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

O’Coll<strong>in</strong>s, 1979). Women <strong>in</strong> <strong>the</strong> villages surround<strong>in</strong>g PortMoresby requested <strong>the</strong> Adm<strong>in</strong>istration to provide <strong>the</strong>mwith <strong>the</strong> same “medic<strong>in</strong>e” that allowed <strong>the</strong> wives of colonialofficers to limit <strong>the</strong>ir family size to three children. Theavailability of <strong>the</strong> service was not publicized but becameknown through word of mouth. Initially oral contraceptiveswere offered free of cost. When <strong>the</strong> so-called <strong>in</strong>trauter<strong>in</strong>econtraceptive device or IUCD was <strong>in</strong>troduced, <strong>the</strong> freesupply of contraceptive pills was withdrawn <strong>and</strong> IUDs(<strong>in</strong>trauter<strong>in</strong>e devices) were offered free of cost <strong>in</strong>stead.In <strong>the</strong> early stages <strong>the</strong> programme was completely“passive”, provid<strong>in</strong>g services to those who requested <strong>the</strong>mbut not actively promot<strong>in</strong>g contraception. However, <strong>the</strong>programme spread to o<strong>the</strong>r centres <strong>in</strong> <strong>the</strong> country ondem<strong>and</strong>. The programme was not aimed at limit<strong>in</strong>g familysize as such but to assist women who wished to space <strong>the</strong>irchildren. Never<strong>the</strong>less, tubal ligation was offered to womenwho wished to stop childbear<strong>in</strong>g, <strong>and</strong> it was <strong>the</strong> womanherself who decided when she should stop – usually whenshe felt too old to take care of children. Tubal ligation waspopular among rural women but as its use spread <strong>the</strong>rewas opposition from <strong>the</strong> Catholic Church, which opposedany form of contraception. . The Church distributedpamphlets warn<strong>in</strong>g people of <strong>the</strong> dangers of tubal ligation<strong>and</strong> husb<strong>and</strong>s came to believe that <strong>the</strong> operation wouldbe harmful to <strong>the</strong>ir wife’s health (Muirden, 1976). Quitelikely <strong>the</strong> belief that men were opposed to <strong>the</strong>ir wives us<strong>in</strong>gfamily plann<strong>in</strong>g methods orig<strong>in</strong>ated <strong>in</strong> this period. For somemen at least, <strong>the</strong>ir opposition to modern family plann<strong>in</strong>garose from <strong>the</strong> same fears about consequences for women’shealth as women <strong>the</strong>mselves experienced. Research <strong>in</strong> <strong>the</strong>Highl<strong>and</strong>s of Papua New Gu<strong>in</strong>ea shows that men arewell aware that childbirth is dangerous but <strong>the</strong>y are alsoconcerned that whatever contraception method <strong>the</strong>ir wivesuse it should be safe (Pataki-Schweizer, 1996).In later years, when medical officers travelled to rural areaswith <strong>the</strong> necessary medical equipment to perform tuballigations, <strong>the</strong> response was spontaneous. Burdon et al.(2002) reported that village women would walk up to fivedays to obta<strong>in</strong> a tubal ligation. The use of tubal ligation<strong>in</strong>creased rapidly at first but <strong>the</strong>n levelled off <strong>in</strong> <strong>the</strong> mid-1970s, possibly <strong>in</strong> response to Church opposition. TheIUD <strong>and</strong> tubal ligation were particularly popular amongrural women but were <strong>the</strong> most difficult to obta<strong>in</strong> because<strong>the</strong> medical skills necessary to provide <strong>the</strong>se methods wererare.The issue of whe<strong>the</strong>r Papua New Gu<strong>in</strong>ea should adopta large-scale family plann<strong>in</strong>g programme was discussedby demographers <strong>in</strong> a 1970 meet<strong>in</strong>g sponsored by <strong>the</strong>Australian National University before <strong>in</strong>dependence. Theconsensus reached was that a massive family plann<strong>in</strong>gprogramme was “not desirable” at that time but mightbecome imperative “with<strong>in</strong> a decade” (Caldwell, 1971).Three reasons were given for not embark<strong>in</strong>g on a large-scalefamily plann<strong>in</strong>g programme: (a) Papua New Gu<strong>in</strong>ea stillhad low population density; (b) a large-scale programmewas not politically acceptable; <strong>and</strong> (c) a family plann<strong>in</strong>gprogramme would not attract enough clients to justify it.There was, however, a consensus that a programme wouldbe necessary eventually <strong>and</strong> that <strong>the</strong> Adm<strong>in</strong>istrationshould ensure that <strong>the</strong> exist<strong>in</strong>g level of dem<strong>and</strong> was met sothat <strong>the</strong> experience ga<strong>in</strong>ed from a “limited” family plann<strong>in</strong>gprogramme could be applied when <strong>the</strong> time came to<strong>in</strong>itiate a larger scheme. A budget allocation was estimated<strong>and</strong> a programme of tra<strong>in</strong><strong>in</strong>g <strong>and</strong> research was proposed(Caldwell, 1971). It is notable that <strong>the</strong> health benefits offamily plann<strong>in</strong>g were not among <strong>the</strong> criteria used to justifya family plann<strong>in</strong>g programme. 4A nationwide family plann<strong>in</strong>g programme was <strong>in</strong> factestablished shortly afterwards by a Cab<strong>in</strong>et decision<strong>in</strong> 1973 under <strong>the</strong> self-govern<strong>in</strong>g Adm<strong>in</strong>istration thatpreceded full <strong>in</strong>dependence. After <strong>in</strong>dependence, however,political opposition to family plann<strong>in</strong>g grew, confirm<strong>in</strong>gearlier concerns that a large programme would not f<strong>in</strong>dpolitical support. The first Governor-General opposedfamily plann<strong>in</strong>g on <strong>the</strong> grounds that Papua New Gu<strong>in</strong>eaneeded a population of 20 million to protect <strong>the</strong> l<strong>and</strong>from <strong>in</strong>vasion (D’Sa, 1988). Some post-<strong>in</strong>dependencepoliticians saw family plann<strong>in</strong>g as a “colonial” imposition.A lively debate <strong>in</strong> <strong>the</strong> newspapers on <strong>the</strong> issue cont<strong>in</strong>uedfor many years. By 1978 posts <strong>and</strong> tra<strong>in</strong><strong>in</strong>g programmeshad never<strong>the</strong>less been created, <strong>in</strong>clud<strong>in</strong>g <strong>the</strong> establishmentof an <strong>in</strong>formation, education <strong>and</strong> communication (IEC)unit.By <strong>the</strong> late 1970s, an active government family plann<strong>in</strong>gprogramme was <strong>in</strong> operation supported by a specificallocation <strong>in</strong> <strong>the</strong> total health budget. The programmefocused on maternal <strong>and</strong> child health (MCH). Womenwere motivated dur<strong>in</strong>g <strong>the</strong> antenatal period, at <strong>the</strong> timeof delivery <strong>and</strong> post-partum to adopt family plann<strong>in</strong>g.Women who did not deliver at a health centre weremotivated dur<strong>in</strong>g visits to child health cl<strong>in</strong>ics (Muirden,1982). Tra<strong>in</strong><strong>in</strong>g of medical officers, aid post orderlies,nurses, nurs<strong>in</strong>g supervisors <strong>and</strong> o<strong>the</strong>r health staffaccelerated dur<strong>in</strong>g <strong>the</strong> late 1970s. <strong>Family</strong> plann<strong>in</strong>g services,<strong>in</strong>clud<strong>in</strong>g <strong>in</strong>jectables, IUDs, condoms, tubal ligation <strong>and</strong>vasectomy, were available at various levels of health-careservice delivery. A range of o<strong>the</strong>r activities support<strong>in</strong>gfamily plann<strong>in</strong>g had also been undertaken, <strong>in</strong>clud<strong>in</strong>g <strong>the</strong>development of IEC materials, radio programmes, familylife education <strong>in</strong> schools (<strong>in</strong>clud<strong>in</strong>g <strong>the</strong> use of studentsto give family plann<strong>in</strong>g education <strong>in</strong> <strong>the</strong>ir home villagesdur<strong>in</strong>g vacations) <strong>and</strong> various sem<strong>in</strong>ars for governmentofficers on population <strong>and</strong> family plann<strong>in</strong>g topics. By 1978it was estimated that 6 per cent of women of reproductiveage were us<strong>in</strong>g family plann<strong>in</strong>g (Muirden, 1982).351