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to limit fertility, or had that effect, it is highly probablethat traditional fertility levels were not particularlyhigh (Carroll, 1975). There is also evidence that, dur<strong>in</strong>gtraditional times <strong>and</strong> well <strong>in</strong>to <strong>the</strong> modern period, women<strong>in</strong> <strong>the</strong> <strong>Pacific</strong> were not particularly enthusiastic abouthav<strong>in</strong>g many children (Connell, 1977; Carroll, 1975). InKiribati, historical data suggests that fertility was relativelylow, probably about four children per woman, prior to <strong>the</strong>1920s (Tesfaghiorghis, 1995). It is <strong>the</strong>refore unlikely thathigh fertility was necessary to compensate for high <strong>in</strong>fantmortality, as presupposed by some versions of demographictransition <strong>the</strong>ory. Pirie (1995; 2000) has argued that<strong>in</strong> Polynesia general mortality due to disease was notparticularly high <strong>in</strong> traditional times (given <strong>the</strong> absence of<strong>the</strong> diseases found <strong>in</strong> <strong>Asia</strong> or Europe) so periods of highfertility would have resulted <strong>in</strong> resource pressures, <strong>and</strong>countermeasures, such as <strong>in</strong>fanticide <strong>and</strong> abortion, wouldhave been employed.As demonstrated by Harris <strong>and</strong> Ross (1987) all pre<strong>in</strong>dustrialsocieties have a particular “mode of reproduction”that is associated <strong>in</strong> broad general terms with its mode ofproduction. Hunter-ga<strong>the</strong>rer societies, for example, tendto limit fertility through abortion or <strong>in</strong>fanticide because<strong>the</strong> ability of women to move with <strong>the</strong> group would beconstra<strong>in</strong>ed by hav<strong>in</strong>g too many young children, giventhat long periods of breastfeed<strong>in</strong>g were essential to childsurvival. At higher levels of economic development thatpermits a more sedentary way of life, higher fertility can betolerated, because <strong>the</strong>re is less conflict between childcare<strong>and</strong> women’s work. As <strong>in</strong>dustrialization develops, <strong>the</strong>conflict between women’s work <strong>and</strong> childbear<strong>in</strong>g <strong>in</strong>creasesaga<strong>in</strong>, <strong>and</strong> <strong>the</strong> tendency to apply fertility control <strong>in</strong>creases.While remnants of traditional practices <strong>and</strong> ideologiesassociated with fertility limitation still exist <strong>in</strong> some <strong>Pacific</strong>countries (Pulea, 1986), reference to traditional “modes ofreproduction” as a way of encourag<strong>in</strong>g <strong>Pacific</strong> isl<strong>and</strong> peopleto adopt family plann<strong>in</strong>g has not proven to be an effectivestrategy. The reasons for this are many <strong>and</strong> complex. First,<strong>in</strong>itial contact with European visitors resulted <strong>in</strong> <strong>the</strong>importation of diseases that previously did not exist <strong>and</strong>to which <strong>Pacific</strong> peoples had no immunity. The epidemicsthat followed <strong>in</strong>creased <strong>the</strong> death rate well above <strong>the</strong> birthrate, result<strong>in</strong>g <strong>in</strong> low or negative population growth <strong>and</strong>fears of “depopulation”. Missionary <strong>and</strong> later colonialauthorities adopted pronatalist policies <strong>and</strong> suppressedmemory of earlier fertility <strong>and</strong> mortality control practicesthat <strong>in</strong> any case were considered immoral. The suppressionof collective memory took place over several generationsto <strong>the</strong> po<strong>in</strong>t where most <strong>Pacific</strong> isl<strong>and</strong>ers today woulddeny that any such practices ever occurred <strong>in</strong> traditionaltimes. Colonial authorities with <strong>the</strong> support of churchesensured that abortion <strong>and</strong> <strong>in</strong>fanticide were crim<strong>in</strong>alized.Formal laws regard<strong>in</strong>g marriage, births <strong>and</strong> deaths werefor <strong>the</strong> most part derived from church law. The decl<strong>in</strong>e<strong>in</strong> traditional population control methods such as postpartumabst<strong>in</strong>ence <strong>and</strong> abst<strong>in</strong>ence from sexual activitydur<strong>in</strong>g ceremonial events resulted <strong>in</strong> an <strong>in</strong>creas<strong>in</strong>g “supply”of children, encouraged