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

ecause of a lack of knowledge of contraceptive methods or<strong>the</strong> <strong>in</strong>ability to obta<strong>in</strong> <strong>the</strong> necessary supplies <strong>and</strong> services.Ability is a multidimensional concept that <strong>in</strong>cludes notonly <strong>the</strong> knowledge of a contraceptive method but also <strong>the</strong>means of obta<strong>in</strong><strong>in</strong>g <strong>the</strong> method, such as <strong>the</strong> availability oftransport to a service facility or <strong>the</strong> money to pay for <strong>the</strong>method. <strong>Family</strong> plann<strong>in</strong>g programmes generally focus onability or access, somewhat less on will<strong>in</strong>gness <strong>and</strong> muchless on read<strong>in</strong>ess – which may be considered outside <strong>the</strong>doma<strong>in</strong> of family plann<strong>in</strong>g as normally understood.One advantage of <strong>the</strong> R-W-A conceptualization is that datacollected <strong>in</strong> DHS can be used to measure <strong>the</strong> impact of eachof <strong>the</strong> prerequisites. Fur<strong>the</strong>rmore, <strong>in</strong>dividual respondentscan be classified accord<strong>in</strong>g to which of <strong>the</strong> three groups<strong>the</strong>y comprise, <strong>and</strong> <strong>the</strong> results can be aggregated at <strong>the</strong>national or subnational level.Purpose of this paperIn <strong>the</strong> present paper an attempt is made to place recentDHS results <strong>in</strong>to <strong>the</strong> framework proposed by Lesthaeghe<strong>and</strong> V<strong>and</strong>erhoeft (2001) <strong>in</strong> order to contribute to a betterunderst<strong>and</strong><strong>in</strong>g of low contraceptive use, unmet need <strong>and</strong> <strong>the</strong>stalled fertility transition <strong>in</strong> some <strong>Pacific</strong> isl<strong>and</strong> countries<strong>and</strong> territories. At <strong>the</strong> same time, <strong>the</strong> paper explores someof <strong>the</strong> socio-economic factors that have been measured <strong>in</strong>recent DHS that may account for variations <strong>in</strong> contraceptiveuse <strong>and</strong> unmet need among different groups. F<strong>in</strong>ally, <strong>the</strong>paper considers some of <strong>the</strong> “macrolevel” factors that mightaccount for variations <strong>in</strong> <strong>the</strong> level <strong>and</strong> trends <strong>in</strong> fertilityamong <strong>Pacific</strong> isl<strong>and</strong> countries <strong>and</strong> territories. The overallpurpose is to contribute to <strong>the</strong> development of strategiesto reduce unmet need for contraception <strong>in</strong> accordance with<strong>the</strong> pr<strong>in</strong>ciples laid out <strong>in</strong> <strong>the</strong> ICPD Programme of Action.By analys<strong>in</strong>g <strong>the</strong> socio-economic factors at <strong>the</strong> micro- <strong>and</strong>macrolevels, it is possible that <strong>the</strong> specific role of familyplann<strong>in</strong>g programmes can be more precisely stated.The geographical <strong>and</strong>demographic contextThe isl<strong>and</strong> countries <strong>and</strong> territories of <strong>the</strong> <strong>Pacific</strong> are shown<strong>in</strong> Figure 1. The <strong>Pacific</strong> isl<strong>and</strong>s, toge<strong>the</strong>r with Australia <strong>and</strong>New Zeal<strong>and</strong>, make up <strong>the</strong> region conventionally knownas “Oceania”. The <strong>Pacific</strong> isl<strong>and</strong>s are also conventionallydivided <strong>in</strong>to three subregions: Melanesia, Micronesia <strong>and</strong>Polynesia. These divisions reflect both ethno-culturalvariations <strong>and</strong> geographical characteristics. Melanesianpeople are descendants of <strong>the</strong> very first settlement of <strong>the</strong><strong>Pacific</strong>, which commenced approximately 40,000 yearsago <strong>in</strong> New Gu<strong>in</strong>ea. Melanesians, along with more recentmigrants, occupy <strong>the</strong> largest isl<strong>and</strong> countries <strong>and</strong> territoriesof Fiji, New Caledonia, Papua New Gu<strong>in</strong>ea, SolomonIsl<strong>and</strong>s <strong>and</strong> Vanuatu. Micronesians are descendants of amuch more recent settlement pattern from South-East<strong>Asia</strong> (primarily <strong>the</strong> Philipp<strong>in</strong>es <strong>and</strong> Taiwan) <strong>and</strong> occupy<strong>the</strong> isl<strong>and</strong>s north of <strong>the</strong> equator <strong>and</strong> spread across <strong>the</strong><strong>Pacific</strong> on an east-west axis. Most of <strong>the</strong> isl<strong>and</strong>s occupiedby Micronesians are small <strong>and</strong> of atoll formation, althoughsome are of volcanic orig<strong>in</strong>. Polynesians are descendantsof people who entered <strong>the</strong> <strong>Pacific</strong> from South-East <strong>Asia</strong>5,000 years ago <strong>and</strong> occupied <strong>the</strong> isl<strong>and</strong>s located from <strong>the</strong>central <strong>Pacific</strong> east of Fiji to Pitcairn Isl<strong>and</strong> <strong>in</strong> <strong>the</strong> easternextremity of <strong>the</strong> region 3 .Although orig<strong>in</strong>ally formulated by n<strong>in</strong>eteenth centuryethnographers <strong>and</strong> explorers, <strong>the</strong> dist<strong>in</strong>ction between <strong>the</strong>subregions of <strong>the</strong> <strong>Pacific</strong> rema<strong>in</strong> important today due tovariations <strong>in</strong> social organization, culture <strong>and</strong> geography.Most importantly for population issues, <strong>the</strong> Melanesiansubgroup makes up <strong>the</strong> largest proportion of <strong>the</strong> l<strong>and</strong> areaof <strong>the</strong> overall <strong>Pacific</strong> isl<strong>and</strong>s region. In general, Melanesiais a resource-rich area, Polynesia less so <strong>and</strong> Micronesiamuch less so. The different resource endowments of <strong>the</strong>subregions have played a significant role <strong>in</strong> <strong>the</strong> way <strong>in</strong> whichpopulation issues, <strong>in</strong>clud<strong>in</strong>g fertility, have been addressed– both <strong>in</strong> traditional times <strong>and</strong> <strong>in</strong> <strong>the</strong> modern era.The total population of <strong>the</strong> 22 countries <strong>and</strong> territories of<strong>the</strong> <strong>Pacific</strong> isl<strong>and</strong>s <strong>in</strong> Oceania is currently 9.85 million <strong>and</strong>is grow<strong>in</strong>g at approximately 1.9 per cent per year (Table1). At this growth rate, <strong>the</strong> population will reach 10.0million by <strong>the</strong> end of 2011. Current projections suggestthat <strong>the</strong> population of <strong>the</strong> region could <strong>in</strong>crease by ano<strong>the</strong>r6.5 million by 2050 before stabiliz<strong>in</strong>g (Secretariat of <strong>the</strong><strong>Pacific</strong> Community, 2010).Population growth rates vary widely between countries<strong>and</strong> subregions. At <strong>the</strong> country level, <strong>the</strong> highest growthrates are occurr<strong>in</strong>g <strong>in</strong> <strong>the</strong> Melanesian countries of PapuaNew Gu<strong>in</strong>ea (2.2%) Solomon Isl<strong>and</strong>s (2.7%) <strong>and</strong> Vanuatu(2.5%). These three countries currently account for 89per cent of <strong>the</strong> population growth of <strong>the</strong> larger region. At<strong>the</strong> o<strong>the</strong>r end of <strong>the</strong> scale are <strong>the</strong> Polynesian countries of<strong>the</strong> Cook Isl<strong>and</strong>s, Samoa, Tonga <strong>and</strong> Tuvalu, with annualgrowth rates of less than 0.5 per cent. Some Micronesiancountries, such as <strong>the</strong> Federated States of Micronesia,Marshall Isl<strong>and</strong>s <strong>and</strong> Palau also have low growth rates.At <strong>the</strong> subregional level it is clear that Melanesia accountsfor most population growth <strong>in</strong> <strong>the</strong> larger region (92.5%),<strong>and</strong> Melanesian growth is dom<strong>in</strong>ated by <strong>the</strong> largest country<strong>in</strong> <strong>the</strong> <strong>Pacific</strong>: Papua New Gu<strong>in</strong>ea. Future populationgrowth <strong>in</strong> <strong>the</strong> <strong>Pacific</strong> will be concentrated <strong>in</strong> <strong>the</strong> Melanesiansubregion. Population growth <strong>in</strong> <strong>the</strong> Micronesian <strong>and</strong>Polynesian subregions is currently concentrated <strong>in</strong> <strong>the</strong>territories of Guam <strong>and</strong> French Polynesia, respectively. Theo<strong>the</strong>r countries <strong>in</strong> <strong>the</strong>se subregions have low populationgrowth, with <strong>the</strong> exception of Kiribati <strong>and</strong> Nauru.66