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

service delivery po<strong>in</strong>ts.Encourage all prov<strong>in</strong>ces to appo<strong>in</strong>t a family plann<strong>in</strong>glogistics manager.Review <strong>the</strong> implementation of <strong>the</strong> recommendationsmade <strong>in</strong> <strong>the</strong> 2003 <strong>and</strong> 2005 RHCS assessments byUNFPA.Plan for a follow-up family plann<strong>in</strong>g assessment <strong>in</strong>2012 to review changes s<strong>in</strong>ce <strong>the</strong> last comprehensiveassessment by Burdon et al. <strong>in</strong> 2002.End Note1 For fur<strong>the</strong>r details, see IPPF.org/en/where/CN.htm. Accessed on8 October 2010.2 In Papua New Gu<strong>in</strong>ea, <strong>the</strong> lowest level of rural health-careprovision is <strong>the</strong> “aid post”, which usually services one or morerural villages or hamlets. The next step up <strong>the</strong> hierarchy of serviceprovision is <strong>the</strong> “health subcentre”, which serves a larger cluster ofvillages. A “health centre” is one step up from a health subcentre<strong>and</strong> services a district. In larger districts <strong>the</strong> health centre has beenupgraded to a district hospital. Reference to “health centre” <strong>in</strong> thisdocument refers to ei<strong>the</strong>r a health subcentre or a health centre, i.e.,step two or three up <strong>the</strong> hierarchy of services.3 O<strong>the</strong>r projections <strong>in</strong>dicate a population of 13.3 million by 2050(see SPC, 2010).4 The question of whe<strong>the</strong>r a focused family plann<strong>in</strong>g programmewas needed <strong>in</strong> Papua New Gu<strong>in</strong>ea was still be<strong>in</strong>g discussed 30years later (Burdon et al., 2002) but <strong>the</strong> justification had shifted tomaternal <strong>and</strong> <strong>in</strong>fant health.5 Personal communication with NGOs operat<strong>in</strong>g <strong>in</strong> Port Moresby.6 One nurse reported: “I even wrote a letter to <strong>the</strong> Bishop ask<strong>in</strong>gpermission to give FP to <strong>the</strong> high risk mo<strong>the</strong>rs who have had 5, 6or 7 children as <strong>the</strong>y are dy<strong>in</strong>g like flies up here—<strong>and</strong> <strong>the</strong>y told meno” (Burdon et al., 2002).7 The family plann<strong>in</strong>g review noted: “[M]ost health workers wouldnot dream of giv<strong>in</strong>g any family plann<strong>in</strong>g methods to anyone over<strong>the</strong> age of 16 who is unmarried. In fact, most family plann<strong>in</strong>gappears to be distributed only to women who already have a child(Burdon et al., 2002).8 The Population Reference Bureau (2008) reported Haiti’s CPR as24.8 for modern methods.9 The “ovulation” method is taught by family health workersassociated with <strong>the</strong> Catholic Church, but this is not a “traditional”method of birth control <strong>in</strong> Papua New Gu<strong>in</strong>ea, even though DHSclassifies it as such.10 Unmet need can also be calculated, <strong>and</strong> <strong>in</strong>creas<strong>in</strong>gly is, for allwomen of reproductive age regardless of <strong>the</strong>ir marital status. In thispaper only currently married women are <strong>in</strong>cluded <strong>in</strong> <strong>the</strong> numerator<strong>and</strong> denom<strong>in</strong>ator. If all women of reproductive age are <strong>in</strong>cluded,some method of exclud<strong>in</strong>g women who are not sexually active mustbe applied. O<strong>the</strong>rwise, unmet need will tend to be overstated.11 The method used was to calculate <strong>the</strong> proportion of women notus<strong>in</strong>g contraception who did not want to have ano<strong>the</strong>r child.Although this is not an unreasonable calculation, <strong>the</strong> st<strong>and</strong>ardformula uses all women of reproductive age as <strong>the</strong> denom<strong>in</strong>ator.The latter calculation gives a lower figure.12 The actual “dem<strong>and</strong>” for family plann<strong>in</strong>g <strong>in</strong> 2006 was 69.8 per cent.Only 36.8 per cent of dem<strong>and</strong> was satisfied.13 McRae (1982) po<strong>in</strong>ted out that <strong>the</strong> Papua New Gu<strong>in</strong>ea