UN Population Division, Department of Economic and Social Affairs,
with support from the UN Population Fund (UNFPA)
|
| UN Population Division, Department of Economic and Social Affairs, with support from the UN Population Fund (UNFPA) |
|
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The electronic version of this newsletter is being made available by
the UNFPA Country Support Team for Central and South Asia and the
Population Information Network (POPIN). For further information,
please contact the UNFPA Country Support Team via email at:
CSTNEP@unfpa.mos.com.np
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UNFPA
United Nations CASA News & Views
Population Fund
=====================================================================
Vol.4 No.1, April 1996
Published by the UNFPA Country Support Team for Central & South Asia
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News from the region
Dr. Sadik addresses ECO/UNFPA Conferences in
Islamabad & Almaty
Islamabad: Access to and Quality of Reproductive Health and Family
Planning Services: Expanding Contraceptives
The Conference was the second to be convened in accordance with
the Memorandum of Understanding signed between the Economic Co-
operation Organisation (ECO) and the United Nations Population Fund
(UNFPA). The first Conference on "Women's Status and Health" was
convened in Tehran, Iran in August 1995, and a report on it appeared
in our August '95 issue.
The Conference, hosted by the Government of Pakistan and held
in Islamabad during 13-15 April 1996, brought together around one
hundred participants among whom were senior officials of Governments
and representatives of NGOs from nine ECO member countries
(Azerbaijan, Iran, Kazakhstan, Kyrgyzstan, Pakistan, Tajikistan,
Turkey, Turkmenistan, Uzbekistan). A number of resource persons of
international repute from the region as well as outside, participated
in the discussions and deliberations.
Begum Shahanaz Wazir Ali, Special Assistant to the Prime
Minister on Social Sector of Pakistan attended both the opening and
closing sessions indicating the importance so that the host
Government of Pakistan, gave to the issues addressed at the
Conference. The Conference was inaugurated by H.E. Julius Salik,
Minister for Population Welfare, Government of Pakistan. Also
attending the plenary session was Mr. S. Zafar Ali Shah, Deputy
Speaker of the National Assembly and President of the Pakistan
Parliamentary Group on Population and Development.
H.E. Mr. Salik in his inaugural address stated that reproductive
rights and reproductive health constitute important aspects of
civilized and organised community living and that besides providing
adequate family planning services and safe motherhood, availability
of contraceptives choices had emerged as one of the essential needs
in this context.
Speaking on the occasion, Mr. Shamshad Ahmad, Secretary General
of ECO, noted that family planning being largely a male influenced
decision, the educational campaigns must also be targeted at men.
In her keynote address Dr. Nafis Sadik, Executive Director of
UNFPA, noted that there can be no sustainable development unless
women become full partners with men in all aspects of life.
Referring to the ICPD recommendations for programmes to shift from
demographic targets to meeting individuals needs, she noted that
empowering women through education and employment, and the provision
of the widest range of contraceptives are important issues needing
priority attention. Each of the delegations also highlighted the
steps that are being taken in their respective countries to implement
ICPD Programme of Action on Reproductive Health, and referred to the
issues faced by them in this context.
The Conference organised in Plenary and Working Group Sessions,
discussed at length a number of these issues. As a prelude to these
discussions, Dr. Tomris Turmen, Executive Director, Family Health and
Population Division, World Health Organisation, outlined the
components of reproductive health and what it means to move from
family planning to reproductive health for national programmes.
Subsequent plenary and working group sessions focused on access
and quality of RH/FP services, monitoring and evaluating RH/FP
programmes, financing RH/FP programmes, and recent advances in
contraceptive technologies based on the background papers and
discussions by resource persons. The recommendations emanating from
these discussions include inter alia policy reorientation, training
of service providers, IEC and advocacy activities towards the
reproductive health approach. Special needs of women and
adolescents, and the need to broaden contraceptive choices were duly
recognised. The Conference also called upon the countries to collect
and analyze data that would help monitor the progress in the RH
status of the population. It also suggested a number of ways through
which domestic resources can be mobilised to support the RH/FP
programmes. The participants were also appraised of the UNFPA
Policies and Procedures in regard to its support for RH/FP Programme
in the lights of ICPD Programme of Action.
The participants thanked the Government of Pakistan for hosting
the Conference, and UNFPA and ECO for assisting in its organisation.
The Conference also paid tribute to Mr. Muzaffar Mahmood Qureshi,
Secretary to the Ministry for Population Welfare and the Chairperson
of the Conference for the excellent work done. A report containing
the details of the discussion and recommendations that was adopted
at the Conference will be published shortly for wider dissemination.
Almaty: Implementation of the International Conference on Population
and Development (ICPD) Programme of Action in the ECO Region Almaty:
The Conference on the Implementation of the ICPD Programme of
Action in the Economic Cooperation Organization (ECO) Region was
held from 18-20 April at the Maternal and Child Health (MCH) Centre
of the Ministry of Health, in Almaty. The Conference was co-
sponsored by ECO and the United Nations Population Fund (UNFPA), and
hosted by the Government of the Republic of Kazakstan. It was
attended by a total of 80 delegates comprising representatives from
ten member states of ECO, UN agencies, selected donors, UNFPA staff,
and national and international NGOs.
Welcoming the delegates of the Conference on behalf of the
Government of the Republic of Kazakstan, Mr. V. Devyatko, Minister
of Health stated that the presence of H.E. Mr. Sobolev, Vice-Prime
Minister of Kazakstan at the inaugural session was a reflection of
the commitment of the Government of Kazakstan to the shared goals of
ECO and UNFPA in this important field of population and development.
