ROADMAP TO

ACHIEVING ZERO
UNMET NEED IN THE
PACIFIC
Olanike Adedeji
Technical Specialist RHCS, Pacific Sub-
Regional Office
20th July 2020
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 Problem Statement

Methodology

OUTLINE Country Categorization for Unmet Need

Solomon Islands FP Opportunity Brief

Policy Recommendations
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Problem Statement
• As at 2015, analysis of Demographic Health Surveys in countries indicated
that 64% of married or in-union women of reproductive age worldwide were
using some form of contraception. However, contraceptive use was much
lower in the least developed countries (40%) and was particularly low in
Melanesia, Polynesia and Micronesia (39%).
Source: United Nations, Department of Economic and Social Affairs, Population Division (2015). Trends in
Contraceptive Use Worldwide 2015 ST/ESA/SER.A/349).

• As at 2019, 48.5% of women of reproductive age globally are using a method

of contraception whereas this is only 28% in low income countries and 30.9%
in least developed countries.
Source: United Nations, Department of Economic and Social Affairs, Population Division (2019). Contraceptive
Use by Method 2019: Data Booklet (ST/ESA/SER.A/435).
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Problem Statement Cont’d

• It is extremely concerning that the Pacific is the region with the highest level of
unmet needs for Family Planning in the world at 25%, even more than Sub
Saharan Africa at 23%. The remoteness of many of the outer Islands and atolls in
Pacific Island Countries poses an on-going challenge to provide universal access
to sexual and reproductive health services.
Source: Population Reference Bureau, 2019 FAMILY PLANNING DATA SHEET

• As at 2015, the DHS data analysis indicates that in the Pacific, unmarried women
who are sexually active have a far higher total demand for family planning (93%)
and a much greater unmet need (83%) than married women (64% who have a
total demand, and 35% who have an unmet need).
• This unmet need is particularly high for 15–19 year old at 91%.
• Only one in ten sexually active unmarried women have their family planning
demand satisfied (10%) compared with almost five in ten married women (46%).
Source: United Nations, Department of Economic and Social Affairs, Population Division (2015). Trends in
Contraceptive Use Worldwide 2015 (ST/ESA/SER.A/349).
Methodology

Phase 1 – Mapping and analysis of regional and Country level current situation and trends of
unmet need.
Phase 2 – Inventory of evidence based interventions and high impact practices that have
demonstrated to deliver on reduction of unmet need in diverse circumstances and contexts
(including case studies).
Phase 3 – Identifying accelerators and developing a road map to achieving the aspiration goal
of zero unmet need. A categorization model is developed to guide efforts to accelerate
progress to reduce unmet need for Family Planning to zero by 2030.

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 Rationale for Country Categorization

• The country categorization model is designed to identify the areas where countries can
accelerate progress towards reducing unmet need for FP to zero by 2030

• By grouping countries with similar opportunities to accelerate progress, countries will be able to
guide its programmatic efforts by prioritizing a recommended set of interventions that can be
implemented at the country level in response to similar needs, context and opportunities.

• More importantly, to guide national strategies in planning and tracking a path to reduce unmet
need

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 Methodological Approach/Philosophy

• Philosophy is to build on existing structures and systems e.g. Business Model; Global FP
Strategies; Connectors of the Nairobi Submit; FP2020 data/products, etc.

• Projections of unmet need in 2030 place countries across 5 categories of unmet need.

• This grouping does not necessarily mean that countries will share the same path – not all
countries in the high unmet need category will progress together.

• Countries across the range of unmet need share common barriers and opportunities.

• By categorizing by these sets of common characteristics, rather than on their current level of
unmet need, UNFPA’s investments can positively impact countries across the spectrum,
pushing some countries across the goal line while also helping to bring along those who
may otherwise be left behind.

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 Issues and Themes for Categorization
UNFPA Business Model Categorization
• FP Policy Environment
Enabling the • Restrictive Policies (Youth)
Unmet Need Environment • Gender Equity/Inequity
• Financial Access for Sustainability
• Donor Dependence & Sustainability
Low - Fertility
Fulfilling Reproductive • Increasing Demand
• High Potential for Accelerated Improvement
Health Intentions
Humanitarian
Context Securing Supplies/ • Commodities Security
• Products Availability
Expanding Choice
Youth • Quality of Service
Population Enabling Access for All
• Measurements & Information Systems
• Healthcare Provider Coverage
• Rights-based Access to FP Services
Small Island • Youth Access
States Leaving No One Behind • Subnational Disparities
• Access in Humanitarian Contexts

