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TableTable4Contraceptive prevalence rates (%) <strong>and</strong> trends <strong>in</strong> <strong>the</strong> <strong>Pacific</strong> isl<strong>and</strong>s: 1990, 2000 <strong>and</strong> latest available(currently married women, modern methods)*Country/territory <strong>and</strong> subregionMelanesia1990s 2000s 2005-09Fiji 31 (1991) 44 (2002) 43 (2007)Papua New Gu<strong>in</strong>ea 20 (1996) na 24 (2006)Solomon Isl<strong>and</strong>s 11 (1997) 7 (2001) 27 (2007)Vanuatu 28 (1999) na 38 (2008)MicronesiaMicronesia (Federated States of ) 40 (1990) 49 (2000) 26 (2007)Kiribati 17 (1999) na 18 (2009)Nauru na na 25 (2007)Palau na 17 (2000) 17 (2002)Marshall Isl<strong>and</strong>s 31 (1995) 34 (2001) 42 (2007)PolynesiaCook Isl<strong>and</strong>s 46 (1991) 44 (2000) 46 (2005)Niue 36 (1991) na 21 (2007)Samoa 43 (1996) na 27 (2009)Tonga 33 (1999) 22 (2003) 28 (2007)Tuvalu 39 (1990) 32 (2002) 22 (2007)Sources: 1990 <strong>and</strong> 2000 data from UNFPA (2008); 2006-2009 figures are from DHS reports: Nauru (2007), Marshall Isl<strong>and</strong>s(2007), Samoa (2009), Solomon Isl<strong>and</strong>s (2007), Tuvalu (2000)Vanuatu, 2003-2008 from Z<strong>in</strong>ck (2008). Federated States ofMicronesia from Naduva (2008). Tonga from Wagatakirewa (2008). Cook Isl<strong>and</strong>s from Nawadra-Taylor (2008). Fiji fromUNFPA (2008).* Figures are rounded to <strong>the</strong> nearest percent.end of <strong>the</strong> range are not, however, among those which havehad a recent DHS, so <strong>the</strong> method of measurement is notnecessarily comparable <strong>and</strong> <strong>the</strong> accuracy of <strong>the</strong> figures isquestionable. Given that Palau has one of <strong>the</strong> lowest TFRs<strong>in</strong> <strong>the</strong> <strong>Pacific</strong> (2.0), <strong>the</strong> reported CPR of 17 per cent isquite likely to be an underestimate.It is also likely that Fiji’s reported CPR of 43 per cent isunderestimated given that contraceptives are <strong>in</strong>creas<strong>in</strong>glyavailable from private practitioners <strong>and</strong> pharmacies <strong>and</strong>are not captured <strong>in</strong> health <strong>in</strong>formation system data. It islikely that urban CPRs have been particularly understated<strong>in</strong> Fiji’s service statistics given that CPR <strong>in</strong> rural areaspopulated largely by poor tenant farmers, such as <strong>in</strong> <strong>the</strong>Nor<strong>the</strong>rn Division, has occasionally exceeded that of <strong>the</strong>most urbanized Central Division where a much higherproportion of <strong>the</strong> labour force is <strong>in</strong> white collar <strong>and</strong>professional occupations 13 . In rural areas, governmen<strong>the</strong>alth facilities are <strong>the</strong> ma<strong>in</strong> sources of contraceptives,whereas <strong>in</strong> urban areas o<strong>the</strong>r sources are available – butnot necessarily captured <strong>in</strong> health <strong>in</strong>formation systems.When only CPRs estimated from DHS are considered,however, a similar range of variation is evident. At <strong>the</strong> highend of <strong>the</strong> range is <strong>the</strong> Marshall Isl<strong>and</strong>s with a CPR of 42per cent; at <strong>the</strong> low end of <strong>the</strong> range is <strong>the</strong> neighbour<strong>in</strong>gcountry of Kiribati with a CPR of only 18 per cent. The(unweighted) average CPR for <strong>the</strong> seven countries <strong>and</strong>territories that have had a DHS is about 30 per cent.Clearly, by <strong>the</strong> st<strong>and</strong>ards of <strong>the</strong> less developed countries asa group (with a CPR of 45 per cent if Ch<strong>in</strong>a is excludedor 56 per cent if Ch<strong>in</strong>a is <strong>in</strong>cluded), current contraceptiveprevalence <strong>in</strong> this subset of <strong>Pacific</strong> countries <strong>and</strong> territoriesis surpris<strong>in</strong>gly low, given <strong>the</strong> long history of family plann<strong>in</strong>gprogrammes <strong>in</strong> <strong>the</strong> region.Trends <strong>in</strong> contraceptive use 1990-2010An assessment of contraceptive trends <strong>in</strong> <strong>the</strong> <strong>Pacific</strong> iscomplicated by variations <strong>in</strong> methodology <strong>and</strong> <strong>the</strong> potentialfor error or <strong>in</strong>completeness <strong>in</strong> earlier figures. It is oftenunclear whe<strong>the</strong>r published CPRs <strong>in</strong>clude women us<strong>in</strong>g socalled“traditional” methods or whe<strong>the</strong>r only those us<strong>in</strong>gmodern methods are considered as us<strong>in</strong>g contraception.Also, it is not always clear if <strong>the</strong> denom<strong>in</strong>ator employed is allwomen of reproductive age or only married women. Given76
