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married or <strong>in</strong> union. Women with anunmet need are those who are fecund<strong>and</strong> sexually active but are not us<strong>in</strong>g anymethod of contraception, <strong>and</strong> report notwant<strong>in</strong>g any more children or want<strong>in</strong>gto delay <strong>the</strong> birth of <strong>the</strong>ir next child(UNDESA, 2009).This def<strong>in</strong>ition is identical to that used <strong>in</strong> DHS. Themethod of computation requires that surveys identifywomen who are married or <strong>in</strong> a sexual union <strong>in</strong> variousstatuses requir<strong>in</strong>g a complex branch<strong>in</strong>g process basedupon answers to questions appear<strong>in</strong>g at various po<strong>in</strong>ts of<strong>the</strong> DHS questionnaire.Women who are excluded from <strong>the</strong> numerator <strong>in</strong>cludethose who:(a) Are us<strong>in</strong>g contraception to delay <strong>the</strong>ir next birth;(b) Are us<strong>in</strong>g contraception to stop childbear<strong>in</strong>g;(c) Are currently pregnant or amenorrhoeic <strong>and</strong> <strong>the</strong>pregnancy was:(i) Intended, or(ii) Due to a method failure;(d) Are <strong>in</strong>fecund (accord<strong>in</strong>g to an objective set ofcriteria);(e) Want a child with<strong>in</strong> <strong>the</strong> next two years.By a process of elim<strong>in</strong>ation, a residual is obta<strong>in</strong>ed that<strong>in</strong>cludes women who:(a) Are not us<strong>in</strong>g contraception;(b) Are not pregnant or amenorrhoeic;(c) Do not want ano<strong>the</strong>r child or do not want it with<strong>in</strong> <strong>the</strong>next two years;(d) Are pregnant or amenorrhoeic <strong>and</strong>(i) Did not want <strong>the</strong> child;(ii) Wanted <strong>the</strong> child but at a later date;(e) Are unsure about want<strong>in</strong>g a child at a later date.The denom<strong>in</strong>ator is all women who are married or <strong>in</strong> asexual union. 10The def<strong>in</strong>ition of unmet need employed by variousanalysts is not always consistent with <strong>the</strong> DHS def<strong>in</strong>ition,ei<strong>the</strong>r <strong>in</strong> terms of <strong>the</strong> numerator or <strong>the</strong> denom<strong>in</strong>ator orboth. For example, women who are unsure or “don’t know”whe<strong>the</strong>r <strong>the</strong>y want ano<strong>the</strong>r child can be considered bysome analysts to have an unmet need, whereas o<strong>the</strong>rswould exclude <strong>the</strong>m. Burdon et al. (2002) reported thatunmet need for family plann<strong>in</strong>g based on <strong>the</strong> 1996 DHSwas 62 per cent for currently married women. However,this percentage was not calculated us<strong>in</strong>g <strong>the</strong> <strong>in</strong>ternationalst<strong>and</strong>ard formula <strong>and</strong> is <strong>the</strong>refore not comparable withunmet need <strong>in</strong> o<strong>the</strong>r countries. 11Papua New Gu<strong>in</strong>ea is <strong>the</strong> only <strong>Pacific</strong> isl<strong>and</strong> country tohave two comparable measures of unmet need (1996 <strong>and</strong>2006), thus enabl<strong>in</strong>g <strong>the</strong> analysis of trends over time.However, Papua New Gu<strong>in</strong>ea’s DHS tables do not show<strong>the</strong> unmet need for spac<strong>in</strong>g separately from <strong>the</strong> unmet needfor stopp<strong>in</strong>g. Women are considered to have an unmetneed if <strong>the</strong>y say that <strong>the</strong>y want no more children (or arenot sure or undecided) <strong>and</strong> are not us<strong>in</strong>g contraception.It is possible that total unmet need as measured by DHSwould be higher if <strong>the</strong> unmet need for spac<strong>in</strong>g were to becalculated separately <strong>and</strong> <strong>in</strong>cluded <strong>in</strong> <strong>the</strong> total.Table 11 shows that, while a decl<strong>in</strong>e <strong>in</strong> unmet need isevident at <strong>the</strong> national level (from 45.9 to 43.9%) over <strong>the</strong>decade 1996-2006, <strong>the</strong> rate of decl<strong>in</strong>e was slow <strong>and</strong> unmetneed rema<strong>in</strong>ed quite high. In <strong>the</strong> Isl<strong>and</strong>s region, however,unmet need actually <strong>in</strong>creased over <strong>the</strong> period, while <strong>in</strong> <strong>the</strong>Highl<strong>and</strong>s region it rema<strong>in</strong>ed at <strong>the</strong> same level. In 2006<strong>the</strong> Sou<strong>the</strong>rn region had <strong>the</strong> lowest