UNFPA

UNFPA – ICOMP WORKSHOP ON OPERATIONALIZING THE CALL FOR ELIMINATION OF UNMET NEED FOR FAMILY PLANNING IN ASIA AND THE PACIFIC REGION 18-19 September 2012 The Imperial Queen’s Park Hotel, Bangkok, Thailand

Introduction The Programme of Action of the 1994 Cairo International Conference on Population and Development [ICPD] called on all countries to take steps to provide universal access to a full range of safe and reliable family planning methods and related reproductive health services. The ultimate goal was to help couples and individuals achieve their reproductive goals and to allow them to exercise their human right to have children as and when they choose. It is acknowledged that meeting the RH needs of the population is also critical to achieving the Millennium Development Goals [MDGs]. The adoption of the new MDG target in 2007 – MDG5b:to achieve universal access to RH – with indicators on contraceptive prevalence rate and unmet need for family planning - have reaffirmed the importance of family planning as a key strategy for improving the sexual and reproductive health of women, men and young people. The adoption of MDG 5b recognized family planning as a cost effective intervention that can impact maternal mortality in low-resource settings.

Although ICPD was emphatic in its support to family planning, in the nearly two decades that followed, family planning has stagnated and stalled because it did not receive the priority that it should have received. It was observed that this relative neglect of family planning has had major consequences for health (specifically women’s health) and the demographics of poor and developing nations. In addition, the prospects of environmental protection and sustainable development have also suffered negative consequences.

With this backdrop in mind, the Asia and the Pacific Regional Office of the United Nations Population Fund (UNFPA), in collaboration with the International Council on Management of Population Programmes (ICOMP), held a High Level Regional Consultation on: “Family Planning in Asia and the Pacific: Addressing the Challenges” in Bangkok, 8-10th December, 2010. It was the first major meeting on the subject and other regions followed with subsequent meetings.

The situation of fertility decline and status of family planning programmes in the region were reviewed for background documentation for the consultation (which is now available through ICOMP Website as well as a publication). One of the overwhelming findings was that unmet need is high across countries of Asia and the Pacific, as well as within some of the countries.

The consultation succeeded in achieving its major objective of gaining the support of Governments and Civil Society representatives of the Asia Pacific countries and the development partners of UNFPA to commit to the rejuvenation of family planning programmes in the countries of this region. The ‘Asia and the Pacific Call for the Elimination of Unmet Need for Family Planning’ (Annex -1) endorsed at the end of the consultation proposed ten strategic actions for governments and other stakeholders to address the unmet needs for family planning, within the context of sexual and reproductive health, with particular focus on the underserved.

As a follow-up of the meeting in December 2010, UNFPA APRO, in collaboration with ICOMP organized a workshop on “Operationalizing the Call For Elimination of Unmet Need For Family Planning In Asia And The Pacific Region” in Bangkok, 18 – 19 September 2012 with focus on selected countries with high and medium fertility rate and high unmet need for family planning in the Asia and the Pacific Region. The idea was to take another step forward in both advocating and collectively identifying action areas in these priority countries, namely, Afghanistan,

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Cambodia, India, Lao PDR, Myanmar, Nepal, Pakistan, Philippines, and Timor Leste. In view of the unique and largely unaddressed needs of young people for quality sexual and reproductive health information and services, it was decided that addressing the needs of unmarried young people would be one of the topics for discussion.

As a follow-up of the Regional Consultation, ICOMP had commissioned two sub-regional (South Asia and South East Asia) papers to review the status of the implementation of the Call for Elimination of Unmet Needs for Family Planning. In addition to the sub-regional papers, two-country speciďŹ c reviews were conducted in India and Nepal. The analysis focused on the interventions and actions at policy and programme level, in terms of eectiveness, eďŹƒciency, accessibility, aordability and sustainability of the interventions that comply with the strategies agreed at the 2010 Regional Consultation. It also looked at the issue of addressing the unmet needs for family planning.

The consultants who prepared the sub-regional and country-speciďŹ c review papers are as follows: Name of the Consultants

Title of the Paper

1. Prof. Gavin Jones, Director, Comparative Asia Research Centre, National University of Singapore

Feedback Report on the Status of the Implementation of the Call for the Elimination of Unmet Need for Family Planning in Southeast Asia

2. Prof. Barkat Khuda, Professor of Economics, University of Dhaka, Bangladesh

Unmet Contraceptive Need and Family Programmatic Challenges in South Asia

3. Dr. Mohammad Ejazuddin Khan, Senior Programme Associate, Population Council, India

Unmet Need for Contraception in India: Review and Recommendations

4. Mr. Anand Kumar Tamang, Founder Chairperson and Director, Center for Research on Environment Health and Population Activities (CREHPA), Nepal

Feedback Report on Status of Implementation of The Call for Elimination of Unmet Need of Family Planning in Nepal

Planning

In addition to the sub-regional and country-speciďŹ c review papers, a number of technical paper on young people were also commissioned to determined the overall status of young people, and their unmet needs, including family planning, as well as best practices/lessons learned from successful projects from within and across countries. It focuses on selected countries in South Asia and South-East Asia (Indonesia, India, Malaysia, Nepal and Philippines).

It identiďŹ ed successes, changing needs and gaps that contribute to the development of country-speciďŹ c action plan for renewed focus and increased investment for addressing the unmet needs of family planning of young people.

The consultants who prepared the technical papers on young people are as follows: Name of the Consultants

Title of the Paper

1. Assoc. Prof. Dr. Mary Huang, Department of Nutrition and Dietetics, Faculty of Medicine& Health Sciences, Universiti Putra Malaysia

Overall status of Sexual and Reproductive Health and Family Planning (SRH & FP) of Young People in Indoneisa, Malaysia and the Philippines

2. Mr. Anand Kumar Tamang, Founder Chairperson and Director, Center for Research on Environment Health and Population Activities (CREHPA)

Overall status of Sexual and Reproductive Health and Family Planning (SRH & FP) of Young People in Nepal,

3. Dr. Bella Patel Utteker, Research Director, Centre For Operation Research and Training, India

Overall status of Sexual and Reproductive Health and Family Planning (SRH & FP) of Young People in India

2. Purpose of the Workshop Building on the 2010 Call for Elimination of Unmet Need for Family Planning and taking into consideration the outcome of the Family Planning Summit in July 2012, the main purpose of the UNFPA-ICOMP Workshop on “Operationalizing the Call for Elimination of Unmet Need for Family Planning in Asia and the PaciďŹ c Regionâ€? were: t 5P UBLF TUPDL PG DIBMMFOHFT UIBU XFSF JEFOUJmFE JO UIF QSJPSJUZ DPVOUSJFT BOE FYBNJOF QSPHSFTT BOE CBSSJFST t 5P JEFOUJGZ LFZ TUSBUFHJFT BOE BDUJPOT UIBU XJMM IFMQ BDDFMFSBUF QSPHSFTT UPXBSET BEESFTTJOH VONFU OFFE

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A total of 42 participants from nine high and medium fertility countries with high unmet need for family planning participated in the meeting. The participants comprised of representatives of government line ministries of Health and Population and civil societies including young people as well as the UNFPA Representatives and concerned Country OďŹƒce focal persons from the nine countries, namely, Afghanistan, Cambodia, India, Lao PDR, Myanmar, Nepal, Pakistan, Philippines, and Timor Leste. In addition, selected resource persons (who authored the review papers) and thematic experts from the UNFPA Asia and the PaciďŹ c Regional OďŹƒce (APRO) and other external partners (UN and INGOs) were also invited and contributed signiďŹ cantly in the deliberations of the workshop (Annex-2).

3. Thematic Issues Five thematic topics were identiďŹ ed for focused discussion on strategies to accelerate progress towards addressing unmet needs for contraception/family planning. They include: t *NQSPWJOH UIF RVBMJUZ BOE DPWFSBHF PG GBNJMZ QMBOOJOH JOGPSNBUJPO BOE TFSWJDF EFMJWFSZ JODMVEJOH TLJMMFE IVNBO resources t 3FDPHOJ[JOH BOE BEESFTTJOH UIF VOJRVF OFFET PG ZPVOH QFPQMF GPS RVBMJUZ TFYVBM BOE SFQSPEVDUJWF IFBMUI information and services, including family planning/ contraception. t &OTVSJOH DPNNPEJUZ TFDVSJUZ UISPVHI FTUBCMJTINFOU PG GBWPVSBCMF QPMJDZ mOBODJOH BOE FÄŠFDUJWF TZTUFNT GPS supply chain management, to ensure sustainable supplies of a broad range of contraceptives to all t 4FDVSJOH BO FOBCMJOH FOWJSPONFOU UISPVHI TUSPOHFS QBSUOFSTIJQT BOE MFBEFSTIJQ GPS SFQPTJUJPOJOH 'BNJMZ Planning t %JNJOJTIJOH TPDJP DVMUVSBM BOE PUIFS CBSSJFST UISPVHI TUSFOHUIFOJOH DPNNVOJUZ FOHBHFNFOU BOE EFNBOE GPS family planning services.

The above ďŹ ve thematic topics were identiďŹ ed as the key operational issues and actions among the 10 points of the Call for Action. The other calls are highly important enabling factors which are overarching and facilitate in moving towards operation and action. By examining the actions taken, progresses, challenges and lesson learned based on the thematic areas, each country was expected to come up with speciďŹ c actions to address the unmet need for family planning and prioritize them for follow up in their respective countries and at the regional and global level.

4. Workshop Proceedings The following sections of the report present highlights from each session in line with the agenda for the workshop (Annex-3) and key issues raised during discussions. Key points from the presentations on the two sub-regional reviews on the unmet need for family planning in South East Asian and South Asia and panel discussion on responding to the unique needs of young people as well as comments made during discussions are presented. Finally, the key issues and action points raised at the ďŹ ve parallel thematic and three country cluster group discussions along with way forward are presented in the subsequent sections.

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Opening Remarks Dr. Wasim Zaman, Executive Director, ICOMP Dr. Wasim Zaman, the Executive Director of ICOMP stated that family planning programmes have been in place in all countries in Asia for several decades and signiďŹ cant achievements have been made. Yet, many challenges still remain in terms of stagnating Contraceptive Prevalence Rate (CPR) and high-unmet family planning needs in several countries (e.g.

Bangladesh, Indonesia, Nepal and Pakistan). There are also disparities on contraceptive use and unmet need for family planning amongst states or provinces within countries like India. The key determinant factors of unmet need are not only the “accessâ€?, but also the “unwillingnessâ€? to use due to socio-cultural barriers, health concern and inadequate knowledge about the contraceptives. Similarly, high unmet needs for family planning among dierent marginalized groups including young people (both married and unmarried), people in the lower economic quintile, migrants and displaced people, indigenous populations and people living with HIV continues to exists, which indicate a need for focused interventions.

Dr. Zaman emphasized on the linkages between achieving the MDG targets, especially MDG 5a and 5b, and meeting the needs for family planning and the need for increasing investment in family planning to achieve the MDGs and ICPD goals.

Pointing to the ICPD Beyond 2014 processes, he added that key challenges in meeting the ICPD agenda include, among others, the inequalities and inequities between and within countries, ensuring universal access to comprehensive quality SRH services, supplies and information, and the recognition of rights of individuals, civil society and culture. In addition, he shared that the London Summit on Family Planning held in July 2012 with an aim to reach 120 million more women from the world’s poorest countries with access to contraceptives by 2020. The Summit was able to mobilize ďŹ nancial commitment amounting 2.6 billion from donors, multi-lateral and bilateral agencies (Box-1: slide on ďŹ nancial commitment made at London summit to be inserted). Thus emphasis on repositioning FP is not only in words, but money is where it is needed and it is time to take action.

With the above background, Dr. Zaman reiterated the rationale for selection of the nine countries with high/medium fertility level and high unmet needs for contraception/family planning.

Five thematic topics were identiďŹ ed for focused discussion on strategies to accelerate progress towards addressing unmet needs for contraception/family planning are as follows: *NQSPWJOH UIF RVBMJUZ BOE DPWFSBHF PG '1 JOGPSNBUJPO BOE TFSWJDF EFMJWFSZ 3FTQPOEJOH UP UIF VOJRVF OFFET PG ZPVOH QFPQMF &OTVSJOH DPNNPEJUZ TFDVSJUZ 4USFOHUIFOJOH DPNNVOJUZ FOHBHFNFOU BOE EFNBOE GPS GBNJMZ QMBOOJOH TFSWJDFT BOE 5. Strengthening partnerships and collaboration with stakeholders.

He concluded the introductory note outlining the three expectations from the workshop and urged the participating country representatives to focus, prioritize and act on the 2010 Call for Actions to revitalize and reposition the family planning programmes, with particular focus on the ďŹ ve thematic areas, in respective countries.

The three expected outcomes include: &YBNJOF QSPHSFTT BOE CBSSJFST JO UIF mWF QSJPSJUZ BSFBT *EFOUJGZ DBQBDJUZ CVJMEJOH BOE UFDIOJDBM TVQQPSU OFFET 3. Develop key strategies and actions that will accelerate progress towards addressing unmet need.

“FAMILY PLANNING SAVES LIVES. IMPROVES QUALITY OF LIFE‌ YET MILLIONS CAN’T ACCESS IT‌ TIME FOR ACTION.â€?

- Dr. Wasim Zaman, Executive Director, ICOMP

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Scaling-up Support for Family Planning – a vision for Asia and the Pacific Ms. Nobuko Horibe, Director, UNFPA Asia and the Pacific Regional Office Ms. Nobuko Horibe the Director of the UNFPA Asia and the Pacific Regional Office (APRO) reiterated that the workshop is a follow-up to the 2010 Regional Conference on Family Planning in Asia and the Pacific, which produced a very comprehensive outcome document - the “Call for Elimination of Unmet Need for Family Planning”. The document is considered as a good framework for developing strategy for revitalizing family planning. This Regional Workshop is a step ahead to take actions on operationalizing the call for action and repositioning family planning, especially in high/medium fertility countries.

Ms. Horibe remarked that in the recent years, family planning is gaining renewed interest and attention, rightfully so, given its cost-effective contribution that it can make to sustainable development and achievement of MDGs. Yet there is continuous high unmet need in many countries regardless of their development stage. She informed that UNFPA has made a commitment at the London Summit in July 2012 to increase resources for family planning and to put in place a Family Planning Reform Agenda, which includes 15 priority actions to strengthen oversight, governance and performance in family planning. In this context, UNFPA is currently developing a family planning strategy addressing various aspects including the availability, quality, commodity security, services, demand, information systems and policy environment.

Ms. Horibe shared her concern about stagnation of family planning/contraceptive use in many countries in Asia leading to approximately two-fifth of pregnancies (38%) as unintended and one-fifth of them (21%) ending as induced abortion.

Moreover, the highest unmet need for FP has been reported among young women aged 15-24 years and both married and unmarried girls require better access to family planning services, including information and counseling support.

She pointed inadequate resource allocation and socio-cultural barriers as two major obstacles, among others, in repositioning FP. Many governments in the region spend less than 10% of health expenditures in RH, of which the amount spent on FP is often not known or very minimal. Impact of investment in FP is not immediately visible, compared to other investment in the health sector, though benefits in terms of savings in health spending are much higher in later years. So, she urged the participants to play catalytic role to convince the government to continue investment in family planning, as this is a long-term investment. The causes of unmet need are indeed complex, and policymakers and programme managers can strengthen FP programmes by understanding better this complexity through using data and research findings.

UNFPA APRO is committed to providing support for strengthening advocacy and research to repositioning family planning, to improve the quality of FP services and to strengthen national capacities for Reproductive Health Commodity Security (RHCS) as part of the regional programme. She urged that the next few years will be challenging years for the achievement of the ICPD goals and MDGs, thus all concerned stakeholders – governments, intergovernmental bodies, bilateral and multilateral organizations, NGOs, civil society, communities and individuals - need to play a catalytic role to scale up the successes and address shortcomings.

PLENARY 1: ANALYTICAL REVIEW OF UNMET NEEDS FOR FAMILY PLANNING IN SOUTH EAST ASIA AND SOUTH ASIA Chairperson: Ms. Nobuko Horibe, Director, UNFPA Asia and the Pacific Regional Office The objective of this session was to take stock of the progress and challenges in addressing the unmet needs for family planning in the priority countries of Southeast Asia and South Asia and examine strategies for moving forward. The session includes presentations from two overarching sub-regional review papers that analysed the interventions and actions at policy and programme level that comply with the strategies agreed at the 2010 Regional Consultation. It also looked at the issue of addressing the unmet needs for family planning. Overall, the session brought in important data and analysis, which was much needed as background for setting the tone to come up with practical actions to be implemented at ground level.

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Feedback Report on the Status of Implementation of the Call for the Elimination of Unmet Need for Family Planning in Selected Countries in Southeast Asia.

