Afterthoughts

Indonesia: A Family Planning Model for the Philippines?

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11:25 PM July 16th, 2011

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By: Walden Bello, July 16th, 2011 11:25 PM

The facts are clear.

In terms of key economic and social indicators, the Philippines was ahead of Indonesia, Thailand, and Vietnam 40 years ago.  Today, we are behind and face the dismal prospect of falling even farther behind in the next few years.  And a major part of the reason is that in contrast to the Philippines, the three carried out successful population management programs.  As a result, all three are now enjoying the dividends of effective family planning: rapid economic growth, decreasing poverty, and a better quality of life.

We did not take the population challenge seriously.  Our neighbors did.

Fertility Fall Precedes Economic Growth

Indonesia is perhaps the clearest case of the causal relationship of population management to economic growth and poverty reduction.  As Peter Miller, a leading family planning analyst with experience in Indonesia, told me, “family planning clearly preceded economic growth in Vietnam, Thailand, and Indonesia, but it is in Indonesia that the case is most clearly seen.”

Miller recalls going from an assignment in Bohol to Surabaya in Indonesia in 1975.  Compared to Bohol then, Surabaya was desperately poor, with “the children lining the streets showing signs of severe malnutrition.”  But what he found significant is that in contrast to Bohol, family planning was widely practiced. Surabaya was a microcosm of Indonesia during this period of widespread poverty, where the key program to promote economic growth was the vigorous family planning program pushed by the Suharto government.

The demographic transition in the West was marked by economic growth followed by a fall in the fertility rate.  In contrast, Indonesia’s economic takeoff was preceded by a fall in the fertility rates.  The Total Fertility Rate (TFR), or average number of children expected in a woman’s lifetime, dropped from 5.6 in 1965-70 to 5.2 in 1970-75 to 4.7 in 1975-80 to 4.11 in 1980-85.  This left Indonesia well positioned for its golden period of economic growth in 1985 to 1995, when per capita income grew by 70 per cent.

A low population growth rate translates into a higher gross domestic product (GDP) per capita, and this translates into higher incomes, higher savings, and higher investments.  Effective population management interacted with economic growth to trigger a virtuous circle that made a central contribution to reducing the percentage of the population living in poverty from 40 per cent in the late seventies to around 11 per cent in the mid-nineties, or an overall reduction of almost 75 per cent in two decades!

Ingredients of a Success Story

What accounted for the success of program?

One very important ingredient was national leadership.  There were many things wrong with Suharto, and the man was responsible for countless human rights violations, but one of the things the dictator apparently got right was that any possibility of development would be choked by unrestrained population growth.  As Jose Ferraris, the United Nations Population Fund (UNFPA) representative in Indonesia, put it, “Suharto had vision. He saw things thirty years down the road, and he provided the high-level political will.”

Second, the population program became a mass movement. “It began as a top-down movement, but it soon became a bottom-up movement,” says Ferraris. Innovative organizing at the village level sustained the momentum of the program, and central to this process was a charismatic individual named Haryono Suyono, who was described as a “cross” between Juan Flavier, the dynamic Filipino civil society figure, and Meechai Viraidya, a central figure in the history of family planning in Thailand.  Highly motivated field workers promoted the idea of “small, healthy, prosperous and happy family.”  Signs proclaiming “Two Children are Enough” were planted everywhere, and blue chromatic circles were imprinted on houses whose residents were practicing contraception.

Third, the program was integrated into income-support programs.  One of the major reasons for successful expansion of village family planning groups in Indonesia was the ability of National Family Coordinating Board (BKKBN) to come up with innovations to make these groups more attractive to village women that served as incentives for women to limit births.  Making micro-credit available was one such initiative, analyst Ashok Barnwal claims, “The BKKBN provided funds with low interest rates to the groups for micro-credit purposes…requiring family planning use for a specific period of time before they could have access to these low interest loans. This worked like an incentive to use the family planning methods. This intervention also helped in strengthening the government-society link.”

A fourth reason was an active government effort to recruit religious leaders to support the process.  The role of the ulamas or Muslim leaders trained in Islamic doctrine and laws was critical in convincing Indonesia’s majority Muslim population, so the BKKBN initiated a sustained dialogue with them.  The decisive outcome of this effort was the ulamas’ issuing of a fatwa, or religious opinion, supporting the use of contraceptive methods except for vasectomy.  As a result, about 90 per cent of the Muslim community now supports family planning, according to Eddy Hasmi, head of BKKBN’s Center for International Training and Collaboration.

