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 Thailand and Family Planning: An Overview
 Background                                                   Figure 1: Population Pyramid Thailand
 The Thai government established its first                 75-79
 Population Policy in 1970. As a result of
 participation in the 1994 International
 Conference on Population and Development                  60-64    Male                        Female
 (ICPD), reproductive health policies were
 reviewed by the National Family Planning
 Committee. In 1997, the Minister of Public                45-49
 Health set forth the National Reproductive
 Health Policy, which includes family planning and   Age
 maternal and child health.                                30-34


 As of July 2003, Thailand’s population was 63.2
 million. As Figure 1 shows, 25% of the population         15-19
 is under the age of 15. About 66% of the
 population lives in rural areas and the majority
 are farmers reliant on subsistence agriculture.             0-4
 The urban population is, however, increasing.                                   Percent
 Sweeping social changes have had an impact
                                                     Source: UNAIDS, 2002
 on sexual lifestyles; there has been an increase
 in pre-marital sex, unwanted pregnancies,
 unsafe abortions, and the transmission of HIV       Almost all of the contraceptive methods
 and STIs.                                           used in Thailand are modern methods. Oral
                                                     contraception is the most popular method.
 Situation Analysis                                  According to users, it is easy, convenient,
                                                     inexpensive, and accessible at drug stores.
 Examples of progress made:                          As shown in Figure 3, female sterilization is
  When Thailand started its National Family         the second most popular method followed by
    Planning Programme in 1967, the total            injectables, which are increasing in popularity.
    fertility rate (TFR) was 6.3. By 2003 TFR        Methods for men are not widely used.
    was reduced to below replacement level, at
    1.7.                                           Of the women using contraception, 68.6% said
  Over the last 30 years, Thailand’s annual       they did so because they did not want more
    population growth rate decreased by more children, 30.5% said they wanted to space
    than half; in 1970 it was 3.3%                              their births, and 1% said they had
    and by 2003 it was 0.8%.                                    health problems.
                                       The transformation
  In 1970, the contraceptive
    prevalence rate (CPR) was           in attitudes and        Elements that have contributed
    14.4%. Since then, CPR             behaviour, and the       to the success of Thailand’s family
    has continuously increased,          rapid decline in       planning programme include:
    reaching 79.2% in 2000.             fertility over the       Family planning has been a
                                      past several decades        government priority, in policy
 Figure 2 shows the trend in          have been described         and implementation. It has been
 specific contraceptive methods        as a “reproductive         integrated with other public
 used.                                                            health services in existence,
                                           revolution”.
                                                                  especially MCH.
                     Figure 2: Trends in Contraceptive Method Use                                                                                                sector have facilitated work that the
                                                                                                                                                                 government alone would not have been able




                                                                                                                    78.9




                                                                                                                                                      79.2
                     90                                                                                                                                          to provide. Government support of this work




                                                                                                                                               72.2
                                                  1987




                                                                                                             69.8
                     80                           1997                                                                                                           comes in the form of technology, funds,




                                                                                                                                            61.8
                                                                                                                                                                 contraceptives, and medical equipment.




                                                                                                      60.1
                                                  2000
                     70
% of Married Women




                     60
                                                                                                                                                                University-based research has facilitated
                     50
                                                                                                                                                                 acquisition of data.
                     40
                                                                                                                                                                Integration    with    other    development
                                                                                                                                                                 programmes, including agriculture, education,
                                 26.8




                                                                        22.6
                              23.1




                                                                        22.3




                     30
                                                                                                                                                                 and community development, has increased
                                                                        22
                                             22
                                          17.7
                          17.3




                                                                                                                                                                 the demand for family planning.
                     20
                                        7.8




                                                                 6.4




                                                                                   5.3




                     10
                                                               3.2
                                                               3.1




                                                                                                                           2.4
                                                                                               1.8
                                                                                               1.7




                                                                                                                           1.7
                                                       1.5




                                                                                         1.2




                                                                                                                                      0.3
                                                                                          2


                                                                                               1
                                                  0
                                                  0




                     0
                            Pill        Injectables Implants    IUD     Female         Male       Condom  Any                 Any       Other   Any
                                                                      sterilization sterilization        modem             traditional methods method
                                                                                                         method             method
                                                                           Method Used                                                                               Rapid change and urban migration
                                                                                                                                                                      have had a disruptive effect on
                            Source: Thailand DHS, 1987;1997; Thailand Reproductive Health
                            Profile, 2003, Unpublished                                                                                                                       social structures.