By Prof. Gavin W. Jones, Director, Comparative Asia Research Centre Prof. Gavin W. Jones presentation on the ďŹ ndings from the comprehensive report on the status of unmet need for family planning in the high and medium fertility countries in South East Asia region was divided into three sections: a) an overview PG UIF TUBUVT PG VONFU OFFE GPS GBNJMZ QMBOOJOH C BOBMZTJT PG QPMJDJFT BOE QSPHSBNNBUJD JOUFSWFOUJPOT JNQMFNFOUFE BU DPVOUSZ MFWFM UP SFEVDF VONFU OFFE BOE D 3FDPNNFOEBUJPOT o CZ FWBMVBUJOH BWBJMBCMF QSPHSBNNF PQUJPOT BOE SFDPNNFOE strategic actions to address the unmet need for family planning.

The presentation highlighted that the total fertility rate (TFR) has been declining in almost all countries in the South-East Asia region between 2000 and 2010. The TFR has remained highest in Timor Leste (5.7) followed by Lao PDR (4.1). However, Philippines has experienced the lowest decline in TFR (from 3.5 in 2003 to 3.3 in 2008), while substantial decline in the TFR has been seen in Cambodia (from 4.0 in 2000 to 3.0 in 2010) and Myanmar (from 2.4 in 2001 to 2.0 in 2007).

With respect to the incidence and trends in unmet need for FP in the region, women with the highest unmet needs were those who had higher parity (e.g. in Cambodia, Indonesia and Philippines), who came from rural areas and were economically poor. However, there was no clear pattern in level of unmet need with educational dierences – dierent countries have dierent level of unmet need. There has been consistent decline overtime in percentage of women with unmet need in Cambodia and Indonesia, while not much changes in Philippines (Figure -1). However, in Timor Leste, there has been sharp rise in unmet need between 2003 and 2009, which is quite diďŹƒcult to interpret. It may be attributed either to a sharp rise in demand for contraception over the period or to a deterioration in the provision of contraception. It may also be due to lack of comparability between the two sources of data.

As for unplanned births as percentage of recent births and percentage of women with unmet need, it was noted that in Cambodia unplanned birth is declining signiďŹ cantly, while it has declined slightly in Indonesia and Philippines. On the other hand, the proportion of mistimed births has increased in Timor Leste.

Reasons for not using a method among the married women with unmet need, as reected in the DHS surveys, have been HSPVQFE JO UISFF CSPBE DBUFHPSJFT FYQPTVSF SFMBUFE SFBTPOT XPNFO QFSDFJWFE UIFNTFMWFT BU MPX SJTL PG HFUUJOH QSFHOBOU

supply of methods and services (reasons related to availability of contraceptive supplies and services) and demand-side reasons (opposition to family planning/contraception either from the woman’s part or on the part of her husband/partner).

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Figure 1: Trends and Differentials in Unmet Need, by Poverty Status % with Unmet Need 40 35 30 25 20 15 10 5 0

2000

2010 2005 Cambodia

2003 2008 Indonesia Poor

2003 2008 Philippines Nonpoor

2002 Vietnam

2003 2009 Timor Leste

% with Unmet Need

Non-use because of opposition to family planning (demand-side reasons) is high in Cambodia and Philippines, but very low in Indonesia. Non-use due to supply-related factors is high in the Philippines and Indonesia. Similarly over one-fourth of married women with unmet need cited exposure-related reasons in Cambodia, Indonesia and Philippines.

High unmet need in South-East Asia region may be reflected as high rates of induced abortion, as the rate of induced abortion in the sub-region exceeds that for Asia as a whole, and well over half the abortions are characterized as unsafe. In general, the legal status of abortion in a country affects the safety of abortion and it differs widely between the countries covered in this study, with liberal abortions regulations in Cambodia and Vietnam, restrictive in Philippines and a rather uncertain and misunderstood legal status of abortion in Indonesia.

In South East Asia region, overall the lack of knowledge or access is an uncommon reason for non-use among married women with unmet need for contraception. Yet, in Cambodia, Philippines and Indonesia, the proportion giving these reasons almost doubled for poor women, indicating a lack of access or knowledge as compared with wealthier women. ɩF PUIFS GBDUPST DPOUSJCVUJOH UP MJNJUFE VTF PG NPEFSO DPOUSBDFQUJWFT JODMVEFE GFBS PG TJEF FĊFDUT UIF SPMF PG SFMJHJPVT MFBEFST PSHBOJTBUJPOT JO JOnVFODJOH (PWFSONFOU T QPQVMBUJPO QPMJDZ BOE QSPNPUJOH OBUVSBM GBNJMZ QMBOOJOH MBDL PG LOPXMFEHF BCPVU DPSSFDU UJNJOH PG GFSUJMJUZ QFSJPE BNPOH NBSSJFE XPNFO VTJOH UIF USBEJUJPOBM SIZUIN NFUIPE JOTVċDJFOU RVBOUJUZ BOE RVBMJUZ PG GBNJMZ QMBOOJOH DBSF BOE JOUFSBDUJPO BOE VOFRVBM BDDFTT CZ QPPS XPNFO UP TUFSJMJ[BUJPO TFSWJDFT BOE so on.

Drawing from the issues and challenges faced by the high and medium fertility countries in the South East Asia sub-region, Prof. Gavin concluded that major challenges remain in meeting the unmet need for family planning in the focused countries.

He urged all concerned governments to pay attention to the following policy issues and challenges: t ɩF OFWFS NBSSJFE are a growing proportion of reproductive age population, not only adolescents, but also rising proportion of single population aged above 25, in almost all countries covered by the study, who are sexually active and therefore would justify a need for rethinking of reproductive health strategies and addressing their unmet need for family planning. t ɩF DIBMMFOHF PG VONFU OFFE GPS CFUUFS DPOUSBDFQUJPO BNPOH UIPTF QSBDUJDJOH B NFUIPE suggests a need to take a life cycle approach to unmet need. While young women may be best served by methods requiring constant resupply, 7

such as the pill and injectables, older women who deďŹ nitely want to stop reproduction will normally be better served by permanent or long-acting methods such as sterilization, implants, and IUDs. Therefore provision of a better and wider range of methods would make a crucial dierence to many contraceptive users and potential contraceptive users. t 'JOEJOH BO BQQSPQSJBUF QPMJDZ PO JOEVDFE BCPSUJPOT – Meeting unmet need for contraception should be the aim of a FP programme and achievement of this aim would greatly reduce the resort to induced abortion. However, in cases where there is a need for abortion, facilities need to be accessible where such an abortion can be conducted safely. t /FFE UP JNQSPWF RVBMJUZ PG TFSWJDFT especially the supply chains and re-supply of contraceptives in more isolated areas and for low-income women who may have trouble coming to clinics for re-supply need to be assured. Similarly, the attitudes of suppliers of services need to be sensitive to the needs of those seeking services, particularly if they come from lower Socio-economic groups, those dealing with crisis situation and those who come from speciďŹ c target group (such as sexually active but non-married ). t .FFUJOH VONFU OFFE BNPOH NBSHJOBMJ[FE HSPVQT BOE JO DSJTJT TJUVBUJPOT OFFE UP CF QSJPSJUJ[FE Higher levels of unmet need among the poor than better-o group and those coming from rural areas, marginalized group, or from isolated areas generally give the reasons for non-use as their poorer knowledge and access to services. For instance, in Cambodia, Philippines and Indonesia, the proportion giving these reasons for unmet need almost doubled for poor women compared to better-o women. In Laos the unmet need for family planning is 22% in urban areas but 32% in rural areas. A balance need to be struck between maximizing reproductive choice and avoiding problems of resupply or access to services. t /FFE GPS FÄŠFDUJWF TUSBUFHJFT UP DPVOUFS PQQPTJUJPO GSPN SFMJHJPVT DPOTFSWBUJWFT There is a need for sensitivity in approaches and publicity drives due to opposition from religious conservatives. Preventing unintended pregnancy is fundamental to reducing abortion. In a situation such as that faced in the Philippines and Timor Leste, the argument for a “least worstâ€? situation – making contraception more widely available to reduce the recourse to induced abortion - can still be made to religious conservatives. t /FFE GPS DMBSJUZ PG SPMF PG EJÄŠFSFOU HPWFSONFOU BHFODJFT BOE DPPQFSBUJPO CFUXFFO BHFODJFT In countries such as Indonesia and Philippines, where devolution of planning and administrative functions to lower levels of government have taken place, the need for eective collaboration between government agencies and the importance of deďŹ ning roles as clearly as possible is strongly emphasized.

Unmet Contraceptive Need and Family Planning Programmatic Challenges in South Asia

By Prof. Barkat E Khuda, Department of Economics, University of Bangladesh, Dhaka Prof. Barkat E Khuda focused on the trends in patterns of family planning and fertility, the levels of contraceptive prevalence rates and unmet need for family planning, the diversities and inequalities in the use of contraceptives in South Asia. He also discussed the policy and programmatic challenges in reducing the unmet need for contraception and recommended strategic actions for addressing the unmet need in the South Asian Countries.

In most of the South Asian countries the family planning programmes started in early 1950s, with India being the ďŹ rst country in the world to initiate an organized family planning programme in 1952, followed by Bangladesh, Pakistan (1953) and Nepal (1959). In South Asia, there has been considerable increase in CPR and decline in fertility until mid-1990s, however, since then slowed down. The TFR is recorded highest in Afghanistan at 6.25 in 2006, which declined to 5.1 in 20101, while the CPR increased from 10% in 2006 to 22% (20 % for modern methods) in 2010. In Bangladesh, with the lowest fertility rate at 2.3 in 2011, the CPR increased around six-folds between 1970 and mid-1990s, but the rate of increase slowed down during last decade (from 56% in 2007 to 61% in 2011), in which according to Prof. Barkat-E-Khuda is attributed to erosion in political will and commitment to the programme and various organizational problems.

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Aghanistan Mortality Survey, 2010

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The presentation emphasized on the remarkable variations in the contraceptive use and fertility levels among dierent states (in case of India) as well as by geographical location (urban/rural), education level and the wealth quintiles within the country. In general, the contraceptive use is relatively high among women with education, those living in urban areas and those from higher wealth quintiles. Similarly, the fertility level is higher for women with no education than for those with education, higher among women living in the lowest wealth quintile households than those living in the highest wealth quintile households.

The presentation revealed that in South Asia, the extent of unmet need for family planning ranged between 7 percent in Sri Lanka and 28 percent in Maldives. While the unmet need for family planning has declined in almost all South Asian countries, it has remained relatively high (e.g. Nepal - around 27 percent, Pakistan - 25 percent, Afghanistan - 23 percent, India - 13 percent, and 12 percent each in Bangladesh and Bhutan). The unmet need for family planning for limiting births was higher in Bangladesh, Nepal and Pakistan, while it remained same for both limiting and spacing in India, Maldives and Sri Lanka. In general, the unmet need for family planning was found high among adolescent and young women for spacing, rural, uneducated and poor women making them more vulnerable to having unintended pregnancies and resorting to abortions, mostly unsafe.

Prof. Barkat-E-Khuda viewed that in most of the South Asian countries, the knowledge of family planning methods and their sources of supplies is widespread (except in Afghanistan and Pakistan), the desired number of children has declined signiďŹ cantly due to socio-economic changes over time contributing to increased decision-making role of women, including contraception and thus a lower ideal family size ranging from 2.3 in Bangladesh and Nepal to 4.1 in Pakistan, as well as lower wanted fertility at around 2. Yet, there are large numbers of couples not using contraceptives/family planning methods, the major barriers preventing women from practicing contraception being health concerns, fear of side eects, low quality of services, objections from husband or other family members. In fact, limited access to contraception was not the main barrier to contraception use and the poor quality of family planning services is the major problem among those not intending to use contraceptives in future and/or a reason for discontinuation of use.

Key challenges faced by family planning programmes in South Asia include: t -BDL PG QPMJUJDBM XJMM BOE DPNNJUNFOU weak political commitment, inconsistency in population policies and programmes, lack of provincial ownership of the programme, weak capacity and commitment of programme personnel, and inadequate allocation of resources have slowed down the pace of progress in the family planning programme. t 8FBL MJOLBHFT CFUXFFO GBNJMZ QMBOOJOH BOE PUIFS 3) QSPHSBNNF While the 1994 ICPD POA emphasized on the need to integrate family planning as part of the overall RH programme was quite justiďŹ ed, its operationalization was not clearly conceptualized. RH services are oered by vertical programmes without clear division of responsibility and BDDPVOUBCJMJUZ BOE UIFSF JT MBDL PG DPPSEJOBUJPO BOE DPPQFSBUJPO XJUIJO UIF MJOF NJOJTUSJFT t -PXFS $13 BNPOH BEPMFTDFOUT The CPR and the use of modern methods among adolescent women are considerably lower than the national rates in the South Asian Countries, except in Bangladesh (47% compared to 61% nationally) and Sri Lanka (54% compared to 68% nationally). Adolescents in South Asia faced problems, such as, lack of access to family planning services and supplies, especially for unmarried adolescents, inadequate knowledge about contraception, and little independence in deciding on the timing of births and use of contraception. The low CPR and high unmet need among adolescents often lead to unwanted pregnancies, unsafe abortions, and insuďŹƒcient spacing between pregnancies, resulting in increased risks for the development of maternal and newborn complications. t 3FHJPOBM WBSJBUJPO JO DPOUSBDFQUJWF 6TF The signiďŹ cant variations in contraceptive use, regionally and by rural-urban areas within countries in South Asia indicate limited access to, and availability of, family planning services across dierent regions/states. As a result, sizeable segments of the eligible population remain under-served, resulting in high unmet need. t $IBOHFT JO DPOUSBDFQUJWF NFUIPE NJY The relative share of modern methods has increased in contraceptive methodmix over that of longer-acting and permanent methods (LAPM) in some countries in South Asia. This aects mostly the relatively older, high-parity women who have completed their family size, and who could be potential candidates for LAPM, indicating unmet need for such methods among them. Relying on short-term temporary methods rather than accepting LAPM poses a major problem for the eďŹƒciency and overall sustainability of the programmes. The decline 9

in the relative share of LAPM in some of the South Asian countries, especially Bangladesh, is a major programmatic challenge. t )JHI EJTDPOUJOVBUJPO SBUF A high discontinuation rate among women using temporary modern methods mainly due to method failure, side eects, health reasons, or because they want to become pregnant indicates low quality of FP services, and contributes to the prevalence of unmet need. Such high drop-out rate indicates huge system loss for the programme, which could be addressed through improved quality of FP services. t 0SHBOJ[BUJPOBM QSPCMFNT Some of the other organizations challenges in FP programmes prevailing in the South Asian countries were identiďŹ ed as lack of adequate and skilled human resources, weakness in contraceptive security and logistics system, inadequacies in behavioral change communication (BCC) eorts, limited funding and actual spending (i.e. not being able to spend the funds allocated) and thereby not being able to achieve the programme objectives.

