Indonesia's Family Planning Program Falling Apart

http://thejakartaglobe.com/news/indonesias-family-planning-program-falling-apart/303754

See Also: Experts Sound Warning on Impact on Islamic Conservatism on Population Growth

All smiles in her sparkly wedding dress, former Miss Indonesia Artika Sari Devi began counting on her fingers when a mob of gossip show television crews threw the bride and groom the obligatory question: How many children do you plan to have?

"One, two, three, four … four!" Artika shouted happily without hesitation during a posh post-wedding reception last August.

If it were the 1980s, she would probably be reprimanded by government officials for not publicly supporting the national family planning program with its infamous slogan “Two children are enough.”

During the Suharto regime, a family planning policy that began in the early 1970s was practically forced, with program counselors knocking on doors to ask people, mostly women, to use contraceptives. The counselors would chase people down to join the program, and those who refused to join were threatened with, among other punishments, forced transmigration to rural areas of Indonesia, according to the Urban Poor Consortium, a nongovernmental organization based in Jakarta.

The country at that time had a high fertility rate of 5.6 children per family. Population experts issued dire warnings about the effects of a huge population on the country’s economy.

“We were given a target to find a certain number of couples every week to join the program. It was kind of embarrassing if we didn’t make it,” said Robiyatun, 51, who has worked as a family planning counselor in East Jakarta since 1985.

The New York-based Lawyers Committee for Human Rights, now called Human Rights First, reported in 1995 that military officers were also deployed to recruit people to use contraceptives.

Hundreds, even thousands, of contraceptive distribution points and posyandu , or child health care posts, were established throughout the country and staffed with counselors.

Even though sex education in Indonesian schools is limited, students nationwide had to learn a song called “Keluarga Berencana” (Family Planning), a military-style marching tune regularly played on national television and radio stations with the lyrics, “The family planning program is important for a bright future. Healthy, strong and smart children are the nation’s hope.”

Couples that ignored the song’s message, however, were scolded by government officials, subjected to whispering campaigns and singled out in their communities. Civil servants who had more than two children were denied the education tuition subsidies that were part of their employment packages.

Despite criticism of the Gestapo-like tactics used to enforce the two-children limit and the basic suspension of women’s reproductive rights — couples were not allowed to select which form of contraception best suited their needs — Suharto’s family planning program was an unqualified success. Indonesia’s fertility rate dropped from 5.6 percent in the 1970s to 3 percent in 1991, and is presently 2.3 percent.

The program was hailed as one of the world’s best by various international organizations, and Indonesia became a model for other countries with booming populations.

After Suharto resigned in disgrace in 1998, many of his policies and programs were swept away, while the family planning program was given low priority as the public sought to purge the “New Order” regime from their memories. Attitudes toward family planning were more relaxed and successive presidents have had far bigger issues — social unrest, sectarian violence, terrorism — to do deal with.

After the fall of Suharto, only several hundred posyandu centers remained open, most of which were in Java. Regional governments, breaking away from Jakarta’s grip through the nationwide decentralization process, paid little attention to the old program, thinking that population growth was no longer a significant problem.

The famous family planning marching tune now only echoes at the National Coordinating Agency for Family Planning, or BKKBN.

“We don’t have to go door-to-door anymore and there can’t be any coercion. We only meet people’s requests now,” said Robiyatun, the counselor, adding that there was no longer a budget for door-to-door visits and that people would no longer accept such an intrusion.

As a consequence of this more relaxed attitude, the Central Bureau of Statistics projected recently that Indonesia would experience a new population boom in the next two decades. As the world’s fourth-most populous country, Indonesia has actually experienced declining population growth, from 2.3 percent in the 1980s to 1.3 percent today. By 2020, it is expected to fall as low as 0.9 percent. However, given that the country’s population is already 222 million, the bureau projected that 247.5 million people could live in Indonesia by 2015, and 273 million by 2025.

Meanwhile, Java Island’s population is expected to grow by 20 million by 2025. It is already home to more than 100 million people, despite making up only 6 percent of Indonesia’s land area.

“In the long term, the population boom will affect the provisions of government funding for health and education facilities, and food supplies,” said Suahasil Nazara, director of the Demographic Institute at the University of Indonesia. “It will also affect nutrition levels among babies and push up the unemployment rate.”

There are already 10 million people unemployed at the moment, he said, while more than 100 million live on $2 or less a day.

The cost of immunizing children, for example, will rise from roughly Rp 791.6 billion ($73.6 million) in 2008 to Rp 1.4 trillion in 2015.

In terms of rice consumption, the country currently consumes 33 million tons a year, but will have to supply 38 million tons by 2025.

The operational budget for elementary education is predicted to jump from Rp 100.3 trillion in 2008 to Rp 187.4 trillion in 2015. There are numerous other issues to consider, as well, including an aging population and urban migration.

Efforts to reduce the fertility rate, however, have failed in the past five years, with the figure only dropping slightly from 2.6 children per family in 2003 to 2.3 in 2008.

Sugiri Syarief, head of the National Coordinating Agency for Family Planning, said that regional governments considered family planning efforts successful, given the declining birth rate, and that the matter should be handled by the central government. “Especially because it is a program with long-term results,” he said.

Sugiri’s agency no longer has authority over regional governments and cannot simply order them to increase their budgets for family planning. The agency was once led by a minister who reported to the president, but now it only exists as a subordinate agency to the Ministry of Health.

