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

More documents

Recommendations

Info

<strong>in</strong>clud<strong>in</strong>g <strong>the</strong> Catholic Church leaders of Timor Leste,have expressed <strong>the</strong>ir support for implementation of [a]family plann<strong>in</strong>g programme” (MOH, 2004a: 4). Thepolicy document makes explicit reference to <strong>the</strong> ICPDProgramme of Action, not<strong>in</strong>g that <strong>the</strong> latter “shifted <strong>the</strong>population debate away from a demographic framework,with its focus on population control, to a reproductivehealth framework, with a focus on meet<strong>in</strong>g <strong>the</strong> needs of<strong>in</strong>dividuals <strong>and</strong> couples” (MOH, 2004a: 6). The “guid<strong>in</strong>gpr<strong>in</strong>ciple” of <strong>the</strong> policy is “‘plann<strong>in</strong>g a family’ with<strong>in</strong> <strong>the</strong>context of responsible parenthood” (MOH, 2004a: 7) 3 .Among its clauses <strong>the</strong> policy states: “In order to ensurethat all couples <strong>and</strong> <strong>in</strong>dividuals <strong>in</strong> Timor-Leste have <strong>the</strong>means <strong>and</strong> <strong>in</strong>formation needed to make <strong>in</strong>formed <strong>and</strong> freechoices about <strong>the</strong> number <strong>and</strong> spac<strong>in</strong>g of <strong>the</strong>ir children,<strong>the</strong> Government undertakes to make accessible at all levelsof <strong>the</strong> public health system, with technical <strong>and</strong> f<strong>in</strong>ancialassistance from <strong>the</strong> <strong>in</strong>ternational community if necessary,family plann<strong>in</strong>g, <strong>in</strong>clud<strong>in</strong>g natural family plann<strong>in</strong>g,<strong>in</strong>formation, counsel<strong>in</strong>g <strong>and</strong> services” (MOH, 2004a:9-10). The policy covers service delivery (both healthcentre-basedservices <strong>and</strong> outreach activities), humanresources <strong>and</strong> <strong>in</strong>formation, education <strong>and</strong> communication(IEC).The M<strong>in</strong>istry of Health has overall responsibility forimplement<strong>in</strong>g <strong>the</strong> national family plann<strong>in</strong>g policy. Thisresponsibility rests with <strong>the</strong> Department of Maternal <strong>and</strong>Child Health, ensur<strong>in</strong>g that FP is <strong>in</strong>tegrated with o<strong>the</strong>rreproductive health services (as advocated by ICPD).Implementation is also guided by <strong>the</strong> M<strong>in</strong>istry’s NationalReproductive Health Strategy 2004-2015 (MOH, 2004b).The strategy has four ma<strong>in</strong> components:Young people’s sexual <strong>and</strong> reproductive healthReproductive choice (family plann<strong>in</strong>g)Safe mo<strong>the</strong>rhoodGeneral reproductive health.FP <strong>and</strong> RH programmes are implemented <strong>in</strong> partnershipwith o<strong>the</strong>r stakeholders, <strong>in</strong>clud<strong>in</strong>g communities <strong>and</strong>o<strong>the</strong>r relevant government departments, <strong>and</strong> threenational work<strong>in</strong>g groups have been established (one eachon FP, RH, <strong>and</strong> adolescent reproductive health) withbroad stakeholder representation to provide a forum fordiscussion <strong>and</strong> debate <strong>and</strong> facilitate wide ownership of<strong>the</strong> programme. Timor-Leste’s system of governance isadm<strong>in</strong>istratively decentralized so much of <strong>the</strong> responsibilityfor implementation of programme activities lies with <strong>the</strong>districts <strong>and</strong> <strong>the</strong>ir local communities. Accord<strong>in</strong>g to <strong>the</strong>strategy document:As with education, community actionfor health is critical <strong>in</strong> all <strong>the</strong> priorityareas of <strong>in</strong>terventions outl<strong>in</strong>ed below.The community has a particularly strongrole to play <strong>in</strong> streng<strong>the</strong>n<strong>in</strong>g l<strong>in</strong>kagewith health services, <strong>in</strong> <strong>in</strong>creas<strong>in</strong>gawareness of reproductive health needs<strong>and</strong> <strong>in</strong> improv<strong>in</strong>g <strong>the</strong> quality of care. In<strong>the</strong>se areas, <strong>in</strong>creased knowledge of <strong>the</strong>community results <strong>in</strong> <strong>in</strong>creased actionfor health <strong>and</strong> <strong>in</strong>creased participation <strong>in</strong>problem-solv<strong>in</strong>g to meet maternal <strong>and</strong>newborn health needs.As decentralization streng<strong>the</strong>ns, efforts<strong>and</strong> plann<strong>in</strong>g will <strong>in</strong>clude streng<strong>the</strong>n<strong>in</strong>gof district <strong>and</strong> community forums sothat community representatives canactively assume ownership of reproductivestrategies <strong>and</strong> pass this ownership on [to]<strong>the</strong> community <strong>in</strong> general. For community<strong>in</strong>terventions, skills for communitymobilization, community dialogue,communication, research, educationalapproaches <strong>and</strong> for <strong>in</strong>teract<strong>in</strong>g with <strong>the</strong>community, need to be assessed.Community efforts should work closelywith advocacy efforts of reproductivehealth programs. Several community<strong>in</strong>terventions are advocacy-oriented,<strong>in</strong>creas<strong>in</strong>g <strong>the</strong> “dem<strong>and</strong>” fromcommunities, rais<strong>in</strong>g communityawareness about reproductive health issues<strong>and</strong> participation <strong>in</strong> <strong>the</strong> decisions taken at<strong>the</strong> district level for f<strong>in</strong>d<strong>in</strong>g solutions <strong>and</strong>allocat<strong>in</strong>g resources.The various levels of <strong>the</strong> district healthservices (DHS) are directly responsible for338
plann<strong>in</strong>g, implement<strong>in</strong>g, <strong>and</strong> manag<strong>in</strong>gRH program activities. The structureof <strong>the</strong> MOH DHS extends from <strong>the</strong>first po<strong>in</strong>t of contact, <strong>the</strong> Health Post,to more advanced services <strong>in</strong> <strong>the</strong> HealthCentre with small mobile cl<strong>in</strong>ics provid<strong>in</strong>gservices to significant population groups <strong>in</strong><strong>the</strong> absence of fixed facilities. …With<strong>in</strong> <strong>the</strong> District Health ManagementTeam (DHMT) <strong>the</strong>re will be appo<strong>in</strong>teda focal po<strong>in</strong>t for RH who shouldcoord<strong>in</strong>ate <strong>and</strong> <strong>in</strong>tegrate <strong>the</strong> componentsof Reproductive Health. These districtofficers will work with o<strong>the</strong>r DHMTofficers to establish mechanisms for RHSactivities with<strong>in</strong> <strong>the</strong> district framework.It is <strong>the</strong> RH focal po<strong>in</strong>t responsibility, asa component of <strong>the</strong> DHMT, to ensuretechnical guidance, support (flow ofsupplies, tra<strong>in</strong><strong>in</strong>g needs <strong>and</strong> delivery,access to guidel<strong>in</strong>es <strong>and</strong> protocols) <strong>and</strong>monitor<strong>in</strong>g of RH are <strong>in</strong>corporated <strong>in</strong>to<strong>the</strong> DHP plann<strong>in</strong>g, processes, monitor<strong>in</strong>g<strong>and</strong> evaluation. …A referral system feeds from <strong>the</strong> front l<strong>in</strong>ehealth services through to referral hospitalsfor ei<strong>the</strong>r anticipated cases of