Tetsuo Kato writes:

According to the State of World Population 1997 published by the United Nation Population Fund (UNFPA), current contraceptive use worldwide is now approaching 60 per cent, compared with an estimated 57 per cent in 1991. Even in the less developed regions, prevalence of family planning reached 53 per cent in 1991 and 56 per cent in 1995. However, there is still a big difference in the prevalence rate from region to region. For example, Africa has the lowest contraceptive prevalence, only 13 per cent. In addition to prevalence rate of contraceptives, the unmet-need for contraceptives is also another important issue on family planning. The UN-led International Conference on Population and Development (ICPD) held in Cairo in 1994 estimated that 350 million couples worldwide lack access to the full range of modern family planning methods.

It is further estimated that 120-150 million married women worldwide wish either to have no more children or to delay their next birth at least two years but are not using any methods of family planning. As you may know, according to statistics, short birth space (less than two years) between pregnancies biologically increases mortality and morbidity of both mother and child, and undesired pregnancy and delivery socioeconomically can lead them to the vicious cycle of poverty. For this reason, it is a mission for the international medical society to make much more effort to promote contraceptive methods, especially in the developing countries.

Japan has succeeded in lowering population growth through promotion of family planning after World War II. Keys to success in family planning promotion were health system reforms based on legalization of contraceptive methods and health personnel organization. Public health nurses and midwives have been important agents in Information, Education and Communication (IEC) strategy. They have visited local people in a door to door way and integrated family planning services into other health related services such as maternal-child health and periodical medial checkups. Through these activities, they have made people sure that practice of family planning helps keep their family healthy. As discussed above, the most important aspect for family planning promotion is developing human resources. Japan has already held international seminars targeting health administrators from developing countries and economic transit countries in the Overseas Development Agency scheme. In the seminars they have opportunities to observe Japan's system and bring back essentials to their own communities.

As this type of assistance has been considered useful, Japan may have to widen the scale with support from the Japanese medical society. On the other hand, dispatch of experts in this area to the developing countries is another form of assistance. They are expected to serve as advisers for the aid-recipient government through model projects formulation in the scheme of bilateral assistance. In fact, Japan has already set out family planning promotion projects in some countries. This type of cooperation would be much better, if projects could pay much attention to small-scale but more needy facility construction such as health posts/centers in each community, not only emphasizing to build up "center facilities" such as large and highly equipped hospitals. In addition, bilateral assistance may duplicate other donor countries' aid and, as a result, it has often turned to be inefficient. In this context, multilateral medical assistance is another important factor for worldwide promotion of contraceptives. Through international organizations including UNFPA and UNICEF, contraceptives could be collectively purchased and distributed to recipient countries. Although Japan will drastically cut budget allocations to these international organizations due to Japan's financial crisis, we may have to reconsider the effectiveness of medical assistance through multilateral channels.

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