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

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FigureFigure3TRF54.5Scatter plots of total fertility rate with contraceptive prevalence rate, by ethnic group, 1974 <strong>and</strong> 2004,Pen<strong>in</strong>sular MalaysiaMalay 1974Contraceptive prevalence rate (%)43.5India 1974Ch<strong>in</strong>ese 197432.5Malay 200421.510.5India 2004Ch<strong>in</strong>ese 2004020 30 40 50 60 70Source: National Population <strong>and</strong> <strong>Family</strong> Development Board (NPFDB); Malaysian Population <strong>and</strong> <strong>Family</strong> Surveys <strong>in</strong> 1974, 1984,1994 <strong>and</strong> 2004.also decl<strong>in</strong>ed sharply despite <strong>the</strong> ra<strong>the</strong>r modest <strong>in</strong>crease <strong>in</strong><strong>the</strong>ir CPR over <strong>the</strong> same period.A correlation analysis between CPR <strong>and</strong> TFR at <strong>the</strong> statelevel shows a correlation ratio of –.72. The more developedstates generally have a higher CPR <strong>and</strong> lower TFR. Thetwo east-coast states (Kelantan <strong>and</strong> Terengganu) have <strong>the</strong>lowest CPR (see Table 3) <strong>and</strong> highest TFR at 4.3 <strong>and</strong> 3.7respectively.Emerg<strong>in</strong>g issues <strong>and</strong>recommendationsAs part of its efforts to monitor <strong>the</strong> implementation of <strong>the</strong>national family plann<strong>in</strong>g <strong>and</strong> development programmes,NPFDB has conducted Malaysian Population <strong>and</strong> <strong>Family</strong>Surveys <strong>in</strong> 1974, 1984, 1994 <strong>and</strong> 2004. Many o<strong>the</strong>rsmaller-scale surveys on specific topics, such as adolescentsexuality, <strong>in</strong>ternational migration <strong>and</strong> <strong>in</strong>fertility, have alsobeen conducted. NPFDB recently conducted an assessmentof <strong>the</strong> implementation of ICPD+10 (NPFDB, 2005)<strong>and</strong> a second population strategic plan (unpublished). Amid-term review of <strong>the</strong> UNFPA Country Programmefor Malaysia (2008-2012) has just been completed (Tey,2010). These reviews <strong>and</strong> assessments have highlightedseveral emerg<strong>in</strong>g issues that warrant attention.The stagnation <strong>in</strong> CPR <strong>and</strong> <strong>the</strong> <strong>in</strong>crease <strong>in</strong> unmet needshow that <strong>the</strong>re is a need to revitalize family plann<strong>in</strong>g <strong>in</strong>order to prevent unplanned/unwanted births <strong>and</strong> <strong>in</strong>ducedabortion, <strong>in</strong> l<strong>in</strong>e with <strong>the</strong> targets of MDGs. The lowlevel of contraceptive use may have resulted <strong>in</strong> <strong>in</strong>creasedabortion among married as well as unmarried women.<strong>Family</strong> plann<strong>in</strong>g <strong>and</strong> reproductive health services shouldbe targeted at <strong>the</strong> underserved <strong>and</strong> <strong>the</strong> disadvantaged,<strong>in</strong>clud<strong>in</strong>g foreign migrants <strong>and</strong> those <strong>in</strong> remote areas ofSabah <strong>and</strong> Sarawak. Improved family plann<strong>in</strong>g serviceswould lead to a reduction <strong>in</strong> maternal mortality, which is<strong>the</strong> aim of Goal 5 of MDGs. In this regard, specializedservices are needed, such as treatment of <strong>in</strong>fertility,reproductive tract <strong>in</strong>fection, sexually transmitted diseases,menopause <strong>and</strong> o<strong>the</strong>r reproductive health conditions; <strong>in</strong>addition cancer screen<strong>in</strong>g needs to be made more accessible<strong>and</strong> affordable to <strong>the</strong> public. The private sector should beencouraged to play an important role <strong>in</strong> this regard, asmany are rely<strong>in</strong>g on such services.To improve reproductive health <strong>and</strong> to br<strong>in</strong>g <strong>the</strong> benefitsof planned parenthood <strong>and</strong> to a wider segment of <strong>the</strong>population, programme adm<strong>in</strong>istrators should pay specialattention to <strong>the</strong> follow<strong>in</strong>g target groups:Those with unmet need for contraception <strong>in</strong> orderto space childbear<strong>in</strong>g, <strong>and</strong> to prevent unwanted ormistimed births;Husb<strong>and</strong>s/males who are apa<strong>the</strong>tic to <strong>the</strong> benefits ofplanned parenthood;Marg<strong>in</strong>alized groups who may lack knowledge of <strong>and</strong>access to family plann<strong>in</strong>g;Users of traditional methods;258
