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

Response:The presentation on reproductive health commoditysecurity <strong>in</strong>cluded a comparison between HIV allocations<strong>and</strong> RH allocation as an illustration of how f<strong>in</strong>anc<strong>in</strong>ghad changed. HIV also needed more fund<strong>in</strong>g. Globalf<strong>in</strong>anc<strong>in</strong>g worked very strangely; family plann<strong>in</strong>g wascurrently gett<strong>in</strong>g less focus, <strong>and</strong> strategies needed tobe implemented <strong>in</strong> order to br<strong>in</strong>g those issues to <strong>the</strong>forefront.Question/issue:Decentralization was good but not for procurement;however, <strong>in</strong> Indonesia decentralization was started<strong>in</strong> 2001. Currently, <strong>the</strong>re were 500 districts witha decentralized system, <strong>the</strong> majority of which hadplaced low priority on <strong>the</strong> family plann<strong>in</strong>g programme<strong>and</strong> put more emphasis on physical procurement.Decentralization was good <strong>in</strong> <strong>the</strong>ory but many countrieswere challenged <strong>in</strong> its operationalization. The issue ofvertical <strong>and</strong> <strong>in</strong>tegrated programmes was discussed.Experiences from Bangladesh, India <strong>and</strong> Pakistanhighlighted some perspectives related to family plann<strong>in</strong>gprogrammes. Bangladesh had attempted to <strong>in</strong>tegrateits programme <strong>in</strong> 1998 <strong>and</strong> 2003. The programmewas revised to start a vertical programme for health<strong>and</strong> family plann<strong>in</strong>g. India had determ<strong>in</strong>ed that familyplann<strong>in</strong>g programmes worked best if <strong>the</strong>y were run as acomponent of mo<strong>the</strong>r <strong>and</strong> child health programmes.Response:There were many perspectives related to vertical versus<strong>in</strong>tegrated programmes. Evidence suggested that familyplann<strong>in</strong>g did benefit from be<strong>in</strong>g part of an overall system.Verticality did not deliver enough.Response:NGOs also played an important <strong>and</strong> active role <strong>in</strong>provid<strong>in</strong>g family plann<strong>in</strong>g services. In <strong>the</strong> <strong>Pacific</strong>, for<strong>in</strong>stance, IPPF affiliates were <strong>in</strong>strumental <strong>in</strong> reach<strong>in</strong>g<strong>and</strong> deliver<strong>in</strong>g services to young people.Question/issue:The presentations revealed that some countries weresubstantially left beh<strong>in</strong>d despite operat<strong>in</strong>g familyplann<strong>in</strong>g programmes. What would be <strong>the</strong> reasons forthat outcome?Response:There were many reasons why countries were leftbeh<strong>in</strong>d. In countries where prevalence was low, such asTimor-Leste, <strong>in</strong>frastructure played a role; gender roleswith high levels of gender <strong>in</strong>equality contributed to <strong>the</strong>situation <strong>in</strong> Afghanistan, while high levels of unmetneed affected Pakistan.Question/issue:The experience of India showed that <strong>in</strong>tegration offamily plann<strong>in</strong>g did not always work. It was suggestedthat <strong>the</strong> programme lost its focus along <strong>the</strong> way. O<strong>the</strong>rf<strong>in</strong>d<strong>in</strong>gs from India related to <strong>the</strong> relationship betweenCPR <strong>and</strong> TFR, use of condoms <strong>and</strong> o<strong>the</strong>r spac<strong>in</strong>gmethods which did not translate <strong>in</strong>to changes <strong>in</strong> TFR.For example, condom use had gone up but that had nottranslated <strong>in</strong>to a lower<strong>in</strong>g of <strong>the</strong> birth rate.Response:Sou<strong>the</strong>rn India had <strong>the</strong> lowest levels of sterilization.There seemed to be <strong>in</strong>terest <strong>in</strong> hav<strong>in</strong>g smaller families.There were also many people that did not <strong>in</strong>tend to useany contraceptive method. Spac<strong>in</strong>g was as important assterilization.Question/issue:Adolescent sexual <strong>and</strong> reproductive health comprisedimportant elements to be considered when assess<strong>in</strong>gfertility behaviour. Evidence showed that age at marriagewas an important factor <strong>in</strong> determ<strong>in</strong><strong>in</strong>g reproductivehealth behaviour. Access of young people to <strong>in</strong>formation<strong>and</strong> services rema<strong>in</strong>ed a central issue.Response:Evidence showed that youth did not usually access publichealth services; <strong>the</strong> challenge was to develop public (oro<strong>the</strong>r) health services to ensure <strong>the</strong>y got <strong>the</strong> services <strong>the</strong>yneeded.SESSION 2: Voices fromcountriesModerator:Mr. Thomas Osias, Executive Director, Commission onPopulation, Philipp<strong>in</strong>esCountry case studies <strong>and</strong> responses <strong>and</strong>/or statementsfrom government counterpartsThe second session <strong>in</strong>cluded presentations from allcountries clustered around similarities <strong>in</strong> <strong>the</strong>ir familyplann<strong>in</strong>g situation or <strong>the</strong> approach of <strong>the</strong>ir programme.The first group <strong>in</strong>cluded Afghanistan, Pakistan, PapuaNew Gu<strong>in</strong>ea <strong>and</strong> Timor-Leste, which representedcountries with high fertility rates. The second group<strong>in</strong>cluded countries that could present success <strong>and</strong> alsostagnation of <strong>the</strong>ir family plann<strong>in</strong>g programme, suchas Bangladesh, India, Indonesia <strong>and</strong> Nepal. The thirdcluster addressed countries that presented challenges<strong>in</strong> susta<strong>in</strong><strong>in</strong>g universal access to family plann<strong>in</strong>g; <strong>the</strong>y<strong>in</strong>cluded Malaysia, Sri Lanka <strong>and</strong> Thail<strong>and</strong>. The f<strong>in</strong>al16