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FigureThe existence of traditional magical orherbal methods of family limitation is notnecessarily favourable to <strong>the</strong> acceptance ofmodern family plann<strong>in</strong>g if shame, secrecyor disapproval surround <strong>the</strong>ir use.Until today, however, <strong>the</strong> use of modern forms ofcontraception <strong>in</strong> Papua New Gu<strong>in</strong>ea, such as condoms,oral contraceptives, <strong>in</strong>jections <strong>and</strong> tubal ligation, coexistswidely with traditional forms, such as sexual abst<strong>in</strong>ence,withdrawal, <strong>the</strong> use of herbal medic<strong>in</strong>es, anal sex <strong>and</strong> o<strong>the</strong>rsex acts. Induced abortion by traditional means is ano<strong>the</strong>roption practised today to avoid an unwanted birth. Thechoice of contraceptive method may be determ<strong>in</strong>edby circumstances, such as lack of access to moderncontraceptives <strong>in</strong> remote rural areas or a preference fortraditional ways of manag<strong>in</strong>g family life. Similarly, amongthose who have little underst<strong>and</strong><strong>in</strong>g of how variouscontraceptives work, fears of adverse health consequencesapply to both modern <strong>and</strong> traditional forms. Cost mayalso be a consideration, but it is not necessarily <strong>the</strong> casethat modern methods are expensive while traditionalmethods are not. Traditional methods may be more costlythan modern ones because only older men or women (orpersons skilled <strong>in</strong> sorcery) have <strong>the</strong> knowledge of how toprepare traditional medic<strong>in</strong>es <strong>and</strong> <strong>the</strong>y expect to be paidei<strong>the</strong>r <strong>in</strong> cash or k<strong>in</strong>d. Traditional methods are normallyaccompanied by rituals that give an impression of witchcraft<strong>and</strong> may be shunned by those who adhere to Christianbeliefs. Health policies prohibit <strong>the</strong> use of “witchcraft” or“sorcery” <strong>in</strong> <strong>the</strong> provision of public health.While modern contraception may <strong>in</strong> pr<strong>in</strong>ciple be free ofcost at <strong>the</strong> distribution po<strong>in</strong>t, reach<strong>in</strong>g a service deliverypo<strong>in</strong>t (most often a health centre ra<strong>the</strong>r than a village-basedaid post) 2 <strong>in</strong>volves not only <strong>the</strong> cost of transport but also<strong>the</strong> opportunity costs aris<strong>in</strong>g from <strong>the</strong> neglect of gardensor <strong>the</strong> care of children. In <strong>the</strong> more remote areas, a healthcentre or district hospital may only be accessible on foot<strong>and</strong> after a walk of several days <strong>in</strong> some cases. Where <strong>the</strong>reis a high probability that <strong>the</strong> health centre will not have asupply of contraceptives, such arduous journeys may notbe undertaken, <strong>and</strong> reversion to traditional methods mayoccur. It is also well understood that <strong>the</strong> health centre maycharge fees for <strong>the</strong> consultation, even if <strong>the</strong> contraceptivesare free.The complexity of current practices that show evidenceof <strong>in</strong>term<strong>in</strong>gl<strong>in</strong>g of traditional <strong>and</strong> modern forms ofcontraception needs to be taken <strong>in</strong>to account whenconsider<strong>in</strong>g <strong>the</strong> relationship between <strong>the</strong> contraceptiveprevalence rate (CPR) <strong>and</strong> fertility levels <strong>and</strong> trends. Tosome extent this is <strong>the</strong> case <strong>in</strong> all <strong>Pacific</strong> societies, butnowhere more so than <strong>in</strong> Papua New Gu<strong>in</strong>ea.The slow fertility transition <strong>in</strong> PapuaNew Gu<strong>in</strong>eaThere is no evidence to suggest that average completedfertility per woman <strong>in</strong> Papua New Gu<strong>in</strong>ea at <strong>the</strong> nationallevel reached <strong>the</strong> heights of o<strong>the</strong>r <strong>Pacific</strong> isl<strong>and</strong> countries<strong>in</strong> <strong>the</strong> 1960s <strong>and</strong> 1970s, where total fertility rates (TFRs)peaked at 7 or 8 (Hayes <strong>and</strong> Robertson, 2010). Papua NewGu<strong>in</strong>ea’s TFR reached a historical peak at 6.3 <strong>in</strong> <strong>the</strong> 1960-1965 period (see Figure 1), after which it commenced aFigure1 Fertility transition <strong>in</strong> Papua New Gu<strong>in</strong>ea <strong>and</strong> less developed countries compared, 1950-2005PNGLDCs6.565.55TFR4.543.532.521950-551955-601960-651965-701970-751975-801980-851985-901990-951995-002000-05YearSource: UNDESA (2009).348
Figureslow decl<strong>in</strong>e to its most recently measured level of 4.4 <strong>in</strong><strong>the</strong> 2001-2006 period (National Statistical Office, 2006).However, <strong>the</strong> fertility transition has not proceeded ata consistent pace s<strong>in</strong>ce fertility first began to decl<strong>in</strong>e <strong>in</strong><strong>the</strong> early 1970s. Compared with <strong>the</strong> pace of <strong>the</strong> fertilitytransition <strong>in</strong> less developed countries (LDCs) as a group,<strong>the</strong> rate of fertility decl<strong>in</strong>e <strong>in</strong> Papua New Gu<strong>in</strong>ea has beenslow, as can be seen <strong>in</strong> Figure 1. Fur<strong>the</strong>rmore, Papua NewGu<strong>in</strong>ea experienced a dist<strong>in</strong>ctive slowdown <strong>in</strong> <strong>the</strong> rate of itsfertility decl<strong>in</strong>e from <strong>the</strong> period 1985-1990 to 1995-2000.For <strong>the</strong> 10 years centred on 1987-1997, <strong>the</strong> country’s TFRdropped by only 0.33, compared with a decl<strong>in</strong>e of 0.79 <strong>in</strong><strong>the</strong> LDCs as a group. As of <strong>the</strong> 2000-2005 period, PapuaNew Gu<strong>in</strong>ea’s TFR was about 1.5 children per womanabove <strong>the</strong> TFR for all LDCs – a difference of 51 per cent.As Figure 2 shows, Papua New Gu<strong>in</strong>ea’s reduced rate offertility decl<strong>in</strong>e <strong>in</strong> <strong>the</strong> late 1980s <strong>and</strong> early 1990s opened agap between <strong>the</strong> country <strong>and</strong> o<strong>the</strong>r LDCs that will probablytake a long time to close. The United Nations mediumvariant projections for Papua New Gu<strong>in</strong>ea <strong>and</strong> <strong>the</strong> LDCssuggest that Papua New Gu<strong>in</strong>ea would reach a TFR of 2.5about 20 years after <strong>the</strong> o<strong>the</strong>r LDCs <strong>and</strong> that it would takeuntil 2045 before “replacement” fertility of 2.2 children perwoman was reached. Had Papua New Gu<strong>in</strong>ea’s fertilitytransition not “stalled” prematurely, replacement fertilitymight have been reached much earlier, <strong>and</strong> <strong>the</strong> impact ofpopulation “momentum” that much less. As it is, <strong>the</strong> UnitedNations medium variant population projections suggestthat Papua New Gu<strong>in</strong>ea’s total population would reach12.9 million by 2050, while <strong>the</strong> “low” projection basedon a faster rate of fertility decl<strong>in</strong>e would produce a 2050population of 11.1 million, or 1.8 million fewer people.Research issuesThe relatively slow pace of <strong>the</strong> fertility transition <strong>in</strong> PapuaNew Gu<strong>in</strong>ea relative to LDCs as a group <strong>and</strong> relative too<strong>the</strong>r <strong>Pacific</strong> isl<strong>and</strong> countries is <strong>the</strong> primary issue <strong>in</strong> needof explanation. However, an explanation that is aimedat be<strong>in</strong>g complete, or at least comprehensive, is certa<strong>in</strong>lybeyond <strong>the</strong> scope of <strong>the</strong> present paper as it would require areview of a large number of development <strong>in</strong>dicators <strong>and</strong> aneffort to l<strong>in</strong>k <strong>the</strong>se <strong>in</strong>dicators to a general <strong>the</strong>ory of fertilitychange. What this paper is aimed at do<strong>in</strong>g is to consider<strong>the</strong> specific relationship between fertility decl<strong>in</strong>e <strong>and</strong> <strong>the</strong>use of family plann<strong>in</strong>g, or more precisely, contraception.For example, is <strong>the</strong>re evidence to demonstrate that <strong>the</strong> paceof fertility decl<strong>in</strong>e has been constra<strong>in</strong>ed by various typesof barriers or impediments to <strong>the</strong> use of effective forms ofcontraception? Even this much reduced question presentsanalytical problems aris<strong>in</strong>g from <strong>the</strong> difficulty of adequatelymeasur<strong>in</strong>g <strong>the</strong> dem<strong>and</strong> for <strong>and</strong> <strong>the</strong> supply of familyplann<strong>in</strong>g services. As <strong>in</strong> all analysis us<strong>in</strong>g <strong>the</strong> economicconcepts of “supply” <strong>and</strong> “dem<strong>and</strong>”, supply <strong>and</strong> dem<strong>and</strong><strong>in</strong>teract <strong>in</strong> complex ways. An <strong>in</strong>crease <strong>in</strong> supply can createits own dem<strong>and</strong>, as when <strong>the</strong> diffusion of family plann<strong>in</strong>gservices raises knowledge <strong>and</strong> awareness of <strong>the</strong> possibilityof effectively controll<strong>in</strong>g fertility among populations thatpreviously had little awareness of this, hence <strong>in</strong>creas<strong>in</strong>g<strong>the</strong> dem<strong>and</strong> for it. Conversely, a belief among authoritiesthat <strong>the</strong> dem<strong>and</strong> for family plann<strong>in</strong>g is low <strong>and</strong> <strong>the</strong>refore<strong>the</strong>re is no po<strong>in</strong>t <strong>in</strong> supply<strong>in</strong>g services will almost certa<strong>in</strong>lybe self-re<strong>in</strong>forc<strong>in</strong>g, as <strong>the</strong> best <strong>in</strong>dicator of a dem<strong>and</strong> forfamily plann<strong>in</strong>g is <strong>the</strong> actual use of it.In spite of <strong>the</strong>se analytical difficulties, it is possible to ga<strong>in</strong>some <strong>in</strong>dication of supply <strong>and</strong> dem<strong>and</strong> <strong>in</strong> <strong>the</strong> Papua NewFigure2 Actual <strong>and</strong> projected fertility change <strong>in</strong> Papua New Gu<strong>in</strong>ea <strong>and</strong> less developed countries, 1950-2050PNGLDCs7.56.5Total Fertility Rate5.54.53.52.51950-551960-651970-751980-851990-952000-052010-15Year2020-252030-352040-452050-55Source: UNDESA (2009).349
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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
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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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292
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TableTableA296
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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
Page 398 and 399: 54Ms. Shadiya IbrahimAssistant Repr
Page 400 and 401: 93Mr. Melkie AntonProject OfficerUn
Page 402 and 403: 131Dr. John P. SkibiakDirectorRepro
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