‘Poster child’

JAKARTA—Despite political and financial factors that have set back its family planning program, Indonesia remains a “poster child” among countries seeking to curb or slow down population growth.

Having adopted a national family planning policy and program in the 1970s, Indonesia has made impressive gains in terms of slowing its population momentum and meeting the reproductive needs of its citizens. Studies show that if Indonesia’s fertility rate had remained constant at the 1965 level, where the average rate was 5.6 children per woman, its projected total population by 2050 would be 1.6 billion, making it the second most populous country in the world behind India.

But—and this is a big but—with the adoption of a massive, community-based family planning and reproductive health program, Indonesia has been able to slow down that momentum, with the total fertility rate (TFR, or the number of children a woman expects to bear in her reproductive lifetime) brought down to 2.6. However, said Dr. Sugiri Syarief, head of the BkkbN, Indonesia’s population and family planning board, they expect the latest Demographic and Health Survey to show a decline of TFR to 2.3 or 2.4, very near what demographers call “replacement level” fertility.

To a large extent the halving of the average number of children borne by Indonesian women is an accomplishment of the BkkbN, a government board created in the 1970s to plan and oversee national efforts at family planning and promotion of reproductive health. BkkbN is undergoing what Sugiri calls a “revitalization” phase, after years of stagnation following political turmoil and a regional financial crisis. But the renewed commitment of President Susilo Bambang Yudhoyono has served to refocus the national government commitment’s to population issues. This time around, said Sugiri, their focus has shifted to previously neglected target sectors of the population: youth and the very poor, and remote areas of Indonesia, particularly small islands.

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Yet there remain serious obstacles to the full realization of reproductive health among Indonesians. One major factor is the still-high maternal mortality rate (MMR) of 228 deaths per 100,000 live births (which is very near the Philippines’ own MMR). This is already a huge improvement, down from the 1970s level of 960. Indonesia’s MMR target for the Millennium Development Goals (which culminates in 2016) is 102, more than half the current rate. But, said Sugiri, “we may achieve that goal only by 2020.”

Sugiri met us at the BkkbN headquarters in Jakarta, and it was obvious he had done this presentation many times. “We need to explain to the people that family planning is not just about bringing down the population, but about improving the family,” he said. Which is why part of the campaigns that BkkbN conducts in communities is the launch of income-generating programs and provision of capital for small businesses. After all, the reason couples in poor urban and rural areas have many children is the uncertainty about the number of children surviving childbirth, and the need for more hands to help with livelihood. If parents could be assured of the survival and health of the children they do have, and could be helped to ensure a stable livelihood, then they would not have so many children and the surviving children could be assured of basic education and health needs.

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Another unique factor in Indonesia’s approach to family planning is that the BkkbN operates with a majority Muslim population where the misconception remains that family planning is forbidden by Islam.

One of the first actions of the government was to approach the leaders of the two biggest Muslim welfare groups in Indonesia: Muhammadiyah and the Muslimat Nahdlatul Ulama, which together accounts for millions of members. The two groups work to promote Islam among communities and provide for the spiritual, educational, health and material needs of their members.

Dr. Wan Nedra Komaruddin, a vice dean at a local university and volunteer leader of Muslimat, said the group’s involvement in family planning is based not just on its desire to “increase the knowledge of women on family planning” but, more importantly, on “incorporating religious values into family planning activities.”

As Muslim organizations, both Muhammadiyah and Muslimat can offer only a limited set of family planning services: injectables and pills, the IUD, and withdrawal. As religious organizations, they cannot provide services to unmarried young people, although Komaruddin said they do incorporate sex education (using a different terminology) into the curriculum of the “pesantren” or Islamic boarding schools.

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But even a limited menu of family planning services and devices can go a long way in a country coping with the “demographic momentum,” the inevitable growth in population fueled by large numbers of babies born decades earlier.

Part of the effort is the manufacture of contraceptives, which in Indonesia has grown into an industry of its own, by local companies or tie-ups between locals and multinationals.

We visited one such factory, the Triyasa Nagamas Farma, which manufactures implants, injectables and contraceptive pills (we also saw a small bottled-water operation).

Anton Tjandra, a director of the company (and son-in-law of the CEO and founder), said he saw the company’s role as “trying to fulfill the government’s needs for family planning,” although it also provides its products in the “free market,” including export markets like the Philippines.

Tjandra put it succinctly: “It makes good business sense to set up contraceptive manufacturing when you have such huge demand.”