The presentation highlighted strategies adopted by respective Governments to address challenges faced by the FP programmes in the South Asian countries. t &OIBODJOH QPMJUJDBM BOE QPMJDZ DPNNJUNFOUT With a growing realization of the need to develop a supportive and proactive political and policy environment by sensitizing and engaging the political leadership and other stakeholders to strengthen the FP programmes, the policies and strategies adopted by the countries in South Asia region ranged from developing the National Strategy for FP/Birth Spacing (2006) and National RH Strategy (2012-2016) in Afghanistan UP UIF OFX IFBMUI QPQVMBUJPO BOE OVUSJUJPO TFDUPS QMBO )1/4%1 JO #BOHMBEFTI B SFOFXFE GPDVT PO QPQVMBUJPO JTTVFT BJNFE BU BDIJFWJOH QPQVMBUJPO TUBCJMJ[BUJPO CZ BOE JOJUJBUJPO PG EFWFMPQNFOU PG OFX QPQVMBUJPO policy based on the ďŹ ndings from Census 2011 and FP remote area guideline to get long-acting reversible contraceptives to people in remote areas in Nepal. In Pakistan, the 2010 Population Policy intends to bring population at the centre stage of development process through greater focus and investment to achieve the lost momentum of fertility transition. t *NQSPWJOH BDDFTT UP RVBMJUZ '1 TFSWJDFT &ÄŠPSUT BSF CFJOH NBEF JO UIF DPVOUSJFT PG 4PVUI "TJB UP JNQSPWF BDDFTT UP quality FP services in hard- to-reach areas, among underserved population including adolescents, young people and older couples in need of LAPM, and during periods of natural disasters by ensuring availability of trained service providers, QSPWJEJOH BO BQQSPQSJBUF NFUIPE NJY GPS TQBDJOH BOE MJNJUJOH CJSUIT SFWJFXJOH FYJTUJOH TUBOEBSET HVJEFMJOFT BOE UPPMT BOE VQEBUF UIPTF EPDVNFOUT BOE FOTVSJOH UIBU UIFSF JT OP TUPDL PVU PG '1 NFUIPET BOE TP PO t 4USFOHUIFOJOH BOE FYQBOEJOH TFSWJDF EFMJWFSZ *O WJFX PG UIF VOEFSVUJMJ[BUJPO PG FYJTUJOH IFBMUI DBSF GBDJMJUJFT MBDL PG trained human resources and negligence towards priority segments of the population in South Asian countries, various measures are being undertaken to strengthen and expand the service delivery. Eorts are being made, for instance, to: maximize the use of existing trained personnel, health care facilities, equipment and services for promotion of family QMBOOJOH NFUIPET FOTVSF CFUUFS DPPSEJOBUJPO BOE MJOLBHFT CFUXFFO UIF JNQMFNFOUJOH BHFODJFT TVDI BT UIF %('1 BOE the DGHS within the MOHFW in Bangladesh and between two dierent ministries implementing the programmes in 1BLJTUBO BOE MJOL GBNJMZ QMBOOJOH TFSWJDF XJUI UIF CSPBEFS EJNFOTJPO PG SFQSPEVDUJWF BOE NBUFSOBM IFBMUI BT SFnFDUFE JO its strategies of the national family planning programme in Nepal. Similarly, in Afghanistan, the National Reproductive Health Strategy (2012-16) has identiďŹ ed a number of approaches to strengthen and expand service delivery by improving QSPWJTJPO PG GBNJMZ QMBOOJOH TFSWJDFT BU BMM MFWFMT FYQBOEJOH BQQSPBDIFT GPS DPNNVOJUZ CBTFE GBNJMZ QMBOOJOH BOE strengthening family planning services through the private sector. In India, the government has taken several measures UP TUSFOHUIFO TFSWJDF EFMJWFSZ CZ BNPOH PUIFST JODMVEJOH mYFE EBZ TUBUJD TFSWJDFT VQ UP UIF 1)$ MFWFM BWBJMBCJMJUZ PG QPTUQBSUVN GBNJMZ QMBOOJOH TFSWJDFT BU BMM GBDJMJUJFT XIFSF EFMJWFSJFT BSF DPOEVDUFE USBJOJOH BOE QMBDFNFOU PG TFSWJDF QSPWJEFST JODSFBTJOH NBMF QBSUJDJQBUJPO JO WBTFDUPNZ #$$ BDUJWJUJFT GPDVTJOH PO TQFDJmD JTTVFT TVDI BT EFMBZFE BHF BU NBSSJBHF CJSUI TQBDJOH BOE NBMF QBSUJDJQBUJPO BDDSFEJUBUJPO PG QSJWBUF QSPWJEFST UP JODSFBTF UIF OVNCFS PG TFSWJDF providers (Khan and Hazra 2012). t "EESFTTJOH PSHBOJ[BUJPOBM QSPCMFNT &ÄŠPSUT BSF CFJOH NBEF JO UIF 4PVUI "TJBO DPVOUSJFT UP BEESFTT WBSJPVT PSHBOJ[BUJPOBM and administrative issues. For instance, to address the problem of human resources, priority is being given to recruitment PG BEEJUJPOBM XPSLGPSDF JNQSPWJOH TUBÄŠ NPSBMF UISPVHI CFUUFS KPC TFDVSJUZ DBSFFS QMBOOJOH BOE DPNQFOTBUJPO QBDLBHFT BOE USBJOJOH TVQFSWJTPST BOE NBOBHFST XIP DBO QSPWJEF HVJEBODF UP PUIFS TUBÄŠ QSPWJEF OFDFTTBSZ USBJOJOH UP QSPHSBNNF QFSTPOOFM UP CVJME MFBEFSTIJQ BOE NBOBHFNFOU TLJMMT JNQSPWF JNQMFNFOUBUJPO DBQBDJUZ BOE FOTVSF HSFBUFS JOWPMWFNFOU

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PG PUIFS DPODFSOFE NJOJTUSJFT BOE TUBLFIPMEFST TUSBUFHJFT IBWF CFFO EFWFMPQFE GPS NPSF GPDVTFE #$$ JOUFSWFOUJPOT and measures were taken to improve the commodity security and logistics management systems and initiatives have been taken to increase funding for the FP programmes in focused states/regions. All these eorts/interventions are expected to enhance programme performance, and thereby help achieve the targeted increase in the CPR and the targeted reduction in unmet need for contraception.

Discussion: Some of the questions/issues and comments raised during open discussion included: t *TTVF PG UIF VTF PG PME EBUB JO UIF BOBMZTJT BOE UIF OFFE GPS BO VQEBUFE EBUB 'PS JOTUBODF JO DBTF PG *OEJB 5'3 JT instead of 2.7 and several states have already achieved replacement level fertility). DHS data used for the comprehensive reports are more than 10 years old and outdated for most of the countries. There is a need to get new data as soon as possible. However, most of the DHS are only conducted periodically (once in 5 to 10 years interval) as it involves a lot of resources and manpower. It was suggested that DHS surveys need to be undertaken more frequently and UNFPA should take a lead in this. t *U XBT BMTP TIBSFE UIBU TQFDJmD JOJUJBUJWFT IBWF CFFO UBLFO UP QSPNPUF JOTUJUVUJPOBM EFMJWFSZ JO *OEJB F H QSPWJEJOH incentives to women for institutional deliveries and free delivery services including transportation in all public health facilities under JSY and JSSK). t ÉŠF EFWPMVUJPO PG UIF .JOJTUSZ PG 1PQVMBUJPO 8FMGBSF .018 GSPN 'FEFSBM (PWFSONFOU UP 1SPWJODJBM (PWFSONFOU as per the 18th Amendment of Constitution in April 2010 in Pakistan has far reaching eects on the quality, eectiveness and eďŹƒciency of the family planning programme in the provinces as there has been a major setback in terms of both the quality and quantity of the family planning services being oered. Furthermore, the resources are allocated based on the size of population at provincial level and with large provincial variations in the population size (e.g. Baluchistan has the larger population than other provinces), reducing population has become political issue. With the devolution of MOPFW, population has become a provincial subject. However, none of the provinces have population programme in place and there was lack of coordination at provincial level. Although provincial governments are committed to work on population programmes the main constraint is resources. Thus there is need for more funding. t *O NPTU DPVOUSJFT B TQFDJmD CVEHFU JT BMMPDBUFE GPS GBNJMZ QMBOOJOH 8JUI UIF FNQIBTJT PO 3) UIFTF EBZT UZQJDBMMZ UIFSF is no speciďŹ c budget allocation for family planning as such. The main issue is, however, within the budget allocated for RH/FP, whether the funds are available for a particular activity in order to have eective family planning programme. t *O DBTF PG "GHIBOJTUBO NJTCFMJFWFT JO GBNJMZ QMBOOJOH JT UIF NBKPS DIBMMFOHFT ÉŠF SPMF PG SFMJHJPVT MFBEFST JT DSVDJBM JO advocating family planning for birth spacing. t ÉŠF DPODFQU PG VONFU OFFE BT VTFE JO %)4 TVSWFZT OFFE UP CF SFEFmOFE BT JU JT BMTP BÄŠFDUFE CZ GBDUPST TVDI BT TFQBSBUJPO of families/couples due to temporary migration of a huge number of populations for employment or other purposes. t $PODFSO XBT SBJTFE PO UIF VTF PG UIF UFSNT iGBNJMZ QMBOOJOHw PS i$POUSBDFQUJPOw XIJDI JT HFOFSBMMZ VTFE JOUFSDIBOHFBCMZ However, ‘family planning’, in general, connotes the need of married women/couples, but it does not reect the need for contraception among unmarried population, such as young people or those separated from families to avoid pregnancy.

Thus, it was suggested to use the term “Contraceptionâ€? instead of family planning. However, each country needs to use the term sensitively within its own cultural and religious context. t *U XBT QPJOUFE UIBU UIF QSFTFOUBUJPOT EJE OPU GPDVT NVDI PO NBMF JOWPMWFNFOU .BMF SFTQPOTJCJMJUJFT BOE DPNNVOJDBUJPO between couples need to be emphasized as they play signiďŹ cant role in the acceptance of contraception and its continuation rates and thus reducing unmet need. The issues of need for eective behavioral change communication (BCC) and skilled human resources on family planning needs to addressed. It was observed that information and materials used for BCC and counseling need to be revitalized and also take into account what new generation of IEC is needed for repositioning FP at country level.

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t /FFE UP GPDVT PO BEESFTTJOH UIF JTTVF PG BEPMFTDFOU ZPVUI GFSUJMJUZ BNPOH CPUI NBSSJFE BOE VONBSSJFE BEPMFTDFOUT young people, as they are involved in risky behaviours and also contribute substantial part in TFR (e.g. Bangladesh, Nepal). t *TTVF PG BEESFTTJOH UIF GBNJMZ QMBOOJOH OFFET JO DSJTJT TJUVBUJPOT TVDI BT OBUVSBM EJTBTUFST BOE PUIFS DBMBNJUJFT BOE ensuring provision for contraceptive supplies to prevent unwanted pregnancies (e.g. ooding in Pakistan, Philippines etc) Ms. Nobuko Horribe, Chairperson concluded the session with a note that FP programmes need to address the diversity of challenges in dierent countries and among dierent target groups. She emphasized on improving the existing FP programmes in an eective way to reduce the unmet need, which will ultimately contribute to achieving the two important indicators of MDG 5b. She also requested to update the information as available at country level.

PANEL DISCUSSION: RESPONDING TO THE UNIQUE NEEDS OF YOUNG PEOPLE Chairperson: Ms. Anjali Sen, Regional. Director, IPPF South Asia Regional Office, New Delhi Ms. Anjali Sen initiated the session with a short introduction of the panelists participating in the panel discussion on Responding to the Unique Needs of Young People in selected countries of Southeast and South Asia. The panelists for the session included three experts from India, Malaysia and Nepal who shared the situation analysis of fertility, contraceptive use and unmet needs of young people and policies and strategies adopted in respective countries for responding to the unique needs of young people for quality RH and family planning information and services.

The panelists were: 1. Dr. M.E. Khan, Senior Associate, Population Council, India 2. Dr. Mary Huang Soo Lee, Associate Professor, Faculty of Medicine & Health Sciences, University Putra Malaysia 3. Mr. Anand Tamang, Founder Chairperson and Director, CREPHA, Nepal Brief highlights from the panel discussions are summarized as follows: 1SFTFOUBUJPO CZ %S . & ,IBO 4FOJPS "TTPDJBUF 1PQVMBUJPO $PVODJM *OEJB The presentation highlighted the patterns of fertility, contraceptive use and unmet needs for contraception among young people, the barriers and challenges in addressing the needs of young people in India. According to 2011 Census, youth population aged 15-24 years constituted one-ďŹ fth of the total population (1210 million) and young couples contribute twothirds of total fertility. Teen age pregnancy among young women is the major risk factor with births to women aged 15-19 years out of total births estimated at 8.2 percent for Bihar, 6.3 percent for Uttar Pradesh and 5.9 percent for Rajasthan, the rates higher than national average of 5.6 percent. The unintended pregnancy among youths remained high (25 percent) and high infant mortality was found among women who were too young, who had too many and too frequent pregnancies. It was emphasized that delaying child and teenage marriages, promoting birth spacing, and encouraging fewer births per woman all help to reduce maternal and child mortality by eliminating the potential for high-risk births. Recent studies have shown that in South Asia, early marriage, especially among young women who were poor with no education, continued to be a major challenge in addressing the needs of young people.

The presentation revealed that only 18 percent of youth reported current use of contraception, only few young people practiced contraception to delay the ďŹ rst pregnancy (12 percent for men and 5 percent for women) and the most commonly used methods were condoms, oral pills and, irrespective of their young age, female sterilization. Thus contraception was generally used for fertility limitation and NOT for fertility planning.

Some of the observations from the ďŹ eld showed although many young couples wanted to delay their ďŹ rst pregnancy and over two-thirds wanted to space their next pregnancy, they face many barriers in accessing family planning services embedded in social and structural barriers (such as social compulsion to demonstrate fertility, threat of desertion by husband/second marriage, peer pressure and opposition from husband) and programmatic barriers (such as, lack of knowledge among both women and FHW about return of fertility after lactating amenorrhea, contraceptive methods and misconceptions 12

BCPVU DPOUSBDFQUJWFT BDDFTT BOE DPTU QSPWJEFS CJBT JO TVHHFTUJOH '1 NFUIPET BOE NJTTFE PQQPSUVOJUJFT GPS DPVOTFMJOH on method use). The other barriers faced by young people include gender disparity in school enrollment and educational milestones, poverty, unfavourable attitude to education, school related issues, pressure to marry early for young women, lack of employment opportunities, especially among poor people and lack of decent and productive work for those who enter to work force, making the transition painful.

The key challenges identiďŹ ed in addressing the unmet needs of young people included: t %JWFSTJUZ BNPOH ZPVOH QFPQMF BOE UIVT B OFFE GPS SFDPHOJ[JOH UIF DIBOHJOH OBUVSF BOE EFNBOE PG ZPVUI XJUI EJÄŠFSFOU set of policies to address needs dierent groups. t 5PP NVDI FNQIBTJT PO TVQQMZ TJEF XIJMF EFNBOE HFOFSBUJPO JT NJTTJOH PS PG QPPS RVBMJUZ ÉŠF FYJTUJOH #$$ JOUFSWFOUJPOT are not evidence based and context and cultural aspects are missing. t :PVOH QFPQMF TIPVME CF HJWFO DIPJDFT PG DPOUSBDFQUJPO BOE UIFJS SJHIUT NVTU CF SFDPHOJ[FE BOE BEESFTTFE t %BUB BOE TUBUJTUJDT PO ZPVUI BSF IJEEFO ÉŠFZ OFFE UP CSPVHIU JOUP UIF DFOUSF PG BMM EFWFMPQNFOU QSPHSBNNFT BOE provided with educational and employment opportunities.

The presentation concluded with sharing of some lessons learnt as follows: t 3FQPTJUJPOJOH PG '1 QSPHSBNNF JT DSJUJDBM UP BEESFTT UIF VONFU OFFE GPS DPOUSBDFQUJPO BNPOH ZPVOH QFPQMF t :PVOH DPVQMFT BSF DIBOHJOH BOE UIFZ EFTJSF UP EFMBZ mSTU QSFHOBODZ CVU TPDJBM OPSNT BOE QSPWJEFST CJBT DPOTUSBJO UIFN to practice this. t 1PTU EFMJWFSZ NBKPSJUZ PG XPNFO XBOUFE UP EFMBZ OFYU QSFHOBODZ 1SPHSBNNBUJD DPOTUSBJOUT JODMVEJOH NJTDPODFQUJPOT about contraceptive methods, accessibility and lack of comprehensive BCC strategy hinder them to practice spacing of births. t .BOZ NJTTFE PQQPSUVOJUJFT DPVOTFMMJOH EVSJOH "/$ OFFET SFJOGPSDFNFOU JO SE UI NPOUI QPTUQBSUVN XIFO UXP UIJSET BSF FYQPTFE UP VOXBOUFE QSFHOBODZ DSJUJDBM QFSJPE GPS JOUFHSBUFE NFTTBHJOH t 1PPS BOE NBSHJOBMJ[FE ZPVUI OFFE TQFDJBM FÄŠPSU BOE QSPHSBNNF BUUFOUJPO 1SFTFOUBUJPO CZ %S .BSZ )VBOH 4PP -FF "TTPDJBUF 1SPGFTTPS 'BDVMUZ PG .FEJDJOF )FBMUI 4DJFODFT 6OJWFSTJUZ 1VUSB .BMBZTJB In her presentation, Dr. Mary Huang shared key ďŹ ndings from her review on unmet needs for family planning among young people in Malaysia, Indonesia and Philippines, including reproductive health status of young people, contraceptive use and barriers in using contraception. She shared that as evident from her experiences of working with young people for last 30 years, the lives, exposures and needs of young people have changed dramatically over time. Young people reach their puberty earlier, had more opportunities to further their education, greater exposure to the internet (including exposure to pornography) and they marry late. As such, there was a need of dierent approaches in addressing young people needs, especially the needs of young people from dierent groups. Sex education needs to be introduced and young people need to be equipped with the skills to protect themselves.

Overall, young people aged 10-24 constituted one-third of total population in all the three countries reviewed, with almost universal literacy, but increasing trend in unemployment, which stand at around 11 percent in Malaysia, 17 percent in Philippines and 30 percent in Indonesia. The age at ďŹ rst marriage is increasing in all the three countries and the adolescent fertility is declining in Southeast Asia except in case of Philippines. Yet the easy access to information technology and TV programmes and exposures to pornography encourage them to risky sexual behaviours, including premarital sex (For example, a recent study of Juvenile boys in Malaysia had found that 67 percent of boys have sex at the age of 14.7 years).

The presentation also highlighted that young people have limited knowledge and information on sexual and reproductive health and sex education is not introduced in the schools due to cultural and religious barriers. Among the young people aged 15-24 who were sexually active, ďŹ rst sexual experiences reported by them were not planned/just happened or they did not want it to happen at the time and that almost all of them did not use contraceptives, especially in the ďŹ rst sexual intercourse.

It was also revealed that no study is available on contraceptive use among unmarried young people in Malaysia, Indonesia and Philippines and thus use of contraception and unmet needs of unmarried young people remains unknown. However, the use of contraception among married young people aged 20-24 in the three countries remained low at about 30 percent and 13

most of them stated “fear of side eectsâ€? and “husband’s objectionâ€? as the reasons for not using contraception. Furthermore, there is culture, religious and gender barriers that need to be addressed. It is diďŹƒcult to challenge religious leaders and even where we ďŹ nd allies among religious leaders, they need to be treated carefully. The service providers should play crucial role as moral gatekeepers and provide quality information and services to young people who need it.