Foreign workers.The method mix shows that male participation <strong>in</strong> familyplann<strong>in</strong>g is still very low. More concerted efforts are neededto encourage <strong>and</strong> facilitate <strong>the</strong> active participation of males,<strong>and</strong> to reduce <strong>the</strong>ir objection to <strong>the</strong> practice of familyplann<strong>in</strong>g. Male participation <strong>in</strong> shar<strong>in</strong>g <strong>the</strong> responsibilityto practise family plann<strong>in</strong>g is identified as a vital strategyfor <strong>in</strong>creas<strong>in</strong>g CPR. It is important to neutralize <strong>the</strong>stereotyp<strong>in</strong>g or “fem<strong>in</strong>ization” of <strong>the</strong> service as a whole;<strong>the</strong>refore, activities must <strong>in</strong>volve both <strong>the</strong> health-careproviders <strong>and</strong> <strong>the</strong> clients (Rosliza <strong>and</strong> Majdah, 2010).A ra<strong>the</strong>r high proportion of couples are still us<strong>in</strong>g traditionalmethods. Users of traditional methods represent a potentialtarget group for modern methods of contraception.However, religious issues <strong>and</strong> fear of <strong>the</strong> side effects ofsome modern methods need to be addressed properly.With regard to <strong>the</strong> high non-use <strong>and</strong> discont<strong>in</strong>uation rates,a wider range of contraceptives methods, such as low-doseestrogen <strong>and</strong> long-act<strong>in</strong>g formulations, need to be madewidely available with <strong>in</strong>creased coverage, as well as effortsto effectively reduce side effects.Much has been said about social <strong>and</strong> health problemsbrought about by foreign workers. With <strong>the</strong> <strong>in</strong>creas<strong>in</strong>gnumber of foreign workers <strong>in</strong> Malaysia, <strong>the</strong>ir reproductivehealth needs must be addressed. More concerted efforts arerequired to prevent <strong>the</strong> spread of STIs <strong>and</strong> HIV/AIDSamong this population group.The IEC programmes that had previously played a veryimportant role <strong>in</strong> promot<strong>in</strong>g planned parenthood shouldbe <strong>in</strong>tegrated <strong>in</strong>to <strong>the</strong> reproductive health programme.There is also a need to <strong>in</strong>troduce reproductive <strong>and</strong> sexeducation <strong>in</strong>to schools <strong>in</strong> order to prepare young peoplefor healthy <strong>and</strong> responsible liv<strong>in</strong>g. With <strong>the</strong> advent ofmodern <strong>in</strong>formation <strong>and</strong> communications technologies,IEC programmes can now be implemented more effectively<strong>in</strong> educat<strong>in</strong>g <strong>and</strong> motivat<strong>in</strong>g <strong>the</strong> public concern<strong>in</strong>g <strong>the</strong>benefits of planned parenthood <strong>and</strong> <strong>in</strong>form<strong>in</strong>g <strong>the</strong>m of <strong>the</strong>availability of reproductive health services. Appropriateprogrammes should be implemented for specific targetgroups to enable <strong>the</strong>m to decide on <strong>the</strong> number <strong>and</strong> tim<strong>in</strong>gof births <strong>and</strong> to upgrade <strong>the</strong>ir socio-economic <strong>and</strong> healthconditions. On a broader scale, IEC programmes shouldencompass promotion by <strong>the</strong> private sector <strong>in</strong> respect ofprovid<strong>in</strong>g family plann<strong>in</strong>g services <strong>in</strong> areas where CPR islow.Adolescent sexuality has emerged as one of <strong>the</strong> mostpress<strong>in</strong>g social problems <strong>in</strong> Malaysia. The ris<strong>in</strong>g problemsof youth sexuality, teenage pregnancy <strong>and</strong> ab<strong>and</strong>onedbabies have been highlighted <strong>in</strong> <strong>the</strong> media. Strategiesare be<strong>in</strong>g developed <strong>and</strong> implemented to overcome suchproblems. The <strong>in</strong>troduction of reproductive health <strong>and</strong>social education must <strong>the</strong>refore be given high