A Brief Summary by Bob Gillespie, President Population Communication
presented at the Partners in Population and Development Conference Indonesia, 2011
During the last 50 years, the governments that have established successful family planning, reproductive health and population stabilization policies and programs deliver services and the communication and education strategies using a human rights approach. Women in villages have been actively engaged in the design and implementation of providing quality services. The first family planning programs to introduce the IUD and oral pill in Korea and Taiwan focused on training health providers in the public and private sector. Using a fee-for-service contract system, women could obtain health and contraceptive services from private health providers. Concurrent with the delivery of family planning and health services was improving the status of women, providing education and literacy programs and eventually access to credit.
The success stories are exciting, inspirational and can be replicated in many of the countries that have yet achieved replacement size families. Today the TFR of Taiwan is 1, Sri Lanka 2.4, South Korea 1.2, Vietnam 2.1 , Myanmar 2.4, Thailand 1.8, Morocco 2.4, Tunisia 2.1, Turkey 2.1, Brazil 2.0, Mexico 2.2. Similar results have occurred in the states of India with Andhra Pradesh, Goa and Tamil Nadu each having a TFR of 1.8, Himachal Pradesh and Kerala at 1.9, Punjab and Sikkim at 2, Karnataka and Maharashtra at 2.1, and West Bengal at 2.3. Close behind are the states of Gujarat, Jammu and Kashmir, and Orissa each with a TFR 2.4.
Because of the dynamic leadership of the family planning program in Indonesia and in Bangladesh, the TFRs are now 2.4. Egypt, with a TFR of 3, is well on its way to population stabilization. The major challenge now in India is in the states of Uttar Pradesh with a TFR of 3.8, Bihar at 4 and Rajasthan at 3.2.
The PPD meeting in Yogyakarta has as its focus a human rights approach to population stabilization. At the ICPD Conference in Cairo, Dr. Nafis Sadik, Executive Director of the UNFPA, accepted the Statement on Population Stabilization signed by 75 heads of government from Haryono Suyono, chairman of the BKKBN. President Suharto personally requested all 109 heads of government of the Non-Aligned Nations to sign and support the Statement. On October 25th, 1995, at the 50th anniversary of the United Nations, Dr. Sadik presided over the ceremony in which President Suharto presented the Statement to the Secretary General of the UN. Boutros Boutros-Ghali. In Dr. Sadik's comments, she emphasized, "The importance of population and development issues and the urgency of population stabilization must be recognized." Each year Population Communication promotes the Statement with government, donor and NGOs on July 11th, World Population Day.
The Partners in Population and Development have pioneered in a south-South cooperation that has underscored the International Conference on Population and Development (ICPD) principles established at the Cairo conference in1994, the challenge of fulfilling the declarations of the Beijing Women's Conference in1995 and addressing the Millennium Development Goals ratified by 189 UN member states in 2000.
We are honored to collaborate with Abdul Ghaffar Khan, Director General in the Ministry of Population Welfare in Pakistan. Five-hundred copies of his report authored "Population Stabilization: the Case for Pakistan," have been published. Abdul informed us, "You will be happy to know that the proposed population policy contained in Pakistan Report, 2010 has been shared with all public and private sector organizations working for population stabilization in Pakistan. It has been distributed to national and international NGOs, International Development Partners and donors working in Pakistan. The draft policy has been presented to religious scholars of Pakistan through four provincial and one national level seminar. The report has been presented to media and at press clubs in federal and provincial capitals. Recently it was presented to Senate Standing Committee and National Assembly Standing Committee. We shall be shortly presenting it to Council of Common Interests (CCI); thereafter it would be approved by the Cabinet. But even at the draft stage, the policy is being implemented and the next five year population program plan (2010-15) worth Rs. 52 Billion is based on this draft policy."
Dr. Osama Refaat, Deputy Director of the Regional Center for Training in Family Planning and Reproductive Health of the OB/GY Hospital, Faculty of Medicine, Ain Shams University, authored the report, "Population Stabilization Policies and Programs in Egypt." On September 23rd, Osama wrote, "The population stabilization report has been circulated to most of the targeted family planning, reproductive health, maternal and child health organizations in Upper / Lower Egypt. It has been also circulated to directors, policy makers and stakeholders who are working in the field of population.
