<strong>in</strong>ed a number of measures forgovernments to take <strong>in</strong> order to improve access to<strong>and</strong> use of family plann<strong>in</strong>g services, based on f<strong>in</strong>d<strong>in</strong>gsfrom <strong>the</strong> research. One key recommendation was toimprove <strong>the</strong> quality, scope <strong>and</strong> accessibility of familyplann<strong>in</strong>g programmes through <strong>the</strong> tra<strong>in</strong><strong>in</strong>g of providers<strong>in</strong> counsell<strong>in</strong>g skills; to streng<strong>the</strong>n primary healthcare, especially <strong>in</strong> rural areas, for a widened choice ofcontraceptives; to place more emphasis on communityoutreach; as well as to ensure that family plann<strong>in</strong>gservices rema<strong>in</strong>ed free of cost. Also, <strong>the</strong> research revealed14
that improv<strong>in</strong>g <strong>in</strong>formation <strong>and</strong> knowledge throughresearch would contribute to stronger programmes.Some suggestions to achieve that <strong>in</strong>cluded fur<strong>the</strong>ranalysis of DHS results <strong>and</strong> conduct<strong>in</strong>g country-specificqualitative research to better underst<strong>and</strong> <strong>and</strong> address <strong>the</strong>causes of unmet need <strong>and</strong> <strong>the</strong> sociocultural obstacles toservice provision.It was imperative to address sociocultural barriers <strong>in</strong>order to asses use by: ensur<strong>in</strong>g that reproductive rightswere highlighted <strong>in</strong> policies <strong>and</strong> tra<strong>in</strong><strong>in</strong>g; design<strong>in</strong>gtailored methods of youth-friendly services for youngpeople; <strong>and</strong> work<strong>in</strong>g towards greater outreach <strong>and</strong>sensitization <strong>in</strong> condom programm<strong>in</strong>g. Countries shouldendeavour to streng<strong>the</strong>n <strong>the</strong>ir policies <strong>and</strong> strategies byplac<strong>in</strong>g emphasis on <strong>the</strong> central role of family plann<strong>in</strong>g <strong>in</strong>reproductive health policies <strong>and</strong> strategies <strong>and</strong> clarify<strong>in</strong>g<strong>the</strong> relationship between <strong>the</strong> two. Policies <strong>and</strong> strategiesshould re<strong>in</strong>force <strong>the</strong> concept of reproductive rights for all,<strong>in</strong>clud<strong>in</strong>g adolescents <strong>and</strong> older women, as well as ensurethat disadvantaged groups were highlighted <strong>in</strong> policies<strong>and</strong> strategies. Ano<strong>the</strong>r measure was for countries toimplement reproductive health commodity securityplans, <strong>in</strong>clud<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g <strong>in</strong> logistics, warehous<strong>in</strong>g, supplycha<strong>in</strong> management <strong>and</strong> appo<strong>in</strong>t<strong>in</strong>g <strong>and</strong> tra<strong>in</strong><strong>in</strong>g staff tomanage distribution at <strong>the</strong> subnational level.Address<strong>in</strong>g universal access to family plann<strong>in</strong>gthrough reproductive health commodity security byMr. Jagdish Upadhyay, Chief, Commodity Security Branch,UNFPAThe presentation focused on <strong>the</strong> pivotal role reproductivehealth commodity security played <strong>in</strong> address<strong>in</strong>g universalaccess to family plann<strong>in</strong>g. Most maternal deaths could beprevented by access to contraceptives <strong>in</strong> order to avoidun<strong>in</strong>tended pregnancies, as well as access to skilled careat <strong>the</strong> time of birth <strong>and</strong> timely access to good-qualityemergency obstetric care <strong>in</strong> <strong>the</strong> case of complications.However, those <strong>in</strong>terventions were dependent on asecure, reliable stream of reproductive health supplies ofcontraceptives, medic<strong>in</strong>es <strong>and</strong> o<strong>the</strong>r kits <strong>and</strong> equipment.Reproductive health supplies were crucial componentsof maternal survival.Reproductive health commodities security (RHCS) wasa prerequisite for achiev<strong>in</strong>g MDGs. RHCS was achievedwhen all <strong>in</strong>dividuals could obta<strong>in</strong> <strong>and</strong> use affordable,good-quality reproductive health commodities of <strong>the</strong>irchoice whenever <strong>the</strong>y needed <strong>the</strong>m. It was more than asupply-side issue as it had elements related to quality ofcare, access <strong>and</strong> dem<strong>and</strong>. Also, RHCS <strong>in</strong>volved ensur<strong>in</strong>gthat people, especially women, <strong>the</strong> newborn <strong>and</strong> youngpeople, faced no obstacles <strong>in</strong> access<strong>in</strong>g <strong>and</strong> utiliz<strong>in</strong>g lifesav<strong>in</strong>g<strong>and</strong> health-promot<strong>in</strong>g supplies.RHCS l<strong>in</strong>ked reproductive health <strong>and</strong> HIV preventiontoge<strong>the</strong>r through <strong>the</strong> supply of contraceptives, maternal<strong>and</strong> newborn drugs, STI drugs <strong>and</strong> o<strong>the</strong>r equipment, kits<strong>and</strong> emergency supplies with<strong>in</strong> <strong>the</strong> overall managementof <strong>the</strong> health system. Research showed that about 30 percent of maternal deaths (over 100,000 maternal deaths)<strong>and</strong> nearly 10 per cent of childhood deaths (about 1million) could be reduced through family plann<strong>in</strong>g.Many nations would witness a doubl<strong>in</strong>g or tripl<strong>in</strong>g <strong>in</strong><strong>the</strong> size of <strong>the</strong>ir populations <strong>in</strong> <strong>the</strong> com<strong>in</strong>g decades.In some of those countries, women were more likelyto die of unsafe abortion than most diseases. Donorexpenditures for family plann<strong>in</strong>g had decl<strong>in</strong>ed. In 1997,family plann<strong>in</strong>g had been supported by US$ 653 million<strong>in</strong> donations, which was reduced by over US$ 80 millionto US$ 572 million <strong>in</strong> 2008. By comparison, fund<strong>in</strong>gfor HIV/AIDS activities had <strong>in</strong>creased from US$ 294million <strong>in</strong> 1997 to US$ 7.7 billion <strong>in</strong> 