priority,especially now that <strong>the</strong> government has approved <strong>the</strong> policyon reproductive health <strong>and</strong> social education. The allianceof partners needs to be streng<strong>the</strong>ned <strong>in</strong> advocat<strong>in</strong>g <strong>the</strong>desensitization of SRH education so that it can be moreeffectively implemented. The M<strong>in</strong>istry of Education hasdecided to <strong>in</strong>troduce sex education <strong>in</strong>to schools, based on<strong>the</strong> previously mentioned module “I Am <strong>in</strong> Control” under<strong>the</strong> Kafe@Teen project. The Kafe@Teen concept <strong>and</strong>strategies have proven to be acceptable to <strong>the</strong> community;hence, efforts will be made to streng<strong>the</strong>n <strong>and</strong> up-scale<strong>the</strong>m. The Reproductive Health Adolescent Moduledeveloped by FRHAM should also be updated for widerdissem<strong>in</strong>ation.The HIV/AIDS p<strong>and</strong>emic has been a major concerns<strong>in</strong>ce <strong>the</strong> 1990s. Measures implemented to combat HIV/AIDS <strong>in</strong>clude blood screen<strong>in</strong>g, <strong>in</strong>formation <strong>and</strong> educationcampaigns, antiretroviral treatment, non-discrim<strong>in</strong>atorypolicies <strong>and</strong> <strong>the</strong> distribution of condoms. FRHAM hassuccessfully implemented many projects, some with <strong>the</strong>assistance of UNFPA, to reach youth <strong>and</strong> women, especially<strong>in</strong> areas considered sensitive. FRHAM has also been animportant partner <strong>in</strong> <strong>the</strong> fight aga<strong>in</strong>st HIV/AIDS. Thevarious pilot projects should be exp<strong>and</strong>ed <strong>and</strong> up-scaledwith assistance from UNFPA <strong>and</strong> o<strong>the</strong>r agencies.Studies have shown <strong>the</strong> close l<strong>in</strong>kage between reproductivehealth <strong>and</strong> HIV/AIDS <strong>and</strong> provided evidence ofimportant synergies between reproductive health <strong>and</strong>HIV prevention, care <strong>and</strong> treatment <strong>in</strong>terventions.Forg<strong>in</strong>g closer l<strong>in</strong>kages between such programme areasshould result <strong>in</strong> significant public health benefits. WHO<strong>and</strong> UNFPA are currently conduct<strong>in</strong>g a jo<strong>in</strong>t study aimedat streng<strong>the</strong>n<strong>in</strong>g <strong>the</strong> l<strong>in</strong>kages between HIV <strong>and</strong> SRH <strong>in</strong>Malaysia. UNFPA should cont<strong>in</strong>ue to work with WHO,<strong>the</strong> M<strong>in</strong>istry of Health <strong>and</strong> o<strong>the</strong>r relevant agencies <strong>in</strong>implement<strong>in</strong>g programmes to reduce HIV <strong>in</strong>fectionthrough SRH programmes.To be effective, NPFDB must cont<strong>in</strong>ue to work closely with<strong>the</strong> relevant government agencies, such as <strong>the</strong> Economic<strong>Plann<strong>in</strong>g</strong> Unit, <strong>the</strong> M<strong>in</strong>istry of Health, <strong>the</strong> M<strong>in</strong>istry ofEducation, <strong>the</strong> M<strong>in</strong>istry of Information, <strong>the</strong> Treasury<strong>and</strong> <strong>the</strong> M<strong>in</strong>istry of Youth <strong>and</strong> Sport, all of which arerepresented on <strong>the</strong> Board. NPFDB must also engage <strong>in</strong>smart partnerships with <strong>the</strong> private sector <strong>and</strong> NGOs,as well as <strong>in</strong>stitutions of higher learn<strong>in</strong>g <strong>in</strong> implement<strong>in</strong>g<strong>the</strong>se programmes. At <strong>the</strong> same time, it is necessary towork closely with United Nations agencies, <strong>in</strong> particularUNFPA, <strong>and</strong> engage <strong>in</strong> <strong>in</strong>ternational collaboration.259
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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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Figureto have the
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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 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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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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