HIV/AIDS

Reproductive Health: Lessons from Bangladesh

The first time a coherent population policy framework linked to family planning was adopted in the Philippines was during martial law. In 1968, contraception adoption in the Philippines (measured by the ratio of married women aged 15-49 who practice or whose sexual partner practices any form of contraception) was 15%*. By 1986, that ratio went up to 44%. The average number of births per woman during this 18 year period declined from 6.45 to 4.66.

The Aquino administration upon assuming office in 1986 and heavily influenced by the Catholic bishops of the Philippines abolished the population commission set up by Marcos. Over two years, the prevalence of contraception went down to 36%. Since then it has steadily risen to just over 50% where it stood in 2008. The number of births per woman went down to 3.08 (forty years for it to halve!).

During this time, something remarkable happened in Bangladesh. With the adoption of some sensible population and health policies, they have been able to increase contraceptive prevalence from 27% in 1986 (when records were first kept) to 53% in 2008. Similarly, the number of births per woman went down from 5.4 to 2.3 in that same period. It took them just over two decades to halve their fertility rate to roughly equal the replacement rate (meaning that over the coming years their population will remain stable).

This is remarkable given that the per capita GDP (adjusted for purchasing power) in Bangladesh was in 2008 only about a third of the Philippines ($1,350 v $3,690). For those that argue that a change in fertility is affected by income, this might seem puzzling. Of course in general higher income levels lead to smaller families as demonstrated by the fact that fertility rates for both countries have been declining as incomes have risen. But policies aimed at providing options to families also play a determining role.

Continuity and stability of policy framework

Consider the different policies adopted by these two countries. I have already mentioned the almost stop-and-go nature of population planning and policy in the Philippines. In Bangladesh, they have sustained their policy framework close to forty years and have already graduated into second generation policies.

The first phase of their population policy lasted just over twenty years, from 1973 to 1996.  This phase focused on implementing programs aimed at reducing the population growth rate. These programs were centered on providing maternal and child health care services through home visitations, expanding the availability of contraceptives, multi-sectoral collaboration and encouraging the adoption of family planning services.

It took Bangladesh half the time it took the Philippines to halve its fertility rate. This is despite the fact that Bangladeshis are poorer on average than their Filipino counterparts.

The second phase began in 1997 and continues until the present. It has been more focused on integrating family planning services into a broader set of health programs affecting a wider target group.  From just focusing on reproductive and infant health it became concerned with the control of HIV/AIDS and other sexually transmitted diseases. From being home-based, the services concentrated on clinics to deliver a broad range of services.

The results speak for themselves. One area in which such programs have been effective has been in reducing adolescent fertility. In Bangladesh, the number of adolescents giving birth has gone down from 114 (per one thousand women) to just 70.5 in a span of just ten years (from 1998 to 2008).  In contrast the figure for the Philippines has hardly moved in that time moving from 47 down to 44.

This reduction in adolescent fertility might have helped Bangladesh increase the participation of women in school. In 1990, the ratio of girls to boys in primary and secondary education for Bangladesh was at 75%. By 2006, this rose to 105%. It went from 99% to 102% for the Philippines.

As a result of their integration of maternal and child health services, Bangladesh saw a reduction in the cases of infant mortality and a rise in immunization rates of infants. In 1986, infant mortality in Bangladesh was at 111 (per 1,000 live births), more than twice that of the Philippines which was at 50. By 2008, it was down to 43 for the former, while for the latter it had declined to 27. In 1986 immunization of children (between 12 and 23 months) was at a mere 3% in Bangladesh compared to 51% for the Philippines. By 2008, it rose to 89% for the former compared to 92% for the latter.

Lessons and assignments

As Father Joaquin Bernas, SJ wrote in his column for today’s Inquirer, the merits of the current RH bill must be debated on the basis of whether or not the use of state power to influence the behavior of the populace serves the public good and whether it is exercised in a reasonable manner, not coercive or oppressive.

These statistics demonstrate that the adoption of some kind of reproductive health service is defensible from a public benefit point of view. Whether the use of the public purse in providing “safe, effective and legal methods, whether the natural, or artificial that are registered with the Food and Drug Administration (FDA) of the Department of Health (DoH)” (notice how the wording avoids the use of prescriptive terms such as pill, intra-uterine device (IUD), injectables, condoms, ligation, vasectomy) is reasonable depends on the specific measures in the bill.

One of these provisions has to do with the way employers include such services as part of their worker’s entitlements. For Father Bernas, the specifics of the policy are worth debating, but not the policy aims. For him, you don’t “burn down an entire house to make lechon.” In other words, if there are certain objectionable parts to the Reproductive Health Bill, then these provisions should be revised, but that should not alter the need to have this all important bill passed.

