MARSHALL ISLANDS. Population and Development Policy, November 1995. (Population and Development Policy, Marshall Islands, National Population Council, 1995, 49 p.)
This document is a presentation of policies, targets and strategies aimed at raising the real standard of living and the quality of life of all the people in the Republic of the Marshall Islands. The document is structured in the following manner. First, based on available evidence, it discusses recent trends in population growth and its spatial distribution, the age structure of the population and the problems that have arisen due to rapid population growth. Next, it shows that at present, the economy is not capable of supporting a high population growth rate while maintaining the present living standards. This is followed by a discussion of two main types of population policies needed: those that are aimed at restraining population growth rate, and those that are aimed at satisfying the needs of a growing population.
Finally, the document presents a vision for the Republic to be achieved through the policy actions recommended. Part of this vision is about the ideal role that individuals, families and communities would play in solving their own population and health problems. Another part of the vision is about realizing a process of self-sustained growth through a greater utilization of domestic resources by a Marshallese population more evenly distributed throughout the country, paying greater attention to protection of the fragile environment of Marshall Islands.
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C. Need for a Population Policy
Third, in view of the above, the document recommends that there should be a public policy action to bring about a balance between the available resources and the number of people sharing those resources.
The policy actions recommended in this document may be classified broadly under two types:
(a) Policies aimed at restraining future growth of population within manageable and suitable limits while maintaining the right of every couple to decide on the number of children they wish to have; and
(b) Policies aimed at meeting the needs of the future population.
Population Growth Restraining Policies
(a) The following are among the main recommendations made with regard to the first type of policies:
1. Lower the growth rate of Marshallese population from 3.6 percent in 1995 to 3.2 percent in the year 2000 and to 2.8 percent in 2005 through the following means:
· lowering the total fertility rate from 5.7 in 1994 to 5.2 in 2000 and to 4.0 in 2005;
· reducing the infant mortality rate from 63 per 1000 live births to 50 in 2000 and to 38 in 2005;
· reducing the child mortality rate from 80 per 1000 live births to 64 by the year 2000 and to 48 by the year 2005;
· increasing the spacing of births; and
· reducing adolescent and teenage unwanted pregnancies by 50 percent by the year 2000 and by 80 percent by the year 2005.
2. Lower the total fertility rate by the following means:
· enhancing family planning programs that are responsive to the needs of both men and women;
· creating a greater level of national awareness of the negative consequences of rapid population growth on the potential for development and of larger families on the welfare of the family members;
· integrating population, information, education and communications into the formal school system and other institutions including work place and social groups;
· raising the status of women in society by, among other things, increasing the education and employment opportunities available to them.
(b) Population Responsive Policies
The following are among the second type of policies recommended in this document:
· improving the quality of education, increasing school enrollments and reducing dropout rates;
· making available more classrooms, furniture, instructional material, qualified teachers and equipment;
· increasing the capacity for counselling in high schools;
· increasing parental and community awareness of their roles and responsibilities in the education of their children;
· identifying and adopting measures to increase cost recovery of educational services as a way of making more resources available for education;
· providing more job opportunities through the development of domestic resources such as fisheries, tourism potential for establishing industries;
· imparting job skills to Marshallese workers through improvement in the vocational education;
· undertaking environment research and education programs;
· discouraging migration to urban areas through programs to develop Outer Islands;
· integrating population factors into the development planning process.
Overall Vision of the Document
Although this document identifies areas of action for the government, the document is also aimed at the community at large. Much of the success of the population policy will depend on the individual families taking a greater responsibility for their own well-being.
Planning for smaller families will improve the quality of life for all members in the family. Within a given income, a smaller number of children means that more resources will be available per member of the family, as compared to the situation with a larger number of children. Pregnancies should be planned, so that every Marshallese child comes into the world wanted by his/her parents. It must be recognized that babies have a right to grow up with family support, love, proper nutrition and health care.
There are a number of other ways, and at low cost, by which individuals and families can contribute to the benefit of the society while enhancing their own well-being. Following are some of these ways. Ensuring that:
· their water supply is safe and adequate;
· family members receive, on a regular basis, adequately nutritious diets;
· children are immunized against communicable diseases;
· mothers and children receive appropriate health care;
· members of the family pay adequate attention to their personal hygiene and to the sanitation in and around the household;
· family planning information and materials are made available whenever they are sought;
· parents learn about the nutritional and health care needs of their children;
· they work with other members of the community to ensure that facilities for treatment of common ailments are provided at the community level with support from the community;
· parents participate actively in the management of local schools and realize that they have to share a greater responsibility in educating their children.
