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These results suggest that about 70 per cent of marriedwomen have a need for FP, yet CPR for <strong>the</strong>se women isonly 22.4 per cent. If <strong>the</strong>se f<strong>in</strong>d<strong>in</strong>gs are robust, <strong>the</strong>n <strong>the</strong>rehas clearly been massive growth <strong>in</strong> unmet need for FP s<strong>in</strong>ce2003 (both for spac<strong>in</strong>g <strong>and</strong> limit<strong>in</strong>g). The most strik<strong>in</strong>gfeature of <strong>the</strong> 2003 f<strong>in</strong>d<strong>in</strong>gs was how little dem<strong>and</strong> forFP <strong>the</strong>re appeared to have been; <strong>the</strong> most amaz<strong>in</strong>g th<strong>in</strong>gsabout <strong>the</strong> 2009/10 f<strong>in</strong>d<strong>in</strong>gs are how huge <strong>the</strong> dem<strong>and</strong> istoday <strong>and</strong> how rapidly that dem<strong>and</strong> has grown.There may be a “dem<strong>and</strong> for FP” <strong>in</strong> <strong>the</strong> way DHS def<strong>in</strong>es“dem<strong>and</strong>”, but that does not mean that <strong>the</strong>se women willnecessarily want to be part of <strong>the</strong> national FP programme.There is an enormous opportunity here, but at <strong>the</strong> sametime an equally enormous challenge as well. The availabledata on why women who say <strong>the</strong>y do not want ano<strong>the</strong>rchild now, yet who are not practis<strong>in</strong>g FP, are fragmentarybut <strong>the</strong> qualitative data <strong>in</strong>dicate that all <strong>the</strong> usual factorsplay a role: lack of knowledge or underst<strong>and</strong><strong>in</strong>g about FP;husb<strong>and</strong> does not agree to use of modern contraception;fear of side effects; distance to nearest health centre <strong>and</strong><strong>the</strong> cost of travel; o<strong>the</strong>r real or perceived cost factors,<strong>in</strong>clud<strong>in</strong>g opportunity costs; hav<strong>in</strong>g a previous unfortunateexperience at a health centre; preferred method notavailable etc. (Mosquera et al., 2009a; Zwi et al., 2009).The new RH BCC programme is designed to address suchconcerns, but it has not been fully rolled out yet. Part of<strong>the</strong> challenge – to which programmes <strong>in</strong> o<strong>the</strong>r countrieshave sometimes not risen – is to treat women <strong>and</strong> <strong>the</strong>irpartners with equal respect whe<strong>the</strong>r <strong>the</strong>y choose to jo<strong>in</strong><strong>the</strong> programme or not.Important partners <strong>in</strong> <strong>the</strong> programme’s advocacy <strong>and</strong> BCCcomponents are Timor-Leste Asistensia Integradu Saude(TAIS), which is funded by <strong>the</strong> United States Agencyfor <strong>International</strong> Development (USAID) <strong>and</strong> <strong>the</strong> HealthAlliance <strong>International</strong> (HAI), funded by <strong>the</strong> AustralianAgency for <strong>International</strong> Development (AusAID) <strong>and</strong>USAID.Dur<strong>in</strong>g <strong>the</strong> past few years much effort has necessarilyfocused on develop<strong>in</strong>g <strong>the</strong> supply side of <strong>the</strong> FP programme.Exp<strong>and</strong><strong>in</strong>g <strong>the</strong> supply of services <strong>in</strong> a way which ensuresquality yet is cost-efficient, <strong>and</strong> which is nei<strong>the</strong>r too farahead nor too far beh<strong>in</strong>d <strong>the</strong> curve of grow<strong>in</strong>g dem<strong>and</strong> forservices, rema<strong>in</strong>s a constant challenge. Tra<strong>in</strong><strong>in</strong>g midwives,doctors <strong>and</strong> programme staff is an ongo<strong>in</strong>g task. Qualityassurance is ano<strong>the</strong>r constant challenge.A cadre of largely volunteer fieldworkers who will provideFP/RH education <strong>and</strong> counsell<strong>in</strong>g at <strong>the</strong> village level isenvisioned for <strong>the</strong> com<strong>in</strong>g years.Manag<strong>in</strong>g contraceptive supplies to ensure “contraceptivesecurity” is yet ano<strong>the</strong>r constant challenge. There havebeen