Family Planning: Indonesia #1

In 1991, at the start of George Bush Senior’s Gulf War, I spent a month at Gadjah Mada University in Yogjakarta. It is located on Indonesia’s most populous and densely populated island, Java. Part of my studies involved research into Indonesia’s approach to family planning.

The Suharto government, in keeping with its authoritarian military nature, carried out an effective program based around the slogan ‘Dua Anak Cukup’ (Two Children Are Enough) or dua cukup for short. The ideal family was promoted everywhere, including public parks as shown in the photo from 1991.

The 1990 Census population figure was 197 million. The current estimate exceeds 240 million making it the fourth largest nation on the planet after China, India and the United States of America. My 1991 research included two visits to family planning clinics. The first clinic was attached to a public hospital and was run by the National Family Planning Coordinating Board (BKKBN). The BKKBN is still the responsible government agency. Their proudest boast of the time was the number of condoms used in Indonesia. In addition, contraceptive strategies included implants, intrauterine devices (IUDs), injections, the pill and sterilisation.

USAID worked with the BKKBN for 35 years until winding up the partnership in 2006. At the time USAID hailed it as a major success story:

In the early 1970s, a woman had an average of six children. Today most women have between two or three children. It is estimated that Indonesia has 80 million fewer people today due to the success of family planning.
Ambassador Pascoe Applauds Indonesia’s Successes in Family Planning

In 2006 they cited not only deceleration of population growth but also the drop in the fertility rate from 5.6% to 2.7% as key indicators. The CIA World Factbook estimates the current population growth rate to be 2.097% (118 out of 213 in the world) and the fertility rate 2.28 (107). This graph illustrates the clear link between contraceptive use and fertility rates and hence population growth:

A number articles from the Jakarta Post show that there may be a rocky road ahead. Firstly, on top of religious reservations about contraception, family planning is being increasingly politicised, especially by Muslim activists:

Speakers at a conference for young Indonesian Muslims Friday, urged the audience to denounce birth control methods such as condoms and the government’s family planning program, claiming such measures were part of a conspiracy to weaken the country.
Population control ‘a weapon of the West’

Secondly, some of the steam seems to have gone out of the national program since President Suharto’s overthrow in 1998:

Despite a decades-old family planning program, Indonesia continues to be unable to control population increase and now faces serious social and economical problems due to overpopulation. With about 4.2 million babies being born yearly, the country’s total population reached 240 million in 2009, a government agency said. … According to the ministry, 9.1 percent of fertile couples, which is the board’s main target segment, did not have access to family planning in 2009, compared to 8.6 percent in 2008.
Indonesia faces ‘serious’ population problem

Indonesia moved to privatise and deregulate its family planning program in 1989. A user-pays system, with subsidies for the poor, was introduced as part of a shift to private providers. Whether this has had a negative impact is open to debate. A third Jakarta Post story supports this argument:

Family planning programs are an unfamiliar service among city residents, especially among the poor, with an observer warning of the looming phenomenon of a lost generation.
Urban poor ‘lack access’ to family planning

There are efforts being made by BKKBN,  the government of Indonesia, the private sector and overseas aid agencies  to reinvigorate their crucial family planning program. Let's hope they are successful. My next Family Planning post will look at an Indonesian NGO and their novel approaches to reaching the people.