The document envisions that over the next five years and beyond, individuals and families will bear an increasing proportion of the responsibility in tackling their health and population problems. Such participation will certainly enhance the quality of life for all individuals and families.
On the sustainable development front, the document anticipates a variety of positive changes. As a result of measures taken by the government to encourage economic activities in the Outer Islands, more people would be attracted to those places. Reduction in the public payroll and reduced employment opportunities with the Army at Kwajalein would be added incentives to leave urban areas. With these shifts, there would be a new and more balanced spatial distribution of the population between urban and rural areas. There will be more neighborly and less crowded communities which would be diverse and interesting for the children.
It is possible to envision that such redistribution of population would be accompanied by the growth of a wide variety of diversified commercial activities in the Outer Islands. These would include the small shops and bakeries, small restaurants, furniture shops, boat yards, and small tourist operations. The men in some families will be fishermen; they will operate their own boats and may sell their catch in their own neighborhood shop or to a cannery. There would probably be some small factories that produce goods for export. With all this productive activity local food and other local products will be more generally available.
The environment will not be harmed as it has been by urbanization. The suburban and rural communities will be well maintained. Members of the communities will take pride in their productive agricultural land and their park land.
There will be a more self-sustaining process of economic growth, creating more jobs and incomes for Marshallese people.
People will enjoy fuller lives as they come together within the family for work, celebration and fellowship, and as they gather together with their neighbors for recreation, continuing education and community activities.
What is described above is a realistic vision. This document provides guidelines on how this vision might be realized.
Chapter 1. Introduction
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2. Rationale for National Population Policy
The population policy of the Marshall Islands shall be founded on the general and individual rights of the Marshallese people to resolve personal concerns in ways that are socially and culturally acceptable and on the responsibility of the government to sustain and enhance the well-being of the public by providing essential social services. If the government intervention by the implementation of a population policy is treated as a fundamental component of the social contract, then the government has a moral responsibility to influence those aspects of the social setting that might be detrimental to the effective delivery of these services.
Fertility behavior is an aspect of human endeavor that has heretofore been shielded by the privacy of the individual.
With the appreciable decline in the mortality rates of infants, children and adults resulting from health and social policy interventions by the government over the years, there should have been a sustained decline in the fertility rate in order to ensure the maintenance or improvement of the real quality of life of all Marshallese people. However, [the] fertility rate for the nation still remains high. In this situation, it is warranted that practices pertaining to fertility should become a matter of public policy quite beyond the private beliefs and practices of individuals and couples. An acceptable common ground must be found to accommodate both private rights and aspirations and the responsibilities of the state for the general welfare, including provision for the consequences [of] child bearing behavior. Individuals should understand that the national population policy transcends personal considerations, since all social problems and other problems emanating from unplanned child bearing would have crucial implications for the general health status of the nation.
On this basis, the state may intervene, as it has for other important issues, in matters relating to the child bearing behavior of the Marshallese public, so as to achieve the greater benefit to Marshallese society.
In addition, it has been shown in other countries that closely spaced births and pregnancies in older women can pose significant health hazards. The intervention of a national population policy would improve the lives of these Marshallese women.
Government intervention in fertility will be based on sound considerations of ethics, social welfare and economic well-being of all individuals in the society.
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Chapter 4. Population Policy Goals, Objectives and Targets
The overall goal of the Marshall Islands population and development policy is to raise the real standard of living and the quality of life of all the people. The policy is directed to ensure that the future growth of the population is restrained within manageable and suitable bounds while maintaining the right of every couple to decide on the number of children they wish to bring into the world.
