Executive Summary
Significant growth of the population of Maldives first occurred during the 1970s. Prior to
that population growth was slow frequently fluctuating between negative and positive
growth rates. Its population at the turn of the 20th Century took 70 years to double. By
1977 the country’s population was 142,000 with a sex ratio of 111. During the next seven
years or so the average annual growth rate of the population stood at 3.2 percent. The
intercensal growth rate for the period 1985-1990 increased to 3.4 percent. Thereafter it
began to decline – improved access to education and health care, as well as increasing
child survival, also contributed to the decline in the growth rate to 2.7 percent during
1990-1995, and to 1.9 percent during 1995-2000. Rapid population growth threatened to
hinder the social and economic development efforts of the country during the late 80s and
early 90s. In addition, population distributional effects were also recognised as major
obstacles to equitable social and economic development. Population spatial distribution
continues to be perhaps the biggest challenge to the eradication of poverty in the present
context.
While the Maldives has made significant progress in many areas, poverty, as measured in
terms of income and access to social and physical infrastructure, continues to be of
concern. Vulnerability, caused by food insecurity, unequal access to social infrastructure
and employment are among other inequalities that remain to be addressed. Disparities that
exist within larger population centres such as Male’ have until now been overlooked in
most development programmes, and can be identified as an area for immediate policy
attention.
While food insecurity cannot be considered a major problem, nutrition emerges as one of
the greatest causes for concern. Recent studies suggest high prevalence of malnutrition
among the population. Particularly crucial is the issues of malnutrition among children
and pregnant mothers, as it impacts severely on the country’s present and future human
capital stock, thus depriving its most promising resource of achieving its maximum
potential.
The government fully recognises the significance of human resources for sustainable
development of the Maldives. It therefore accords high priority to the development of
human resources of its youthful population. Its investments in the development of human
1
resources, through local and overseas training programmes comprise a large chunk of
government expenditure.
Maldives is at a crucial crossroads where major decisions focusing on national population
policies are needed. As it stands, current population trends and the resulting age structural
changes will have major implications on the social and economic development of the
nation.
While population ageing is not yet a significant demographic problem in the country, the
increasing numbers of older people call for specific policy to address their needs. This is
an area that needs policy attention.
With the recognition of the importance of sound social and economic research relating to
population and development for informed policy making, population data analysis and
research is now a priority of the government. These efforts are hampered by an extremely
limited capacity to conduct such research, both in terms of institutional setup for such
research and skilled personnel to conduct such research in the Maldives.
The total fertility rate (TFR) has declined from 6.4 in the period 1985-1990 to 2.8 in the
period 1995-2000. The contraceptive prevalence rate (CPR) has increased substantially
from 15 percent in 1991 to 32 percent by 1999 for modern methods, although this is still
low by global standards. A wide range of family planning methods are now widely
available throughout the country and are provided free by the government. These include
modern temporary methods and permanent methods. Despite the availability of free
contraceptives throughout the country, the unmet need for family planning remains high.
The reasons may be in part due to logistics, due to socio-cultural factors, and due to
rumours of side-effects experienced by some users.
Despite the high unmet need, the effects of fertility decline are already being felt in some
smaller islands, where the numbers of children born is declining to the extent that there is
a growing concern that there populations will soon be diminishing.
With improvements in primary health care delivery, particularly with extensive
immunisation coverage, mortality rates at the very early ages of life began declining
rapidly during the 70s. In 1977, infant mortality was high at 120 per thousand live births.
In the same year, the crude death rate was 12 per thousand and life expectancy at birth was
46.5 years. By 1985 these indicators had improved tremendously. Infant mortality in
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1985 was observed at 47 per thousand live births in Male’ and 63 per thousand live births
in the atolls. Corresponding figures for 1990 were 35 and 33 and in 2000 were 17 and 23,
respectively.
Improvements in health care delivery and referral services have also had a substantial
impact on the numbers of maternal deaths. The maternal mortality ratio (MMR) has
declined from 330 per hundred thousand live births in 1985 to 500 per hundred thousand
live births in 1990 to 143 per hundred thousand live births in 2001.
The most significant change in mortality is the shifting of sex differentials in life
expectancy in favour of females. In 1985 the life expectancy for females was 59.48 years
and for males 62.20 years (Statistical Yearbook of Maldives, 1987).
Corresponding
figures for 2000 were 72.2 years for females and 70.7 years for males.
Although ageing per se is not yet a major population problem in the Maldives – nor is it
expected to be in the next 50 years – the growing numbers of older persons in the
population call for adequate policy attention.
Declining family sizes and nuclearisation of families are likely to disrupt the present
system of shared burden of caring for the elderly among several members of the family,
thereby adding to the burden of families, particularly women.
Despite the positive
developments, transport difficulties such as high cost continue to be major barriers to
further improvements in maternal health, especially in remote/poorer areas. Nutrition
amongst women and children and the population as a whole continues to be a major
challenge faced by the country.
Most adolescents have some knowledge and awareness regarding RTI/STDs and
HIV/AIDS, in terms of symptoms and methods of transmission. The incidence and
prevalence of HIV/AIDS is very low in the Maldives. The actual confirmed incidence of
HIV/AIDS in the Maldives remains at 11 cases amongst locals since 1991. Nevertheless,
there is a strong need for vigilance and coordinated intervention for preventing its spread
in the future (Jenkins, 2000).
While Maldivian women enjoy higher social status and greater political and social
freedom than women in many other countries with similar social backgrounds, there are
several areas where urgent action is needed to improve women’s current status. Although
the Constitution does not allow any form of discrimination between men and women, in
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reality discriminatory practices exist in the society. These are manifested mainly in areas
such as marriage and divorce, property rights, and the provision of evidence in courts of
law. Other more abstract areas of subordination relate to perceptions held by the society at
large concerning the domestic roles of women. Number of measures have been taken to
address gender issues in the country during the past decade. The passing of the Family
Law Act by the People’s Majlis in December 2000 is a milestone in protecting the rights
of women and children in the Maldives.
As part of the government’s poverty reduction strategy, many programmes have been
introduced to involve women in economic activities, particularly at the project level.
These programmes, which have been limited to selected atolls, have met with considerable
success.
Internal migration has been a male dominated activity in the Maldives. Absence of male
members of households from the rural areas of the country compels rural women to take
the full responsibilities of being the caregivers of children, as well as the elderly parents,
often of their own and also of their husband’s. This imposes additional hardships on
women and also their children. In such situations, women, children, the elderly and those
needing special care are particularly disadvantaged.
In the absence of a housing finance scheme, housing situation continues to deteriorate,
giving rise to a host of social and environmental problems. Often, those who are at the
deep end of the housing problems are migrant families – women, children, the aged and
people with special needs being at the most disadvantaged. The difference in level of
nutrition between men and women indicate the nature of equity and access between
genders. The situation of girl-children is of particular concern.
The health information system of the government needs to be greatly strengthened. The
present national system collects a considerable amount of data through various reporting
forms, registers and surveys. However, only a small proportion of this data is processed
and analysed for effective, evidence based management decision-making and for wider
dissemination.
The main reason for under-utilisation of valuable information is
inadequate capacity at the different levels of the information management chain; namely
data collection, data storage and retrieval, as well as the capacity to analyse and present
information. Due to the lack of research institutions focusing on social and economic
development research in the country, there is a general dearth of research facilities and
4
expertise available. The issue of human resource development is often singled out as the
biggest constraint to development efforts in the Maldives. Island level analysis is needed
to formulate effective policies to address the needs of the widely scattered population of
the country.
