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

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FigureFigure7Traditional method use <strong>in</strong> <strong>the</strong> Philipp<strong>in</strong>es <strong>and</strong> neighbour<strong>in</strong>g <strong>Asia</strong>n countrieswoman's fertile period – from 26 per cent to 48 per cent<strong>in</strong> <strong>the</strong> four surveys from 1993 to 2008. This <strong>in</strong>dicates thatmost users have not had any formal orientation, much lesstra<strong>in</strong><strong>in</strong>g, about <strong>the</strong> method.The Department's goal 30 of 80 per cent total CPR <strong>and</strong> 60per cent modern-method CPR by 2010 implies a target of20 per cent use rate for traditional methods, which meansthat <strong>the</strong> current high levels will be raised fur<strong>the</strong>r. Thiscontradicts <strong>the</strong> Department's own family plann<strong>in</strong>g methodmix. Policy clarification is needed <strong>in</strong> this area.Unmet need for modern methodsUnmet need measures <strong>the</strong> proportion of married womenwho are able to get pregnant (fecund), want to space <strong>the</strong>next pregnancy by two years or more or stop childbear<strong>in</strong>galtoge<strong>the</strong>r, but are not us<strong>in</strong>g any method of contraception.Accord<strong>in</strong>g to this def<strong>in</strong>ition, users of traditional methodsare classified as hav<strong>in</strong>g “met” <strong>the</strong>ir need for prevent<strong>in</strong>gpregnancy. Ow<strong>in</strong>g to <strong>the</strong> large risks posed by traditionalmethods <strong>in</strong> lead<strong>in</strong>g to un<strong>in</strong>tended pregnancies <strong>and</strong> <strong>the</strong>exclusion of <strong>the</strong>se methods <strong>in</strong> official family plann<strong>in</strong>gprogrammes, organizations such as <strong>the</strong> GuttmacherInstitute (“unmet need for effective contraception” 31 ) <strong>and</strong>ICF Macro of <strong>the</strong> MEASURE DHS project (“unmet needfor modern methods” 32 ) have began releas<strong>in</strong>g comb<strong>in</strong>edcounts of women with unmet need toge<strong>the</strong>r with thoseus<strong>in</strong>g traditional methods. This is especially useful forcountries such as <strong>the</strong> Philipp<strong>in</strong>es with high levels oftraditional method use. These comb<strong>in</strong>ed counts will beused <strong>in</strong> <strong>the</strong> present report.Unmet need for modern methods provides a simple basisfor target<strong>in</strong>g levels of contraceptive use that is groundedon <strong>the</strong> expressed desires of women to regulate <strong>the</strong>irchildbear<strong>in</strong>g. With <strong>the</strong> unmet need approach, however,a problem occurs if women <strong>and</strong> couples desire a largenumber of children that, when aggregated, would lead tounsusta<strong>in</strong>able population growth. This desire may havebeen true for <strong>the</strong> Philipp<strong>in</strong>es <strong>in</strong> <strong>the</strong> earlier decades, but <strong>the</strong>latest studies show a different picture.Westoff 33 calculated <strong>in</strong> a 2006 multi-country study that<strong>the</strong> Philipp<strong>in</strong>es would have a total fertility rate (TFR) of2.4 to 2.8 children per woman if <strong>the</strong> unmet need based on2003 DHS data were elim<strong>in</strong>ated or substantially reduced.Shift<strong>in</strong>g <strong>the</strong> large number of traditional method usersto modern methods would fur<strong>the</strong>r reduce <strong>the</strong> predictedTFR.In a 2006 study us<strong>in</strong>g cross-tabulations <strong>and</strong> multivariateanalyses of socio-economic status <strong>and</strong> demographicbehaviour, Orbeta 34 concluded that “it is not <strong>the</strong> dem<strong>and</strong>for more children that is <strong>the</strong> reason for [<strong>the</strong> poor's] largefamily size but <strong>the</strong>ir use of <strong>in</strong>effective fertility controlmeasures”. He proposed three factors or mechanisms thatcould expla<strong>in</strong> this outcome: “(a) <strong>the</strong> crowd<strong>in</strong>g out of womenfrom poor households by a significant percentage of womenfrom richer households that are gett<strong>in</strong>g <strong>the</strong>ir supplies ofmodern contraception also from public sources, (b) <strong>the</strong>lower education of women from poorer households, <strong>and</strong>(c) <strong>the</strong> lower capacity of women from poorer householdsto pay for private supplies”.Proportion of women withunmet needThe Philipp<strong>in</strong>e government does not have a target forreduction of unmet need but gave a CPR target of 80 percent for all methods <strong>and</strong> 60 per cent for modern methodsby 2010, <strong>and</strong> a CPR of 100 per cent by 2015. 