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several countries, <strong>the</strong> fertility transition has slowed or“stalled”. In some cases <strong>the</strong>re has been no change <strong>in</strong> <strong>the</strong>level of fertility <strong>in</strong> two decades. Similarly, contraceptiveuse has rema<strong>in</strong>ed well below <strong>the</strong> average for less developedcountries, even 50 years after family plann<strong>in</strong>g programmeswere first <strong>in</strong>troduced, <strong>and</strong> <strong>in</strong> several countries contraceptiveuse appears to be decl<strong>in</strong><strong>in</strong>g. Thus, it is plausible that a“reposition<strong>in</strong>g” of family plann<strong>in</strong>g <strong>in</strong> <strong>the</strong> region would havea positive effect <strong>in</strong> reduc<strong>in</strong>g <strong>the</strong> level of unmet need <strong>and</strong>facilitat<strong>in</strong>g fur<strong>the</strong>r decl<strong>in</strong>e <strong>in</strong> fertility levels (Robertson,2009).<strong>Family</strong> plann<strong>in</strong>g <strong>and</strong> <strong>the</strong> ICPDProgramme of ActionTo reposition family plann<strong>in</strong>g on <strong>the</strong> development agendaof <strong>Pacific</strong> isl<strong>and</strong> countries, as <strong>in</strong> o<strong>the</strong>r regions of <strong>the</strong> world,it is first necessary to underst<strong>and</strong> <strong>the</strong> current status offamily plann<strong>in</strong>g programmes <strong>and</strong> to identify <strong>the</strong> factorsthat have contributed to this status. This is more complexthan it first appears. Prior to <strong>the</strong> 1994 ICPD Programmeof Action, <strong>the</strong> pr<strong>in</strong>ciple measure of success of a familyplann<strong>in</strong>g programme was <strong>the</strong> contraceptive prevalence rate(CPR) or <strong>the</strong> “acceptor” rate. In most countries it couldbe assumed that <strong>the</strong>re was a reasonably close relationshipbetween CPR <strong>and</strong> fertility levels (as measured by TFR). IfCPR was ris<strong>in</strong>g as a result of family plann<strong>in</strong>g programmes,<strong>the</strong>n reduced fertility could be expected. Thus, familyplann<strong>in</strong>g reduced fertility <strong>and</strong> <strong>the</strong> reduction of fertilitycontributed to reduced population growth <strong>and</strong> more rapideconomic growth. After ICPD, both CPR <strong>and</strong> TFR lostfavour as policy targets because <strong>the</strong> use of such statisticalmeasures appeared to violate <strong>the</strong> pr<strong>in</strong>ciple of voluntarism<strong>and</strong> <strong>the</strong> aim of meet<strong>in</strong>g <strong>in</strong>dividual needs. The ICPDProgramme of Action encouraged countries to move awayfrom a macrolevel focus on statistical <strong>in</strong>dicators <strong>and</strong> <strong>the</strong>use of <strong>in</strong>centives <strong>and</strong> dis<strong>in</strong>centives by family plann<strong>in</strong>gprogrammes towards a microlevel approach focused on<strong>the</strong> freely chosen reproductive goals of <strong>in</strong>dividuals <strong>and</strong>couples. This was <strong>in</strong>terpreted by many to mean thatnational population policies should not employ fertility orgrowth targets at all. A more extreme position was thatpopulation policies were no longer necessary <strong>and</strong> countriesshould be discouraged from formulat<strong>in</strong>g <strong>the</strong>m.The ICPD Programme of Action, <strong>in</strong> fact, attempted toma<strong>in</strong>ta<strong>in</strong> a f<strong>in</strong>e balance between population goals at <strong>the</strong>societal level <strong>and</strong> <strong>the</strong> reproductive rights of <strong>in</strong>dividuals <strong>and</strong>couples. The reduction of population growth was treatedas a “legitimate <strong>in</strong>terest” of governments, particularly <strong>in</strong> <strong>the</strong>context of environmental susta<strong>in</strong>ability <strong>and</strong> reduction ofpoverty, but <strong>the</strong> legitimacy of this <strong>in</strong>terest was conditionalon <strong>the</strong> extent to which demographic rates <strong>and</strong> social,economic <strong>and</strong> environmental goals were imbalanced.Thus, “stabilization” of population growth ra<strong>the</strong>r than itsrapid reduction was <strong>the</strong> key policy objective. While familyplann<strong>in</strong>g is mentioned <strong>in</strong> various contexts, <strong>and</strong> familyplann<strong>in</strong>g makes