some “stock-outs” (events that occur when <strong>in</strong>ventoryhas been exhausted) <strong>and</strong> maldistribution of commodities<strong>in</strong> <strong>the</strong> past (Belton, 2010). Lessons have been learned <strong>and</strong>applied. RH commodities are listed on <strong>the</strong> M<strong>in</strong>istry ofHealth’s Essential Drug List; Belton (2010) recommendedthat <strong>the</strong>y be upgraded to “vital” commodities s<strong>in</strong>ce“maternal <strong>and</strong> <strong>in</strong>fant mortality are high <strong>and</strong> access toemergency obstetric care very limited”. It is certa<strong>in</strong>ly crucialthat l<strong>in</strong>ger<strong>in</strong>g problems with supply systems be addressedpromptly <strong>in</strong> <strong>the</strong> light of recent <strong>in</strong>dications that dem<strong>and</strong> forservices may be at <strong>the</strong> po<strong>in</strong>t of ris<strong>in</strong>g rapidly.Currently UNFPA pays for all FP commodities, witha major f<strong>in</strong>ancial contribution from AusAID, but <strong>the</strong>government has <strong>in</strong>dicated it is prepar<strong>in</strong>g to share <strong>the</strong> bill,start<strong>in</strong>g perhaps <strong>in</strong> 2011.An important partner <strong>in</strong> service provision is Marie Stopes<strong>International</strong>, 8 funded partly by AusAID. Caritas providescounsell<strong>in</strong>g, has nuns tra<strong>in</strong>ed <strong>in</strong> FP (all methods) <strong>and</strong> willopen <strong>the</strong> new Centre for <strong>Family</strong> <strong>in</strong> Dili next year. 9Underst<strong>and</strong><strong>in</strong>g <strong>the</strong> currentsituationIf <strong>the</strong> f<strong>in</strong>al report of <strong>the</strong> 2009/10 DHS confirms that <strong>the</strong>rehas been massive growth <strong>in</strong> unmet dem<strong>and</strong> for FP, <strong>the</strong>n thisfactor has major implications for FP/RH programm<strong>in</strong>g.Where women say <strong>the</strong>y do not want ano<strong>the</strong>r child <strong>in</strong><strong>the</strong> next 2-3 years but are not practis<strong>in</strong>g FP, we need tounderst<strong>and</strong> <strong>the</strong> situation clearly. Tractable obstacles toaccess<strong>in</strong>g FP services need to be removed. The M<strong>in</strong>istry ofHealth recognizes <strong>the</strong> challenge of gett<strong>in</strong>g <strong>the</strong> services “out<strong>the</strong>re” as close as possible to <strong>the</strong> people who need <strong>the</strong>m.There are some subtle dimensions to this challenge too.A strong po<strong>in</strong>t <strong>in</strong> <strong>the</strong> M<strong>in</strong>istry’s tentative plan to have avolunteer fieldworker <strong>in</strong> every village; such volunteerswill be “counsellors” not “recruiters”. If <strong>the</strong> outreach <strong>and</strong>communication programmes are too forceful, <strong>the</strong>y mightraise memories of <strong>the</strong> “strong persuasion” tactics of <strong>the</strong>Indonesian programme.The Catholic Church <strong>in</strong> East Timor had been a staunchdefender of human rights dur<strong>in</strong>g <strong>the</strong> country’s recenthistory. The Church is currently mak<strong>in</strong>g a valuablecontribution to <strong>the</strong> national FP/RH programme by<strong>in</strong>sist<strong>in</strong>g that <strong>the</strong> programme should be structured <strong>in</strong>such a way that people are encouraged to th<strong>in</strong>k deeply<strong>and</strong> responsibly about what it means to plan <strong>the</strong>ir families<strong>and</strong> not accept “modern practices” uncritically. O<strong>the</strong>rs maysee this <strong>in</strong>sistence as a h<strong>in</strong>drance <strong>and</strong> may believe that<strong>in</strong>stitutionaliz<strong>in</strong>g “<strong>in</strong>formed consent” is sufficient. Therehas been a healthy dialogue between programme officials<strong>and</strong> <strong>the</strong> Church, <strong>and</strong> among o<strong>the</strong>r stakeholders. This342