The benefits have been as follows:
Last week Dr. Lolito Tacardon, Program Manager of the Philippines' Commission on Population, gave us the following description of the dissemination and use of the report, "People Beyond Numbers: the Road to Population Stabilization in the Philippines."
These are some of the accomplishments we gained in disseminating the Report:
The report on, "Population Stabilization in Bihar, India: Situational Analysis and Future Directions," authored by Anant Kumar and Jay Satia, focuses on the demographic diversity and social and cultural context of high fertility, the status of family planning and unmet need, the current status of health services, and the strategies to achieve population stabilization in the government and private sectors. Additional sections outline the needs of youth and research requirements. Jay Satia stresses the importance of improving the quality of care, addressing the social and economic factors affecting fertility, including women's empowerment, and delaying marriage and the first birth. Dr. Usha Ram of the International Institute for Population Sciences in Mumbai is currently preparing a population stabilization report for the state of Uttar Pradesh. Her report will be used in our comparative analysis of population stabilization policies at the time of the PDD meeting.
Indonesia is an ideal setting for a PPD Conference on Promoting Family Planning and Maternal Health for Poverty Alleviation. The BKKBN has a dramatic and pioneering role in bringing family planning and maternal and child health to the doorstep of every household in Indonesia. The autonomous leadership of the BKKBN has mobilized support from all cabinet members, governors-general, parliamentarians, the mass media and achieved the active participation of the religious, business, labor and health infrastructure. Over 50,000 field workers conduct home visits. One million Indonesians wake up every day and provide health and family planning services in both the public and private sector. The BKKBN's creative and dynamic leadership provides a model for all countries that are on a path to pursue population stabilization. The social marketing program has extended access to services and now provides contraceptives to close to 20% of the women in Indonesia.
The recent decentralization has maintained the integrity of delivery of contraceptive services and the disciplines associated with a mass mobilization program to lower infant and maternal mortality, improve the status of women and have the active participation of women in the design and direction of the national program. From soap operas to discount cards, from youth supporting activities focused on preventing adolescent pregnancies to population and sex education, there have been cradle to the grave initiatives that have increased age at marriage, reinforced birth spacing and couples have chosen small families for the sake of their children, themselves and the community. In many villages a child's birth has been a collective decision by the community and for the benefit of the community.
In Bangladesh, Ms. Qyamrun Nahar Khanam, PCC and Joint Secretary of Family Welfare and Program, authored a report in 2008 that focused on, "Bangladesh's Policies and Programs Focused on Achieving Population Stabilization." Her report, which is available upon request, reviewed the evolution of population policies and demographic targets, the programs, strategies and policies and current progress towards population stabilization, including addressing the population momentum.
This year Dr. Atiqur Rahman Khan, who has had numerous positions in the government of Bangladesh, focused on population policy, training and strategic management, as well as distinguished career with UN agencies, his wife Mufaweza Khan, the executive director of Concerned Women for Family Planning, authored the report, "Population Programs in Bangladesh: Problems, Prospects And Policy Issues." After a preliminary distribution of the report, a seminar co-hosted by EngenderHealth brought together leading stakeholders to utilize the report for formulating women's reproductive health, family planning and population policies. Bangladesh has achieved a dramatic mobilization of family planning and primary health services in both the public and private sectors.
Bangladesh also has a TFR of 2.4 Since independence many of the same actions initiated in Indonesia have governed population policy in Bangladesh. Fundamental to delivering family planning services was the integration of maternal and child health, nutrition and population education.
