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

implementation plans <strong>in</strong> health <strong>and</strong> several concernreproductive health <strong>and</strong> family plann<strong>in</strong>g.The ma<strong>in</strong> problem with <strong>the</strong>se plans is that, while<strong>the</strong>y are formulated by <strong>the</strong> national government, <strong>the</strong>irimplementation is <strong>the</strong> responsibility of prov<strong>in</strong>cial <strong>and</strong>district governments.Ano<strong>the</strong>r problem is that policies <strong>and</strong> plans set unrealistictargets <strong>and</strong> do not address <strong>the</strong> constra<strong>in</strong>ts block<strong>in</strong>g<strong>the</strong>ir achievement. Many plans are poorly formulated(confusion between ends <strong>and</strong> means) but even wellformulatedplans are not necessarily implemented.It is not helpful to characterize <strong>the</strong> dem<strong>and</strong> for familyplann<strong>in</strong>g <strong>in</strong> Papua New Gu<strong>in</strong>ea as “low”, as is suggested<strong>in</strong> <strong>the</strong> current draft National Sexual <strong>and</strong> ReproductiveHealth Policy. This perception needs to be corrected.Dem<strong>and</strong> for family plann<strong>in</strong>g <strong>in</strong> Papua New Gu<strong>in</strong>ea ishigh <strong>and</strong> only 37 per cent of current dem<strong>and</strong> is be<strong>in</strong>gmet.The review of family plann<strong>in</strong>g <strong>in</strong> 2002 states that<strong>the</strong> shift to a reproductive health approach hasdiluted <strong>the</strong> focus on family plann<strong>in</strong>g. In <strong>the</strong> NationalSexual <strong>and</strong> Reproductive Health Policy, it is statedthat concentration on family plann<strong>in</strong>g has dilutedreproductive health.Policies are not focused sufficiently on reproductiverights.The family plann<strong>in</strong>g policy is clear <strong>and</strong> <strong>the</strong> guidel<strong>in</strong>esfor service provision are good. However, it is possiblethat <strong>the</strong> policy is not widely distributed or well knownamong health staff.Some health staff do not follow <strong>the</strong> family plann<strong>in</strong>gpolicy on condom distribution, <strong>the</strong> legal right ofadolescents to be provided with contraception if <strong>the</strong>yare over 16 years of age, <strong>and</strong> <strong>the</strong> right of <strong>in</strong>dividuals toreceive contraception (<strong>in</strong>clud<strong>in</strong>g permanent methods)without <strong>the</strong> consent of a spouse.RecommendationsAddress <strong>the</strong> issue of <strong>the</strong> unwill<strong>in</strong>gness of some churchesto provide modern contraception, by:o Provid<strong>in</strong>g alternative government- or NGO-operatedhealth services <strong>in</strong> <strong>the</strong> catchment area of health servicesoperated by churches.o Promote community-based distribution <strong>and</strong> healthvolunteers <strong>in</strong> districts that are served only by churchhealth services.o Mobile family plann<strong>in</strong>g cl<strong>in</strong>ics.o Negotiate service agreements that permit churchhealth services to refer clients to alternative services.o Church health services need to be made aware ofhealth <strong>and</strong> family plann<strong>in</strong>g policies <strong>and</strong> guidel<strong>in</strong>es.Place <strong>in</strong>creased emphasis on aid posts as <strong>the</strong> primaryservice delivery po<strong>in</strong>t for contraception <strong>and</strong> familyplann<strong>in</strong>g, by:o More reliable distribution of commodities to aidposts (commodity security).o Produce a new, revised version of <strong>the</strong> family plann<strong>in</strong>gpolicy <strong>and</strong> service delivery technical guidel<strong>in</strong>es <strong>and</strong>distribute to all aid posts, health centres <strong>and</strong> cl<strong>in</strong>ics.o The <strong>in</strong>troduction to <strong>the</strong> guidel<strong>in</strong>es needs to be revised<strong>in</strong> order to put focus on reproductive rights, maternal<strong>and</strong> child health <strong>and</strong> not demographic issues.o Community health workers <strong>and</strong> o<strong>the</strong>r health staffneed to be tra<strong>in</strong>ed <strong>in</strong> order to emphasize <strong>the</strong> adoptionof appropriate attitudes towards clients, client rights<strong>and</strong> quality of care.Review all previous recommendations on how toimprove family plann<strong>in</strong>g, <strong>in</strong>clud<strong>in</strong>g <strong>the</strong> review offamily plann<strong>in</strong>g <strong>in</strong> Papua New Gu<strong>in</strong>ea by Burdon et al.(2002), <strong>the</strong> National Population Policy 2000-2010 <strong>and</strong><strong>the</strong> Report of <strong>the</strong> M<strong>in</strong>isterial Task Force on MaternalHealth (2009), <strong>and</strong> cross-check for consistency.Harmonize <strong>the</strong> recommendations <strong>and</strong> targets.Specifically review <strong>the</strong> recommendations of <strong>the</strong> Burdonet al. report <strong>and</strong> <strong>the</strong> Maternal Health Task Force on <strong>the</strong>management of <strong>the</strong> family plann<strong>in</strong>g programme.In particular, review <strong>the</strong> CPR <strong>and</strong> TFR targets <strong>in</strong> <strong>the</strong>Draft National Sexual <strong>and</strong> Reproductive Health Policy<strong>and</strong> <strong>the</strong> Maternal Health Task Force Report <strong>and</strong> adjust<strong>the</strong>m to realistic levels.Seek ways to elim<strong>in</strong>ate consultation fees for familyplann<strong>in</strong>g services imposed at facility level.Fur<strong>the</strong>r analysis of DHS data is needed, particularlyto fur<strong>the</strong>r assess <strong>the</strong> relationships between religion,contraceptive use <strong>and</strong> unmet need.Also recheck <strong>the</strong> DHS data on <strong>the</strong> low uptake of familyplann<strong>in</strong>g <strong>in</strong> <strong>the</strong> context of MCH cl<strong>in</strong>ics.Put stronger emphasis on reproductive rights <strong>in</strong>policy documents <strong>and</strong> materials used <strong>in</strong> <strong>the</strong> tra<strong>in</strong><strong>in</strong>gof health workers. Efforts should be made to educate<strong>the</strong> population at large about rights to family plann<strong>in</strong>gservices, regardless of who is manag<strong>in</strong>g <strong>the</strong> facility.Posters outl<strong>in</strong><strong>in</strong>g client rights should be displayed at all377