Dr. Nafis Sadik, Executive Director of UNFPA, said that the purpose
of the Conference in Almaty was to provide a forum for the exchange
of information and experiences regarding strategies, policies and
initiatives undertaken to implement the International Conference on
Population and Development (ICPD) Programme of Action in the ECO
member countries. Dr. Sadik said that although rapid progress had
been made in the Central Asian Republics, Azerbaijan and Kazakstan
in the last three years, from the time UNFPA began to provide
assistance to these countries, such as a marked decline in the number
of abortions, progress in improving the status of women, etc., there
was still a critical need to consolidate the shift towards the
contemporary concept of reproductive health, including family
planning and sexual health, and to guarantee a wider choice of
reliable methods of contraception.
Mr. Shamshad Ahmad, Secretary General of ECO, underscored the
importance of this Conference as it addresses the broader agenda of
population and development enshrined in the ICPD POA. His
Excellency, Mr. Sobolev, Vice-Prime Minister, Republic of Kazakstan,
in his inaugural address extended warm felicitations to the
participants of the Conference and wished the Conference every
success. The Vice-Prime Minister especially thanked Dr. Nafis Sadik
for her support and cooperation for holding this Conference in
Almaty. On this occasion, His Excellency also read out a message of
welcome from President H. E. Sultan Nazarbaev.
The delegates recommended: to strengthen and to integrate data
collection systems on population and reproductive health for quality
assurance and timely dissemination to consolidate research and
technical base and improve techniques for utilization and
dissemination of information including disaggregation by gender and
age; and to establish a regional data bank and information exchange
system. Government, NGOs and international organizations also need
to pay special attention to the needs and costs of repatriating
refugees and internally displaced persons. In view of critical
ecological problems, (in particular in Central Asia, such as the
gradual disappearance of the Aral Sea and the danger of waste from
the mining industry, including radioactivity), government, NGOs and
international organizations need to continue to pay due attention to
these problems.
Other recommendations included: to establish an inter-sectorial
coordination council consisting of representatives of various
ministries, NGOs, and community members, for the realization of
population and RH programmes under the guidance of the National
government in each country. If currently lacking, each country
should standardize curriculum for primary and secondary schools and
for courses in para-professional university and post-graduate
institutes on RH issues under the supervision of the national
Ministries of Health; to strengthen, or if necessary, to establish
national IEC, training and research centres in each country. One of
these centers should work as an international training and
collaborating Centre in the ECO region.
Developing strategies for information, education and communication
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One effect of the ICPD's POA has been that interest in information,
education and communication (IEC) has been renewed in several
countries of the region. An evidence of this can be seen in the
workshops on strategy planning that have taken place in Iran,
Pakistan and Sri Lanka. A brief note on each of the workshops
follows:
-------------------------------------------------------------------
Iran: "IEC activities are important for population"
The Deputy Minister for Health Affairs stressed on the
importance of IEC activities for population issues in line with the
Programme of Action adopted at ICPD. The first workshop on IEC, in
support of Reproductive Health and Family Planning was convened
nationally at the IEC Center on 24-28 February 1996, and executed by
the Ministry of Health and Medical Education (MOHME) within the
framework of the UNFPA supported project IRA/95/P01: "Establishment
of Family Planning IEC Center". The Director General of Health,
Nutrition and Family Planning Department of MOHME and the UNFPA
National Programme Officer (on behalf of the Country Director) also
addressed the workshop. The workshop was facilitated by Mr. Najib
M. Assifi. In all, 43 participants attended the workshop, 30 of whom
were Family Planning and Health Education Experts at the provincial
level and others were from the IEC Center, experts from the MOHME
Hqs., and a few representatives from NGOs and the Ministry of
Education. The participants were divided into 4 working groups and
each group produced a plan of action for IEC activities in respect
of one of the following issues: unwanted pregnancies, adolescent
health, male participation and gender preference. Later, participants
were asked to act as IEC focal points and train other IEC related
staff and prepare a plan of action according to the needs of their
respective provinces after they returned home.
The workshop received wide publicity in the mass media. This
workshop, to a great extent, has further enhanced the UNFPA mandate
and its visibility among the governmental organizations as well as
in the public (Contribution from: UNFPA Iran).
Pakistan: Baluchistan and Punjab formulate their IEC strategies
From 18-21 March, an IEC strategy formulation workshop was held
in Serena Hotel, Quetta, which was the first in a series of five
workshops agreed upon during the TPR held for the IEC project
PAK/94/P08. In this workshop, 22 participants representing all staff
levels, such as Village Based Workers, and their supervisors, to the
Provincial level officers participated. The group had 25-30% female
participants. The inaugural session was addressed by Mr. Kaleem Ullah
Khan, Provincial Minister of S&GAD and Parliamentary Affairs, Capt.
(Retd.) Niaz Mohammad Jafar, the Provincial Secretary of Population
Welfare Department, and Ms. Cynthia Burton, the Representative of
AusAID. Mr. Javed S. Ahmad, who was the facilitator of the workshop,
read a message on behalf of Mr. Nesim Tumkaya. At the inaugural
session speakers suggested that socio-cultural concerns should be
kept in mind while designing IEC strategies.
The basis for the development of the strategies were three: use
of national and provincial policy goals translated in quantitative
terms; use of research and census data in segmenting target audience
and making target audience as the point of determination for
selecting messages, media and activities. A national resource person,
Dr. Abdul Hakim, Director of the National Institute of Population
Studies (NIPS), provided most of the research and demographic data.
This mission made a brief presentation on the nine basic steps in IEC
strategy formulation. This led to an in-depth discussion of each
point and completion of the conceptualization of the strategy
formulation process and segmentation of the target audience.
In all, eight target groups were identified. Participants were
divided into four groups assisted by resource persons, Mr. Wali
Ahmad Khan, Director-General, Programmes, Mr. Zahur Iqbal, Director.
