Philippines: decentralized approach shows results

In the Philippines several steps have been taken to meet the challenge of increasing population growth. Commencing with the Republic Act 6365, known as the Population Act (1971) program directives focus on achieving and maintaining population levels most conducive to the national welfare. In 1978 a Special Committee was constituted by the President to review the population program. Pursuant to the Committee's findings certain changes were adopted. The thrust is now towards longterm planning to ensure a more significant and perceptible demographic impact of development programs and policies. Increasing attention is paid to regional development and spatial distribution in the country. The 1978-82 Development Plan states more clearly the interaction between population and development. The National Economic and Development Authority, the central policy and planning agency of the government, takes charge of formulation and coordinating the broader aspects of population policy and integrating population with socioeconomic plans and policies. At present the National Economic and Development Authority (NEDA) is implementing a project known as the Population/Development Planning and Research (PDPR) project with financial support from the UN Fund for Population Activities (UNFPA). This project promotes and facilitates the integration of the population dimension in the planning process. It does this by maintaining linkages and instituting collaborative mechanisms with the different NEDA regional offices and sectoral ministries. It also trains government planners in ways of integrating population concerns into the development plan. PDPR promotes the use of population and development research for planning purposes and policy formation. The Philippine Development Plan, 1978-82, recognized that an improvement in the level of 1 sector reinforces the performance of the other sectors. Since the establishment of the National Population Program 12 years ago, population and family planning have been successfully integrated with various development sectors, notably, labor, health, and education. Through the policies of integration, multiagency participation, and partnership of the public and private sectors, the Commission on Population uses existing development programs of government and private organizations as vehicles for family planning information and services and shares the responsibility of implementing all facets of the population program with various participating agencies in the government and private sector.     

Redefining family planning programs

The Population Council's issue paper entitled Reconsidering the Rationale, Scope, and Quality of Family Planning Programs calls on family planning programs to focus only on reducing unwanted fertility by helping people meet their own reproductive goals safely and ethically. Many family planning programs have been wrongly handed the extra responsibility of reducing wanted fertility. They have therefore used inappropriate means (e.g., incentives, quotas, and coercion) to boost contraceptive prevalence. If programs do focus on reducing unwanted fertility, they will foster reductions in overall fertility and population growth as well as improvements in clients' health and well-being. A new framework has emerged from this shift in rationale. It sets the stage for expanding the scope, improving the quality, and assessing the impact of family planning programs in terms of client choice, health, and well-being. A program needs to determine the range and quality of family planning services it provides at the local level. Local program managers, policymakers, and consumer interest groups should establish minimum or achievable standards of service based on the local health care capacity. Program items that should be assessed include choice of methods, information for clients, technical competence, interpersonal relations, mechanisms to encourage continuity of care, and appropriate constellation of services. The Population Council has conducted rapid appraisals of the quality of care of family planning services to help local program managers to evaluate the strengths and weaknesses of their programs. The HARI (Helping Individuals Achieve their Reproductive Intentions) Index measures a program's success in helping clients safely prevent unwanted or unplanned pregnancy. Program managers can conduct a self-assessment that revolves around answering four questions. Family planning services are an important social investment and are essential to development.     

The Philippines: country statement prepared for the International Conference on Population,Mexico City,August 1984

This statement, prepared for the 1984 International Conference on Population, summarizes the demographic situation in the Philippines, the Philippine position regarding implementation of the World Population Plan of Action, and current population policies. In 1980, the population of the Philippines stood at 48.1 million. The country's current population growth rate reflects the interplay between decreasing mortality and still high but declining fertility. The 1984-87 Philippine Development Plan aims to achieve sustainable economic growth, equitable distribution of the gains of development, and personal development. A net reproduction rate of unity by the year 2000 is sought, and preschool-age children, youth, premarriage-age groups, and married couples of reproductive age have been targeted for special outreach efforts. The national population program will concentrate on developing a network of public and private community-based organizations, strengthening the capacity of local government and community organizations to plan and manage the population program, developing community capacity to finance family planning services, upgrading the quality of natural family planning practice, continuing the promotion of effective contraceptive methods, developing a population data bank, and upgrading the technical and management capabilities of population program personnel. Increasing attention is being paid to regional development and spatial distribution. The average annual population growth rate is expected to decline from 2.8% in 1970-75 to 2.2% by 1987. The crude birth rate is expected to drop from 34/1000 in 1980 to 31/1000 in 1987. To help achieve this goal, the contraceptive prevalence rate should increase from 34% in 1983 to 41% in 1987 and 50% by 1993. In addition, attempts will be made to reduce the proportion of women marrying below the age of 20 years and to improve women's access to educational and employment opportunities.     

