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

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is able to achieve. In Papua New Gu<str<strong>on</strong>g>in</str<strong>on</strong>g>ea <str<strong>on</strong>g>and</str<strong>on</strong>g> o<str<strong>on</strong>g>the</str<strong>on</strong>g>r <str<strong>on</strong>g>Pacific</str<strong>on</strong>g>cultures, teenage births generally occur outside marriage– even if marriage eventually occurs between mo<str<strong>on</strong>g>the</str<strong>on</strong>g>r <str<strong>on</strong>g>and</str<strong>on</strong>g>fa<str<strong>on</strong>g>the</str<strong>on</strong>g>r <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> fullness of time. Here<str<strong>on</strong>g>in</str<strong>on</strong>g> lies <str<strong>on</strong>g>the</str<strong>on</strong>g> problem foradolescents <str<strong>on</strong>g>in</str<strong>on</strong>g> access<str<strong>on</strong>g>in</str<strong>on</strong>g>g family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g prior to becom<str<strong>on</strong>g>in</str<strong>on</strong>g>gparents. Although both <str<strong>on</strong>g>the</str<strong>on</strong>g> law <str<strong>on</strong>g>and</str<strong>on</strong>g> government policy <str<strong>on</strong>g>in</str<strong>on</strong>g>Papua New Gu<str<strong>on</strong>g>in</str<strong>on</strong>g>ea allows any pers<strong>on</strong> above <str<strong>on</strong>g>the</str<strong>on</strong>g> age of 16to obta<str<strong>on</strong>g>in</str<strong>on</strong>g> c<strong>on</strong>traceptives from government cl<str<strong>on</strong>g>in</str<strong>on</strong>g>ics, or anyo<str<strong>on</strong>g>the</str<strong>on</strong>g>r source, <str<strong>on</strong>g>the</str<strong>on</strong>g> practice is ra<str<strong>on</strong>g>the</str<strong>on</strong>g>r different. Many healthworkers <str<strong>on</strong>g>in</str<strong>on</strong>g> family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g cl<str<strong>on</strong>g>in</str<strong>on</strong>g>ics regard <str<strong>on</strong>g>the</str<strong>on</strong>g>mselves asguardians of <str<strong>on</strong>g>the</str<strong>on</strong>g> moral order ra<str<strong>on</strong>g>the</str<strong>on</strong>g>r that a service provider.As Burd<strong>on</strong> et al. (2002) noted, “…most health workerswould not dream of giv<str<strong>on</strong>g>in</str<strong>on</strong>g>g any family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g methodsto any<strong>on</strong>e over <str<strong>on</strong>g>the</str<strong>on</strong>g> age of 16 who is unmarried” (p. 56).While this attitude may not be universal, it is probablyquite comm<strong>on</strong>.One of <str<strong>on</strong>g>the</str<strong>on</strong>g> limitati<strong>on</strong>s of <str<strong>on</strong>g>the</str<strong>on</strong>g> MCH approach to familyplann<str<strong>on</strong>g>in</str<strong>on</strong>g>g is that young unmarried people without childrenhave no access to <str<strong>on</strong>g>the</str<strong>on</strong>g> services. This was part of <str<strong>on</strong>g>the</str<strong>on</strong>g> rati<strong>on</strong>alefor broaden<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>the</str<strong>on</strong>g> approach to family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>and</str<strong>on</strong>g> plac<str<strong>on</strong>g>in</str<strong>on</strong>g>git with<str<strong>on</strong>g>in</str<strong>on</strong>g> a rights-based reproductive health strategy. Inpractice, this approach is still <str<strong>on</strong>g>in</str<strong>on</strong>g>sufficient for young people.C<strong>on</strong>sequently, adolescents have to seek services fromNGOs, or STI cl<str<strong>on</strong>g>in</str<strong>on</strong>g>ics, community-based distributors, orprivate pharmacies. However, <str<strong>on</strong>g>the</str<strong>on</strong>g>se sources are difficult forrural youth to access as most NGOs operate <str<strong>on</strong>g>in</str<strong>on</strong>g> urban areasor at best <str<strong>on</strong>g>in</str<strong>on</strong>g> peri-urban villages. Similarly, peer educators<str<strong>on</strong>g>and</str<strong>on</strong>g> university-based cl<str<strong>on</strong>g>in</str<strong>on</strong>g>ics serv<str<strong>on</strong>g>in</str<strong>on</strong>g>g students are bydef<str<strong>on</strong>g>in</str<strong>on</strong>g>iti<strong>on</strong> urban <str<strong>on</strong>g>and</str<strong>on</strong>g> not of much assistance to rural