Recognizing that greater emphasis must be given to planning to cater to the needs of babies and infants, school age population, teenagers, women, labor force and the aged, the principal objectives of this policy are:
· To lower the rate of population growth to a level compatible with the country's resource base and its social and economic potential;
· To lower fertility, morbidity and infant, child and maternal mortality;
· To raise the status of women in society, and to ensure that they are heavily involved in population and development strategies to improve [the] quality of life for all;
· To curtail adolescent and teenage unwanted pregnancies;
· To raise the profile of population-related issues in the country by creating a greater national level of awareness of the negative consequences of rapid population growth on the potential for development;
· To enhance family planning programs that are responsive to the needs of the people, both men and women;
· To facilitate convenient and free access for each individual and every couple to family planning information and services;
· To improve the collection and analysis of demographic and socio-economic data, disaggregated by gender, and so promote research and the utilization of the results for population and development planning;
· To improve the quality and relevance of all levels of education;
· To improve the efficiency of the education system by increasing enrollments and reducing the rate of repeating, failing and dropping out students at all levels;
· To fully integrate population information, education and communications into the formal school system and other institutions including the work place and social groups;
· To upgrade the skill profile of the country's labor force to promote an entrepreneurial spirit and those skills necessary for self-employment;
· To raise the production of traditional food supplies and other food crops in order to increase the level of household food security and nutritional adequacy, particularly for children and pregnant and lactating mothers;
· To increase the rate of labor absorption into productive employment, especially the employment of women in the formal sector of the economy;
· To ensure that all development projects and interventions incorporate a thorough assessment of their environmental and socio-economic impacts;
· To promote environmental education and knowledge among the various demographic groups of the country;
· To increase nutritional knowledge among all groups in the country about the health benefits of traditional dietary foodstuffs;
· To retard the very high rate of migration into Majuro and Ebeye by promoting alternative development opportunities in the Outer Islands.
· To achieve a balance between development objectives and the objective of protecting the environment.
Policy Targets to the Year 2005
Meeting the quantitative targets given below will ensure that the objectives of the policy are fully attained. It must be noted, however, that these quantitative targets are not the primary objective of the present population and development policy, but that they merely constitute a means and [an] end: a means of providing a better life for all Marshallese people.
· To reduce the annual rate of growth of the Marshallese population from 3.6 to 3.2 percent per annum by the year 2000 and to 2.8 percent per annum by the year 2005;
· To reduce the total fertility rate (TFR) in the Marshall Islands from 5.7 to 5.2 by the year 2000 and to 4.0 by the year 2005;
· To reduce the rate of infant mortality rate (IMR) from the present high level of 63 per 1000 live births to 50 per 1000 live births by the year 2000 and 38 per 1000 live births by the year 2005;
· To reduce child mortality rate from 80 per 1000 live births to 64 per 1000 live births by the year 2000 and to 48 per 1000 live births by the year 2005;
· To increase life expectancy at birth from 61 to 66 years for men, and from 64 to 69 years for women;
· To reduce the maternal mortality rate by 50 percent;
· To reduce the number of adolescent pregnancies by 50 percent by the year 2000 and by 80 percent by the year 2005;
· To reduce closely spaced births by 50 percent by the year 2000 and by 90 percent by the year 2005;
· To reduce the proportion of births to women aged 35 years and above by 50 percent by the year 2000 and by 90 percent by the year 2005;
· To improve the nutritional status of mothers and children in order to reduce anaemia, obesity and malnutrition by 50 percent.
· To reduce the rate of in-migration to Ebeye and Majuro by 50 percent;
· To attain a 75 percent level of knowledge of at least 4 modern methods of contraception among Women of Reproductive Ages (WRA) by the year 2000 and 90 percent by the year 2005;
· To increase the modern Contraceptive Prevalence Rate (CPR) among WRA from 37 percent to over 41 percent by the year 2000 and 45 percent by the year 2005;
· To attain a 50 percent level of knowledge of modern contraception among men by the year 2000 and a level of 75 percent by the year 2005;
· To increase CPR among males from 26 to 31 percent by the year 2000 and to 36 percent by the year 2005;
· To increase the number of contraceptive service outlets from 68 to over 75;
· To raise the number of field workers, including volunteers, providing family planning services in Community-Based Distribution (CBD) from 71 to 100;
· To increase the number of CBD operational sites from 65 to 80;
· · To increase the number of cycles of condoms sold annually through social marketing outlets from 0 in 1993 to 25 in 2005;
· To enable at least 50 percent of all mothers reduce birth intervals to a minimum of three years;
· To introduce legislation which will impose steep fines on men who impregnate girls who are aged 16 or less;
· To disseminate information to parents about the existence of legislation which ensures that men provide paternal support to children they father;
· [To] ensure that 100 percent of school going and out-of-school youth have access to information on population education and safe contraceptive methods, to promote responsible sexual practices and parenthood.