dialogue needs to cont<strong>in</strong>ue to prevent misunderst<strong>and</strong><strong>in</strong>gsfrom tak<strong>in</strong>g root <strong>and</strong> potentially underm<strong>in</strong><strong>in</strong>g <strong>the</strong> widesupport that <strong>the</strong> programme currently enjoys.RecommendationsThe FP/RH programme <strong>in</strong> Timor-Leste is still young. Thema<strong>in</strong> concerns are not so much whe<strong>the</strong>r <strong>the</strong> programmeneeds to be “repositioned” or “revitalized” but how it canavoid common problems <strong>and</strong> pitfalls as <strong>the</strong> programmegrows <strong>and</strong> matures. (The follow<strong>in</strong>g recommendationswere presented as discussion po<strong>in</strong>ts for <strong>the</strong> UNFPA <strong>and</strong>ICOMP Regional Consultation on <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> <strong>in</strong><strong>Asia</strong> <strong>and</strong> <strong>the</strong> <strong>Pacific</strong>: Address<strong>in</strong>g <strong>the</strong> Challenges, whichwas held <strong>in</strong> Bangkok, from 8 to 10 December 2010.)Recommendation 1Streng<strong>the</strong>n <strong>the</strong> dialogue among allstakeholders, especially with <strong>the</strong>Catholic Church.Such a dialogue already exists through <strong>the</strong> Work<strong>in</strong>g Groupfor FP/RH <strong>and</strong> o<strong>the</strong>r mechanisms, but <strong>the</strong> work<strong>in</strong>g groupdoes not meet regularly, <strong>and</strong> while <strong>the</strong> collaboration among<strong>the</strong> programme’s partners is truly commendable, agreementsreached <strong>in</strong> <strong>the</strong> past should not be taken for granted butra<strong>the</strong>r built on <strong>and</strong> exp<strong>and</strong>ed. There is some discussion <strong>in</strong>Dili currently regard<strong>in</strong>g “how fast <strong>the</strong> programme shouldmove forward”, for example. For some, this is essentiallya technical question about deliver<strong>in</strong>g health services; foro<strong>the</strong>rs it is <strong>in</strong>separable from o<strong>the</strong>r questions regard<strong>in</strong>gchang<strong>in</strong>g values <strong>and</strong> spiritual development. There iscommon ground but it seems to depend significantly ontacit underst<strong>and</strong><strong>in</strong>gs at present. This leaves <strong>the</strong> programmevulnerable to unforeseen “shocks” <strong>in</strong> <strong>the</strong> future.Recommendation 2Streng<strong>the</strong>n <strong>the</strong> focus on encourag<strong>in</strong>gbirth spac<strong>in</strong>g <strong>and</strong> meet<strong>in</strong>g unmetdem<strong>and</strong> through evidence-based<strong>in</strong>itiatives.The dem<strong>and</strong> for FP services is likely to grow considerablydur<strong>in</strong>g <strong>the</strong> next 5 years if approximately 50 per cent of allmarried women do not want a child <strong>in</strong> <strong>the</strong> next 2-3 years yetare not us<strong>in</strong>g any method of contraception. There is a needfor more data (quantitative <strong>and</strong> qualitative) on who <strong>the</strong>sewomen are, what <strong>the</strong>ir values <strong>and</strong> aspirations (especiallyregard<strong>in</strong>g family life) are, <strong>and</strong> what factors determ<strong>in</strong>e <strong>the</strong>irfertility behaviour. The programme needs to be focused, butit is important for policymakers to remember that people’sfertility behaviour responds to many social, cultural <strong>and</strong>economic factors (which <strong>the</strong>mselves are likely to changerapidly <strong>in</strong> com<strong>in</strong>g years), not just to a national FP/RHprogramme. Fur<strong>the</strong>r, it is crucial that <strong>the</strong>se women shouldplay an important role <strong>in</strong> <strong>the</strong> design <strong>and</strong> monitor<strong>in</strong>g of <strong>the</strong>services <strong>the</strong>y are offered. Policymakers <strong>and</strong> programmemanagers can learn from <strong>in</strong>ternational best practices <strong>and</strong>can contribute to <strong>the</strong> latter too.ConclusionThe aim of family-plann<strong>in</strong>g programmesmust be to enable couples <strong>and</strong> <strong>in</strong>dividualsto decide freely <strong>and</strong> responsibly <strong>the</strong>number <strong>and</strong> spac<strong>in</strong>g of <strong>the</strong>ir children<strong>and</strong> to have <strong>the</strong> <strong>in</strong>formation <strong>and</strong> meansto do so <strong>and</strong> to ensure <strong>in</strong>formed choices<strong>and</strong> make available a full range of safe<strong>and</strong> effective methods. … The pr<strong>in</strong>cipleof <strong>in</strong>formed choice is essential to <strong>the</strong>long-term success of family-plann<strong>in</strong>gprogrammes. … Government goals forfamily plann<strong>in</strong>g should be def<strong>in</strong>ed <strong>in</strong>terms of unmet needs for <strong>in</strong>formation <strong>and</strong>services (United Nations, 1994: para7.12).Timor-Leste’s national FP/RH programme is relatively new<strong>and</strong> it is off to a good start. It enjoys strong political supportfrom <strong>the</strong> government, parliament <strong>and</strong> key stakeholders,<strong>in</strong>clud<strong>in</strong>g <strong>the</strong> Catholic Church. The programme is unique<strong>in</strong> <strong>the</strong> region <strong>in</strong> <strong>the</strong> way it was established after ICPD<strong>and</strong> fully embraces <strong>the</strong> pr<strong>in</strong>ciples advocated <strong>in</strong> <strong>the</strong> 1994Programme of Action. It needs no “reposition<strong>in</strong>g”, <strong>and</strong>it is too young to talk of its “revitalization”. The ma<strong>in</strong>challenges are exp<strong>and</strong><strong>in</strong>g <strong>the</strong> programme to meet grow<strong>in</strong>gdem<strong>and</strong> <strong>and</strong> at <strong>the</strong> same time ma<strong>in</strong>ta<strong>in</strong><strong>in</strong>g <strong>the</strong> broad publicsupport <strong>the</strong> programme currently enjoys. The secret is tostay committed to <strong>the</strong> ICPD pr<strong>in</strong>ciples <strong>and</strong> deepen <strong>the</strong>emphasis on client-orientation even as activities are scaledup.End Note1 One needs to be careful <strong>in</strong> us<strong>in</strong>g published statistics on Timor-Leste s<strong>in</strong>ce many are calculated from <strong>in</strong>complete or unreliable datasets, <strong>and</strong> some demographic rates can be calculated only by us<strong>in</strong>g“<strong>in</strong>direct estimation techniques” based on assumptions which mightnot be accurate for Timor-Leste.343
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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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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
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Demographic data sheet: population
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population size, with just 336,000
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NuptialityIn Myanmar nuptiality is
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FigureIn Myanmar, birth-spac<strong
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Scope of coverage and</stro
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FigureIn Myanmar, out of six select
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equirements. The Min</stron
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according to <stro
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Adolescent sexual and</stro
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FigureHIV/AIDS. An HIV-positive wom
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National Population PolicyMyanmar i
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Linkages with o<st
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TableTable4Achievements of Myanmar
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monitoring <strong
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Nay Pyi Taw, 26 October 2010.53 Sit
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Page 348 and 349: includin</
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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
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131Dr. John P. SkibiakDirectorRepro
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International <str
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