Addressing rights-based family planning in the context of demographic transition in Asia and the Pacific Region and Eastern Europe and Central Asia re

Hosted by the IPPF ESEAOR office in Malaysia, the Asia and Pacific Hub, one of tis dedicated to driving commitments, fostering collaboration, and advocating for family planning at different levels, from region to community. With a strong presence in country support, data analysis, and evidence-based decision-making, the hub works towards tailoring actions to achieve FP2030’s strategic goals in the region.

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FP2030 Asia-Pacific Regional Hub, in collaboration with UNFPA Asia Pacific and Eastern Europe and Central Asia Regional Offices, is commissioning a comprehensive study on rights-based family planning amidst demographic transitions. This study aims to provide compelling evidence and policy recommendations to support women and men in achieving their fertility preferences, addressing gender equality, and promoting reproductive rights. Stay tuned for more insights and findings as we advance family planning and SRHR across the regions.

Introduction

Profound changes in demographic patterns are taking place globally. Birth rates are falling in most
countries around the world. In several low fertility contexts, people are having fewer children than
desired, a trend that varies within populations. These unfulfilled fertility desires are linked to broader socio-economic changes in education and labour force participation, and conflicting expectations of women in domestic and professional spheres2. Although the right to decide whether, how and when, to have children is enshrined in international law, many policy responses to low fertility often fall short of upholding these established standards.

Significant changes in fertility trigger anxieties about shrinking and ageing populations, which are
often viewed as a threat to national welfare, healthcare, and the economy. Countries in different
world regions are increasingly promoting pronatalist policies and rhetoric in response to demographic change. This has prompted active global and local debates over reproductive rights and choices in the context of perceived national threats of under-population, with significant implications for women’s freedom, bodily autonomy, and agency as policymakers and societies put pressure on them to reproduce for a perceived “national” interest.

Understanding the factors that cause women and men to have fewer or more children than they
want to have is an important step toward developing policies and programs that support women
and men in achieving their fertility preferences.

Background

The Asia Pacific region plays a pivotal role in global sustainable development. Around 52 per cent of
the world’s population, or equivalent to 4.2 billion people, resides in this region3. It is currently
undergoing a significant transition characterized by a shift from high to low fertility and mortality
rates, coupled with increased longevity and migration levels, leading to older and more urban
populations. Within these overarching trends, population dynamics differ across subregions and
countries. More than 1404 million women have an unmet need for modern contraception, resulting in more than 135 million unplanned pregnancies in the region. This situation poses serious potential consequences for women’s health and well-being, including the risk of unsafe abortions and even death, increases the likelihood that girls drop out of school, and decreases women’s and girls’ chances of earning an income.Eastern Europe and Central Asia region has some of the world’s lowest rates of utilization of modern contraceptives. This is particularly true in South-Eastern Europe. Albania has modern CPR 5% which is 5.6 times lower than the level of the world’s least developed countries (28 per cent).

In Asia and Pacific Region, fertility has declined to below replacement level in 23 countries with an
additional 2 countries at replacement level, totalling 25 out of 50 countries. This trend is particularly
notable in East Asia, Southeast Asia, and South Asia. Fertility rates in all five countries of Central Asia
are slightly higher than the replacement level. Similarly, in Pacific countries, 13 out of 17 countries
have fertility rates that exceed the replacement level. According to estimates from the UN Population Division, contraceptive prevalence rates (mCPR) for currently married women are below 50% in 17 out of 41 Asia-Pacific countries with available data, and above 50% in 24 countries. Generally, countries with higher than replacement fertility have lower CPRs compared to those at or below replacement fertility levels. The levels of unmet need for family planning are notably high in 29 out of the 41 Asia-Pacific countries, at over 10%. Only 12 countries have an unmet need prevalence of less than 10%, with China at 3%, Thailand at 6%, Sri Lanka at 7%, and Uzbekistan at 8%.

Gender-related barriers to reproductive autonomy severely undermine the success of sexual and
reproductive health programmes. These barriers include reproductive coercion by partners or family
members, child marriage, patriarchal gender norms, and the underrepresentation of women in
national, regional, and local decision-making roles. Low fertility naturally suggests that the childbearing period is decreasing, and the contraceptive period is increasing during one’s childbearing age, which defines the imperative for rights-based family planning programmes. In some instances, this transition is accompanied by excess use of traditional methods of contraception and abortions, such as in Western Balkans.

Scope of Work

The purpose of the consultancy is to provide compelling evidence on the factors in low fertility
settings that cause women and men to have fewer children than desired and recommend policies and programmes, including right-based family planning, that support achieving their fertility preferences. The aim is to ensure everyone has access to person-centred, human-rights-based family planning to enable them to “decide whether, when and by what means to have a child or children, and how many children to have” in low fertility contexts. This inquiry places a particular emphasis on women’s reproductive agency, autonomy, and empowerment.

The study will foster collaboration between disciplines such as demography, economics, sociology,
public health, and public policy development to address the multifaceted nature of low fertility. It will
inspire the development of policy options to address political anxieties caused by falling fertility rates,
with a central focus on ensuring women’s reproductive rights in this discourse. It will also examine
women’s participation in the labour force and contribution to the country’s economic growth.