Provincial Training Institute, Lahore, Dr. Hakim and Mr. Mohammad
Iqbal Qureshi, Project Coordinator, decided upon the IEC objectives,
identification of key messages, selection of media suitable to the
audience and messages, and related activities (e.g., frequency and
duration of broadcasts of tv spots) among others.
The second workshop was held in Lahore, Punjab. It was similar
in content and approach to the one held in Quetta, with few
exceptions. Inaugurating the workshop Mr. Ismail Qureshi, Provincial
Secretary, Punjab Population Welfare Department said that
decentralization of the IEC strategy was important not only at the
Province level but also within the Province. Begum Sayyada Sajida
Nayyar Abidi, Adviser to PPWD welcomed the guests, and Begum Mehmooda
Afzal Sindhu, the Chief Patron PPWD, among others, addressed the
participants.
The Lahore participants identified twelve target groups and at
the concluding session presided by Mr. Muzzafar Mehmood Qureshi,
each of the four working groups made presentations on the IEC
strategies they had formulated for the assigned target group work.
Sri Lanka: National IEC strategy plan drafted
Over 24 participants representing all participating
organizations, in a workshop held in January 1996 in Colombo,
identified the IEC priority target groups, messages and IEC goals.
Under each goal, key outcomes, strategies and performance indicators
were developed. The inputs of the workshop participants, which was
facilitated by Mr. Najib M. Assifi, were consolidated and the first
draft of the IEC strategic plan was developed. Copies of the plan
have been circulated to all participating organizations for further
review and comments. It is expected that the final draft will be
submitted to the National Coordinating Council on Population for
approval in March 1996.
IEC Strategies are clear and forceful
Concluding the IEC Strategy Formulation Workshop in Lahore,
Pakistan, Mr. Muzaffar Mahmood Qureshi, Secretary, Ministry of
Population Welfare said: "I am impressed with the presentation of
the strategies today. These presentations were not only clear but
also forceful. Once these strategies are ready, we will implement
them".
Dr. Nafis Sadik's Visit to India
Dr. Nafis Sadik, Executive Director of the United Nations
Population Fund (UNFPA) and Under Secretary-General of the United
Nations, visited India on a State visit from 19-22 December 1995.
In addition to her individual meetings with Mr. J. C. Pant,
Secretary, Ministry of Health and Family Welfare and Dr. Sarla
Gopalan, Secretary, Women and Child Development, Dr. Sadik was
also invited to chair the meeting convened by Mr. J. C. Pant on
the post-Cairo scenario in India.
She addressed a special inter-agency group of the United
Nations on Population and Development issues which was attended by
the UN Heads in India and their representatives. On another
occasion, while addressing a special gathering of Members of
Parliament in Parliament House Annexe, Dr. Sadik stated, "The
Cairo conference adopted a programme of action which emphasized
the need to address population factors in all development efforts,
and called specifically for action to redress gender inequality
and to meet the health and educational needs of everyone". Mr.
Manmohan Singh, Finance Minister, Government of India also
attended the function.
Dr. Sadik addressed the participants at the National Seminar
on "Policy Directions and Strategy of Action in Population and
Reproductive Health" organized by the Population Foundation of
India (PFI). Among the distinguished participants were Dr. Bharat
Ram, Chairman and Dr. Srinivasan, Executive Director of PFI.
Indian children make posters on population and development
Five out of the 6,000 children of ages 5 to 19, who had sent
entries in the poster competition, were chosen as winners by the
judges. The contest was organized by UNFPA in collaboration with
the National Council of Educational Research and Training. The
topic of the contest was "Where we live now", same as being used
by the UNFPA headquarters at the global level, to increase
awareness and understanding of population and development issues.
Workshops, seminars and conferences
Central Asia
TSS and CSTs conduct training on data collection
A 4-week training-workshop on Demographic Data Collection was
held in Ashkabad on 4-29 March 1996 for the Central Asian
Republics. The main objective of the workshop was to develop the
national capacity in these countries to plan and implement
population censuses and surveys. A total of 32 participants from
the Statistical Offices of the 6 Republics (Azerbaijan,
Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and
Uzbekistan)came to attend the training. The participants included
statisticians/demographers and data processing specialists.
The workshop was held at a time when these countries (with
the exception of Turkmenistan which conducted its census in 1995)
were preparing for their first census since their independence to
be undertaken in early 1999. The workshop proved to be useful as
it discussed procedures for planning a census including issues and
considerations that statistical offices must give attention to in
order to ensure that data are accurate and reliable.
Organized jointly by the State Statistical Committee of
Turkmenistan, UNDP Ashgabat and the UNFPA Country Support Team of
Kathmandu, the workshop was coordinated by Ms. Luisa Engracia,
Adviser on Population Statistics. Other resource persons
included: Mr. K. S. Seetharam (CST Kathmandu), Mr. Nuri Ozsever
(CST Bangkok), Mr. Sam Suharto, Mr. Carlos Ellis and Mr. Oleg
Volkov (all of UN Statistics Division, TSS). Funds for the
workshop were provided by UNFPA.
Students use riddles and humour to explain family planning in
Tajikistan
The pre-diploma students of the Medical University, under the
direction of the responsible assistant of the Chair of Obstetrics
and Gynecology, Mrs. Munira Abdurakhimova, organized a Students'
Research Practical Conference on Family Planning. At the
conference participants utilized various visual and oral
communication techniques such as reports, slides, posters,
questionnaires, riddles, film, verses and humour, to explain
methods of family planning. The best presenters were awarded
prizes and diplomas. Mr. Johan Fagerskiold, the UNICEF's Country
Programme Officer in Tajikistan, Mrs. Evgenia Narzullaeva,
Director of the Research Institute of Obstetrics, Gynecology and
Pediatrics, Ms. Zukhra Akhmedova, UNFPA National Programme
Officer, Mrs. Munavarra Dodkhoeva, Chair, and Mrs. Munira
Abdurakhimova stressed upon the importance of the conference and
the importance of family planning in the Republic of Tajikistan.
