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

BackgroundGlobal development efforts today are framed largely by<strong>the</strong> Millennium Development Goals (MDGs). Of thoseeight Goals, <strong>the</strong> one most widely acknowledged to beoff-track is No. 5, “Improv<strong>in</strong>g maternal health”. Target 5bof that Goal, “Universal access to reproductive health”, isexperienc<strong>in</strong>g <strong>the</strong> same lack of progress <strong>in</strong> low-resourcesett<strong>in</strong>gs. Achiev<strong>in</strong>g MDG 5 <strong>and</strong> Target 5b is seen to bekey to <strong>the</strong> achievement of all <strong>the</strong> MDGs (Cates et al.,2010). <strong>Family</strong> plann<strong>in</strong>g, <strong>in</strong>clud<strong>in</strong>g specifically <strong>the</strong> practiceof contraception, is a social <strong>and</strong> health <strong>in</strong>tervention thatdirectly addresses all objectives under that Target, whe<strong>the</strong>rby avert<strong>in</strong>g births that carry high mortality risk for <strong>the</strong>mo<strong>the</strong>r <strong>and</strong> newborn, prevent<strong>in</strong>g un<strong>in</strong>tended pregnancies,reduc<strong>in</strong>g STI/HIV transmission through consistentcondom use, enabl<strong>in</strong>g women <strong>and</strong> girls to decide when <strong>and</strong>how many children to bear, or by alter<strong>in</strong>g <strong>the</strong> dynamics ofpopulation change to facilitate susta<strong>in</strong>able development.As def<strong>in</strong>ed by <strong>the</strong> 1987 report 1 of <strong>the</strong> Brundtl<strong>and</strong>Commission, “Susta<strong>in</strong>able development is developmentthat meets <strong>the</strong> needs of <strong>the</strong> present without compromis<strong>in</strong>g<strong>the</strong> ability of future generations to meet <strong>the</strong>ir own needs”.Contraceptive practice has been <strong>the</strong> primary proximatedeterm<strong>in</strong>ant beh<strong>in</strong>d fertility transitions <strong>in</strong> <strong>Asia</strong> <strong>and</strong> <strong>the</strong><strong>Pacific</strong> <strong>and</strong> o<strong>the</strong>r develop<strong>in</strong>g regions, <strong>and</strong> a behavioural<strong>in</strong>novation embraced by governments <strong>in</strong> <strong>the</strong> region tosecure susta<strong>in</strong>able development. Susta<strong>in</strong>able developmentrema<strong>in</strong>s <strong>the</strong> collective aim of all eight MDGs.The develop<strong>in</strong>g world has a long history of family plann<strong>in</strong>gefforts embedded <strong>in</strong> population development policies,with <strong>the</strong> strongest record be<strong>in</strong>g <strong>in</strong> <strong>Asia</strong> <strong>and</strong> Lat<strong>in</strong> America.These efforts materialized between <strong>the</strong> mid-1960s <strong>and</strong>late 1980s, all predat<strong>in</strong>g <strong>the</strong> formation of <strong>the</strong> MDGframework. Rob<strong>in</strong>son <strong>and</strong> Ross (2007) <strong>in</strong> The Global<strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> Revolution: Three Decades of PopulationPolicies <strong>and</strong> Programs wrote <strong>the</strong> follow<strong>in</strong>g:The years just after 1960 saw<strong>the</strong> appearance of a new fertilitydeterm<strong>in</strong>ant—organized actions bywhole societies to br<strong>in</strong>g birth rates downto match fall<strong>in</strong>g death rates, <strong>and</strong> to ease<strong>the</strong> accompany<strong>in</strong>g dislocations faced byeducational, medical, economic, hous<strong>in</strong>g<strong>and</strong> family system <strong>in</strong>stitutions <strong>and</strong> o<strong>the</strong>rs.Those actions were also meant to givewomen greater control over <strong>the</strong>ir ownchildbear<strong>in</strong>g <strong>and</strong> to relieve families from<strong>the</strong> unexpected burdens of