1SFTFOUBUJPO CZ .S "OBOE 5BNBOH 'PVOEFS $IBJSQFSTPO BOE %JSFDUPS $FOUSF GPS 3FTFBSDI PO &OWJSPONFOU 1PQVMBUJPO BOE )FBMUI "DUJWJUJFT $3&)1" /FQBM Mr. Anand Tamang in his presentation shared the issues and challenges in responding to the unmet needs of young people for contraception based on experiences from his several years of work on young people in Nepal. He shared that the unmet need for family planning among married young women aged 15 -19 and 20-24 years have shown an increasing trend between NDHS 2001 and NDHS 2011. He viewed that the prevalence of high unmet needs for FP among young peopled reected the fact that the FP programmes are not delivering eectively to the young people who constitute about one-fourth of the UPUBM QPQVMBUJPO JO /FQBM /FWFSUIFMFTT '1 JT OPU UIF POMZ OFFE GBDFE CZ ZPVOH QFPQMF JO /FQBM UPEBZ UIFZ IBWF PUIFS needs to met, such as education, employment, prevention of early marriage, early childbearing, unintended pregnancies and abortions and so on.

Some of the key issues and challenges in addressing young people’s needs and in provision of SRH services to young people were highlighted as: t 4PDJP DVMUVSBM OPSNT UIBU QFSQFUVBUF TVDI BT FBSMZ NBSSJBHF BOE FBSMZ DIJME CFBSJOH HFOEFS JOFRVBMJUZ BOE TPO preferences t (SPXJOH VOFNQMPZNFOU MFBEJOH UP IJHI MBCPVS NJHSBUJPO JOnPX PG SVSBM ZPVOH QFPQMF FTQFDJBMMZ ZPVOH XPNFO JOUP night entertainment industry in urban areas making them vulnerable to STDS and HIV/AIDS and sex traďŹƒcking t FBSMZ TFYVBM BDUJWJUJFT BOE BEWFSTF PVUDPNFT TVDI BT VOJOUFOEFE QSFHOBODJFT BOE VOTBGF BCPSUJPOT EPNFTUJD HFOEFS based violence t JTTVFT SFMBUFE UP IVNBO SFTPVSDFT PO IFBMUI TIPSUBHF PG IFBMUI XPSLFST JOBEFRVBUF TLJMM NJY MBDL PG QSF BOE JO TFSWJDF training, and diďŹƒculty in retention of health workers) t 4FSWJDF EFMJWFSZ SFMBUFE JTTVFT JOBQQSPQSJBUF DMJOJD IPVS GPS ZPVOH QFPQMF HFOEFS BOE BUUJUVEF PG UIF IFBMUI XPSLFST limited method choice for contraception or abortion services – abortion services is legalized in Nepal but medical abortion is available only e in a few districts). t %FNBOE TJEF CBSSJFST JHOPSBODF BCPVU FYJTUJOH MBXT BOE TFSWJDFT NJTDPODFQUJPOT PO '1 NFUIPET JOBCJMJUZ UP QBZ TFSWJDF fee, fear of stigmatization, lack of autonomy and decision making) The presentation concluded with suggestions on possible actions for responding to the needs of young people, which included: a. Research Response: t /FFE GPS JOUFSWFOUJPO SFTFBSDI UP JODSFBTF 43) '1 TFSWJDF BDDFTT BNPOH ZPVOH NJHSBOU DPVQMFT BOE FÄŠFDUJWF implementation of adolescents and youth friendly clinics, and t BTTFTTNFOU PG GBDUPST BTTPDJBUFE XJUI IJHI VONFU OFFE TUBHOBOU $13 BOE EFDMJOJOH 5'3 b. Policy and programmatic response: t /FFE GPS JOUFS TFDUPSBM BOE JOUFS EFQBSUNFOU DPMMBCPSBUJPO VOEFS UIF MFBEFSTIJQ PG UIF .JOJTUSZ PG )FBMUI BOE 1PQVMBUJPO in formulating and implementing policies and programmes with focus on preventing early marriage, early childbearing and reducing Unmet needs in SRH. This would include monitoring of implementation of National SRH Programme *NQMFNFOUBUJPO (VJEF FOTVSJOH FOBCMJOH FOWJSPONFOU GPS GFNBMF TUVEFOUT UP DPNQMFUF BU MFBTU IJHIFS TFDPOEBSZ FEVDBUJPO BEWPDBDZ GPS FOGPSDJOH MBX HPWFSOJOH BHF BU NBSSJBHF FOTVSJOH BQQSPQSJBUF TLJMM NJY PG )8T BU BMM MFWFMT BOE USBJOJOH PG )8T GPS RVBMJUZ TFSWJDF EFMJWFSZ JNQMFNFOU HFOEFS TFOTJUJWF " :1 GSJFOEMZ TFSWJDFT BOE BEFRVBUF CVEHFU allocation for National AYRH Programme.

Discussion: Some of the issues and concerns raised at the open forum on the plenary discussion included: t OFFE GPS DPVOTFMJOH TFSWJDFT UP ZPVOH QFPQMF PO VTF PG DPOUSBDFQUJWFT BOE JNQSPWJOH DPVOTFMJOH TLJMMT PG TFSWJDF QSPWJEFST t OFFE UP GPDVT PO TVQQMZ PG DPOUSBDFQUJWFT BT JU JT DSVDJBM JTTVF JO SVSBM BSFBT FYBNQMF GSPN 1BLJTUBO T 1FPQMF 1SPHSBNNF

14

from Health Care Initiatives) t OFFE UP FOTVSF XJEFS NFUIPE DIPJDF GPS ZPVOH QFPQMF t ɊF NPEFSO DPOUSBDFQUJWFT MJLF DPOEPNT QJMMT BSF BWBJMBCMF JO QSJWBUF NBSLFU BOE ZPVOH QFPQMF DBO CVZ JU XJUIPVU BOZ barrier. However, unmarried young people have vague knowledge of the contraceptives. t 0O FNFSHFODZ $POUSBDFQUJPO o NBOZ XPNFO BSF VTJOH FNFSHFODZ DPOUSBDFQUJPO BOE UIFZ TIPVME CF BMMPXFE UP VTF JU instead of going for induced abortion or suicide in case of unintended pregnancies. t QPMJUJDBM DPNNJUNFOU UP NFFU UIF OFFET PG ZPVOH QFPQMF *OEJB NBEF DPNNJUNFOU BU -POEPO '1 4VNNJU UP BEESFTT UIF young people’s FP needs). t FĊFDUJWF JNQMFNFOUBUJPO PG MFHBM BHF BU NBSSJBHF BOE UIFSF TIPVME CF OP EJTQBSJUZ JO UIF BHF BU NBSSJBHF GPS CPZT BOE HJSMT t EFNBOE GPS VTJOH B ZPVUI NPEVMF JO %)4 BOE /')4 GPS RVBMJUZ EBUB PO ZPVOH QFPQMF t /FFE UP FNQIBTJ[F PO BEPMFTDFOU TFYVBM FEVDBUJPO BOE QSPWJTJPO PG RVBMJUZ BEPMFTDFOU ZPVUI GSJFOEMZ 3) TFSWJDFT t /FFE UP EJĊFSFOU TUSBUFHJFT GPS EJĊFSFOU HSPVQT PG ZPVOH QFPQMF TVDI BT JO TDIPPM BOE PVU PG TDIPPM ZPVOH QFPQMF BOE they have dierent needs t &OTVSF NBMF JOWPMWFNFOU JO GBNJMZ QMBOOJOH DPOUSBDFQUJWF VTF t $PNNVOJDBUJPO HBQ CFUXFFO JOUFSOBUJPOBM PSHBOJ[BUJPOT MJLF 64"*% QSPWJEJOH BTTJTUBODF JO UIF IFBMUI TFDUPS /FFE to critically review what have been done so far and what more needs to be done. t 1BSUOFSJOH XJUI /(0T BOE DPNNVOJUZ NPCJMJ[BUJPO GPS FĊFDUJWFOFTT PG '1 QSPHSBNNFT t "EESFTTJOH PQFSBUJPOBM QSPCMFNT XJUI FYJTUJOH QSPHSBNNFT SBUIFS UIBO DPNJOH VQ XJUI OFX JEFBT JT B CJH DIBMMFOHF Youth Voices 1. Ms Anzaira Roxas, young participant, Family Planning Organization of Philippines 2. Ms. Sundas Warsi, young participant, Pakistan Two young participants from Philippines and Pakistan shared their thought and experiences on SRH needs from the young people’s point of view. They felt strongly that unmet need is due to lack of information among young people. Sexual and reproductive health education is essential for young people and it is their right to have information and knowledge about their own sexual and reproductive health needs and behaviour. Furthermore, they viewed that sex education should be linked with youth friendly services and young people should be involved in RH programme from planning stage to its implementation and monitoring.

Holistic interventions are needed for young people programme and we also need to recognize young people from diverse background including those who are involved in sex work, young people living with HIV, LGBT and both married and unmarried young people. Instead of saying that young people had premarital sex, the term of “early sex involvementâ€? may be more appropriate to describe the sexual activity among unmarried young people. .T "O[BJSB 3PYBT, member of Family Planning Organization of Philippines shared a quotation as, “...tell me I forget, show me I remember, involve me and I will understandâ€?, which reected on the need for active involvement of young people in any development programmes, especially in adolescent reproductive health programmes. She viewed that unmet need for family planning generally relates to the married young people. But when we talk of young people, there are varied groups of young people, such as sex workers, those living with HIV or those in humanitarian or conict situation and those with dierent sexual orientation (LGBT). So there should be a holistic approach in addressing the unmet needs of young people and their early sexual involvement and the young people themselves need to be involved in the process. Moreover, dierent groups of young people have diverse culture, beliefs and practices. She shared the example of her involvement with the Family Planning Organization of Philippines that used to work for dierent groups of young people (such as LGBT, MSM, sex workers etc) and viewed a need for mapping of institutions and agencies working in the areas of sexual and reproductive health and rights of similar groups of populations and facilitate collaboration among those institutions working in similar initiatives including SRH and FP needs of young people.

Ms. Roxas also emphasized on the need for working together with health service providers, religious leaders, teachers and academicians, parents, and local government units as part of peer education approach for educating young people about 15

their sexual and reproductive health needs and life skill education and providing SRH and FP information and services to them from respective ďŹ elds. This will enable the young people to have healthy sexual behaviour and make right choices at right time. She also viewed a need for thinking out-of-box on how we visualize young people in Asia by next 10 years - are we visualizing young people with no data on their SRH and FP needs, their reproductive health behaviours or with full and correct information and evidences on them. It is very worthy to invest on young people and make them involved for their better life. She concluded her remarks with a recommendation to organize a workshop for young people on addressing the unmet needs of young people because one person alone cannot represent the views of whole youth population in a country and s/he may not be doing justice to the issues of young people in general. .T 4VOEBT 8BSTJ a youth activist from Pakistan commended the realities of the situation of young people and their unmet needs for SRH and FP information and services in the South and Southeast Asia brought up in the presentations and panel discussion. However, she raised concern on the practical implementation of policies and programmes related to young people and achievements made so far in the tow subregion. Sharing experiences from her ďŹ eld visits in Pakistan, she viewed that although various donors and government have had worked with young people, most of those programmes were periodic and concentrated in certain locations only, and very few of programme interventions have been targeted to the RH needs of young people, especially the unmarried. She emphasized on male involvement and educating young people, both men and women, on sexual and reproductive health from the very young age because timely access to RH information and services have societal, economic and health beneďŹ ts and they will be able to make informed choice about their marriage, desired family size, birth spacing and so on, which result in multiple beneďŹ ts.

Ms. Warsi concluded with the note that there has been huge spending for family planning programmes for married people since decades, but not for young, unmarried population, yet progress has been stagnant or very slow. She suggested that donors and policy makers should think of targeting young people and develop programmes on a mega scale because a well educated young person today will be a mother or father tomorrow with decisive roles on every aspects of life, including reproductive health. Young people are not always the problem of society, they are also the solutions. We need to trust them, and provide them the necessary skills through adult and young people partnership to have a meaningful and better life.

At the subsequent open forum discussion, participants reiterated the need for engaging men and educating them on SRH and FP information and services. As young girls usually get SRH related information from mothers, but young boys rely mostly on information from internet surďŹ ng and peer groups, which are generally incomplete or misleading. Thus it is essential to incorporate SRH education in the school curriculum. Also, with a peer education approach, parents, teachers and young people can be collectively educated on their SRH and rights issues.

In Lao PDR, the unmet need for family planning and addressing the needs of young people is a new subject for the country as family planning is understood as focussing on married couples only. Since sex education is a sensitive topic and even health personnel do not dare to discuss in front of young people, the Ministry of Education has found a right word to be comfortable to discuss the topic with young people.

Attention was also drawn to the fact that unmet need leads to maternal deaths due to unwanted pregnancies and ultimate resort to unsafe abortions. So contraception should be promoted as a life saving initiative.

Experience from India revealed that most of the FP programmes focus on raising awareness among young women on FP through female community volunteers like ASHA. However, it is diďŹƒcult to increase the contraceptive use (the CPR) unless men are educated and motivated for contraception. The female health workers/ASHA usually felt shy to talk to husbands about FP. So one programme intervention in India used male teachers and male health workers to talk to male members/ husbands on FP and was successful to raise CPR from 2 percent to 13 percent within 18 months.

The Panel discussion ended with a concluding remark from the Chairperson, Ms. Anjali Sen. She appreciated the presentations made by the three line experts with substantive information, lessons learned and challenges in responding to the unique unmet needs of young people, drawing on country based information. She also thanked the two young advocated for sharing their observations based solely on their own interesting experiences and knowledge, which were quite thought provoking. The observations made inspired key stakeholders and participants to look back on programme interventions so far implemented at country level for addressing the needs of young people before stepping for new interventions.

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Parallel Thematic Group Discussions The objective of this thematic group discussion session was to identify key strategies and actions to operationalized the key thematic strategies outlined in the Call for Elimination of Unmet Need for Family Planning. The discussion took note on the country experiences that will help accelerate progress towards addressing unmet need.

The participants were divided into ďŹ ve groups by the thematic topics as follows: 1. Improving the quality and coverage of family planning information and service delivery, including skilled human resources.

2. Recognizing and addressing the unique needs of young people for quality sexual and reproductive health information and services, including family planning / contraception.

3. Ensuring commodity security through establishment of favourable policy, ďŹ nancing and eective systems for supply chain management, to ensure sustainable supplies of a broad range of contraceptives to all 4. Securing an enabling environment through stronger partnerships and leadership for repositioning FP 5. Diminishing socio-cultural and other barriers through strengthening community engagement and demand for family planning services.

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The summary of outcomes from the parallel thematic group discussions is presented by each thematic topic below: ÉŠFNBUJD 5PQJD *NQSPWJOH UIF RVBMJUZ BOE DPWFSBHF PG GBNJMZ QMBOOJOH JOGPSNBUJPO BOE TFSWJDF EFMJWFSZ JODMVEJOH skilled human resources This thematic group consisted of participants from Cambodia, India, Lao PDR, Myanmar, Nepal, Pakistan, Philippines and Timor Leste. Summary of the outcomes from the group discussions are as follows: Suggested actions to address the challenges: t 4UBOEBSEJ[F VQEBUF UIF GBNJMZ QMBOOJOH TFSWJDF HVJEFMJOFT UP GBDJMJUBUF RVBMJUZ TFSWJDFT BOE QSPWJEF SFGSFTIFS USBJOJOH UP service providers on the updated guidelines t $PMMBCPSBUF XJUI QSJWBUF TFDUPS FOHBHFE JO IFBMUI TFSWJDF EFMJWFSZ QVCMJD QSJWBUF QBSUOFSTIJQ NPEFM

t %FWFMPQ GBDJMJUZ DIFDL MJTU GPS TFMG BTTFTTNFOU BOE DPOEVDU DMJFOU TBUJTGBDUJPO TVSWFZT t 4USFOHUIFO IFBMUI NBOBHFNFOU JOGPSNBUJPO TZTUFN ).*4 BOE BOBMZ[F EBUB PO SFHVMBS CBTJT GPS EFDJTJPOT BOE actions t &OHBHF DPNNVOJUZ IFBMUI XPSLFST FTQFDJBMMZ NFO JO NPSF FÄŠFDUJWF NBOOFS UP QSPWJEF GBNJMZ QMBOOJOH JOGPSNBUJPO UP the beneďŹ ciaries t 6TF PQQPSUVOJUJFT MJOLFE XJUI TPDJBM XFMGBSF JOJUJBUJWFT NVMUJ TFDUPSBM BQQSPBDI F H JOUFHSBUF GBNJMZ QMBOOJOH NFTTBHFT with non-health messages like poverty alleviation etc.)

