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Contraceptive Use in a Changing Service Environment: Evidence from Indonesia During the Economic Crisis
Abstract
In the late 1990s, most Southeast Asian countries experienced substantial economic downturns that reduced social-sector spending and decreased individuals' spending power. Data from Indonesia were collected in 1997 (just before the crisis) and in 1998 (during the crisis) that are used in this study to examine changes in the contraceptive supply environment and in women's choices regarding contraceptive use. Despite substantial changes in providers' characteristics during the first year of the crisis, no statistically significant differences are found between 1997 and 1998 in overall levels of prevalence, in unmet need, or in method mix. Women's choices regarding source of contraceptive supplies, however, changed considerably over the period. Changes in the contraceptive supply environment are linked here to changes in women's choice of source of supply, and a number of providers' characteristics are found to be significantly associated with women's choices in this regard.
... Penelitian sebelumnya seputar variabel demografis menyebutkan bahwa usia dan pendidikan berpengaruh positif terhadap pilihan kontrasepsi (Rosenzweig & Seiver, 1982) (Frankenberg, Sikoki, & Suriastini, 2003) (Widji, 2009). Hal yang sama khususnya mengenai usia juga dianggap determinan yang mempunyai pengaruh dalam penelitiannya tentang Oral Contraception (Nakamura, 2013). ...
... Namun ada perbedaan dalam hal sumber ekonomi yang diproksikan dengan pekerjaan. menyebutkan bahwa ekonomi berhubungan lemah dengan pilihan alat kontrasepsi (Frankenberg, Sikoki, & Suriastini, 2003). Sebaliknya sebuah penelitian menyatakan ada hubungan positif antara pekerjaan dengan pilihan alat kontrasepsi (Widji, 2009). ...
The behavior of spouses of fertile age (EFA) in choosing a contraceptive that will she wear is influenced by many factors. Previous research extensively covered socio-demographic factors correlated to the choice of contraception. Rationally, households in choosing a contraceptive based on the benefits of optimal and minimal costs. This study will discuss the price as reflecting rationality EFA determinant in choosing a contraceptive. By using data from the BKKBN Family Data Collection In 2015, this study will use the order logit models to determine causality or correlation between price and other determinants of the choice of contraception. It was found that the price of a statistically significant effect on the choice of contraception. Probability of contraceptive choices tend towards the long-term contraception with increases in the price of each contraception.
... In 1998, inflation reached 80% but prices of basic goods increased by between 100% and 400%, while real wages fell by 40% (Setiawan 2000). Faced with liquidity constraints, households sold assets (such as gold) and decreased non-food consumption, including spending on health and education (Frankenberg, Sikoki, and Suriastini 2003). ...
... In Indonesia, the National Family Planning Coordinating Board, created in the 1970s, promoted small families and, in particular, a two-child norm. Volunteer and village midwife services were used to promote and distribute different contraceptives, and those were made freely available during the 1970s and 1980s (Frankenberg, Sikoki, and Suriastini 2003). As a result, total fertility rates decreased from 5.6 children per woman in the late 1960s to 3.4 in 1984-87 and to 2.8 in 1995-97 (Permana and Westoff 1999. ...
This paper uses data from Indonesia around the time of the economic crisis in late 1990s to examine the role of parental preferences in human capital accumulation. Using a household fixed effects estimation, I test whether parental education spending is affected by child mathematics test scores. I find that parents are more sensitive to the human capital of younger children, penalizing them for having lower skills compared to their older siblings. No differences in investment by child gender or birth order exist in 1997, before the East Asian Financial crisis hit Indonesia. This suggests that only when resource constrained, parents may have an efficiency investment strategy and that education of the younger children may be a luxury good.
... For example, the Kenya Ministry of Health (MOH) projects that the share of injectables in the contraceptive method mix will increase from 40% in 00 to 50% in 00. In 003 the MOH's reproductive health advisory board projected a shortfall of injectables beginning in mid-004 and recommended that the MOH seek more funds from the government and donors (58). As a result of the forecasting, the government for the first time allocated funds in the budget specifically for injectables and covered part of the shortfall. ...