· To increase the net enrollment ratio from 85 percent to 100 percent in elementary schools and to reduce the elementary school dropout rate from 19 percent to 5 percent;
· To increase the proportion of students graduating from high school from 45 percent to 90 percent;
· To increase the absorptive capacity of high schools by at least 30 percent;
· To increase the counselling and advising capacity in secondary schools;
· To increase the capacity for vocational training, including an increased in-take of girls by 50 percent;
· To encourage continuing research on and monitoring of the operation and efficiency of the Marshall Islands education system;
· To increase the quality of education imparted to Marshallese students by increasing the per student availability of classrooms, furniture, instructional materials and qualified teachers;
· To increase parental and community awareness of their roles and responsibilities in the education of their children;
· To reduce the overall adult illiteracy rate from 9 percent to 5 percent;
· To raise the proportion of women receiving government scholarships from 36 to 50 [percent].
Women in Development (WID) Targets
· To reduce female illiteracy from 9 percent to 5 percent;
· To reduce teenage pregnancies by ... percent;
· To reduce rates of diabetes and obesity in women by 75 percent;
· To raise the enrollment rate of girls in high school from 35 percent to 65 percent;
· To raise the development, production and dissemination of IEC materials on child growth, breast feeding and nutrition;
· To provide high quality, safe, effective and readily accessible family planning services to 100 percent of all women of reproductive age regardless of marital status;
· To reduce the rate of drop-out of girls from school by 80 percent;
· To raise the representation of Marshallese women in formal employment from 12 percent to 40 percent in the public sector, and from 29 to 45 [percent] in the private sector;
· To ensure that at least 30 percent of scholarships awarded for post-high school studies are to women.
· To raise the growth of formal sector employment to at least 6.6 percent per annum;
· To lower the rate of unemployment from 12.5 percent to 5 percent;
· To reduce the annual labour force growth rate from 4.4 percent [in] 1995 to 3 percent in 2010;
· To promote traditional, artisan skills and vocational training opportunities in order to have many more Marshallese absorbed in the informal sector and in self-employment;
· To discourage migration to urban centers;
· To encourage overseas employment.
Environment Protection and Other Targets
· To integrate environmental protection measures into national development planning, emphasizing their inextricable link to population dynamics;
· To increase the collection, analysis and dissemination of relevant environmental information in the Marshall Islands;
· To promote the compulsory registration of births, deaths, migration status and marriage;
· To encourage savings as an important measure for meeting current and future needs of individual families and of the government.
Chapter 5. Strategies and Programs for Policy Implementation
The Marshall Islands population and development policy requires the establishment of clear priorities, well-defined strategies and relevant and implementable programming measures, all of which are consistent with the country's goal of achieving sustainable social and economic development. The focus of the policy is on achieving social and development objectives, many of which aim to promote health and other improvements, which are prerequisites for realising a significant decline in fertility. These include achievements in health conditions as well as in education, agriculture and food production, protection of the environment, employment creation, as well as elevated roles and statuses for women and youth.
The attainment of the policy's goals and objectives by implementing certain programs and strategies will require support and contributions from all sectors of society, both public and private, as well as the churches, social groups and the media. Within the public sector it requires closer and more effective co-ordination among implementing agencies.
A. Population Advocacy (Information, Education and Communications)
A national population awareness-raising campaign is urgently required to propel the Marshall Islands population problem and possible responses [to it] on to [the] center stage. All levels of society must be informed of the seriousness of the situation, and the dire consequences which will follow without a dramatic change in fertility behavior. Political and community leaders must speak out openly on every public occasion about the potential crises which will follow unless demographic behavioral changes are forthcoming. In order to raise the demand for family planning services, clear, unambiguous and sensitive IEC messages will be prepared and disseminated through the national and local political and administrative machinery, by person to group and person to person communication, including [via] hand-outs, posters and the mass media. To ensure that all messages are synchronized and in harmony, overall co-ordination of these IEC activities will be the responsibility of a revived and strengthened Population and Health Education Unit in the Ministry of Health and Environment, which will work closely with the Ministries of Social Services, Education, the Office of Planning and Statistics as well as with the local governments.
Family Life Education (FLE) mass media campaigns will be geared towards provoking all Marshallese to address the burdensome family problems that arise from high and unplanned fertility. Population education in schools (both primary and secondary) will address these issues and contribute to the success of the programs contained in this policy. In order to sharpen the messages sent, and to increase their relevance, an attempt will be made to define the audiences. At the same time, advocacy strategies will be made more sensitive to the social and cultural values of the Marshallese society.