All of the 90 pre-diploma students were presented a complete set
of books on family planning.
Country Support Team's activities
AZERBAIJAN
Women NGOs to play an active role in IEC
From Jan. 29 - Feb. 2, Mr. Javed S. Ahmad, Adviser on Labour &
Population (IEC) together with Dr. Ummaiyyah Khammash, the Regional
Technical Adviser for Central Asia, formulated projects AZE/96/P02
and P01 respectively in consultation with the officials of the
Ministry of Health, Ministry of Education, various Departments and
NGOs,. An important feature of the project P02, designed to provide
`IEC Support to RH/FP Programme', is to specifically involve two of
the well known and established NGOs in the country, i.e., the
Association of Women of Azerbaijan and the Oil Women Association.
These NGOs will recruit and train volunteers from amongst their vast
membership who will be trained to carry out Community-Based type
activities that would include visiting mothers from door-to-door and
giving them information and education on matters of concern in the
area of reproductive health and family planning. If agreed by the
authorities, these volunteers shall also provide a re-supply of
contraceptives.
BANGLADESH
UNFPA's support for project to educate sex workers
UNFPA Dhaka is considering to support a proposed project which
will assist in establishing two clinics, one to serve the "floating"
commercial sex workers in two geographical areas in Dhaka, and the
other one to serve the sex workers in a brothel area in Mymensingh
town. Mr. Najib M. Assifi, the Adviser on Population Advocacy,
during his mission to Bangladesh from 10-19 April, examined the
proposal for the reproductive health care of commercial sex workers,
drafted by a local consultant in collaboration with the Nari Maitree,
a women's NGO group. The main aim of the project is to provide
HIV/AIDS education and clinical services for commercial sex workers
in selected areas. The project duration is for two years and when
approved, it will be executed by the Family Planning Services and
Training Centre (FPSTC). To establish contacts and gain their trust,
the project will recruit former sex workers to work as motivators.
These motivators will also be given training in communication skills
and counselling under the project.
Population Education through NGOs
Under a UNFPA/Dhaka supported project, reviewed by Mr. Sans S.
Hutabarat, Regional Adviser Population Education Out-of-School, (23
Jan.-4 Feb.), key concepts in reproductive health, physiology and
human sexuality and the associated psychological, social and
emotional problems, will be included in a curricula of family life
education for the non-formal education programmes of the Grameen
Bank, the Bangladesh Rural Advancement Committee (BRAC) and others.
The Adviser has recommended creation of an office called Population
and Family Life Education Coordination Cell by the National
Curriculum and Textbook Board to ensure coordination of the
activities.
BHUTAN
Replacement level fertility by the year 2017 projected
Medium variant projection prepared by Mr. Rafiqul Huda
Chaudhury, Adviser, Population Policy and Development Strategy, in
consultation with various Government Ministries and Departments,
indicate that Bhutan would achieve replacement level fertility by the
year 2017. The set of population projections were prepared by Mr.
Chaudhury, during his mission to that country (from 11-29 March),
mainly for the Eighth Five-Year Plan period (1997-2002), and extended
to cover the period 2002-2017. In addition, he assessed the
implications of population growth under different scenarios on
various aspects of the quality of life of the people in Bhutan such
as environment, carrying capacity of land, universal education, basic
health, employment, etc.; determined contraceptives requirements and
recommended strategies beyond family planning to moderate population
growth. Under the medium variant projection, in which fertility is
assumed to decline by over 60 percent from its level of 5.32 in 1997,
to the replacement level of two surviving children per woman in 2017,
the total population will grow to 855,000 or 42.5 percent by the year
2017.
Mr. Chaudhury has stated in his mission report that the
population growth, although declining drastically, would continue
even if fertility could be reduced to the replacement level within
a short period of 20 years as targeted by Medium variant projection.
This is attributed to population momentum, resulting largely from a
young age structure. Mr. Chaudhury has recommended: adoption of a
comprehensive population policy, inclusion of a separate chapter on
Population and Development in the Plan document, and training in
integration of population concerns in the development planning.
INDIA
Preparing for the PRSD. . .
On request of the UNFPA country office, several CST
advisers participated in various activities in India in
preparation to the forthcoming Programme Review and
Strategy Development (PRSD) exercise. Gists compiled from
the mission reports filed by the advisers follows:
Mr. P.M. Jessie Brandt, RH-FP Logistics and MIS Adviser, visited
India from 8-23 January. The purpose of the mission was to assess
the current status of the logistics system and have discussions with
concerned Government officials and officers of the consultant firm,
Tata Consultancy Services, who have been contacted by UNFPA to
conduct a comprehensive logistics study. After visiting Rajasthan,
UP and Bihar, along with General (Rtd.) Bhandari, Mr. Brandt
concluded that excellent opportunities exist to restructure the
current logistics and supply systems into a combined and integrated
central-divisional, sub-district hub system of logistics management.
Later, from 3-15 March, as a member of a four-person team, Mr. Brandt
re-visited India with the assignment to, among others, propose broad
objectives and key strategies for the national Family Welfare
programme for the next 10 years in the areas of logistics,
contraceptives requirements, sources of supplies and projected needs,
CBD and social marketing and MIS.
Mr. Najib A. Assifi, Adviser, Population Advocacy, made two
visits to India i.e., from 11-16 February and 4-15 March to carry out
a review of the IEC programme in India and propose strategies for the
next ten years in support of the broader population and development
programme. During these visits he met the Government and UNFPA
officials in Rajasthan and New Delhi. He proposed his strategy to
be based on both national and state level institutions. He
recommended advocacy through the national institutions and
establishment of IEC Bureaus in the priority States.