2008.The presentation concluded by highlight<strong>in</strong>g somepriority actions: Support for country-led health plans, supported bypredictable <strong>and</strong> susta<strong>in</strong>able <strong>in</strong>vestments. Integrateddelivery of health services <strong>and</strong> life-sav<strong>in</strong>g <strong>in</strong>terventions– enabl<strong>in</strong>g women <strong>and</strong> <strong>the</strong>ir children to accessprevention, treatment <strong>and</strong> care when <strong>and</strong> where <strong>the</strong>yneeded it; Support to establish stronger health systems, withsufficient skilled health workers at <strong>the</strong>ir core; Use of <strong>in</strong>novative approaches to f<strong>in</strong>anc<strong>in</strong>g, productdevelopment <strong>and</strong> <strong>the</strong> efficient delivery of healthservices; Improved monitor<strong>in</strong>g <strong>and</strong> evaluation to ensure <strong>the</strong>accountability of all actors for results; Review of national policies <strong>and</strong> priorities to ensure afocus on <strong>in</strong>-country <strong>in</strong>equalities; Avoidance of fragmentation <strong>and</strong> decentralization ofprocurement; Enhanced private sector participation; Build<strong>in</strong>g of emergency preparedness; Assur<strong>in</strong>g good-quality production <strong>and</strong> distribution,regulations <strong>and</strong> tariff issues; Build<strong>in</strong>g of South-South collaboration <strong>and</strong> exchanges,which was especially relevant <strong>in</strong> <strong>the</strong> <strong>Asia</strong>n <strong>and</strong> <strong>Pacific</strong>region.Discussion po<strong>in</strong>ts:Question/issue:Global fund<strong>in</strong>g for HIV had <strong>in</strong>creased <strong>in</strong> comparisonto family plann<strong>in</strong>g <strong>and</strong> reproductive health. Would itbe useful to separate family plann<strong>in</strong>g from reproductivehealth <strong>in</strong> order to ensure that family plann<strong>in</strong>g receivedmore attention?15
Page 1: Family Pla
Page 7 and 8: ForewordThe Asia <
Page 11: Part 1Part 1Asia <
Page 14 and 15: Ensuring that <str
Page 16 and 17: of methods for all, in</str
Page 18 and 19: and undertake <str
Page 21 and 22: Report on the Regi
Page 23: SESSION 1: Changin
Page 31: at a hospital would be offered post
Page 35: Bounkoung Phichit, Deputy M
Page 38 and 39: medicines
Page 40 and 41: Thus, while knowledge of modern met
Page 42 and 43: Hon. Mr. Malakai Tabar, Chairman, P
Page 44 and 45: curricula. If the
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Page 51: BackgroundGlobal development effort
Page 54 and 55: TableTable1EventNational policyYear
Page 56 and 57: A third observation is that reporte
Page 58 and 59: TableTable2Current Contraceptive Pr
Page 60 and 61: Figure(-1.2), Cook Island</
Page 62: FigureTableTable3Trends in<
Page 65 and 66: Nam. Nearly all economies i
Page 67: 2008 2009% Bilateral % Multilateral
Page 70 and 71: family planning wi
Page 73 and 74: 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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that of the nation
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TableTable12 7some policies that ex
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The system guides the</stro
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FigureFigure4Total donor expenditur
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FigureFigureagain
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Impact of family plannin</s
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marketing of contr
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United States Agency for In
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200
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acceptable. From an NGO perspective
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FigureThis trend of limited donor f
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Figureto have the
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FigureFigure5Percentage change <str
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FigureFigure6Desire to limit childb
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coordination betwe
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the 1980s
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Policy Management.__________ (n.d.,
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218
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Population Activities (UNFPA) for a
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where family plannin</stron
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Thus an objective assessment of <st
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226
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Figureeconomic growth durin
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TableTable1TableTable2For spac<stro
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eflect a provider bias (e.g., <stro
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The Indonesian delegation was very
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than in ensur<stro
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in-country <strong
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(Ministry of Healt
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242
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244
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FigureTrends and p
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TableTable3Unmet need for contracep
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TableTable5TableTable6TableTable725
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TableTable8TableTable9Malaysia, abo
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previously mentioned is based on fo
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TableTable16births and</str
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FigureFigure3TRF54.5Scatter plots o
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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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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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TableTable11326
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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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