youth,who have to fall back <strong>on</strong> an aid post or a health centre,where <str<strong>on</strong>g>the</str<strong>on</strong>g>ir access to services depends <strong>on</strong> <str<strong>on</strong>g>the</str<strong>on</strong>g> attitude of<str<strong>on</strong>g>the</str<strong>on</strong>g> community health worker or aid post orderly. Wherea health centre is Church-operated, it would be difficultfor unmarried adolescents to access c<strong>on</strong>tracepti<strong>on</strong>, even ifsupplies are available.The recent <str<strong>on</strong>g>in</str<strong>on</strong>g>crease <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> number of NGOs address<str<strong>on</strong>g>in</str<strong>on</strong>g>greproductive health needs <str<strong>on</strong>g>in</str<strong>on</strong>g> Port Moresby is of assistanceto youth <str<strong>on</strong>g>and</str<strong>on</strong>g> adolescents as <str<strong>on</strong>g>the</str<strong>on</strong>g>se organizati<strong>on</strong>s are notc<strong>on</strong>cerned with uphold<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>the</str<strong>on</strong>g> moral order, as manygovernment staff seem to be. The expansi<strong>on</strong> of <str<strong>on</strong>g>the</str<strong>on</strong>g> PapuaNew Gu<str<strong>on</strong>g>in</str<strong>on</strong>g>ea <str<strong>on</strong>g>Family</str<strong>on</strong>g> Health Associati<strong>on</strong>’s operati<strong>on</strong>sbey<strong>on</strong>d its current three cl<str<strong>on</strong>g>in</str<strong>on</strong>g>ics would be of great assistance<str<strong>on</strong>g>in</str<strong>on</strong>g> improv<str<strong>on</strong>g>in</str<strong>on</strong>g>g access to family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g for young unmarriedpeople.Older pers<strong>on</strong>sOlder pers<strong>on</strong>s face barriers of a different type to thosefaced by adolescents. In this c<strong>on</strong>text, “older pers<strong>on</strong>s” refersto women who wish to stop childbear<str<strong>on</strong>g>in</str<strong>on</strong>g>g before <str<strong>on</strong>g>the</str<strong>on</strong>g>ywould naturally do so. Even <str<strong>on</strong>g>in</str<strong>on</strong>g> traditi<strong>on</strong>al times, womensought ways to cease childbear<str<strong>on</strong>g>in</str<strong>on</strong>g>g l<strong>on</strong>g before <str<strong>on</strong>g>the</str<strong>on</strong>g>y lost <str<strong>on</strong>g>the</str<strong>on</strong>g>biological capacity to c<strong>on</strong>ceive. It is important to recall thatunmet need for family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>in</str<strong>on</strong>g> 2006 was 61.5 per centam<strong>on</strong>g women aged 40-44 <str<strong>on</strong>g>and</str<strong>on</strong>g> 76.8 per cent am<strong>on</strong>g women45-49. These are <str<strong>on</strong>g>the</str<strong>on</strong>g> women who generally would like tostop childbear<str<strong>on</strong>g>in</str<strong>on</strong>g>g but may still be at risk of c<strong>on</strong>ceiv<str<strong>on</strong>g>in</str<strong>on</strong>g>g if<str<strong>on</strong>g>the</str<strong>on</strong>g>y are not us<str<strong>on</strong>g>in</str<strong>on</strong>g>g some form of family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g. Ruralwomen are particularly at risk of an unwanted pregnancy<str<strong>on</strong>g>in</str<strong>on</strong>g> older age.As Townsend (1984) po<str<strong>on</strong>g>in</str<strong>on</strong>g>ted out, tubal ligati<strong>on</strong> is <str<strong>on</strong>g>the</str<strong>on</strong>g>ideal c<strong>on</strong>traceptive method for rural women who have hadall <str<strong>on</strong>g>the</str<strong>on</strong>g> children <str<strong>on</strong>g>the</str<strong>on</strong>g>y wish to have had. When tubal ligati<strong>on</strong>was <str<strong>on</strong>g>in</str<strong>on</strong>g>troduced <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> 1970s it was taken up rapidly byrural women. In <str<strong>on</strong>g>the</str<strong>on</strong>g> Goroka area <str<strong>on</strong>g>the</str<strong>on</strong>g> average age of womenseek<str<strong>on</strong>g>in</str<strong>on</strong>g>g tubal ligati<strong>on</strong> <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> 1970s was 34 years <str<strong>on</strong>g>and</str<strong>on</strong>g>average parity was 5.5 (Townsend, 1984). When healthcentres were functi<strong>on</strong><str<strong>on</strong>g>in</str<strong>on</strong>g>g