Most cities and provincial districts no longer have a family planning office, only a population office with limited capacity to conduct campaigns and provide services. The population offices also do not provide counseling.

Some family planning counselors have abandoned their jobs, opting instead to run for office in local elections, Sugiri said.

“Family planning programs have stagnated. The contraceptive prevalence rate has increased only slightly from 55 percent in 1994 to 61.4 percent in 2007,” he said. “The most pressing problem is that poor people continue to have more than two children, resulting in children lacking nutrition and education.”

The Central Bureau of Statistics conducted a demographic and health survey in 2007 that found that the fertility rate among poor families is 3.2 children, higher than the national rate. Fertility rates in poorer regions are also high: Families in East Nusa Tenggara Province, for example, have an average of 4.2 children, while those in Papua Province have 3.4. In addition, the contraception prevalence rate among the poor, 52.4 percent, is lower than the national rate.

Karmila, a 33-year-old mother of three in North Jakarta, said that her husband had wanted a big family. He only had one sibling growing up.

“It is indeed tough, financially, as my husband only works as an office cleaner. So, three children are enough,” said Karmila, whose family lives in a 3-by-3-meter rented room in a slum area of Kelapa Gading and shares a bathroom with the neighbors.

However, Karmila said that she had difficulty finding a suitable method of contraception to help avoid an unplanned pregnancy. The pill made her nauseous, IUD coils made her bleed, and a hormonal injection made her feel bloated. After several failed attempts, she finally settled on an implant in her arm.

“It was free of charge, thank God. The family planning counselor came to this area and gave us free service and consultation,” she said.

Karmila said that she previously had to pay for contraceptives, even though the National Coordinating Agency for Family Planning was supposed to distribute them to the poor for free. Sumarjati Arijoso, the former head of the agency, admitted that some officers charged money for the contraceptives.

Nurhayati, 25, who lives near Karmila, gave up on the injected contraceptive after one year because she felt it was too much work.

“I had to go back and forth three times a year to the midwife’s place and it cost me money,” said Nurhayati, a housewife and mother of a two-year-old boy.

Nurhayati appeared frail and skinny, sitting on the floor, holding her sleeping son in a tiny rented room she shares with her three siblings and parents. Her husband, who works in a factory in Bekasi, some 30 kilometers east of Jakarta, only returns home on weekends.

Nurhayati said that she had to change public buses twice to get to her midwife, paying around

Rp 25,000 for her contraceptives. She was reluctant to use other methods, and condoms are out of the question in her relationship.

There is a general notion that condoms reduce sexual pleasure, which often puts the burden of contraception on women. Contraceptive prevalence among sexually active Indonesian men is just 1.3 percent, with 0.9 percent using condoms.

Nurhayati’s mother, Misih, 41, encourages her to have another child, saying, “an only child would be too spoiled.” Her father, Rohim, 51, who is currently unemployed, agreed.

Muhadjir Darwin, director of the Center of Population and Policy Studies at the Yogyakarta-based University of Gadjah Mada, said: “Poor families have low aspirations for the future of their children, and as child mortality among the poor is higher than the national rate, which is 40 per 1,000 births, they often have more babies to compensate for ones that die.”

Indonesia still has the highest maternal mortality rate in Southeast Asia at 262 deaths per 100,000 births, based on 2007 data. Maternal mortality is three to four times more likely among poorer Indonesian women than among the wealthy.

“However,” Muhadjir added, “poor families cannot be entirely blamed [for the low contraceptive rate] either, as they have difficulty accessing contraceptives.”

The number of participants in the family planning program has remained largely consistent in the past decade, with an increase of less than 1 percent between 2000 and 2007.The number of family planning counselors, however, has decreased from 35,000 during the Suharto era to only 21,000 people serving the entire country today.

Sugiri estimates that 9.1 percent of married women are in need of contraceptives. “There are people who want contraceptives but fail to get them,” she said. “It could be because they are afraid or have no money to go to the clinic.”

Robiyatun suggested that cash incentives should be given to counselors who are able to persuade more people to use contraceptives.

“We counselors get a lot of help from cadres to reach neighborhoods or community units, but they only get Rp 25,000 every three months,” she said. “Even a cadre in the dengue fever eradication program receives around Rp 100,000 a month. If more incentive is given, more people can be reached by the cadres.”

Despite its draconian measures, Suharto’s policy of installing cadres in health and family planning positions was effective in reaching out to target groups. Now, though, their involvement is no longer enough.

Sugiri said the family planning agency would accelerate programs aimed at boosting contraceptive use, particularly those targeting poor families and isolated regions. The agency, for example, has set a target of increasing the number of mobile contraceptive service providers from 33 to more than 300 in 2009, with the aim of covering the whole country.

“Currently, we only have the funding to provide free contraceptives to the number of poor people based on official state figures,” Sugiri said. “But I believe many other people are in a gray area, as they are just slightly above the poverty line but cannot afford contraceptives. We have to target them, too.”

He urged both the central and regional governments to increase their budgets for family planning programs, which he said should ideally amount to Rp 3 trillion. Currently, however, just Rp 1.2 trillion has been allocated, of which 98 percent is provided by the central government and 2 percent by regional authorities.

Posted by hera at Friday, January 2, 2009 1:24 AM | Permalinks