complicateddeliveries or for emergency obstetricservices <strong>and</strong> certa<strong>in</strong> types of familyplann<strong>in</strong>g methods, <strong>and</strong> eventually to <strong>the</strong>National Hospital <strong>in</strong> Dili for highest levelof service when required (MOH, 2004b:33-34).In 2007 <strong>the</strong> National Reproductive Health BehaviourChange Communication Strategy 2008-2012 wasdeveloped, which identified behavioural objectives foreach of <strong>the</strong> four components of <strong>the</strong> National ReproductiveHealth Strategy. The objective (“key behaviour”) for FPis for women <strong>and</strong> men of reproductive age to space <strong>the</strong>irchildren by at least three years.The key policy documents for FP <strong>and</strong> RH are remarkablefor <strong>the</strong>ir clarity of purpose <strong>and</strong> objectives, <strong>and</strong> for <strong>the</strong>succ<strong>in</strong>ct yet comprehensive way <strong>the</strong>y outl<strong>in</strong>e wellthought-outstrategies for atta<strong>in</strong><strong>in</strong>g <strong>the</strong>se objectives.Many lessons learned from <strong>in</strong>ternational experience havebeen <strong>in</strong>corporated. Also apparent is <strong>the</strong> conviction withwhich ICPD pr<strong>in</strong>ciples have been embraced <strong>and</strong> are be<strong>in</strong>gacted upon. Unlike many countries <strong>in</strong> <strong>the</strong> region witholder FP programmes which were established pre-ICPD,Timor-Leste has been spared <strong>the</strong> difficulty of convert<strong>in</strong>ga population control programme <strong>in</strong>to a programmepromot<strong>in</strong>g reproductive rights. Timor-Leste’s programmehas been firmly grounded <strong>in</strong> a human rights perspectivefrom its <strong>in</strong>ception.As <strong>the</strong> passage from <strong>the</strong> Strategy document quoted aboveillustrates, those plann<strong>in</strong>g FP/RH programmes are alsoeager that community “ownership” of services should beencouraged.Changes <strong>in</strong> fertility behaviour<strong>and</strong> fertility outcomesThe first Demographic <strong>and</strong> Health Survey <strong>in</strong> <strong>in</strong>dependentTimor-Leste was conducted <strong>in</strong> 2003. Ano<strong>the</strong>r wasconducted <strong>in</strong> 2009/10, but at <strong>the</strong> time of writ<strong>in</strong>g <strong>the</strong>present report only limited prelim<strong>in</strong>ary results are available(MEASURE DHS, 2010). Table 1 summarizes relevantchanges between <strong>the</strong> two surveys. We have also <strong>in</strong>cludedsimilar statistics from previous DHS when East Timorwas considered part of Indonesia, although it should beremembered that at that time many of those counted aspractis<strong>in</strong>g FP <strong>in</strong> <strong>the</strong> territory were actually Indonesiansliv<strong>in</strong>g <strong>and</strong> work<strong>in</strong>g <strong>in</strong> East Timor, many of <strong>the</strong>m civilservants.The very low knowledge level about contraception recorded<strong>in</strong> 2003 is ano<strong>the</strong>r sign of how atypical Timor-Leste is of<strong>the</strong> region. It will be <strong>in</strong>terest<strong>in</strong>g to see how this statistic mayhave changed <strong>in</strong> <strong>the</strong> 2009/10 survey. The 2009 Basel<strong>in</strong>eStudy for RH Behaviour Change Communication foundthat just over 50 per cent of married women 15-49 hadheard of birth spac<strong>in</strong>g but only 11 per cent of <strong>the</strong> samplecould identify three or more methods of contraception(Mosquera et al., 2009a).The DHS data suggest that <strong>the</strong> contraceptive prevalencerate (CPR) (all methods) has <strong>in</strong>creased by at least 12percentage po<strong>in</strong>ts <strong>in</strong> 6 years, that is, an average of 2 po<strong>in</strong>tsper year. 4 This is a respectable rate of <strong>in</strong>crease <strong>in</strong> CPR,339
