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

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TableTable15The immediate past National Health Plan covered <strong>the</strong>period 2001-2010. (A new National Health Plan has beenformulated for <strong>the</strong> period 2011-2020.) Volume I of <strong>the</strong>2001-2010 plan outl<strong>in</strong>es <strong>the</strong> overall policy direction <strong>and</strong>priorities that <strong>the</strong> government has pursued over <strong>the</strong> pastdecade. These are <strong>the</strong> policies underly<strong>in</strong>g <strong>the</strong> patterns <strong>and</strong>trends discussed <strong>in</strong> this paper.The 2001-2010 National Health Plan places familyplann<strong>in</strong>g under <strong>the</strong> general head<strong>in</strong>g of “<strong>Family</strong> Health,with a focus on Women’s <strong>and</strong> Children’s Health”, <strong>and</strong> <strong>the</strong>subhead<strong>in</strong>g “Reproductive Health”. The key statementsare:All couples <strong>and</strong> <strong>in</strong>dividuals shall have access to<strong>in</strong>formation needed to decide freely <strong>and</strong> responsibly <strong>the</strong>number, spac<strong>in</strong>g <strong>and</strong> tim<strong>in</strong>g of <strong>the</strong>ir children.All adolescents shall have access to <strong>in</strong>formation <strong>and</strong>advice on sexual health <strong>and</strong> family plann<strong>in</strong>g.All health facilities shall provide high-quality familyplann<strong>in</strong>g services that emphasize client needs, sensitive366
counsell<strong>in</strong>g, choice of methods <strong>and</strong> comprehensive<strong>in</strong>formation.All family plann<strong>in</strong>g cl<strong>in</strong>ics shall make available treatmentfor sexually transmitted <strong>in</strong>fection <strong>and</strong> screen<strong>in</strong>g servicesfor cancer.Women <strong>and</strong> adolescents shall be <strong>in</strong>volved <strong>in</strong> <strong>the</strong> design<strong>and</strong> implementation of family plann<strong>in</strong>g <strong>and</strong> sexualhealth programmes.It is difficult to assess <strong>the</strong> significance of <strong>the</strong> word<strong>in</strong>g of<strong>the</strong>se statements. For example, <strong>the</strong> reference to adolescentsrefers to <strong>the</strong>ir hav<strong>in</strong>g access to <strong>in</strong>formation <strong>and</strong> advice, butservices are not mentioned. Certa<strong>in</strong>ly <strong>the</strong> statement couldbe <strong>in</strong>terpreted to mean that health facilities were obligedonly to provide <strong>in</strong>formation <strong>and</strong> “advice”, not to providecontraceptives.The Implementation Plan for <strong>the</strong> Strategic Directions <strong>in</strong>Safe Mo<strong>the</strong>rhood, Neonatal <strong>and</strong> Reproductive Healthprovides more details of <strong>the</strong> strategies selected to achieve<strong>the</strong> objectives stated <strong>in</strong> <strong>the</strong> National Health Plan. Thestrategies <strong>in</strong>clude “…a special focus on adolescents toencourage responsible sexual behaviour, family plann<strong>in</strong>g<strong>and</strong> <strong>the</strong> prevention of sexually transmitted <strong>in</strong>fections<strong>in</strong>clud<strong>in</strong>g HIV/AIDS”. It is likely that some healthstaff paid more attention to <strong>the</strong> expression “encourageresponsible sexual behaviour” than <strong>the</strong> provision of familyplann<strong>in</strong>g.On a positive note, one objective of <strong>the</strong> implementationplan was to <strong>in</strong>crease CPR for modern methods to 25 percent – a target that may well have been achieved given that<strong>the</strong> 2006 DHS reported a CPR of 24.4 per cent. Perhaps<strong>the</strong> target was on <strong>the</strong> low side.The current National Health Plan (2011-2020) was <strong>in</strong>draft form at <strong>the</strong> time <strong>the</strong> present paper was be<strong>in</strong>g written,but it is clearly focus<strong>in</strong>g on restructur<strong>in</strong>g health services <strong>in</strong>an effort to recover from <strong>the</strong> consequences of <strong>the</strong> revisionsto <strong>the</strong> organic law on prov<strong>in</strong>cial governments that resulted<strong>in</strong> <strong>the</strong> dis<strong>in</strong>tegration of health service delivery <strong>in</strong> PapuaNew Gu<strong>in</strong>ea. The plan is aimed at rebuild<strong>in</strong>g primaryhealth services <strong>in</strong> rural areas through <strong>the</strong> creation of a newfirst-l<strong>in</strong>e <strong>in</strong>stitution to replace <strong>the</strong> aid post <strong>and</strong> <strong>the</strong> healthsubcentre, to be known as a “community health post”.Ano<strong>the</strong>r change is likely to be <strong>the</strong> creation of regionalspecialist hospitals. All health-care delivery po<strong>in</strong>ts up to<strong>the</strong> level of regional specialist hospitals will come under <strong>the</strong>management of <strong>the</strong> proposed “prov<strong>in</strong>cial health authority”.The challenge of this restructure at <strong>the</strong> primary healthlevel will be to ensure that <strong>the</strong> new community health postis capable of supply<strong>in</strong>g services more effectively than <strong>the</strong>aid post was.The ma<strong>in</strong> objective of <strong>the</strong> National Health Plan (2011-2020) is to “<strong>in</strong>crease family plann<strong>in</strong>g coverage”, with <strong>the</strong>primary strategy be<strong>in</strong>g to ensure that “every health facilityhas <strong>the</strong> capacity to offer family plann<strong>in</strong>g services at all times”.A related objective is to “improve sexual <strong>and</strong> reproductivehealth for adolescents, with <strong>the</strong> primary strategy be<strong>in</strong>g to“Increase <strong>the</strong> knowledge of adolescents about sexual <strong>and</strong>reproductive health”.Reproductive health policyA comprehensive national sexual <strong>and</strong> reproductive healthpolicy was developed <strong>in</strong> 2009 (National Departmentof Health, 2009). One of <strong>the</strong> stated justifications fordevelop<strong>in</strong>g an RH policy is that “reproductive healthservices have concentrated on family plann<strong>in</strong>g to <strong>the</strong>detriment of o<strong>the</strong>r components”. The situational analysisalso notes that “On <strong>the</strong> whole, <strong>the</strong> total dem<strong>and</strong> for familyplann<strong>in</strong>g is still relatively low as only 35.7 per cent ofwomen dem<strong>and</strong>ed for family plann<strong>in</strong>g accord<strong>in</strong>g to <strong>the</strong>2006 DHS report”. 12 Despite this, <strong>the</strong> policy expresses <strong>the</strong><strong>in</strong>tention to:Promote access to <strong>in</strong>formation on familyplann<strong>in</strong>g <strong>and</strong> provide wide choices ofcontraceptive methods <strong>in</strong>clud<strong>in</strong>g surgicalmethods <strong>and</strong> encourage <strong>the</strong> developmentof new <strong>in</strong>itiatives for identify<strong>in</strong>g <strong>and</strong>solv<strong>in</strong>g logistical problems at all levels toensure reproductive health commoditysecurity.The primary policy objective that relates to familyplann<strong>in</strong>g is to reduce unwanted pregnancies, with <strong>the</strong>target be<strong>in</strong>g a 50 per cent reduction by 2012. To achievethis it is proposed to <strong>in</strong>crease CPR from 20 to 60 percent over <strong>the</strong> same period. Needless to say, this is a highlyunrealistic target, given that (based on recent trends) <strong>the</strong>use of modern contraception is <strong>in</strong>creas<strong>in</strong>g only at <strong>the</strong> rateof about 2.4 per cent per year.<strong>Family</strong> plann<strong>in</strong>g policyThe second edition of <strong>the</strong> National <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> Policy,Implementation Strategy <strong>and</strong> Technical St<strong>and</strong>ards wasissued <strong>in</strong> 2007 (National Department of Health, 2007).This document covers family plann<strong>in</strong>g policy <strong>in</strong> detail <strong>and</strong>furnishes guidance to health staff on <strong>the</strong> application of <strong>the</strong>policy. The policy notes that access to <strong>and</strong> use of familyplann<strong>in</strong>g has been stagnant over <strong>the</strong> period 1996-2003 asmeasured by <strong>the</strong> “couple years of protection”. It also po<strong>in</strong>ts367
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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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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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Figurethe use of c
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FigureFigure15Sexual behaviour <str
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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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