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!