level of unmet need, aswas also <strong>the</strong> case <strong>in</strong> 1996.Expla<strong>in</strong><strong>in</strong>g patterns of unmet needGeographical variations <strong>in</strong> unmet need are predom<strong>in</strong>antlyreflections of socio-economic, socio-cultural <strong>and</strong> historicalfactors. As previously noted, <strong>the</strong> Isl<strong>and</strong>s region has a largeproportion of Catholics <strong>and</strong> this probably expla<strong>in</strong>s <strong>the</strong>decl<strong>in</strong><strong>in</strong>g trend <strong>in</strong> <strong>the</strong> use of modern methods of familyplann<strong>in</strong>g <strong>in</strong> that region. It is notable that it is only <strong>in</strong> <strong>the</strong>Isl<strong>and</strong>s region that unmet need <strong>in</strong>creased between 1996<strong>and</strong> 2006 (Table 11) <strong>and</strong> it is likely that this is due toefforts by <strong>the</strong> Catholic Church to discourage <strong>the</strong> use ofmodern contraception (Burdon et al., 2002).A valid explanation of <strong>the</strong> socio-economic <strong>and</strong> socioculturaldeterm<strong>in</strong>ants of unmet need would require amultivariate analysis that allowed for some variables, suchas education <strong>and</strong> labour force status, to be controlled.Published tables do not permit such analysis <strong>in</strong> <strong>the</strong> PapuaNew Gu<strong>in</strong>ea case <strong>and</strong> only two-way descriptive analysis ispossible. The only variables available aside from region <strong>and</strong>rural/urban residence are age <strong>and</strong> education.As is evident from Table 12, unmet need rises with age<strong>and</strong> falls with educational achievement. This pattern wasevident <strong>in</strong> both 1996 <strong>and</strong> 2006. The highest level of unmet362
TableTable12TableTable13need is found <strong>in</strong> women aged 45-49 <strong>in</strong> both years, althoughit is very likely that many women <strong>in</strong> this age group believed<strong>the</strong>mselves to be at low risk of conceiv<strong>in</strong>g a child. Amongwomen aged 40-49, unmet need <strong>in</strong>creased somewhatbetween <strong>the</strong> two surveys, whereas <strong>in</strong> all age groups between15 <strong>and</strong> 39 it decl<strong>in</strong>ed, although not by much. In <strong>the</strong> caseof education, unmet need fell among those with less thangrade 6 education but <strong>in</strong>creased among women with grade6 or more, but <strong>in</strong> both years women with no education had<strong>the</strong> highest unmet need – over 50 per cent <strong>in</strong> both years –while women with grade 7 or higher had <strong>the</strong> lowest.Although <strong>the</strong> proportion of women aged 15-49 hav<strong>in</strong>g anunmet need for family plann<strong>in</strong>g decl<strong>in</strong>ed between 1996 <strong>and</strong>2006, <strong>the</strong> decl<strong>in</strong>e was not sufficient to offset <strong>the</strong> growth <strong>in</strong><strong>the</strong> population of women <strong>in</strong> <strong>the</strong> reproductive age range.Consequently, <strong>the</strong> actual number of women with an unmetneed rose significantly over <strong>the</strong> decade (see Table 13 <strong>and</strong>Figure 5). The number of women with an unmet need forFP rose from an estimated 480,000 <strong>in</strong> 1996 to 632,000 <strong>in</strong>2006, an <strong>in</strong>crease of about 30 per cent. As Figure 5 makesclear, <strong>the</strong> <strong>in</strong>crease <strong>in</strong> <strong>the</strong> number of women with an unmetneed is particularly large among women aged 40 years <strong>and</strong>363
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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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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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dispense and adm<s
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(1) I am against a
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FigureFigureFigure3Use of modern co
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FigureFigure7Traditional method use
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Figureprojection, and</stro
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Figure 11 summarizes the</s
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correlating <stron
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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
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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