This is the abstract presentation of Olanike Adedeji, which took place as part of the third session of #APCRSHR10 #Virtual on the theme of "Sexual and reproductive health and rights in the Pacific" | more details are online at www.bit.ly/apcrshr10virtual3 Thanks

1. 1
ROADMAP TO
ACHIEVING ZERO
UNMET NEED IN THE
PACIFIC
Olanike Adedeji
Technical Specialist RHCS, Pacific Sub-
Regional Office
20th July 2020

2. OUTLINE
Problem Statement
Methodology
Country Categorization for Unmet Need
Solomon Islands FP Opportunity Brief
Policy Recommendations

3. 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).
3

4. 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).
4

5. 5
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.
Methodology

6. 6
• 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
Rationale for Country Categorization

7. 7
• 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.
Methodological Approach/Philosophy

8. 8
Issues and Themes for CategorizationUNFPABusinessModel
Categorization
Humanitaria
n Context
Low -
Fertility
Unmet Need
Youth
Population
Small Island
States
Cross-Cutting Issues
Enabling the
Environment
Securing Supplies/
Expanding Choice
Fulfilling Reproductive
Health Intentions
Enabling Access for All
Leaving No One
Behind
• FP Policy Environment
• Restrictive Policies (Youth)
• Gender Equity/Inequity
• Financial Access for Sustainability
• Donor Dependence & Sustainability
• Increasing Demand
• High Potential for Accelerated
Improvement
• Commodities Security
• Products Availability
• Quality of Service
• Measurements & Information Systems
• Healthcare Provider Coverage
• Rights-based Access to FP Services
• Youth Access
• Subnational Disparities
• Access in Humanitarian Contexts
Priority Themes Topics for Categorization

9. 9
Indices and Data Sources for Categorization
Priority Themes Topics For Categorization Selected Indicator(s) Source
Cross Cutting Issues
UNFPA B/M UNFPA Business Model Country Categorization UNFPA
Unmet Need % of WRA with an Unmet Need for FP in 2030 UNPD WPP 2017
Low Fertility Total Fertility Rate in 2019 UNPD WPP 2017
Humanitarian Context Inform Index "Risk Class" Inform Index
Youth - Population Structure % of WRA who are Youth (15-24) in 2020 UNPD WPP 2017
Small Population/Island States UN Small Island Developing States (SIDS) UN SIDS
Enabling the
environment
FP Policy Environment FPE Policy Score FPE (Avenir Health)
Restrictive Policies (Youth)
Average Rating : Are their policies in place to prevent discrimination against Youth / Unmarried
Women
NCIFP (Avenir Health)
Gender Equity/Inequity Gender Inequality Index UNDP HDI
Financial Access for Sustainability
"Catastrophic Spending on Health" : Proportion of population spending more than 10% of household
consumption or income on out-of-pocket health care expenditure (%)
Health Equity and Financial
Protection Indicators (HEFPI) ; World
Bank Data Bank
Donor Dependence (Sustainability) % of Public Sector Commodity Expenditure provided by Donors Commodity Gap Analysis 2019
Fulfilling
reproductive health
intentions
Increasing Demand Track20 Demand Curve Categorization DHS
Increasing Demand % of Users discontinuing while in need DHS
Countries with very high potential for
accelerated improvement
"High Potential for Growth" based on 1) TFR vs Ideal # of Children, 2) Intention to use among non-
users, and 3) Current mCPR
DHS
Securing supplies &
expanding choice
Commodities Security Average rating : Contraceptive Logistics and Transport Systems NCIFP (Avenir Health)
Commodities Security (2) Average central level stockout rate for contraceptive products Contraceptive Securities
Products Availability Average Rating : Accessibility of STMs/LAPMs NCIFP (Avenir Health)
Products Availability (2) Average Facility Level Stockout rate for contraceptive products
UNFPA Facility Surveys/
Contraceptive Securities
Enabling access for
all
Quality of Service Method Information Index DHS/PMA2020
Measurements & Information Systems Data Score (average of "Data" focused elements for NCIFP) NCIFP (Avenir Health)
Healthcare Provider Coverage Nurse/Midwife Density (# of Nurses and Midwives per 1000 Population)
World Bank World Development
Indicators
Right-based access to FP Services Disparity in Unmet Need by wealth, residence, and education DHS/MICS/PMA2020
Leaving no one
behind
Youth Access Disparity in Unmet Need between Youth and Overall WRA DHS/MICS
Subnational Disparities Disparity in Unmet Need between region with the highest and lowest unmet need (MW) DHS/MICS
Access in humanitarian context Access to health care Index (Inform Index) Inform Index

