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

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curricula. If <strong>the</strong> state was unwill<strong>in</strong>g to provide sucha service, l<strong>in</strong>ks should be forged with <strong>the</strong> NGOcommunity.Question/issue:Hon. Mr. Raymond Palat<strong>in</strong>o, Congressman for <strong>the</strong>Philipp<strong>in</strong>e Congress, was asked to comment on how totackle a grow<strong>in</strong>g number of young fundamentalists, asituation also faced by Indonesia. Had <strong>the</strong> Philipp<strong>in</strong>esfaced any challenges <strong>in</strong> deal<strong>in</strong>g with religion? What wereways to advocate issues among young people who mightnot have had a good underst<strong>and</strong><strong>in</strong>g of <strong>the</strong> issues.Response (Hon. Mr. Raymond Palat<strong>in</strong>o, <strong>the</strong>Philipp<strong>in</strong>es):There was no major problem <strong>in</strong> <strong>the</strong> Philipp<strong>in</strong>es. Therewas a separatist movement, but it had not translated <strong>in</strong>todifficulties <strong>in</strong> <strong>the</strong> provision of services. Experiences from<strong>the</strong> Philipp<strong>in</strong>es suggested that it was best to providepolitical <strong>and</strong> economic reforms <strong>in</strong> those areas.Response (Hon. Dr. Sumaryati Arjoso, Indonesia):Condom promotion for HIV prevention <strong>in</strong> Indonesiawas complicated as it was often viewed as promot<strong>in</strong>gextramarital sex. One entry po<strong>in</strong>t was to use children’srights.Access of Young Peopleto Contraceptive ServicesModerator:H.E. Dr. Nadera Hayat Burhani, Deputy M<strong>in</strong>ister ofHealth, AfghanistanThe session <strong>in</strong>cluded presentations on unmet needfor contraception among adolescents from a globalperspective, programme experiences from India <strong>and</strong> VietNam on youth-friendly services <strong>and</strong> behavioural changecommunication, as well as <strong>the</strong> lack of access of youngpeople to services <strong>in</strong> India. The session closed with a paneldiscussion featur<strong>in</strong>g young people from Bangladesh,India, <strong>the</strong> Marshall Isl<strong>and</strong>s <strong>and</strong> <strong>the</strong> Philipp<strong>in</strong>es.Unmet need for contraception among adolescents by Dr.Nuriye Ortayli, <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> Advisor, UNFPAThe presentation focused on address<strong>in</strong>g unmet need forcontraception among adolescents. Youth were <strong>the</strong> mostunderserved group <strong>and</strong> were disadvantaged <strong>in</strong> terms ofrealiz<strong>in</strong>g <strong>the</strong>ir wishes to avoid pregnancy. Young peoplewere be<strong>in</strong>g left beh<strong>in</strong>d. The largest cohort of adolescents,<strong>in</strong>dividuals between 10 <strong>and</strong> 19 years old, were <strong>in</strong> aperiod of transition from childhood to adulthood, <strong>and</strong><strong>the</strong> current group represented <strong>the</strong> largest cohort ofadolescents that <strong>the</strong> world had ever seen.Evidence showed that adolescents were sexually active.More than three quarters were sexually active by age 20.The assumption had been that sex started with marriage<strong>and</strong> many surveys covered unmarried youth; however,evidence showed that adolescents did engage <strong>in</strong> sexbefore marriage. The age at first marriage, based on DHSfigures, varied across <strong>the</strong> region; however, a substantialnumber of young people got married before <strong>the</strong> age of15. Among that group, <strong>the</strong> use of contraception was lowfor a variety of reasons: some wanted to get pregnant,while o<strong>the</strong>rs wanted to avoid pregnancy but did not have<strong>the</strong> means to do so.Across <strong>the</strong> region, <strong>the</strong> youngest age group wasdisadvantaged <strong>in</strong> terms of realiz<strong>in</strong>g <strong>the</strong>ir wishes to avoidpregnancy. Analysis of total dem<strong>and</strong> <strong>and</strong> total dem<strong>and</strong>satisfied among age groups showed that young peoplehad been left beh<strong>in</strong>d. Those patterns were evident <strong>in</strong>Cambodia, India, Nepal <strong>and</strong> Pakistan. In many sett<strong>in</strong>gsdem<strong>and</strong> was low, but total dem<strong>and</strong> satisfied was evenlower.Access of young people to reproductive health services,<strong>in</strong>clud<strong>in</strong>g contraceptive services – experience