A STRATEGIC ASSESSMENT OF REPRODUCTIVE HEALTH IN THE LAO PEOPLE’S DEMOCRATIC REPUBLIC Ministry of Public Health, The Lao PDR. Institute of Maternal and Child Health In collaboration with World Health Organization Family Care International/New York Population Council/Bangkok International Council on the Management of Population Programmes Reproductive Health and Research World Health Organization 1211 Geneva 27 Switzerland Cover Design: Máire Ní Mhearáin © World Health Organization 2000 This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved, abstracted, reproduced and translated, in part or in whole, but not for sale nor for use in conjunction with commercial purposes. The World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. 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A STRATEGIC ASSESSMENT OF REPRODUCTIVE HEALTH IN THE LAO PEOPLE’S DEMOCRATIC REPUBLIC Report of a Strategic Assessment Undertaken by: MINISTRY OF PUBLIC HEALTH INSTITUTE OF MATERNAL AND CHILD HEALTH Phonethep Pholsena Pany Sananikhom Khonesavanh Pholsyna Khamseng Philavong Manisone Oudom Saysouda Sayasene Oudone Southalack Somphathai Bouathong Nirabonh Chanlivong Chanthavone Louangkhot NATIONAL CENTRE FOR CONTROL OF AIDS Phouthaly Keomoukda CENTRE FOR EDUCATION AND INFORMATION FOR HEALTH Vanmaly Svanmaly COLLEGE OF HEALTH TECHNOLOGY Sengmany Nochaleun LAO YOUTH UNION Sompheng Phamixay WORLD HEALTH ORGANIZATION Agostino Borra Giovanni Deodato Peter Fajans Richard J. Guidotti Kevin O’Reilly FAMILY CARE INTERNATIONAL Ietje Reerink INTERNATIONAL COUNCIL ON MANAGEMENT Jay Satia OF POPULATION PROGRAMMES POPULATION COUNCIL Christopher Elias EXECUTIVE SUMMARY ................................................................................................................................... 1 1 INTRODUCTION .......................................................................................................................................... 11 1.1 STRATEGIC ASSESSMENT IN REPRODUCTIVE HEALTH .............................................................................. 11 1.2 STRATEGIC ASSESSMENT METHODOLOGY ............................................................................................... 13 1.3 NATIONAL CONTEXT ................................................................................................................................ 14 1.4 HEALTH SECTOR PROFILE ......................................................................................................................... 14 1.5 PUBLIC HEALTH SECTOR ........................................................................................................................... 15 1.6 PUBLIC HEALTH PERSONNEL..................................................................................................................... 15 1.7 PRIVATE HEALTH SECTOR ......................................................................................................................... 16 1.8 REPRODUCTIVE HEALTH STATUS ............................................................................................................. 16 1.9 GOVERNMENT POLICIES ON REPRODUCTIVE HEALTH .............................................................................. 19 1.10 CURRENT ACTIVITIES IN REPRODUCTIVE HEALTH ................................................................................... 20 2 CRITICAL ISSUES ON REPRODUCTIVE HEALTH ............................................................................. 21 2.1 MATERNAL HEALTH................................................................................................................................. 21 2.1.1 Maternal Health Needs Assessment................................................................................................ 21 2.1.2 Strategic Assessment Recommendations......................................................................................... 32 2.2 BIRTH SPACING ........................................................................................................................................ 34 2.2.1 National Birth Spacing Policy and Programme ............................................................................. 34 2.2.2 Provision of Contraceptives under the Birth Spacing Programme................................................. 35 2.2.3 Contraceptive Knowledge............................................................................................................... 36 2.2.4 Demand for Contraception ............................................................................................................. 36 2.2.5 Contraceptive Use .......................................................................................................................... 37 2.2.6 Sources and Supply of Contraceptive Methods............................................................................... 37 2.2.7 Access to Contraceptive Services.................................................................................................... 38 2.2.8 Affordability of Contraceptives....................................................................................................... 38 2.2.9 Quality of Care ............................................................................................................................... 39 2.2.10 Reasons for Use and Non-Use of Contraception ............................................................................ 41 2.2.11 Users’ Experiences and Perceptions about Contraceptive Methods .............................................. 41 2.2.12 Strategic Assesement Recommendations ........................................................................................ 44 2.3 REPRODUCTIVE TRACT INFECTIONS.......................................................................................................... 46 2.3.1 Overview of RTI Prevalence ........................................................................................................... 46 2.3.2 Community Knowledge and Perceptions ........................................................................................ 48 2.3.3 Care Seeking Behaviour ................................................................................................................. 51 2.3.4 Public Sector Service Delivery ....................................................................................................... 52 2.3.5 Role of Pharmacies and Other Private Providers .......................................................................... 53 2.3.6 Strategic Assessment Recommendations......................................................................................... 55 2.4 ADOLESCENT HEALTH.............................................................................................................................. 56 2.4.1 Adolescent Pregnancy..................................................................................................................... 56 2.4.2 Pregnancy in Unmarried Adolescents ............................................................................................ 57 2.4.3 Community Perceptions Related to Adolescent Pregnancy ............................................................ 57 2.4.4 High Risk Sexual Behaviour ........................................................................................................... 58 2.4.5 Other Reproductive Health Problem .............................................................................................. 58 2.4.6 Access to and Use of Reproductive Health Information and Services ............................................ 59 2.4.7 Community Perceptions about Adolescent Health.......................................................................... 61 2.4.8 Strategic Assessment Recommendations......................................................................................... 63 3 PROPOSED STRATEGIC ACTION........................................................................................................... 64 3.1 PRIORITY INTERVENTIONS........................................................................................................................ 65 3.2 PROGRAMME STRATEGY DEVELOPMENT.................................................................................................. 66 3.3 POLICY AND PROGRAMME DEVELOPMENT ............................................................................................... 67 3.4 RESEARCH FOR POLICY AND PROGRAMME DEVELOPMENT ...................................................................... 71 3.5 DEVELOPING A COMPREHENSIVE REPRODUCTIVE HEALTH POLICY ......................................................... 72 3.6 PROVIDING INTEGRATED REPRODUCTIVE HEALTH CARE......................................................................... 73 4 CONCLUSION..............................................................................................................................................