1) All men and women will be supplied with information, and be made aware of, the advantages of family planning and small family size and the hazards associated with high risk pregnancies ("too early, too late, too close together and too many"); sexuality education will be provided for traditional leaders, parents and youths as well as the in-school population;
2) Students, out-of-school youth and formal sector workers will have access to information and services of the family planning program[s]; sexuality education will be envisaged as an integral part of lifetime education in which the social and economic repercussions of unwanted pregnancies are considered within the social and cultural values and traditions;
3) Adolescents of both sexes will be made aware of the dangers of early pregnancies, sexually transmitted diseases and HIV/AIDS;
4) Family planning service providers will disseminate information on the nature and seriousness of the population-related problems being encountered by the Marshall Islands;
5) All national and community level as well as Outer-Island leaders will be given access to relevant and timely population data and information; the participation of local governments in population IEC activities will be actively sought and promoted;
6) Co-ordination of Population Education, Population IEC and FLE projects to raise national and individual awareness of population problems facing the Marshall Islands will be the responsibility of an enlarged and strengthened Population and Health Education Unit in the Ministry of Health and Environment. The IEC strategy will encompass formal and informal communication channels and incorporate training programs for creating these kinds of communications skills;
7) The capacity for producing and widely distributing IEC/FLE materials to the target populations will be greatly expanded;
8) IEC/FLE programs will be closely monitored and evaluated to ensure that all targeted populations are reached;
9) Action will be taken to increase the counselling capacity in high schools to provide more counselling services on family life and career goals to students.
B. Reproductive rights and reproductive health
While it is true that the country is a signatory to all human rights declarations and protocols of the United Nations and that [the] same rights are guaranteed in the Republic's constitution, the issue of reproductive rights which are part of those human rights, should, in addition to being given legal recognition, be made both socially and economically meaningful. These rights imply that people must have the ability and freedom to decide IF, WHEN and HOW often, when it comes to the question of reproduction. For this to be possible, it is necessary that all men and women of relevant ages are well-informed and have unhindered access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for [the] regulation of fertility, as long as they are within the ambit of the national laws, customs and practices. It is, therefore, the intention of this document, that for all the rights in human reproduction to be effective and efficient in the country, adequate and well-fashioned reproductive health programs should be in place throughout the country.
Consequent upon these requirements, and given the social and cultural needs of the people of Marshall Islands, this policy seeks to work towards the following objectives within the next decade:
· At least 50 percent of all men and women of relevant ages have access to information [and] education on reproductive health by the year 2000 and 80 percent by the year 2005;
· All men and women of relevant ages are informed and educated, through culturally acceptable means, on STD/HIV and high risk sexual behaviors and partner relationships;
· Women and their partners have timely and relevant counselling on family life, responsible parenthood and safe sex;
· All women are adequately informed of their biological formations and their rights within and outside the family;
· All women, and of course men, are protected against any form of sexual assault or harassment either at home or at places of employment;
· All married couples take joint and informed decisions on the timing, spacing and number of their children; and
· The term "family health" in health programs would cover all members of the family and would extend to all aspects of family life, and not merely maternal and child health.
The following family planning activities will be carried out with regard to family planning:
1) Maternal and Child Health (MCH) interventions, provision of safe drinking water and sanitation improvements, education upgrading, expanded and diversified employment opportunities and increased production of traditional food;
2) Expanded knowledge of the contraceptives available in order to correct misconceptions, which induce clients not to accept them;
3) The service providers' knowledge, attitudes and skills will be enhanced in order to counsel clients more effectively;
4) The service delivery contacts will be expanded by more frequent mobile visits to the Outer Islands, and by a larger number of service outlets in urban areas;
5) Community Based Distribution (CBD) and the Social Marketing of Contraceptives (SOMARC) will be greatly expanded;
6) Because delivery before the age of 20 years puts the health and welfare of the mother and child at great risk, individuals and families will be encouraged to delay the first pregnancy until at least that age; similarly, because of the risks associated with births to mothers over 35 years, individuals and families will be encouraged to avoid pregnancies [in] women over 35 years;
7) Exclusive breastfeeding will be promoted for the first six months postpartum to enhance the health status of the mother and child;
8) The health of the mother and child and the welfare of the family are at greatly increased risk after the fourth pregnancy, such that individuals and couples will be encouraged to have small families;
9) All woman regardless of age and parity will be eligible for long-term injectable contraceptives such as Norplant and Depo Provera provided they show no contrary indications;
10) All government ministries and non-government organizations, including places of work, will be encouraged to participate in family planning programs by providing motivation and service outlets for non-medical contraceptives;
11) Social marketing outlets will include existing retail shops and social organizations in order to reach individuals and couples, who are not being well-served by hospital and clinic-based delivery systems;
12) The quality of health facilities and their equipment will be periodically reviewed and upgraded in order to improve the efficiency and effectiveness of the family planning programs;
13) Increased surveillance and stronger preventive measures will be taken to curtail the introduction of HIV/AIDS into the Marshall Islands;
14) The capacity of the system to deliver extended MCH/FP services will be improved by the training of an increased number of personnel through a greater number of in-service courses, and expanded pre-service training opportunities;
15) Greater efforts will be made to trace drop-outs from the family planning program, to investigate the reasons for dropping out, and to correct deficiencies in the program so as to increase the continuation rate;
16) Strenuous efforts will be made to establish a timely and efficient monitoring and evaluation system, in order that information and data base play a facilitating role in future planning efforts;
17) Public awareness campaigns will be mounted to emphasize the dangers of too-close birth intervals for the health of mothers and children;
18) Measures will be taken to ensure that there is better communication between couples, so that both female and male partners will participate in decisions and actions related to the choice of the ideal family size and contraceptive behavior.