                                       Family planning services are extensive.                                                                              Although a period of fast economic and social
                                        Methods of contraception have been provided                                                                          transformation improved the quality of life, there
                                        conveniently, largely free of charge, without                                                                        is now evidence that the income disparities both
                                        incentives, and with controls for quality and                                                                        within and between regions and populations are
                                        safety.                                                                                                              widening.
                                       A range of health care providers have been
                                        involved in implementing family planning                                                                             Current Family Planning Efforts
                                        programming, from physicians to midwives.
                                        This enables the government to expand                                                                                The Thai Government, led by the Prime
                                        services from the district to the community                                                                          Minister’s Thai Rak Thai party, won the last
                                        level, providing convenience to clients and                                                                          national election on a pro-poor, pro-rural, and
                                        more choices in contraception.                                                                                       pro-Thailand platform. Since its installation, the
                                       Partnerships with NGOs and the private                                                                               government has focused on five programmes,


                                                               Figure 3: Contraceptive Method Use by Married Women in Thailand, 2000
                                                                                                 Other methods: 0.3%                                                             Not using any
                                                                      Condom: 1.7%                                                                                               method: 20.8%

                                                                      Male sterilization:                                                                                            Pill: 26.8%
                                                                      1.2%


                                                                      Female
                                                                      sterilization :
                                                                      22.6%




                                                                                                                                                                                   Injectables: 22%

                                                                                           IUD: 3.1%                                                          Implants: 1.5%


                                                             Source: Thailand Reproductive Health Profile, 2003, Unpublished
including providing universal health care to                                                              Key Indicators:
the population at 30 baht per visit. The
                                                                                                              Total Population, 2003 (in millions)       63.2
government is in the process of implementing
its medium-term strategies through the Ninth                                                                  Population Growth Rate, 2003               0.8%
National Economic and Social Development Plan                                                                 Population Density, 2003 (people per
                                                                                                                                                          122
(2002-2006).                                                                                                  square km)
                                                                                                              Urban Population, 2003                      34%
The present National Plan clearly recognizes                                                                  Population <15 years of age, 2003           25%
reproductive health. Strategies identified                                                                    Total Fertility Rate (TFR), 2000-2005        1.7
include:
                                                                                                              Contraceptive Prevalence Rate (CPR),
 Maintain fertility at replacement level by                                                                                                            79.2%
                                                                                                              2000
    fostering knowledge and understanding,
    providing health education and information,                                                                 -   Pills                                26.8
    and integrating reproductive health and                                                                     -   Injectables                          22.0
    family planning;                                                                                            -   Implants                               1.5
 Disseminate        population knowledge into                                                                  -   IUD                                    3.1
    education curriculum at every level; and                                                                    -   Female Sterilization                 22.6
 Promote life skills learning, sex education,
                                                                                                                -   Male Sterilization                     1.2
    family education, and equitable gender roles.
                                                                                                                -   Condom                                 1.7
With regard to family planning, the Thai                                                                        -   Other Methods                          0.3
government aims to:                                                                                           Unmet Need                                 5.9%
 Accelerate family planning efforts in areas                                                                 Average age at first marriage, 2003        23.5
   where TFR is still high and CPR is low;                                                                    Average age at first birth                   N/A
 Provide services for married and unmarried
                                                                                                              Crude Birth Rate (CBR) (per 1,000
   male and female youth, specifically aiming to                                                                                                         19.6
                                                                                                              population), 1995-2000
   reduce adolescent pregnancy;
 Promote a three-year birth space interval;
                                                                                                              Maternal Mortality Ratio (MMR), 2000      36.46
 Monitor quality of services;                                                                                Infant Mortality Rate (IMR), 2000-2005       20
 Promote male involvement in family planning;                                                                HIV adult prevalence, 2002                 1.8%
   and
                                                                                                              Better meet the needs of specific populations,
          Figure 4: Population Projection: Thailand                                                            including ethnic minorities, such as Muslims,
             4.9
                                                                                                               migrant workers, slum dwellers, and the
      5
                                 TFR
                                                                     72.8
                                                                            80
                                                                                                               under-served.
                                 Total Population            72.1


