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TableTable16births <strong>and</strong> abortion. The reproductive health risks amongolder women are known to be higher than for youngerwomen. For <strong>in</strong>stance, while women aged 40-44 <strong>and</strong> 45-49contributed, respectively, only 5.1 <strong>and</strong> 0.4 per cent of <strong>the</strong>total births, <strong>the</strong>y accounted for 12.0 <strong>and</strong> 1.6 per cent of <strong>the</strong>maternal deaths, as shown <strong>in</strong> Table 15.L<strong>in</strong>kages of family plann<strong>in</strong>gwith o<strong>the</strong>r reproductive healthprogrammesIn <strong>the</strong> M<strong>in</strong>istry of Health, family plann<strong>in</strong>g services arealready <strong>in</strong>tegrated with o<strong>the</strong>r services, namely maternal<strong>and</strong> child care services, <strong>and</strong> outpatient care, <strong>in</strong>clud<strong>in</strong>gfor HIV <strong>and</strong> sexually transmitted <strong>in</strong>fections (STIs). For<strong>in</strong>stance, women who are be<strong>in</strong>g followed up for medicalreasons <strong>in</strong> outpatient care are also counseled on familyplann<strong>in</strong>g. HIV <strong>and</strong> STI education <strong>and</strong> counsell<strong>in</strong>g aregiven dur<strong>in</strong>g family plann<strong>in</strong>g visits. S<strong>in</strong>ce its <strong>in</strong>ception,NPFDB has <strong>in</strong>corporated STI management <strong>in</strong> its familyplann<strong>in</strong>g services; however, it is only recently that HIV<strong>in</strong>formation <strong>and</strong> counsell<strong>in</strong>g have been <strong>in</strong>troduced.FRHAM has also played a substantial role <strong>in</strong>implement<strong>in</strong>g HIV/AIDS-related programmes s<strong>in</strong>ce <strong>the</strong>launch<strong>in</strong>g of <strong>the</strong> first country report on <strong>the</strong> MillenniumDevelopment Goals (MDGs) <strong>in</strong> 2005. Although sexual<strong>and</strong> reproductive health (SRH) <strong>and</strong> family plann<strong>in</strong>g havebeen <strong>the</strong> core bus<strong>in</strong>ess of FRHAM, <strong>the</strong>re are some shared<strong>and</strong> common areas of concern with regard to both SRH/FP <strong>and</strong> HIV/AIDS; some l<strong>in</strong>kages between <strong>the</strong> two areashave been promoted <strong>and</strong> <strong>in</strong>tegrated wherever necessary<strong>and</strong> possible. FRHAM has been promot<strong>in</strong>g SRH <strong>and</strong>HIV/AIDS education at state FPAs <strong>in</strong> deliver<strong>in</strong>g <strong>the</strong>irprogrammes <strong>and</strong> services for <strong>the</strong> general public, as well asfor vulnerable population groups (sex workers, men whohave sex with men, <strong>in</strong>ject<strong>in</strong>g drug users, spouses of suchpersons, transsexuals <strong>and</strong> o<strong>the</strong>rs). Based on <strong>the</strong> UNFPA<strong>and</strong> World Health Organization study on streng<strong>the</strong>n<strong>in</strong>gHIV <strong>and</strong> SRH l<strong>in</strong>kages <strong>in</strong> Malaysia (August 2010),FRHAM is currently try<strong>in</strong>g to network with HIV/AIDSorganizations on promot<strong>in</strong>g fur<strong>the</strong>r <strong>and</strong> more mean<strong>in</strong>gfull<strong>in</strong>kages.Role of <strong>in</strong>ternational agencies<strong>and</strong> <strong>in</strong>ternational cooperationForeign assistance played an important role <strong>in</strong> <strong>the</strong> earlystages of <strong>the</strong> Malaysian family plann<strong>in</strong>g programme.<strong>International</strong> agencies <strong>and</strong> foreign foundations, suchas <strong>the</strong> Ford Foundation, Population <strong>Council</strong>, Swedish<strong>International</strong> Development Cooperation Agency <strong>and</strong>United Nations Children’s Fund, provided various typesof assistance. With <strong>the</strong> implementation of <strong>the</strong> PopulationProject (1973-1978) <strong>and</strong> <strong>the</strong> Population <strong>and</strong> <strong>Family</strong>Health Project (1979-1982), UNFPA <strong>and</strong> <strong>the</strong> WorldBank also furnished significant f<strong>in</strong>ancial <strong>and</strong> technicalassistance for <strong>the</strong> implementation of <strong>the</strong> population, familyplann<strong>in</strong>g <strong>and</strong> family health programmes (Noor Lailyet al., 1982). NPFDB has also been collaborat<strong>in</strong>g with256