rais<strong>in</strong>g moresurviv<strong>in</strong>g children than <strong>in</strong> <strong>the</strong> past. Thetwo results toge<strong>the</strong>r, societal benefits <strong>and</strong>personal benefits, flowed from programsbased on new contraceptive technologiesthat could be deployed to wholepopulations. (Preface)Indeed, long before modern contraceptive technologiesas we know <strong>the</strong>m today became widely available, India<strong>in</strong> 1951 was <strong>the</strong> first country to adopt family plann<strong>in</strong>gas part of its economic development plan. O<strong>the</strong>r <strong>Asia</strong>ncountries followed suit shortly <strong>the</strong>reafter: Pakistan(1960), <strong>the</strong> Republic of Korea (1961), Ch<strong>in</strong>a <strong>and</strong> Fiji(1962), S<strong>in</strong>gapore <strong>and</strong> Sri Lanka (1965), with non-<strong>Asia</strong>n countries, such as Egypt <strong>and</strong> Turkey, committ<strong>in</strong>g<strong>the</strong>mselves <strong>in</strong> 1965 to <strong>the</strong> support of family plann<strong>in</strong>g.This show of national commitment occurred one decadebefore develop<strong>in</strong>g countries’ contrast<strong>in</strong>g views on familyplann<strong>in</strong>g’s role <strong>in</strong> economic development would lead <strong>the</strong>mto align <strong>the</strong>mselves <strong>in</strong> political blocs at <strong>the</strong> 1974 WorldPopulation Conference <strong>in</strong> Bucharest. It was not until 20years later that <strong>the</strong> reproductive health/reproductive rightsframework emerged at <strong>the</strong> 1994 <strong>International</strong> Conferenceon Population <strong>and</strong> Development. In 1976 nearly half of <strong>the</strong>37 governments <strong>in</strong> <strong>the</strong> <strong>Asia</strong>n region at that time reportedto <strong>the</strong> United Nations that <strong>the</strong>ir fertility levels were toohigh (United Nations, 2009a). The demographic <strong>in</strong>tentof manag<strong>in</strong>g national fertility levels – because populationgrowth rates were too high – was voiced by nearly twofifths of governments <strong>in</strong> <strong>the</strong> region. Two thirds of <strong>the</strong>m (25governments) were also directly support<strong>in</strong>g contraceptiveaccess, <strong>and</strong> by 2009, four fifths (39 governments or 83%of <strong>the</strong> total 47 governments <strong>in</strong> <strong>the</strong> <strong>Asia</strong>n region) weresupport<strong>in</strong>g such access.<strong>Asia</strong> had a population of 1,886 million persons <strong>in</strong> 1965,<strong>and</strong> countries where governments had declared for familyplann<strong>in</strong>g had annual population growth rates that rangedfrom 2.07 per cent (India) to 3.27 per cent (Fiji). Theserates are higher than those found among most countries<strong>in</strong> sub-Saharan Africa today, <strong>the</strong> world’s fast<strong>in</strong>g grow<strong>in</strong>gregion <strong>in</strong> demographic terms. With a population of4,167 million persons currently, <strong>Asia</strong>’s estimated annualpopulation growth rate is 1.05 per cent (United Nations,2009b). Total fertility rates (TFRs) range from below<strong>the</strong> replacement level <strong>in</strong> nearly all countries <strong>in</strong> East <strong>Asia</strong>to below 2.5 births per woman <strong>in</strong> 11 Sou<strong>the</strong>ast <strong>Asia</strong>ncountries, but above 3.0 <strong>in</strong> countries such as Afghanistan(5.7), Bhutan (3.1), Cambodia (3.3), <strong>the</strong> Lao People’sDemocratic Republic (3.5), Pakistan (4.0), <strong>the</strong> Philipp<strong>in</strong>es(3.2), Tajikistan (3.4) <strong>and</strong> Timor-Leste (5.7). With thisrange, not surpris<strong>in</strong>gly, 28 per cent of <strong>the</strong> 47 governments<strong>in</strong> <strong>the</strong> region view <strong>the</strong>ir current fertility levels as be<strong>in</strong>g too41