With the changing shape of the population age structure, it is expected that the proportions
in the working ages will swell in the near future, putting pressures on the country’s labour
market in the next 10 years or so. The challenge for the government is to prepare the
potential labour force with quality and appropriate skills to meet the needs of the jobs of
tomorrow. The opportunity for rapid growth posed by changing age structure must not be
lost.
5
1: Overview of the population and development situation
and prospects, with special attention to poverty
The earliest records of the population of Maldives are from the census of 1911, which was
conducted by the British colonial administration in Ceylon to coincide with their decennial
census. At that time, there were 72,237 persons in the Maldives (National Planning
Agency, 1981) with a sex ratio of 119. Due to various factors such as the absence of
modern medical facilities, prevalence diseases such as malaria and influenza and the
effects of famine (National Planning Agency, 1981:148), mortality was high and
population growth rate fluctuated between positive and negative growth. This situation
continued until the mid-1960s. Improvements in health enabled the rapid decline of
mortality, and the population increased.
However, it was only after 1977 that the
country’s population nearly doubled its 1911 size, with a census count of 142,832 and a
sex ratio of 111 in 1977.
Subsequent censuses show that the population growth rate accelerated around this time,
reaching its highest levels during the intercensal period, 1985 to 1990 at 3.4 percent. The
impact of hastening of the growth rate was felt through extreme pressures on the basic
social infrastructure namely, primary schooling, basic health care and related social
services. While these impacts were slightly buffered by the high rate of economic growth
that occurred almost simultaneous to population growth acceleration, policy makers began
to appreciate the crucial link between development and population growth. These concerns
led to policies and programmes promoting family planning, thereby encouraging the onset
of fertility decline during the early 1990s. Improved access to education and health care,
as well as increasing child survival, also contributed to further decline in the growth rate to
2.7 percent during 1990-1995, and to 1.9 percent during 1995-2000.
The effects of rapid population growth and the resulting age composition are not the only
population and development challenges facing the country.
Population distributional
effects were also recognised as major obstacles to equitable social and economic
development, and perhaps the biggest challenge to the eradication of poverty in the present
context. Many among the 199 inhabited islands are subjected to extreme hardships and
vulnerability due to either severe population densities or due to a host of environmental
6
problems such as land erosion, desertification, and fresh water depletion. The government
not only encourages inhabitants of such islands to move to other islands of their own
volition, but actually facilitates the process through government subsidies for housing and
other infrastructure.
While the Maldives has made significant progress in many areas, poverty, as measured in
terms of income and access to social and physical infrastructure, continues to be an area of
concern. According to the Maldives Vulnerability and Poverty Assessment (VPA, 1998),
significant disparities exist between Male’, the capital and other inhabited islands and also
within Male’ itself. The VPA identifies islands with greater income poverty and estimates
that 42 percent of the Maldivian population lives under Rufiya 15 (US$ 1.27) per day.
Vulnerability caused by food insecurity, unequal access to social infrastructure and
employment are among other inequalities identified in the VPA. Disparities that exist
within large population centres such as Male’ have until now been overlooked in most
development programmes, and can be identified as an area for policy concern. On a more
positive note, a comparison of the findings of the VPA for Male’ with earlier studies
suggest that income inequalities declined in Male’ between 1993 and 1998 (Ministry of
Planning and National Development, 1998:92).
While food insecurity cannot be considered a major problem, nutrition emerges as one of
the greatest causes for concern. Thirty-six percent of children in the age group 1-5 years
can be considered suffering from stunting and 20 percent from wasting (Ministry of
Planning and National Development, 1998:93).
Stunting among girls is higher than
among boys. Overall stunting among girls is estimated to be 49 percent compared with 37
percent for boys (Ministry of Planning and National Development, 1998:93).
Due to concerted efforts by the government, supported by donors and supplemented by the
NGO sector, the population growth rate has begun to decline significantly after reaching a
high of 3.4 percent per annum during the inter-censal period 1985-1990. Currently, the
Maldives is at a crucial crossroads where major decisions focusing on national population
policies are needed. As it stands, current population trends and the resulting age structural
changes will have major implications on the social and economic development of the
nation.
Maldives is party to major international conventions and declarations of the United
Nations, including the Bali Declaration on Population and Sustainable Development,
7
Programme of Action of the International Conference on Population and Development,
and others. This sub-section will briefly outline the status of implementation of the goals
contained in the Bali Declaration and the ICPD Programme of Action.
Maldives is committed to the goals of sustainable social and economic development.
Measures taken include, phasing out environmentally harmful products, proper
management of waste, protection of species to ensure bio-diversity, increased awareness
through education and awareness creation, mandatory EIA for all projects and NGO
participation in sustainable development programmes.
While considerable progress has been made in all these areas, problems arising due to
housing shortage and population congestion in the more urbanised centres, particularly in
Male’, are on the increase. In Male’, the existence of polluting industries in the midst of
congested housing is blamed for increasing incidence of respiratory problems among
children. Pollution of the sea surrounding Male’ has also destroyed its reef.
Part of the environmental pressures in Male’ has been caused due to internal migration and
urbanisation. In general, the pattern of population distribution at present is a hindrance to
sustainable development efforts of the country. Acknowledging that urbanisation is an
inevitable process of development, the government has embarked on a programme of
encouraging the growth of regional centres servicing as growth hubs for the delivery of
social and economic services, generate employment opportunities and other decentralised
facilities for regional development and population and development consolidation,
equitable distribution of development and alleviation of poverty. The First Regional
Development Project with assistance from the Asian Development Bank and Islamic
Development bank has been implemented in two of the five proposed regions; Southern
Region consisting of four southernmost atolls and Northern Region consisting of the three
northernmost atolls.
While significant achievements were made towards reaching many of the international
health goals set prior to Bali and ICPD, these international conferences were key to
bringing the issues of sustainable development, reproductive health, gender, adolescent
sexual health, and HIV/AIDS to the attention of planners and policy makers. Significant
progress has been made in achieving the ICPD goals in many of these areas. In fact, a
Reproductive Health Baseline Survey conducted by the government in 1999 observed that,
the level of awareness on HIV/AIDS among the population was striking although the level
8
of awareness on STDs was not so impressive. At present, the awareness on HIV/AIDS
being high, the prevalence is also low. However, factors such as, a large proportion of
youth population, socio-cultural factors hindering the availability of condoms for
unmarried persons, high divorce and remarriage rates, a large expatriate population, a
large tourist population, and increasing drug usage among youth, high frequency of
international travel of Maldivians, Maldives remain at highly volatile to HIV/AIDS.
Improvements made in the delivery of health care services, including maternal and child
health services, through a five-tier referral system, maternal mortality has been reduced
substantially since ICPD. However, largely due to the dispersed nature of the population,
maternal deaths due to preventable causes still occur in the country. Much of the delay is
caused due to lack of efficient and affordable transportation to hospitals.
As a result of sustained efforts by the government through IEC and Advocacy
programmes, progress has been made in the area of gender equality, despite socio-cultural
constraints.
However, employment opportunities in the economic sectors remain
generally inaccessible to females due to several factors such as, perceived roles of males
and females in the society and geographical factors such as, location of tourist resorts and
other attractive industries separate from inhabited islands.
