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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
Current Status of <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> <strong>in</strong> Papua NewGu<strong>in</strong>ea, Port Moresby: M<strong>in</strong>istry of Health.Bhushan, I. (1997). Underst<strong>and</strong><strong>in</strong>g Unmet Need,Johns Hopk<strong>in</strong>s School of Public Health, Center forCommunication Programmes, Work<strong>in</strong>g Paper No. 4,November.Caldwell, J. (1971). “Conclusions”, 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, September.Casterl<strong>in</strong>e, J. B. <strong>and</strong> S.W. S<strong>in</strong>d<strong>in</strong>g (2000). “Unmet needfor family plann<strong>in</strong>g <strong>in</strong> develop<strong>in</strong>g countries <strong>and</strong>implications for population policy”, Population <strong>and</strong>Development Review, 26(4):691-723.Coale, A.J. (1973). The Demographic TransitionReconsidered. Proceed<strong>in</strong>gs of <strong>the</strong> IUSSP <strong>International</strong>Population Conference, Liege, Belgium, pp. 65-72.D’Sa, E. (1988). “Population <strong>and</strong> development: majorissues <strong>and</strong> a modell<strong>in</strong>g proposal”, Yagl Ambu, 15(2):5-21.Department of <strong>Plann<strong>in</strong>g</strong> <strong>and</strong> Monitor<strong>in</strong>g (1999). PapuaNew Gu<strong>in</strong>ea National Population Policy 2000-2010,Waigani: Department of <strong>Plann<strong>in</strong>g</strong> <strong>and</strong> Monitor<strong>in</strong>g.Faithorn, E. (1975). The concept of pollution among <strong>the</strong>Kafe of <strong>the</strong> Papua New Gu<strong>in</strong>ea Highl<strong>and</strong>s. In R.R.Reiter (ed) Toward an Anthropology of Women.New York: Monthly Review Press, pp.127-140.Hayes, G. (1993). “The demographic situation <strong>in</strong>Papua New Gu<strong>in</strong>ea <strong>and</strong> its policy implications: an<strong>in</strong>ternational perspective”, In: T. Taufa <strong>and</strong> C. Bass,eds., Population <strong>Family</strong> Health <strong>and</strong> Development.Papers from <strong>the</strong> 19th Waigani Sem<strong>in</strong>ar. Vol. 1, PortMoresby: University of Papua New Gu<strong>in</strong>ea Press, pp.28-67.__________ (1998). Population Dynamics, PopulationModell<strong>in</strong>g <strong>and</strong> <strong>the</strong>ir Behavioural Base. In Haliza,M.R. <strong>and</strong> Pataki-Schweizer (eds) Behavioural Models<strong>in</strong> Medico-Health Research <strong>and</strong> Health Intervention.Kuala Lumpur: Institute of Medical Research <strong>and</strong>WHO. Pp. 21-40._________ (2002). A Population Profile of Papua NewGu<strong>in</strong>ea. Suva: UNFPA Country Support Team.Discussion Paper No. 25.__________ (2007) “The demographic impact of <strong>the</strong>HIV/AIDS Epidemic <strong>in</strong> Papua New Gu<strong>in</strong>ea, 1990-2030. <strong>Asia</strong>-<strong>Pacific</strong> Population Journal. 11(3) 11-30.Hayes, G. <strong>and</strong> A. Robertson (2010). “<strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> <strong>in</strong><strong>the</strong> <strong>Pacific</strong> Isl<strong>and</strong>s: Current Status <strong>and</strong> Prospects forRe-position<strong>in</strong>g <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> on <strong>the</strong> DevelopmentAgenda”, Paper prepared for High-Level Meet<strong>in</strong>g onAddress<strong>in</strong>g <strong>the</strong> Unf<strong>in</strong>ished Work of <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong><strong>in</strong> <strong>Asia</strong> <strong>and</strong> <strong>the</strong> <strong>Pacific</strong> Region, 8-10 December 2010,Bangkok, Thail<strong>and</strong>.Heider, K. (1976). “Dani sexuality: a low energy system”,Man (N.S.),11:188-201.Jenk<strong>in</strong>s, C. <strong>and</strong> National Sex <strong>and</strong> ReproductionResearch Team (1994). National Study of Sexual <strong>and</strong>Reproductive Knowledge <strong>and</strong> Behaviour <strong>in</strong> Papua NewGu<strong>in</strong>ea, Goroka: Papua New Gu<strong>in</strong>ea Institute ofMedical Research.Lesthaeghe, R. <strong>and</strong> C. V<strong>and</strong>erhoeft (2001). “Ready,will<strong>in</strong>g <strong>and</strong> able: a conceptualization of transitionsto new behavioural forms”, In: J. Caterl<strong>in</strong>e, ed.,Diffusion Processes <strong>and</strong> Fertility Transition: SelectedPerspectives, Wash<strong>in</strong>gton, D.C.: National AcademyPress.McDowell, Nancy (ed.) (1988). Reproductive DecisionMak<strong>in</strong>g <strong>and</strong> <strong>the</strong> Value of Children <strong>in</strong> Rural PapuaNew Gu<strong>in</strong>ea, Boroko, Papua New Gu<strong>in</strong>ea: Institute ofApplied Social <strong>and</strong> Economic Research.Maibani-Michie, G. (1998). <strong>Family</strong> plann<strong>in</strong>g: approval<strong>and</strong> use of modern contraceptives amongst ruralpeople of Rabaraba district, Milne Bay Prov<strong>in</strong>ce,Master of Community Health Thesis, Departmentof Community Health, University of Papua NewGu<strong>in</strong>ea.Midire, M., K. Ahmed <strong>and</strong> A. Robertson (2005).Reproductive Health Commodity SecurityComprehensive Assessment, Suva: UNFPA <strong>Pacific</strong>Sub-Regional Office.M<strong>in</strong>isterial Task Force on Maternal Health (2009).Report of <strong>the</strong> M<strong>in</strong>isterial Task Force on MaternalHealth <strong>in</strong> Papua New Gu<strong>in</strong>ea, Port Moresby: NationalDepartment of Health.Muirden, N. (1976) “The delivery of family plann<strong>in</strong>gservices with<strong>in</strong> primary health care. Unpublishedpamphlet. National Research Institute Library, PortMoresby._____________. (1982). “<strong>Family</strong> plann<strong>in</strong>g programmes”,In: Population of Papua New Gu<strong>in</strong>ea, ESCAP CountryMonograph Series 7.2, chap. VI.National Department of Health (2007). National <strong>Family</strong><strong>Plann<strong>in</strong>g</strong> Policy, Implementation Strategy <strong>and</strong> TechnicalSt<strong>and</strong>ards, second edition, Waigani, Papua NewGu<strong>in</strong>ea: National Department of Health._________. (2009). National Sexual <strong>and</strong> ReproductiveHealth Policy. Port Moresby: National Departmentof Health.National Statistical Office (1995). Report on <strong>the</strong> 1991Demographic <strong>and</strong> Health Survey. Port Moresby:NSO._________. (1997). Papua New Gu<strong>in</strong>ea Demographic <strong>and</strong>Health Survey 1996: National Report. Port Moresby:National Statistical Office.__________. (2009). Papua New Gu<strong>in</strong>ea Demographic<strong>and</strong> Health Survey 2006, National Report. PortMoresby: National Statistical Office.O’Coll<strong>in</strong>s, M. (1979). Population <strong>and</strong> <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> <strong>in</strong>Papua New Gu<strong>in</strong>ea <strong>and</strong> Solomon Isl<strong>and</strong>s, Waigani:University of Papua New Gu<strong>in</strong>ea (pamphlet).Pataki-Schweizer, K.J. (1996). On Reproduction <strong>and</strong>379