                                                                            70
                                                    63.1

      4
                                    57.8
                                                                            60                                    The government has an integrated
                          50.6
                                                                                                                   development policy of population,
                                                                            50
      3                                                                                                             environment and maternal and
                                                                                 Population in Millions




                                                                                                                            child health.
TFR




                   41.3                                                     40
                           2.3


      2                                  1.9
                                                                            30
                                                       1.7


                                                                                                          The Ministry of Health is the main provider of
      1
                                                                            20
                                                                                                          family planning services in the country.
                                                                            10

                                                                                                          Challenges and Opportunities
      0                                                                     0

            1976          1987         1994         2004     2025   2050
                                                                                                          1. Inadequate number of health personnel.
Source: World Population Policies, 2003                                                                      The number of health personnel in Thailand
    is inadequate, especially for deployment at                           access to services. The Southern region
    the health centre level (tambon/sub-district                          of Thailand still has: low CPR and high TFR;
    level). According to staffing patterns (1995-                         limited reproductive health information and
    1997), each health centre should have five                            services for unmarried youth and weak male
    staff members yet the average is only three.                          involvement.
    There are wide regional disparities, with
    the lowest numbers of health personnel                             3. Decreasing use of male contraceptive
    in the Northeast, followed by the North.                              methods. Use of male contraceptive methods
    Shortages of health personnel are also due                            is low and decreasing. Generally, Thai women
    to ill-distribution of staff, designators and                         take the responsibility of limiting or spacing
    transfers.                                                            births. Myths regarding condoms and
                                                                          vasectomies abound, and that Thai men do
2. Low access to family planning services in                              not like to use condoms for family planning as
   Southern region. While Thailand has been                               they associate them with preventing sexually
   overall successful with its family planning                            transmitted diseases and HIV.
   programming, there are still disparities in




Sources
1. Epidemiological Fact Sheet on HIV/AIDS and Sexually                 6. “Thailand Reproductive Health Profile” by Reproductive Health
   Transmitted Infections: Thailand, 2002. UNAIDS, UNICEF &                Division, Department of Health, Ministry of Public Health,
   WHO.                                                                    Thailand. With support from WHO. Unpublished, 2003
2. Thailand Country Profile, 2003. International Planned               7. Thailand, USAID Country Profile, 2003: http://www.usaid.gov/
   Parenthood     Federation:      http://ippfnet.ippf.org/pub/IPPF_       pubs/cbj2003/ane/th/
   Regions/IPPF_CountryProfile.asp?ISOCode=TH                          8. World Contraceptive Use, 2003, United Nations, Population
3. Thailand Demographic and Health Survey, 1987; 1997.                     Division, Department of Economic and Social Affairs.
4. Thailand Country Health Profile, WHO/SEARO, 2003: http://           9. World Population Data Sheet, 2003. Population Reference
   intranet/cntryhealth/thailand/index.htm                                 Bureau. www.prb.org
5. Thailand Health and Population, World Bank. http://www.             10. World Population Policies, 2003. United Nations, Population
   worldbank.or.th/                                                        Division, Department of Economic and Social Affairs.




                                      For Further Information please contact:
                                   The Department of Family and Community Health
                                             World Health Organization
                                         Regional Office for South-East Asia
                                                World Health House
                                                Indraprastha Estate
                                               Mahatma Gandhi Marg
                                             New Delhi - 110002 India
                                               Email: fch@whosea.org
                                                  www.whosea.org
                                              http://w3.whosea.org/fch

				
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