10. Categorization of Countries by 2030 Unmet Need
Algeria, Argentina,
Bahamas, Bahrain,
Bangladesh, Belarus,
Bhutan, Brazil,
Cambodia, Chile, China,
Colombia, Costa Rica,
Cuba, Dominican
Republic,
DPR Korea, Ecuador,
El Salvador, Grenada,
Honduras, Iran, Jamaica,
Mexico, Morocco,
Nicaragua, Paraguay,
Peru, Sri Lanka,
Thailand, Tunisia, Turkey,
Ukraine, Uruguay,
Uzbekistan, Venezuela,
Viet Nam,
Zimbabwe
Albania, Antigua and Barbuda,
Armenia, Azerbaijan, Barbados,
Bolivia, Bosnia and Herzegovina,
Botswana, Cabo Verde, Dominica,
Egypt, Eswatini, Georgia,
Guatemala, India, Indonesia, Iraq,
Jordan, Kazakhstan, Kenya,
Kuwait, Lao PDR, Lebanon,
Lesotho, Madagascar, Malawi,
Malaysia, Marshall Islands,
Moldova, Mongolia, Montserrat,
Myanmar, Namibia, Panama,
Philippines, Qatar, Rwanda,
Saint Kitts and Nevis, Saint Lucia,
Saint Vincent and the Grenadines,
Serbia, South Africa, State of Palestine,
Syria, Turkmenistan,
United Arab Emirates, Zambia
Anguilla, Belize,
Cameroon, Congo,
Cook Islands,
Ethiopia, Fiji,
Kyrgyz Republic,
Libya, Maldives,
Nepal, Niger,
North Macedonia,
Pakistan, Palau,
Suriname, Tajikistan,
Tanzania,
Trinidad and Tobago,
Vanuatu, Yemen
Afghanistan, Burkina Faso,
Burundi, CAR,
Chad, Côte d'Ivoire,
Djibouti, Gabon,
Ghana, Guinea-Bissau,
Guyana, Kiribati, Liberia,
Mali, Mozambique,
Nauru, Nigeria,
Oman, PNG,
Sao Tome & Principe,
Saudi Arabia, Senegal,
Sierra Leone,
Solomon Islands,
Somalia, Timor-Leste,
Uganda
High
(25%+)
Angola,
Benin,
Comoros,
DR Congo,
Equatorial
Guinea,
Eritrea,
Gambia,
Guinea,
Haiti,
Mauritania,
Samoa,
South
Sudan
Sudan,
Togo,
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
Middle High
(20-24%)
Middle
(15-20%)
Low-Middle
(10-14%)
Low
(<10%):

11. 11
• 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
FP Database & FP Country Opportunity Briefs: Overview

12. 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.

13. Health
System
Overview
Provinces Divisions
Primary
Health Care
facilities
(Health
Clinics,
Nursing Aid
Posts)
Secondary level
facilities
(Reproductive
Health Clinics)
Tertiary
level
facilities
(Hospital)
Private
Hosp Total
Choisuel 3 15 9 0 24
Western 6 38 23 0 61
Isabel 4 26 10 0 36
Central 0 1 21 1 23
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

14. Percentage
T: 45
%
(2020)

15. Source: Country DHS Reports

16. 0
10
20
30
40
Urban Rural
Percentage
Unmet need for FP in Married
women disaggregated by
Residence
Solomons Islands DHS 2007
Solomons Islands DHS 2015
0
10
20
30
40
Lowest Second Middle Fourth Highest
Percentage
Unmet need for FP in Married Women
disaggregated by Wealth Quintile
Solomons Islands DHS 2007

19. • The contribution to CYP of Jadelle has more than doubled
between 2017 and 2018 (from 8,740 to 18,240)
18,2408,740

20. Question and
Answer
 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
improvement over time.
 Women in rural areas have higher CPR and slightly lower unmet need
than women in urban areas.
 Knowledge about contraceptives need to be improved, more so among
men and boys.
Solomon Islands Summary

21. 21
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
focus on unmarried youth. 50% data not available*
FP Country Opportunity Briefs
(page 1)

22. 22 22

23. 23

24. 24

25. 25

26. 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.

27. Question and
Answer
Q & A