up a significant section <strong>in</strong> <strong>the</strong> chapter onreproductive rights <strong>and</strong> reproductive health, <strong>the</strong> ICPDProgramme of Action goes to some length to <strong>in</strong>sulatefamily plann<strong>in</strong>g from macroeconomic concerns <strong>and</strong> toplace it firmly with<strong>in</strong> <strong>the</strong> context of reproductive health<strong>and</strong> rights. The pr<strong>in</strong>ciple of “<strong>in</strong>formed free choice”, it wasargued, should govern family plann<strong>in</strong>g programmes. Ifeducation <strong>and</strong> services are provided, <strong>in</strong>dividuals can beexpected to “act responsibly <strong>in</strong> <strong>the</strong> light of <strong>the</strong>ir own needs<strong>and</strong> those of <strong>the</strong>ir families <strong>and</strong> communities” (UnitedNations, 1995, para. 7.12). The implication was thatgovernments do not need to set <strong>the</strong> reproductive goals of<strong>in</strong>dividuals <strong>and</strong> families, <strong>and</strong> should not do so.Importantly, this argument was supported by a comparisonof <strong>the</strong> fertility <strong>and</strong> contraceptive use targets conta<strong>in</strong>ed<strong>in</strong> <strong>the</strong> development plans of 12 develop<strong>in</strong>g countries<strong>and</strong> <strong>the</strong> level of fertility that would be achieved only if<strong>the</strong> expressed fertility desires of <strong>in</strong>dividual women wereachieved. Analysis by S<strong>in</strong>d<strong>in</strong>g, et al. (1994) showed that,by reduc<strong>in</strong>g <strong>the</strong> unmet need for family plann<strong>in</strong>g, fertilitylevels would be <strong>the</strong> same, or lower, than <strong>the</strong> demographictargets specified <strong>in</strong> government development plans. Theyconcluded:<strong>Family</strong> plann<strong>in</strong>g still needs quantitative objectives by whichto assess <strong>the</strong>ir performance. But <strong>the</strong>se objectives can <strong>and</strong>should be addressed <strong>in</strong> terms of satisfy<strong>in</strong>g people’s statedneeds ra<strong>the</strong>r than planners’ notions of what a society’sbirthrate should be.This pr<strong>in</strong>ciple was accepted <strong>in</strong> <strong>the</strong> formulation of <strong>the</strong>ICPD Programme of Action <strong>and</strong> has been <strong>the</strong> underly<strong>in</strong>gphilosophy of family plann<strong>in</strong>g programmes s<strong>in</strong>ce <strong>the</strong>n.Address<strong>in</strong>g unmet need ra<strong>the</strong>r than demographic targetshas been <strong>the</strong> cornerstone of reproductive health <strong>and</strong> familyplann<strong>in</strong>g programmes s<strong>in</strong>ce <strong>the</strong> 1994 ICPD.In harmony with this voluntaristic formulation, governmentswere expected to assess <strong>the</strong> extent of <strong>the</strong> “unmet need” forfamily plann<strong>in</strong>g <strong>and</strong> to meet those needs by, among o<strong>the</strong>rmeasures, remov<strong>in</strong>g “all <strong>the</strong> major rema<strong>in</strong><strong>in</strong>g barriers to <strong>the</strong>utilization of family-plann<strong>in</strong>g services” (United Nations,1995, para. 7.19). The Programme of Action fur<strong>the</strong>rstates that “governmental goals for family plann<strong>in</strong>g shouldbe def<strong>in</strong>ed <strong>in</strong> terms of unmet needs for <strong>in</strong>formation <strong>and</strong>services” (United Nations, 1995, para. 7.12). The ICPD +5review of <strong>the</strong> Programme of Action was more explicit <strong>and</strong>proposed that “Where <strong>the</strong>re is a gap between contraceptiveuse <strong>and</strong> <strong>the</strong> proportion of <strong>in</strong>dividuals express<strong>in</strong>g a desireto space or limit <strong>the</strong>ir families, countries should attemptto close this gap by at least 50 per cent by 2005, 75 percent by 2010 <strong>and</strong> 100 per cent by 2015” (United Nations,1999, para. 58).64