Crim<strong>in</strong>alCode allows a person to perform a surgical operation on a personthat is for his benefit, but a medical practitioner who performs asterilization know<strong>in</strong>g that <strong>the</strong> consent of <strong>the</strong> patient has not beenobta<strong>in</strong>ed will be considered guilty of assault <strong>and</strong> subject to civilaction by <strong>the</strong> patient. There is no law that requires <strong>the</strong> consent of aspouse before sterilization can be carried out, but until recently thiswas <strong>the</strong> general practice <strong>in</strong> Papua New Gu<strong>in</strong>ea. At least one NGOthat carries out tubal ligations <strong>in</strong> Papua New Gu<strong>in</strong>ea still requires<strong>the</strong> written consent of both <strong>the</strong> woman <strong>and</strong> her husb<strong>and</strong> if she ismarried. This practice is to protect <strong>the</strong> facility aga<strong>in</strong>st any risk oflaw suits or violence aga<strong>in</strong>st <strong>the</strong> facility or its staff. McRae fur<strong>the</strong>rnoted that any attempt to restrict access to contraception mayviolate <strong>the</strong> right to privacy guaranteed by <strong>the</strong> country’s constitution.It is unlikely that this right has been tested <strong>in</strong> <strong>the</strong> courts.14 Unfortunately <strong>the</strong> report misses an opportunity to expla<strong>in</strong> <strong>the</strong>possibility that <strong>the</strong> apparent doubl<strong>in</strong>g of <strong>the</strong> maternal mortalityratio between <strong>the</strong> last two DHS is a consequence of statisticalproblems ra<strong>the</strong>r than a real change.15 Midire et al. (2005) reported visit<strong>in</strong>g an aid post that had beenout of stock of condoms for four months, even though a plentifulsupply was available <strong>in</strong> <strong>the</strong> area medical stores. Baravilala (2006)reported that many health centres <strong>in</strong> prov<strong>in</strong>ces supported by aUNFPA project ran out of condoms with<strong>in</strong> two weeks of receiv<strong>in</strong>ga supply. Supply is clearly not dem<strong>and</strong>-driven.16 The National Sexual <strong>and</strong> Reproductive Health Policy (2009)does not refer to any of <strong>the</strong>se recommendations or <strong>the</strong> activitiesassociated with <strong>the</strong>m.17 Pirie (1971) noted that “Melanesian societies show a notablerestra<strong>in</strong>ed attitude toward fertility compared with Polynesian <strong>and</strong><strong>the</strong>re is every reason to believe that an effective means of limit<strong>in</strong>gfamily size would be welcomed”.18 The elim<strong>in</strong>ation of clan fight<strong>in</strong>g has reduced <strong>the</strong> <strong>in</strong>centive to havemany boys to <strong>in</strong>crease <strong>the</strong> strength of <strong>the</strong> clan.19 This was only possible <strong>in</strong> 1991 when DHS asked questionsdesigned to determ<strong>in</strong>e male <strong>and</strong> female mortality separately. SeeHayes (1993).ReferencesAgyei, W. (1988). Fertility <strong>and</strong> <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> <strong>in</strong> <strong>the</strong>Third World: A Case Study of Papua New Gu<strong>in</strong>ea.London: Croom Helm.Azcuna, R.M.S. (2007). The 2002 Reproductive HealthSurvey—A Technical Report. WHO/UNFPA(unpublished).Baravilala, W. (2006). An Assessment of <strong>the</strong> ReproductiveHealth Sub-Programme of UNFPA’s Third CountryProgramme <strong>in</strong> Papua New Gu<strong>in</strong>ea, Suva: UNFPA<strong>Pacific</strong> Sub-regional Office.Bowler, D.P. (1968). Prospects for <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong>.Sem<strong>in</strong>ar on <strong>the</strong> Demography of Papua <strong>and</strong> NewGu<strong>in</strong>ea. Canberra: Australian National University.Bulmer, R.N.H. (1971). “Traditional forms of familylimitation <strong>in</strong> New Gu<strong>in</strong>ea”, Population Growth<strong>and</strong> Economic Change: Papers from <strong>the</strong> SecondDemographic Sem<strong>in</strong>ar, 1970. New Gu<strong>in</strong>ea ResearchBullet<strong>in</strong>, 42:137-162, September.Burdon, R., H. Polume <strong>and</strong> R. Iangalio (2002). The378