State of World Population 2012 - UNFPA Haiti

people in mobile, temporary, and resource-poorsettings manage their fertility (United NationsHigh Commissioner for Refugees, 2011).Potential beneficiaries of family planningservices may feel alienated by their providersat moments that compromise their long-termhealth. For example, in communities with highlevels of HIV, alienating experiences amongyoung people from select castes or ethnic groupscan dissuade them from accessing services atcritical moments in their sexual and reproductivelives (United Nations, Economic and SocialCouncil, 2009a). Ethnic minorities, people fromlower castes, and sex workers who may spendconsiderable portions of their lives in poor,hard-to-reach, or other stigmatized communitiesdo not always benefit from the full range ofapproaches to distribution (UNHCR, 2011).These include the safe, community-based provisionof injectables and intrauterine devices thatthe World Health Organization has approved foruse (World Health Organization, USAID andFamily Health International, 2009).CASE STUDYTajikistanTajikistan has worked to overcome a lack ofinformation and services, particularly in ruralareas. Through the joint efforts of UNFPA andthe Ministry of Health, Tajikistan has improvedthe access of vulnerable populations to familyplanning. Family planning information andservices are being provided in the context ofcomprehensive and quality reproductive healthservices and information, a key stipulation ofthe ICPD Programme of Action. Tajikistan hasaccomplished this shift through building capacity,conducting awareness-raising campaigns, providingcontraceptives and ensuring there is adequateequipment to support quality services.CASE STUDYIndiaIn keeping with its demographic goals, India’sfamily planning programme had in the 1970sestablished targets for a narrow range of methodsand relied on health workers to promotethese methods. Many people were pressured oreven coerced into using long-term or permanentmethods of family planning, and the approachrestricted access to the full range of methods.Evidence existed, however, that unmet needcould be addressed without resorting to targetsby making supply respond more effectively tolocal needs. In response, the Government developeda new framework that provided familyplanning in the context of broader reproductiveand child health services, and that built on planningat the local level based on an assessment ofwomen’s need for services (Murthy et al., 2002).Though shifting a massive national programmeis a slow process, increasing the range of methods,managing health workers in a less directiveway, and making the programme more responsiveto local needs has contributed to increasingdemand for family planning.tHealth extensionworker dispensesfamily planning in anEthiopian village.©UNFPA/Antonio FiorenteTHE STATE OF WORLD POPULATION 201267