by <strong>the</strong> belief <strong>in</strong>stilled by <strong>the</strong> churchthat children are a “gift from God”.It took several decades for mortality levels to decl<strong>in</strong>e <strong>and</strong>fertility to rise to <strong>the</strong> po<strong>in</strong>t where natural <strong>in</strong>crease becamepositive. In some <strong>Pacific</strong> groups this did not occur until<strong>the</strong> 1940s (Bayliss-Smith, 1975). By <strong>the</strong> 1950s, many<strong>Pacific</strong> countries were approach<strong>in</strong>g <strong>the</strong> “natural” fertilitylevels presupposed by demographic transition <strong>the</strong>ory tocharacterize all pre-<strong>in</strong>dustrial societies. By <strong>the</strong> 1950s <strong>in</strong>some areas <strong>and</strong> <strong>the</strong> 1960s <strong>in</strong> o<strong>the</strong>rs, fertility had reachedhigh levels, with TFRs of 7-8 quite common at <strong>the</strong>national level <strong>and</strong> even higher <strong>in</strong> some subregions. At <strong>the</strong>same time, while overall mortality had decl<strong>in</strong>ed relative to<strong>the</strong> period follow<strong>in</strong>g <strong>the</strong> missionary work, <strong>in</strong>fant mortalityrates rema<strong>in</strong>ed quite high. Thus, <strong>the</strong> demographic regimeoperat<strong>in</strong>g <strong>in</strong> most <strong>Pacific</strong> societies began to approximate<strong>the</strong> pretransition situation of “high mortality, high fertility”envisioned by demographic transition <strong>the</strong>ory 10 . Whenfamily plann<strong>in</strong>g programmes were first <strong>in</strong>troduced bycolonial adm<strong>in</strong>istrations, <strong>the</strong> demographic circumstanceswere quite different from those that prevailed <strong>in</strong> traditionaltimesModern family plann<strong>in</strong>g programmes<strong>Family</strong> plann<strong>in</strong>g programmes <strong>in</strong> <strong>the</strong> <strong>Pacific</strong> were<strong>in</strong>itiated <strong>in</strong> <strong>the</strong> late 1950s <strong>and</strong> early 1960s to enhancesocio-economic development through reduction of <strong>the</strong>population growth rate, as well as to improve women’s <strong>and</strong>children’s health (House, 1999a). The earliest programmeswere established <strong>in</strong> Fiji <strong>and</strong> Tonga <strong>in</strong> <strong>the</strong> late 1950s withan official government policy <strong>in</strong> place by 1962 (Pirie,1995; Ivarature, 2000). In Fiji <strong>the</strong> Medical Departmenttook on <strong>the</strong> responsibility of family plann<strong>in</strong>g but <strong>Family</strong><strong>Plann<strong>in</strong>g</strong> Associations (affiliated with IPPF) also becameactive. IPPF surveys that revealed high fertility <strong>and</strong> ris<strong>in</strong>gpopulation growth rates provided <strong>the</strong> <strong>in</strong>itial impetus for<strong>the</strong>se family plann<strong>in</strong>g programmes. The Fiji programmewas considered a success as fertility rates among Indo-Fijian women immediately decl<strong>in</strong>ed while <strong>the</strong> fertility ofethnic Fijians began to decl<strong>in</strong>e a decade later <strong>and</strong> at a ra<strong>the</strong>rslower pace (Lev<strong>in</strong> <strong>and</strong> Re<strong>the</strong>rford, 1986). Differentialrates of fertility <strong>and</strong> contraceptive use between <strong>the</strong> twomajor ethnic groups <strong>in</strong> Fiji have persisted until today, withTFR for Indo-Fijians now below replacement level.In Tonga, <strong>the</strong> family plann<strong>in</strong>g programme was supportedby <strong>the</strong> K<strong>in</strong>g, who expressed concern about <strong>the</strong> <strong>in</strong>creas<strong>in</strong>gpopulation, <strong>the</strong> ris<strong>in</strong>g population density of <strong>the</strong> Tongatapuurban area <strong>and</strong> <strong>the</strong> difficulty of provid<strong>in</strong>g traditional l<strong>and</strong>allotments to all eligible males. The programme was<strong>in</strong>stitutionalized when a Tongan medical officer became74
