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

FigureAims of <strong>the</strong> reportThe Programme of Action adopted by <strong>the</strong> <strong>International</strong>Conference on Population <strong>and</strong> Development (ICPD) <strong>in</strong>Cairo <strong>in</strong> 1994 put forward an ambitious goal:All countries should take steps to meet family-plann<strong>in</strong>gneeds of <strong>the</strong>ir populations as soon as possible <strong>and</strong> should,<strong>in</strong> all cases by <strong>the</strong> year 2015, seek to provide universalaccess to a full range of safe <strong>and</strong> reliable family-plann<strong>in</strong>gmethods <strong>and</strong> to related reproductive health services whichare not aga<strong>in</strong>st <strong>the</strong> law (United Nations, 1994: para 7.16;emphasis added).Today <strong>the</strong>re is a widespread view that nei<strong>the</strong>r <strong>the</strong><strong>in</strong>ternational community nor <strong>the</strong> majority of nationalgovernments have pursued <strong>the</strong> ICPD Programme ofAction with <strong>the</strong> level of commitment it requires <strong>and</strong>deserves. Many national family plann<strong>in</strong>g programmesappear to have lost focus <strong>and</strong> momentum.Aga<strong>in</strong>st this background, <strong>the</strong> <strong>International</strong> <strong>Council</strong> onManagement of Population Programmes (ICOMP) <strong>and</strong><strong>the</strong> <strong>Asia</strong> <strong>and</strong> <strong>Pacific</strong> Regional Office of <strong>the</strong> United NationsPopulation Fund (UNFPA) are undertak<strong>in</strong>g a reviewof <strong>the</strong> status of family plann<strong>in</strong>g <strong>in</strong> selected countries of<strong>Asia</strong> <strong>and</strong> <strong>the</strong> <strong>Pacific</strong>. The present country report is onecomponent of this broader undertak<strong>in</strong>g.The aims of this report are to:Provide a succ<strong>in</strong>ct review of <strong>the</strong> overall status of familyplann<strong>in</strong>g (FP) <strong>and</strong> related reproductive health (RH)programmes <strong>in</strong> Timor-Leste today;Identify key issues <strong>and</strong> obstacles which may be limit<strong>in</strong>guniversal access to good-quality FP services;Make recommendations (where appropriate) regard<strong>in</strong>ghow <strong>the</strong> provision of services <strong>and</strong> <strong>the</strong> practice of FPcould be improved by “reposition<strong>in</strong>g”, “revitaliz<strong>in</strong>g” oro<strong>the</strong>rwise adjust<strong>in</strong>g <strong>the</strong> national FP programme.Past achievements <strong>in</strong> familyplann<strong>in</strong>g <strong>and</strong> reproductivehealthTimor-Leste is currently <strong>the</strong> youngest new nation <strong>in</strong> <strong>the</strong>world, hav<strong>in</strong>g ga<strong>in</strong>ed full <strong>in</strong>dependence after a bitter <strong>and</strong>protracted struggle only <strong>in</strong> 2002. It is estimated that <strong>the</strong>violence follow<strong>in</strong>g <strong>the</strong> 1999 referendum destroyed about80 per cent of all health cl<strong>in</strong>ics <strong>and</strong> schools, as well as muchof <strong>the</strong> country’s electricity generat<strong>in</strong>g capacity. All <strong>the</strong>normal political <strong>and</strong> adm<strong>in</strong>istrative <strong>in</strong>stitutions needed bya modern state had to be created virtually from scratch.Demographic contextThere is not an abundance of demographic data for Timor-Leste but <strong>the</strong> broad picture is clear 1 . Relative to <strong>the</strong> restof South-East <strong>Asia</strong>, Timor-Leste is still <strong>in</strong> an early stageof its demographic transition: while death rates have beencom<strong>in</strong>g down steadily for more than half a century, birthrates have rema<strong>in</strong>ed high (see Figure 1). The United Nationshas estimated that <strong>the</strong> average crude death rate dur<strong>in</strong>g <strong>the</strong>period 2005-2010 was 8.8 deaths per 1,000 population,<strong>and</strong> <strong>the</strong> average crude birth rate dur<strong>in</strong>g <strong>the</strong> same periodwas 40.2 births per 1,000 population. The 2003 Timor-Leste Demographic <strong>and</strong> Health Survey (DHS) recordeda total fertility rate (TFR) of 7.8 children per woman, <strong>the</strong>highest <strong>in</strong> <strong>the</strong> world 2 . The grow<strong>in</strong>g difference between <strong>the</strong>number of births <strong>and</strong> <strong>the</strong> number of deaths every yearresults <strong>in</strong> a high population growth rate (estimated by <strong>the</strong>United Nations to be 3.3 per cent per annum dur<strong>in</strong>g <strong>the</strong>period 2005-2010).Figure50403020101Crude birth <strong>and</strong> death rates, Timor-Leste,1950-201001950-55 1960-65 1970-75 1980-85 1990-95 2000-05National <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> PolicyThe National <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> Policy was established <strong>in</strong>2004, after significant consultations with stakeholders,<strong>in</strong>clud<strong>in</strong>g religious leaders. It is noteworthy that an FPprogramme was established so early <strong>in</strong> <strong>the</strong> history of <strong>the</strong>new nation. The Prime M<strong>in</strong>ister at <strong>the</strong> time lent his activesupport. The policy enjoys good support <strong>in</strong> parliament, <strong>and</strong>is deliberately designed so as not to offend <strong>the</strong> teach<strong>in</strong>gs of<strong>the</strong> Roman Catholic Church.The rationale for <strong>the</strong> national FP policy builds on <strong>the</strong>country’s constitution, which states (section 57): “everyonehas <strong>the</strong> right to health <strong>and</strong> medical care <strong>and</strong> <strong>the</strong> duty toprotect <strong>and</strong> promote <strong>the</strong>m”. Given <strong>the</strong> very high level offertility <strong>in</strong> <strong>the</strong> country at <strong>the</strong> time, it was clear dur<strong>in</strong>gconsultations held <strong>in</strong> 2003 that <strong>the</strong> “majority of <strong>the</strong> people,CDRCBR337