Page 1:
Family Pla
Page 7 and 8:
ForewordThe Asia <
Page 11:
Part 1Part 1Asia <
Page 14 and 15:
Ensuring that <str
Page 16 and 17:
of methods for all, in</str
Page 18 and 19:
and undertake <str
Page 21 and 22:
Report on the Regi
Page 23 and 24:
SESSION 1: Changin
Page 25 and 26:
that improving <st
Page 31:
at a hospital would be offered post
Page 35:
Bounkoung Phichit, Deputy M
Page 38 and 39:
medicines
Page 40 and 41:
Thus, while knowledge of modern met
Page 42 and 43:
Hon. Mr. Malakai Tabar, Chairman, P
Page 44 and 45:
curricula. If the
Page 47:
dialogue as well as regional <stron
Page 51:
BackgroundGlobal development effort
Page 54 and 55:
TableTable1EventNational policyYear
Page 56 and 57:
A third observation is that reporte
Page 58 and 59:
TableTable2Current Contraceptive Pr
Page 60 and 61:
Figure(-1.2), Cook Island</
Page 62:
FigureTableTable3Trends in<
Page 65 and 66:
Nam. Nearly all economies i
Page 67:
2008 2009% Bilateral % Multilateral
Page 70 and 71:
family planning wi
Page 73 and 74:
IntroductionFamily
Page 75 and 76:
The advent of the
Page 77 and 78:
FigureFigure1Oceania and</s
Page 79 and 80:
next 25 years, however, TFR fluctua
Page 81 and 82:
FigureFigureFigure2Total fertility
Page 83 and 84:
family planning pr
Page 85 and 86:
esponsible for the
Page 87 and 88:
that estimates of CPR for earlier p
Page 90 and 91:
Figuremarried at an older age compa
Page 92 and 93:
As previously mentioned most <stron
Page 94 and 95:
FigureFigure945Relationship between
Page 96 and 97:
The concept of “unmet need” has
Page 98 and 99:
TableTable8Percentage of th
Page 100 and 101:
TableTable9Percentage of reasons fo
Page 102 and 103:
family planning pr
Page 104 and 105:
As far as the supp
Page 106 and 107:
Socio-cultural challenges tofamily
Page 108 and 109:
likely to use contraception than yo
Page 110 and 111:
15 Tests of statistical significanc
Page 112 and 113:
of the South <stro
Page 114 and 115:
104
Page 116:
Figurewill exceed the</stro
Page 119 and 120:
in urban (67%) tha
Page 121 and 122:
ased service delivery poin<
Page 123 and 124:
Most FWAs who were recruited two to
Page 125 and 126:
are considered, unmet need for effe
Page 127 and 128:
Households pay the
Page 129 and 130:
Effective public-private partnershi
Page 131 and 132:
ConclusionThe Bangladesh Fa
Page 133 and 134:
the Family
Page 135 and 136:
National Institute for Population R
Page 137 and 138:
IndiaIndiaFamily <
Page 139:
IntroductionThe use of contraceptiv
Page 142 and 143:
TableTable2Indicators of tra<strong
Page 144 and 145:
FigureFigureFigure1Contraceptive pr
Page 146 and 147:
TableTable5Indicators of contracept
Page 148 and 149:
TableTable6Adjusted odds ratios for
Page 150 and 151:
FigureFigure3Contraceptive prevalen
Page 152 and 153:
TableTable7Adjusted and</st
Page 154 and 155:
the north
Page 156 and 157:
TableTable10Differences between nor
Page 158 and 159:
TableTable11 Total fertility rate <
Page 160 and 161:
End Note1The first camp was success
Page 162 and 163:
152
Page 164 and 165:
154
Page 166 and 167:
Figure1980s and ex
Page 168 and 169:
health care and ed
Page 170 and 171:
assistance from UNFPA and</
Page 172 and 173:
in CPR. Likewise,
Page 174 and 175:
International supp
Page 176 and 177:
in development has
Page 178 and 179:
__________ (2007). Population <stro
Page 180 and 181:
170
Page 182 and 183:
TableTable2What has the</st
Page 184 and 185:
174
Page 186 and 187:
per cent of women reported us<stron
Page 188 and 189:
is provider bias that such methods
Page 190 and 191:
TableTable7skewed distribution of h
Page 192 and 193:
TableTable8TableTable9182
Page 194 and 195:
that of the nation
Page 196 and 197:
TableTable12 7some policies that ex
Page 198 and 199:
The system guides the</stro
Page 200 and 201:
FigureFigure4Total donor expenditur
Page 202 and 203:
FigureFigureagain
Page 204 and 205:
Impact of family plannin</s
Page 206 and 207:
marketing of contr