that estimates of CPR for earlier periods generally derivefrom service statistics based ultimately upon attendanceat family plann<strong>in</strong>g cl<strong>in</strong>ics or rural health centres, couplesus<strong>in</strong>g “withdrawal” or “rhythm” may not be <strong>in</strong>cluded as noattendance at cl<strong>in</strong>ics is required to practise <strong>the</strong>se methods.On <strong>the</strong> o<strong>the</strong>r h<strong>and</strong>, some health departments <strong>in</strong> <strong>the</strong> <strong>Pacific</strong>do give advice on <strong>the</strong> use of “natural” family plann<strong>in</strong>g, <strong>in</strong>which case users of <strong>the</strong>se methods would be recorded <strong>and</strong><strong>in</strong>cluded <strong>in</strong> <strong>the</strong> CPR estimates.Tak<strong>in</strong>g a cautionary approach to <strong>the</strong> figures presented <strong>in</strong>Table 4, it would appear that most countries <strong>and</strong> territories<strong>in</strong> <strong>the</strong> Polynesia subregion have experienced decl<strong>in</strong><strong>in</strong>g orbarely chang<strong>in</strong>g CPRs over <strong>the</strong> past 15 years. In Micronesiaonly Marshall Isl<strong>and</strong>s shows evidence of an <strong>in</strong>creas<strong>in</strong>gCPR while <strong>in</strong> o<strong>the</strong>r countries <strong>the</strong> estimates are fluctuat<strong>in</strong>g(Federated States of Micronesia) or show little change(Kiribati). In Melanesia, however, three countries (PapuaNew Gu<strong>in</strong>ea, Solomon Isl<strong>and</strong>s <strong>and</strong> Vanuatu) show a ris<strong>in</strong>gtrend. Although <strong>the</strong>re are doubts about <strong>the</strong> accuracy of itsearlier estimates, Solomon Isl<strong>and</strong>s has had <strong>the</strong> fastest rateof <strong>in</strong>crease <strong>in</strong> its CPR s<strong>in</strong>ce <strong>the</strong> 1990s, whereas PapuaNew Gu<strong>in</strong>ea’s CPR has risen quite slowly (2.4% <strong>in</strong>creaseper year) <strong>in</strong> <strong>the</strong> decade 1996-2006.That some of <strong>the</strong> poorest countries <strong>in</strong> <strong>the</strong> <strong>Pacific</strong> haveexperienced <strong>in</strong>creas<strong>in</strong>g CPRs <strong>in</strong> <strong>the</strong> past decade <strong>and</strong> ahalf, whereas some relatively better off countries have haddecl<strong>in</strong><strong>in</strong>g or at least static CPRs, suggests that <strong>the</strong> rateof contraceptive uptake at an early stage of <strong>the</strong> fertilitytransition is likely to be higher than at later stages. Thisphenomenon can possibly be expla<strong>in</strong>ed by a fairly generalpattern whereby family plann<strong>in</strong>g programmes achieveearly success followed by a plateau <strong>and</strong> stagnation. As Back(1989) has observed:The work on enhanced <strong>in</strong>ternational distribution ofcontraceptives shows a pattern of <strong>in</strong>itial success thatat first looks encourag<strong>in</strong>g but often reaches a plateau.In <strong>the</strong> <strong>in</strong>troduction of new contraceptive methods to acommunity, <strong>the</strong> tapped are those who are highly motivatedto prevent future pregnancies <strong>and</strong> with <strong>the</strong>se recruits <strong>the</strong>enterprise succeeds. In order to reach beyond <strong>the</strong>se <strong>in</strong>itialrecruits, however, to <strong>the</strong> less motivated <strong>the</strong> availability ofeasy contraceptive methods is not enough <strong>and</strong> <strong>the</strong> cl<strong>in</strong>icprogramme frequently stagnates.This description would appear to describe <strong>the</strong> situation<strong>in</strong> many <strong>Pacific</strong> isl<strong>and</strong> countries <strong>in</strong> <strong>the</strong> 1990s. Womenwho might o<strong>the</strong>rwise have given birth to six or sevenchildren, a situation that prevailed when family plann<strong>in</strong>gprogrammes were <strong>in</strong>stituted <strong>in</strong> <strong>the</strong> 1960s <strong>and</strong> 1970s, werevery motivated to adopt family plann<strong>in</strong>g. Once