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

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Figure<strong>the</strong> use of contraceptives, urban woman had almost noadvantage over rural women. The same pattern is found <strong>in</strong><strong>in</strong>equities based on education <strong>and</strong> region.For contraception, it is apparent that percentages for<strong>the</strong> usually advantaged sectors are unusually dampened.Whereas <strong>the</strong>se high-perform<strong>in</strong>g sectors got 78-94 per cent<strong>in</strong> skilled attendants, <strong>the</strong>y achieved only moderate levels of47-62 per cent <strong>in</strong> contraception. As a result, better equitywas achieved through roughly equal levels of dampenedcontraceptive use.Unwanted fertilityAlthough <strong>in</strong>equities <strong>in</strong> contraceptive use are somewhatmoderated, <strong>the</strong>re are large <strong>in</strong>equities <strong>in</strong> unwanted birthsor fertility. In <strong>the</strong> 2008 NDHS, 37 per cent of all births bywomen <strong>in</strong> <strong>the</strong> lowest qu<strong>in</strong>tile were unwanted, comparedwith 16 per cent <strong>in</strong> <strong>the</strong> highest. There are two possibleexplanations shown <strong>in</strong> Figure 13. First, wealthier womenare better at avoid<strong>in</strong>g early pregnancy. Only 13 per cent ofwomen <strong>in</strong> <strong>the</strong> highest qu<strong>in</strong>tile began childbear<strong>in</strong>g between<strong>the</strong> ages of 15 <strong>and</strong> 24, compared with 44 per cent of women<strong>in</strong> <strong>the</strong> poorest qu<strong>in</strong>tile. This may be related to <strong>the</strong> lengthof time <strong>the</strong>y spent <strong>in</strong> school – 66 per cent of <strong>the</strong> richestwomen f<strong>in</strong>ished high school or reached college, comparedwith only 11 per cent of <strong>the</strong> poorest women. Second, poorwomen had lower rates of us<strong>in</strong>g sterilization to limit <strong>the</strong>irchildbear<strong>in</strong>g*5 – 7 per cent for <strong>the</strong> poorest comparedwith 20 per cent for <strong>the</strong> richest – most likely due to <strong>the</strong>higher costs of <strong>the</strong> procedure compared with o<strong>the</strong>r familyplann<strong>in</strong>g methods. The median cost of female sterilizationwas recorded by <strong>the</strong> 2008 NDHS at 1,476 pesos <strong>in</strong> <strong>the</strong>public sector <strong>and</strong> 9,929 pesos <strong>in</strong> <strong>the</strong> private sector, some30-33 times <strong>the</strong> cost of an IUD*6 <strong>in</strong> <strong>the</strong> same sector.Voluntary sterilization <strong>and</strong> <strong>in</strong>equityInequity <strong>in</strong> rates of tubal ligation has been observed s<strong>in</strong>cewealth qu<strong>in</strong>tiles were added to <strong>the</strong> DHS. In <strong>the</strong> 1998 <strong>and</strong>2003 surveys, among women who do not want any morechildren, <strong>the</strong> percentage that got a tubal ligation <strong>in</strong>creasedat a constant rate with every rise <strong>in</strong> wealth qu<strong>in</strong>tile, with <strong>the</strong>highest gett<strong>in</strong>g four times <strong>the</strong> rate of <strong>the</strong> lowest (see Figure14). This pattern changed <strong>in</strong> 2008. The percentage among<strong>the</strong> highest, fourth <strong>and</strong> middle fell while <strong>the</strong> second <strong>and</strong>lowest qu<strong>in</strong>tiles rema<strong>in</strong>ed <strong>the</strong> same. The highest ended upwith just three times <strong>the</strong> rate of <strong>the</strong> lowest. The lessen<strong>in</strong>gof <strong>in</strong>equity came from decl<strong>in</strong>es <strong>in</strong> <strong>the</strong> better-off qu<strong>in</strong>tiles,not from any improvement for <strong>the</strong> poor.To both elim<strong>in</strong>ate <strong>in</strong>equity <strong>and</strong> return to <strong>the</strong> 2003 peakrate achieved by <strong>the</strong> highest qu<strong>in</strong>tile, that is, 27 per centof all those who wanted no more children, regardless ofwealth, <strong>and</strong> are able to get tubal ligation, it is estimatedthat for 2010, some 1.13 million procedures were needed:370,000 for <strong>the</strong> lowest; 260,000 for <strong>the</strong> second; 240,000for <strong>the</strong> middle; 136,000 for <strong>the</strong> fourth; <strong>and</strong> 126,000 for<strong>the</strong> highest qu<strong>in</strong>tile. The two poorest qu<strong>in</strong>tiles need 55 percent (630,000) of all <strong>the</strong>se procedures <strong>and</strong> required easieraccess to subsidies from public health funds to elim<strong>in</strong>ate<strong>the</strong> equity gap. In October 2008, <strong>the</strong> country's nationalFigure12Comparison of <strong>in</strong>equities <strong>in</strong> maternal care <strong>and</strong> family plann<strong>in</strong>g, married women (15-49)312
