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Indonesia to revive national family planning programme
World Report
Indonesia to revive national family planning programme With a growing population that is worrying officials, Indonesia is reinvigorating its efforts in family planning provision. But the endeavour is no mean feat. Abby Seiff reports.
www.thelancet.com Vol 383 February 22, 2014
goal of 2·1 children per women by 2025, the government is boosting training. “In the last couple of years, BKKBN has already conducted training for more than 50 000 midwives and 12 000 medical doctors in intrauterine device [IUD] and implant insertion and removal. Training of midwives and doctors for the insertion and removal of IUDs and implants will continue in the coming years according to the need. Similarly, training for vasectomy and tubectomy is also being [focused on]”, says Hasmi.
“To reach the now-reset goal of 2·1 children per women by 2025, the government is boosting training.” While the government is increasing efforts, however, some rights groups have argued that more needs to be done at a cultural and legal level. In a 2010 report by Amnesty International, the group highlighted several barriers to safe and effective family planning. “Sexual and reproductive rights in Indonesia are further compromised by the state’s failure to challenge attitudes and practices that discriminate against women and entrench stereotyped roles for men and women. For example, health workers often deny childless married women and girls the full range of available contraceptive services, in part due to specific views about gender roles and the importance of childbearing”, notes the report. Hari Fitri Putjuk, country representative at the Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs, Baltimore, MD, USA, said their studies had hit upon similar issues. “From demand side: there is still lots of fear due to myths, lack of understanding
of methods, and some conservative religions are opposed to [family planning]. Most of the problem from demand side is that there is no focused information, all is generic. Mass media such as TV is the most effective media [but it is] not utilised effectively; social media is not developed effectively”, she tells The Lancet. In Indonesia, the rate of 15–19 year olds having children in rural areas is more than double that in urban areas. In the coming years, says Hasmi, the government will focus its efforts on the rural population. “To reach populations that [lack] access [to] static health care facilities such as those living in remote areas, border areas, in remote islands, and in the slum areas, BKKBN and relevant partners [have] increased mobile services activities”, he says, adding that women are being encouraged to use long-term contraceptive methods. In the 1970s, dua anak cukup (two children are enough) became more than a fertility campaign—it was a rallying cry for the country. There can be little doubt of its effectiveness. As Hasmi points out, contraceptive use has jumped from below 5% in the early 1970s to 62% in 2012. “The fall in fertility from 5·6 to 2·6 during the same time, has successfully averted around 100 million births”, he says. Based on population projections, had the planning programme not gone ahead, today’s population would be nearer 330 million people. When other low-income countries look to improve their family planning schemes, the Indonesian model often tops the list. And so, to lower fertility rates, Indonesia need look no further than within its borders. Today, after a two-decade hiatus, dua anak cukup commercials have returned to the air.
Barbara Walton/epa/Corbis
In the beginning of the 1970s, fertility rates in Indonesia hovered around 5·6 children per women. Seeking to combat poverty and improve quality of life, the government launched a family planning programme still considered an exemplar today. Within a decade, the rate had dropped to 4·7 and by the early 1990s, that figure was 3·0 births per women. Over the course of the next decade, the figure continued to dip, according to government data. In 2002, it had hit 2·6. And then, progress halted. At the close of 2013, the figure was identical: 2·6. By 2014, the country had aimed to reach a total fertility rate of 2·1 and maintain that for a decade. But the goal was set in 2004, just years after the nation’s sweeping decentralisation, which added layers of complexity that might be expected to slow progress. Now, however, Indonesia is reviving its family planning programme once again. Eddy Hasmi, director of collaboration on population education at the National Population and Family Planning Board (BKKBN), tells The Lancet: “The revitalisation process is ongoing...we must look at the existing political reality with a growing number of districts and local government dynamics changing very rapidly. It’s all a challenge to be faced.” According to Hasmi, who is also general secretary of the Indonesian Demographic Association, the government is changing laws regarding regional autonomy, which “will benefit the family planning programme since it results in making the responsibility of local government to the programme clearer, whereas in the current regional autonomy act, it is a bit vague”. With a highly heterogeneous population nearing 250 million, spread across thousands of islands, undertaking sweeping changes is no easy task. To reach the now-reset
Abby Seiff 683
Indonesia to revive national family planning programme With a growing population that is worrying officials, Indonesia is reinvigorating its efforts in family planning provision. But the endeavour is no mean feat. Abby Seiff reports.