... In Indonesia during the economic crisis in the late 990s, prices rose faster than incomes. The price of injectables more than doubled on average, but demand was unchanged (58,8). ...
Injectable contraception includes progestin-only and combined estrogen and progestin agents that provide safe and highly effective birth control for one to three months. Injectable agents are widely available and play an important role in family planning programs worldwide. Depot medroxyprogesterone acetate, available for intramuscular injection and subcutaneous injection, is the best known and most broadly distributed injectable contraceptive agent, and is an ideal agent for women who have contraindications to estrogen use. Despite their effectiveness, progestin-only injectables are associated with high rates of discontinuation due to bothersome side effects including abnormal bleeding, health controversies including decreased bone mineral density, and increased risk of human immunodeficiency virus acquisition. Injectables do offer non-contraceptive benefits including symptom control related to endometriosis and fibroids, and decreased risk of endometrial cancer. Research is ongoing to determine new injectable hormone formulations that provide longer-acting contraceptive protection and fewer side effects.
... Mengapa masyarakat masih sulit berobat ke fasilitas pelayanan kesehatan. Walaupun untuk masalah kesehatan ini, misalnya penggunaan alat kontrasepsi, telah ada perubahan 11 . Dari latar belakang diatas, perlu dilakukan analisis pemilihan dukun sebagai penolong persalinan di Puskesmas Bulak Banteng, Surabaya. ...
Maternal mortality of Surabaya, in 2017, reached 79.40 per 100,000 live births due to direct causes by 77.2%. There are many programs to reduce maternal mortality and infant mortality such as improving delivery services in the health facility. In 2008, the partnership program between midwives and traditional birth attendants had developed to increase the access of quality maternal services for mothers and babies. However, in 2017 the delivery practice with traditional birth attendants has remained active in the area of Bulak Banteng Community Health Center, Surabaya. This study aimed to analyze the women’s decision selecting the traditional birth attendants for their delivery practice by exploring knowledge factor, belief factor, health service access factor, and family factor in Bulak Banteng Community Health Center of Surabaya. The research was a qualitative study using the approach of case study including in-depth interview and exploring secondary data. The sample was the mothers who delivered the baby with the traditional birth attendant from a previous year ago, and the midwife of health community center. The variable from this study were knowledge factor, belief factor, health service access factor, and family factor. The study used the analytical method consisted of data collecting, data reduction, and verification. The result showed less knowledge factor of healthy and safe delivery in the community. The belief factor and family factor held an important role in the selection of the traditional birth attendants during birth attendance, while the factor of health service access showed nothing related to the selection process. There is a need to implement health education for pregnant women, husband, family, and people with an aim of giving the understanding about healthy and safe birth attendance. In conclude, the selection on traditional birth attendant was influenced by knowledge factor, belief factor, and family factor.
... Indonesia was global family planning success story in the 1980s and 1990s. The governmental decentralization that began in the early 2000s fundamentally changed the nature of the national family planning program in two important ways (Frankenberg et al. 2003(Frankenberg et al. , 2005(Frankenberg et al. , 2009; Hull and Mosely 2009). ...
SDG and FP2020 goals are for the most part being tracked at the national level. In large, diverse countries such as Indonesia, national-level monitoring can obscure important sub-national heterogeneity. We used the Family Planning Estimation Tool (FPET) to develop estimates and projections of key family planning indicators for Indonesian provinces from 1990 to 2030 in order to better understand the evolution of the national family planning program and priorities going forward. Although Indonesia continues to be a global family planning success story, provinces have evolved differently, and there remain pockets of high unmet need. Projections to 2030 indicate that while Indonesia will far surpass the SDG target of 75% of demand satisfied, geographic inequities will persist. Future family planning program efforts must target remaining geographic and socioeconomic inequities in access to accurate information and quality services from a reproductive rights perspective in order to "move" other headline family planning indicators.