from <strong>the</strong>region by Ms. Sono Aibe – Senior Advisor for StrategicInitiatives, Pathf<strong>in</strong>der <strong>International</strong>The presentation focused on experiences <strong>and</strong>conclusions from <strong>in</strong>terventions implemented byPathf<strong>in</strong>der <strong>International</strong> on public sector youth <strong>in</strong> anSRH programme <strong>in</strong> Viet Nam <strong>and</strong> <strong>the</strong> PRACHAR(Promot<strong>in</strong>g Change <strong>in</strong> Reproductive Behaviour <strong>in</strong>Bihar) programme <strong>in</strong> rural parts of India’s Bihar state.Experiences related to youth-friendly services <strong>in</strong> VietNam showed that public sector facilities were <strong>the</strong> mostsusta<strong>in</strong>able <strong>and</strong> cost-effect <strong>in</strong>terventions. However, ifboys <strong>and</strong> high-risk groups did not want to visit publichealth centres, mobile services could reach large numbersof youth that might not seek services <strong>in</strong> o<strong>the</strong>r locations.Multi-purpose centres had proven to be quite costly <strong>and</strong>did not reach many with RH services, especially if thosecentres were built as st<strong>and</strong>-alone structures. They weretoo costly unless located <strong>in</strong> urban areas.Experiences related to behavioural change communication<strong>in</strong> Bihar <strong>in</strong>cluded <strong>in</strong>creased dem<strong>and</strong> for contraceptives.Audience segmentation <strong>and</strong> message tailor<strong>in</strong>g weregood methods to address that approach. Efforts werebe<strong>in</strong>g made to target unmarried boys <strong>and</strong> girls, as wellas newlywed youth. The <strong>in</strong>itiative had <strong>in</strong>spired <strong>the</strong> activeengagement of gatekeepers, work<strong>in</strong>g through communitychange agents that went from door to door <strong>and</strong> worked34
with local <strong>the</strong>atre groups. The results <strong>in</strong>cluded <strong>in</strong>creasedcontraceptive use.The presentation suggested <strong>the</strong> need for better datawith<strong>in</strong> government health systems; go<strong>in</strong>g beyond <strong>the</strong>traditional def<strong>in</strong>ition of education <strong>and</strong> <strong>in</strong>stead look<strong>in</strong>gat life skills. Also, work<strong>in</strong>g towards delay<strong>in</strong>g <strong>the</strong> age atmarriage <strong>and</strong> first birth <strong>and</strong> ensur<strong>in</strong>g access to affordablecontraceptives for all youth were o<strong>the</strong>r importantmeasures to take.The presentation concluded with suggest<strong>in</strong>g that, s<strong>in</strong>ce<strong>the</strong> <strong>Asia</strong>n <strong>and</strong> <strong>Pacific</strong> region had been a leader <strong>in</strong> familyplann<strong>in</strong>g, it was now time to become a leader aga<strong>in</strong> <strong>in</strong>adolescent family plann<strong>in</strong>g <strong>and</strong> reproductive health.Meet<strong>in</strong>g <strong>the</strong> sexual <strong>and</strong> reproductive health of youth:<strong>in</strong>sights from India by Dr. Shireen Jejeeboy, SeniorAssociate, Population <strong>Council</strong>, IndiaThe presentation focused on <strong>the</strong> sexual <strong>and</strong> reproductivehealth of youth based on programme experiences <strong>in</strong>India. There was evidently a dem<strong>and</strong> for sexual <strong>and</strong>reproductive health services among youth, but it was notbe<strong>in</strong>g met. Key obstacles that youth faced <strong>in</strong> meet<strong>in</strong>g<strong>the</strong>ir SRH needs <strong>in</strong>cluded lack of access to, <strong>and</strong> lack ofcapacity of, relevant services. There was a lack of goodqualitycare. Youth lacked <strong>in</strong>formation <strong>and</strong> negotiationskills. Evidence showed that tak<strong>in</strong>g a multisectoralapproach to <strong>the</strong> issue was crucial.The presentation <strong>in</strong>cluded an analysis of DHS data onmarried <strong>and</strong> non-married youth. The data revealed thatpremarital sex was happen<strong>in</strong>g, primarily <strong>in</strong> rural areas<strong>and</strong> across all states. Early marriage was persist<strong>in</strong>g, ashalf of youth were married before 18. Most of thoseyouth wanted just two children.Evidence showed that unmarried youth wished to avoidpregnancy, yet few had practised contraception. Among<strong>the</strong> married group, very few delayed <strong>the</strong> first