Ms. D. M. De Rebello, Adviser Population Education in the Formal
Sector, participated in a workshop on Future Strategies in Population
Education from 21-23 January. The suggestions and recommendations of
the workshop are meant to be fed into the documentation for the PRSD.
Some of the common concerns of the participants were: in view of the
Programme of Action of ICPD, contents and strategies of population
education should be re-defined; advocacy is needed to secure support
of the policy makers and media for the training of the teaching staff
and to change their attitudes; and multi-strategies were needed to
approach population education for both in and out-of-school groups,
particularly adolescents. From 13-17 February, Ms. de Rebello also
attended a seminar on adolescent education in Banglore.
Executive Programme for Developing Countries (EPDC)
EPDC is a collaborative effort between the University of North
Carolina at Chapel Hill, and the Indian Institute of Health
Management Research (IIHMR) in Jaipur leading to a MPH degree. UNFPA
supports this programme through a regional project. EPDC consists of
over 15 courses and two field projects. Mr. G. Giridhar, Adviser on
Management of Population Programmes, in a two-week mission (26
February - 8 March) taught the course Management Information System
(MIS) for Health and Population to 24 mid level managers from
Bangladesh, India, Nepal, Sri Lanka, Viet Nam and USA.
IRAN
A workshop on Management of Reproductive Health and Family
Planning Programme was designed by Mr. G. Giridhar during his mission
to Iran from 8-14 January 1996. This workshop, to be held in May this
year will be conducted by the Ministry of Health and Medical
Education (MOH-ME) with support from UNFPA. About 40 national and
provincial level officers will be invited to participate in this
workshop.
Advocacy recommended at all levels
At the advocacy sector review held on the 24 & 25 April,
covering six projects, Ms. D. M. de Rebello recommended advocacy at
all levels for achieving the ICPD goals. Her other recommendations
which cut across all projects were: the need for greater focus on
reproductive health issues, more inter and intra sectoral cooperation
and collaboration, and greater gender sensitization. Sectoral review
meetings were scheduled by the UNFPA Country Office, Iran as a
preliminary step in the process leading to the Mid Term Review
proposed to be held in September 1996.
KYRGYZSTAN
Kyrgyz journalists exposed to population and development issues
For the first time, Kyrgyz journalists were given an opportunity to
learn and discuss a wide variety of issues concerning population and
development, reproductive health and contraception in a workshop
organized under the UNFPA/UNDP/UNESCO supported project, "Mass Media
in a period of Reform and Transition", from 6-14 March in Bishkek.
The Workshop on Population and Development for print, television
and radio journalists was inaugurated by Dr. Mrs. Beyshekan Kalieva,
the First Deputy Minister for Health, and addressed by Mr. Ercan
Murat, the UNFPA Representative and Mr. Javed S. Ahmad during the
inaugural session, held at the Media Resource Centre. Mr. Ahmad
facilitated the workshop with assistance from the staff and
volunteers of the Media resource Centre, Mr. Mustafa Kemal Eric,
Ms. Cholpon, Mrs. Trudy, and Ms. Indira Moldogazieva, NPO UNFPA
Kyrgyzstan.
The participants heard from top level national experts, such as
Mr. Akeenev, Chairman of the National Statistical Committee, Dr. J.
Doskeeva, Head of MCH, Prof. Pototskii and Dr. Sagynbaeva, research
specialists, Dr. Boris Shapiro, Head of the AIDS programme and
Dr. Jamal Nurgazieva, Head of the National Venereological Hospital,
among others, on subjects such as demographic situation in
Kyrgyzstan, reproductive health and contraception issues and
services, and problems of adolescent sexuality. The participants were
taken to a field visit to get a first hand experience of knowing the
reproductive health problems such as abortions, STDs and teenage
pregnancies.
Are women choosing contraception over abortion in Kyrgyzstan?
by Dr. Anara Doolotova* and Mr. Javed S. Ahmad
The extensive reliance on abortions as means to avoid unwanted
births in the newly independent states of Central Asia is a matter
of grave concern for the governments and health agencies. Until
recently, the only contraceptive offered by the health systems in the
six countries of Central Asia (that include Kazakstan and Azerbaijan)
was IUD. In 1993, UNFPA sent several missions to the region and
followed them up with an emergency supply of Copper-T IUDs, oral
pills, Depo Provera and condoms. This action was soon followed by
several training programmes in contraceptive technology. In order
to develop a profile of the women seeking abortions, so that suitable
information and education strategies could also be developed, in
November 1995, a study to analyze clinic record cards of abortion
clients was initiated in the Marriage and Family Guidance
Consultation (M&FGC) clinic in Bishkek, Kyrgyzstan.
In February 1996, while conducting the analysis of the 743
clinic record cards of the clinic, it was revealed that the total
number of abortion clients in M&FGC have declined sharply since the
previous year for the matching period. This led to a quest for
similar data from six other clinics in Bishkek. The results
confirmed the trend. The number of abortions seemed to be declining
in the city in general. Could this change be attributed to the
supply of UNFPA provided contraceptives during the same period? This
assumption, although highly plausible, would need further data for
validation.
It is noteworthy that M&FGC is the main government health
facility in Bishkek, Kyrgyzstan, which provides all reproductive
health services to roughly 300 men and women who visit it every
working day. The services include diagnostic tests and referrals,
treatments for related diseases, infertility and both mini and longer
term abortions. Headed by an Obstetrics & Gynecologist, and staffed
by several specialist physicians and nurses, the clinic is
conveniently located, and practically a walking distance away from
the city's main railway station. Although the majority of the
clients come from urban areas (basically Bishkek), there is a
significant percentage that comes from rural areas.