... Walaupun untuk masalah kesehatan ini, misalnya penggunaan alat kontrasepsi, telah ada perubahan. 5 Apakah penyebabnya? Jawaban atas pertanyaan-pertanyaan ini membutuhkan kerjasama antar disiplin ilmu, yaitu antara ilmu kedokteran dengan ilmu antropologi dan ilmu kesehatan masyarakat. ...
One of health case which still many happened in Indonesia, born children with helped by baby soothsayer. In reality, most all Indonesia publics either that is who live in rural and also more even a urban love to be helped by soothsayer. The thing because of local tradition and mores. Purpose of research. Finds strategic to build cohesive network between the prominent as of themes, public, soothsayer and midwife in executing health service of maternal and perinatal joinly. Research method. Applies qualitative method. Technique done is in-depth interview. Informan is baby soothsayer, nurse and delivering birth mother helped by delivering birth baby soothsayer and mother helped by midwife. Research is done in Kabupaten Kendari (South-east Sulawesi), countryside Tobimiita and countryside Inalobu and countryside Lapulu; Sub-Province Cirebon (West Java), countryside Bode Sari and countryside Karangasem and countryside Gombong. Analysis. Effort for improvement of service of health of like the one mirror in soothsayer program to train that of course not aim to eliminate role played by system treatment of old health and changes it with system treatment of new health. Education given in soothsayer program to train that is justri realized as confession to carry out (enforcement) health service to baby soothsayer institute. Moreover, with education given, baby soothsayer is assumed can replace presence of new health facility assumed able to increase public health level. Conclusion. Partnership is one of solution for this problem most off all will develop cloistered areas where access every very limited health service.
... In addition, disentangling and identifying the effects of any economic crisis is difficult. The Indonesian economic crisis of 1998 provides one of those rare opportunities for research, leading to studies on the effects of economic crisis on education (Thomas et al., 2004), household expenditure (Thomas et al., 2005), wealth and welfare (Frankenberg and Smith, 2003), health and family planning (Frankenberg et al., 2003, 1999), and also labor market outcomes (Smith et al., 2002). Thomas et al. (2003), in particular, studied the labor force participation of women during the Indonesian economic crisis of 1998 and found that unemployment did not change during this period, although real wages fell by about 40%. ...
In the last three decades, Iranian women's educational attainment has continuously increased while their fertility rate has fallen rapidly. Yet in spite of these developments, which in many countries have a positive effect on women's labor force participation, female labor force participation (FLFP) rates have remained at low levels. This paper argues that despite its overall static trend, FLFP of some Iranian women responded to economic pressures induced by macroeconomic instabilities. Looking at the Iranian economic crisis of 1994–5, the study shows that, controlling for individual fixed effects, married women in rural areas and never-married women in urban areas increased their participation rate by as much as 38 percent. No change in hours worked was found for any group of women. The differences in responses and their underlying reasons have policy implications for many developing countries.
... At that time, family planning policy discussions centered on BKKBN's ability to supply contraceptives. Frankenberg, Sikoki and Suriastini (2003) establish that while users changed providers from whom they obtained contraceptives, between 1997 and 1998, there was very little change in overall contraceptive use. In this paper, we examine the short and longer-run impact of price and income shocks on contraceptive choices. ...
Substantial international aid is spent reducing the cost of contraception in developing countries, as part of a larger effort to reduce global fertility and increase investment per child worldwide. The importance for fertility behaviors of keeping contraceptive prices low, however, remains unclear. Targeting of subsidies and insufficient price variation have hindered prior attempts to estimate the effect of monetary and non-monetary contraceptive costs on fertility behavior. Using longitudinal survey data from the Indonesia Family Life Survey, we exploit dramatic variation in prices and incomes that was induced by the economic crisis in the late 1990s to pin down the effect of contraceptive availability and costs as well as household resources on contraceptive use and method choice. The results are unambiguous: monetary costs of contraceptives and levels of family economic resources have a very small (and well-determined) impact on contraceptive use and choice of method.