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t %FWFMPQ VTFS GSJFOEMZ JOOPWBUJWF UBSHFU PSJFOUFE *&$ NBUFSJBMT t 1PTU QBSUVN GBNJMZ QMBOOJOH TFSWJDFT OFFE UP CF TUSFOHUIFOFE t &YQBOE NFUIPE NJY JOUSPEVDF NPSF OFX NFUIPET JO QSPHSBNNF

t *OWPMWF QSJWBUF FOUJUJFT UP NBLF F─КFDUJWF QVCMJD QSJWBUF QBSUOFSTIJQ BOE FOTVSF SFBDIJOH UIF NPTU OFFEZ TFHNFOU PG population t *ODMVEF DPNNVOJUZ MFWFM MFBEFST SFQSFTFOUBUJWFT JO QMBOOJOH PG TFSWJDFT MJLF VUJMJ[BUJPO PG TQBDF HJWFO CZ BOZ NFNCFS JO the community) ╔йFNBUJD 5PQJD 3FDPHOJ[JOH BOE BEESFTTJOH UIF VOJRVF OFFET PG ZPVOH QFPQMF GPS RVBMJUZ TFYVBM BOE SFQSPEVDUJWF IFBMUI JOGPSNBUJPO BOE TFSWJDFT JODMVEJOH GBNJMZ QMBOOJOH DPOUSBDFQUJPO This thematic group consisted of participants from Cambodia, India, Lao PDR, Myanmar, Malaysia, Nepal, Philippines, and Timor Leste. The discussion covered diямАerent aspects of the unmet needs of young people, such as sexual and reproductive health information and services, education, human rights and youth participation and so on. The key outcomes of the group discussion are as follows: Suggested Actions: t 6TF PG *5 JO SFBDIJOH ZPVOH QFPQMF XJUI TFYVBM BOE SFQSPEVDUJWF IFBMUI JOGPSNBUJPO t *OWPMWF DFMFCSJUZ BNCBTTBEPST QVCMJD mHVSFT PG TFYVBM BOE SFQSPEVDUJWF IFBMUI PG ZPVOH QFPQMF t 1SPWJEF DPNQSFIFOTJWF QBDLBHF PG QSFWFOUJWF BOE DVSBUJWF TFSWJDFT GPS ZPVOH QFPQMF t "EESFTTJOH TPDJBM EFUFSNJOBOUT PG ZPVOH QFPQMF T SFQSPEVDUJWF BOE TFYVBM IFBMUI TQFDJBMMZ HFOEFS OPSNT t &OHBHFNFOU PG QBSFOUT BOE DPNNVOJUZ HBUFLFFQFST BOE PUIFS QSPGFTTJPOBM CPEJFT GPS 43) FEVDBUJPO PG ZPVOH QFPQMF t 4FOTJUJ[BUJPO PG BOE BEWPDBDZ XJUI QBSMJBNFOUBSJBOT NFEJB DPNNVOJUZ MFBEFST SFMJHJPVT HSPVQT BOE QSFTTVSF HSPVQT ╔йFNBUJD 5PQJD &OTVSJOH DPNNPEJUZ TFDVSJUZ UISPVHI FTUBCMJTINFOU PG GBWPVSBCMF QPMJDZ mOBODJOH BOE F─КFDUJWF TZTUFNT GPS TVQQMZ DIBJO NBOBHFNFOU UP FOTVSF TVTUBJOBCMF TVQQMJFT PG B CSPBE SBOHF PG DPOUSBDFQUJWFT UP BMM This group consisted of participants from Cambodia, India, Lao PDR, Myanmar, Philippines and Pakistan. The key outcomes from the group discussion included: Suggested Actions t *ODSFBTF USBOTQBSFODZ CZ TUSFOHUIFOJOH QVCMJD QSJWBUF QBSUOFSTIJQ t *OUFOTJGZ BEWPDBDZ F─КPSUT GPS (PWFSONFOU PXOFSTIJQ PG QSPDVSFNFOU BOE JOUFHSBUFE TVQQPSU t 1PMJDZ BOE BDUJPOT UP VOJGZ JOUFHSBUF -.*4 GPS 3) DPNNPEJUJFT t $PPSEJOBUF IBSNPOJ[F QMBO BOE TUSBUFHZ GPS EJTUSJCVUJPO USBOTQPSUBUJPO PG 3) DPNNPEJUJFT CZ UBLJOH JOUP BDDPVOU geographical location t *NQSPWF QSPDVSFNFOU TZTUFN UISPVHI QSJWBUF BOE 6/ QSPDVSFNFOU TZTUFN ╔йFNBUJD 5PQJD 4FDVSJOH BO FOBCMJOH FOWJSPONFOU UISPVHI TUSPOHFS QBSUOFSTIJQT BOE MFBEFSTIJQ GPS SFQPTJUJPOJOH FP This group consisted of participants from Bangladesh (resource person), Cambodia, India, Myanmar, Nepal, Philippines and Pakistan. The key outcomes of the discussion are as follows: Suggested actions: t ╔йF MFBEFSTIJQ OFFET UP CF TFOTJUJ[FE t $BQBDJUZ CVJMEJOH PG QPMJDZ NBLFST t 3FTPVSDF NPCJMJ[BUJPO BOE TFSWJDF DIBSHFT SFMJBODF PO TFSWJDF t 3FMJHJPVT MFBEFST IBWF UP CF CSPVHIU JO UIF GPME t ╔йF TPDJP DVMUVSBM CBSSJFST DPVME CF EFBMU UISPVHI FWJEFODF CBTFE BEWPDBDZ BOE DPIFSFOU #$$ t $BQBDJUZ CVJMEJOH BOE SBUJPOBMJ[FE EJTUSJCVUJPO PG IVNBO SFTPVSDFT BTTVSFE TFSWJDF EFMJWFSZ 18

Thematic topic 5: Diminishing socio-cultural and other barriers through strengthening community engagement and demand for family planning services.

This group consisted of participants from Afghanistan, Cambodia, India, Lao PDR, Pakistan, Philippines and TimorLeste. It was pointed that the socio-cultural, religious and other barriers to family planning exists in almost all countries Afghanistan, Cambodia, India, Lao PDR, Pakistan, Philippines and Timor-Leste. These countries are experiencing dierent forms barriers, which include: (a) Religious barriers, (b) Barriers to free and informed decision-making by women, and (c) Geographic barriers The group discussed about actions that have been taken to address each of those barriers at country level, the lessons learned (what has worked and what can be improved), the issues and challenges in addressing those barriers and suggested actions for addressing those barriers to facilitate increase in overall contraceptive use. The key outcomes from the group discussion are as follows: Suggested Actions t &EVDBUF PO BDDFQUBCJMJUZ PG '1 JO UIF DPOUFYU PG GBJUIT SFMJHJPOT t $POUJOVPVT EJBMPHVFT XJUI SFMJHJPVT MFBEFST DPNNVOJUZ MFBEFST t *TTVBODF PG GBUXB PS TFOTJUJ[BUJPO UISPVHI ,IVUCBI PO GBNJMZ QMBOOJOH t 4PDJBM NPCJMJ[FST UP TVTUBJO JOJUJBUJWFT t &YQPTF SFMJHJPVT MFBEFST UP FYQFSJFODFT PG PUIFS DPVOUSJFT t /PO NPOFUBSZ JODFOUJWFT UP WPMVOUFFST F H IFBMUI JOTVSBODF SFDPHOJUJPO FEVDBUJPOBM TVQQPSU GPS DIJMESFO

t $POUJOVF EJBMPHVF XJUI DPNNVOJUJFT t 4VTUBJO JOJUJBUJWFT t (PWFSONFOU NVTU JOWFTU JO EFNBOE HFOFSBUJPO BOE OPU POMZ JO FOTVSJOH TVQQMZ t 4USFOHUIFOJOH PG . & TZTUFN t 4VTUBJOJOH UIF QSPHSBNNF t 3FGSFTIFS USBJOJOHT Discussion: Dr. Wasim Zaman, chairperson for session thanked all the presenters and participants of the ďŹ ve thematic group discussions for their active engagement and sharing of experiences from respective country programmes and coming out with very substantive and action oriented product. He suggested that the outcomes from group discussions should be taken as ingredients for subsequent session on country cluster discussion and included in programme development for repositioning family planning and addressing the unmet need.

Some of the concerns/comments raised and suggestions made by the participants at the open forum discussion included: 1. Engaging religious leaders in the FP programme with due attention to their speciďŹ c concerns, help to promote contraception/family planning. For example, in Pakistan, the message on “birth spacingâ€? is more acceptable and supported by religious leaders than a message on “birth limitingâ€? or “family with 2 childrenâ€?. Some participants proposed to translate the supports from religious leaders into fatwa, however, issuance of fatwa might create more barriers for the programmes, thus might require a more careful planning. One concern raised regarding the term ‘Fatwa’ is that it gives negative connotation and suggested to use ‘Khutbah’ or sermons during Friday prayers to sensitize the public.

2. Involving young people in programmes implementation and mentoring has been successful. Example from India on the success of youth centres managed by young people.

3. There is a need to generate new and updated evidences for overcome the socio-cultural barriers and information on indigenous people, as we need to act based on evidences. In most countries, national data, including DHS data are quite old. Thus data generation and research for evidences and indicators should not be ignored. Moreover, quality of data/new research evidences, proper utilization of available data and translating them to decision-making tools are important.

4. The RH programmes should make use of the emerging information technology such as mobile phone, social network, 19

etc to reach out more people, especially young people and generate data. Instances were cited from India where social media, mobile phones, SMS and IT kiosk are being used frequently for information sharing and data collection as well as maintaining data base on outreach workers (ASHA), monitoring of their works, and contacting clients through SMS/ mobile phones for ante-natal visits, immunization and other services.

5. Need for adoption of a right-based approach in family planning programmes and provide a wide range of method choice (method mix) in order to reduce the unmet needs. Also need to address the issues of those who experienced ďŹ nancial barriers in accessing contraceptives (especially in Cambodia). Need to consider developing method speciďŹ c strategies according to country context rather than global programming.

6. Need to integrate family planning programmes with other maternal and child health and nutrition programme, rather than providing services through vertical programmes.

7. Need to strengthen partnership with dierent agencies, such as UNFPA for addressing the commodity security issues. A few examples of successful partnerships in RH/FP service delivery and commodity security from Philippines following the adoption of contraceptive self reliance strategy were shared, such as, performance based grants in partnership with 6/'1" BOE MPDBM HPWFSONFOUT GPS '1 BOE PUIFS 3) DPNNPEJUJFT DPOUSBDFQUJWF TPDJBM NBSLFUJOH UISPVHI QPQ TIPQT BU #BSBOHVZ MFWFMT QBSUOFSTIJQT XJUI 6OJPO PG -PDBM "VUIPSJUJFT PG UIF 1IJMJQQJOFT 6-"1 -FBHVF PG .VOJDJQBMJUJFT PG UIF Philippines (LMPs), and FP Consortium (composed of local FP practitioners), Philippines Obstetric and Gynecological society – professionals societies (POGS) and International Midwives Association of Philippines (IMAP).

In his concluding note, Dr. Zaman emphasized on the need to address the unmet needs of all those, including young people and other disadvantaged groups who want to use contraception for planning their fertility and avoid unintended pregnancies.

The respective governments and donor agencies like UNFPA need to make commitments as needed and translate the commitments made into actions for addressing the unmet needs of the target population including young people. He added that programmes on commodity security had been continued for last 40 years, yet the issue still exists. This calls for a good collaboration between donors and country government for ensuring commodity security for meeting the unmet needs. He urged to make optimal use of available resources, not only in money terms, but all other resources for repositioning FP programmes in the priority countries with speciďŹ c focus on Afghanistan and Timor Leste and the needs of young people. We need to ensure how much evidences are available on young people and how much do we use. We have enormous evidences, but need to make good use of them and we need to make signiďŹ cant dierence on usage and passage of messages to young people and other groups of population who are in need of quality information and services.

4FTTJPO 1BSBMMFM $PVOUSZ $MVTUFS (SPVQ %JTDVTTJPO BOE 1MFOBSZ 1SFTFOUBUJPOT PG 0VUDPNFT Chairperson: Ms. Lubna Baqi, Deputy Regional Director, UNFPA APRO, Bangkok 0CKFDUJWF To examine how best to operationalize in-country actions to address unmet need, particular among marginalized

groups including young people.

The session started with a remark from Ms. Lubna Baqi that the presentations and discussion at the workshop had been very productive and the thematic group discussions have came up with reach outcomes. She expected that the discussion at country level and country cluster group at the present session would bring some concrete actions that would be a step further at country level to take forward the actions to reduce unmet need.

One of the resource persons suggested a need for establishing a mechanism by the government representatives present at the workshop or by UNFPA to interact with respective governments for putting the actions in place.

Dr. Aurelio Camilo B. Naraval, Senior Programme OďŹƒcer, ICOMP introduced the participants with the objectives of the session, the process being followed for the country cluster group discussion and the guiding questions/points for facilitating the discussion. The participants from each country were requested to ďŹ rst have a country level discussion to identify and prioritize, keeping in mind the thematic issues that came up during thematic group discussion, ďŹ ve challenges experienced by the country in addressing the unmet needs, the actions taken so far to address the challenges, lessons learned and possible strategies/suggested actions for addressing the unmet need at country level.

Following the country group discussion, the priority challenges identiďŹ ed at the country level were to be brought to the country cluster group discussion. The participating countries were grouped into three clusters based on level of fertility and unmet needs. The country cluster group facilitated sharing of experiences and lessons learned among the cluster country participants.

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The three-country cluster group included: Cluster 1: India, Pakistan & Afghanistan Cluster 2: Lao PDR, Myanmar & Nepal Cluster 3: Cambodia, Philippines, Timor Leste Each cluster group was requested to select a moderator, a rapporteur to consolidate the outcome and a presenter to present the outcome at the plenary. Each group was provided with a worksheet with the questions and points for discussion and assigned with experts/resource persons to help facilitate the discussion.

The cluster groups were requested to prioritize ďŹ ve challenges out of the country-level outputs/challenges brought in by the cluster group countries. Based on the identiďŹ ed challenges, the cluster groups were requested to discuss the following questions and come out with suggested strategic actions for reducing unmet need: a. What has been done so far in selected countries towards addressing unmet need? b. Lessons learned (What worked well and what needs to be improved upon?) c. IdentiďŹ cation of groups requiring special focus (multiple burden, disadvantaged groups, geographical disparities, education and economic disparities) d. What are the strategies or suggested actions to address those challenges? e. What support/s is needed to take forward the strategies and suggested actions? i. Technical support ii. Capacity Building f. Who are the key actors or responsible parties for action?

The outcome from the country cluster group discussions as presented by each cluster group are summarized as follows: $MVTUFS *OEJB 1BLJTUBO "GHIBOJTUBO " ,FZ QSJPSJUJFT t 5P FMJNJOBUF UIF VONFU OFFE PG NBSHJOBMJ[FE BOE ZPVUI QPQVMBUJPO UISPVHI - Political will, policy and programmes - Functional Integration of dierent ministries involved in RH/FP programmes - Appropriate resource allocation - Understand, identify and remove socio cultural barriers in consistence with the country context - Research to generate evidence #

(SPVQT SFRVJSJOH TQFDJBM GPDVT JODMVEFE t .BSHJOBMJ[FE QPQVMBUJPO o UIPTF XIP BSF QPPS MBDL BDDFTT UP '1 JOGPSNBUJPO BOE TFSWJDFT t :PVUI HSPVQ t 1PMJDZ NBLFST

$ 4USBUFHJFT 4VHHFTUFE BDUJPOT t 4FOTJUJ[F BOE JOWPMWF 8PNFO 1BSMJBNFOUBSZ DBVDVT GPS BEFRVBUF CVEHFU BMMPDBUJPO BEWPDBDZ BOE NPOJUPSJOH BOE evaluation t (FOFSBUF 2VBMJUZ EBUB UISPVHI SFTFBSDI BOE EFTJHO FWJEFODF CBTFE JOUFSWFOUJPOT t *OUFHSBUFE JOUFS TFDUPSBM BOE DPOWFSHFOU BDUJPO &Y 4FMG )FMQ (SPVQT XPSLJOH PO FNQMPZNFOU /BSJ 4IBLUJ .JTTJPO Using teachers at the community, Youth clubs, Total Sanitation Campaign, NYKS, Panchayati Raj Institutions, SC/ ST Missions, Tribal Residential schools). t $BQBDJUZ CVJMEJOH PG HPWFSONFOU IFBMUI TZTUFN BU BMM MFWFMT t 6TF BOE VQTDBMF F PG *5 TPDJBM NFEJB BOE EFEJDBUFE UFMFQIPOF GPS JOGPSNBUJPO BOE DPVOTFMJOH PO DPOUSBDFQUJPO '1 (Ex. Free Toll phones and engaging corporate companies like Airtel) t 1SPWJTJPO PG DPNQSFTTJWF QBDLBHF PG QSFWFOUJWF BOE DVSBUJWF TFSWJDFT JOGPSNBUJPO DPVOTFMJOH BOE DMJOJDBM TFSWJDFT BT per the need of speciďŹ c groups of marginalized and young people. t (PWFSONFOU UP EJBMPHVF XJUI JOUFSOBUJPOBM BHFODJFT TVDI BT 6/'1" BOE PUIFS UFDIOJDBM BHFODJFT GPS UFDIOJDBM BOE ďŹ nancial support.