The case of Bangladesh clearly demonstrates how a sustained implementation of an integrated health, family planning and population policy has had a massive positive impact on the welfare of its citizens within a generation. It should serve as a reminder to our politicians that a far-sighted policy outlook is needed in dealing with this issue.

For too long, the country has gone without a legal framework for determining its reproductive health policies. It is about time that our leaders and the public at large take a look at the proposals embodied in the reproductive health bill. Above the shrill cries of those who seem to be stuck over worries that this will lead to population control (a hangover from the 1970s’ debate) on the one hand, and on the other hand those who see in the bill a path towards the legalization of abortion, our leaders need to chart a sensible path based on reason and common sense.

* This and all other statistics cited in this article come from the World Development Indicators taken from the World Bank and available on Google’s public data explorer.

Asean lists down causes of failure to meet MDGs

Asean lists down causes of failure to meet MDGs
Written by Estrella Torres
Business Mirror

LINGERING conflicts, fragile political situations and armed violence in Southeast Asia hamper the achievement of the Millennium Development Goals (MDGs) among the members of the Association of Southeast Asian Nations (Asean).

Dr. Surin Pits wan, Asean secretary-general raised the need to address these concerns of members, particularly developing countries like the Philippines, at the sidelines of the United Nations Review Conference of the MDGs in New York City.

Surin met with Timor Leste President Jose Ramos Horta; officials of the Mo Ibrahim Foundation and of the World Bank and the United Kingdom, to identify programs to raise the importance of peace-building and state-building in achieving the MDGs, according to a briefing statement issued by the Asean.

Indonesia, Myanmar, Laos, Cambodia and the Philippines are having difficulty complying with the MDG commitments due to the lingering conflict and fragile political conditions in those countries.

In March 2009, Asean members agreed to align to the attainment of MDGs the road map to establish a single market by 2015.

The signatories to the MDG compact signed in year 2000 also set year 2015 as the end-year for compliance with the eight goals.

The declaration “reflects Asean’s serious commitment to reducing poverty and inequality and improve the standard and quality of life of the peoples of Asean,” Surin said

The MDGs are time-bound goals that aim to halve global poverty incidence by 2015 by eradicating extreme poverty and hunger, achieving universal access to primary education, promoting gender equality and empowering women, reducing child mortality, improving maternal health, combating HIV/AIDS, malaria and other diseases, ensuring environmental sustainability and developing a global partnership for development.

Asean signed an assistance program with the European Union to develop statistical reports using the MDG indicators to support regional programs aligned to achieving the MDGs.

Infrastructure woes hinder MDGs

Infrastructure woes hinder MDGs
Written by Cai U. Ordinario
Business Mirror

DESPITE the country’s efforts to increase social spending through programs like the conditional cash-transfer (CCT) program to meet the Millennium Development Goals (MDGs), the Asian Development Bank (ADB) believes that addressing infrastructure constraints will still hold the key in achieving the goals by 2015.

In a statement, ADB president Haruhiko Kuroda said developing countries like the Philippines must address basic infrastructure constraints to achieve the MDGs in five years.

Kuroda said many areas in developing countries still do not have electricity, all-weather roads and other basic infrastructure. These limit access to health care and discourage children from completing their education.

He said the region is lagging in the targets for basic sanitation, infant mortality, maternal health, hunger and environmental improvements, and reducing greenhouse-gas emissions.

“Less developed countries, or those suffering from conflicts or disaster, will need more regional help to make progress, and the Asia and Pacific region must step up cross-border cooperation in trade, investment, knowledge and technology, to help bridge gaps in resources and capacities,” the ADB added.

Addressing these concerns is National Economic and Development Authority (Neda) Director General
Dr. Cayetano Paderanga, who delivered the Philippines’ statement during the High-Level Meeting on the Millennium Development Goals in New York City.

Paderanga, who is also the Socioeconomic Planning secretary, said while the Philippines made considerable strides in meeting some of the MDGs, like cutting child mortality, and malaria and tuberculosis incidence; increasing access to sanitation and safe and potable water; and providing equal education for girls, there is still a lot to be done.

The Neda chief said the measures that will be implemented by the national government to help achieve the MDGs will be included in the Medium-Term Development Plan for 2010-2016.

He said the MTDP will make sure this growth is inclusive and can help protect the vulnerable by ensuring access of every Filipino to quality health, education and employment opportunities.

