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

FigureFigure67Relationship between ideal number of children <strong>and</strong> children ever born <strong>and</strong> surviv<strong>in</strong>g, 2002Demographic <strong>and</strong> Health Survey of selected prov<strong>in</strong>ces654321015-19 20-24 25-29 30-34 35-39 40-44 45-49Mean No. Children ever Born Plus Current PregnancyMean No. of Liv<strong>in</strong>g ChildrenIdeal No. ChildrenSource: Azcuna (2007).Gender <strong>and</strong> family relationsThe figure shows that if this group of women were membersof <strong>the</strong> same cohort, <strong>the</strong>y would have reached <strong>the</strong>ir preferredor ideal family size (about 3.8 children) by age 35-39.However <strong>the</strong> mean number of children ever-born <strong>and</strong> <strong>the</strong>mean number of surviv<strong>in</strong>g children cont<strong>in</strong>ue to <strong>in</strong>creasebeyond that age, reach<strong>in</strong>g about 5.5 by age 40-44. This isnot, of course, a real cohort <strong>in</strong> <strong>the</strong> same sense that TFRis not calculated on <strong>the</strong> basis of a real cohort but ra<strong>the</strong>r asyn<strong>the</strong>tic cohort. Yet <strong>the</strong> data give an <strong>in</strong>dication that <strong>the</strong>“supply” of children exceeds <strong>the</strong> “dem<strong>and</strong>” for children evenwhen allow<strong>in</strong>g for <strong>the</strong> mortality of children. The motive tohave more births than needed <strong>in</strong> order to achieve a preferrednumber of children is significantly weakened as <strong>the</strong> <strong>in</strong>fantmortality rate decl<strong>in</strong>es, as it has been do<strong>in</strong>g <strong>in</strong> Papua NewGu<strong>in</strong>ea <strong>in</strong> recent decades. “Excess” births to compensatefor <strong>the</strong> mortality of children are no longer required <strong>in</strong> <strong>the</strong>Papua New Gu<strong>in</strong>ea context, although <strong>in</strong>dividual women<strong>in</strong> high-mortality areas may be <strong>in</strong> this situation.Gender <strong>and</strong> family relationsGender <strong>in</strong>equality makes a major contribution to maternalhealth problems <strong>in</strong> Papua New Gu<strong>in</strong>ea. Violence aga<strong>in</strong>stwomen is endemic <strong>and</strong> common; it <strong>in</strong>cludes sexual violence,rape <strong>and</strong> gang rape. Women <strong>and</strong> girls have unequal accessto health care. Boy children are more likely to receiveurgent health care than girl children. When life expectancyhas been calculated us<strong>in</strong>g data obta<strong>in</strong>ed on deaths amongadult women, male life expectancy has been shown to behigher than that for females. 19So far as family plann<strong>in</strong>g is concerned, <strong>the</strong> opposition ofhusb<strong>and</strong>’s is not among <strong>the</strong> ma<strong>in</strong> reasons that women givefor not us<strong>in</strong>g family plann<strong>in</strong>g; but it is generally understoodthat men have a major <strong>in</strong>fluence on a woman’s decision touse family plann<strong>in</strong>g <strong>and</strong> what k<strong>in</strong>d to use. Men certa<strong>in</strong>lywish to be more <strong>in</strong>volved <strong>in</strong> family plann<strong>in</strong>g matters than<strong>the</strong>y presently are <strong>and</strong> efforts to facilitate “men as partners”are certa<strong>in</strong>ly necessary. The success of <strong>the</strong> vasectomyprogramme pioneered <strong>in</strong> <strong>the</strong>Conclusions <strong>and</strong>recommendationsConclusionsThe fertility transitionFertility decl<strong>in</strong>e has occurred slowly <strong>in</strong> Papua NewGu<strong>in</strong>ea compared with o<strong>the</strong>r less developed countries<strong>and</strong> virtually came to a stop <strong>in</strong> <strong>the</strong> early 1990s. The mostlikely reason for this is that mortality was also decl<strong>in</strong><strong>in</strong>gslowly <strong>and</strong> this was <strong>in</strong> turn l<strong>in</strong>ked to a general slowdown<strong>in</strong> <strong>the</strong> pace of economic development. Decentralizationof health services, <strong>in</strong>clud<strong>in</strong>g family plann<strong>in</strong>g, may alsohave played a part <strong>in</strong> <strong>the</strong> slow fertility decl<strong>in</strong>e.Given current trends it is unlikely that TFR will reachreplacement level for at least ano<strong>the</strong>r 20 years, by whichtime <strong>the</strong> population will have reached 10 million <strong>and</strong>still be grow<strong>in</strong>g.Knowledge <strong>and</strong> use of family plann<strong>in</strong>g<strong>and</strong> unmet needKnowledge of modern family plann<strong>in</strong>g methods is375