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

out that <strong>the</strong> “new acceptor rate” over <strong>the</strong> period 2001-2005had also been stagnant <strong>and</strong> that 95 per cent of women werenot be<strong>in</strong>g reached by <strong>the</strong> present family plann<strong>in</strong>g services.The policy reiterates that <strong>the</strong> consent of a partner isnot legally required before provid<strong>in</strong>g any contraceptivemethod. 13 This <strong>in</strong>cludes tubal ligation <strong>and</strong> vasectomy.However, <strong>the</strong> family plann<strong>in</strong>g policy suggests that healthworkers should encourage couples to discuss <strong>the</strong> meritsof adopt<strong>in</strong>g a permanent method of contraceptionbefore do<strong>in</strong>g so. Similarly, a person older than 16 yearsdoes not require parental consent to be provided withcontraception.The national policy allows for contraceptives to be providedfree of charge at a public health facility; however, prov<strong>in</strong>cialhealth authorities may charge a consultation fee for <strong>the</strong>provision of cl<strong>in</strong>ical services up to <strong>the</strong> maximum allowedby national policy. It is <strong>the</strong>se fees that discourage wouldbeusers of family plann<strong>in</strong>g from seek<strong>in</strong>g <strong>the</strong> services,especially low-<strong>in</strong>come rural women.The policy goes on to identify a wide range of strategiesto implement <strong>the</strong> measures <strong>in</strong>tended to achieve itsobjectives, <strong>in</strong>clud<strong>in</strong>g management systems <strong>and</strong> monitor<strong>in</strong>g<strong>and</strong> evaluation of <strong>the</strong> services provided. Detailed servicedelivery <strong>and</strong> technical guidel<strong>in</strong>es are provided for <strong>the</strong> useof family plann<strong>in</strong>g nurses <strong>and</strong> o<strong>the</strong>r health staff. Included<strong>in</strong> <strong>the</strong> recommendations is that condoms should be madeavailable <strong>in</strong> such a way that people can access <strong>the</strong>m withouthav<strong>in</strong>g to ask a health worker directly or to formallyregister a request. Detailed guidel<strong>in</strong>es are also providedon <strong>the</strong> st<strong>and</strong>ards of privacy, hygiene <strong>and</strong> cleanl<strong>in</strong>ess thatfacilities should meet for dispens<strong>in</strong>g family plann<strong>in</strong>gservices. M<strong>in</strong>imal equipment lists are described along with<strong>the</strong> educational materials that should be available for clientuse.In general, <strong>the</strong> National <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> Policy (of 2007),especially its service delivery technical guidel<strong>in</strong>es <strong>and</strong> itsspecification of <strong>the</strong> st<strong>and</strong>ards required at family plann<strong>in</strong>gcl<strong>in</strong>ics, hospitals <strong>and</strong> aid posts, is a very useful documentfor health workers, adm<strong>in</strong>istrators <strong>and</strong> supervisors. Asnoted by Burdon et al. (2002) <strong>the</strong> problem <strong>in</strong> <strong>the</strong> past hasbeen that very few health workers are aware of <strong>the</strong> policy orhave a copy of it on h<strong>and</strong>. The o<strong>the</strong>r issue is that, while <strong>the</strong>st<strong>and</strong>ards specified for facilities are reasonable <strong>and</strong> correct,very few family plann<strong>in</strong>g service delivery po<strong>in</strong>ts are able toachieve <strong>the</strong>m.Report of <strong>the</strong> M<strong>in</strong>isterial Taskforce onMaternal Health <strong>in</strong> Papua New Gu<strong>in</strong>eaThis is <strong>the</strong> most important document of relevance tofamily plann<strong>in</strong>g that has been produced by <strong>the</strong> NationalDepartment of Health <strong>in</strong> recent years. 14 It documents<strong>the</strong> maternal health situation <strong>in</strong> some detail, highlight<strong>in</strong>g<strong>in</strong> particular <strong>the</strong> impact that a deteriorat<strong>in</strong>g health<strong>in</strong>frastructure <strong>and</strong> an <strong>in</strong>adequate health budget have hadon maternal health. In <strong>the</strong> report it is noted, for example,that health expenditure as a proportion of GDP is only 0.6per cent <strong>in</strong> Papua New Gu<strong>in</strong>ea compared with 2.1 per cent<strong>in</strong> Indonesia, 4.1 per cent <strong>in</strong> Fiji <strong>and</strong> 4.9 per cent <strong>in</strong> Samoa.Decl<strong>in</strong><strong>in</strong>g real expenditure on health has contributed to<strong>the</strong> closure of 200 aid posts <strong>and</strong> a decl<strong>in</strong>e <strong>in</strong> antenatal carecoverage over <strong>the</strong> period 1997-2004 (NDOH, 2009).Among <strong>the</strong> key circumstances contribut<strong>in</strong>g to maternalmortality <strong>in</strong> Papua New Gu<strong>in</strong>ea, <strong>the</strong> report places strongemphasis on <strong>the</strong> poor access to family plann<strong>in</strong>g <strong>in</strong>formation,services <strong>and</strong> supplies that exists.Accord<strong>in</strong>gly, among <strong>the</strong> seven Taskforce Recommendations,number four concerns family plann<strong>in</strong>g. Thatrecommendation is reproduced <strong>in</strong> full below:That quality of voluntary family plann<strong>in</strong>gservice provision be immediatelystreng<strong>the</strong>ned <strong>in</strong> <strong>the</strong> areas of access <strong>and</strong>coverage for all Papua Niug<strong>in</strong>eans as aprimary <strong>in</strong>tervention to reduce <strong>the</strong> burdenof maternal mortality <strong>and</strong> morbidity<strong>in</strong> PNG. The target should be modernfamily plann<strong>in</strong>g prevalence of 65% by2020 <strong>in</strong> order to achieve a desired TotalFertility Rate of 2.2 by 2020.The recommendation is compromised only by <strong>the</strong>unrealistic 2020 target for CPR <strong>and</strong> TFR. It has taken 30years for CPR to <strong>in</strong>crease from about 6 per cent <strong>in</strong> 1978 to24 per cent <strong>in</strong> 2006, <strong>and</strong> 40 years for TFR to decl<strong>in</strong>e from6 to 4.4. Although it is certa<strong>in</strong>ly possible to <strong>in</strong>crease <strong>the</strong>speed with which women <strong>and</strong> couples are adopt<strong>in</strong>g reliablecontraception, it is highly unlikely that a CPR of 65 percent <strong>and</strong> a TFR of 2.2 could be achieved with<strong>in</strong> 10 years,even with an accelerated programme.In any case, it is worth not<strong>in</strong>g <strong>the</strong> strategies that have beenproposed to achieve this target. These <strong>in</strong>clude:(a) Development <strong>and</strong> resourc<strong>in</strong>g of a national familyplann<strong>in</strong>g strategic plan to support <strong>the</strong> national familyplann<strong>in</strong>g policy.(b) Increas<strong>in</strong>g access to a range of permanent <strong>and</strong> temporarycontraception (long- <strong>and</strong> short-term act<strong>in</strong>g) methods,for males <strong>and</strong> females.368