Access to primary and
secondary levels of education has become equal. However, at higher levels, girls remain
disadvantaged, particularly for the types of vocations involving travel outside their home
islands.
The government fully recognises the significance of human resources for sustainable
development of the Maldives. It therefore accords high priority to the development of
human resources of its youthful population. Its investments in the development of human
resources, through local and overseas training programmes comprise a large chunk of
government expenditure. Due to the small resource base of the government, much of these
opportunities are dependent on the availability of funding from bi-lateral and multi-lateral
sources.
Improvements in the life expectancies during the past couple of decades results in more
and more people surviving to older ages, beyond their productive lives. While population
ageing is not yet a significant demographic problem in the country, the increasing numbers
of older people call for specific policy to address their needs. This is an area that needs
policy attention.
9
With the establishment of a population programme coordination mechanism within the
government, population policy is now widely discussed among concerned government
agencies. Non-Governmental Organisations active in the field of population are taken on
board in these discussions.
Large amounts of population data are collected through
censuses and surveys. More is available from regularly collected administrative data.
Very little of this is analysed and presented in a way that would call the attention of policy
makers to various population issues. Institutional arrangements to conduct such analysis
and research are a priority of the government. These efforts are hampered by an extremely
limited capacity to conduct such research. Such capacity needs to be strengthened in all
fields of population research.
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2: Fertility levels and trends, and their implications for
reproductive health, including family planning
programmes.
The provision of Family Planning services in the country started in 1984 with assistance
from UNFPA and through projects executed by the World Health Organisation (WHO).
With the strong commitment of the government and increased awareness through health
education, more outlets for family planning services have been created, and the use of
contraceptives has risen steadily. The total fertility rate (TFR) has declined from 6.4 in the
period 1985-1990 to 2.8 in the period 1995-2000. The contraceptive prevalence rate
(CPR) has increased substantially from 15 percent in 1991 to 32 percent by 1999 for
modern methods, although this is still low by global standards. Family planning services
are available to all married couples. They are now widely available throughout the
country and are provided free by the government. The contraceptive methods offered
include modern temporary methods such as condoms, pills, injectibles, IUDs and implants
(Norplant), and permanent methods such as male and female sterilisation.
The RH
programme encourages the use of these methods for spacing, limiting, or delaying
pregnancies. However, abortion as family planning is not permitted on any grounds. The
decline in the TFR and the increase in the CPR are a result of the effective IEC campaign
conducted by the government on reproductive health and family planning.
The quality of family planning services provided at all four levels of health care delivery
need further enhancement.
Particular areas of focus should include improvement of
counseling services and the strengthening of (IEC). Special clinics need to be established
for family planning at tertiary and regional levels, in addition to health posts at island
levels to ensure privacy and confidentiality. IEC materials both printed and Audio/Visual
(A/V), as well as access to electronic media are required for better health promotion. It is
felt that IUD insertion should have a broader scope, and a greater number of service
providers should be trained in the procedure, as well as in follow-up care.
Contraceptive procurement, logistics and distribution need to be greatly strengthened for
the future. Problems noted include the frequent experience of stock-outs at some health
11
centres, indicating issues of communication and transportation. Storage conditions for RH
commodities also need to be greatly improved.
The programme has been successful in providing access to a choice of quality family
planning methods and an increased method mix. The methods available at Island Health
Posts include condoms, injectibles and pills; in addition, sterilization and IUD insertion is
available at Regional and Atoll Hospitals.
Implants (Norplant) have recently been
introduced under the RH programme and are now available at IGMH in Male’. Society
for Health Education (SHE), a local NGO, conducts clinics for family planning and
provides access to condoms, pills, injectibles and IUD insertion both in Male’ and on the
islands through their mobile clinics.
The unmet need of contraception needs to be addressed in the near future. Despite the
increased availability and use of contraceptives, there is still a high percentage of unmet
need in family planning services, totaling 35 percent for all methods and 42 percent for
modern temporary methods.
The RH Baseline Survey showed that 34 percent of
contraceptive users discontinued use due to side effects. A more thorough understanding
of these side effects, better management by health care workers and appropriate
counseling are necessary to further increase the CPR.
With fertility decline underway among the urban population, people in the rural areas are
also opting for family planning. The effects of fertility decline are already being felt in
some smaller islands, where the numbers of children born is declining to the extent that
there is a growing concern that their populations will soon be diminishing. Once fertility
decline begins, it can be seen that the pace of decline is much more rapid in the Maldives
than in larger populations.
This is due to the relatively small size of the population, its
social and cultural homogeneity, and the effectiveness of the mass media, especially the
national radio, in reaching a widely dispersed population.
These dynamics of population growth has resulted in a shrinking of the base of the
population pyramid.
With the changing shape of the population age structure, it is
expected that the proportions in the working ages will swell, putting pressures on the
country’s labour market in the next 10 years or so. The challenge for the government is to
prepare the potential labour force with quality and appropriate skills to meet the needs of
the jobs of tomorrow. The opportunity for rapid growth posed by changing age structure
must not be lost.
12
3: Mortality and morbidity trends and poverty
Significant achievements have been made in the area of health in the country. According
to estimates from the Vital Registration System (VRS), crude death rate has declined with
improvement in the level of infant mortality rate during the same period. The expectation
of life at birth not only increased, but more remarkably, now follows the universal pattern
of higher life expectancy for females compared to males. It is worthwhile to note that this
was not the case in the Maldives until the early 1990s, prior to which female life
expectancy was lower than male life expectancy.
This pattern, observed in some
developing countries, is generally attributed to the effects of early age at childbearing, the
high frequency of childbirth and consequently, higher risk of maternal morbidity, and
higher mortality of females arising from complications of pregnancy and childbirth.
While infant mortality has declined to well below the ICPD target levels, child mortality
remains significantly high. Underlying causes of high child mortality in the Maldivian
context need to be studied in order to address this important issue. Recent review of
maternal deaths indicates that many still occur due to preventable causes such as untimely
referral and inefficient transport services. These are difficult issues to resolve, given the
spatial distribution of the population, the high cost of transport between islands, and the
different tiers of the health system.
With improvements in primary health care delivery, particularly with extensive
immunisation coverage, mortality rates at the very early ages began declining during the
70s. In 1977, infant mortality was high at 120 per thousand live births. In the same year,
the crude death rate was 12 per thousand and life expectancy at birth was 46.5 years. By
1985 these indicators had improved tremendously. Infant mortality in 1985 was observed
at 47 per thousand live births in Male’ and 63 per thousand live births in the atolls.
Corresponding figures for 1990 were 35 and 33 and in 2000 were 17 and 23, respectively.
Neo-natal deaths are primarily attributable to endogenous factors and to a lesser extent, to
exogenous and environmental factors.
The endogenous factors are relatively less
important in the post neo-natal period, when exogenous factors dominate. Mortality
during the post neo-natal period is more responsive to environmental factors and health
care delivery (United Nations, 1976:136).
The decline in neo-natal deaths may be
attributable to improvements in neo-natal health care, and social-economic and
13
environmental conditions in the islands of the Maldives. The decline has been due in
particular to recent, significant improvements in health care, delivery and living conditions
of people in the outer islands.