averagecompleted fertility had dropped to between three <strong>and</strong> fourchildren, <strong>the</strong> motivation to reduce it fur<strong>the</strong>r to betweentwo <strong>and</strong> three children became significantly weaker. Thisproposition would appear to describe <strong>the</strong> recent situationof several countries, <strong>in</strong>clud<strong>in</strong>g Samoa, Tonga, Tuvalu, <strong>and</strong>among <strong>the</strong> Melanesian population of Fiji.Socio-economic determ<strong>in</strong>ants ofcurrent contraception use at <strong>the</strong>microlevelAn alternative, or possibly complementary, explanationis that <strong>the</strong> stagnation or very slow <strong>in</strong>crease <strong>in</strong> <strong>the</strong> useof contraception, <strong>and</strong> <strong>the</strong>refore fertility, is l<strong>in</strong>ked to anoverall stagnation <strong>in</strong> <strong>the</strong> pace of economic growth <strong>and</strong>development. This is <strong>the</strong> reason that was tentativelyoffered by Bongaarts <strong>in</strong> expla<strong>in</strong><strong>in</strong>g <strong>the</strong> slowdown <strong>in</strong> <strong>the</strong>pace of fertility decl<strong>in</strong>e <strong>in</strong> sub-Saharan Africa <strong>in</strong> <strong>the</strong> 1990s,although he also acknowledged that <strong>the</strong> decreas<strong>in</strong>g prioritygiven to family plann<strong>in</strong>g programmes over that period mayalso have contributed to <strong>the</strong> slowdown (Bongaarts, 2008).A slow pace of economic growth <strong>and</strong> development wouldpresumably be reflected <strong>in</strong> a more or less static labour forcestructure. In <strong>the</strong> absence of economic growth fewer peoplewould be mov<strong>in</strong>g up <strong>the</strong> occupational hierarchy to moreskilled <strong>and</strong> higher pay<strong>in</strong>g occupations. If contraceptive useis higher among <strong>the</strong> more educated <strong>and</strong> skilled technical<strong>and</strong> professional workers, overall contraceptive use wouldtend to stagnate if <strong>the</strong>se occupational groups were not<strong>in</strong>creas<strong>in</strong>g <strong>in</strong> proportion to o<strong>the</strong>r groups.In <strong>the</strong> <strong>Pacific</strong>, however, <strong>the</strong> association betweencontraceptive use <strong>and</strong> socio-economic status at <strong>the</strong>microlevel appears to be weak. In three out of <strong>the</strong> sevencountries that have had a DHS (Table 5) contraceptive useis higher among less educated women than among moreeducated women. In Solomon Isl<strong>and</strong>s <strong>the</strong> difference <strong>in</strong>contraceptive use between women with no education <strong>and</strong>those with more than secondary education is very small<strong>and</strong> probably not statistically significant. In Kiribati CPRappears to go down <strong>in</strong> l<strong>in</strong>e with <strong>the</strong> more education thata woman has. The lack of a close association betweeneducational achievement <strong>and</strong> contraceptive use was noted<strong>in</strong> one of <strong>the</strong> earliest “KAP” studies <strong>in</strong> Vanuatu (House,1999a).Also contrary to expectations is that, <strong>in</strong> three countries(Kiribati, Marshall Isl<strong>and</strong>s <strong>and</strong> Solomon Isl<strong>and</strong>s), CPR ishigher <strong>in</strong> rural areas than urban ones, whereas it wouldbe expected that this relationship would be <strong>the</strong> reverse,given that “rural” <strong>in</strong> this context refers to remote isl<strong>and</strong>swith poor transport, communications, access to healthservices, <strong>and</strong> a high proportion of <strong>the</strong> labour force work<strong>in</strong>g<strong>in</strong> subsistence production.In Marshall Isl<strong>and</strong>s, <strong>the</strong> higher CPR <strong>in</strong> rural than urban77
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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
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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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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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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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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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