birth, oftenbecause of sociocultural factors. Unmet need amongyouth was twice that of older populations. Abortion wasmost common among youth <strong>and</strong> was conducted <strong>in</strong> <strong>the</strong>second trimester.Programmatic implications <strong>in</strong>cluded tak<strong>in</strong>gmultisectoral action with a focus on collaboration withall relevant partners <strong>in</strong>clud<strong>in</strong>g government <strong>and</strong> NGOs.Fur<strong>the</strong>r, it was imperative to realize <strong>and</strong> take actionon <strong>the</strong> commitments conta<strong>in</strong>ed <strong>in</strong> policy documents.Health-care providers needed to be oriented towardsovercom<strong>in</strong>g <strong>the</strong>ir own bias. Efforts should be placed on<strong>in</strong>itiat<strong>in</strong>g sexuality education. Also, advocacy should betargeted towards <strong>in</strong>creas<strong>in</strong>g <strong>the</strong> age at marriage, as wellas <strong>in</strong>creas<strong>in</strong>g <strong>in</strong>vestment <strong>in</strong> youth.PANEL DISCUSSION WITHYOUNG PEOPLE FROMSELECTED COUNTRIES:Bangladesh, India, TheMarshall Isl<strong>and</strong>s <strong>and</strong> ThePhilipp<strong>in</strong>esYoung people <strong>in</strong>volved <strong>in</strong> advocat<strong>in</strong>g for sexual <strong>and</strong>reproductive health <strong>and</strong> rights for youth <strong>in</strong> <strong>the</strong>ir countriesconducted a panel discussion which <strong>in</strong>cluded briefstatements, discussions <strong>and</strong> a question-<strong>and</strong>-answersession.Bangladesh:Ms. Syefa Ahmed stated that one third of <strong>the</strong> population<strong>in</strong> Bangladesh comprised youths. Generally, parentsrarely talked about sexuality <strong>and</strong> youth did not haveanywhere to go for <strong>in</strong>formation <strong>and</strong> services. Youthissues should be facilitated <strong>and</strong> addressed <strong>in</strong> differentsectors, with emphasis on youth-friendl<strong>in</strong>ess.Philipp<strong>in</strong>es:Ms. Lady Lisondra suggested that <strong>the</strong> largest culturalbarrier <strong>in</strong> <strong>the</strong> Philipp<strong>in</strong>es was underst<strong>and</strong><strong>in</strong>g <strong>the</strong> sexualrights of young people. Her ma<strong>in</strong> recommendationwas for <strong>the</strong> Philipp<strong>in</strong>es to pass <strong>the</strong> RH bill <strong>and</strong> ensurethat sexuality education was <strong>in</strong>corporated <strong>in</strong>to schoolcurricula.Marshall Isl<strong>and</strong>s:Ms. Tata Kalles stated that 80 per cent of young people<strong>in</strong> <strong>the</strong> Marshall Isl<strong>and</strong>s knew about condoms but only5 per cent used <strong>the</strong>m. Key cultural barriers militat<strong>in</strong>gaga<strong>in</strong>st <strong>the</strong>ir use were that sex was not allowed, yet peoplestill became sexually active. Radio <strong>and</strong> television could<strong>in</strong>form but youth could not access <strong>the</strong> commodities <strong>the</strong>yneeded.India:Ms. Suchitra Rath <strong>in</strong>dicated that experiences fromOrissa state showed that community health workersshould have <strong>the</strong> capacity to provide counsell<strong>in</strong>g <strong>and</strong>create dem<strong>and</strong>.Discussion po<strong>in</strong>tsQuestion/issue:What should be done with out-of-school youth, a veryvulnerable group? As <strong>the</strong> curriculum on adolescent sexual<strong>and</strong> reproductive health rema<strong>in</strong>ed deficient <strong>and</strong> teacherswere shy <strong>in</strong> teach<strong>in</strong>g courses on adolescent reproductivehealth, what could be done to address that problem?35
Page 1: Family Pla
Page 7 and 8: ForewordThe Asia <
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Page 51: BackgroundGlobal development effort
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Page 70 and 71: family planning wi
Page 73 and 74: IntroductionFamily
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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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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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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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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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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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