Improvements in health care delivery and referral services have also had a substantial
impact on the numbers of maternal deaths. The maternal mortality ratio (MMR) has
declined from 330 per hundred thousand live births in 1985 to 500 per hundred thousand
live births in 1990 to 143 per hundred thousand live births in 2001 (MoH unpublished
data). However, much remains to be done in order to eliminate the effect of direct,
preventable causes on the numbers of maternal deaths. Even at present, most maternal
deaths that occur in the country are due to direct factors, and are preventable by improving
access to basic emergency obstetric care and referral services, and increasing awareness
among target groups of the population
With declining infant and maternal mortality, the expectation of life at birth has also
increased. The most significant change in mortality is the shifting of sex differentials in
life expectancy from an atypical situation of lower female life expectancy as compared to
males, to the more universal trend of slightly higher life expectancy for females than
males. In 1985 the life expectancy for females was 59.48 years and for males 62.20 years
(Statistical Yearbook of Maldives, 1987). Corresponding figures for 2000 were 72.2 years
for females and 70.7 years for males (Statistical Yearbook of Maldives, 2001). The shift
appears to have occurred during the early part of the 90s, and may be attributable to the
lower incidence of maternal mortality. This in turn may be aided by improvements in
obstetric care and referral services at the regional level, and the provision of emergency
evacuations from the outer islands to Male'.
As mentioned earlier, for people living on islands that do not have an atoll hospital or a
reasonably equipped health centre the cost and effort of a simple consultation with a
doctor can be exorbitant and beyond the reach of the average person. In such situations,
women, children, the elderly and those needing special care are particularly
disadvantaged.
In order to make effective policy interventions, reliable data and rigid analysis is needed
on morbidity and mortality situation in the country. Data on morbidity and mortality,
particularly concerning the cause of death are far from satisfactory at present.
Considerable effort needs to be made in order to collect more relevant data and to utilize
14
the existing sources of such data for analysis and dissemination.
Institutional
strengthening and capacity building may be the initial steps in this direction.
15
4: Migration, urbanization and poverty
The census of 2000 estimates the total population of the country at 270,101. Twenty
seven percent of this total (74,069) lives on the capital island of Male’, with an area of less
than two square kilometres. The remaining population is dispersed widely over 199
inhabited islands, with varying distances of ocean separating them.
The average
population size of these islands is approximately 900. Only fifteen islands have over
2,000 inhabitants, while eleven islands have less than 200.
With the pre-eminence of Male’ since historical times, movement of population between
Male’ and the other islands has always dominated internal migration in the Maldives –
very little movement existed between other islands, whether inter-atoll or intra-atoll. Even
today, this remains largely the case. The most extensive source of data on internal
migration comes from the national censuses of population and housing. As can be seen
from the figures, there are significant differences in the in-migration trends between males
and females. Firstly, the overall in-migration rates are much higher for males in all atolls
than for females, irrespective of age group. Secondly, the main migration poles for males
and females are different – while the Kaafu Atoll and other tourism zone atolls dominate
as the main centres for male in-migrants, Male’ island has been the main centre for female
in-migrants. However, as expected, most migration occurs in the age group of 15 to 24
years for both males and females. This migration is likely motivated by the search for
higher levels of schooling and employment opportunities.
The present spatial distribution of the population presents a crucial obstacle to the
equitable distribution of development capital and benefits to the entire population. While
the total population of Maldives is small, it is thinly spread across 200 different islands,
some of which are so sparsely populated that virtually any type of social or economic
activity becomes unfeasible.
Vital to the link between development and population dynamics are the growing social and
economic sectors in and around Male’. Internal migration from the rural areas to Male’
and back has been crucial in spreading urban concepts to rural households, many of which,
including contraceptive use, are conducive to fertility decline.
The growth of the
population of Male’ itself presents physical barriers to large family size, as internal
migration and resulting overcrowding exert downward pressure on fertility rates.
16
Internal migration is up to now a male dominated activity in the Maldives. Absence of
male members of households from the rural areas of the country compels rural women to
take the full responsibilities of being the caregivers of children, as well as the elderly
parents, often of their own and also of their husband’s. This subjects additional hardships
on women and also their children.
The implications of such situations for social
development and the future of the well-being of the society need to be studied urgently.
From a different angle, the population growth of Male’ is putting severe pressures on the
already overcrowded land area of Male’. In the absence of a housing finance scheme,
housing situation continues to deteriorate, giving rise to a host of social and environmental
problems. Often, those who are at the deep end of the housing problems are migrant
families – women, children, the aged and people with special needs being at the most
disadvantaged.
Earlier National Development Plans (NDPs) tended to interpret population distributional
problems mainly from the perspective of population congestion in Male'; thus, the focus
was on finding solutions to this problem through the development of regional growth
centres and selected islands.
While some attempts were made to implement such
programmes during the '80s and the early '90s, little success was achieved due to high
costs of infrastructure and logistical difficulties, among other problems. The population
distribution across 199 islands was recognised in the late '90s as the country's biggest
development challenge. It is characterised by overcrowding on smaller islands, and thinly
dispersed population on those with greater surface area. To address this challenge the
government has begun implementing policies of regional development and population
consolidation.
The population and development consolidation programme of the government aims at
minimising the serious diseconomies of scale faced in the provision of socio-economic
services to the widely scattered populations. The programme’s strategy is to encourage
the inhabitants of small and remote islands to voluntarily move to larger islands by
providing incentives. These larger islands are islands where available socio-economic
services and employment opportunities may enable them to enjoy a better standard of
living (Ministry of Planning and National Development, 2001).
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5: Population ageing
Although ageing per se is not yet a major population problem in the Maldives – nor is it
expected to be in the next 50 years – the growing numbers of older persons in the
population call for adequate policy attention. While the proportion of population aged 65
and over in 2000 was only 3.7 percent, in absolute numbers this amounts to a little over
10,000 persons in the country with a sex ratio of 144 males per 100 females. Policies to
provide care and recreational facilities specialised for older persons need to be formulated.
While provision of institutional care may not be the best solution to this problem,
educating families with dependent older persons, promoting community care and
providing subsidies may be viable options. Whatever the arrangement is acceptable for the
care of the elderly, there needs to be a social security system for the financing of such
care.
Declining family sizes and nuclearisation of families are likely to disrupt the
present system of shared burden of caring for the elderly among several members of the
family, thereby adding to the burden of families, particularly women. While there is no
compulsory retirement age in the Maldives at present, establishment of such a system
needs to be encouraged.
18
6: Reproductive health
Maldives has made significant progress in attaining the population, reproductive health
and sustainable development goals set by the ICPD in 1994. Performance of the Maldives
in the main components of the ICPD goals is discussed in this section.
In the field of RH services, significant achievements have been made since ICPD, with the
provision of more hospitals at regional and atoll level as well as the upgrading of facilities
at island level health centres/health posts.
There is now improved access to health
personnel, including gynaecologists. RH/FP services have been strengthened and the role
of the private sector has improved in this area. Antenatal care, delivery care and IEC
interventions for RH have been improved, although there is a continued need for further
improvements in quality and access. The relative success of the RH programme is seen in
the decline in TFR and the increasing CPR. However, the unmet need for family planning
needs to be addressed, as do male involvement and participation in RH/FP.
Principle Four of the ICPD Plan of Action (PoA), establishes the essential linkage between
the advancement of gender equality/empowerment of women, and women’s ability to
control their own fertility. These are considered important cornerstones of population and
development programmes. Given the country’s relatively good status in terms of gender
equality, Maldivian women already enjoy a number of reproductive rights and freedom.