Near the end of 1994, the clinic had received Depo Provera,
Copper T and oral pills from UNFPA. Clinic staff received training
organized by Futures' Group (SOMARC), AVSC and FHI. Thereafter, a
majority of the women getting abortion began to be counselled on
newly received contraceptives. A much rapid decline in the abortion
clientel at the M&FGC than the other six clinics could possibly be
owing to patient counselling or other factors that need yet to be
determined. There could be other factors behind the decline, such as
decreased capacity to pay for abortions, switching to private
doctors, and to some extent out-migration of the Russian population.
__________________________________________________________________
* Dr. Anara Doolotova is the Chief, Marriage and Family Guidance
Consultation
Kyrgyz Institute of Obstetric and Gynecology, Ministry of Health,
Government of Kyrgyzstan.
MALDIVES
Training in interpersonal communication and counselling
According to a 1991 KAP survey in Maldives (unpublished)
although 96% of married women between the ages 15-49 knew of one FP
method, only 23% are currently practicing FP. In an attempt to narrow
the KAP gap, a training of Master Trainers was held on Interpersonal
Communication and Counselling Skills from 27 February to 6 March
1996. The training was attended by 17 participants from various
government and nongovernment organisations on the island of
Laamu/Fonaadhu. Ms. Malicca Ratne, IEC Adviser, designed and
facilitated the training. Ms. Husna Razee, Director, Institute of
Health Sciences and the co-facilitator, conducted part of the
workshop in the local language, Divehi. The recently published
Trainers Manual on Interpersonal Communication Skills was the main
resource material. Besides FP clients, the facilitators also trained
a few of the participants on counselling for adolescents on sexual
and reproductive health. As master trainers, most of the participants
will conduct a similar training for Community Health Workers. The
Department of Public Health as the implementers of the UNFPA
supported project "Support to the IEC Activities of the MCH Service
Providers", which funded this training, will translate the training
manual into Divehi, after modifying the modules to fit the Maldivian
cultural context.
A Workshop on IEC materials
A review of printed IEC materials produced in Maldives on
reproductive health and FP revealed that there were very few printed
materials on FP and none on reproductive health; there were no FP
posters; there were no IEC materials targeted at service providers
and special groups such as men, adolescents and religious leaders;
IEC materials on HIV/AIDS were targeted at no specific group. In a
country where the literacy rate among 10-45 is 98%, lack of printed
IEC materials can retard changes in RH and FP behaviour.
To address this severe shortage of printed IEC materials, 17
participants from the government and non-government organisations,
assisted by two commercial graphic artists, attended a hectic five
day workshop to develop and produce prototype IEC materials. Ms.
Ratne spent 10 days in Maldives in March 1996 to design and conduct
the workshop. At the end of five days, a substantial number of
prototype printed IEC materials were developed: targeted at newly
married couples, adolescents, men, religious leaders and health
providers. The materials will be field tested by the Department of
Health.
Maldives' Population Growth Rate highest in South Asia
The Population and Housing census of Maldives enumerated a total
of 213,215 persons, excluding foreign passport holders in 1990. This
number indicates an exponential growth of 3.37 percent annually, the
highest in the SAARC region. Mr. Rafiqul Huda Chaudhury, who have
analyzed the population census data, said that in his view, the
dramatic increase in the rate of population growth was due to the
rapid fall in mortality rate without a corresponding decline in
fertility. Mr. Chaudhury made several other observations on the
demographic picture of the country. He noted that 66 percent of the
total population was under age 25 which predisposes the country for
continued high growth for a long time. He observed a relatively high
divorce rate among women and men and also a high rate of marriages.
For example, over one-half of the ever married women aged 40 years
and above married at least four times. However, high frequency of
marriage, ceteris paribus, does not lead to high fertility.
NEPAL
Major Population and Development Challenges of Nepal
Nepal is making progress in implementing the Programme of Action
agreed upon at ICPD. Mr. Rafiqul Huda Chaudhury, who carried out a
comprehensive sector review on a mission to Nepal during the month
of January, says that Nepal has made some noteworthy progress in
implementing the POA. For instance, actions such as adoption of a
comprehensive and multi-sectoral national population policy;
preparation and utilization of population projections; establishment
of population committee, (the highest policy making body on
population), headed by the Prime Minister; establishment of the
Ministry of Population and Environment; establishment of various
organizational structures to promote population in national
development planning, speak for themselves.
In spite of these laudable achievements towards integration of
population concerns into development planning, however, there are
many constraints such as: dearth of adequate and appropriate
population policy research, lack of reliable and accurate data on
population and development variables in usable form; and lack of a
cadre of trained manpower with necessary skills to formulate and
implement integrated population and sustainable development policies
and programmes at all levels. In order to achieve ICPD's POA goals,
the country has its task cut out: to remove targets from the
population policy/programme; to ensure universal accessibility of
reproductive health information and services by the year 2015; to
have a perspective plan with a definite time table to remove the
existing gender disparities in education, health, administrative and
political decision making and access to resources; to broaden
contraceptive choices; and to improve quality of reproductive health
services. This is yet to be ensured as the following statistics
show: only 18% of women receive ante-natal care; over 90 percent of
births are still delivered at home and maternal mortality risk (8.5
per 1,000 live births) is one of the highest in the world.
Mr. Chaudhury's report was prepared to be incorporated in the
documentation for the PRSD mission in May 1996.
Change curricula of population education per ICPD's
Ms. D. M. De Rebello, during her mission from 31 Jan- 12 Feb.,
has advised the Government of Nepal to reconceptualize population
education in the light of new population paradigm. She said that the
curricula should give adequate coverage to important concerns such
as gender sensitivity, reproductive choices and responsibilities and
sexually transmitted diseases. However, the most important ingredient
of population education is teacher orientation and training, she
said.
Nepal emulates Bangladesh's model: will it succeed?
