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

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Figure 11 summarizes <strong>the</strong> explanations*2 provided bywomen when asked for one ma<strong>in</strong> reason why <strong>the</strong>y did not<strong>in</strong>tend to use any method of contraception <strong>in</strong> four surveysdone from 1993 to 2008. About one third did not <strong>in</strong>tend touse a method simply because <strong>the</strong>y wanted to get pregnantor <strong>the</strong>y could not get pregnant anymore due to menopauseor hysterectomy. The rema<strong>in</strong><strong>in</strong>g two thirds gave o<strong>the</strong>rreasons, which <strong>in</strong>dicate that <strong>the</strong>y had an unmet need, <strong>and</strong>would cont<strong>in</strong>ue to have an unmet need unless barriers touse are successfully addressedSafety concernsThe top concern is about safety, cited by half of thosewith an unmet need. The issues with<strong>in</strong> this group revolvearound doubts about <strong>the</strong> <strong>in</strong>tr<strong>in</strong>sic safety of contraceptiveproducts or <strong>the</strong>ir suitability or fit (hiyang <strong>in</strong> Filip<strong>in</strong>o)to <strong>the</strong> user. Focus group discussions typically open upconcerns about cancer, weight loss, dangerous levels ofchemical build-up due to prolonged use, excessive bleed<strong>in</strong>g,<strong>the</strong> build-up of unclean blood if menstruation stops, lossof physical strength which leads to <strong>in</strong>ability to work,debilitat<strong>in</strong>g headaches or stomach aches, devices that getlost or entangled <strong>in</strong>side, among many more such concerns.A study39 done <strong>in</strong> 2003 has documented many of <strong>the</strong>sefears (see Table B).Filip<strong>in</strong>o women have relatively high levels of formaleducation: 71 per cent of women not us<strong>in</strong>g any method <strong>in</strong><strong>the</strong> 2008 NDHS had a high school or college/universityeducation. However, contraception is not a st<strong>and</strong>ard partof <strong>the</strong> curriculum. The Department of Education hada much publicized attempt to pilot-test <strong>the</strong> <strong>in</strong>clusion ofsexuality <strong>and</strong> family plann<strong>in</strong>g topics <strong>in</strong> some public highschools <strong>in</strong> <strong>the</strong> last few months of <strong>the</strong> previous government,but this effort was blocked by lobby<strong>in</strong>g conducted byCatholic bishops <strong>and</strong> clergy. A policy of <strong>in</strong>tegrat<strong>in</strong>g ageappropriatereproductive health <strong>and</strong> sexuality education<strong>in</strong>to <strong>the</strong> formal school system is also part of numerousreproductive health bills filed <strong>in</strong> Congress s<strong>in</strong>ce 2001, butall such attempts have been successfully blocked by <strong>in</strong>tense<strong>and</strong> widespread lobby<strong>in</strong>g by <strong>the</strong> Catholic hierarchy.Ano<strong>the</strong>r factor for <strong>the</strong> prom<strong>in</strong>ence of safety questions is<strong>the</strong> open <strong>and</strong> cont<strong>in</strong>u<strong>in</strong>g campaign by Catholic bishops, laygroups, some Catholic medical practitioners <strong>and</strong> politiciansto raise doubts about <strong>the</strong> safety of contraceptives. 40 Some of<strong>the</strong> worst documented cases occurred <strong>in</strong> <strong>the</strong> city of Manila(population 1.7 million). In a 2006 video documentary 41 ,<strong>the</strong> city mayor justified his ban of contraceptives with <strong>the</strong>follow<strong>in</strong>g assertion: “Contraceptive materials actually arepoison to <strong>the</strong> woman's body. You look at <strong>the</strong> <strong>in</strong>ternet, it'seven described as a pesticide. Why should I be teach<strong>in</strong>gpeople how to take pesticide?” In 2007, medical doctorsemployed by <strong>the</strong> city government admitted <strong>in</strong> <strong>in</strong>terviewsabout <strong>the</strong> contraceptive ban <strong>in</strong> <strong>the</strong> city that <strong>the</strong>y teachpeople that contraceptives are unsafe or <strong>in</strong>effective, thatoral pills conta<strong>in</strong> pesticides <strong>and</strong> cause cancer, <strong>and</strong> thatcondoms are not effective <strong>in</strong> prevent<strong>in</strong>g HIV because <strong>the</strong>virus is smaller than <strong>the</strong> condom’s pores <strong>and</strong> can penetratethrough. 42In a focus group discussion by one of <strong>the</strong>authors with long-time community healthworkers, some of <strong>the</strong>m tried four modernmethods – usually pills, DMPA, condom,breastfeed<strong>in</strong>g <strong>and</strong> IUD – <strong>in</strong> differentorders, before <strong>the</strong>y settled on a methodthat was most comfortable for <strong>the</strong>m. A fewused a comb<strong>in</strong>ation of modern methods<strong>and</strong> herbal “menstrual regulators”, such asroots of achuete, makahiya, makabuhay<strong>and</strong> marabilos. The shift to differentmethods is triggered by side effects, suchas headaches, ligh<strong>the</strong>adedness, gastritis;unexpected effects, such as cessationof menses with pills <strong>and</strong> IUD; <strong>and</strong>cont<strong>in</strong>uous method failure, usually withpills <strong>and</strong> DMPA; <strong>and</strong> heavy bleed<strong>in</strong>gwith DMPA. A few used withdrawal.Despite <strong>the</strong> difficulties, women persist <strong>in</strong>us<strong>in</strong>g <strong>the</strong>se methods for many reasons.In <strong>the</strong>ir experience, clients who havedifficulty susta<strong>in</strong><strong>in</strong>g use are those whoexperience side effects, some of whichare contrary to <strong>the</strong> postulated effects ofmethods – amenorrhoea with IUD <strong>and</strong>pills, monthly bleed<strong>in</strong>g with <strong>in</strong>jectables– or symptoms which are not logicallyrelated to <strong>the</strong> methods, such as chestpa<strong>in</strong>, mass <strong>and</strong> asthma. There are thosewho fear experienc<strong>in</strong>g pa<strong>in</strong> on gett<strong>in</strong>gan IUD because <strong>the</strong>y th<strong>in</strong>k it is asurgical procedure, or because of previousexperiences with pa<strong>in</strong>ful <strong>in</strong>sertion,<strong>in</strong>fection <strong>and</strong> abscess formation, <strong>and</strong>perforation.308
Low fecundityFocus group discussions 43 revealed misconceptionsabout fertility that might lull women <strong>in</strong>to a false senseof be<strong>in</strong>g protected from pregnancy. Some beliefs arerooted <strong>in</strong> tradition, <strong>and</strong> some are probably due to <strong>the</strong>absence of sexual health topics <strong>in</strong> <strong>the</strong> school curriculumdiscussed previously. A common traditional practice, stillflourish<strong>in</strong>g, is called pagpahilis ng matris (misalign<strong>in</strong>g <strong>the</strong>uterus) which <strong>in</strong>volves a hilot (traditional birth attendant<strong>and</strong> healer) manipulat<strong>in</strong>g <strong>the</strong> lower abdomen, supposedlyto reposition <strong>the</strong> uterus <strong>in</strong> such a way that <strong>the</strong> womanbecomes safe from pregnancy. O<strong>the</strong>r beliefs <strong>in</strong>cludeTableTableC309
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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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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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Page 270 and 271: ReferencesAng, Eng Suan (2007). Stu
Page 272 and 273: Demographic data sheet: population
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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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Page 308 and 309: dispense and adm<s
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Page 348 and 349: includin</
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Page 358 and 359: FigureThe existence of traditional
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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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