However, there is scope for further improvement. When current, female users of
contraception were asked which partner had decided to use contraception, 70 percent said
they made the decision together with their spouse, 15 percent said they made the decision
themselves and 15 percent said that their spouse made the decision. Nevertheless, women
continue to face certain inequities in the area of reproductive and sexual health due to legal
provisions and cultural attitudes.
The burden for contraception continues to fall on
women, with low utilisation of male methods and husband’s disapproval continuing to be
a primary cause for discontinuation. (Ministry of Health, 1999).
Although there is as yet no legislation related to RH/FP, a number of measures are being
implemented to ensure quality and use of RH/FP services.
Recent initiatives have
attempted to provide clear guidance on client rights and on standards to be met by service
providers. Several of these initiatives have been undertaken with UNFPA support.
19
The government has recently extended maternity leave to sixty days for government
employees in order to support women during pregnancy and childbirth and to promote
breast-feeding and better postnatal health. Women also have the option of taking leave
without pay for a period of one year to look after their babies.
Flexible working
conditions also allow women to continue breast-feeding and work. Fathers are granted a
seven-day leave when a child is born.
Despite this generally positive situation for
government employees, laws and regulations are not yet in place to facilitate women to
combine employment, child bearing, breast-feeding, etc in all the sectors. In this regard,
women working in the private sector are particularly disadvantaged.
The past and current National Development Plan (NDP) documents consistently reiterate
the government's continuing commitment to improving quality of life through the
expansion of RH/FP services. Successive improvements have been made in the provision
of services, especially for antenatal care (ANC). The recruitment of gynaecologists in
regional and atoll hospitals, and the construction of increasing numbers of health centres
and health posts, which provide a private space for consultations, have further contributed
to improving comprehensive RH services at the primary health care level.
The
reproductive health programme aims to deliver a package of comprehensive maternal and
child health services that include ANC and postnatal care; FP services, promotion of better
nutrition and access to essential obstetric care, care of the new-born, and promotion of
breast-feeding.
A number of local NGOs are currently working in fields related to population and RH.
SHE and FASHAN have both made notable contributions to improving RH, and SHE has
been instrumental in initiating the public provision of RH/FP services.
This NGO
continues to assist the RH programme considerably by providing services through clinics
in Male’, and with its regular mobile clinics in the islands. Its contributions have been
especially significant in the provision of information, education, and communication (IEC)
support on RH/FP issues and in raising public awareness. FASHAN has been active in
IEC activities relating to HIV/AIDS prevention. Two new NGOs have come into being
during the last two years and have been active in the health field. These are CARE
Society, whose main areas of focus are mental health and disabilities, and the Cancer and
Diabetes Society. These NGOs continue to face capacity constraints and limited access to
funds.
20
The RH programme is primarily managed by the Department of Public Health of the
Ministry of Health. At the island level, the Family Health Worker (FHW) and the
Foolhumaa (traditional birth attendants) provide health care services, after participating in
very basic pre-service training. In addition, the FHWs provide FP services at the island
level, which include condoms, pills, and injectables, at all islands, where upgraded FHWs
are available. FHWs and Foolhumaas work in either Health Posts or Family Health
Sections at the Island Offices. The Health Posts have better facilities such as separate
delivery rooms and separate areas for health promotion activities.
At the atoll level, health services are provided in Health Centres staffed by a medical
doctor, Community Health Worker (CHW), Nurse Midwives, Nurse Aides and other
clerical and support staff. The FHW and the Foolhumaa also work at the Health Centres,
on islands where these are found. The Health Centres provide curative, preventive and
promotive health care. Four Atoll Health Centres were upgraded to Atoll Hospitals in
2001, with improved and additional facilities such as an operating theatre. The services of
a gynaecologist and an anaesthetist have been made available at these hospitals to perform
Caesarian sections. Contraceptives provided at the atoll level include condoms, pills,
injectables and the intra-uterine device (IUD), where trained people are available. Most
atolls have more than one Health Centre. These centres and Atoll Hospitals each serve 510 islands.
At the regional level, health services are provided by the Regional Hospitals, located in six
geographic areas of the country, each serving 2-4 atolls. These Regional Hospitals deliver
secondary level curative services, including specialist services such as gynaecology,
paediatrics, internal medicine and surgery. The RH services at the Regional Hospitals are
integrated into routine and emergency services. Regional Hospitals are referral centres for
emergency obstetric cases from the atoll and island levels. The Public Health Units
(PHUs), established at the Regional Hospitals for health promotion activities, carry out
preventive and health awareness programmes.
At the central level, the Indira Gandhi Memorial Hospital (IGMH) and the private
hospital, ADK Hospital Pte. Ltd., provide tertiary medical care. A wide range of general
and specialist services is provided at this level. IGMH is the highest referral centre in the
country and caters to specialty care in obstetrics and gynaecology.
21
Safe motherhood initiatives focus on creating awareness about the risks to mothers and
infants associated with overly early, late, or closely spaced pregnancies. The aim is for all
pregnant mothers to receive a minimum of three antenatal check ups, followed by
deliveries that are without exception conducted or assisted by trained health personnel.
The training of health personnel is an integral part of this strategy. Improvements in
quality of care have been initiated, with the development of midwifery guidelines to be
used by health personnel in all facilities.
The country has made significant strides in improving RH services and providing wide
ANC coverage. The Multi-Indicator Cluster Survey (MICS) II of 2001 found that prenatal
care and medical advice are commonly sought during pregnancy (Ministry of Health,
2001). Over three-quarters of pregnant women were examined by a doctor during their
pregnancy. The RH Baseline Survey conducted in 1999 found that 88 percent of women
of reproductive age had at least one antenatal visit during their last pregnancy, and 62
percent had at least four. There is, however, room for improvement before meeting the
government target of 3 or more antenatal visits during each pregnancy for 100 percent of
pregnant women. The availability of better transport facilities over the last decade has
enabled quicker travel, and thus more frequent hospital attendance (regional and Male') for
antenatal check-ups and delivery. This increased rate of attendance is still influenced by
the proximity of home islands to service delivery points. About 48 percent of deliveries
are attended by doctors and over 22 percent attended by auxiliary nurse midwives/nurses.
However, it is a cause for concern that 44 percent of deliveries are attended by
Foolhumaas, whose level of training is very basic (Ministry of Health, 2001).
Despite the positive developments, transport difficulties such as high cost continue to be
major barriers to further improvements in maternal health, especially in remote/poorer
areas. While antenatal care coverage has increased substantially, a proportion of women
do not receive or have access to any antenatal care during pregnancy, and in some cases
face life-threatening situations at the time of childbirth. These women have to be targeted
by RH programmes as recipients of increased awareness and upgraded quality of
reproductive health services in these areas.
Nutrition amongst women and children and the population as a whole continues to be a
major challenge faced by the country. Although protein energy malnutrition is not at
present a public health concern, under-nutrition, stunting and wasting and micro-nutrient
22
deficiencies continue to be problems, despite intensified efforts to address these issues.
Anaemia amongst women continues to be another area of major concern that contributes
to an increased risk of premature delivery and low birth weight. According to the 19931994 National Nutrition Survey, nearly 68 percent of pregnant women were anaemic. The
anaemia levels have seen some improvements over the past few years, with the latest
figures showing anaemia amongst pregnant women to be 56 percent, with about 23
percent suffering from moderate anaemia (Ministry of Health, 2001). The RH programme
is ustilising some IEC measures to promote better nutrition for pregnant and lactating
mothers, including iron supplementation.
