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

A third observation is that reported outreach to specialpopulations, such as adolescents, men <strong>and</strong> older women,began much later – after <strong>the</strong> 1980s, for <strong>the</strong> most part.Address<strong>in</strong>g client populations outside <strong>the</strong> ma<strong>in</strong>stream ofmarried couples with wives of childbear<strong>in</strong>g age requiredresources that were often not available until contraceptiveprevalence reached robust enough levels where privatizedservices could contribute. Adolescents represent a hugelyimportant segment of <strong>the</strong> population <strong>in</strong> <strong>the</strong> <strong>Asia</strong>n <strong>and</strong><strong>Pacific</strong> region; however, social norms regard<strong>in</strong>g premaritalsex tend to work aga<strong>in</strong>st actively promot<strong>in</strong>g family plann<strong>in</strong>gservices among this group.A fourth observation from Table 1 is that family plann<strong>in</strong>gprogrammes <strong>in</strong> <strong>the</strong> twenty-first century enjoy a profoundlydifferent mix of available contraceptive methods thanprogrammes did <strong>in</strong> <strong>Asia</strong> <strong>and</strong> <strong>the</strong> <strong>Pacific</strong> <strong>in</strong> <strong>the</strong> latter halfof <strong>the</strong> twentieth century. Initially only oral contraceptives<strong>and</strong> condoms were available, followed by IUDs, with<strong>the</strong>ir hormonal comb<strong>in</strong>ations <strong>and</strong> <strong>in</strong>trauter<strong>in</strong>e designs<strong>in</strong>troduc<strong>in</strong>g many undesirable side effects, such asbreakthrough bleed<strong>in</strong>g, nausea <strong>and</strong> weight ga<strong>in</strong>. Currentcontraceptive technologies m<strong>in</strong>imize side effects muchmore effectively <strong>and</strong> offer a range of options that can meet<strong>the</strong> needs of any <strong>in</strong>terested female or male user. In <strong>the</strong>cluster of reported key events around contraceptives, <strong>the</strong>sequential <strong>in</strong>troduction of new <strong>and</strong> ref<strong>in</strong>ed methods hasoffered additional options to new segments of potentialusers, <strong>the</strong>reby rais<strong>in</strong>g overall use. Liberalized access topregnancy term<strong>in</strong>ation services is reported for HongKong SAR, India, <strong>the</strong> Republic of Korea <strong>and</strong> S<strong>in</strong>gapore.However, reports of <strong>the</strong> sponsored provision of <strong>in</strong>fertilityor sub-fertility services are notably <strong>in</strong>frequent.Fifth, <strong>the</strong> importance of build<strong>in</strong>g a data-driven base ofevidence on <strong>the</strong> progress of contraceptive adoption<strong>and</strong> <strong>the</strong> fertility transition, <strong>in</strong> <strong>the</strong> context of chang<strong>in</strong>g<strong>in</strong>fant <strong>and</strong> child mortality levels <strong>and</strong> social <strong>and</strong> economicdevelopment, was cited for nearly every one of <strong>the</strong> 12country case studies. Dissem<strong>in</strong>ation of f<strong>in</strong>d<strong>in</strong>gs fromnational surveys, <strong>in</strong> particular <strong>the</strong> early knowledgeattitude-practice(KAP) surveys, followed by <strong>the</strong> WorldFertility <strong>and</strong> Demographic <strong>and</strong> Health Survey (DHS)programmes, gave credence to <strong>the</strong> measured dem<strong>and</strong>for family plann<strong>in</strong>g <strong>and</strong> <strong>the</strong> systemic ability of both <strong>the</strong>public <strong>and</strong> private health sectors to respond with services.The serial availability of such national-level results <strong>in</strong>Bangladesh, Indonesia, Nepal <strong>and</strong> <strong>the</strong> Philipp<strong>in</strong>es, <strong>and</strong>more recently India, cannot be underestimated for <strong>the</strong>irability to <strong>in</strong>form <strong>and</strong> shape family plann<strong>in</strong>g, reproductive,child <strong>and</strong> sexual health policies <strong>and</strong> programmes regionally.Authors of <strong>the</strong> case studies also cited <strong>the</strong> establishment ofspecialist research centres devoted to family plann<strong>in</strong>g <strong>and</strong>family welfare, <strong>in</strong>clud<strong>in</strong>g <strong>the</strong> Korean Institute for <strong>Family</strong><strong>Plann<strong>in</strong>g</strong>, <strong>the</strong> National Institute of Health <strong>and</strong> <strong>Family</strong>Welfare