India's population: second and growing

Attention in this discussion of the population of India is directed to the following: international comparisons, population pressures, trends in population growth (interstate variations), sex ratio and literacy, urban-rural distribution, migration (interstate migration, international migration), fertility and mortality levels, fertility trends (birth rate decline, interstate fertility differentials, rural-urban fertility decline, fertility differentials by education and religion, marriage and fertility), mortality trends (mortality differentials, health care services), population pressures on socioeconomic development (per capita income and poverty, unemployment and employment, increasing foodgrain production, school enrollment shortfalls), the family planning program, implementing population policy statements, what actions would be effective, and goals and prospects for the future. India's population, a total of 684 million persons as of March 1, 1981, is 2nd only to the population of China. The 1981 population was up by 136 million persons, or 24.75%, over the 548 million enumerated in the 1971 census. For 1978, India's birth and death rates were estimated at 33.3 and 14.2/1000 population, down from about 41.1 and 18.9 during the mid-1960s. India's current 5-year plan has set a goal of a birth rate of 30/1000 population by 1985 and "replacement-level" fertility--about 2.3 births per woman--by 1996. The acceleration in India's population growth has come mainly in the past 3 decades and is due primarily to a decline in mortality that has markedly outstripped the fertility decline. The Janata Party which assumed government leadership in March 1977 did not dismantle the family planning program, but emphasis was shifted to promote family planning "without any compulsion, coercion or pressures of any sort." The policy statement stressed that efforts were to be directed towards those currently underserved, mainly in rural areas. Hard targets were rejected. Over the 1978-1981 period the family planning program slowly recovered. By March 1981, 33.4 million sterilizations had been performed since 1956 when statistics were 1st compiled. Another 3 million couples were estimated to be using IUDs and conventional contraceptives.     

The Philippine population program under the Aquino administration

3 views of the Philippine Population Program under the Aquino government are presented: the first states the government's position on population programs and the next 2 criticize that position. Issued by the Commission on Population (POPCOM) in early 1987, the first statement establishes the government's stance on population programs. It explains that the 1987 Philippine Constitution reaffirms the government's commitment to the ultimate goal of the Population Program: the improvement of the quality of life in a just and humane society. The statement explains the constitutional guarantees, policy principles, and policy strategies concerning population. The next view presented is an excerpt from Alejandro N. Herrin's paper entitled "Population, Health and Education: Policy Initiatives Under the Aquino Administration." In it, Herrin explains that after 1 year of silence, POPCOM finally issued a policy statement. The statement, however, is marked by ambiguity, avoiding an explicit mention of a policy to moderate fertility. Furthermore, the statement fails to clarify the government's position on 2 basic issues: whether or not an acceptable economic and social development can be achieved within a reasonable time without a moderation of the current high fertility and population growth, and whether or not the government is justified in sponsoring a program to moderate fertility and population growth. The 3rd view presented in the document is that of Virginia A. Miralao. In her essay "Population Policies, Family Planning Programs, and Women's Reproductive Rights," Miralao explains that the current population program -- which directly affects the lives of women -- has virtually excluded women in its planning. Moreover, since Aquino came into power, the Catholic church has gained great influence and has opposed family planning programs.     

Kenya's record population growth: a dilemma of development

The causes and implications of Kenya's 4% rate of natural increase and fertility rate of 8.1 births per woman were examined. Attention was directed to the following: pronatalist pressures; inadvertent pronatalist impact of development; women's education and employment and fertility; population growth and pressures; mortality decline and population growth; fertility levels and differentials; fertility desires; the family planning program; and family planning knowledge, attitudes, and practice. Kenya's development success has worked to push up the population growth rate. Improved health care and nutrition halved infant mortality from 160 to 87 deaths/1000 live births between 1958 and 1977 and a marked increase in primary school enrollment may be factors in the birthrate increase to 53/1000 population. At this time fertility is highest among women with 1-4 years of education. The 1977-1978 Kenya Fertility Survey showed that only 5.8% of married women were using modern contraception, indicating that the national family planning program, established in 1967, has made little progress. Program difficulties have included shortages of staff, supplies and easily accessible clinic as well as an almost universal desire on the part of Kenyans for families of at least 7 children. Children are viewed as essential to survival and status to the rural population.     