Numerous issues continue to inhibit the promotion of better maternal and child health.
The 1999 RH Baseline Survey found that less than half (46 percent) of pregnant women
took iron supplements during their last pregnancy, despite the fact that a stock of iron
supplements was available in 17 out of 19 health facilities visited. Given the situation of
high anaemia, it is a cause for concern that the proportion of women taking iron
supplementation is so low. The survey found that women who had regular antenatal visits
also took oral iron supplements during pregnancy. Women with some formal education
and women below 30 years of age were also more likely to take iron supplements. The
reasons why women are not taking iron need to be investigated further. Malnutrition and
Vitamin A deficiency are also areas where urgent action is necessary.
Additional
interventions including greater advocacy/IEC efforts are required to encourage women to
take iron supplements, improve their general nutrition, especially during pregnancy and
lactation. The quality of life of many women is greatly lessened due to ailments related to
or aggravated by pregnancy and childbirth.
These include conditions such as iron
deficiency aneamia and heart disease. In some cases women have to live with debilitating
conditions such as obstetric fistulae and uterine prolapse, which often result in rejection by
their husbands. Additional efforts are required to increase understanding of maternal
morbidity in the Maldives as well as to strengthen focused interventions to reduce
maternal morbidity.
Trained Foolhumaas (TBAs), FHWs and CHWs in the islands give a basic level of postnatal care. FHWs and Foolhumaas are expected to make home visits and advise on
breast-feeding, care of the newborn, immunisation and contraception. It is felt that general
post-natal care should be greatly strengthened, and counseling on exclusive breast-feeding
23
and breast-feeding support introduced. Information and counseling on nutrition, exercise,
and options for FP in the post-natal period also need to be provided.
Studies reveal that breast-feeding is almost universal in the Maldives with 97 percent of
children (under 5 years of age) being breastfed. Mean length of exclusive breast-feeding
is 3.9 months and supplementary foods are normally introduced from the fourth month.
There is a need to promote exclusive breast-feeding for up to six months and improve
weaning practices, since under-nutrition typically starts from the sixth month onwards.
There is still cause for concern due to the high number of low birth weight babies and
minimal knowledge on situations requiring immediate medical attention for infants.
Feeding practices during illnesses also need to be greatly improved.
The maternal mortality rate has been unacceptably high in the past. This was mainly due
to the fact that complications arising from pregnancy or during childbirth can only be
attended to in Male’, or to some extent in Regional Hospitals, and valuable time is lost in
transferring the patients in emergencies. This is because of the country’s geography and
lack of an adequate transport system, especially for emergencies. Qualified obstetricians,
anaesthesiologists and facilities for emergency surgery are now available at the regional
and atoll hospitals, eliminating the need for women to undertake long journeys to reach
appropriate health care facilities.
However, despite improvements, transportation
continues to be too costly for many.
Trained care during the antenatal period has increased, complications are diagnosed early
and patients are being referred to higher centres for management. As a result, the number
of maternal deaths has been decreasing over the past few years and has come down from
16 in 1997 to a total of 7 in the year 2001.
Male involvement and male responsibilities in population issues and RH has been largely
ignored until recently. The trend has been to focus on women as the target group for
RH/FP programmes. Consequently, the role, involvement and responsibility of men in
RH/FP have much scope for improvement.
According to the RH Baseline Survey, only 1 percent of the women interviewed noted
male sterilisation as their method of contraception, and about 6 percent reported the use of
condoms. Vasectomy is not very popular and there is little advocacy or promotion of this
method. Misconceptions about vasectomy should be addressed and this method promoted,
as some women are unfit to undergo sterilisation due to medical complications of
24
pregnancy. The burden for contraception continues to fall on women while their decisionmaking role remains somewhat limited. Future interventions are needed to promote male
methods of contraception.
Despite the previous low involvement of men in RH/FP, there have been some recent
positive developments. The recognition of male responsibility has led to a focus on men
as a target group in RH/FP awareness programmes. Certain trends also show the gradually
increasing involvement of men in the area of RH/FP. In Male’, the number of men
attending antenatal clinics with their wives has increased somewhat. More men are taking
an active interest and participating in the care of the mother and baby, but more emphasis
needs to be placed on increasing male motivation in RH/FP.
A national health promotion plan has been finalised and a number of steps taken towards
improvement and strengthening of RH IEC planning and coordination. With the focus
shifting towards preventive and promotive measures, there is a need to further strengthen
this area. There is also a need to review and assess the impact of IEC activities that have
been carried out in the past, including initiatives involving community volunteers. It is
necessary to continue the implementation of strengthened, target oriented IEC
programmes. The focus should be specifically towards men, women and adolescents. In
order to promote better RH and FP, IEC materials should be disseminated though printed,
audio-visual as well as electronic media. While significant investments have been made in
developing the required human resources through training, there is a need to continue
refresher in-service and pre-service training on RH IEC and counseling.
25
7: Adolescent reproductive health
The RH needs of adolescents are one of the most important areas requiring focussed
interventions for the future. In Maldives, adolescents (10-19 years) account for 27.5
percent of the population. However, adolescent RH remains one of the least addressed
areas requiring significant attention. Very little emphasis has been placed on specific
adolescent programmes including population and development, RH and gender.
A
rethinking and shifting of national priorities to place emphasis on adolescents would also
involve a re-thinking of the current Population Education focus.
Young people are greatly affected by the social environment where they live and grow up.
In today’s rapidly evolving environment, young people are exposed to a vast network of
information. Therefore, it is important to provide the right guidance about RH issues as
early as possible. The RH Baseline Survey of 1999 found that both boys and girls are
aware of a range of modern contraceptive methods and have a positive outlook on family
planning. They are aware of common sexually transmitted diseases and their knowledge
of HIV/AIDS is high.
Most adolescents have some knowledge and awareness regarding RTI/STDs and
HIV/AIDS, in terms of symptoms and methods of transmission. From the focus group
discussions during the RH Baseline Survey, it was clear that all groups were aware of how
HIV/AIDS is transmitted and their knowledge was generally accurate. One important
observation made in the RH Baseline Survey report was that in many (particularly male)
groups, researchers had to continue informal discussions and answer questions about
contraception, STDs and other reproductive health issues for quite sometime after the
group "officially ended". This reveals the huge thirst for knowledge and information
amongst adolescents.
The UNFPA supported Population Education programmes have met with some success.
Work has been undertaken to include reproductive health issues in the school curriculum
and teachers have been trained in ICPD and post-ICPD issues. However, it is believed
that the messages of this curriculum are not being adequately disseminated to students at
secondary level in many schools. There is, therefore, a need to build a more systematic
26
and effective programme for adolescents. Innovative approaches should be created to
satisfy the RH education needs of adolescents, both in and out of school.
The curriculum-based system does not respond well to changes in trends and the
emergence of new social issues. A large percentage of the secondary school age cohort
needs to be targeted through the non-formal approach. With the increase in the use of
tobacco and drugs, unprotected sexual relations, and unwanted pregnancies/ unsafe
abortions, it is necessary to use preventive interventions among adolescents. There is a
strong need to strengthen life skills amongst adolescents and provide sound information,
services, guidance and support.
The incidence and prevalence of HIV/AIDS is very low in the Maldives. The actual
confirmed incidence of HIV/AIDS in the Maldives remains at 11 cases amongst locals
since 1991. Nevertheless, there is a strong need for vigilance and coordinated intervention
for preventing its spread in the future (Jenkins, 2000). An assessment of the situation
shows that some risk factors could greatly worsen the future HIV/AIDS situation unless
action is taken now.