of India, <strong>and</strong> <strong>the</strong> University of <strong>the</strong> Philipp<strong>in</strong>es’Population Institute.F<strong>in</strong>ally, a sixth lesson to be lifted from <strong>the</strong>se country casestudies is <strong>the</strong> <strong>in</strong>itial adm<strong>in</strong>istrative locus of nationalfamily plann<strong>in</strong>g efforts, whe<strong>the</strong>r under <strong>the</strong> highestpolitical authority, such as a president or prime m<strong>in</strong>ister, or<strong>in</strong>stitutionalized <strong>in</strong> a national commission, <strong>in</strong>ter-m<strong>in</strong>isterialbody with a policy or service implementation m<strong>and</strong>ate, or<strong>in</strong>tegrated <strong>in</strong>to <strong>the</strong> m<strong>in</strong>istry of health. These corporateentities <strong>in</strong>itially enjoyed senior-level membership <strong>and</strong>direct access to <strong>the</strong> decision-mak<strong>in</strong>g authority of a primem<strong>in</strong>ister or m<strong>in</strong>ister of f<strong>in</strong>ance or plann<strong>in</strong>g. Often <strong>the</strong>se werenational population commissions which <strong>in</strong>cluded oversightover <strong>the</strong> deployment of a family plann<strong>in</strong>g workforce <strong>and</strong>services, <strong>and</strong> disbursement of centrally budgeted resources.The Indonesian National Population <strong>and</strong> <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong>Board <strong>and</strong> similar committees <strong>in</strong> Malaysia, S<strong>in</strong>gapore <strong>and</strong>Viet Nam, as well as <strong>the</strong> Commission on Population <strong>in</strong><strong>the</strong> Philipp<strong>in</strong>es, are well-known examples. Over time, <strong>the</strong>maturation of <strong>the</strong> family plann<strong>in</strong>g programmes saw manyof <strong>the</strong>ir functions absorbed <strong>in</strong>to m<strong>in</strong>istries of health <strong>and</strong>social affairs. Follow<strong>in</strong>g a board or commission model didnot guarantee a successful national programme however,<strong>and</strong> nei<strong>the</strong>r was one absolutely necessary, as <strong>in</strong> <strong>the</strong> case of<strong>the</strong> national revitalization of family plann<strong>in</strong>g <strong>in</strong> <strong>the</strong> IslamicRepublic of Iran (Roudi-Fahimi, 2002). A national-levelentity, however, afforded significant public visibility <strong>and</strong>credence of <strong>the</strong> importance of family plann<strong>in</strong>g <strong>in</strong> <strong>the</strong>framework of population <strong>and</strong> development efforts.One can visually appreciate trends <strong>in</strong> government supportfor contraceptive method access <strong>in</strong> Figure 1 (dashed redl<strong>in</strong>e) aga<strong>in</strong>st <strong>the</strong> backdrop of government views on <strong>the</strong> levelof fertility beg<strong>in</strong>n<strong>in</strong>g <strong>in</strong> 1976 through to 2009. In 1976,46 per cent (17 governments) of <strong>the</strong> 37 <strong>the</strong>n <strong>in</strong> <strong>the</strong> <strong>Asia</strong>nregion viewed <strong>the</strong>ir fertility as be<strong>in</strong>g too high (diagonallyhatched area), with 49 per cent consider<strong>in</strong>g it satisfactory(solid area). Over time, <strong>the</strong> number of governments grewto 47, with those hold<strong>in</strong>g <strong>the</strong> view of high fertility decl<strong>in</strong><strong>in</strong>gto 32 per cent <strong>in</strong> 2009. At <strong>the</strong> same time, direct supportfor contraceptive access among <strong>the</strong> same governments heldsteady at about 68-71 per cent from 1976 to 1996 <strong>and</strong><strong>the</strong>n <strong>in</strong>creased to 83 per cent <strong>in</strong> 2009 (United Nations,2009a). While expressed commitment to contraceptiveaccess rema<strong>in</strong>s strong nationally, actual levels of use at <strong>the</strong>population level reveal a different picture of utilization.Contraceptive prevalence levels <strong>and</strong>method compositionTable 2, based on <strong>the</strong> United Nations World ContraceptiveUse 2009 wallchart, provides a snapshot of contraceptiveprevalence rates (CPRs) among women of reproductiveage <strong>in</strong> union <strong>in</strong> <strong>Asia</strong>n <strong>and</strong> <strong>Pacific</strong> countries, both <strong>in</strong> termsof overall use, use of modern or traditional methods <strong>and</strong>specific methods used. Annual change <strong>in</strong> use levels over46