Cross-Cutting Issues Priority Themes Topics for Categorization 8

 Indices and Data Sources for Categorization
Priority Themes Topics For Categorization
UNFPA B/M
Unmet Need
Low Fertility
Cross Cutting Issues
Humanitarian Context
Youth - Population Structure
Small Population/Island States
FP Policy Environment
Restrictive Policies (Youth)
Enabling the Gender Equity/Inequity
environment
Financial Access for Sustainability
Donor Dependence (Sustainability)
Increasing Demand
Fulfilling Increasing Demand
reproductive health
intentions Countries with very high potential for
accelerated improvement
Commodities Security
Commodities Security (2)
Securing supplies &
expanding choice Products Availability
Products Availability (2)
Quality of Service
Measurements & Information Systems
Enabling access for
all
Healthcare Provider Coverage
Right-based access to FP Services
Youth Access
Leaving no one
Subnational Disparities
behind
Access in humanitarian context
Selected Indicator(s) Source
UNFPA Business Model Country Categorization UNFPA
% of WRA with an Unmet Need for FP in 2030 UNPD WPP 2017
Total Fertility Rate in 2019 UNPD WPP 2017
Inform Index "Risk Class" Inform Index
% of WRA who are Youth (15-24) in 2020 UNPD WPP 2017
UN Small Island Developing States (SIDS) UN SIDS
FPE Policy Score FPE (Avenir Health)
Average Rating : Are their policies in place to prevent discrimination against Youth / Unmarried
NCIFP (Avenir Health)
Women
Gender Inequality Index UNDP HDI
Health Equity and Financial
"Catastrophic Spending on Health" : Proportion of population spending more than 10% of household
consumption or income on out-of-pocket health care expenditure (%) Protection Indicators (HEFPI) ; World
Bank Data Bank
% of Public Sector Commodity Expenditure provided by Donors Commodity Gap Analysis 2019
Track20 Demand Curve Categorization DHS
% of Users discontinuing while in need DHS
"High Potential for Growth" based on 1) TFR vs Ideal # of Children, 2) Intention to use among non- DHS
users, and 3) Current mCPR
Average rating : Contraceptive Logistics and Transport Systems NCIFP (Avenir Health)
Average central level stockout rate for contraceptive products Contraceptive Securities
Average Rating : Accessibility of STMs/LAPMs NCIFP (Avenir Health)
Average Facility Level Stockout rate for contraceptive products UNFPA Facility Surveys/
Contraceptive Securities
Method Information Index DHS/PMA2020
Data Score (average of "Data" focused elements for NCIFP) NCIFP (Avenir Health)
World Bank World Development
Nurse/Midwife Density (# of Nurses and Midwives per 1000 Population)
Indicators
Disparity in Unmet Need by wealth, residence, and education DHS/MICS/PMA2020
Disparity in Unmet Need between Youth and Overall WRA DHS/MICS
Disparity in Unmet Need between region with the highest and lowest unmet need (MW) DHS/MICS
Access to health care Index (Inform Index) Inform Index
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 Categorization of Countries by 2030 Unmet Need
Low Low-Middle Middle Middle High High
(<10%): (10-14%) (15-20%) (20-24%) (25%+)
Albania, Antigua and Barbuda, Afghanistan, Burkina Faso, Angola,
Algeria, Argentina, Anguilla, Belize,
Bahamas, Bahrain, Armenia, Azerbaijan, Barbados, Cameroon, Congo, Burundi, CAR, Benin,
Bangladesh, Belarus, Bolivia, Bosnia and Herzegovina, Cook Islands, Chad, Côte d'Ivoire, Comoros,
Bhutan, Brazil, Cambodia, Botswana, Cabo Verde, Dominica, Ethiopia, Fiji, Djibouti, Gabon, DR Congo,
Chile, China, Colombia, Egypt, Eswatini, Georgia, Kyrgyz Republic, Equatorial
Ghana, Guinea-Bissau, Guyana,
Costa Rica, Cuba, Guatemala, India, Indonesia, Iraq, Libya, Maldives, Kiribati, Liberia, Guinea,
Dominican Republic, Jordan, Kazakhstan, Kenya, Nepal, Niger, Eritrea,
Mali, Mozambique,
DPR Korea, Ecuador, Kuwait, Lao PDR, Lebanon, North Macedonia,
Nauru, Nigeria, Gambia,
El Salvador, Grenada, Lesotho, Madagascar, Malawi, Pakistan, Palau,
Malaysia, Marshall Islands, Oman, PNG, Guinea,
Honduras, Iran, Jamaica, Suriname, Tajikistan, Tanzania,
Mexico, Morocco, Moldova, Mongolia, Montserrat, Trinidad and Tobago, Sao Tome & Principe, Haiti,
Nicaragua, Paraguay, Peru, Myanmar, Namibia, Panama, Vanuatu, Yemen Saudi Arabia, Senegal, Mauritania,
Sri Lanka, Thailand, Philippines, Qatar, Rwanda, Samoa,
Sierra Leone,
Tunisia, Turkey, Ukraine, Saint Kitts and Nevis, Saint Lucia, South Sudan
Saint Vincent and the Grenadines, Solomon Islands,
Uruguay, Uzbekistan, Sudan,
Venezuela, Viet Nam, Serbia, South Africa, State of Palestine, Somalia, Timor-Leste, Uganda
Syria, Turkmenistan, Togo,
Zimbabwe
United Arab Emirates, Zambia Tonga

