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State of World Population 2012 - UNFPA Haiti

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people in mobile, temporary, and resource-poorsettings manage their fertility (United NationsHigh Commissioner for Refugees, 2011).Potential beneficiaries <strong>of</strong> family planningservices may feel alienated by their providersat moments that compromise their long-termhealth. For example, in communities with highlevels <strong>of</strong> 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 <strong>of</strong> their lives in poor,hard-to-reach, or other stigmatized communitiesdo not always benefit from the full range <strong>of</strong>approaches to distribution (UNHCR, 2011).These include the safe, community-based provision<strong>of</strong> injectables and intrauterine devices thatthe <strong>World</strong> Health Organization has approved foruse (<strong>World</strong> Health Organization, USAID andFamily Health International, 2009).CASE STUDYTajikistanTajikistan has worked to overcome a lack <strong>of</strong>information and services, particularly in ruralareas. Through the joint efforts <strong>of</strong> <strong>UNFPA</strong> andthe Ministry <strong>of</strong> Health, Tajikistan has improvedthe access <strong>of</strong> vulnerable populations to familyplanning. Family planning information andservices are being provided in the context <strong>of</strong>comprehensive and quality reproductive healthservices and information, a key stipulation <strong>of</strong>the ICPD Programme <strong>of</strong> 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 <strong>of</strong> methodsand relied on health workers to promotethese methods. Many people were pressured oreven coerced into using long-term or permanentmethods <strong>of</strong> family planning, and the approachrestricted access to the full range <strong>of</strong> 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 <strong>of</strong> broader reproductiveand child health services, and that built on planningat the local level based on an assessment <strong>of</strong>women’s need for services (Murthy et al., 2002).Though shifting a massive national programmeis a slow process, increasing the range <strong>of</strong> 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.©<strong>UNFPA</strong>/Antonio FiorenteTHE STATE OF WORLD POPULATION <strong>2012</strong>67

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