It is hoped that when appropriate programs are implemented to achieve these objectives, reproductive rights would have been established, and reproductive health would have been assured for all in our country.
C. Women in Development (WID) Strategies
The goals, objectives and targets of this policy can only be achieved if the prevailing disadvantaged social and economic status of Marshallese women is uplifted. Even though this is a matrilineal society, it is well recognized that the standing of women has deteriorated as urbanization and Western influences have grown. Lower educational enrollments and higher rates of drop-out for girls lead to inferior labor market and life-time opportunities for women, including subsequent poor health and welfare status for their children and families.
A number of gender-related programs have been created in various institutions. For example, with the Cabinet's 1981 endorsement of the need for promoting greater involvement of women in national development, the Office of Women's Affairs (OWA) in the Ministry of Social Services was expanded and its functions redefined. This office and a reformed umbrella women’s organisation constitute the national machinery for WID initiatives.
These initiatives must be viewed as integral parts of this population and development policy. They must continue to be fully implemented and elicit wide participation, so as to achieve significant improvements in the status of women. They must redress the various constraints imposed on women at the household and community levels, so that an enabling environment for sustainable WID initiatives is created.
The WID component of this policy will address all the constraints faced by women, such that interventions are promoted which include positive attitudinal and behavioral changes by both men and women. Demographic behavioral changes would then follow. The WID strategy will include the following components:
· Raising the national and local level of awareness, intensifying political commitment and inducing greater understanding and sympathy for women's problems. This implies greater recognition of the pivotal role of women in planning and decision-making at the household, local and national levels; ensuring that women are better apprised of the non-traditional opportunities available to them in education and employment;
· Promoting the generation of gender-disaggregated data and research in order to contribute to a greater understanding of the contribution of women to national socio-economic development;
· Co-ordinating all WID activities;
· Strengthening all the principal sectors engaged in WID initiatives in both the public and private sectors, including the Ministries of Resources and Development, Education, Internal Affairs, Social Services and Health and Environment, and particularly the Office of Planning and Statistics (OPS), to address women's issues in all planning and programming activities;
· Promoting greater awareness of gender issues and the legal and constitutional rights of women in areas relating to land inheritance and use-rights, physical and mental abuse, adolescent fertility and teenage pregnancy;
· Incorporating more fully women in decision-making at the national, local and household levels, and in the search for alternative sources of energy, in the protection of the natural environment, in HIV/AIDS prevention campaigns, and in promoting food security and nutrition improvement, safe and reliable sources of water supplies and better sanitation;
· Including women in the design, implementation and management of all public-private/NGO population-influencing programs;
· Supporting all promotional measures to improve the education and training attainments of women, including their enhanced enrollment in vocational and technical training courses;
· Reviewing the adequacy of existing maternal leave provisions for working women and the extent to which women are discriminated against in terms of job opportunities and pay;
· Using opinion-leaders/notables in the community as channels of advocacy for family planning/small family size ideals, responsible parenthood and total health care for women, including safe motherhood.
