The Status of Family Planning in Indonesia Today: A Story of Success and Fragmentation

Transcription

1 The Status of Family Planning in Indonesia Today: A Story of Success and Fragmentation UNFPA and ICOMP Regional Consultation on Family Planning in Asia and the Pacific: Addressing the Challenges Bangkok, 8-10 December 2010 Adrian C. Hayes Australian Demographic and Social Research Institute (ADSRI) The Australian National University adrian.hayes@anu.edu.au 1

2 1. Introduction The International Conference on Population and Development (ICPD) in Cairo (1994) adopted a Programme of Action with an ambitious goal: All countries should take steps to meet family-planning needs of their populations as soon as possible and should, in all cases by the year 2015, seek to provide universal access to a full range of safe and reliable family-planning methods and to related reproductive health services which are not against the law (UN 1994: para 7.16). Can the national FP program of Indonesia meet this goal? 2

3 2. Past Achievements in FP/RH The national FP program in Indonesia was widely proclaimed an impressive success during By the mid-1990s the practice of FP was broadly accepted as a social norm, and fertility had declined to around 2.7 births per woman. 3

4 Total fertility rate (TFR), countries of SE Asia, Source: Data from UN (2009). 4

5 Program factors Reasons for success Establishing BKKBN in 1970 Outreach and field workers Program innovations Commitment from President Soeharto Non-program factors Political-administrative apparatus put in place by the New Order government Social and economic development 5

6 3. Current Issues in the National Program The program s performance has been noticeably less impressive during the last 15 years. There are significant issues regarding: 1.CPR; 2.unmet need; 3.contraceptive mix; 4.access to services for unmarrieds; and 5.source of supply. 6

7 Contraceptive prevalence rate, Indonesia, Source: Data from Indonesia Demographic and Health Survey (1987, 1991, 1994, 1997, 2002/03, 2007). 7

8 Met need (MN) and unmet need (UN) for FP among currently married women (15-49), Indonesia, Source: IDHS. 8

9 Contraceptive mix among currently married women using contraception, Indonesia, Source: IDHS. 9

10 Marital status of women by age, Indonesia, 1990, 2000 Source: Indonesia Population Census. 10

11 Source of supply for married women practicing modern contraception, Indonesia, Source: IDHS. 11

12 4. Understanding the Current Situation The status of BKKBN has been seriously tested by recent developments, including: 1.changing demographics in Indonesia; 2.the changing international agenda; and 3.political reforms and decentralization. As a result the national FP program is increasingly seen as behind the curve by RH advocates 12

13 Cairo and the changing international agenda Cairo was truly a watershed. Some have already seen it as the end of the family planning movement, an event celebrated by many feminists and women s rights activists as a paradigm shift and equally regretted by traditional population advocates, including many demographers and others concerned about high fertility rates, as abandonment of a decades-long commitment to population stabilization. Steven W. Sinding (2007) 13

14 Political reforms and decentralization Background: 1999, 2004 Decentralization Laws BKKBN s adjustment to decentralization Issue: Making the national FP program more responsive to local needs Platforms for good governance: Civil service reform and public demand for good governance 14

15 5. Recommendations If the national FP program is to be revitalized and responsive to the evolving needs and aspirations of Indonesian citizens this will require significant structural change in the current institutional arrangements. 15

16 Recommendation 1 Can Indonesia s national FP program make meeting all remaining unmet need for services by 2015 its central focus? 16

17 Recommendation 2 Can primary responsibility for FP policy be transferred to the Ministry of Health within the next few years? 17

18 Recommendation 3 Can a new vision and mission be developed for BKKBN which satisfies three requirements: a. it is centered on an holistic (inter-sectoral) vision of population policy and its role in development; b. it is acceptable to other parts of the government; and c. it gives BKKBN an important and exciting future? 18

19 6. General Conclusion While we all embrace Cairo today we still need to clarify precisely what we stand for as a result. 19

20 The Cairo Programme of Action promotes two goals Goal A : Providing universal access to a full range of safe and reliable family-planning methods and to related reproductive health services. This is a challenge for the health sector; the PoA articulates it well and lists concrete steps to achieve it. Goal B: Integrating population concerns into development strategies with the goal of meeting the needs, and improving the quality of life, of present and future generations. This is an inter-sectoral challenge; the PoA does little to clarify this goal and provides little guidance on how to achieve it. In many countries (including Indonesia) A and B are confused both intellectually and in the organization of government. A and B need to be kept quite distinct, without denying that there are some relationships between them. The common tendency to support one at the expense of the other should also be resisted. Note: Quoted phrases are from ICPD. 20