o<strong>the</strong>r <strong>in</strong>ternational agencies, such IPPF, <strong>the</strong> <strong>International</strong><strong>Council</strong> on Management of Population Programmes,Japanese Organization for <strong>International</strong> Cooperation<strong>in</strong> <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong>, <strong>Asia</strong>n Forum of Parliamentarianson Population <strong>and</strong> Development, <strong>Asia</strong>n Institute forDevelopment Communication, Pan-<strong>Pacific</strong> <strong>and</strong> Sou<strong>the</strong>ast<strong>Asia</strong> Women’s Association <strong>and</strong> <strong>Asia</strong>n-<strong>Pacific</strong> Resource<strong>and</strong> Research Centre for Women.Malaysia has been participat<strong>in</strong>g actively <strong>in</strong> <strong>in</strong>ternationalforums on population issues; for example, it participatesactively <strong>in</strong> <strong>the</strong> ASEAN-Australian PopulationProgramme, among o<strong>the</strong>rs. UNFPA Malaysia has playeda bridg<strong>in</strong>g role <strong>in</strong> some of <strong>the</strong> pioneer<strong>in</strong>g work done <strong>in</strong> <strong>the</strong>country on population, <strong>the</strong> reproductive health of youngpeople <strong>and</strong> gender issues. UNFPA support has enabledparticipat<strong>in</strong>g agencies to <strong>in</strong>itiate new programmes <strong>and</strong>strategies, streng<strong>the</strong>n exist<strong>in</strong>g ones, develop expertise <strong>and</strong>capability (capacity-build<strong>in</strong>g) <strong>and</strong> foster network<strong>in</strong>g <strong>and</strong>partnership <strong>in</strong> implement<strong>in</strong>g programmes to address areasthat are of grow<strong>in</strong>g concern. The assistance of UNFPA hasmade it possible for NGOs to implement projects that areconsidered sensitive, such as those <strong>in</strong>volv<strong>in</strong>g HIV <strong>in</strong>fection<strong>and</strong> sex workers.UNFPA began provid<strong>in</strong>g assistance to Malaysia <strong>in</strong> 1973for its national family plann<strong>in</strong>g programme. In addition tof<strong>in</strong>ancial assistance, UNFPA has been provid<strong>in</strong>g technicaladvisory services <strong>and</strong> support for strategic development <strong>in</strong>population-related areas, focus<strong>in</strong>g on family/reproductivehealth <strong>and</strong> gender issues. From 1973 through 1996,UNFPA supported programmes <strong>and</strong> projects for RH/FP, tra<strong>in</strong><strong>in</strong>g, research <strong>and</strong> capacity-build<strong>in</strong>g activities,as well as o<strong>the</strong>r project areas related to population <strong>and</strong>development. In view of Malaysia’s progress towardsbecom<strong>in</strong>g self-reliant <strong>and</strong> its success with populationstrategies, <strong>the</strong> assistance provided by UNFPA s<strong>in</strong>ce 1997has been directed towards selected areas of <strong>in</strong>tervention,particularly <strong>in</strong> <strong>the</strong> area of reproductive health, as prescribed<strong>in</strong> <strong>the</strong> ICPD Programme of Action. The areas covered<strong>in</strong>clude family plann<strong>in</strong>g; maternal <strong>and</strong> child health; family<strong>and</strong> reproductive health; population <strong>and</strong> development;population education; population studies <strong>and</strong> surveyresearch; tra<strong>in</strong><strong>in</strong>g of staff, women <strong>and</strong> youth; sett<strong>in</strong>g upspecialist <strong>and</strong> research centres; upgrad<strong>in</strong>g <strong>in</strong>frastructure<strong>and</strong> facilities; community participation; <strong>and</strong> South-Southcooperation.In 2004, UNFPA funded <strong>the</strong> project entitled “South-SouthCooperation <strong>in</strong> Reproductive Health <strong>in</strong> Malaysia”, whichwas aimed at <strong>in</strong>creas<strong>in</strong>g <strong>the</strong> utilization of reproductivehealth services through <strong>the</strong> shar<strong>in</strong>g of knowledge <strong>and</strong>experience with<strong>in</strong> countries that are members of <strong>the</strong>Association of Sou<strong>the</strong>ast <strong>Asia</strong>n Nations (ASEAN). It wasalso aimed at streng<strong>the</strong>n<strong>in</strong>g <strong>the</strong> capacity of <strong>the</strong> agencies<strong>in</strong>volved, particularly NPFDB, M<strong>in</strong>istry of Health <strong>and</strong>FRHAM, to organize, manage <strong>and</strong> monitor broader,<strong>in</strong>tegrated reproductive health services.A regional technical meet<strong>in</strong>g <strong>and</strong> regional