D. Employment, Migration, Environment Protection and Other Strategies
As stated earlier, creation of acceptable job opportunities to increasing numbers of educated young Marshallese to the labor force is a serious problem. The problem is made even more serious because [of] divergence between the expectations of the job seekers and the job opportunities available: the workers expect paid office jobs, whereas the jobs available are those of skilled workers. Even the few office jobs that [are] available, such as those of accountants and bookkeepers, are taken by foreign workers, because Marshallese workers do not have the required skills. Under [such] circumstances, a policy of job creation must also be accompanied by a policy of equipping the Marshallese with the necessary skills through a vocational training program with a formal training component, and an on-the-job training component. Discouraging urban migration is another way of keeping youths in rural areas, where they may be able to find self-employment in fishing and agro-based activities. Overseas employment is another option available for solving the unemployment problem. At the same time it should be recognized that in selecting and implementing development projects adequate care must be taken to ensure that [the] environmental impact of such projects [has] been given due consideration.
· Every effort will be made to create jobs for Marshallese workers through the implementation of a public investment program which seeks to develop domestic resources and create incomes in the economy;
· Development of the private sector will be encouraged with a view to creating paid employment and self-employment through a variety of measures, such as encouraging foreign investment and making credit available for small-scale enterprises;
· The ability of Marshallese workers to compete in the labor market will be improved through the continuation and strengthening of on-going vocational training programs;
· Job opportunities in the Outer Islands will be enhanced through the promotion of commercial farming and fishing and tourism in those islands;
· Proper structure and procedures to implement and monitor programs to assist Marshallese to find overseas employment will be established;
· EPA and other environmental protection institutions will be strengthened to ensure that the impact of development projects on the environment is taken into account;
· Priority will be given to the provision of essential health and education services, and in view of the declining government revenues in the future years, taxes on alcohol and tobacco will be increased to generate revenue for health and education programs;
· Population factors will be integrated into the development planning process which, in turn, will give emphasis to the development of cottage industries, farmers' markets, integrated rural development and effective handling of land issues.
E. Research Strategies
The dearth of policy-related research in the RMI has played no small part in the lack of effective development planning in the country. Yet, such research is an integral part of policy formulation, implementation and monitoring. Recognizing the constraints in the country -- the lack of research skills and finance -- this policy will promote training and social, economic and demographic research to assist in the implementation and evaluation of the goals and targets as set out in the policy. Research in the following areas is necessary for effective policy formulation and implementation, much of which will be initiated and co-ordinated by the Population and Development Unit in the OPS:
· A study of the financial costs and extra demands for additional human resources arising from the implementation of this policy;
· An investigation of the social, cultural and economic determinants of high fertility, morbidity and infant and child mortality, and their patterns of change over time. (The multi-purpose household survey being co-ordinated by the OPS will allow these issues to be investigated during 1994-95);
· An investigation into the complex interrelationships between women's status, their labor force participation and the demographic response parameters of fertility, mortality and migration;
· A study of the causal relationship between desired and achieved fertility and realized mortality, and vice-versa;
· An in-depth study of the socio-economic characteristics of family planning acceptors, users and drop-outs, by methods and the reasons for discontinuation;
· A study of the social, cultural, economic, environmental and demographic impact of in-migration to Majuro and Ebeye on both sending and receiving areas;
· An investigation into the operation of the labor market in the RMI, including the reasons for the high rate of employment of foreign labor.
The policy has proposed innovative goals, objectives and targets for population and development activities and interventions in the Republic of the Marshall Islands. To be successful, many long-time habits and behavioral patterns deeply embedded in the population will need to change, and change quickly. On the other hand, the policy calls for a retardation in the manner in which recent Western-modern-style behavior has been too easily adopted. Yet, given the crisis-level nature of the population-related problems facing the country, radical change is urgently required. Success crucially depends on adequate institutional arrangements being made to co-ordinate and implement the program. Close collaboration between individuals and public and private organizations is a prerequisite for attainment of the principal objectives.
Role of Co-ordinating and Monitoring Institutions
With the rationale, objectives, targets and strategies adequately put in place in the policy document, the success of the program of action depends very much on the co-operation of all interests touched whenever population issues are addressed. Such interests include traditional and social institutions with interest groups and communities performing auxiliary roles. Every possible effort will be made to secure the support of these institutions for the implementation of this document.
In the Marshall Islands, traditional leadership and the associated institutions still exert a considerable degree of influence on the attitudes of individuals and families towards family size as well as other target factors identified in this document. Therefore it is extremely important to obtain the support of such leadership and the institutions representing them for the action plan identified in this document.
Similarly, efforts will be made to take account of the influence of family traditions and extended family system on the determination of family size.