Republic of Korea. Country feature

The Government of Korea's 5th 5-Year Economic and Social Development Plan (1982-86) seeks to reduce the population growth rate from its 1982 level of 1.58% to 1.49% by 1986; it is assumed that the population replacement level of fertility (total fertility rate, 2.1) will be attained in 1988. The task of achieving these demographic targets is expected to be made more difficult by factors such as the impact of the 1950s baby boom and widespread son preference. New population control policy measures announced in 1981 call for improvements in the current family planning program management system; a new social and institutional support system to inculcate the small family size norm; strengthened information, education, and communication activities for family planning; and establishment of coordination among the government organizations involved in population-related activities. Numerous social support measures have already been put into effect, including income tax exemptions for up to 2 children, inclusion of population education in the school curriculum, priority in alloting public housing to sterilization acceptors with 2 or fewer children, and provision of IUD services through the medical insurance system. The number of contraceptive acceptors in the government program increased 78.3% from 1981-83, from 614,000 to 1,094,600. Sterilization and menstrual regulation services have shown particularly sharp increases. Program achievement for 1983 was equivalent to 19% of eligible women ages 15-44 years. The total fertility rate stood at 2.7 in 1982. Major efforts now must be directed toward eradicating the strong parental son preference and ensuring better family planning program efficiency and effectiveness.     

论计划生育政策对实现福利适度人口的意义

我国人口问题十分严重,人口因素很难自发地与社会其他要素相适应,不利于社会经济的全面协调与可持续发展,对社会福利目标的实现构成了一定阻碍。我国计划生育政策的实施,解决了生育率与死亡率不对称性的矛盾,解决了物质资料再生产与人类自身再生产不平衡性的矛盾,解决了家庭生育计划与社会适度人口不一致性的矛盾,促进了人口因素与其他社会因素的协调与可持续性发展。     

India: New family planning program direction outlined

The focus of the current Family Welfare Program in India is education and active community involvement rather than coercion and compulsion. The government is totally committed to the program and has indicated that it will spare no efforts to motivate people to voluntarily accept family planning. However, there is a need for family planning efforts to include all aspects of family welfare, particularly those designed to promote the health of mothers and children. All family planning methods will be made available, and the family will be free to choose the method they prefer. As part of the program, employees of the Union government, State governments, autonomous and local bodies are expected to set an example and adopt the small family norm. The policy statement made by Mr. Raj Narain, Minister of Health and Family Welfare, revealed the government's decision not to legislate, either at the national or the State level, for compulsory sterilization. Sterilization services will be available free of charge to those who voluntarily choose this method. A plan for training indigenous midwives will be implemented as part of the program in order that maternity services may be available to all expectant mothers. Additionally, in recognition of the direct correlation between illiteracy and fertility and between infant/maternal mortality and age at marriage, the government will introduce legislation to raise the minimum age at marriage to 18 years for girls and to 21 years for boys. The plan is for trade unions, Chambers of Commerce, cooperative societies, women's organizations, teachers' federation, district councils, and other voluntary institutions to be associated intimately with the educational campaign launching the Family Welfare Program.     

Population goal set for China's new five-year plan

China's 7th Five-Year Plan recommends that China's total mainland population be held within the limit of 1.113 billion, with an annual average natural growth rate of about 12.4/1000. As a large number of youths will reach marriage and childbearing age during the course of the 7th Five-Year Plan, the Plan affords a high priority to the family planning program and to the control of population growth. The plan proposes 5 policies and measures to realize its goal: continuous efforts need to be made to give family planning a high priority; late marriage, late childbearing, and the 1-child family should be advocated; ideological and political education should be strengthened; scientific and technological research devoted to family planning should be intensified; and family planning communication and service centers at the county level should be consolidated and strengthened, and the family planning program should be conducted systematically and be ongoing.     

Thinking about several problems of the research of our family planning strategy]

On the basis of 1982 census data, it is estimated that from 1987-1997 13 million women will enter the age of marriage and child-bearing each year. The tasks of keeping the population size around 1.2 billion by the year 2000 is arduous. Great efforts have to be made to continue encouraging one child/couple, and to pursue the current plans and policies and maintain strict control over fertility. Keeping population growth in pace with economic growth, environment, ecological balance, availability of per capita resources, education programs, employment capability, health services, maternal and child care, social welfare and social security should be a component of the long term development strategy of the country. Family planning is a comprehensive program which involves long cycles and complicated factors, viewpoints of expediency in guiding policy and program formulation for short term benefits are inappropriate. The emphasis of family planning program strategy should be placed on the rural areas where the majority of population reside. Specifically, the major aspects of strategic thrusts should be the linkage between policy implementation and reception, between family planning publicity and changes of ideation on fertility; the integrated urban and rural program management relating to migration and differentiation of policy towards minority population and areas in different economic development stages. In order to achieve the above strategies, several measures are proposed. (1) strengthening family planning program and organization structure; (2) providing information on population and contraception; (3) establishing family planning program network for infiltration effects; (4) using government financing, taxation, loan, social welfare and penalty to regulate fertility motivations; (5) improving the system of target allocation and data reporting to facilitate program implementation; (6) strengthening population projection and policy research; (7) and strengthening training of family planning personnel to improve program efficiency.     