35 The 100per cent CPR target is likely a mistake because <strong>the</strong>re willalways be women who do want to get pregnant. This is anarea that needs policy clarification from <strong>the</strong> government.304
FigureFigureFigure8Total dem<strong>and</strong> for family plann<strong>in</strong>g <strong>and</strong> its various components1009080Pregnant &wanted, want toget pregnantsoon, <strong>in</strong>fecundTotal dem<strong>and</strong> forfamily plann<strong>in</strong>g7060504041%Unmet need formodern method38%Unmet need (nomethod used)Traditionalmethod user32%39%302010Modern methoduser01993 1998 2003 2008Figure9Estimated number of married women aged 15-49 with unmet need for modern methodsFrom 1993 to 2003, <strong>the</strong> proportion of women with unmetneed for modern methods went down from 41 to 32 percent (see Figure 8). The improvement came almost solelyfrom a drop <strong>in</strong> those not us<strong>in</strong>g any method; traditionalmethod use rema<strong>in</strong>ed practically <strong>the</strong> same. From 2003to 2008, however, unmet need for modern contraceptionwent up aga<strong>in</strong> to 39 per cent. The <strong>in</strong>crease came from bothnon-users <strong>and</strong> traditional method users, with <strong>the</strong> formercontribut<strong>in</strong>g <strong>the</strong> larger hike.MagnitudeThe s<strong>in</strong>gle-digit movements <strong>in</strong> unmet need percentagesmask <strong>the</strong> huge number of women affected. The countryhas millions of married women <strong>in</strong> <strong>the</strong>ir reproductiveyears because <strong>the</strong> population is young <strong>and</strong> grow<strong>in</strong>g, <strong>and</strong><strong>the</strong> proportion of women <strong>in</strong> union (married or <strong>in</strong> a live<strong>in</strong>arrangement) has not gone down. For example, a rise<strong>in</strong> <strong>the</strong> average age at marriage could br<strong>in</strong>g <strong>the</strong> proportiondown, but this has not occurred. There is evidence that <strong>the</strong>proportion has gone up slightly: <strong>the</strong> proportion of women<strong>in</strong> union was 58.2 per cent <strong>in</strong> <strong>the</strong> 2000 census <strong>and</strong> 61.9 percent <strong>in</strong> <strong>the</strong> 2008 NDHS.Figure 9 presents an estimate of <strong>the</strong> number of marriedwomen who do not want a pregnancy now or ever, butare not us<strong>in</strong>g any modern method of contraception. Ituses <strong>the</strong> medium scenario population projections nearesta survey year (i.e., <strong>the</strong> 1993 survey was matched to <strong>the</strong>1995 population projection, <strong>the</strong> 1998 survey to <strong>the</strong> 2000305
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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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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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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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Page 270 and 271: ReferencesAng, Eng Suan (2007). Stu
Page 272 and 273: Demographic data sheet: population
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Page 276 and 277: NuptialityIn Myanmar nuptiality is
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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
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Page 300 and 301: Nay Pyi Taw, 26 October 2010.53 Sit
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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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