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% 5FDIOJDBM 4VQQPSU $BQBDJUZ #VJMEJOH OFFET t $PVOTFMJOH TLJMMT FOHBHJOH UFBDIFST BT DPVOTFMPST t %BUB "OBMZTUT t 5SBJOJOH GPS NJEMFWFM IFBMUI DBSF QSPWJEFST GPS 11*6$% *6$% BOE WBTFDUPNJFT t 5SBJOJOH GPS .BSWJ XPSLFST JO 1BLJTUBO

t *&$ NBUFSJBMT CVJMEJOH TLJMMT GPS JOUFSQFSTPOBM DPNNVOJDBUJPOT t *ODSFBTF VUJMJ[BUJPO CZ EFNBOE HFOFSBUJPO MPHJTUJDT BOE GVOEJOH TVQQPSUT $MVTUFS -BP 1%3 .ZBONBS /FQBM " ,FZ 1SJPSJUJFT t %FNBOE HFOFSBUJPO t "DDFTT UP '1 TFSWJDFT t $BQBDJUZ CVJMEJOH PG IFBMUI XPSLFST WPMVOUFFST JO CPUI QVCMJD BOE QSJWBUF TFDUPS t %FWFMPQ *OUFHSBUFE -PHJTUJDT NBOBHFNFOU JOGPSNBUJPO TZTUFN # t t t t

(SPVQT SFRVJSJOH TQFDJBM GPDVT JODMVEFE "EPMFTDFOUT :PVUI PUIFS NBSHJOBMJ[FE JODMVEJOH GFNBMF TFY XPSLFST QPPS XPNFO MJWJOH JO SFNPUF BSFBT *%1 FUD

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$ 4USBUFHJFT TVHHFTUFE BDUJPOT t 6TJOH NBTT NFEJB BOE JOUFSQFSTPOBM DPNNVOJDBUJPOT IPU MJOFT

t &TUBCMJTI TUSFOHUIFO :PVUI JOGPSNBUJPO DFOUFST BOE TUSFOHUIFO ZPVUI GSJFOEMZ 3) '1 TFSWJDFT GPS SFBDIJOH JO BOE out-of тАУschool youths t 5BSHFUFE BQQSPBDIFT GPS EJ─КFSFOU HSPVQT UISPVHI i. Micro-planning- identify diямАerent groups of marginalized population and develop programmes as per their need ii. Design and implement women protection services t *NQSPWF BDDFTT UP '1 TFSWJDFT UISPVHI DPNNVOJUZ CBTFE EJTUSJCVUJPO PG DPOUSBDFQUJWFT 0VUSFBDI TBUFMMJUF DMJOJD BQQSPBDIFT *OUFHSBUJPO PG '1 TFSWJDF EFMJWFSZ XJUI PUIFS 3) QSPHSBNNFT BOE TPDJBM NBSLFUJOH XJUI 1VCMJD QSJWBUF -partnership t 4USFOHUIFOJOH FYJTUJOH USBJOJOH TJUFT BOE FYQBOEJOH OFX TJUFT t 5SBJOJOH PG )8T WPMVOUFFST BOE 1FFS FEVDBUPST PO "34) PO TJUF DPBDIJOH BOE TVQQPSUJWF TVQFSWJTJPO PG USBJOFFT t 3FWJTJUJOH JO QSF TFSWJDF DVSSJDVMVN PG )FBMUI 8PSLFST t 4JUVBUJPOBM BOBMZTJT BOE DBQBDJUZ EFWFMPQNFOU PO JOUFHSBUFE -.*4 TZTUFNT t 4USFOHUIFOJOH QBSUOFSTIJQ GPS SFTPVSDF IBSNPOJ[BUJPO % 5FDIOJDBM TVQQPSU DBQBDJUZ CVJMEJOH OFFET t 4LJMM EFWFMPQNFOU GPS #$$ t %FWFMPQNFOU PG OBUJPOBM HVJEFMJOFT QSPUPDPMT t 5FDIOJDBM BTTJTUBODF UP SFWJTJU USBJOJOH DVSSJDVMVN BOE TVQQMZ DIBJO NBOBHFNFOU t 'JOBODJBM UFDIOJDBM TVQQPSU GPS GBDJMJUJFT VQHSBEJOH $MVTUFS $BNCPEJB 1IJMJQQJOFT 5JNPS -FTUF A. Common Priorities: t 6QEBUF QPMJDJFT t 4FSWJDF QSPWJTJPO GPS ZPVOH QFPQMF

22

t 2VBMJUZ PG TFSWJDFT F H "43) DPOUSBDFQUJPO NFUIPE NJY BOE TVQFSWJTJPO t 4VTUBJOFE OBUJPOBM CVEHFUBSZ TVQQPSU t .BOBHJOH PQQPTJUJPO 5JNPS -FTUF BOE 1IJMJQQJOFT

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(Detailed outcome from Country Cluster Group Discussions are enclosed as Annex -5) Open Discussion: Some of the questions/issues and comments raised at the open discussion included: 1. There is a need for disaggregated data on unmet need of the poor and young people, such as by location/residence, education and equity issues for advocacy purposes. Parliamentarians are the best advocates and they listen to us when it is related to their constituencies. The policy makers and parliamentarians need to be equipped with simple and easy-tounderstand data/evidences for advocacy (e.g. for increased budget allocation) and to translate the data into programme intervention. In some South East Asian countries, national health surveys (NHS) are contracted out to private sector and thus not institutionalized leading to accuracy and accountability of data. Need to do secondary analysis of DHS data to generate disaggregated data/evidences at lower levels, which are very useful for planning and programming. It is important to look at the validation of the data and to train human resources (especially those from district and grassroots level) on using data for planning and programming purposes. Also, we need to use the latest and most relevant data for policy and programming.

2. In some countries (e.g. India) huge data are available and data are analyzed at district levels. However, the issue is capacity building in using available data. Capacity building is a long term process and need a hand-holding support that requires adequate time and resources.

3. More people are using services from private sectors (Afghanistan – 20% of the people using services from private sectors.).

There is a need to strengthen Public Private Partnership, wherever feasible.

4. The issue of resource constraints and need for increased funding for repositioning FP programmes came out very strongly.

5. In the context of decentralization and devolution process happening in many countries (e.g. Pakistan, Philippines, Indonesia etc), there is a need to engage local government in planning and programming. The issue of tapping local resources and raising resources from other sources for health programmes was also brought up in group discussion.

Decentralized opportunities also provide space for engagement of young people in planning and programming. In case of Pakistan, with decentralization and devolution of population programmes, there is a need for capacity building in handling the decentralization. Examples of from Indonesia, which has also been decentralized recently, would be useful for learning process.

6. It is important to have a family planning subcommittee at the national level that represent by government, UN representatives and civil societies in order to have a better planning and implementation of the family planning programme, avoid duplication and harmonization of resources (e.g. the FP Sub-committee under Family Health Division in Nepal has representation from government, external development partners and CSOs involved in FP programme).

7. FP programmes have to compete with other incentive driven RH programmes and thus low motivation (e.g.: abortion programme in Nepal). Need to have solutions for such problem.

23

Dr. Zaman thanked all participants for the very productive outcome from the country cluster group discussion. He remarked that many important concerns and issues have been raised by the participants which need to be addressed in order to reduce the unmet need. There are participants representing the Government, the young people and the UN and all of them can make a dierence together. He viewed that UNFPA Representatives and other participants should start working together on the suggested actions points that came from the country group discussions. Since UNFPA has presence in every country, it can take a role of catalyst in all countries.

Ms. Baqi appreciated the active participation by all participants in the group discussion and coming up with the framework of strategic actions that need to be undertaken for addressing the priority challenges in meeting the unmet needs. $PODMVTJPOT BOE 4VNNJOH VQ PG 3FHJPOBM 1SJPSJUJFT 4USBUFHJFT &YUFSOBM 4VQQPSU Chairperson: Ms. Lubna Baqi, Deputy Regional Director, UNFPA APRO Based on the outcomes from the thematic group discussion and country cluster group discussion, Ms. Lubna Baqi summarized the key challenges and priority actions that need to be focused at the regional and country level for repositioning FP programmes and addressing the unmet needs of the marginalized groups of population including young people. Those included, among others, as follows: t /FFE GPS SFOFXJOH QPMJUJDBM DPNNJUNFOU GPS SFQPTJUJPOJOH '1 QSPHSBNNF BOE NBOBHJOH UIF PQQPTJUJPO t /FFE UP GPDVT PO NVMUJ TFDUPSBM BOE JOUFHSBUFE BQQSPBDIFT JO 3) BOE '1 TFSWJDF EFMJWFSZ BT TFWFSBM HPPE FYBNQMFT PG integrated approaches were highlighted during discussion. t ɊF JTTVF PG TVTUBJOBCJMJUZ BOE OFFE GPS CVEHFUBSZ TVQQPSU BOE BEFRVBUF SFTPVSDF BMMPDBUJPO JO BO FOWJSPONFOU XJUI resource constraint need to be focused. Suggestion were made for tapping local resources at country level through eective FOHBHFNFOU PG MPDBM HPWFSONFOU BOE DPNNVOJUZ NPCJMJ[BUJPO EJWFSTJmDBUJPO PG QSPHSBNNF BDUJWJUJFT JO QBSUOFSTIJQ with private sectors. t ɊF 1VCMJD 1SJWBUF QBSUOFSTIJQ 111 DBNF VQ WFSZ TUSPOHMZ BOE UIFSF BSF MPUT PG QPUFOUJBMT UIBU IBWF OPU CFFO UBQQFE yet. Need to explore PPP approach at country and regional level. t *TTVF PG DPPSEJOBUJPO PG TFWFSBM QBSBMMFM QSPHSBNNF BDUJWJUJFT CFJOH JNQMFNFOUFE BU DPVOUSZ FYBNQMF GSPN 1BLJTUBO

Respective government should be in driving seat or play leadership role in coordinating such parallel programme with strong policies and strategies. t /FFE UP GPDVT PO UIF NBSHJOBMJ[FE HSPVQT BOE UIF JTTVF PG FRVJUZ JO BDDFTT BOE VUJMJ[BUJPO PG TFSWJDFT /FFE UP JEFOUJGZ who are the marginalized group and once identiďŹ ed, make sure the services are tailored made to their needs. t ÉŠF -JGF DZDMF BQQSPBDI JO BEESFTTJOH VONFU OFFET TIPVME CF GPDVTFE BT SBJTFE CZ 1SPG +POFT 3FBTPOT GPS OPO VTF PG contraception are closely associated with the supply side of contraceptives and the method-mix. Need to make sure of commodity security and supply-chain management at all levels of service delivery. t 2VBMJUZ PG EBUB BOE FOTVSJOH FWJEFODF CBTFE QMBOOJOH BOE QSPHSBNNJOH JT BO JNQPSUBOU BSFB UIBU OFFET UP CF GPDVTFE BU country and regional level. t 1SPWJEF NPSF DBQBDJUZ CVJMEJOH PQQPSUVOJUJFT FTQFDJBMMZ TLJMMT EFWFMPQNFOU JO EBUB BOBMZTJT BOE VUJMJ[BUJPO QSPDVSFNFOU and supply chain management. Also informed of forthcoming WHO regional capacity building initiative on Family Planning and capacity building on warehousing and supply-chain management being organized by UNFPA in selected countries. t *TTVF PG EFDFOUSBMJ[BUJPO BOE JUT JNQBDU PO '1 QSPHSBNNF JT JNQPSUBOU POF JO TFWFSBM "TJBO DPVOUSJFT t )VNBOJUBSJBO SFTQPOTFT JO FNFSHFODZ DSJTJT TJUVBUJPO BOE VONFU OFFET PG EJTQMBDFE QFPQMF EVF UP EJTBTUFST BOE OBUJPOBM calamities did not come up strongly. However, they need further action.

4. Concluding Session The workshop concluded with a vote of thanks from Dr. Wasim Zaman, Executive Director, ICOMP to all participants from the nine countries, the UNFPA Country OďŹƒces for facilitating the participation of respective government representatives and other delegates as well as providing country speciďŹ c reference materials and the UNFPA Asia and the PaciďŹ c Regional OďŹƒce for the collaboration and continued guidance in substantive aspects of the workshop. He also thanked the resource persons for their contribution in preparing the background documents and availing themselves at the workshops and to the UNFPA APRO and ICOMP sta for their tireless support in making the workshop success.

24

In terms of the product from the workshop, Dr. Zaman mentioned that ICOMP and UNFPA APRO will come up with a publication of background papers prepared for the workshop. Prior to that, the revised papers, all the presentations and summarized succinct aspects of deliberations will be put in ICOMP website and sent by emails for use at country level.

He urged to recognize the works done by the predecessors and ended with a note that “Unhappiness that something could

be done better, keeps us working on it. While dealing with new generations of problems and challenges, some outdated messages need to be addressed with new ways of addressing the challenges.”

Ms. Lubna Baqi, Deputy Regional Director, UNFPA APRO and Chairperson thanked all participants for their valuable contribution to the deliberations of the workshop and making it a success. She then announced closing of the workshop.

Annex -1 ,FZ 4USBUFHJFT PG UIF "TJB BOE UIF 1BDJmD $BMM GPS UIF &MJNJOBUJPO PG 6ONFU /FFE GPS 'BNJMZ 1MBOOJOH #BOHLPL %FDFNCFS 1. Enhancing leadership, governance and political commitment for repositioning family planning in the national development agenda.

2. Raising and sustaining adequate financial resources for ensuring universal access to family planning information, services and commodities.

3. Improving the quality and coverage of family planning information and service delivery to ensure free and informed choice through the provision of a broader range of methods for all, including the underserved groups.

4. Empowering individuals, especially the underserved, and communities to exercise their rights to demand and use family planning information and services 5. Recognizing and responding to the unique needs of young people for quality sexual and reproductive health information and services 6. Ensuring commodity security including policy, demand creation and logistics management to ensure sustainable supplies of a broad range of contraceptives to all, including underserved groups 7. Ensuring an adequate and equitably distributed supply of skilled human resources to provide quality family planning information and services 8. Strengthening partnerships and collaboration with stakeholders, including religious groups, for making family planning information and services available, accessible, acceptable and affordable to all.

9. Improving data collection and analysis of disaggregated data for monitoring inequities and evaluating the impact of family planning for all.

10. Undertaking operations and socio cultural research to improve knowledge base for policy and programming reforms.

25

Annex -2 UNFPA-ICOMP Workshop on Operationalizing the Call for Elimination of Unmet Need for Family Planning in Asia and the Pacific Region 18-19 September 2012, Bangkok -*45 0' 1"35*$*1"/54 No Name

Title

Organization

Email Address

"'()"/*45"/ 1

Dr. Abdul Malik Faize

National Programme Officer, FP

UNFPA

faize@unfpa.org

$".#0%*" 2

Dr. Sarath Kros

Director, Provincial Health Department of Siem Reap

Ministry of Health

sarathkros@gmail.com

3

Dr. Lam Phirun

Deputy Director of RH Programme, National Maternal and Child Health Centre

Ministry of Health

lamphirun@yahoo.com

4

Dr. Chivorn Var

Associate Executive Director

Reproductive Health chivorn@rhac.org.kh Association of Cambodia

5

Ms. Dara Kreal

Assistant Team Leader, Maternal Reproductive Health

Reproductive and Child Health Alliance (RACHA)

kdara@racha.org.kh

6

Dr. Chris Vickery

Health Adviser

AusAid

chris.vickery@ausaid.gov.au

7

Dr. Marc Derveeuw

Representative

UNFPA

derveeuw@unfpa.org

8

Dr. Sochea Sam

National Programme Officer, RH

UNFPA

ssam@unfpa.org

INDIA 9

Dr. B.N. Dash

Director of Family Welfare

Ministry of Health, Govt odisha@gmail.com of Odisha, India

10

Dr. Sushma Dureja

Deputy Commissioner, Family Planning Division

Ministry of Health and Family Welfare, Govt of India

sushmadureja@gmail.com

11

Mr. Venkatesh Srinivasan

Assistant Representative

UNFPA

srinivasan@unfpa.org

12

Mr. Tej Ram Jat

State Programme Officer

UNFPA

tejram@unfpa.org

-"0 1%3 13

Dr. Many Thammavong

Deputy Director of Medical Products and Supply Centre, Dept of Food and Drug

Ministry of Health

thmany@gmail.com

14

Dr. Kopkeo Souphanthong

Reproductive Health Programme Coordinator, Mother and Child Health Centre

Ministry of Health

kopkeo@hotmail.com

15

Ms. Oulayvan Sayarath

Logistical Management Officer

UNFPA

sayrath@unfpa.org

16

Ms. Siriphone Sally Sakulku

MNCH Coordinator

UNFPA

ssakulku@unfpa.org

.:"/."3 17

Dr. Hnin Hnin Lwin

Assistant Director, Maternal and Child Heath

Ministry of Health

hninhninlwin@gmail.com

18

Dr. Nang Htawn Hla

President

Myanmar Nurse and Midwife Association

mnacentral@gmail.com

19

Dr. Myint Zaw

Project Coordinator, Reproductive Health Project

Myanmar Medical Association

mma.myintzaw@gmail.com

20

Dr. Mohamed AbdelAhad

Representative

UNFPA

ahad@unfpa.org

26

21

Dr. Hla Hla Aye

Assistant Representative

UNFPA

hlaye@unfpa.org

/&1"- 22

Dr. Senendra Raj Upreti

Director, Family Health Division

DOHS,Teku

senendra.upreti933@hotmail. com

23

Ms. Lila Kumari K.C.