Radio: a strategic tool for development

Every country should recognize the need to fully involve media leaders in the planning and implementation of population and family planning programs. Broadcasters are the best equipped to understand the "mind-set" of the mass audience and what is needed to bring about changes therein. If there is to be involvement of the media, particularly radio professionals, in the design, development and implementation of population and family planning programs, attention must be given to the inmplications of this in terms of implementing the World Population Plan of Action. Strategies for population communication using radio as the central medium include the following: 1) development of an adequate in-country support structure; 2) development of a sound, well-researched population communication program; 3) on-air programming in the form of instruction rather than entertainment; 4) provision for substantial and continuous feedback from the audience; 5) frequent broadcasts at a prime time of day; and 6) a program commitment of from 5 to 6 years. Radio needs to be recognized as a strategic tool for development; it should be used professionally and should receive sufficient priority by funding agencies.     

The population program shifts to 'high-scenario' targets

The Philippine Population Program would like to achieve a replacement level of 1 daughter per childbearing woman by the year 2000 to reduce the population growth rate to 2% by 1992. Laing projected that high performance by the National Population Program would mean continued increase of sterilization prevalence at an average 1978-1983 rate. Strategies have been adopted to strengthen information-education-communication efforts, to attain higher contraceptive prevalence rates and use-effectiveness, to develop manpower, to achieve self-reliance, and to effect better program coordination, monitoring, research use. Effective service delivery will be a key to achieving the high-scenario targets. Effective use of natural family planning (NFP), will help in achieving the high-scenario goals. Apart from the heavy demand on NFP follow-up, need for prompt delivery of supplies, and lack of doctors and nurses, other factors may impede the high-scenario targets. Saniel believes that program workers should be allowed to insert IUDs and to dispense pills. Under the cost-recovery and cost-sharing schemes of the high-scenario targets, only sterilization will be done for free. It might affect the campaign for increased acceptors, but the start for self-reliance must happen now.     

The participation of non-governmental organizations in the Philippine population program

In 1957 the National Council of Churches in the Philippines (NCCP) established the Family Welfare Center, offering an educational program in family planning; it was subsequently expanded and reorganized into the Planned Parenthood Movement of the Philippines. Since its creation in 1970 the Philippine Population Program has brought together government, private, and religious activities. Under the 1987-92 development plan nongovernmental organizations (NGOs) will be taking a more active role in the implementation of the population program by contributing to the maternal and child health/family planning and the information, education, and communication (IEC) components. There are more than 50 private organizations engaged in such population activities. These include national women's organizations and development NGOs with a mass base. The Family Planning Organization of the Philippines is carrying out a 3-year comparative study of the effectiveness of community volunteers in the acceptance of natural family planning. The Reproductive Health Philippines has completed a follow-up of Depo Provera defaulters in a previous clinical study of Depo Provera acceptors conducted in 1985-87. IEC support from various medical and social organizations also helped advance family planning and population awareness of the program. The Mary Johnston Hospital and Iglesia ni Kristo have been front-runners in sterilization through their mobile teams and regular clinics. On the negative side, funding constraints are threatening the very existence of some NGOs. Even those that do not face such constraints face problems related to cost effectiveness, priority setting, capability building, and staff development. A survey of the Population Center Foundation identified some urgent concerns: sharing experience in self-reliance, enhancement of the managerial skills of staff, and funding problems. NGOs complement the family planning services of the government as well as focus on the smooth flow of IEC activities.     

A fresh look at family planning communication

As a step toward development of a national information, education, and communication (IEC) plan, a reassessment of such efforts practiced by the agencies involved was undertaken. A paper published in 1978 by the Research Utilization Unit of the Population Information Division, Population Center Foundation, reviewed materials used and accounts of experience in conceptualizing and communicating family planning messages by 12 private and public sector agencies. The most common concepts employed by the agencies were small family size, responsible parenthood, family welfare, community and national development, birth spacing, delayed marriage, contraceptive use-effectiveness, "manliness," delayed 1st pregnancy, value and rights of children, human behavior and social environment, and population dynamics. Most of the messages were conceptualized and developed through formal and informal consultation with field staff. The need to consider the specific needs of target audiences was considered crucial, and thus decentralization of IEC production was recommended. Such decentralization has been a goal of the Philippine program since 1976, but the effort has been hampered by lack of local training and resources, and of studies to support successful implementation. Mass and mixed media approaches were found to be used by most of the agencies, although a reliance on interpersonal approaches was found to be most prevalent in rural areas. Among recommendations for policy makers were development of a systematized data base for IEC materials, regional capabilities in research and development, and studies of funding and existing resources.     