esponsible for <strong>the</strong> family plann<strong>in</strong>g programme, a familyplann<strong>in</strong>g cl<strong>in</strong>ic was opened <strong>and</strong> <strong>the</strong> number of familyplann<strong>in</strong>g acceptors <strong>in</strong>creased over time (Ivarature, 2000).The <strong>in</strong>tegration of family plann<strong>in</strong>g programmes withmaternal <strong>and</strong> child health programmes occurred around1968 <strong>and</strong> contributed to high levels of acceptors be<strong>in</strong>greported. The formation of <strong>the</strong> Tonga <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong>Association <strong>in</strong> 1969 fur<strong>the</strong>r streng<strong>the</strong>ned advocacy forfamily plann<strong>in</strong>g. In <strong>the</strong> 1970s <strong>and</strong> 1980s, <strong>the</strong> <strong>in</strong>clusion offamily plann<strong>in</strong>g <strong>in</strong> national development plans heightened<strong>the</strong> commitment to family plann<strong>in</strong>g. In 1976, a surveyreported that 45.7 per cent of all women of reproductiveage were us<strong>in</strong>g contraception, with <strong>the</strong> highest level of 63.3per cent be<strong>in</strong>g recorded <strong>in</strong> Kolonga, Tongatapu. The surveyrevealed that acceptors were young, were us<strong>in</strong>g highlyeffective contraceptive methods <strong>and</strong> had fewer childrenonce <strong>the</strong>y adopted family plann<strong>in</strong>g (Ivarature, 2000)(ref ).In Kiribati, family plann<strong>in</strong>g was <strong>in</strong>itiated <strong>in</strong> <strong>the</strong> 1960s <strong>and</strong><strong>the</strong> family plann<strong>in</strong>g campaign was officially launched <strong>in</strong>1968 (Tesfaghiorghis, 1995). While fertility decl<strong>in</strong>ed <strong>in</strong>all age groups between <strong>the</strong> 1960s <strong>and</strong> 1990s, <strong>the</strong> pace ofdecl<strong>in</strong>e was much slower after 1973, concomitant with <strong>the</strong>wan<strong>in</strong>g of <strong>the</strong> family plann<strong>in</strong>g programme (Booth, 1994).In 1972, <strong>the</strong> percentage of family plann<strong>in</strong>g users amongwomen of reproductive age was 40.1 per cent. However,<strong>the</strong>re was significant opposition to <strong>the</strong> family plann<strong>in</strong>gprogramme, particularly from <strong>the</strong> Catholic Church <strong>and</strong>traditional leaders. The family plann<strong>in</strong>g programmestalled <strong>in</strong> <strong>the</strong> 1970s <strong>and</strong> <strong>the</strong> percentage of users droppedto 15.8 per cent. By 1990, CPR was approximately 27 percent, a level which fell short of <strong>the</strong> national target of 35 percent. The relatively high percentage of users on <strong>in</strong>jectables(60%) was noted <strong>in</strong> <strong>the</strong> 1980s but with time, <strong>the</strong> ovulationmethod became <strong>the</strong> more frequently used method <strong>and</strong> <strong>the</strong>use of <strong>in</strong>jectables decl<strong>in</strong>ed to 39 per cent. Fertility studieshave found significant religious <strong>and</strong> geographic variationswith higher fertility rates <strong>in</strong> outer isl<strong>and</strong>s <strong>and</strong> amongCatholics. The geographic differences <strong>in</strong> fertility reflectedmostly <strong>the</strong> religious composition of <strong>the</strong> isl<strong>and</strong>s. Higherfertility rates were also noted among women with lowereducation.O<strong>the</strong>r countries <strong>in</strong> <strong>the</strong> <strong>Pacific</strong> also <strong>in</strong>itiated familyplann<strong>in</strong>g programmes with modest success (Kenyon<strong>and</strong> Power, 2003). The Federated States of Micronesia,Marshall Isl<strong>and</strong>s, Papua New Gu<strong>in</strong>ea, Solomon Isl<strong>and</strong>s<strong>and</strong> Vanuatu – all considered as hav<strong>in</strong>g high fertility <strong>and</strong>some of <strong>the</strong> atolls as hav<strong>in</strong>g high population densities–showed some decl<strong>in</strong>e <strong>in</strong> fertility (Pirie, 1994). Negativereactions, however, <strong>in</strong> part fuelled by fear of side effects,were often reported by women. Papua New Gu<strong>in</strong>ea <strong>and</strong>Solomon Isl<strong>and</strong>s adopted population policies aimed atfertility reduction <strong>in</strong> <strong>the</strong> early 1990s, but data on patternsof contraceptive use over time rema<strong>in</strong> limited <strong>in</strong> <strong>the</strong>secountries <strong>and</strong> <strong>the</strong>ir success is unclear.Follow<strong>in</strong>g <strong>the</strong> 1994 ICPD, st<strong>and</strong>-alone family plann<strong>in</strong>gprogrammes were given lower priority worldwide whilecountries established more <strong>in</strong>tegrated <strong>and</strong> comprehensiveapproaches to reproductive health. This occurred <strong>in</strong><strong>the</strong> <strong>Pacific</strong> as