Section Officer

Ministry of Health and Population

lilakc1978@gmail.com

24

Dr. Shilu Adhikari

Health System Strengthening Officer

UNFPA

sadhikari@unfpa.org

1",*45"/ 25

Dr. Ruqia Aijaz

Director, Reproductive and Child Health

Health Dept, Provincial Govt. of Sindh Province

26

Dr. Nighat Shah

Director

Society of Gynacologists & Obstetrics, Karachi, Sindh Province

27

Dr. Riaz Memon

Programme Director

People’s Primary Health Care Initiative, Provincial dr_riaz62@hotmail.com Govt of Sindh Province

28

Mr. Syed Ashfaque Ali Shah

Additional Secretary (ME & P)

Dept of Population Welfare Provincial Govt of Sindh Province

ashfaqpwds@yahoo.com

29

Dr. Shahnaz Shallwani

Provincial Coordinator Officer

UNFPA

shallwani@unfpa.org

30

Ms. Sundas Warsi

M&E Officer

Consultant EPI/ UNICEF for GAVI CSO Support

sundaswarsi@hotmail.com

31

Dr. Bernabe Marinduque

Family Planning Officer, Dept of Health

Ministry of Health

abemarinduque@yahoo.com

32

Ms. Anzaira Roxas

Family Planning Organization of Philippines

anzairabroxas@gmail.com

33

Dr. Honorata Catibog

Medical Officer, Dept of Health

Ministry of Health

honoratacatibog@yahoo.com

34

Ms. Ann Maria Leal

National Programme Associate

UNFPA

leal@unfpa.org

35

Dr. Joseph Michael Singh

Programme Officer for Reproductive Health

UNFPA

jsingh@unfpa.org

5*.03 -&45& National Director of Community Health Services

36

Ms. Isabel Maria Gomes

37

Ms. Aurea Celina Martins Family Planning Officer Da Crus

38

Dr. Domingas Bernando

Assistant Representative and RH Focal Person

39

Dr. Jannatul Ferdous

Technical Adviser MNCH/FP, Timor-Leste Health Improvement HADIAK Project

jferdous@jsi-timor.com

40

Mr. Pornchai Suchitta

Representative

suchitta@unfpa.org

Ministry of Health

imgomes02@yahoo.com

Ministry of Health

cruzaureau88@yahoo.com

UNFPA

bernando@unfpa.org

UNFPA PARTNERS

41

Ms. Anjali Sen

Regional Director

International Planned Parenthood Federation (IPPF)

asen@ippfsar.org

42

Ms. Armin Jamshedji Neogi

Director, Monitoring and Evaluation

Family Planning Association of India

armin@fpaindia.org

&91&354 3&4063$& 1&340/4 43

Prof. Gavin Jones

Comparative Asia Research Centre

Director

27

arigwj@nus.edu.sg

44

Prof. Barkat Khuda

Professor of Economics

University of Economics

CBSLBUFL!ZBIPP DPN barkatek@gmail.com

45

Dr. Mohammad Ejazuddin Khan

Senior Programme Associate

Population Council

mekhan@popcouncil.org

46

Assoc. Prof. Dr. Mary Huang Soo Lee

Chairperson

Federation of Reproductive Health Association Malaysia (FRHAM)

huang@medic.upm.edu.my

47

Dr. Avishek Hazra

Programme OďŹƒcer

Population Council

ahazra@popcouncil.org

48

Mr. Anand Kumar Tamang

Founder Chairperson and Director

Center for Research on Environment Health and Population Activities (CREHPA)

anand@crehpa.org.np

49

Ms. Neera Shrestha

50

Ms. Lim Shiang Cheng

shrestha@icomp.org.my University Putra Malaysia

Consultant

shiangcheng@yahoo.com

&91&354 3&4063$& 1&340/4 51

Ms. Nobuko Horibe

Regional Director

UNFPA APRO

horibe@unfpa.org

52

Ms. Lubna Baqi

Deputy Regional Director

UNFPA APRO

baqi@unfpa.org

53

Ms. Soyoltuya Bayaraa

Programme Specialist

UNFPA APRO

soyoltuya@unfpa.org

54

Dr. Ali Shirazi

Programme Specialist

UNFPA APRO

shirazi@unfpa.org

55

Ms. Rizvina De Alwis

Programme Specialist

UNFPA APRO

dealwis@unfpa.org

56

Mr. Golden Mulilo

Programme Specialist

UNFPA APRO

mulio@unfpa.org

57

Dr. Josephine Sauvarin

Technical Adviser, HIV/ASRH

UNFPA APRO

sauvarin@unfpa.org

58

Dr. Chaiyos Kunanusont

Technical Adviser

UNFPA APRO

kunanusont@unfpa.org

59

Dr. Vinit Sharma

Technical Adviser, RH/RHCS

UNFPA APRO

visharma@unfpa.org

60

Ms. Anne Harmer

UNFPA APRO

harmer@unfpa.org

61

Suchitra Thamromdi

UNFPA APRO

suchitra@unfpa.org

Programme Assistant *$0.1

62

Dr. Wasim Zaman

Executive Director

ICOMP

zaman@icomp.org.my

63

M. Aurelio Camilo Naraval

Senior Programme OďŹƒcer

ICOMP

junnavaral@icomp.org.my

64

Mr. Hairudin Masnin

Programme OďŹƒcer

ICOMP

hairudin@icomp.org.my

65

Ms. Josephine Chong

Senior Secretary

ICOMP

josephine@icomp.org.my

28

UNFPA – ICOMP WORKSHOP ON OPERATIONALIZING THE CALL FOR ELIMINATION OF UNMET NEED FOR FAMILY PLANNING IN ASIA AND THE PACIFIC REGION 18-19 September 2012 The Imperial Queen’s Park Hotel, Bangkok, Thailand Tentative Programme (as of 12 Sept 2012) 17 Sep 2012

Sessions / Topics

Processes / Speakers

18.00 – 21.00

REGISTRATION (Workshop Secretariat ICOMP Room @ 37th Floor)

18 Sep 2012

Sessions / Topics

Processes / Speakers

07.30 – 08.30

REGISTRATION (Conference Hall @ Sakura Room, 37th Floor)

ICOMP / UNFPA APRO

08.30 – 09.00

OPENING SESSION Purpose of the Meeting and Expectations: 2010 Asia and the Pacific Call for the Elimination of Unmet Need for Family Planning

Dr. Wasim Zaman, Executive Director, ICOMP

Scaling-up Support for Family Planning – a vision for Asia and the Pacific Ms. Nobuko Horibe, Director, UNFPA Asia and the Pacific Regional Office 09.00 – 13.00

SESSION 1 - PLENARY Objective: To take stock of the progress and challenges in the priority countries and examine strategies for moving forward

09.00 – 10.00

Chairperson: Ms. Nobuko Horibe, Director, UNFPA Asia and the Pacific Regional Office

Analytical Review of Unmet Need of Family Presentation by Prof. Gavin W. Jones, Director, Planning in South East Asia Comparative Asia Research Centre (30 minutes presentation followed by discussions)

10.00 – 10.30

Tea Break

10.30 – 11.30

Analytical Review of Unmet Need of Family Planning in South Asia

Presentation by Prof. Barkat E-Khuda, Dept. of Economics, University of Bangladesh, Dhaka (30 minutes presentation followed by discussions)

11.30 – 12.30

Panel Discussion: Responding to the Unique Needs of Young People

Chairperson: Panellists 4.Dr. M.E. Khan, Senior Associate, Population Council, India 5.Dr. Mary Huang Soo Lee, Associate Professor, Faculty of Medicine & Health Sciences, University Putra Malaysia 6.Mr. Anand Tamang, Founder Chairperson and Director, CREPHA, Nepal 15 minutes presentation by each panelist, followed by 15 minutes discussions)

12.30 – 13.15

Voices of Young People

1.Ms Anzaira Roxas, Family Planning Organization of Philippines 2.Babu Ram Pant, Nepal 3.Ms Sundas Varsi, Pakistan (10 minutes presentation by each panelist, followed by 15 minutes discussion)

13.15 – 14.00

Lunch

29

14.00 – 17.30

SESSION 2 - PARALLEL THEMATIC GROUP DISCUSSIONS Objective: To identify key strategies and actions based on country experience that will help accelerate progress towards addressing unmet need.

14.00 – 14.10

Introduction To The Parallel Thematic Group Session

Dr Jun Naraval, Senior Programme OďŹƒcer, ICOMP

14.10 – 15.30

Parallel Thematic Discussions by Group Group 1: Improving the quality and coverage of family planning information and service delivery, including skilled human resources Group 2: Recognizing and addressing the unique needs of young people for quality sexual and reproductive health information and services, including family planning / contraception.

Group 3: Ensuring commodity security through establishment of favourable policy, ďŹ nancing and eective systems for supply chain management, to ensure sustainable supplies of a broad range of contraceptives to all Group 4: Securing an enabling environment through stronger partnerships and leadership for repositioning FP Group 5: Diminishing socio-cultural and other barriers through strengthening community engagement and demand for family planning services.

Grouping: 5 groups will be formed, one per issue.

Process: t " NPEFSBUPS XJMM CF BTTJHOFE UP FBDI HSPVQ t " SBQQPSUFVS XJMM CF FMFDUFE XIP XJMM DPOTPMJEBUF BOE present the outcome of the group discussion. t %JTDVTTJPO QPJOUT XJMM CF QSPWJEFE UP UIF HSPVQT t &YQFSUT SFTPVSDF QFSTPOT XJMM CF BTTJHOFE UP FBDI HSPVQ to help facilitate the discussion.

15.30 – 16.00

Tea break

18 Sep 2012

Sessions / Topics

Processes / Speakers

16.00 – 17.30

$POUJOVBUJPO PG UIF 1BSBMMFM ÉŠFNBUJD (SPVQ %JTDVTTJPOT

t(SPVQT XJMM DPOUJOVF XJUI UIF EJTDVTTJPO t1SFQBSF TVNNBSZ DPODMVTJPO PO UIF NBKPS JTTVFT t1SFQBSF UIF QSFTFOUBUJPO UP CF NBEF PO UIF GPMMPXJOH morning

17.30-17.45

Remarks by ICOMP/UNFPA APRO End of Day’s Proceedings

19 Sep 2012

Sessions / Topics

Processes & Speakers / Facilitators

9.00 – 10.30

Presentation on the Outcome of Thematic Group Discussions

Chairperson: Process: t " SFQSFTFOUBUJWF GSPN FBDI HSPVQ XJMM NBLF B CSJFG presentation, consolidating the outcomes of the thematic group discussions.

10.30 – 11.00

Tea Break

30

11.00 – 1.00

SESSION 3 - PARALLEL COUNTRY GROUP DISCUSSIONS Objective: To examine how best to operationalize in-country actions to address unmet need, particular among marginalized groups including young people Issues to be discussed: t $PVOUSZ TQFDJmD DIBMMFOHFT BOE QSJPSJUZ t $PVOUSZ TQFDJmD TUSBUFHJFT UP BEESFTT HBQT t *EFOUJmDBUJPO PG HSPVQT SFRVJSJOH TQFDJBM focus t ,FZ BDUPST BOE SFTQPOTJCMF QBSUJFT responsible for actions t ,FZ BDUJPOT UP TFDVSF BO FOBCMJOH environment t ,FZ BDUJPOT UP CVJME OBUJPOBM DBQBDJUJFT

Grouping: 3-4 groups country clusters be formed Process: t&BDI HSPVQ XJMM FMFDU B NPEFSBUPS BOE B 3BQQPSUFVS XIP will consolidate and present the outcome of the group discussion. t(VJEFMJOFT GPS SFQPSUJOH CBDL XJMM CF QSPWJEFE t4VCNJU UIF PVUDPNF PG UIF HSPVQ EJTDVTTJPO UP UIF secretariat for comparative analysis

13.00 – 14.00

Lunch

During the lunch time the ICOMP & UNFPA APRO team will extract the common issues/strategies/priorities/ needs

14.00 – 15.45

Presentations of the Country Clusters Actions and External Support

Chairperson: Process: 20 minutes per cluster A brief analysis on the common issues/strategies/ priorities/needs will be given to the chair

15:45 – 16-.15

Tea break

16.15 – 17.00

Presentation and Discussion for Regional Priorities/Strategies/External support

UNFPA

17.00 – 17.30

Closing Session

UNFPA & ICOMP

17.30

End of Workshop

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Annex -4: Outcome from each five thematic group discussions Thematic Group 1: Improving the quality and coverage of family planning information and service delivery, including skilled human resources.

Group Members: t .T "SNJO KBNTIFEKJ /FPKJ o *OEJB t %S ,PQLFP 4PVQIBOUIPOH o -BP 1%3 t %S #FSOBCF .BSJOEVRVF o 1IJMJQQJOFT t %S -BN 1IJSVO o $BNCPEJB t %S 3VRJB "JKB[ o 1BLJTUBO t %S 4FOFOESB 3BK 6QSFUJ o /FQBM t %S %PNJOHBT #FSOBOEP o 5JNPS -FTUF t .T "VSFB $FMJOB .BSUJOT %B $SVT o 5JNPS -FTUF t .T 4PZPMUVZB #BZBSBB o "130 t %S /BOH )UBXO )MB o .ZBONBS t %S "WJTIFL )B[SB o *OEJB

8IBU IBT CFFO done on the thematic area?

8IBU BSF UIF MFTTPOT MFBSOFE QSPDFTT BOE PVUDPNF

8IBU XPSLFE XFMM FYBNQMFT PG TVDDFTT TUPSJFT BOE XIBU DBO CF JNQSPWFE VQPO

1. Govt. commitment: policies and programme framework (all countries) 2. Introducing community health workers/ volunteers (Pakistan, India, Philippines, Nepal, Timor Leste)

8IBU BSF UIF DIBMMFOHFT JTTVFT JO BEESFTTJOH UIF thematic area?

Lack of competencies/ skills: Clinical as well as Counseling

t %FWFMPQ TUSFOHUIFO o supportive supervision mechanism o monitoring tool to be used at all levels including community level (CBDs) t 4UBOEBSEJ[F VQEBUF UIF '1 TFSWJDF guidelines to facilitate good quality services

2VBMJUZ PG IFBMUI QSPWJEFS T training

t *NQMFNFOU FÄŠFDUJWF #$$ BQQSPBDI may be using ICTs t 3FGSFTIFS USBJOJOH

Inadequate human resources

3. Community based distribution (CBD) points (Lao, Cambodia, India) 4. Training on FP to the Midwives, ANMs, Nurses (Myanmar)

8IBU BSF TVHHFTUFE BDUJPOT UP BEESFTT UIF DIBMMFOHFT JO JNQSPWJOH UIF UIFNBUJD BSFB

Lack of choices of FP methods

t (PWU UP BMMPDBUF TVÄ‹DJFOU GVOET UP recruit/retain providers t 1SJWBUF TFDUPS NBZ CF SPQFE JO 111 model) t (PWU UP BMMPDBUF TVÄ‹DJFOU GVOET UP recruit/retain providers t 1SJWBUF TFDUPS NBZ CF SPQFE JO 111 model)

5. FP competency based training system that includes counseling adopted by the countries (Philippines, Nepal)

Provider bias towards speciďŹ c methods

t ÉŠJOL PG XBZT UP TVQQPSU NPUJWBUJPO of community level health workers

6. Countries are integrating the FP with MCH (Lao, India, Myanmar)

Target driven (unwritten) approach

t $POEVDU DMJFOU TBUJTGBDUJPO TVSWFZT or exit interviews or ‘mystery client’ approach

Condition (cleanliness and hygienic) of health facilities

t 5SZ GPS SFTPVSDF NPCJMJ[BUJPO t %FWFMPQ BOE VTF GBDJMJUZ DIFDL MJTU GPS self assessment and improvement

Provider’s attitude and behavior

t $MJFOU TBUJTGBDUJPO TVSWFZ FYJU interview as a feedback of provider’s attitudes

Lack of evidence based approach to decision making and management of service delivery

t 4USFOHUIFO ).*4 BOE BOBMZ[F EBUB on regular basis for decision and action

7. Approaches like social franchising of FP methods through community based health worker (India)

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Thematic Topic 2: Recognizing and addressing the unique needs of young people for quality sexual and reproductive health information and services, including family planning / contraception.

Group Members: t 7BS $IJWPSO o $BNCPEJB t "O[BJSB 3PYBT 1IJMJQJOFT t 3J[WJOB %F "MXJT 6/'1" "130 t +P 4BVWBSJO 6/'1" "130 t 4BMMZ 4BLVMLV o -BP 1%3 t .ZJOU ;BX .ZBONBS t *TBCFM .BSJB (PNFT 5JNPS -FTUF t 4IJMV "EIJLBSJ /FQBM t -JMB , $ o /FQBM t 5FK 3BN +BU *OEJB t .BSZ )VBOH .BMBZTJB

8IBU IBT CFFO done on the thematic area?