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Family Pla
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ForewordThe Asia <
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Part 1Part 1Asia <
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Ensuring that <str
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of methods for all, in</str
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and undertake <str
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Report on the Regi
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SESSION 1: Changin
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that improving <st
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at a hospital would be offered post
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Bounkoung Phichit, Deputy M
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medicines
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Thus, while knowledge of modern met
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Hon. Mr. Malakai Tabar, Chairman, P
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curricula. If the
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dialogue as well as regional <stron
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BackgroundGlobal development effort
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TableTable1EventNational policyYear
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A third observation is that reporte
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TableTable2Current Contraceptive Pr
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Figure(-1.2), Cook Island</
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FigureTableTable3Trends in<
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Nam. Nearly all economies i
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2008 2009% Bilateral % Multilateral
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family planning wi
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IntroductionFamily
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The advent of the
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FigureFigure1Oceania and</s
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next 25 years, however, TFR fluctua
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FigureFigureFigure2Total fertility
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family planning pr
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esponsible for the
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that estimates of CPR for earlier p
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Figuremarried at an older age compa
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As previously mentioned most <stron
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FigureFigure945Relationship between
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The concept of “unmet need” has
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TableTable8Percentage of th
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TableTable9Percentage of reasons fo
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family planning pr
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As far as the supp
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Socio-cultural challenges tofamily
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likely to use contraception than yo
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15 Tests of statistical significanc
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of the South <stro
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104
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Figurewill exceed the</stro
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in urban (67%) tha
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ased service delivery poin<
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Most FWAs who were recruited two to
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are considered, unmet need for effe
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Households pay the
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Effective public-private partnershi
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ConclusionThe Bangladesh Fa
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the Family
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National Institute for Population R
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IndiaIndiaFamily <
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IntroductionThe use of contraceptiv
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TableTable2Indicators of tra<strong
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FigureFigureFigure1Contraceptive pr
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TableTable5Indicators of contracept
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TableTable6Adjusted odds ratios for
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FigureFigure3Contraceptive prevalen
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TableTable7Adjusted and</st
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the north
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TableTable10Differences between nor
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TableTable11 Total fertility rate <
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End Note1The first camp was success
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152
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154
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Figure1980s and ex
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health care and ed
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assistance from UNFPA and</
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in CPR. Likewise,
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International supp
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in development has