Page 208 and 209:
United States Agency for In
Page 210 and 211:
200
Page 212 and 213:
acceptable. From an NGO perspective
Page 214 and 215:
FigureThis trend of limited donor f
Page 216 and 217:
Figureto have the
Page 218 and 219:
FigureFigure5Percentage change <str
Page 220 and 221:
FigureFigure6Desire to limit childb
Page 222 and 223:
coordination betwe
Page 224 and 225:
the 1980s
Page 226 and 227:
Policy Management.__________ (n.d.,
Page 228 and 229:
218
Page 230 and 231:
Population Activities (UNFPA) for a
Page 232 and 233:
where family plannin</stron
Page 234 and 235:
Thus an objective assessment of <st
Page 236 and 237:
226
Page 238 and 239:
Figureeconomic growth durin
Page 240 and 241:
TableTable1TableTable2For spac<stro
Page 242 and 243:
eflect a provider bias (e.g., <stro
Page 244 and 245:
The Indonesian delegation was very
Page 246 and 247:
than in ensur<stro
Page 248 and 249:
in-country <strong
Page 250 and 251:
(Ministry of Healt
Page 252 and 253:
242
Page 254 and 255:
244
Page 256 and 257:
FigureTrends and p
Page 258 and 259:
TableTable3Unmet need for contracep
Page 260 and 261:
TableTable5TableTable6TableTable725
Page 262 and 263:
TableTable8TableTable9Malaysia, abo
Page 264 and 265:
previously mentioned is based on fo
Page 266 and 267:
TableTable16births and</str
Page 268 and 269:
FigureFigure3TRF54.5Scatter plots o
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
Page 280 and 281:
Scope of coverage and</stro
Page 282 and 283:
FigureIn Myanmar, out of six select
Page 284 and 285:
equirements. The Min</stron
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
Page 298 and 299: monitoring <strong
Page 300 and 301: Nay Pyi Taw, 26 October 2010.53 Sit
Page 302 and 303: 292
Page 304 and 305: 294
Page 306 and 307: TableTableA296
Page 308 and 309: dispense and adm<s
Page 310 and 311: (1) I am against a
Page 312 and 313: FigureFigureFigure3Use of modern co
Page 314 and 315: FigureFigure7Traditional method use
Page 316 and 317: Figureprojection, and</stro
Page 318 and 319: Figure 11 summarizes the</s
Page 320 and 321: correlating <stron
Page 322 and 323: Figurethe use of c
Page 324 and 325: FigureFigure15Sexual behaviour <str
Page 326 and 327: track the distribu
Page 328 and 329: Figureservices, which should <stron
Page 330 and 331: FigureFigureFigure18 Population <st
Page 332 and 333: National Statistics Office, <strong
Page 334 and 335: TableTable6TableTable7TableTable832
Page 336 and 337: TableTable11326
Page 338 and 339: TableTable14TableTable15TableTable1
Page 340 and 341: TableTable19Laws and</stron
Page 342 and 343: worker and hours w
Page 344 and 345: 334
Page 346 and 347: 336
Page 350 and 351: TableTable1Contraceptive prevalence
Page 352 and 353: These results suggest that about 70
Page 354 and 355: 2 The (period) TFR is the</
Page 356 and 357: 346
Page 358 and 359: FigureThe existence of traditional
Page 360 and 361: Guinea case by <st
Page 362 and 363: The establishment of provin
Page 364 and 365: provide family plannin</str
Page 366 and 367: Figurelegal requirement nor a condi
Page 368 and 369: FigureTableTable5TableTable6Figure4
Page 370 and 371: modern method and
Page 372 and 373: married or in unio
Page 374 and 375: Figureolder. Both the</stro
Page 376 and 377: TableTable15The immediate past Nati
Page 378 and 379: out that the “ne
Page 380 and 381: Commodity securitySupply cha<strong
Page 382 and 383: is able to achieve. In Papua New Gu
Page 384 and 385: Qualitative assessments by a number
Page 386 and 387: increasin<
Page 388 and 389: service delivery poin</stro
Page 390 and 391: Population: Views from Men
Page 392 and 393: 1545-1730Day 2: December 9Session 2
Page 394 and 395: Day 3, December 10Session 50830-100
Page 396 and 397: 15Mr. Tong Sithen1
Page 398 and 399:
54Ms. Shadiya IbrahimAssistant Repr
Page 400 and 401:
93Mr. Melkie AntonProject OfficerUn
Page 402 and 403:
131Dr. John P. SkibiakDirectorRepro
Page 404:
International <str
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?