The support of other institutions and groups such as Church groups will also be actively sought in the implementation of this document.
The services Ministries of Health and Environment, Interior, Education, Social Services and Resources and Development as well as NGOs, such as Youth-to-Youth in Health and the Women's umbrella group, must work together to ensure complementarity in program implementation. Furthermore, there is a priority need to intensify efforts in family planning research, IEC and training.
All of these parties will concentrate their efforts on promoting an eventual situation in which family planning will be accepted, recognized, propagated and practiced as an integral and critical part of the socio-economic development process in the Marshall Islands. The policy's success hinges on those programs aimed at increasing awareness of the benefits of family planning and the demand for services. Another component program will be to improve the quality and delivery of child-spacing and family planning services.
The Population and Development Unit (PDU) in the OPS needs to be strengthened considerably to play its assigned role of co-ordinating the implementation of the activities encompassed in the policy. It must ensure that demographic and related factors are fully integrated in the national development planning process. The OPS and the Ministry of Finance must accord priority status to the sectors relating to population, and ensure that the programs elaborated upon in this document are not curtailed by [the] lack of adequate funding.
OPS is expected to build partnerships with, and undertake collaborative programs with, family planning providers in the government, NGOs and the private sector. The National Population Co-ordinating Committee (NPCC), composed of technical personnel from the various ministries and NGOs, will seek to co-ordinate the various multisectoral programs to ensure collaboration and consistency in program goals and interventions. Under the chairpersonship of the OPS the Committee will serve as the technical secretariat of the recently inaugurated National Population Council. The Committee will provide technical advice to the various programs and facilitate the exchange of information and experiences, expertise, equipment and facilities, contributing to the capacity-building efforts of the individual ministries and NGOs. It will continuously review population programs and monitor the successes and failures of these interventions in order that the pace of change is on-track for meeting the goals and targets of the population policy. Together with OPS, and with the assistance of donors, the Committee is expected to initiate sectoral development policies, programs and interventions that will induce a decline in desired and achieved fertility, and a rise in the demand for family planning services. The NPCC role in co-ordinating the national population program will be strategic in meeting the policy's goals and objectives.
Implementation of this policy calls for the fullest involvement of all women in the Marshall Islands. Only then can an enabling environment for WID initiatives be realized, and the full integration of women's concerns into population, sustainable development and environmental planning be accomplished.
At the highest echelons of Marshallese society there is a growing appreciation of the country's population problem and of the importance of the close interrelationships between women, population and development. This concern must be seen to filter through all strata of the country, to the remotest community in the farthest atoll. Those responsible for implementing this policy at the local level must give due weight to the need to target women in programs relating to agriculture and fishing, social services and human resource development as a prerequisite to sustainable development. Issues of a healthy life-style, safe motherhood, reproductive health and affordable family size will need to be continuously and repeatedly emphasized by national and community leaders as well as through the media. Gender issues must be incorporated in all sectoral programs, and disaggregated demographic data by gender must be generated. Women must be more involved in designing, managing and implementing these programs in order to ensure that women's access to education, training and information becomes more equitable.
It is imperative that the co-ordinating role of the Health Education Unit of the Ministry of Health and Environment be enhanced in terms of IEC activities, so that all those agencies engaged in FLE and other population education and awareness-raising activities address a common goal, to raise the profile of population issues and the level of national awareness on the interrelationships between population growth, limited natural resources and the well-being of the family.
The availability of family planning services must be made known and extended to all Marshallese, wherever they live. They must also be made to appreciate the advantages and disadvantages of each method in order that they have a sound base on which to make rational decisions, and the satisfaction of knowing that counselling services are available for those who need more information. An appreciation of the causal relationship between large family size and family health status should be extended to all Marshallese. Population education must be extended throughout the school system in order to contribute to the successful implementation of the programs portrayed in this policy.
In order to attain the ambitious family planning targets contained in this policy, the financial and human resources made available to the Ministry of Health and the Environment must be greatly expanded if the projected increased demand for family planning services is to be met. The small number of NGOs currently engaged in the IEC/FLE campaign must be expanded significantly; their involvement in a certain amount of service provision would enhance and facilitate the capacity of the public health clinics.
This population and development policy illustrates how seriously the Government views the present and impending situation. Its intention to ensure positive demographic change and social and economic development is unequivocal. The financial and technical assistance needed to implement this population policy will require traditional and new international donors for some time to come.