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The establishment of prov<strong>in</strong>cial governments after<strong>in</strong>dependence was followed by decentralization ofhealth service provision. Tra<strong>in</strong><strong>in</strong>g of family plann<strong>in</strong>gworkers devolved gradually to <strong>the</strong> prov<strong>in</strong>ces. In 1982,<strong>the</strong> responsibility for family plann<strong>in</strong>g was transferred toprov<strong>in</strong>cial governments <strong>and</strong> funds for family plann<strong>in</strong>gwere withdrawn from <strong>the</strong> national budget (Townsend,1984). The <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> Division of <strong>the</strong> Departmentof Health was abolished. Decentralization of healthservices had a negative impact on <strong>the</strong> national familyplann<strong>in</strong>g programme, result<strong>in</strong>g <strong>in</strong> a decl<strong>in</strong>e <strong>in</strong> <strong>the</strong> numberof contraceptive users (Burdon et al., 2002), <strong>and</strong> its effectsare still evident up to today.Church health servicesAn important feature of Papua New Gu<strong>in</strong>ea’s healthcaredelivery system is that a large proportion of ruralhealth centres are operated by churches, primarily <strong>the</strong>Catholic Church, but also <strong>in</strong>clud<strong>in</strong>g Anglican <strong>and</strong> o<strong>the</strong>rdenom<strong>in</strong>ations. This has arisen because mission stationsnormally <strong>in</strong>clude a health centre or hospital. These healthfacilities now receive subsidies from <strong>the</strong> government tosupport <strong>the</strong> provision of primary health care, <strong>in</strong>clud<strong>in</strong>gfamily plann<strong>in</strong>g.In 1974, shortly after a government family plann<strong>in</strong>gprogramme was established, <strong>the</strong> Catholic Churchestablished <strong>the</strong> Catholic <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> Office <strong>and</strong> later<strong>the</strong> <strong>Family</strong> Life Association that commenced teach<strong>in</strong>g<strong>the</strong> ovulation (or rhythm) method of family plann<strong>in</strong>g.This method is still taught <strong>in</strong> Catholic-run health centres<strong>and</strong> o<strong>the</strong>r methods are discouraged. In <strong>the</strong> early 1980s<strong>the</strong> Catholic Church distributed a pamphlet aga<strong>in</strong>sttubal ligation (Ayers-Counts, 1981), <strong>and</strong> pamphletswarn<strong>in</strong>g aga<strong>in</strong>st <strong>the</strong> use of modern contraception areallegedly still distributed today. 5 The Anglican Churchhas similarly voiced its opposition to tubal ligation, as wellas <strong>the</strong> provision of contraceptives to young or unmarriedpeople. The latter policy has caused anguish <strong>in</strong> some ruralcommunities where <strong>the</strong> majority of <strong>the</strong> population feelthat <strong>the</strong> Church should relax its restrictions (Maibani-Michie, 1998).The Health Department currently distributes “kits” ofmedic<strong>in</strong>es (funded by AusAID) conta<strong>in</strong><strong>in</strong>g a supplyof contraceptives to all health centres, <strong>in</strong>clud<strong>in</strong>g thoseoperated by Churches. It has been reported that someChurch-operated health centres remove <strong>the</strong> contraceptivesfrom <strong>the</strong> kits <strong>and</strong> destroy <strong>the</strong>m, a practice that is at <strong>the</strong>least wasteful (Midire et al., 2005).Non-governmental organizations <strong>and</strong>community-based distributionThe pr<strong>in</strong>cipal NGO provid<strong>in</strong>g family plann<strong>in</strong>g <strong>in</strong> PapuaNew Gu<strong>in</strong>ea, as <strong>in</strong> o<strong>the</strong>r <strong>Pacific</strong> countries, is <strong>the</strong> <strong>Family</strong>Health Association (FHA). Affiliated with IPPF, <strong>the</strong><strong>Family</strong> Health Association (orig<strong>in</strong>ally <strong>the</strong> <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong>Association) was established <strong>in</strong> Port Moresby <strong>in</strong> 1967.Management difficulties resulted <strong>in</strong> FHA withdraw<strong>in</strong>goperations from Port Moresby <strong>in</strong> <strong>the</strong> mid-1990s <strong>and</strong>re-establish<strong>in</strong>g itself <strong>in</strong> Lae. The Association currentlyoperates cl<strong>in</strong>ics <strong>in</strong> Lae, Goroka <strong>and</strong> Rabaul. It also supportscommunity-based distribution (CBD) of contraceptives<strong>in</strong> six rural districts <strong>in</strong> Morobe Prov<strong>in</strong>ce <strong>and</strong> providesfemale condoms to <strong>the</strong> “Save <strong>the</strong> Children