Conventional methods were delivered by full-time family planning field workers and a social marketing program focused on delivering contraceptives in retail outlines. The first priority was establishing 2,350 family welfare centers consisting of a medical assistant, a family welfare visitor and a pharmacist. In addition there were 48 health sub centers and 1,275 rural dispensaries. Sterilization services were provided by physicians with fee-for-service contracts. A coupon system was used to measure and monitor the performance of the program and to arrange appropriate payments. As director of training, Atiqur Rahman Khan co-authored a letter with Dr. Chowdury to inform all 3,000 general practitioners where to go for manual vacuum aspiration training at 22 provincial hospitals. There was an active information, education and motivation program using both the mass media and a multi-sectoral approach in the school system. As soon as twelve welfare training sites were designated, 6,700 traditional birth attendants (TBAs), 13,500 Dais (village midwives) 13,500 family welfare attendants, 2,722 family welfare visitors and 18,000 family welfare workers were trained and mobilized from 1975 to 1978. All of these efforts were complemented by extensive research and evaluation. All cabinet members and at the district level, the district councils, Thana (councils), union parishads and village leadership structures were mobilized. Specific reforms were institutionalized to raise age at marriage to 21.
In continental sub Saharan Africa, the only country with a TFR below 3, South Africa (2.4), provides a major challenge to achieve contraceptive acceptance levels that will result in replacement size families. Governments in collaboration with the social marketing initiatives are making headway assisted by the NGOs, donors, foundations and universities. The challenge is to lower infant and maternal morbidity and mortality. By increasing access to primary health care, preventing adolescent pregnancies, increasing the age at marriage, and reinforcing the small family value by improving the status of women through justice, literacy, credit, education and employment. Social marketing and community-based initiatives have been complemented with mass media campaigns, functional literacy programs, women's clubs and cooperatives and access to micro enterprise.
A concurrent study of contraceptive practices at teaching hospitals has been conducted in each of the six countries. Atiqur Rahman Khan and Dr. Osama Refaat were the principal investigators in Bangladesh and Egypt respectively, Dr. Felix Barrah (Director, El Norf Clinic and Maternity Gombe) conducted the survey in Nigeria, and Dr. Fides Rodriguez-Ababon (Chairperson, Department of OB\GYN, Davao Medical School Foundation, Inc. & DMSFI Hospital) in the Philippines. The responses from India were sent directly from the teaching hospitals to Population Communication. The 19th edition of the textbook, "Contraception Technology," edited by Bob Hatcher, was sent to all hospitals and clinics who responded to the survey.
Elizabeth Hughes, Director of International Programs at Population Communication, has prepared population stabilization charts using TFRs of 1, 2 and 3, current TFR as reported by PRB, and the desired family size as reported in the latest DHS. If Egypt achieves a TFR today of 2 today, the current population of 80 million will increase by 31 million by 2060. Pakistan has 185 million people today and will add 60 million with a TFR of 2 by 2060. At the time of independence, the population of West Pakistan was 51 million. In the Philippines, the current population of 94 million will increase by 31 million with a TFR of 2. When I was working as a Pathfinder in the Philippines in 1962, the population was 27.2 million. The momentum built into the young age profiles are very dramatic and daunting.
During the last 48 years, I have had the privilege of advising governments on a human rights approach to maternal and child health and family planning in Taiwan, Turkey, Iran, Bangladesh, India, Indonesia, Egypt, Mexico, Nigeria, Pakistan, the Philippines, and Thailand. In collaboration with my colleagues, I have designed 182 action and evaluation instruments that are available to anyone who wants to utilize them. I am distributing a list of materials that are available upon request.
The statement signed by 75 heads of government.
We will distribute to any of the participants at the conference the following reports.
The materials sent to Pakistan consisted of the following:
The packet sent to India consisted of the following:
We produced a documentary, "No Vacancy," available in a 60 and 90-minute version, and a companion book of the edited transcripts. The documentary was filmed here in Indonesia as well as Mexico, India, Ghana, Nigeria, Iran, the US and several other countries. Please let me know if you want the PAL or NTSC version.
Population Communication has arranged for the manufacturing of single valve manual vacuum aspiration kits consisting of a syringe and 4mm, 5mm and 6mm cannulae. We also have Plus devises and will offer free MVA kits where there is adequate training and the distribution does not compete with either Ipas' or WomanCare Global marketing.
We have designed health and functional literacy texts for men and women. If you would like a list of all the 182 items, please let me know.
I am deeply honored to be invited to participate at the Partners in Population and Development conference and wish to express my gratitude to Harry Joosery, his staff and all the collaborators who have participated in preparing country specific and, in the case of India, state specific reports on population stabilization.