These, Paderanga said, will be done through an appropriate mix of physical and social infrastructures, and by strengthening social safety nets, like CCTs and universal health care.

“Despite the gains attained in the last decade, we need to push ourselves more to meet the MDGs, particularly where we lag behind. Moreover, the Philippine scenario is characterized by wide disparities. Our latest progress report also shows that climate change poses a threat to the achievement of our targets. The population above the poverty threshold is declining as a result of low capacities to cope with the effects of shocks leading to more ‘transient poor,’” Paderanga said in a statement.

He urged development partners to also keep their promise of sharing a portion of their gross national income (GNI) to developing countries for MDG achievement. The United Nations official development assistance target is set at 0.7 percent of GNI.

“Excellencies, as we enter the last stretch, the Philippine government is exerting all means to deliver on its promise to realize its MDGs, not just as an international commitment but because our people demand it. Let us remember that each and every one of our citizens deserves a life of quality, meaning and dignity,” Paderanga said.

For its part, the Manila-based ADB said it is targeting increased support for basic infrastructure, such as roads, power and sanitation, which are crucial for meeting MDGs.

It also intends to scale up assistance for education, and for environmental improvements, including the use of clean energy, where ADB investments have grown to more than $1 billion a year, and which are targeted to double to $2 billion by 2013.

Kuroda added that countries in the Asia and the Pacific region, which is home to three-fifths of humanity and two-thirds of the world’s poor, represent the world’s best hope for achieving the MDGs by 2015.

“With more than 500 million people having overcome poverty since 1990, the target for reducing extreme income poverty is in sight. The region is also likely to achieve near universal primary school enrollment by 2015, attain gender parity in education, meet the target on access to safe drinking water, and halt the spread of deadly diseases such as TB and HIV,” Kuroda said.

The country’s fourth progress report on the MDGs showed it had a low probability of achieving indicators—such as increase elementary education net enrollment rate, elementary education cohort survival rate, elementary education completion rate, reduce by three quarters maternal mortality, universal access to reproductive health, halt HIV prevalence among 15 year olds, and provide comprehensive correct knowledge about HIV/AIDS to 15 to 24 year olds.

The report also showed the country had a medium probability of achieving the indicators on halving the proportion of population below the poverty threshold or P15,057 per year per person, halving the prevalence of underweight children under five years old, halving the proportion of households with per capita intake below 100 percent dietary energy requirement, universal access for the proportion of the population with advanced HIV infection to antiretroviral drugs, and halve the proportion of the population with access to safe water.

The indicators also showed the Philippines had a high probability of achieving of halving the proportion of population below the food threshold or P10,025 per year per person, all the indicators of Goal 3 which pertained to gender equality and women empowerment, indicators under Goal 4 of reducing child mortality, the malaria morbidity rate, the malaria mortality rate, the tuberculosis case-detection rate, tuberculosis-cure rate, and the proportion of the population with access to sanitary toilet facilities.

The MDGs are a set of eight goals, 22 quantitative targets and more than 60 specific indicators meant to serve as a focus for international and national development policy.

The first seven goals are concerned with outcomes, identifying the progress toward certain standards of human welfare and development that should be achieved globally and nationally by 2015. The eighth goal is concerned with “global partnership for development” to support the realization of all the goals.

ADB, UNICEF agree to help countries achieve MDG goals

ADB, UNICEF agree to help countries achieve MDG goals
GMA News

The Asian Development Bank (ADB) and the United Nations Children’s Fund (UNICEF) signed an agreement to help some countries in Asia and the Pacific region, including the Philippines, to reduce poverty and inequalities and improve child welfare.
The agreement was signed with five years remaining until the 2015 deadline for the world to achieve the Millennium Development Goals (MDGs), the Manila-based bank said in a statement released to media on Thursday.

The ADB said the two agencies will look for opportunities to work together to accelerate the achievement of the MDGs, including reducing infant and maternal mortality rates, improving the quality and relevance of basic education, promoting investments in water and hygiene, strengthening child protection systems, and combating HIV/AIDS.

They will also look at opportunities to cooperate on public-private partnerships and enable the poor to participate in and benefit from economic growth, the bank said.

The ADB said the agreement will run for five years from the date of the signing of the agreement, and it may be extended by mutual consent.

Apart from the Philippines, priority areas for the project include Armenia, Bangladesh, Cambodia, Georgia, Indonesia, Lao People’s Democratic Republic, Mongolia, Nepal, Pakistan, Papua New Guinea, Timor Leste, Uzbekistan, and Vietnam, the bank said. —JE/VS, GMANews.TV