CST Adviser, Gender, Population and Development, Ms. Vineeta
Rai, on a mission to Nepal from 15-20 January, assessed the
replication of the Bangladesh's model of offering bank loans to rural
women groups to carry out income generation activities. She observed
that in acknowledgment of the fact that economic development is
closely related to th advancement of women, and productive employment
of women is critical in eradicating poverty, the HMG, has set up
Rural Development Banks in four Regions - Biratnagar, Butwal,
Dhangadhi and Nepalgunj, on the pattern of the Grameen Bank of
Bangladesh.
The Bank at Nepalgunj established about a year ago covers,
Banke, Bardiya, Dang and Surkhet Districts. It's basic objective is
to provide group credit to rural poor women without any collateral
for micro enterprises chosen by the women themselves, and also
encourage then to have group savings. So far this Bank has disbursed
loans worth 17 lakhs to 95 womens' groups in their area. The period
for repayment of loan is 50 weeks with weekly repayments of 2%. The
Rate of interest is on a diminishing balance basis. The government
subsidy on the 20% interest rate is 80%. So the beneficiary has to
pay only 2% interest rate on the loan taken by them.
Ms. Rai visited Ranjha village where she met 5 groups of women,
who had taken loans from this Bank. The women were very happy with
the credit they had obtained. The most popular investments made by
them were in setting up tea shops and buying cattle (mainly buffaloes
and goats). The women were very regular in paying back the weekly
loans, and they often held group meetings. All the women were
married, but few practiced family planning. Ms. Rai, however,
recommended that government should consider removing high rate of
subsidy to the borrowers because it could be counterproductive in the
long run.
Ms. Rai also visited Nepalgunj to observe a similar programme
of rural banking through commercial sector. The Production Credit for
Rural Women (PCRW) is an important programme to improve the status
of women in Nepal. This was initiated by HMG and UNICEF in 1982, and
is implemented by the Womens' Development Division, Ministry of Local
Development. It is now operational in 46 districts and is supported
by a number of donors. It assists rural women's groups in obtaining
credit from commercial banks for taking up income generation micro-
enterprises. Under the auspices of this project more than 4000 groups
have been formed and over 170,000 beneficiaries have benefitted.
HMG's two important strategies: integration and decentralization
In his background paper on selected management areas of the MCH-
FP programme in Nepal, prepared for the PRSD mission, Mr. G. Giridhar
has indicated integrated service delivery and decentralized programme
administration for the primary health care as the two most important
strategies adopted by His Majesty's Government in recent years. The
Adviser has recommended that future assistance to the programme
should support these strategies by building capacity for
decentralized management particularly at the district levels and
developing local institutions to facilitate this process on a
continuing basis.
PAKISTAN
Project to analyze CPS proposed
The data gathered for the 1994/95 Contraceptive Prevalence
Survey of Pakistan needs in-depth analysis and findings to be widely
disseminated. Mr. Rafiqul Huda Chaudhury, during his mission to
Pakistan from 24 Feb. to 1st March, finalized the project that will
provide necessary support. Mr. Chaudhury has also recommended that
a Research Committee should be constituted immediately to plan the
analysis and monitor the project implementation.
Post-graduate course in population studies
Under a proposed UNFPA supported project designed to strengthen
the National Institute of Population Studies (NIPS), an additional
component will be added to support launching of a year-long post-
graduate course in population studies. The course is likely to be
offered by the Quaid-e-Azam University in Islamabad, which is
interested to setup a Centre for Population and Development Training
and Research for this purpose. The initial discussions with
concerned authorities were conducted by Mr. K. S. Seetharam, Adviser,
Population Policies, from 25 Feb. To 9 March.
SRI LANKA
Free Trade Zone workers' Project enters Phase II
Phase II of the FTZ project was approved in July 1995. However,
the Ministry of Labour and Vocational Training reported at the Annual
Performance Review meeting with UNFPA, that picking up the
activities after the expiry of the first phase has been rather slow
due to a late start. Mr. Jalaluddin Ahmed, Adviser, Organized Sector
and Community Outreach, who participated in the APR, (12-17 Feb.)
stated in his mission report that the Centre for Women Workers was
officially inaugurated in December 1995, and several activities have
been initiated such as awarding of the baseline survey contract,
recruitment of nurses, and training etc. Mr. Ahmed also attended the
APR for the project "Population and Family Welfare Education through
Department of Labour and Vocational Training", which has undergone
several institutional and staff changes, with mixed results.
Counselling proposed in the school system
Making several recommendations for the next country cycle in the
area of population education through the formal school system, Ms.
D. M. De Rebello recommended introduction of counselling on a pilot
basis in selected schools. She also recommended involving parents
on population and family life education programmes. Ms. Rebello was
on a mission to Sri Lanka from 11-15 March to review progress of the
project SRL/93/P01 on Population and Family Life Education.
TURKMENISTAN
Projects designed to support reproductive health
From Feb. 5-10, Mr. Javed S. Ahmad together with Dr. Ummaiyyah
Khammash formulated projects TUK/96/P02 and P01 respectively in
consultation with the officials of the Ministry of Health, Ministry
of Education, and various Departments, UNDP and UNICEF. Project P02
is designed to provide `IEC Support to the MoH's RH Programme', and
will provide funds and technical assistance to strengthen the Centre
for Health for providing IEC support to the RH services. The Centre
will design IEC materials and distribute the same through service
delivery points. It will also be responsible to use multi-media
including film shows in the rural provinces to reach both men and
women audiences. The project P01 is aimed at strengthening RH
services, by providing training, equipment and technical assistance.
Both projects were developed under advice that Islamic cultural
and religious traditions of Turkmenistan should be strictly observed.