The family planning leaders were aware of possible problems with the minority Catholic community, so, as they did with the Muslim leaders, they placed a special effort on a constructive dialogue with the Catholic hierarchy.  According to Hasmi, the Church in Indonesia supports family planning, and though it does not endorse the use of contraceptives, it does not actively oppose it.   According to UNFPA’s Ferraris, there is dialogue between the State and the Catholic Church, and the process has been made easier by the “relative independence of the Indonesian Catholic Church.” The attitude of the Indonesian Church is that family planning is a matter of moral choice by the individual, and this moral choice can only be exercised “if it is based on information.”  The liberal attitude of the Indonesian Catholic hierarchy is evident in its approving the distribution of a government family planning booklet titled “Building a Prosperous and Responsible Family: the Catholic Perspective,” which has 11 pages that describe in detail the different methods of artificial contraception.

Still, despite the relatively tolerant attitude of the Indonesian Church, the TFR in East Nusa Tenggara, where Catholics form the majority, is 3.7 – the highest in the country – while the national rate is 2.3.   The proportion of sexually active women of reproductive age who want to practice family planning but do not have access to family planning supplies or methods is over 15 per cent in the province, much higher than the national figure of 9 per cent.  Its relatively poor performance in family planning is perhaps not unrelated to the fact that East Nusa Tenggara is also a depressed region, where the unemployment rate in its most populated part, West Timor, reaches as high as 80 per cent.

Losing and Recovering Direction

For a decade after the Asian financial crisis in 1998, Indonesia entered a period of economic crisis and political instability, and the family planning programs saw some scaling down in emphasis and budget-wise.  However, the habits of contraceptive use to limit family size held: from 1997 to 2003, TFR decreased from 2.8 to 2.4, and to 2.3 in 2007.

Nonetheless, the deemphasis on the program might have had some negative consequences.  The current high incidence of abortion, which was estimated in 2010 at about 1.2 million, could have something to do with the fact that “access to and the quality of family planning counseling and other services deteriorated owing to neglect,” according to Eddy Hasmi, who says a number of micro-studies pointed in this direction. There is also the sense that with country’s population reaching 241 million in 2011, the 1.3 per cent population growth is still uncomfortably high and adds a cohort of people “nearly the size of Singapore” each year, as one government publication puts it.

Worried about such trends, President Susilo Bambang Yudhoyono has refocused government attention on and sought to increase government resources for family planning during his second term.

Indonesia’s Window of Opportunity

Today, Indonesia is said to be on the threshold of its “window of opportunity,” with a “dependency ratio” – that is, the ratio of people age 0-14 and age 65 and above to the working age population of 15 to 64 years – moving from 51.9 in 2005 to 48.8 in 2010 to 44.7 in 2020 to 44.0 in 2030.   The members of the labor force entering the work force during this period are also said to be of a better quality from the perspective of skills than earlier cohorts owing to their being born to smaller families, a condition that has helped equip them with higher educational attainments, better health, and modern values.

The entry of this new cohort into the labor force has coincided with the unfolding of a new, sustained boom in the Indonesian economy that saw Indonesia grow by 4.9 per cent during the lowest point of the current global economic crisis in 2009, even as other economies were plunged into recession.  According to the World Economic Forum, “Among Indonesia’s strengths, the macroeconomic environment stands out…Fast growth and sound fiscal management have put the country on a strong fiscal footing.  The debt burden has been drastically reduced, and Indonesia’s credit rating has been upgraded.” It points out that “as one of the world’s 20 largest economies, Indonesia boasts a large pool of potential consumers, as well as a rapidly growing middle class, of great interest to both local and foreign investors.”  A strength that the report should have underlined as well is Indonesia’s having successfully surmounted the population problem.

Lessons for the Philippines

So what lessons can the Philippines learn from Indonesia?

Definitely, the most relevant is a strong commitment on the part of the national government that is sustained over time.

Second, family planning cannot simply be left to the government but must be supported by organizing at the grassroots, community level.

Third, incentives can facilitate commitment to family planning.  The Aquino administration might, for instance, provide more generous benefits in health insurance, housing, and other government programs to low-income families that practice effective family planning.

Finally, the program’s progress can be accelerated if it enjoys the support of a country’s religious leadership.  In Indonesia, the support of the ulamas in the Muslim community has been a big plus for the program.  Unfortunately, the Catholic hierarchy in the Philippines will not be swayed from its opposition to family planning.  Thus, it might be necessary to mobilize lay Catholic leaders as well as priests who believe in the program – of which there are many – to neutralize the opposition of the bishops.

The Indonesian experience shows the value of political will, innovativeness, participation, and dialogue in family planning.  It is one that the Philippines will do well to study and replicate, with sensitivity, of course, to our particular national circumstances.

* Walden Bello represents Akbayan (Citizens’ Action Party) in the House of Representative and serves as a senior analyst in the Bangkok-based research institute Focus on the Global South.  He recently visited Indonesia, Thailand, and Vietnam to investigate the family planning programs in these countries.

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