Reflections
Number 3
Perspectives
December 1999
POPULATION POLICIES IN THE PACIFIC ISLAND
COUNTRIES: WHAT FUTURE?
by
William J. House
Adviser on Population Policies and Development Strategies
The Situation Pre-ICPD
Many of the Pacific island countries
formulated population policies in the period
before the International Conference on
Population and Development (ICPD) which
was held in Cairo in 1994. They expressed a
principal concern for reducing high fertility
and rapid population growth. While the
policy statements often demonstrated the
need for population-responsive policies in
the various social and economic sectors,
their targets and objectives were already
enclosed in various other documents. For
example,
environment
policy
was
sometimes incorporated in a National
Environmental
Management
Strategy
(NEMS), family planning programmes were
being actively implemented by Ministries of
Health and there were often formal policies
both for women and for youth. Yet,
attempts at coordination of the various
policy interventions through a high-level
National Population Council and a multisectoral coordinating committee were not
very effective. Since they pre-dated the
ICPD, the policies were very much driven
by anti-natalist demographic concerns and
failed to introduce the ICPD concepts of
reproductive rights and reproductive health.
And the demographic targets of the policies
were often totally unrealistic. As a result
they seem to have had little lasting
influence, such that many are currently
under revision.
Despite this, family planning programmes
have made progress recently in many
countries by overcoming to some extent
“All States now understand that, if they
are to provide adequately for the future
health and education of their citizens, they
need to incorporate population policies
into
their
development
strategy.”
Secretary-General Kofi Annan, speaking at
the Opening Ceremony of the UN Special
Session of the General Assembly on 30 June
1999.
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various constraints, such as shortages of
finance, skilled service providers and
counsellors, contraceptives, infrastructure
and management skills. But the family
planning programmes generally did not rely
on the national population policy for their
rationale and justification and tended to be
vested in the Ministry of Health. The multisectoral approach to population policy,
which was meant to be reflected in the
operations of the Population Policy
Coordinating Committees, was never very
effective and proved incapable of taking a
leading policy-making role in the
implementation of the policy.
Family
planning units in Ministries of Health
persevered without any major moral or
vocal support for population policy from
Heads of State and Government, Cabinets or
Ministries of Finance.
No doubt, this failure to galvanise the
support of the national political leadership,
particularly the civil and religious leaders,
as well as officials in the National Treasury,
impeded the implementation of the MCHoriented family planning programme as well
as the multi-sectoral population policy. Nor
has population and population-related issues
been adequately integrated into the national
development planning process, partly
because of the failure to raise population
concerns high enough on the policy-agenda.
The result is that population policy has
continued to be largely identified with
Ministries of Health and their family
planning programmes.
Post-ICPD
In the period since ICPD, advocacy has
been undertaken to reorient policy makers,
programme managers and project personnel
towards a better understanding of the
concept and scope of reproductive health
and to assist countries to move towards
comprehensive
reproductive
health,
including family planning and sexual health
services (RH/FP-SH). Reorientation has
sought to generate an appreciation of the
linkages between population dynamics and
development and the implications of the
paradigm shift from MCH/FP to RH/FP-SH.
Emphasis has shifted to promoting
individual choice and well-being rather than
demographic targets, and a stress on
integrated quality of care and services.
After five years of advocacy efforts, the
concept has been widely accepted and the
operational implications are well understood
by national programme managers and
service providers.
The integration of
reproductive health is already occurring in
the practical stages in varying degrees at the
primary care level, but more needs to be
done at the secondary and tertiary or
Indicators and threshold levels of achieving goals of the ICPD Programme
of Action by the 2005.
Goal and Indicators
Threshold Levels
Goal: Access to reproductive health
Proportion of deliveries attended by trained health personnel
Contraceptive prevalence rate
Proportion of population having access to basic health services
60 per cent
55 per cent
60 per cent
Goal: Mortality reduction
Infant mortality rate
Maternal mortality ratio
Goal: Universal primary education
Gross female enrolment rate at primary level
Adult female literacy rate
50 infant deaths per 1,000 per live
births
100 maternal deaths per 100,000 live
births
65 per 100 eligible population
50 per cent
Source: United Nations Population Fund (1996)
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national levels. To this end, increasing
elements of the reproductive health concept
are being incorporated into the new cycle of
various donor projects. However, most
countries need financial and technical
assistance from their development partners
in the interpretation and implementation of
the ICPD POA to meet local conditions.
Of the population policies that have been
designed in the post-ICPD era, perhaps the
draft policy for Vanuatu comes closest to
reflecting the philosophy of the ICPD’s
POA1. For example, the draft document is
explicit in upholding the principles of the
ICPD POA and confirms the inalienable
rights of women to equality and equity, their
right to determine their own fertility, as well
themselves, as well as the means to reduce
fertility and the rate of population growth.
However, the policy has yet to be endorsed
by Government.
With the new emphasis on reproductive
health, where does that leave the
demographic concerns of the earlier
versions of population policy? Will the
purveyors of the new reproductive health
approach be able to galvanise the support of
national political and religious leaders and
policy makers in order to attract their
blessing and financial and moral
commitment, when the earlier family
planning programmes often failed to do so?