8IBU BSF UIF MFTTPOT MFBSOFE QSPDFTT BOE PVUDPNF 8IBU XPSLFE XFMM FYBNQMFT PG TVDDFTT TUPSJFT BOE XIBU DBO CF JNQSPWFE VQPO

t :PVUI GSJFOEMZ service centers. t -JGF TLJMMT BOE ARSH education in schools and out of school adolescents. t "EESFTTJOH adolescent fertility through involvement of Accredited Social Health Activists (ASHAs). t 4PDJBM NBSLFUJOH t /BUJPOBM ZPVUI and population policies and Youth friendly health services guidelines. t /BUJPOBM adolescent health and development strategy. t )BQQZ BOE healthy adolescent life education programme (HHAL).

t 1FFS FEVDBUJPO XPSLT BOE JU is needed. t *OWPMWFNFOU PG ZPVOH QFPQMF at all levels from planning to monitoring of youth programmes t $VMUVSBM TFOTJUJWF BQQSPBDIFT and strategies must be adopted. t %JÄŠFSFOU BQQSPBDIFT GPS addressing the needs of dierent groups of young people have to be customized to the needs of speciďŹ c subgroups. t 1PMJDJFT BOE QSPHSBNNFT must be backed by resources. t 3PCVTU NPOJUPSJOH mechanisms to ensure quality and accountability t #SJOHJOH NBSHJOBMJ[FE ZPVOH people in the focus of the programmes. t 1PMJUJDBM DPNNJUNFOU JT must. t $BQBDJUZ CVJMEJOH PG TFSWJDF providers in counseling, intercultural issues, and needs

8IBU BSF UIF DIBMMFOHFT JTTVFT JO BEESFTTJOH UIF thematic area?

t -BDL PG SFTPVSDFT t -BDL PG QPMJUJDBM XJMM t -BDL PG DPOUJOVJUZ JO programmes t $VMUVSBM CBSSJFST t -BDL PG FWJEFODF BOE EBUB t 1PWFSUZ BOE .JHSBUJPO t $PTU JOUFOTJWF interventions t 4VTUBJOBCJMJUZ t "DUJWF JOWPMWFNFOU PG young people t (FOEFS PG QSPWJEFS JO reaching to adolescent boys t .VMUJTFDUPSBM DPPSEJOBUJPO t 3FBDIJOH PVU VOEFSTFSWFE and marginalized groups. t (FPHSBQIJDBM BDDFTT t &OHBHFNFOU PG NPSBM gatekeepers. t "DUJWF FOHBHFNFOU PG young people.

33

8IBU BSF TVHHFTUFE BDUJPOT UP BEESFTT UIF DIBMMFOHFT JO JNQSPWJOH UIF UIFNBUJD BSFB

t "HF BQQSPQSJBUF TFYVBMJUZ FEVDBUJPO t 6TF PG *5 JO BEESFTTJOH OFFET PG young people. t $FMFCSJUZ "NCBTTBEPST PG TFYVBM BOE reproductive health of young people. t $PNQSFIFOTJWF QBDLBHF PG TFSWJDFT for young people having preventive and curative services. t 4PDJBM NBSLFUJOH BOE QVCMJD QSJWBUF partnership. t "EESFTTJOH TPDJBM EFUFSNJOBOUT PG young people’s reproductive and sexual health specially gender norms. t )BWJOH EJTBHHSFHBUFE EBUB PO adolescent and young people for planning and monitoring of programmes for young people. t &OHBHFNFOU PG QBSFOUT BOE community gatekeepers. t *ODPNF HFOFSBUJPO BOE WPDBUJPOBM opportunities for young people. t *OWPMWFNFOU PG QSPGFTTJPOBM CPEJFT t 4FOTJUJ[BUJPO PG BOE BEWPDBDZ XJUI parliamentarians, media, community leaders, religious groups and

Thematic topic 3: Ensuring commodity security through establishment of favourable policy, financing and effective systems for supply chain management, to ensure sustainable supplies of a broad range of contraceptives to all.

Group Members: t %S # / %BTI o *OEJB t .T "OO .BSJB -FBM o 1IJMJQQJOFT t %S )OJO )OJO -XJO o .ZBONBS t %S 4BSBUI ,SPT o $BNCPEJB t %S .BOZ ÉŠBNNBWPOH o -BP 1%3 t .S 4ZFE "TIGBRVF "MJ 4IBI o 1BLJTUBO t %S 3JB[ .FNPO o 1BLJTUBO

8IBU IBT CFFO done on the thematic area?

8IBU BSF UIF MFTTPOT MFBSOFE QSPDFTT BOE PVUDPNF 8IBU XPSLFE XFMM FYBNQMFT PG TVDDFTT TUPSJFT BOE XIBU DBO CF JNQSPWFE VQPO

t %FDFOUSBMJ[BUJPO of FP functions t 1VCMJD 1SJWBUF Partnership – PPP t 3)$4 Population policy in place in most countries t -.*4 o WBSJPVT models / varying degree of success t *ODSFBTJOH Government’s contribution to procurement t 1BSUOFSTIJQ PG Ministries for promoting FP

t $SVDJBM SPMFT PG QSJWBUF TFDUPS – for improving transparency, accountability and eďŹƒciency t 3PMFT PG /(0T BOE community organizations t *ODSFBTJOH VOEFSTUBOEJOH GPS sustainability t -PDBM DBQBDJUZ IVNBO resources, performance based incentives) t 4.4 CBTFE JOOPWBUJPO GPS LMIS t $PPSEJOBUJOH NFDIBOJTNT for donors and other stakeholders

8IBU BSF UIF DIBMMFOHFT JTTVFT JO BEESFTTJOH UIF thematic area?

t $PSSVQUJPO t 4UPDL PVUT t 7BSJPVT -.*4 DSFBUJOH confusion / work load t %JTUSJCVUJPO transportation t *OFÄ‹DJFOU QSPDVSFNFOU mechanisms

8IBU BSF TVHHFTUFE BDUJPOT UP BEESFTT UIF DIBMMFOHFT JO JNQSPWJOH UIF UIFNBUJD BSFB

t *ODSFBTF USBOTQBSFODZ CZ strengthening PPP t *OUFOTJGZ BEWPDBDZ FÄŠPSUT GPS Government ownership of procurement and integrated support t 1PMJDZ BOE BDUJPOT UP VOJGZ JOUFHSBUF LMIS t $PPSEJOBUF IBSNPOJ[F QMBO and strategy for distribution / transportation t 6TF UIJSE QBSUZ QSPDVSFNFOU QSJWBUF UN)

Thematic Topic 4: Securing an enabling environment through stronger partnerships and leadership for repositioning FP. Group Members: t %S #BSLBU F ,IVEB o #BOHMBEFTI t )POPSBUF $BUJCPH 1IJMMJQJOFT t /JHIBU 4IBI 1BLJTUBO t 4PDIFB 4BN $PNCPEJB t 4VTINB %VSFKB o *OEJB t )MB )MB "ZF o .ZBONBS t "OBOE 5BNBOH /FQBM

34

8IBU IBT CFFO EPOF PO UIF UIFNBUJD BSFB

t #BOHMBEFTI 6OUJM NJE IJHI MFWFM PG QPMJUJDBM commitment, then it slowed down. Now there is renewed commitment but still weak. t $BNCPEJB ɊF QSPHSBNNF TUBSU JO CVU initially it was low key. Then in collaboration between government, partners and NGOs FP has improved. FP policy exist in 1997, but improvement and collaboration with SRH is now having positive impact t *OEJB 'JSTU DPVOUSZ UP TUBSU '1 JO XJUI MPX key programme until Mid 70 when there was lot of work done. In 1977 FP suer from political set back. 2000 NP Policy and Repositioning FP for MCH. t .ZBONBS 4UBSUFE JO MPX GVOEJOH CVU in 2011 with new government which created budget line for RH commodity. t /FQBM '1"/ JOUSPEVDFE '1 QSPHSBNNF JO 1955, then NFP programme was started in 1965. Until 1970 budget allocations were scanty.

Political instability have since 1996-2006, have set back the development.

8IBU BSF UIF MFTTPOT MFBSOFE QSPDFTT BOE PVUDPNF 8IBU XPSLFE XFMM FYBNQMFT PG TVDDFTT TUPSJFT BOE XIBU DBO CF JNQSPWFE VQPO

8IBU BSF UIF DIBMMFOHFT JTTVFT in addressing the thematic area?

8IBU BSF suggested actions to address the DIBMMFOHFT JO JNQSPWJOH UIF UIFNBUJD BSFB

t -BDL PG appreciation on the part of leadership on problems of growing population t 1PMJUJDBM instability t -JNJUFE UFDIOJDBM planning capacity t 'VOEJOH t 3FMJHJPVT fundamentalism t 4PDJP DVMUVSBM barriers t )VNBO SFTPVSDF trained worker t ÉŠF WFSUJDBM programmees

t ÉŠF MFBEFSTIJQ needs to be sensitized t $BQBDJUZ building of policy makers t 3FTPVSDF mobilization and service charges, reliance on service t 3FMJHJPVT leaders have to be brought in the fold t ÉŠF TPDJP cultural barriers could be dealt through evidence based advocacy and coherent BCC t $BQBDJUZ building and rationalized distribution of HR, assured service delivery

Lessons learned: t /1$ JT IFBEFE CZ QSJNF minister, is high powered but in does not meet regularly , health policy has been endorsed but population policy still in draft (Bangladesh and Nepal) t %FNPHSBQIJD EJWJEFOE – to be taken, advantage of intervention in health education was not taken up by politicians. t /BUJPOBM QPQVMBUJPO commission contribute to pop policy-target free, need based approach . t -BDL PG DPNNJUNFOU GSPN govt for commodity security. t ɊF OFFE UP USBJO GPS TQFDJBM FP programme for migrant workers in Nepal and disaster areas in Pakistan t 1PMJUJDBM JOTUBCJMJUZ BĊFDUT sustainable FP programme

t 1BLJTUBO 4UBSU QSPHSBNNF JO BOE PċDJBMMZ What can be improved? launch in 1960. Initially lot of enthusiasm till t 1PMJDZ EJBMPHVF XJUI Government for commitment mid seventies. Then due to religious extremists/ and increase budget allocation Martial law rule, FP programme suered a for FP. backlash until 1988-89. In 90s due to female t 4USFOHUIFOJOH IBSNPOJ[BUJPO PM, there was some emphasis. Past 95, not in convergence and integration high priority and devolution of department of FP. of developmental partners to support for sustainable FP t 1IJMJQJOFT DPNNJTTJPO PO QPQ XBT programme. establish, in 1972, FP programme was t *OWJUF NVMUJ MBUFSBM EPOPST UP established, that is POPCOM. After Martial support FP programmes. law, the new govt introduced new constitution t "EESFTTJOH DPOTUSBJOUT BOE that depressed FP. Right of the unborn misconceptions by evidence was included in new constitution. Then in based rationalized FP 1980s-1990s transfer of FP programme from practices.

POPCOM to MoH. In 1992 devolution of FP t 4LJMM EFWFMPQNFOU BOE to local govt. Devolution has weakened FP. 2001 capacity building and National FP Policy 2004 discourages modern rationalize distribution FP and phase out of donated commodities has of trained FP health care also occurred. providers.

35

Annex – 5: Outcomes from the Country Cluster Group Discussions CLUSTER 1: India, Pakistan & Afghanistan

KEY PRIORITIES

To eliminate the unmet need in marginalized and youth through t 1PMJUJDBM XJMM QPMJDZ and programmes t 'VODUJPOBM Integration of dierent ministries t "QQSPQSJBUF SFTPVSDF allocation t 6OEFSTUBOE JEFOUJGZ and remove socio cultural barriers in there own country context t 3FTFBSDI UP HFOFSBUF evidence – for speciďŹ c geographical area

Groups requiring special focus

Strategies & suggested actions

Technical support/capacity building

t .BSHJOBMJ[FE o Poor, lack access contraceptive materials, lack information t :PVUI t 1PMJDZ NBLFST

t 8PNFO 1BSMJBNFOUBSZ DBVDVT sensitize for budget allocation for procurement, should not be donor dependence, advocacy and monitoring and evaluation – focus on mother health t 2VBMJUZ EBUB 3FTFBSDI BOE FWJEFODF based interventions – address the issues of data collection t *OUFHSBUFE BMM TUBLFIPMEFST UP develop strategy), intersectoral and convergent action (Ex. Self Help Groups working on employment, Nari Shakti Mission, Using teachers at the community, Youth clubs, Total Sanitation Campaign, NYKS, Panchayati Raj Institutions, SC/ST Missions, Tribal Residential schools). t $BQBDJUZ CVJMEJOH PG HPWFSONFOU health system at all levels. t 6TF BOE VQTDBMF PG *5 TPDJBM media and dedicated telephone for information and counseling (Ex. 1800 11 6555 and engaging corporate companies like Airtel) t $PNQSFTTJWF QBDLBHF PG QSFWFOUJWF and curative services (information, counseling and clinical services) as per the need of speciďŹ c groups of marginalized and young people. t (PWFSONFOU UP EJBMPHVF XJUI international agencies such as UNFPA along with other technical agencies.

t $PVOTFMJOH FOHBHJOH teachers as counselors t %BUB "OBMZTUT FH Demographer) t 5SBJOFST NJEMFWFM health care providers for PPIUCD, IUCD, and vasectomies t .BSWJ XPSLFST t *&$ NBUFSJBMT CVJMEJOH skills for interpersonal communications t *ODSFBTF VUJMJ[BUJPO CZ demand generation, logistics, funds

36

CLUSTER 2: Lao PDR, Myanmar & Nepal

SN

1.

2.

,&: 13*03*5*&4

Demand generation

Access to FP services

(SPVQT SFRVJSJOH special focus

4USBUFHJFT TVHHFTUFE actions t 6TJOH NBTT NFEJB and interpersonal communications (hot-lines) t :PVUI JOGPSNBUJPO DFOUFST t 3FBDIJOH PVU UP PVU PG –school youths.

Adolescents, Youth, other marginalized including female sex workers, poor women living in remote areas, IDP etc)

Marginalized communities

3.

Capacity building of health workers & volunteers

5.

Integrated Logistic management information system

Skill development for BCC

Targeted approaches for dierent groups : t .JDSP QMBOOJOH (decentralize planning) t 8PNFO QSPUFDUJPO TFSWJDFT integration with national EPP t $PNNVOJUZ CBTFE distribution of contraceptives t 0VUSFBDI TBUFMMJUF DMJOJD approaches t *OUFHSBUJPO XJUI PUIFS 3) programmes t 4PDJBM NBSLFUJOH 1VCMJD private –partnership

4.

5FDIOJDBM TVQQPSU DBQBDJUZ building

Those in both Public & Private sectors

t 4USFOHUIFOJOH FYJTUJOH training sites and expanding new sites t 5SBJOJOH PG )8T volunteers and Peer educators on ASRH t 0O TJUF DPBDIJOH supportive supervision of trainees t 4JNVMUBOFPVT QSFQBSBUJPO of service site with training of HWs (provide the facilities and training health workers at the site) t 3FWJTJUJOH JO QSF TFSWJDF curriculum of HWs

t 4JUVBUJPOBM BOBMZTJT BOE capacity development t 4USFOHUIFOJOH QBSUOFSTIJQ for resource harmonization

Government

37

t %FWFMPQNFOU PG OBUJPOBM guidelines & protocols.

t 4USFOHUIFOJOH FYJTUJOH training sites and expanding new sites t 5SBJOJOH PG )8T volunteers and Peer educators on ASRH t 0O TJUF DPBDIJOH supportive supervision of trainees t 4JNVMUBOFPVT QSFQBSBUJPO of service site with training of HWs (provide the facilities and training health workers at the site) t 3FWJTJUJOH JO QSF service curriculum of HWs t 5" UP SFWJTJU DVSSJDVMVNT t 'JOBODJBM UFDIOJDBM support for facilities upgrading Technical support for supply chain management

CLUSTER 3: Cambodia, Philippines and Timor Leste ,&: 13*03*5*&4

4USBUFHJFT TVHHFTUFE BDUJPOT

Update policies (right based approach policy)

1PPS ZPVOH QFPQMF GPDVTFE Data collection on unmet need of the poor and young people

Service provision for young people

Outreach

2VBMJUZ PG TFSWJDFT F H "43) DPOUSBDFQUJPO NFUIPE NJY BOE supervision

"43) DPOUSBDFQUJPO DBQBDJUZ CVJMEJOH PS IFBMUI XPSLFST expansion of method mix, supervision, M&E (at district level) and PPP

Sustained national budgetary support

6TF PG /)" /BUJPOBM )FBMUI "DDPVOU BT NPOJUPSJOH "EWPDBDZ XJUI .P' MFHJTMBUPST BOE QBSMJBNFOUBSJBOT CZ $40T UN donors

Managing opposition (Timor Leste and Philippines)

$POTUSVDUJWF FOHBHFNFOU mOEJOH DPNNPO HSPVOET BEWPDBDZ with the Church leaders

Reaching marginalized, tribal, hard to reach populations (geographically isolated)

.PCJMF BO PVUSFBDI $#%T QFFS FEVDBUJPO NFEJB BOE #$$

38