www.thelancet.com Vol 383 February 22, 2014
goal of 2·1 children per women by 2025, the government is boosting training. “In the last couple of years, BKKBN has already conducted training for more than 50 000 midwives and 12 000 medical doctors in intrauterine device [IUD] and implant insertion and removal. Training of midwives and doctors for the insertion and removal of IUDs and implants will continue in the coming years according to the need. Similarly, training for vasectomy and tubectomy is also being [focused on]”, says Hasmi.
“To reach the now-reset goal of 2·1 children per women by 2025, the government is boosting training.” While the government is increasing efforts, however, some rights groups have argued that more needs to be done at a cultural and legal level. In a 2010 report by Amnesty International, the group highlighted several barriers to safe and effective family planning. “Sexual and reproductive rights in Indonesia are further compromised by the state’s failure to challenge attitudes and practices that discriminate against women and entrench stereotyped roles for men and women. For example, health workers often deny childless married women and girls the full range of available contraceptive services, in part due to specific views about gender roles and the importance of childbearing”, notes the report. Hari Fitri Putjuk, country representative at the Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs, Baltimore, MD, USA, said their studies had hit upon similar issues. “From demand side: there is still lots of fear due to myths, lack of understanding
of methods, and some conservative religions are opposed to [family planning]. Most of the problem from demand side is that there is no focused information, all is generic. Mass media such as TV is the most effective media [but it is] not utilised effectively; social media is not developed effectively”, she tells The Lancet. In Indonesia, the rate of 15–19 year olds having children in rural areas is more than double that in urban areas. In the coming years, says Hasmi, the government will focus its efforts on the rural population. “To reach populations that [lack] access [to] static health care facilities such as those living in remote areas, border areas, in remote islands, and in the slum areas, BKKBN and relevant partners [have] increased mobile services activities”, he says, adding that women are being encouraged to use long-term contraceptive methods. In the 1970s, dua anak cukup (two children are enough) became more than a fertility campaign—it was a rallying cry for the country. There can be little doubt of its effectiveness. As Hasmi points out, contraceptive use has jumped from below 5% in the early 1970s to 62% in 2012. “The fall in fertility from 5·6 to 2·6 during the same time, has successfully averted around 100 million births”, he says. Based on population projections, had the planning programme not gone ahead, today’s population would be nearer 330 million people. When other low-income countries look to improve their family planning schemes, the Indonesian model often tops the list. And so, to lower fertility rates, Indonesia need look no further than within its borders. Today, after a two-decade hiatus, dua anak cukup commercials have returned to the air.
Barbara Walton/epa/Corbis
In the beginning of the 1970s, fertility rates in Indonesia hovered around 5·6 children per women. Seeking to combat poverty and improve quality of life, the government launched a family planning programme still considered an exemplar today. Within a decade, the rate had dropped to 4·7 and by the early 1990s, that figure was 3·0 births per women. Over the course of the next decade, the figure continued to dip, according to government data. In 2002, it had hit 2·6. And then, progress halted. At the close of 2013, the figure was identical: 2·6. By 2014, the country had aimed to reach a total fertility rate of 2·1 and maintain that for a decade. But the goal was set in 2004, just years after the nation’s sweeping decentralisation, which added layers of complexity that might be expected to slow progress. Now, however, Indonesia is reviving its family planning programme once again. Eddy Hasmi, director of collaboration on population education at the National Population and Family Planning Board (BKKBN), tells The Lancet: “The revitalisation process is ongoing...we must look at the existing political reality with a growing number of districts and local government dynamics changing very rapidly. It’s all a challenge to be faced.” According to Hasmi, who is also general secretary of the Indonesian Demographic Association, the government is changing laws regarding regional autonomy, which “will benefit the family planning programme since it results in making the responsibility of local government to the programme clearer, whereas in the current regional autonomy act, it is a bit vague”. With a highly heterogeneous population nearing 250 million, spread across thousands of islands, undertaking sweeping changes is no easy task. To reach the now-reset
Abby Seiff 683