While the RH baseline survey reveals a high knowledge of
HIV/AIDS and its methods of transmission, knowledge alone is not sufficient protection
unless accompanied by behavioural change.
For this to occur, it is necessary for
individuals to participate in several sessions of awareness raising activities and effective
follow-up. While the country started off with a strong HIV/AIDS prevention programme
in the mid-1980s, the momentum has since dropped considerably, and because prevalence
is low there is some level of complacency. The programme now needs to be revised and
invigorated.
The risk factors for the spread of HIV/AIDS include a high rate of divorce and remarriage,
a growing trend of drug abuse among adolescents and youth, and tourism related factors
such as a large number of male employees staying away from home. The rate of sexual
partner exchange is one of the most important determinants of HIV epidemics. The high
levels of divorce and re-marriage, if linked with a high level of concurrent partners, can be
seen as risk behaviours that make an HIV epidemic possible. The main HIV/AIDS risk
related to tourism is the exposure of Maldivians to lifestyles other than their own,
accompanied by long periods of separation from families. Such migratory conditions
create considerable vulnerability for sexual transmission of HIV/AIDS. Transmission
from tourists is a risk at present. However, indigenous transmission may become a greater
27
problem in the future. Both the power differentials between the genders and female
physiology make women more vulnerable to infection. The growing drug abuse problem
is worrying, especially when linked to the low condom use in the country. The RH
Baseline survey revealed that of the women interviewed using FP methods, only 6 percent
use condoms as their method of contraception. It is therefore imperative that condom use
be promoted more strongly in the future.
The current HIV/AIDS programme needs to be strengthened in a number of ways. The
nature of surveillance as case detection is not satisfactory for an effective programme.
Testing should be done with informed consent and be accompanied by pre- and post-test
counseling. There is an urgent need for further research on the prevalence of RTI/STD
and strengthening of the RTI/STD programme, which the government is trying to address
with UNFPA support. If RTI/STD prevalence were known, the number of people exposed
through unprotected sex could be estimated.
Laboratory screening is important in
estimating the prevalence of RTI/STD, as many people either do not have symptoms or do
not recognise them. The overemphasis on maintaining confidentiality appears to increase
stigma.
There is also an over-reliance on fear, detection and arrest, and an overall
moralistic approach to control sexual behaviour.
Assessment of the HIV/AIDS situation (Jenkins, 2000) revealed that given the high levels
of awareness and low level of infection, there is no urgent need to act without adequate
preparation. The emphasis of the recommendations of the study focused on monitoring
trends and gaining understanding of factors leading to vulnerability and then designing,
funding and implementing cross-sectoral programmes aimed at reducing that vulnerability.
In this regard, the first steps recommended include the development of a new HIV
prevention policy, based on inter-sectoral policy discussions. It was also recommended
that research on attitudes and sexual behaviour is undertaken to better understand risktaking behaviours. The importance of a thorough study on RTI/STD prevalence was
emphasised as well.
28
9: Gender, equality and development
While Maldivian women enjoy higher social status and greater political and social
freedom than women in many other countries with similar social backgrounds, there are
several areas where urgent action is needed to improve women’s current status. Maldivian
women have been described as among the most emancipated in the Muslim world. This
favourable situation of women is reflected in positive rankings in the Gender-related
Development Index. Maldivian women have always kept their own name after marriage,
could remarry, inherit property, and mix relatively freely with men. However, several
factors, including the somewhat ‘patriarchal’ nature of society, and development processes
that favoured men’s entry into the modernising sector, have restricted the development of
women on par with the development of men.
Although the Constitution does not allow any form of discrimination between men and
women, in reality discriminatory practices exist in the society. These are manifested
mainly in areas such as marriage and divorce, property rights, and the provision of
evidence in courts of law. Other more abstract areas of subordination relate to perceptions
held by the society at large concerning the domestic roles of women.
Maldivian women have traditionally held the main responsibility of managing their
households, taking care of children and looking after older persons. This is a formidable
task in large, extended families. According to the 2000 census, the average household size
stands at 7 and person per room at 6.0. In Male’ and some of the other more populated
islands, large families have resulted in overcrowded households, making the provision of
food and other basic needs more difficult while contributing to health problems and social
tensions.
The media, as important tools for political participation, are largely controlled by men at
all levels. Men dominate newspapers and magazines in ownership, executive positions
and as journalists. The electronic media, which consist of Voice of Maldives (VOM) and
Television Maldives (TVM), have the widest audience in the Maldives partly due to the
geography of the country and the logistical difficulties in delivering newspapers printed in
Male’ to outside Atolls. While many women work at both VOM and TVM at programme
level and as presenters, few women have ever reached executive positions.
29
As part of its efforts towards gender mainstreaming, the Ministry of Women’s Affairs and
Social Security (MWASS) has been advocating for the greater participation of women in
political and other decision-making levels.
Advocacy has focused on improving the
representation of women at policy levels in the government as well as in public office.
In the private sector, there is little data available of the involvement/ representation of
women in businesses. Available data show a dearth of women entrepreneurs in the
country. Women are also unrepresented in the Maldives Chamber of Commerce, the
Maldives Traders Association and the Maldives Association of Tourism Industries, which
are the main organisations advocating the interests of the business community.
The Maldives has one of the highest divorce and remarriage rates in the world with little
or no stigma attached to these practices (Miralao and Ibrahim, 1991:18). During the
period of 1977 to 1981, the crude divorce rate doubled from 12 or 13 per 1,000 people to
25, with a higher incidence in Male’. In the year 2000, a total of 1,383 marriages and 749
divorces took place in Male’. Of these, 529 divorces were initiated by husbands, and 217
by wives. Another issue of concern has been the continuing early age of marriage,
especially among girls.
Number of measures have been taken to address gender issues in the country during the
past decade. The passing of the Family Law Act by the People’s Majlis in December 2000
is a milestone in protecting the rights of women and children in the Maldives. It is
expected the new law will help to reduce the high rate of divorce that has prevailed in the
past, and ensure that children are protected from paternal non-payment of child support.
The new act sets a minimum age for marriage (18 years), and also somewhat restricts
men’s right to enter into polygamous relationships.
General economic growth, which averaged 10 percent per annum over the late 80s and
stayed between 7 and 8 percent during the 90s, has considerably reduced widespread
poverty. However, as the VPA Report states, the main disparity lies between the atolls
and Male’, where income is about 3 times higher than in the rest of the country (VPA,
1998).
As part of the government’s poverty reduction strategy, many programmes have been
introduced to involve women in economic activities, particularly at the project level. The
MWASS, with technical assistance from the Bank of Maldives, conducts a small-scale soft
loan scheme under a United Nations Population Fund (UNFPA) project. As part of their
30
poverty alleviation interventions, the United Nations Development Programme (UNDP)
also supports micro-credit and income-generation schemes for atoll communities, which
focus especially on women. These programmes, which have been limited to selected
atolls, have met with considerable success.
One of the major challenges facing the
Maldives is the identification of viable business/ income generating opportunities for
women in the majority of atolls and islands, and the provision of training and support.
Further efforts are needed to create an enabling environment for such ventures.
The difference in level of nutrition between men and women indicate the nature of equity
and access between genders.