Although Turkmenistan is also a newly independent republic of the now
defunct Soviet Union, it takes special pride in its Islamic roots,
and feels its cultural values should not be confused with those of
some of the westernized republics. The two year long projects are
expected to provide essential inputs in changing the way women's
reproductive health and child spacing have been practiced in the
past.
UNFPA/UNV Award for Distinguished Work in Population
On the occasion of the 25th anniversary of the United Nations
Volunteers (UNV) programme, UNFPA and UNV have agreed to jointly
issue the UNFPA/UNV awards for distinguished work in population. A
maximum of two awards will be given. UNFPA Representatives and UNDP
Resident Coordinators have been invited to send in their
recommendations by 15 July 1996.
Maldives' multi-sectoral team visit Indonesia
A ten-member team from Maldives visited Indonesia on a two-week
study tour, during the first half of April. The team comprised of
representatives from sectors having a role in addressing population
issues: an Atoll Chief, a President and two members of Island Women's
Committees, a journalist from a newspaper, a journalist from TV, a
Family Health Worker, a TBA, a Magistrate of an Island Court and a
senior official from the Health Ministry. The objective of the study
tour was to demonstrate inter-linkages of various sectors and the
importance of co-ordination among them for improving the
effectiveness of population related programmes. This is the first
study tour organized for a multi-sectoral team from Maldives.
The Team was highly impressed by the strong commitment shown for
the family planning programme by community groups and the concept of
integrating family planning messages in the sermon of Friday Prayers.
On return from Indonesia the Team members reviewed their experiences,
with the UNFPA Representative in Maldives, Mr. Narinder Kakar and the
National Programme Officer Mr. Mohamed Zuhair.
India: No More Targets in Family Planning Programme
Beginning April 1995 the Government of India had eliminated
method-specific contraceptive targets in at least one district of
each state. It was expected that elimination of targets will result
in better quality services, and also reduce pressure on workers and
clients. On the basis of the experience in these districts, the
entire country has been made target free as of April 1996.
A new manual on target free reproductive health approach has
been developed by the Department of Family Welfare, to help health
staff throughout the country understand the new approach to the
programme, and the new reporting requirements.
The Programme of Action which emanated from 1994 Cairo
International Conference on Population and Development formalized the
growing international consensus that improving reproductive health
and family planning is essential to human welfare and development.
The Government of India supports the Cairo programme of Action and
the Reproductive Health approach, as already reflected in the country
paper prepared for the Cairo Conference and the action plan prepared
for revamping the family welfare country programme.
The Government of India, Ministry of Health and Family Welfare
has had discussions with state-level health and family welfare
secretaries to discuss how new approaches might be incorporated into
the programme.
There have been some specific reflections from the Government
of India which confirms its commitment to and transition into more
client-need-oriented and quality reproductive health programme in
place of method specific contraceptive driven family planning
services. In a nutshell, there are five main issues which are
receiving attention from the Government of India:
(1) developing client-centred system of performance goals and
measures instead of number oriented, methods-specific
contraceptive targets;
(2) adopting a Reproductive Health approach, expanding the range of
services and increasing funding for the current programme;
(3) involvement of communities and people's participation in
managing the population programme along with the improvements
in the quality of availability and services;
(4) promoting and expanding the prevalence and use of male methods
and reversible methods along with widening the choice of
contraceptives; and
(5) promoting and strengthening the role of private sector in the
national family welfare programme.
The Government of India has accepted the need to broaden the
current programme to address Reproductive health needs. Several
donors are working with the Department of Family Welfare to develop
projects aimed at improving reproductive and child health (RCH),
going beyond child survival, family planning and safe motherhood.
The Government of India is also taking initiatives to bring
about decentralization and to involve district level functionaries
in not only implementing, but also planning programmes locally. It
also envisages involvement of Panchayats (local self-government) in
the process of planning, and monitoring health and family welfare
programmes.
While still encouraging smaller families, the main emphasis is
to help the clients meet their own health and family planning goals.
Performance is to be measured on the quality of care, client
satisfaction and coverage of services.
In addition to initiatives taken by the Central Government,
several states have also been active. Rajasthan, for example,
declared three of its districts target free in April 1995, and they
were encouraged to undertake bottom up planning.
Youth essay writing contest
UNFPA is organizing a world-wide youth essay writing contest
under the theme Promoting Responsible Reproductive Health Behaviour:
the Youth Perspective. The contest is being held in support of the
World Youth Forum of the UN System, which will be held in Vienna from
25 to 29 November 1996. Youth aged 15-24 may participate in the
contest. More details about the contest can be obtained from the
UNFPA offices in most developing countries, and also from the offices
of Red Cross, the World Assembly of Youth, the World Young Women's
Christian Association, among others. The deadline for receiving
entries is 15 September 1996 (Attention: ECY Branch, Technical and
Evaluation Division, UNFPA Headquarters, 220 East 42nd Street, New
York, New York 10017, USA).
DR. UMMAIYEH KHAMMASH
Dr. Ummaiyeh Khammash, Regional Technical Adviser, Reproductive
Health and Family Planning, for Central Asia region that comprises
Kazakstan, Kyrgyzstan, Tajikistan, Turkmenistan, Azerbaijan and
Uzbekistan. Dr. Khammash, before joining UNFPA,has worked with WHO
and NGOs. His last job was with a health related non-governmental
organization in Jerusalem, Israel.
Outside the region
Ms. Vineeta Rai joined the PRSD mission in Cambodia from Feb.
13-March 15. She was responsible for the Gender, Population and
Development component of the exercise.
Editorial Board
Mr. Javed Sajjad Ahmad - Chairperson
Mr. Rafiqul Huda Chaudhury - Member
Mr. G. Giridhar - Member
Ms. Malicca Ratne Castelli - Member,
"The views expressed are those of the author(s) and the editors, and
do not necessarily reflect those of the United Nations".