Family Planning in Papua New Family Planning in Papua New Guinea: A Case StudyGuinea: A Case Study
Geoffrey HayesGeoffrey Hayes(Consultant demographer)(Consultant demographer)
ICOMP/UNFPA HighICOMP/UNFPA High--Level Meeting on Addressing the Unfinished Level Meeting on Addressing the Unfinished Work of Family Planning in the AsiaWork of Family Planning in the Asia--Pacific RegionPacific Region
88--10 December 201010 December 2010Bangkok, ThailandBangkok, Thailand
Research issues:Research issues:
1.1. Has the fertility transition in PNG “stalled”Has the fertility transition in PNG “stalled”2.2. Has the family planning programme also Has the family planning programme also
“stalled”?“stalled”?3.3. Is there a relationship between the two?Is there a relationship between the two?4.4. What is the current status of family What is the current status of family
planning?planning?5.5. What can or could be done to strengthen What can or could be done to strengthen
family planning?family planning?
The fertility transition in PNG and the The fertility transition in PNG and the LDCs (UNDESA data)LDCs (UNDESA data)
22.5
33.5
44.5
55.5
66.5
1950
-55
1955
-60
1960
-65
1965
-70
1970
-75
1975
-80
1980
-85
1985
-90
1990
-95
1995
-00
2000
-05
Year
TFR
PNGLDCs
Conclusions:Conclusions:
Fertility peaked in 1960Fertility peaked in 1960--65 at TFR=6.365 at TFR=6.3
Decline commenced around 1965Decline commenced around 1965--70 and TFR 70 and TFR dropped steadily until 1985dropped steadily until 1985--9090
TFR LeveledTFR Leveled--off and “stalled” in 1990off and “stalled” in 1990--95 at above 95 at above TFR=4.5TFR=4.5
Since declined again to TFR=4.4 in 2006Since declined again to TFR=4.4 in 2006
Thus, some evidence of a temporarily stalled Thus, some evidence of a temporarily stalled transition over the decade 1987transition over the decade 1987--9797
Aside from that, the main feature of the fertility Aside from that, the main feature of the fertility transition in PNG is that it is transition in PNG is that it is very slow!very slow!
Projected TFR 1950Projected TFR 1950--2050 (UNDESA)2050 (UNDESA)
1.5
2.5
3.5
4.5
5.5
6.5
7.519
50-55
1960
-65
1970
-75
1980
-85
1990
-95
2000
-05
2010
-15
2020
-25
2030
-35
2040
-45
2050
-55
Year
Tota
l Fer
tility
Rat
e
PNGLDCs
Projected TFR trends Projected TFR trends At this rate of change, TFR will not reach At this rate of change, TFR will not reach
replacement until 2045replacement until 2045--5050 Population would reach 10 million by 2030 Population would reach 10 million by 2030
and 13 million by 2050and 13 million by 2050 Faster fertility decline could reduce the Faster fertility decline could reduce the
2050 population by 1.8 million2050 population by 1.8 million A more effective family planning A more effective family planning
programme could help to achieve this programme could help to achieve this because demand is high (desired family because demand is high (desired family size is declining fast) size is declining fast)
Family Planning programmesFamily Planning programmes Started on small scale in 1961 as fertility peaked Started on small scale in 1961 as fertility peaked
due to community demand. Slow expansion, due to community demand. Slow expansion, (passive approach)(passive approach)
National programme commenced during selfNational programme commenced during self--government (1973)government (1973)
National programme fully operational by 1978National programme fully operational by 1978 Programme “stalled” in midProgramme “stalled” in mid--1980s as responsibility 1980s as responsibility
for family planning transferred to provincial for family planning transferred to provincial governments governments
National budget and FP posts were abolished. National budget and FP posts were abolished. Provincial governments did not make up for the Provincial governments did not make up for the lost funds and posts.lost funds and posts.
Programme lost momentum and has never fully Programme lost momentum and has never fully recoveredrecovered
Current system of health care deliveryCurrent system of health care delivery
National Department of Health sets National Department of Health sets policypolicy
Provincial governments expected to Provincial governments expected to implement policyimplement policy
ChurchChurch--operated health services and operated health services and district administrations largely district administrations largely deliver rural servicesdeliver rural services
Urban services provided in FP clinics Urban services provided in FP clinics attached to hospitals and NGOsattached to hospitals and NGOs
Is this system working for family Is this system working for family planning?planning?