人口现代化"和"生育现代化":人口发展与计划生育工作的根本目标

人口现代化和生育现代化是人口发展与计划生育工作的根本目标。计划生育就是为了实现生育的现代化,进而来推进人口的现代化。如果说人口现代化是人口发展的战略目标,那么生育现代化就是计划生育事业的战略目标。从政策的角度探讨两大命题的现实意义,在此基础上提出了稳定低生育水平的"三合一"工程。     

Papua New Guinea: first population policy declared

In its 2nd year after achieving political independence, Papua New Guinea declared a general population policy in October 1976, and inaugurated a population research program to guide policy formulation. Population affairs of the country, which has a population of 2.75 million, have been vested with the Ministry of Environment and Conservation. The research program will be implemented in cooperation primarily with the Institute of Applied Social and Economic Research (IASER) and the University of Papua New Guinea, as well as the Central Planning Office, Department of Public Health, Bureau of Statistics, and Office of Information, among other agencies. The priorities for research will initially fall under 5 main concerns: 1) fertility and population growth, and the causes of local differentials; 2) socioeconomic influences on growth trends; 3) interrelation between population and land resources; 4) internal migration; and 5) individual attitudes regarding family planning practice. The research program is designed to become an integral part of national development planning. However, the Government has declared that both policy and research programs must concur with the needs and desires of the people, to pave the way for successful implementation of development plans.     

The Filipino male as a target audience in family planning

Since the official launching of the Philippine Population Program in 1970, family planning campaigns have substantially addressed themselves to women. The suggestion to devote equal, if not more, attention to men as family planning targets had been raised by Dr. Mercado as early as 1971. It was not until 1978, that the deliberate inclusion of males as a target audience in family planning became a matter of policy. The Population Center Foundation (PCF), from 1979 to 1982, carried out research projects to determine the most suitable approaches and strategies to reach Filipino men. The objectives of the PCF's Male Specific Program are: 1) to test alternative schemes in promoting male family planning methods through pilot-testing of family planning clinics for men, 2) to develop teaching materials geared toward specific segments of the male population, 3) to undertake skills training in male-specific motivational approaches for program professionals, and 4) to assess the extent of the husband's role in family planning. An important finding of 1 study was that most outreach workers were female stood in the way of the motivation process, thus hampering the campaign. While the consultative motivational skills training improved knowledge, attitudes, and skills of outreach workers with regard to vasectomy and the motivation process, there were certain predispositions that were hindering the fieldworkers' effectiveness in motivating target clients. Overall, in-depth, 1-to-1 motivation in dealing with men is needed to strengthen internalization of family planning values.     

A sound population program

A sound population program must respond to real human needs, must be rooted in values, must generate results, must be administered in an integrated manner, must be based on the ethic and goal of self reliance and on the belief that it must operate and grow on its own steam, and must release human resources for productive economic endeavors. To make any sense at all, population must be linked to the gut level needs of the individual. People should not be viewed as demographic statistics, and the word human should be used in the basic sense of hunger and poverty. If the goal is to bring about lasting change in the way that Filipinos manage their lives and their living, it is necessary to probe their values. If social change is the goal, tradition must be challenged. In the area of family planning, persons who can communicate the fact that the program seeks to enrich life more than prevent birth must be chosen. There has been some criticism that the population/family planning program is "too contraceptive oriented" and too mechanistic in the approach to population. Contraception is behavior, a good measure of acceptance and an effective measure of commitment. The delivery of welfare must be horizontally integrated. Thus it is necessary to learn to work in teams, teams of development workers. The value of self determination and the conscious practice of planning and shaping one's life is the very logic of family planning. The program needs to implant the values of family planning firmly in the community, or, more accurately, in the small face to face primary groups where social norms are set and where change must take place if it is to last. The answer to how to achieve a sound population program lies less in what is done than how it is done.     

China Faces Nine Obstacles in Population Development

With drastic changes in both the international and domestic environment for population and family planning development, China faces nine major challenges in its efforts to further its population and family planning program, said Zhang Weiqing, Minister of the National Population and Family Planning Commission, in an article in Qiushi (seeking truth), a journal published by the Central Committee of the Communist Party of China. The challenges include: 1. Unstable low fertility level. Th…