tra<strong>in</strong><strong>in</strong>g workshopheld <strong>in</strong> December 2004 contributed to <strong>the</strong> shar<strong>in</strong>g ofexperience <strong>and</strong> <strong>the</strong> tra<strong>in</strong><strong>in</strong>g of programme managers/service providers from ASEAN countries <strong>and</strong> Uzbekistanon <strong>the</strong> key elements of reproductive health at <strong>the</strong> primarycarelevel. In summary, many of <strong>the</strong> participants learnednew strategies for streng<strong>the</strong>n<strong>in</strong>g <strong>the</strong>ir capacity <strong>in</strong> plann<strong>in</strong>g,manag<strong>in</strong>g <strong>and</strong> implement<strong>in</strong>g RH services at <strong>the</strong> primarycarelevel.Impact of <strong>the</strong> national familyplann<strong>in</strong>g programme on fertilitytrendsFertility <strong>in</strong> Pen<strong>in</strong>sular Malaysia decl<strong>in</strong>ed sharply from 5.7children per woman <strong>in</strong> <strong>the</strong> mid-1960s to 4.2 by <strong>the</strong> mid-1970s, follow<strong>in</strong>g <strong>the</strong> implementation of <strong>the</strong> national familyplann<strong>in</strong>g programme.The total fertility rate (TFR) cont<strong>in</strong>ued to decl<strong>in</strong>e from3.3 <strong>in</strong> 1995 to 3.0 <strong>in</strong> 2000 <strong>and</strong> 2.3 <strong>in</strong> 2006, despitestagnation <strong>in</strong> CPR. This can be expla<strong>in</strong>ed partly by <strong>the</strong>ris<strong>in</strong>g age at first marriage. Data from population censusesshow that <strong>the</strong> s<strong>in</strong>gulate mean age at marriage (SMAM)for Malaysian women has been <strong>in</strong>creas<strong>in</strong>g from 22.0 years<strong>in</strong> 1970 to 24.8 years <strong>in</strong> 1991 <strong>and</strong> 25.1 years <strong>in</strong> 2000. In2000, SMAM for women was highest at 27 years among<strong>the</strong> Ch<strong>in</strong>ese population <strong>and</strong> lowest at 24.8 years amongMalays. The proportion of women <strong>in</strong> <strong>the</strong> age group 30-34who had never been married also <strong>in</strong>creased from 6 per cent<strong>in</strong> 1970 to 13 per cent <strong>in</strong> 2000, with <strong>the</strong> Ch<strong>in</strong>ese hav<strong>in</strong>g<strong>the</strong> highest proportion at 18 per cent.Table 16 shows that fertility among women aged 40 <strong>and</strong>older has fallen to a very low level, <strong>and</strong> those <strong>in</strong> <strong>the</strong>ir thirtieshave also registered significant decl<strong>in</strong>e. Fertility decl<strong>in</strong>e hasoccurred <strong>in</strong> all age groups <strong>and</strong> among all ethnic groups.Low CPR <strong>and</strong> low TFR could <strong>in</strong>dicate <strong>the</strong> possibility of<strong>in</strong>creased abortions, but this rema<strong>in</strong>s speculative as dataon abortion are not available.The impact of contraceptive use on fertility can be assessedby compar<strong>in</strong>g <strong>the</strong> CPR <strong>and</strong> fertility levels of differentsubgroups. In Malaysia, fertility rates are much loweramong subgroups that have higher CPR (<strong>the</strong> non-Malays<strong>and</strong> <strong>the</strong> better educated population).CPR among Malays has always been lower than that ofnon-Malays, <strong>and</strong> this is reflected <strong>in</strong> <strong>the</strong> fertility differentials,as shown <strong>in</strong> Figure 3. Among <strong>the</strong> Malays <strong>and</strong> Ch<strong>in</strong>ese, <strong>the</strong>effects of <strong>in</strong>creased contraceptive use on <strong>the</strong> fertility levelover <strong>the</strong> period 1974-2004 is obvious, but TFR for Indians257
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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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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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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 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 290 and 291: FigureHIV/AIDS. An HIV-positive wom
Page 292 and 293: National Population PolicyMyanmar i
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Page 296 and 297: TableTable4Achievements of Myanmar
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Page 300 and 301: Nay Pyi Taw, 26 October 2010.53 Sit
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Page 306 and 307: TableTableA296
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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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