Government operates 51 percent of health centres Government operates 51 percent of health centres but distributes 80% of CYPbut distributes 80% of CYP
50% of health centres are not delivering any modern 50% of health centres are not delivering any modern contraceptioncontraception
50% of health centres provide 95% of CYP50% of health centres provide 95% of CYP
Catholic church operates 20 percent of health centres Catholic church operates 20 percent of health centres but delivers 2% of CYP using modern methodsbut delivers 2% of CYP using modern methods
Churches provide much health training and operate Churches provide much health training and operate two universitiestwo universities
The public has more confidence in churchThe public has more confidence in church--operated operated health centres than governmenthealth centres than government--run health centresrun health centres
Consequences for family planning?Consequences for family planning? Current (’06) CPR for modern methods is Current (’06) CPR for modern methods is
24.4% and growing at the slow rate of 24.4% and growing at the slow rate of 2.4% per year2.4% per year
Will take 30 years to reach 50% at this Will take 30 years to reach 50% at this raterate
Unmet need is 44%, down from 46% in Unmet need is 44%, down from 46% in 19961996
But population growth has increased the But population growth has increased the total number of women with unmet need total number of women with unmet need from 483,000 to 632,000from 483,000 to 632,000
Number of women with unmet need by age group, Number of women with unmet need by age group, 19961996--20062006
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
100,000
110,000
15-19 20-24 25-29 30-34 35-39 40-44 45-49
Age group
Num
ber
19962006
Factors inhibiting access to and use of Factors inhibiting access to and use of family planningfamily planning
Deterioration of government facilities Deterioration of government facilities (aid posts, health centres, hospitals)(aid posts, health centres, hospitals)
Unreliability of supplies at SDPsUnreliability of supplies at SDPs Attitudes of service providersAttitudes of service providers Unwillingness of some churches to Unwillingness of some churches to
supply modern contraceptionsupply modern contraception Religious attitudes in the communityReligious attitudes in the community Fees for FP consultation at government Fees for FP consultation at government
SDPsSDPs
Factors inhibiting access to and use of Factors inhibiting access to and use of family planning (2)family planning (2)
Fear of “side effects” or health Fear of “side effects” or health consequencesconsequences
Moralistic attitudes of health staff Moralistic attitudes of health staff impede access to contraception by impede access to contraception by adolescentsadolescents
Health staff unaware of or resisting Health staff unaware of or resisting health policy of free distribution of health policy of free distribution of condomscondoms
Little awareness of reproductive rightsLittle awareness of reproductive rights
Some recommendationsSome recommendations1. Urgently address the unwillingness of
some churches to provide contraception,• Renegotiate service agreements• Seek cooperation of churches in referring
clients to alternative sources • Upgrade aid posts to provide alternative
source• Support NGOs, CBDs, mobile clinics and
Health volunteers• Make churches aware of rights-based
approach, including constitutional rights of individuals to receive medical treatment for their benefit
2. Implement RHCS strategy, improve logistics
Further Recommendations….Further Recommendations….3.3. Revise Family Planning Policy document to emphasize Revise Family Planning Policy document to emphasize
rightsrights--based approach. Distribute!based approach. Distribute!4.4. Incorporate stronger rightsIncorporate stronger rights--based approach in health based approach in health
worker training and in policy documentsworker training and in policy documents5.5. Review recommendations of 2003 and 2005 family Review recommendations of 2003 and 2005 family
planning assessments and replanning assessments and re--visit recommendationsvisit recommendations6.6. Correct misCorrect mis--statement in the draft Sexual and statement in the draft Sexual and
Reproductive Health Policy that demand for family Reproductive Health Policy that demand for family planning in PNG is “low”. It is not low it is high.planning in PNG is “low”. It is not low it is high.
7.7. Adjust CPR and TFR targets in health policies for Adjust CPR and TFR targets in health policies for realism (CPR of 65% cannot be achieved by 2020!)realism (CPR of 65% cannot be achieved by 2020!)
8.8. Seek ways to eliminate user fees for FP consultationSeek ways to eliminate user fees for FP consultation9.9. Support successful NGOs (e.g. FHA)Support successful NGOs (e.g. FHA)10.10.Continue to promote vasectomy. It is acceptable.Continue to promote vasectomy. It is acceptable.11.11.Plan for followPlan for follow--up FP assessment in 2012up FP assessment in 2012
Thank you!
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