If their principal concern is with too rapid
population growth in relation to natural and
Goal Indicators of the PICs
% of
Deliveries
Attended
by
Trained
Personnel
(1)
60
Contraceptiv
e Prevalence
Rate (%)
(2)
55
60
50
100
65
50
Melanesia
Fiji
Solomon Islands
Vanuatu
100
87
79
*31
*8
*15
100
80
80
16
38
45
31
*550
68
90
*36
70
91
*20
*30
Micronesia
FSM
Kiribati
Marshall Islands
Nauru
Palau
82
72
na
100
100
*25
*28
*26
na
*46
75
100
95
100
80
46
*67
*63
11
20
*561
*225
0
0
0
83
78
79
95
90
66
91
69
95
88
Threshold Level by 2005
% Pop. With
Access
to
Basic Health
Services
(3)
Infant
Mortality
Rate
Maternal
Mortality
Rate
(4)
(5)
Female
Primary
School
Enrolment
(%) 5-14 years
(6)
Polynesia
100
*53
100
11
20
100
Cook Islands
100
*39
100
18
0
96
Niue
100
na
100
38
*170
98
Tokelau
94
*32
100
19
*160
91
Tonga
100
*40
100
*51
0
88
Tuvalu
95
*31
100
22
70
94
Samoa
* Failure to meet the relevant threshold
Source: UNDP (1999). Columns (1) – (3) and (5) are taken from WHO (1997 and 1998). Column (4) is from SPC (1998).
Adult
Female
Literacy
Rate
(7)
94
97
90
99
95
96
as the elimination of violence against
women. However, the draft policy is still
anti-natalist in tone and wishes to lower the
national rate of population growth as well as
fertility and mortality.
The extended
provision of quality reproductive health and
family planning services, including IEC, are
identified to be a worthy end, in and of
other resources, then the reproductive health
agenda emanating from the Cairo POA must
be shown to have a significant demographic
effect. But can this linkage be adequately
demonstrated to the political leadership
which may treat the too rapid growth in
numbers as the priority concern for
development expenditure and planning?
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This writer would propose that high and
middle level political and bureaucratic
The UNFPA Country Support Team based in Fiji has provided
significant technical guidance in the preparatory activities and the
drafting of the policy.
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commitment to address national populationrelated problems, including extensive
reproductive health concerns, are more
likely to be attained if broad-based national
population problems and multi-sectoral
strategies to deal with them are expressed in
a national population policy. To the political
elite, seemingly esoteric reproductive health
and gender concerns will not be adequately
appreciated if they are treated as
independent health issues. They are much
more likely to receive the support and
expanded budgetary allocations of national
exchequers and international donors if they
are conceived to be integral parts of broadbased national efforts to deal with
population and development problems in a
holistic manner.
Already the enthusiasm surrounding the
new concepts arising from the ICPD has
been dampened by the hard reality of having
to compete with other interested parties for
the national purse strings. The international
donor community has fallen way behind in
meeting the projected financial needs for
implementing the reproductive health
programmes identified in the International
Conference
on
Population
and
Development. One way to arouse renewed
interest would be to incorporate the linkages
between interventions to promote improved
reproductive health status, fertility decline
and reduced population growth in the form
of national population policies, conceived as
integral parts of national development
programmes. Meanwhile, if this approach is
accepted, the Pacific island countries will
require much technical support to undertake
this task.
Status of Population Policy in the Countries of the South Pacific
Country
Cook Islands
Fiji
Kiribati
Marshall Islands
FSM
Nauru
Niue
Palau
PNG
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Status of Population Policy
None
Implicit Policy in Development Plan
In preparation
Revised and Endorsed
Draft to be revised
None
In preparation
Completed
Policy revised
Draft completed
Revision completed
In preparation
In preparation
In preparation
Principal Demographic Concerns
Limit population growth
Lower fertility
Reduce fertility: health oriented improvements
To promote return migration and repopulate
Reduce out-migration, retard alien inflows
Lower fertility, reduce urbanization
Lower fertility, promote development
Lower fertility, reduce ubarnization
Lower fertility; reduce urbanization
Lower fertility/RH/FP/ICPD goals
Source: Authors' estimates and interpretation
References:
SPC (1998), Pacific Island Populations, Noumea
UNDP, (1999), Pacific Human Development Report 1999: Creating Opportunities, UNDP, Suva
UNFPA, (1996), A Revised Approach for the Allocation of UNFPA Resources to Country Programmes, New York
WHO (1997), Country Health Information Profiles, WHO Regional Office for the Western Pacific, Manila.
WHO (1998), Western Pacific Regional Health Databank, WHO, Manila.
Reflections will be published periodically by the UNFPA Country Support Team for the South Pacific. Views
expressed do not necessarily reflect the opinions or policy of the United Nations Population Fund.
Correspondence should be addressed to: The Director, UNFPA Country Support Team, GPO Box 441, Suva,
Fiji. Phone: (679) 312-865 Fax: (679) 304-877 Internet email: Registry@unfpacst.org.fj
Homepage: http://www.undp.org./popin/regional/asiapac/fiji/fijihome.htm
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