The advent of <strong>the</strong> Millennium Development Goals(MDGs) saw <strong>the</strong> reditto<strong>in</strong>troduction of CPR <strong>in</strong>to<strong>in</strong>ternational development frameworks, <strong>in</strong>itially <strong>in</strong> <strong>the</strong>context of reduc<strong>in</strong>g exposure to HIV <strong>and</strong> AIDS <strong>and</strong>ultimately as an <strong>in</strong>dicator of <strong>the</strong> target of ensur<strong>in</strong>g“universal access to reproductive health”, along with <strong>the</strong>extent of “unmet need” for family plann<strong>in</strong>g. It is importantto note that, <strong>in</strong> <strong>the</strong> MDG framework, CPR is not itself atarget but is an <strong>in</strong>dicator used to monitor progress towardsachiev<strong>in</strong>g universal access to reproductive health. On <strong>the</strong>o<strong>the</strong>r h<strong>and</strong>, ICPD+5 proposed specific numerical targetsfor <strong>the</strong> reduction of unmet need, which, it stated, shouldbe elim<strong>in</strong>ated entirely by 2050.Explanatory frameworksAs already noted, any explanation of a slowdown <strong>in</strong><strong>the</strong> fertility transition must go beyond family plann<strong>in</strong>gprogrammes as such, but <strong>the</strong> issue of family plann<strong>in</strong>g <strong>and</strong>unmet need for it is an important po<strong>in</strong>t of departure. In<strong>the</strong> <strong>Pacific</strong>, however, <strong>the</strong> measurement of unmet need hasreceived very little attention until recently. Only one country,Papua New Gu<strong>in</strong>ea, has a measure for two po<strong>in</strong>ts <strong>in</strong> time.Seven <strong>Pacific</strong> isl<strong>and</strong> countries have conducted DHS <strong>in</strong> <strong>the</strong>past four years that provide data on unmet need, but <strong>the</strong>analysis of <strong>the</strong>se data has so far been quite limited. It isalso important to acknowledge that <strong>the</strong> concept of unmetneed is far from simple (Bhushan, 1997). The same level ofunmet need can have different mean<strong>in</strong>gs, depend<strong>in</strong>g on <strong>the</strong>demographic <strong>and</strong> social context. Analysis of unmet needfor programm<strong>in</strong>g purposes needs to be complementedwith measures of fertility preferences <strong>and</strong> <strong>the</strong> dem<strong>and</strong> forcontraception. Fur<strong>the</strong>rmore, a purely descriptive analysisis <strong>in</strong>sufficient. It is essential to underst<strong>and</strong> <strong>the</strong> causes ofunmet need <strong>and</strong> how <strong>the</strong>se vary among different groups<strong>and</strong> <strong>in</strong> different circumstances (Bhushan, 1997).To facilitate such underst<strong>and</strong><strong>in</strong>g it is essential to have anexplanatory framework, or “<strong>the</strong>oretical model” to guideanalysis. In particular, it is necessary to have a model thatis not constra<strong>in</strong>ed by a specific discipl<strong>in</strong>ary approach, suchas economics, sociology or communication studies 2 .A relatively simple, microlevel model of <strong>the</strong> factorsconducive to <strong>the</strong> use of contraception to limit fertility was<strong>in</strong> fact elaborated by Ansley Coale nearly four decades ago(Coale, 1973). Coale specified three “prerequisites” thathad to be met before <strong>in</strong>dividuals would take up familyplann<strong>in</strong>g, lead<strong>in</strong>g to a major decl<strong>in</strong>e <strong>in</strong> fertility:(a) Fertility had to be “with<strong>in</strong> <strong>the</strong> calculus of consciouschoice”. In o<strong>the</strong>r words, parents had to believe that itwas an acceptable mode of behaviour to weigh <strong>the</strong>advantages or disadvantages of hav<strong>in</strong>g ano<strong>the</strong>r child.(b) Reduced fertility had to be perceived as economicallyor socially advantageous to <strong>in</strong>dividual couples.(c) Effective techniques of fertility reduction must beavailable. Practices that would <strong>in</strong> fact prevent births haveto be known <strong>and</strong> <strong>the</strong>re must be sufficient communicationbetween spouses <strong>and</strong> sufficient susta<strong>in</strong>ed will <strong>in</strong> both toemploy <strong>the</strong>m successfully.As noted by Lesthaeghe <strong>and</strong> V<strong>and</strong>erhoeft (2001), Coale’sconceptualization of <strong>the</strong> preconditions for susta<strong>in</strong>edfertility decl<strong>in</strong>e received no fur<strong>the</strong>r attention <strong>in</strong> <strong>the</strong>decades s<strong>in</strong>ce it was <strong>in</strong>troduced; yet it provides a usefulmeans of <strong>in</strong>tegrat<strong>in</strong>g <strong>the</strong> approaches of various discipl<strong>in</strong>es,particularly those of economics, sociology, anthropology<strong>and</strong> communication studies. Lesthaeghe <strong>and</strong> V<strong>and</strong>erhoeftproceeded to reconceptualize Coale’s model <strong>in</strong> terms