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

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Thus, while knowledge of modern methods was highacross <strong>the</strong> region, contraceptive use varied. The use oftraditional methods existed regardless of age or wealthqu<strong>in</strong>tile. Reasons for not us<strong>in</strong>g modern methods po<strong>in</strong>tedto programme areas that needed quality improvement.The analysis of DHS data revealed that adolescentsneeded specific attention as well as access to familyplann<strong>in</strong>g services, which was an issue <strong>in</strong> rural areasacross <strong>the</strong> region.Role of counsell<strong>in</strong>g <strong>in</strong> family plann<strong>in</strong>g services byMs. N<strong>in</strong>uk Widyantoro, Chair, Women’s HealthFoundationThe presentation focused on <strong>the</strong> role of counsell<strong>in</strong>g as acrucial, yet often overlooked, component <strong>in</strong> <strong>the</strong> deliveryof good-quality care. A focus on counsell<strong>in</strong>g gave backwomen <strong>the</strong>ir rights.Counsell<strong>in</strong>g was a process that <strong>in</strong>volved empower<strong>in</strong>g aclient <strong>in</strong> mak<strong>in</strong>g his or her own decision. The criteriafor be<strong>in</strong>g an effective counsellor were that he or sheneeded to believe that each client had <strong>the</strong> right to decide;counsellors needed to have a warm, friendly <strong>and</strong> nonjudgmentalpersonality, as well as personal motivationto help o<strong>the</strong>rs. The effective counsellor needed to beskilful <strong>in</strong> <strong>in</strong>terpersonal communication. Two-waycommunication, us<strong>in</strong>g both verbal <strong>and</strong> non-verbal cues,was a crucial component of effective <strong>and</strong> good-qualitycounsell<strong>in</strong>g.Entry po<strong>in</strong>ts to good counsell<strong>in</strong>g <strong>in</strong>cluded supportfor peer education. Tra<strong>in</strong><strong>in</strong>g programmes that weredeveloped for peer education could be adapted tocounsell<strong>in</strong>g. Counsell<strong>in</strong>g would serve <strong>the</strong> communitywith <strong>in</strong>formation <strong>and</strong> knowledge regard<strong>in</strong>g SRHR <strong>and</strong>could play a role <strong>in</strong> community empowerment.Inequity <strong>in</strong> family plann<strong>in</strong>g <strong>and</strong> reproductive healthservices <strong>in</strong> Indonesia byMr. Kartono Muhammed, Women’s Health Foundation,IndonesiaThe presentation focused on some of <strong>the</strong> causes of<strong>in</strong>equity <strong>and</strong> low achievement <strong>in</strong> family plann<strong>in</strong>g <strong>and</strong>reproductive health services <strong>in</strong> Indonesia. Contribut<strong>in</strong>gfactors <strong>in</strong>cluded a lack of underst<strong>and</strong><strong>in</strong>g among decisionmakersat <strong>the</strong> central <strong>and</strong> local levels <strong>and</strong> <strong>in</strong> politicalparties; ambiguity of laws; lack of strong commitmentfrom <strong>the</strong> central government, as well as lack of clearobjectives for FP programmes.Indonesia was divided <strong>in</strong>to 33 prov<strong>in</strong>ces with a totalof 370 districts. Based on a decentralization process,<strong>the</strong> responsibility for family plann<strong>in</strong>g <strong>and</strong> reproductivehealth was at <strong>the</strong> district/municipal levels. Health <strong>and</strong>family plann<strong>in</strong>g policy was formulated <strong>and</strong> carried outat <strong>the</strong> local level. The sudden decentralization thatIndonesia had experienced was not positive as mostdistrict heads <strong>and</strong> mayors were not prepared to take overrelated responsibilities. Population <strong>and</strong> family plann<strong>in</strong>gwere not on <strong>the</strong>ir list of priorities, which resulted <strong>in</strong>those issues be<strong>in</strong>g neglected.There were also some social <strong>and</strong> environmental factors,<strong>in</strong>clud<strong>in</strong>g <strong>the</strong> health-care system still be<strong>in</strong>g based ona fee-for-service system paid out of pocket; <strong>the</strong> rise ofreligious fundamentalism had put political pressureon <strong>the</strong> government. There was also a decl<strong>in</strong>e <strong>in</strong> FPcampaigns <strong>and</strong> services, as well as <strong>the</strong> disb<strong>and</strong><strong>in</strong>g of fieldworkers.It was expected that Indonesia could achieve MDG5 onlyby 2025, unless strong efforts were <strong>in</strong>itiated. Indonesiapresented a paradox <strong>in</strong> terms of maternal mortality ratio<strong>and</strong> CPR, both of which were high. Those phenomenasuggested that someth<strong>in</strong>g was miss<strong>in</strong>g <strong>in</strong> <strong>the</strong> analysis,potentially l<strong>in</strong>ked to unsafe abortion practices.Discussion po<strong>in</strong>tsQuestion/issue:DHS had been conducted <strong>in</strong> Pakistan s<strong>in</strong>ce 1984 (or for26 years). F<strong>in</strong>d<strong>in</strong>gs showed that <strong>the</strong>re were <strong>in</strong>equalities<strong>in</strong> <strong>the</strong> programme. It was suggested that DHS be movedto a second-generation survey that would exam<strong>in</strong>e suchmatters as distance to facilities, causes <strong>and</strong> transportcosts, <strong>and</strong> that costs be broken down better.Response:It was encourag<strong>in</strong>g to conduct fur<strong>the</strong>r studies that lookedmore closely at <strong>in</strong>equalities <strong>and</strong> looked beh<strong>in</strong>d <strong>in</strong>itialfigures. The development of some supplementary surveysunder DHS had been embarked upon. Informationrelated to that development was available on <strong>the</strong> DHSwebsite. Research could be conducted that would becomplementary to <strong>the</strong> DHS surveys. Also, flexibilityexisted <strong>in</strong> terms of add<strong>in</strong>g to <strong>the</strong> DHS questionnaire.The survey had evolved to a po<strong>in</strong>t where it already<strong>in</strong>cluded more <strong>in</strong>formation on cost<strong>in</strong>g, for example.Question/issue:Although DHS <strong>in</strong>cluded contraceptive knowledge,that could depend on how <strong>the</strong> surveys were <strong>in</strong>formed.Almost all persons surveyed (99%) had knowledge ofcontraceptive methods, but might not be sure how touse a certa<strong>in</strong> contraceptive. It was not clear if <strong>the</strong> surveysreally presented what were real needs.Response:The call for additional <strong>in</strong>formation was useful; perhapsit could be satisfied through <strong>the</strong> provision of qualitativedata.30
Question/issue:DHS was time-consum<strong>in</strong>g <strong>and</strong> expensive. One concernwas that <strong>the</strong>re were no mechanisms <strong>in</strong> place to supportcountries <strong>in</strong> <strong>the</strong> development of <strong>the</strong>ir own methods totrack CPR. The <strong>in</strong>formation was delayed. It was alsosuggested that DHS cut <strong>the</strong> number of questions <strong>in</strong> <strong>the</strong>questionnaire.• Comments were raised related to efforts to reduce <strong>the</strong>costs of DHS.• It was reiterated that counsell<strong>in</strong>g played a veryimportant role <strong>in</strong> service delivery. Many women started<strong>and</strong> <strong>the</strong>n stopped us<strong>in</strong>g contraceptives. Evidence wasneeded to show <strong>the</strong> important role of quality of care,<strong>in</strong>clud<strong>in</strong>g conv<strong>in</strong>c<strong>in</strong>g data for shar<strong>in</strong>g with o<strong>the</strong>rs.• WHO had conducted a study on client-providerrelationships, which provided evidence on counsell<strong>in</strong>gneeds.Question/issue:Indonesia <strong>and</strong> Iran (through its university-basedprogramme) were examples of countries that <strong>in</strong>cludedcounsell<strong>in</strong>g as a component <strong>in</strong> <strong>the</strong>ir family plann<strong>in</strong>gprogrammes. Indonesia had high levels of CPR. Whatemphasis was placed on emergency obstetric care <strong>and</strong>skilled birth attendants?Response:One negative factor fac<strong>in</strong>g Indonesia was <strong>the</strong> highmobility of doctors.• Experience had shown that, <strong>in</strong> order to providegood <strong>in</strong>formation, it was important to empower <strong>the</strong>providers, who were usually <strong>the</strong> lowest paid employees<strong>in</strong> <strong>the</strong> family plann<strong>in</strong>g programme even though <strong>the</strong>ywere <strong>the</strong> ones <strong>in</strong> contact with <strong>the</strong> clients. Cont<strong>in</strong>uedevaluations were needed to assess counsell<strong>in</strong>g skills,which should be a component of family plann<strong>in</strong>gprogrammes.• Client satisfaction as an assessment po<strong>in</strong>t was notvery useful <strong>in</strong> determ<strong>in</strong><strong>in</strong>g what were <strong>the</strong> reproductive<strong>in</strong>tentions of people.SESSION 5: Advocacy<strong>and</strong> Actions for Tak<strong>in</strong>gForward Commitmentsto Invest<strong>in</strong>g <strong>in</strong> <strong>Family</strong><strong>Plann<strong>in</strong>g</strong>Moderator:Mr. Najib M. Assifi, Deputy Director, UNFPA APROThe purpose of <strong>the</strong> session was to explore opportunitiesfor advocacy through parliamentarians. There weremany success stories of parliamentarians who stood up,advocated <strong>and</strong> took action for reproductive health. Also,<strong>the</strong>re were examples of not fully us<strong>in</strong>g <strong>the</strong> potential ofparliamentarians. The session was developed as a roundtable with media-led questions to parliamentarians. Thesession also <strong>in</strong>cluded presentations related to youngpeople’s access to contraceptive services, with <strong>in</strong>sightsfrom UNFPA <strong>and</strong> Pathf<strong>in</strong>der <strong>International</strong>, as wellas experiences from India. The session ended with apanel discussion featur<strong>in</strong>g young people from selectedcountries.Round-table discussion with parliamentarians <strong>and</strong>media experts.The follow<strong>in</strong>g section outl<strong>in</strong>ed key po<strong>in</strong>ts raised dur<strong>in</strong>g<strong>the</strong> round-table discussion with parliamentarians fromIndonesia, Papua New Gu<strong>in</strong>ea <strong>and</strong> <strong>the</strong> Philipp<strong>in</strong>es, ledby journalists from Indonesia <strong>and</strong> Pakistan.Hon. Dr. Sumaryati Arjoso, Member of Parliament,Indonesia.Hon. Dr. Sumaryati addressed <strong>the</strong> context ofdecentralization <strong>in</strong> Indonesia <strong>and</strong> <strong>the</strong> importance ofstreng<strong>the</strong>n<strong>in</strong>g networks on all levels. He also raised issuesrelated to adolescent sexual <strong>and</strong> reproductive health <strong>and</strong>highlighted <strong>the</strong> need for work<strong>in</strong>g with <strong>and</strong> advocat<strong>in</strong>gtoge<strong>the</strong>r with community leaders. He voiced concernthat family plann<strong>in</strong>g had lost its momentum once <strong>the</strong>country reached replacement-level fertility.Hon. Congressman Mr. Rodolfo Biazon, Member ofParliament, Philipp<strong>in</strong>es.Hon. Congressman Mr. Rodolfo Biazon suggestedthat population growth <strong>in</strong> <strong>the</strong> Philipp<strong>in</strong>es was putt<strong>in</strong>gpressure on <strong>the</strong> country’s natural resources. Heemphasized <strong>the</strong> need to get <strong>the</strong> message of populationplann<strong>in</strong>g to <strong>the</strong> people <strong>and</strong> forg<strong>in</strong>g a partnership betweenmedia <strong>and</strong> politicians to do so. He acknowledged thatmany campaigners were still at <strong>the</strong> advocacy stage.He suggested that population growth could act as anobstacle to economic development.31
Page 1: Family Pla
Page 7 and 8: ForewordThe Asia <
Page 11: Part 1Part 1Asia <
Page 14 and 15: Ensuring that <str
Page 16 and 17: of methods for all, in</str
Page 18 and 19: and undertake <str
Page 21 and 22: Report on the Regi
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Page 25 and 26: that improving <st
Page 31: at a hospital would be offered post
Page 35: Bounkoung Phichit, Deputy M
Page 38 and 39: medicines
Page 42 and 43: Hon. Mr. Malakai Tabar, Chairman, P
Page 44 and 45: curricula. If the
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Page 51: BackgroundGlobal development effort
Page 54 and 55: TableTable1EventNational policyYear
Page 56 and 57: A third observation is that reporte
Page 58 and 59: TableTable2Current Contraceptive Pr
Page 60 and 61: Figure(-1.2), Cook Island</
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Page 67: 2008 2009% Bilateral % Multilateral
Page 70 and 71: family planning wi
Page 73 and 74: IntroductionFamily
Page 75 and 76: The advent of the
Page 77 and 78: FigureFigure1Oceania and</s
Page 79 and 80: next 25 years, however, TFR fluctua
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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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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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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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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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TableTable11326
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TableTable19Laws and</stron
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worker and hours w
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334
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336
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includin</
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TableTable1Contraceptive prevalence
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These results suggest that about 70
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2 The (period) TFR is the</
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346
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FigureThe existence of traditional
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Guinea case by <st
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The establishment of provin
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provide family plannin</str
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Figurelegal requirement nor a condi
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FigureTableTable5TableTable6Figure4
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modern method and
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married or in unio
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Figureolder. Both the</stro
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TableTable15The immediate past Nati
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out that the “ne
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Commodity securitySupply cha<strong
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is able to achieve. In Papua New Gu
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Qualitative assessments by a number
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increasin<
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service delivery poin</stro
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Population: Views from Men
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1545-1730Day 2: December 9Session 2
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Day 3, December 10Session 50830-100
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15Mr. Tong Sithen1
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54Ms. Shadiya IbrahimAssistant Repr
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93Mr. Melkie AntonProject OfficerUn
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131Dr. John P. SkibiakDirectorRepro
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International <str
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