The consultant will undertake a desk review to address the following key objectives of the study:

• Analyse and provide an in-depth understanding of the current state of low fertility [population
  change] in Asia and the Pacific, and Eastern Europe and Central Asia Regions. Identify the
  determinants and contributing factors leading to low fertility rates. This may include socio-cultural,
  economic, demographic, and policy-related factors.

• Explore sub-regional variations in fertility rates [population change], highlighting differences in
  trends, contributing factors, and responses (South Asia, East Asia, Southeast Asia, Central Asia and
  Pacific, Southeast Europe).

• Analyse and present evidence of the correlation between desired fertility, the fulfilment of
  women’s reproductive rights and choices, and other socioeconomic determinants in countries at
  different demographic transition stages (TFR < 3, TFR 2.5 to 2.1, TFR 2.1 to 1.5 and TFR < 1.5). This
  would include:

  • Fertility preferences and aspirations of people (e.g. mean age of sexual debut and
    childbearing, ideal number of children, child gender preferences, infertility), unmet
    needs for family planning, contraceptive use, demand satisfied with modern methods,
    reducing unintended pregnancies and unsafe abortions, fulfilling fertility desires
    [including equitable access to ART], mean age of mothers at birth and maternal health
    [maternal mortality rates, maternal morbidity].

  • Gender Equality, social norms, and fertility preferences. What gender equality
    measures are associated with fertility rates and produce positive sexual and
    reproductive health outcomes? For instance, women’s empowerment and autonomy,
    female labour participation rate, and supportive work-life balance policies related to
    childcare and the workplace. What is the correlation between family-friendly policies
    and fertility dynamics? How do gendered labour market dynamics, especially within
    the informal sector, hinder couples’ ability to fulfil their fertility desires? How does
    immigration impact the fertility rate of host countries? What ethical considerations
    have arisen in countries offering (or consider offering) financial incentives to increase
    fertility rates? Furthermore, considering the close association between population
    aging and low fertility rates, how can gender parity in the workforce enhance
    economic productivity? This analysis will also delve into the role of families and
    grandparents in providing childcare.

  • Young People and Fertility Rate: What are the key determinants shaping the
    reproductive choices and opportunities of young girls and women, both married and unmarried, in low fertility contexts and how do socio-cultural norms, aspirations, and
    economic factors impact their decisions regarding family size and timing of
    childbearing? What implications does this have for future population dynamics? How
    does the prioritization of sexual pleasure within intimate relationships impact fertility
    rates, considering factors such as contraceptive use, family planning decisions, and
    the intersection of cultural norms and individual desires?

  • Showcase successful initiatives or policies implemented in countries, both within and outside the region, that have effectively addressed low fertility by advancing gender equality establishing family friendly policies and promoting reproductive rights and choices including rights-based family planning services and equitable access to Assisted Reproductive Technologies (ART) but also investing in skills development for an ageing workforce among others.

  • Offer evidence-based solutions and policy recommendations to address sexual and reproductive health and rights related considerations associated with, and aggravated, by the low fertility in Asia and the Pacific and Eastern Europe and Central Asia. This will provide a new narrative to reposition family planning for realization of women’s reproductive rights and choices in low-fertility contexts.

    Please note that there will be three phases of this initiative. This assignment is the first phase followed by 8 country case studies in Phase II and modelling in Phase III. During the first phase, there will be a desk review and facilitated consultation at the FP2030 Regional Focal Points Workshop, taking place from the 1st to the 4th of July 2024 in Manila, Philippines.

• Specific Tasks:

• Desk review: identify pertinent policy documents, research articles and other relevant
  documents related to the study subject. Subsequently, synthesize the information to
  summarize the findings across relevant documents /studies.

• Consultation: Facilitate country consultation at the FP2030 Regional Focal Points Workshop
  1-4 July 2024 that presents the findings of the desk review, study objectives and method
  outline, expected policy related outputs; and elicits participant reactions (areas of research,
  policy recommendations). There will be 8 to 10 country delegations from Asia-Pacific Region.
  This activity is dependent on the start of this consultancy.

• Deliverables, Timeline and Level of Efforts
  The consultants will produce the following deliverables:
  Deliverable 1: A 20-page report on addressing rights-based family planning in the context of
  demographic transition in Asia and the Pacific Region and Eastern Europe and Central Asia
  regions. (To be completed by 30th July 2024)
  a. Presentation of initial findings to the white paper advisory group.

  b. Short summary, max 5 pages, which focuses on the main points of the desk review
  and is geared towards white paper advisory group.
  c. Desk Review Report, approximately 15-20 pages. This should be more in-depth and
  technical for the white paper advisory group with evidence of recommendations
  included. It will include the recommendations of the country consultation.
  d. In addition, annex, detailing methodology, challenges and other details that would
  facilitate future modelling work.

• Deliverable 2: Priority areas for further data analysis, topics to explore during primary data
  collection, and recommendations for phase 3 modelling, max 5 pages. (To be completed by
  30th July 2024)