Fund”, whichhas a project for sex workers. The 2006 DHS showed that18 per cent of respondents obta<strong>in</strong>ed oral contraceptivesfrom FHA, 15 per cent obta<strong>in</strong>ed <strong>in</strong>jections <strong>and</strong> 13 percent received condoms through FHA. Thus FHA is asignificant provider of contraceptives <strong>in</strong> <strong>the</strong> country.O<strong>the</strong>r NGOs have become active <strong>in</strong> recent years, <strong>in</strong> partto address <strong>the</strong> HIV epidemic. Marie Stopes <strong>International</strong>operates cl<strong>in</strong>ics <strong>in</strong> Port Moresby <strong>and</strong> three o<strong>the</strong>r cities, aswell as provides outreach support to peri-urban villagesnear Port Moresby. Voluntary counsell<strong>in</strong>g <strong>and</strong> test<strong>in</strong>g,contraception, <strong>in</strong>clud<strong>in</strong>g tubal ligation <strong>and</strong> vasectomy,treatment of sexually transmitted <strong>in</strong>fections (STIs) areavailable <strong>in</strong> Marie Stopes cl<strong>in</strong>ics. This organization is alsooperat<strong>in</strong>g a trial project on Norplant <strong>in</strong> collaboration with<strong>the</strong> Department of Health.<strong>Family</strong> Health <strong>International</strong> (FHI) operates <strong>in</strong> PortMoresby, address<strong>in</strong>g HIV prevention <strong>in</strong> particular,<strong>in</strong>clud<strong>in</strong>g palliative care for term<strong>in</strong>ally ill AIDS patients.FHI provides outreach support for cl<strong>in</strong>ics <strong>in</strong> peri-urbanPort Moresby <strong>and</strong> also operates <strong>in</strong> Madang <strong>and</strong> EasternHighl<strong>and</strong>s. Population Services <strong>International</strong> (PSI)based <strong>in</strong> Port Moresby has programmes focused on HIVprevention, <strong>in</strong>clud<strong>in</strong>g condom distribution. Pathf<strong>in</strong>der<strong>International</strong> operates a community-based family plann<strong>in</strong>gproject centred <strong>in</strong> Madang. A particular focus of thatprogramme is <strong>the</strong> provision of water supplies to cl<strong>in</strong>icsoffer<strong>in</strong>g family plann<strong>in</strong>g.The private sectorOral contraceptives <strong>and</strong> condoms have been approvedfor sale <strong>in</strong> pharmacies for many years <strong>in</strong> Papua NewGu<strong>in</strong>ea. Overall, however, <strong>the</strong> purchase of contraceptivesat pharmacies or through a private physician is negligible<strong>in</strong> Papua New Gu<strong>in</strong>ea <strong>and</strong> accounts for less that 5 per centof oral contraceptives, <strong>in</strong>jectables <strong>and</strong> condoms (NSO,2009). Only 4.4 per cent of males <strong>in</strong> <strong>the</strong> 2006 DHSreported obta<strong>in</strong><strong>in</strong>g condoms from a pharmacy <strong>and</strong> ano<strong>the</strong>r4.9 per cent obta<strong>in</strong>ed <strong>the</strong>m from a shop. A community-352
ased distributor was a source of condoms for 7 per centof condom users, which makes CBD a more importantsource of condoms than pharmacies or doctors.Current status of family plann<strong>in</strong>gservicesBaravilala (2006) described <strong>the</strong> structure of <strong>the</strong> publichealth system <strong>in</strong> Papua New Gu<strong>in</strong>ea <strong>in</strong> <strong>the</strong> follow<strong>in</strong>gterms:Delivery of services through <strong>the</strong> PNGpublic health system is based on a networkof 2400 aid posts (up to 50% of <strong>the</strong>se areor have been closed because of staff <strong>and</strong>supply shortages), 500 health centres, 18prov<strong>in</strong>cial hospitals, a national hospital,<strong>and</strong> 45 urban cl<strong>in</strong>ics. The numbers offacilities that are open or closed variesaccord<strong>in</strong>g to different prov<strong>in</strong>ces. Inaddition to staff <strong>and</strong> supply shortagessome facilities have had to close becauseof disagreements with l<strong>and</strong>owners <strong>and</strong>security concerns. Over <strong>the</strong> last decade<strong>the</strong> number of closures has cont<strong>in</strong>ued to<strong>in</strong>crease. Private health care is deliveredma<strong>in</strong>ly <strong>in</strong> <strong>the</strong> larger urban centres withmost of <strong>the</strong> larger facilities located <strong>in</strong> PortMoresby.While <strong>the</strong> government is <strong>the</strong> largestprovider of health care, <strong>the</strong> Church HealthService operates approximately half of<strong>the</strong> rural health centres <strong>and</strong> sub-centres.The churches also tra<strong>in</strong> <strong>and</strong> educatemany of PNG's health workers, <strong>in</strong>clud<strong>in</strong>gnurses <strong>and</strong> community health workers.Government does not provide anybasic tra<strong>in</strong><strong>in</strong>g programmes for CHWs.The <strong>Pacific</strong> Adventist University has aschool of health sciences, <strong>and</strong> <strong>the</strong> Div<strong>in</strong>eWord University (DWU) runs a healthadm<strong>in</strong>istration programme.It is with<strong>in</strong> <strong>the</strong> context of this system that <strong>the</strong> governmentprovides <strong>the</strong> public with family plann<strong>in</strong>g services.A comprehensive review of family plann<strong>in</strong>g services wasundertaken <strong>in</strong> 2002 (Burdon et al., 2002). Most of <strong>the</strong>f<strong>in</strong>d<strong>in</strong>gs of that review probably rema<strong>in</strong> valid today but fewof its recommendations appear to have been implemented.The ma<strong>in</strong> po<strong>in</strong>ts of <strong>the</strong> review are summarized below,generally referr<strong>in</strong>g to <strong>the</strong> period 1997-2001 <strong>and</strong> draw<strong>in</strong>gspecifically upon data from <strong>the</strong> Health InformationSystem:The distribution of contraception is highly uneven.Exclud<strong>in</strong>g permanent methods, half of all healthfacilities are provid<strong>in</strong>g 95 per cent of oral contraceptives<strong>and</strong> <strong>in</strong>jections (as measured by CYP).Half of <strong>the</strong> health centres <strong>in</strong> Papua New Gu<strong>in</strong>ea are notprovid<strong>in</strong>g any modern contraceptives at all.The government operates 51 per cent of health centres<strong>and</strong> provides nearly 80 per cent of CYP. The CatholicChurch operates 20 per cent of all health centres <strong>and</strong>provides 2 per cent of CYP for modern methods.Prov<strong>in</strong>ces that have been <strong>the</strong> focus of projects fundedby <strong>in</strong>ternational agencies (<strong>in</strong>clud<strong>in</strong>g <strong>the</strong> United NationsPopulation Fund (UNFPA), World Bank, <strong>Asia</strong>nDevelopment Bank <strong>and</strong> AusAID, <strong>in</strong>dividually or <strong>in</strong>collaboration) have not markedly <strong>in</strong>creased <strong>the</strong> use ofcontraception <strong>in</strong> those prov<strong>in</strong>ces, relative to <strong>the</strong> changesobserved <strong>in</strong> prov<strong>in</strong>ces that have not been <strong>the</strong> focus ofsuch projects.In prov<strong>in</strong>ces supported by UNFPA projects,contraceptive use <strong>in</strong>creased for awhile but <strong>the</strong>n decl<strong>in</strong>ed,suggest<strong>in</strong>g that <strong>the</strong> improvements ga<strong>in</strong>ed were notsusta<strong>in</strong>able.The review also employed a questionnaire to ga<strong>the</strong>r<strong>in</strong>formation on <strong>the</strong> beliefs <strong>and</strong> perceptions of healthworkers with regard to <strong>the</strong> delivery of family plann<strong>in</strong>gservices. The results of this survey were reported accord<strong>in</strong>gto three groups of prov<strong>in</strong>ces: (a) those prov<strong>in</strong>ces that hadbeen <strong>in</strong>cluded <strong>in</strong> <strong>the</strong> large-scale Population <strong>and</strong> <strong>Family</strong><strong>Plann<strong>in</strong>g</strong> Project (PFPP) that operated from 1993 to 1998;(b) focus prov<strong>in</strong>ces that were <strong>in</strong>cluded <strong>in</strong> <strong>the</strong> UNFPACountry Programme (1996-2002); <strong>and</strong> (c) prov<strong>in</strong>ces thathad not received any support from an externally fundedfamily plann<strong>in</strong>g project.The results of <strong>the</strong> survey of health workers are summarized<strong>in</strong> Table 1, which shows <strong>the</strong> two most important reasonsgiven by health workers as to (a) why health workers did not353
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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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294
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TableTableA296
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dispense and adm<s
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(1) I am against a
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Page 348 and 349: includin</
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Page 358 and 359: FigureThe existence of traditional
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Page 366 and 367: Figurelegal requirement nor a condi
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Page 382 and 383: is able to achieve. In Papua New Gu
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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
Page 404: International <str
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