Mild and moderate forms of malnutrition have been
recognised as a problem amongst women and children in the Maldives for quite some
time. The situation of girl-children is of particular concern. It is believed that traditional
eating habits practised in most families may well have a negative impact on women and
girls.
The 1995 Survey on the Maldivian Girl Child conducted by the Ministry of
Women’s Affairs, Youth and Sports and the United Nations Children’s Fund UNICEF
indicates that 50 percent of girls have their meals after the boys and men (Ministry of
Youth, Women's Affairs and Sports, UNICEF, 1995).
The VPA (1998) has found that the extent of malnutrition is greater than previously
believed. Except in four atolls, 1 in 2 of all girls between the ages of 1-5 can be
considered stunted, compared to 1 in 3 amongst boys of the same age group. Iodine
deficiency is also emerging as a nutritional problem in the Maldives.
The girl child survey also concludes that while there is no overt discrimination against
girls, there are a number of areas where differences exist. Interviews with parents and
teachers, as well as girls and boys reveal that girls are expected to perform a range of
household tasks as opposed to boys. In general, parents wanted their daughters to grow up
to be teachers or health workers, or hold government jobs that are island based. More than
half of the girls and boys interviewed felt that girls have fewer opportunities for
employment in contrast to boys. In terms of health care and primary school enrolment
there are no disparities. Additional efforts are required to build the confidence of girl
children in order to work towards greater gender equality and equity.
With the support of UNICEF, the government has recently launched an innovative Early
Childhood Care and Development (ECCD) programme for early stimulation.
This
programme is based on the concept of the importance of the first three years of life and
31
focuses on the child’s cognitive, social and emotional development.
Based on the
indigenous culture and traditions, the programme is designed to address the child as a
whole and build the self-confidence of caregivers, who will in turn build the self-esteem
and confidence of their children. The programme is also designed to involve men as well
as women as positive role models for nurturers of young children.
A systematic effort towards addressing women’s empowerment in the Maldives dates back
over twenty years. Concern for the welfare of women is evident in the introduction and
implementation of programmes organised through women's networks to address social and
economic issues relating to women in the country.
Gender sensitisation and awareness raising on existing gender inequalities are major
components of GAD activities in the Maldives. The MWASS, which grew from a cell in
the President’s Office to a department, and finally to a full-fledged ministry, has played an
important role in advocating for gender equality and has carried out programmes/projects
in this regard. The development of IWCs, the establishment of the National Women’s
Council to advise and guide the development of policies for gender mainstreaming, and
the institutionalisation of women’s issues at the central level show steady development of
the institutional mechanisms for the advancement of women..
At the national level, continued efforts are being made to solidify women's role in
development by mainstreaming gender concerns across all social and economic sectors.
The most significant development in this regard is the preliminary establishment of a
Gender Management System (GMS) in the Maldives.
The GMS, pioneered by the
Commonwealth, is defined as a network of structures, mechanisms and processes put in
place within an existing organisational framework (such as national government). This
network is intended to guide, plan, monitor and evaluate the process of mainstreaming
gender into all areas of the organisation's work, in order to achieve gender equity within
the context of sustainable development.
Through persistent efforts towards strengthening inter-sectoral collaboration for gender
mainstreaming, the Gender Equality Council has been established with high-level
representation of all government ministries and departments. The Council is chaired by
the President.
Policies and programmes encouraging women to participate in development activities and
take up employment outside the home have tended to double women's burden of work.
32
This is due to the lack of simultaneous policies/programmes encouraging men's greater
participation in the private sphere.
In this regard, a more equitable distribution of
responsibilities within the home is necessary to achieve gender equality and women's
empowerment. Future programmes need to place greater emphasis on advocating for
greater male responsibility and involvement in the home.
The prevailing pattern of economic development also has negative consequences. Due to
several factors, such as the geographical layout of the country and certain cultural
customs, women of Maldives have been largely marginalized from participation in
development. This is in part a result of increasing household incomes across the country,
which enables the reinforcement of traditional gender roles within the family, in which
women work as caretakers of the family and household and men as the breadwinners.
(Niyaaz, 2000:390). Women’s participation in the labour force decreased from 62.3
percent in 1977 to 23.8 percent in 1985 and increased to 37.4 percent in 2000. This can be
explained as change in structure of the economy, from a predominantly fisheries based
economy to a tourism based economy.
33
10: Behavioral change communication and advocacy and
information and communication as tools for population
and development and poverty reduction.
a)
Behavioral change communication and advocacy
Awareness and advocacy through mass media and though informal education programmes
have played a key role in the attainment of several international population goals in the
Maldives. The government continues to use these means to promote population and
development issues such as, gender, reproductive health, male participation, adolescent
sexual and reproductive health (ASRH) and STDs including HIV/AIDS.
Advocacy on ASRH include RH interventions such as research on adolescent issues as
well as the life skills development programme. The focus is on promoting responsible
sexual and reproductive behaviours, including responsible parenthood, and tackling issues
such as adolescent fertility, unsafe abortions, STDs and HIV/AIDS.
The media can play an important role in promoting men's role as partners of women in
RH/FP issues and in childcare/domestic responsibilities. This could be undertaken by
presenting role models and programmes encouraging greater sharing of domestic
responsibilities.
b)
Information and communications technology
The health information system of the government needs to be greatly strengthened for
future use. The present national system collects a considerable amount of data through
various reporting forms, registers and surveys. However, only a small proportion of this
data is processed and analysed for effective, evidence based management decision-making
and for wider dissemination.
The main reason for under-utilisation of valuable
information is inadequate capacity at the different levels of the information management
chain; namely data collection, data storage and retrieval, as well as the capacity to analyse
and present information. The information flow system also needs to be strengthened with
appropriate technology and networking.
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The national educational system places high priority on reducing the digital divide by
seeking to provide computer and internet access to all schools in the country. Provision of
telephone access to all inhabited islands during the past decade has been a major
achievement in this respect.
The government is encouraging the private sector to
contribute to this process.
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11: Data, research and training
Population and development data is collected through the quinquennial censuses and
various surveys conducted by the different departments of the government. In addition to
these sources, regular administrative procedures collect large amounts of data at the island
level. Only a fraction of the available data gets analysed and disseminated for policy
purposes. Strengthening of data analysis and dissemination needs to be encouraged with
urgency.
Due to the lack of research institutions focusing on social and economic development
research in the country, there is a general dearth of research facilities and expertise
available. It is important to create such institutional capacity in order to facilitate wellinformed policy making on population and development. Collaborative research with
internationally renowned institutions in the field would be a useful approach to establish
such a facility in the country.
The human resources development programme of the government provides opportunities
for undergraduate and post-graduate training in overseas Centres of Excellence in several
areas of relevance for population and development research. For those involved in such
research, specific training is needed in the form of hands-on training to conduct policy
research and prepare papers and documents for dissemination.
The issue of human resource development is often singled out as the biggest constraint to
development efforts in the Maldives. Both the government and its development partners
have made significant investments towards human resource development; nevertheless,
the success or impact of these investments seems to be low. It is necessary to determine
whether a more effective and efficient system could be instituted for knowledge transfer.
The human resource development issue needs to be reviewed and urgently addressed.
Most of the population data collected in the country is obtained through a decentralized
system of data collection, which provides the possibility of generating island level crosstabulations. However, most analytical exercises focus on broad levels of urban and rural
regions. Island level analysis is needed to formulate effective policies to address the needs
of the widely scattered population of the country.
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