Among UNFPA Supplies Countries – almost 1/3 are projected to fall into the 2 highest Unmet Need categories by
2030 – with more than 20% of Married Women experiencing an Unmet Need for FP.
These countries will require significant effort to contribute to the goal of eliminating unmet need
FP Database & FP Country Opportunity Briefs: Overview

• FP database: contains key data for indicators for Family Planning for UNFPA
programme countries

• FP Country Opportunity Briefs: for each UNFPA programme country, a FP Country

Opportunity Brief can be generated from the FP database

• Data-driven snapshot: The Briefs provide an up-to-date snapshot of progress and

remaining challenges across FP and related areas and are designed to be used—
principally—by UNFPA Country Offices to engage in targeted, data-driven dialogue
with the Government and other in-country partners and stakeholders

• Global Pubic Good: The Database and Briefs will be maintained, updated periodically
and made available to all interested parties in support of efforts to end unmet need

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Solomon Islands Country Context

• Archipelago of >900 islands in spread across

1.3 million square kilometres.
• 6 major islands (Choiseul, Guadalcanal,
Malaita, New Georgia, Makira, and Santa
Isabel)
• 9 administrative provinces & 50 constituencies.
• 79% are rural dwellers.
 Primary
Health Care
facilities
(Health Secondary level Tertiary
Clinics, facilities level
Nursing Aid (Reproductive facilities Private
Provinces Divisions Posts) Health Clinics) (Hospital) Hosp Total
Choisuel 3 15 9 0 24
Western 6 38 23 0 61
Health Isabel 4 26 10 0 36
Central 0 1 21 1 23
System
Overview Rennell-Bellona 0 1 2 0 3

Guadacanal 5 37 13 2 52
Malaita 5 58 22 2 82
Makira 5 37 14 2 53
Temotu 5 11 5 1 17

Total 33 224 119 8 - 351

Percentage

T: 45
%
(2020)
Source: Country DHS Reports
 Percentage
Percentage

Unmet need for FP in Married Women

disaggregated by Wealth Quintile Unmet need for FP in Married women
40 disaggregated by Residence
35 40
30 35
25 30
20 25
15 20
10 15
5 10
0 5
Lowest Second Middle Fourth Highest 0
Urban Rural
Solomons Islands DHS 2007
Solomons Islands DHS 2007 Solomons Islands DHS 2015
 8,740 18,240

• The contribution to CYP of Jadelle has more than doubled

between 2017 and 2018 (from 8,740 to 18,240)
 Solomon Islands Summary
 Unmet need tripled & total demand doubled without significant change
in CPR.
 Discontinuation rates are very high
 Unmet need very high amongst adolescents and sexually active
unmarried women & access to contraceptive services negligible with no

 Question and
improvement over time.
Women in rural areas have higher CPR and slightly lower unmet need


Answer
than women in urban areas.
Knowledge about contraceptives need to be improved, more so among
men and boys.
FP Country Opportunity Briefs
(page 1)
Country briefs provide detailed summaries of the priorities
identified through the categorization process

• Provides a snapshot of Headline Figures and Overarching Themes

for consideration in programming & investment decisions

Example: In Solomon Islands, it is projected that 23% of married

women will have unmet need for FP in 2030 based on current
trends; while 39% of women of reproductive age are under 25 –
how can programming and investments be planned to best function
in this context

• Details priority areas to aid data-driven investment discussions

Example: In Solomon Islands , High Potentials for Acceleration due

to difference between Wanted Fertility and Total Fertility Rate,
Quality of Care of Providers and levels/extent of rights based
access are highlighted as is demand generation and the need to
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focus on unmarried youth. 50% data not available*
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 POLICY RECOMMENDATIONS
1. Enabling Environment - Create a sustainability strategy as integral part of rights-based FP
programme, integrated within health budgeting processes and financing schemes
2. Fulfilling Reproductive Health Intentions – Analyze and assess ongoing demand-side
activities in order to evaluate their coverage and impacts.
3. Securing Supplies & Expanding Choice - Address distribution and other challenges to
ensure reliable access to contraceptives and lifesaving MH medicines to the last mile,
including in humanitarian settings
4. Availability of quality human rights-based FP services - Undertake rights- and skills-based
training to strengthen capacity for counselling, provider-client exchange and service delivery,
and to promote client’s autonomy to choose the methods themselves, including method
switching
5. Leaving No-one Behind - Ensure enabling policy and legal landscape that facilitate full
participation of young people for equitable and universal access to comprehensive SRH
information and services.
6. Data Availability - Ensure availability and analysis of disaggregated data to ensure focused
rights-based interventions to meet the needs of all groups.
 Q&A

Question and
Answer