well (i.e., fully supplied withrunn<str<strong>on</strong>g>in</str<strong>on</strong>g>g water <str<strong>on</strong>g>and</str<strong>on</strong>g> ma<str<strong>on</strong>g>in</str<strong>on</strong>g>ta<str<strong>on</strong>g>in</str<strong>on</strong>g>ed <str<strong>on</strong>g>in</str<strong>on</strong>g> a hygienic c<strong>on</strong>diti<strong>on</strong>)tubal ligati<strong>on</strong> could be c<strong>on</strong>ducted <str<strong>on</strong>g>the</str<strong>on</strong>g>re. Increas<str<strong>on</strong>g>in</str<strong>on</strong>g>gly tuballigati<strong>on</strong> is available <strong>on</strong>ly <str<strong>on</strong>g>in</str<strong>on</strong>g> a prov<str<strong>on</strong>g>in</str<strong>on</strong>g>cial hospital. For poor,rural women liv<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>in</str<strong>on</strong>g> remote areas, travel to a prov<str<strong>on</strong>g>in</str<strong>on</strong>g>cialhospital is very difficult due to <str<strong>on</strong>g>the</str<strong>on</strong>g> cost <str<strong>on</strong>g>and</str<strong>on</strong>g> difficulties oftransport.In health centres operated by <str<strong>on</strong>g>the</str<strong>on</strong>g> Catholic Church, tuballigati<strong>on</strong> is <str<strong>on</strong>g>in</str<strong>on</strong>g> any case not available <str<strong>on</strong>g>and</str<strong>on</strong>g> this is also true <str<strong>on</strong>g>in</str<strong>on</strong>g>some health centres operated by <str<strong>on</strong>g>the</str<strong>on</strong>g> Anglican Church.However, vasectomy is an <str<strong>on</strong>g>in</str<strong>on</strong>g>creas<str<strong>on</strong>g>in</str<strong>on</strong>g>gly popular permanentmeans of stopp<str<strong>on</strong>g>in</str<strong>on</strong>g>g childbirth <str<strong>on</strong>g>and</str<strong>on</strong>g> tra<str<strong>on</strong>g>in</str<strong>on</strong>g><str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>in</str<strong>on</strong>g> n<strong>on</strong>-scalpelvasectomy is be<str<strong>on</strong>g>in</str<strong>on</strong>g>g provided across Papua New Gu<str<strong>on</strong>g>in</str<strong>on</strong>g>eawith UNFPA support.L<str<strong>on</strong>g>in</str<strong>on</strong>g>kages to o<str<strong>on</strong>g>the</str<strong>on</strong>g>r reproductivehealth issuesHIV <str<strong>on</strong>g>and</str<strong>on</strong>g> AIDSThe advent of <str<strong>on</strong>g>the</str<strong>on</strong>g> HIV epidemic <str<strong>on</strong>g>in</str<strong>on</strong>g> Papua New Gu<str<strong>on</strong>g>in</str<strong>on</strong>g>eahas had c<strong>on</strong>sequences for family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> sensethat <str<strong>on</strong>g>the</str<strong>on</strong>g>re is no shortage of c<strong>on</strong>doms <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> country, evenif specific service providers, particular rural aid posts orhealth centres, have <str<strong>on</strong>g>in</str<strong>on</strong>g>termittent or unreliable supply.Female c<strong>on</strong>doms are also be<str<strong>on</strong>g>in</str<strong>on</strong>g>g distributed <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>in</str<strong>on</strong>g>creas<str<strong>on</strong>g>in</str<strong>on</strong>g>gquantities, particularly by NGOs address<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>the</str<strong>on</strong>g> needs ofcommercial sex workers.Government policy is that c<strong>on</strong>doms should be made freelyavailable to any<strong>on</strong>e who wants <str<strong>on</strong>g>the</str<strong>on</strong>g>m without hav<str<strong>on</strong>g>in</str<strong>on</strong>g>g toregister <str<strong>on</strong>g>in</str<strong>on</strong>g> a cl<str<strong>on</strong>g>in</str<strong>on</strong>g>ic. However, <str<strong>on</strong>g>the</str<strong>on</strong>g>re is evidence that healthworkers resist this policy. Despite <str<strong>on</strong>g>the</str<strong>on</strong>g> urgency of <str<strong>on</strong>g>the</str<strong>on</strong>g>HIV <str<strong>on</strong>g>and</str<strong>on</strong>g> AIDS crisis, some health workers c<strong>on</strong>t<str<strong>on</strong>g>in</str<strong>on</strong>g>ue tobelieve that <str<strong>on</strong>g>the</str<strong>on</strong>g> free distributi<strong>on</strong> of c<strong>on</strong>doms encouragespromiscuity or prostituti<strong>on</strong>.372

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