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__________ (2007). Population <stro
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170
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TableTable2What has the</st
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174
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per cent of women reported us<stron
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is provider bias that such methods
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TableTable7skewed distribution of h
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TableTable8TableTable9182
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that of the nation
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TableTable12 7some policies that ex
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The system guides the</stro
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FigureFigure4Total donor expenditur
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FigureFigureagain
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Impact of family plannin</s
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marketing of contr
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United States Agency for In
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200
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acceptable. From an NGO perspective
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FigureThis trend of limited donor f
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Figureto have the
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FigureFigure5Percentage change <str
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FigureFigure6Desire to limit childb
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coordination betwe
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the 1980s
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Policy Management.__________ (n.d.,
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218
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Population Activities (UNFPA) for a
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where family plannin</stron
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Thus an objective assessment of <st
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226
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Figureeconomic growth durin
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TableTable1TableTable2For spac<stro
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eflect a provider bias (e.g., <stro
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The Indonesian delegation was very
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than in ensur<stro
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in-country <strong
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(Ministry of Healt
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242
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244
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FigureTrends and p
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TableTable3Unmet need for contracep
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TableTable5TableTable6TableTable725
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TableTable8TableTable9Malaysia, abo
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previously mentioned is based on fo
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TableTable16births and</str
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FigureFigure3TRF54.5Scatter plots o
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ReferencesAng, Eng Suan (2007). Stu
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Demographic data sheet: population
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population size, with just 336,000
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NuptialityIn Myanmar nuptiality is
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FigureIn Myanmar, birth-spac<strong
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Scope of coverage and</stro
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FigureIn Myanmar, out of six select
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equirements. The Min</stron
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according to <stro
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Adolescent sexual and</stro
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FigureHIV/AIDS. An HIV-positive wom
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National Population PolicyMyanmar i
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Linkages with o<st
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TableTable4Achievements of Myanmar
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monitoring <strong
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Nay Pyi Taw, 26 October 2010.53 Sit
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294
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TableTableA296
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dispense and adm<s
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(1) I am against a
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FigureFigureFigure3Use of modern co
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FigureFigure7Traditional method use
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Figureprojection, and</stro
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Figure 11 summarizes the</s
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correlating <stron
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Figurethe use of c
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FigureFigure15Sexual behaviour <str
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track the distribu
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Figureservices, which should <stron
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FigureFigureFigure18 Population <st
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National Statistics Office, <strong
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TableTable6TableTable7TableTable832
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TableTable11326
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Page 392 and 393: 1545-1730Day 2: December 9Session 2
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Page 396 and 397: 15Mr. Tong Sithen1
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Page 402 and 403: 131Dr. John P. SkibiakDirectorRepro
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