FigureFigureFigure13Inequities <strong>in</strong> unwanted fertility, <strong>and</strong> possible contribut<strong>in</strong>g factorshealth <strong>in</strong>surance programme (PhilHealth) raised itsFigureMorocco (93%). O<strong>the</strong>r <strong>Asia</strong>n countries <strong>in</strong> <strong>the</strong> study had14Percentage able to get tubal ligation among married women who do not want any more childrenbenefit for tubal ligation <strong>and</strong> vasectomy to 4,000 pesos perprocedure, 46 which means that <strong>the</strong> two poorest qu<strong>in</strong>tilesneeded about 2.5 billion pesos (US$ 59 million) toelim<strong>in</strong>ate <strong>the</strong> accumulated need for sterilization services.Steps are also needed to correct <strong>the</strong> <strong>in</strong>equity <strong>in</strong> access tohealth <strong>in</strong>surance. In <strong>the</strong> 2008 NDHS, only 21 per cent ofwomen <strong>in</strong> <strong>the</strong> lowest qu<strong>in</strong>tile <strong>and</strong> 32 per cent <strong>in</strong> <strong>the</strong> secondqu<strong>in</strong>tile had any type of health <strong>in</strong>surance, compared with58 per cent of women <strong>in</strong> <strong>the</strong> highest qu<strong>in</strong>tile.AdolescentsAdolescents aged 15-19 <strong>in</strong> <strong>the</strong> Philipp<strong>in</strong>es have relativelylow pregnancy rates compared with <strong>the</strong>ir peers <strong>in</strong> o<strong>the</strong>rdevelop<strong>in</strong>g countries. In a 2008 study by Khan <strong>and</strong> Mishra 47compar<strong>in</strong>g 38 countries with recent DHS surveys (2001-2005), <strong>the</strong> Philipp<strong>in</strong>es at 92 per cent ranked sixth <strong>in</strong> <strong>the</strong>percentage of adolescents who had never been pregnant.Slightly ahead of <strong>the</strong> Philipp<strong>in</strong>es were Viet Nam (96%),Rw<strong>and</strong>a (96%), Armenia (95%), Moldova (94%) <strong>and</strong>far lower percentages: Nepal at 44 per cent, Bangladeshat 28 per cent <strong>and</strong> Indonesia at 27 per cent (ranked 37th).The 2008 NDHS recorded a slight decl<strong>in</strong>e to 90 per cent,which would leave unchanged <strong>the</strong> country's rank<strong>in</strong>g <strong>in</strong> thisstudy.The low rate of teenage pregnancy is not due to <strong>the</strong> highuse of effective contraception. On <strong>the</strong> contrary, married*7adolescents have <strong>the</strong> lowest use of modern methods at14 per cent compared with 23-40 per cent for o<strong>the</strong>r agegroups, <strong>and</strong> <strong>the</strong> highest rate of unmet need at 36 per centcompared with 18-26 per cent for <strong>the</strong> o<strong>the</strong>r groups. Thereare plenty of anecdotal reports of public health facilitiesrefus<strong>in</strong>g to provide adolescents with contraceptives. Itis possible that health providers do not know or haveno guidel<strong>in</strong>es on how to h<strong>and</strong>le young couples <strong>in</strong> live-<strong>in</strong>relationships, <strong>and</strong> 7 of 10 married adolescents are <strong>in</strong> thistype of marital arrangement.Sexual abst<strong>in</strong>ence is <strong>the</strong> ma<strong>in</strong> strategy used by adolescent313
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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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FigureFigure3TRF54.5Scatter plots o
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ReferencesAng, Eng Suan (2007). Stu
Page 272 and 273: Demographic data sheet: population
Page 274 and 275: population size, with just 336,000
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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 286 and 287: according to <stro
Page 288 and 289: Adolescent sexual and</stro
Page 290 and 291: FigureHIV/AIDS. An HIV-positive wom
Page 292 and 293: National Population PolicyMyanmar i
Page 294 and 295: Linkages with o<st
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
Page 308 and 309: dispense and adm<s
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Page 312 and 313: FigureFigureFigure3Use of modern co
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Page 316 and 317: Figureprojection, and</stro
Page 318 and 319: Figure 11 summarizes the</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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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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