ofthree dimensions relat<strong>in</strong>g to “read<strong>in</strong>ess” (Coale’s prerequisite2), “will<strong>in</strong>gness” (prerequisite 1) <strong>and</strong> “ability” (prerequisite3). In short, <strong>the</strong> adoption of family plann<strong>in</strong>g to control <strong>the</strong>number or tim<strong>in</strong>g of births that a couple will have requiresthat <strong>the</strong>y be “’ready, will<strong>in</strong>g <strong>and</strong> able’ (R,W,A for short)”. Afur<strong>the</strong>r elaboration of <strong>the</strong>se categories may be useful.Read<strong>in</strong>ess. This precondition reflects <strong>the</strong> approach of<strong>the</strong> economics school, which treats childbear<strong>in</strong>g as autilitarian choice <strong>in</strong>volv<strong>in</strong>g <strong>the</strong> weigh<strong>in</strong>g of advantages<strong>and</strong> disadvantages (or costs <strong>and</strong> benefits), usually for <strong>the</strong>parents <strong>the</strong>mselves. The cost-benefit framework can also<strong>in</strong>corporate situations <strong>in</strong> which <strong>the</strong> balance of advantages<strong>and</strong> disadvantages can be assessed from <strong>the</strong> perspectiveof <strong>the</strong> children. From a “supply-dem<strong>and</strong>” viewpo<strong>in</strong>t,read<strong>in</strong>ess can also be stimulated <strong>in</strong> circumstances <strong>in</strong> which<strong>the</strong> “supply” of children is <strong>in</strong>creas<strong>in</strong>g due to <strong>the</strong> <strong>in</strong>creas<strong>in</strong>gsurvivorship of children.Will<strong>in</strong>gness. An <strong>in</strong>dividual or couple may be ready tolimit childbear<strong>in</strong>g <strong>and</strong> adopt family plann<strong>in</strong>g if <strong>the</strong>yhave decided that <strong>the</strong> advantages of do<strong>in</strong>g so outweigh<strong>the</strong> disadvantages, but <strong>the</strong>y may not be will<strong>in</strong>g to do soif such behaviour is contrary to <strong>the</strong> norms <strong>and</strong> values of<strong>the</strong> community or extended family <strong>in</strong> which <strong>the</strong>y live. Thisprecondition concerns cultural precepts <strong>and</strong> attitudesthat determ<strong>in</strong>e whe<strong>the</strong>r or not <strong>in</strong>terference with “nature”is considered to be legitimate behaviour. These preceptsmay derive from religion or from broader concepts, such as“tradition” or “custom”, <strong>and</strong> be accompanied by sanctions fornon-compliance. At <strong>the</strong> <strong>in</strong>dividual level, <strong>the</strong> will<strong>in</strong>gness togo aga<strong>in</strong>st community norms will depend on psychologicaldispositions. Concerns relat<strong>in</strong>g to risks to health may alsobe <strong>in</strong>cluded <strong>in</strong> this category. A perceived risk to health or <strong>the</strong>possibility of uncomfortable “side effects” may contributeto an <strong>in</strong>dividual’s unwill<strong>in</strong>gness to use contraception, evenif it would be advantageous to do so.Ability. An <strong>in</strong>dividual or couple may be ready (R) <strong>and</strong>will<strong>in</strong>g (W) but not able (A) to practise family plann<strong>in</strong>g65
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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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Page 25 and 26: that improving <st
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Page 35: Bounkoung Phichit, Deputy M
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Page 40 and 41: Thus, while knowledge of modern met
Page 42 and 43: Hon. Mr. Malakai Tabar, Chairman, P
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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 65 and 66: Nam. Nearly all economies i
Page 67: 2008 2009% Bilateral % Multilateral
Page 70 and 71: family planning wi
Page 73: IntroductionFamily
Page 77 and 78: FigureFigure1Oceania and</s
Page 79 and 80: next 25 years, however, TFR fluctua
Page 81 and 82: FigureFigureFigure2Total fertility
Page 83 and 84: family planning pr
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Page 94 and 95: FigureFigure945Relationship between
Page 96 and 97: The concept of “unmet need” has
Page 98 and 99: TableTable8Percentage of th
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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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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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