well. The effort to construct an <strong>in</strong>tegratedreproductive health strategy that <strong>in</strong>cluded young, unmarriedpeople <strong>and</strong> moved away from an MCH approach absorbedenergy <strong>and</strong> resources <strong>and</strong> <strong>in</strong> <strong>the</strong> process weakened familyplann<strong>in</strong>g. Globally, <strong>and</strong> <strong>in</strong> some <strong>Pacific</strong> isl<strong>and</strong> countries,funds <strong>and</strong> human resources were diverted to fight <strong>the</strong> HIV<strong>and</strong> AIDS epidemic 11 . However, family plann<strong>in</strong>g had alsoreceived setbacks <strong>in</strong> <strong>the</strong> 1970s <strong>and</strong> 1980s when <strong>the</strong> abusesassociated with forced sterilization, defective IUDs <strong>and</strong>long-act<strong>in</strong>g hormonal contraceptives became well known.The rise of religious <strong>and</strong> political conservatism <strong>and</strong> <strong>the</strong>unwill<strong>in</strong>gness to acknowledge <strong>the</strong> role that universal accessto voluntary family plann<strong>in</strong>g could play <strong>in</strong> reduc<strong>in</strong>g poverty<strong>and</strong> <strong>in</strong>equality were also contribut<strong>in</strong>g factors.While <strong>the</strong> impact of family plann<strong>in</strong>g programmes onfertility rates has been highly significant <strong>in</strong> many <strong>Asia</strong>ncountries, possibly exceed<strong>in</strong>g <strong>the</strong> impact of such socioeconomicfactors as ris<strong>in</strong>g <strong>in</strong>come (Bloom et al., 2002),<strong>the</strong> situation <strong>in</strong> <strong>the</strong> <strong>Pacific</strong> is more complex. Despite <strong>the</strong>existence of virtually free, government-run, voluntary familyplann<strong>in</strong>g programmes, <strong>the</strong> utilization of safe <strong>and</strong> effectivevoluntary contraceptive services based on <strong>in</strong>formed choice<strong>and</strong> a wide range of options, rema<strong>in</strong>s well below potential(Robertson, 2007) 12 .Before review<strong>in</strong>g <strong>the</strong> socio-economic determ<strong>in</strong>ants offertility change at <strong>the</strong> macrolevel that may have contributedto <strong>the</strong> slow or stalled fertility transition <strong>in</strong> some <strong>Pacific</strong>isl<strong>and</strong> countries, it may be <strong>in</strong>structive to look at patternsof contraceptive use <strong>and</strong> <strong>the</strong>ir determ<strong>in</strong>ants as evident <strong>in</strong>recent DHS.Current patterns of contraceptiveuse <strong>and</strong> unmet needCurrent use of contraception <strong>and</strong>trends at <strong>the</strong> national levelContraceptive prevalenceWith 7 of <strong>the</strong> 15 <strong>Pacific</strong> isl<strong>and</strong> countries <strong>and</strong> territorieswith United Nations programmes hav<strong>in</strong>g had a DHSwith<strong>in</strong> <strong>the</strong> past 5 years, it is now possible to comparecontraceptive prevalence rates across those economieswithout recourse to <strong>in</strong>complete service statistics <strong>and</strong> us<strong>in</strong>gcomparable methodology. The figures <strong>in</strong> Table 4 show thatCPR for currently married women <strong>in</strong> <strong>the</strong> period 2005-2009 ranges from a low of 17 per cent <strong>in</strong> Palau to a highof 46 per cent <strong>in</strong> <strong>the</strong> Cook Isl<strong>and</strong>s. The territories at each75
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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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SESSION 1: Changin
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that improving <st
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at a hospital would be offered post
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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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Page 77 and 78: FigureFigure1Oceania and</s
Page 79 and 80: next 25 years, however, TFR fluctua
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Page 131 and 132: ConclusionThe Bangladesh Fa
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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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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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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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