... Injectables had been rapidly gaining popularity in Indonesia since the 1980s: 9% of married women used injectables in 1987, 15% in Figure 6 Current modern contraceptive use among rural married women by wealth quintile Indonesia, 1987Indonesia, -2002 1994 and 21% in 1997 (not shown). The percentage of private providers supplying injectables actually increased after the economic crisis and the stockout rate of injectables was much lower in the private sector than in the public sector (Frankenberg et al. 2003). ...
To determine whether an expansion in private sector contraceptive supply is associated with increased socio-economic inequality in the modern contraceptive prevalence rate (MCPR inequality).
Multiple rounds of Demographic and Health Surveys data were analysed for five countries that experienced an increase in the private sector supply of contraceptives: Morocco, Indonesia, Kenya, Ghana and Bangladesh. Information on household assets and amenities was used to construct wealth quintiles. A concentration index, which calculates the degree of inequality in contraceptive use by wealth, was calculated for each survey round.
Socio-economic inequality in the MCPR (MCPR inequality) declined in Morocco and Indonesia, where substantial expansion in private sector contraceptive supply occurred. In both countries, poor women continued to rely heavily on contraceptives supplied by the public sector even as they increased use of contraceptives obtained from the private sector. A marginally significant decline in MCPR inequality occurred in Bangladesh, where the increase in private sector supply was modest. There was no significant overall change in MCPR inequality in Kenya or Ghana. In Kenya, this lack of significant overall change disguised trends moving in opposite directions in urban and rural areas. In urban Kenya, MCPR inequality declined as low-income urban women increased use of contraceptives obtained primarily from the public sector. In rural Kenya, MCPR inequality increased. This increase was associated with a decline in the supply of contraceptives by the public sector and non-governmental organizations to the poorest, rural, women.
The study found no support for the hypothesis that an increase in private sector contraceptive supply leads to higher MCPR inequality. The findings suggest that continued public sector supply of contraceptives to the poorest women protects against increased MCPR inequality. The study highlights the role of the public sector in building contraceptive markets for the private sector to exploit.
Every four years since 2004, the Copenhagen Consensus Center has organized and hosted a high profile thought experiment about how a hypothetical extra $75 billion of development assistance money might best be spent to solve twelve of the major crises facing the world today. Collated in this specially commissioned book, a group of more than 50 experts make their cases for investment, discussing how to combat problems ranging from armed conflicts, corruption and trade barriers, to natural disasters, hunger, education and climate change. For each case, 'Alternative Perspectives' are also included to provide a critique and make other suggestions for investment. In addition, a panel of senior economists, including four Nobel Laureates, rank the attractiveness of each policy proposal in terms of its anticipated cost-benefit ratio. This thought-provoking book opens up debate, encouraging readers to come up with their own rankings and decide which solutions are smarter than others.
Every four years since 2004, the Copenhagen Consensus Center has organized and hosted a high profile thought experiment about how a hypothetical extra $75 billion of development assistance money might best be spent to solve twelve of the major crises facing the world today. Collated in this specially commissioned book, a group of more than 50 experts make their cases for investment, discussing how to combat problems ranging from armed conflicts, corruption and trade barriers, to natural disasters, hunger, education and climate change. For each case, 'Alternative Perspectives' are also included to provide a critique and make other suggestions for investment. In addition, a panel of senior economists, including four Nobel Laureates, rank the attractiveness of each policy proposal in terms of its anticipated cost-benefit ratio. This thought-provoking book opens up debate, encouraging readers to come up with their own rankings and decide which solutions are smarter than others.
Every four years since 2004, the Copenhagen Consensus Center has organized and hosted a high profile thought experiment about how a hypothetical extra $75 billion of development assistance money might best be spent to solve twelve of the major crises facing the world today. Collated in this specially commissioned book, a group of more than 50 experts make their cases for investment, discussing how to combat problems ranging from armed conflicts, corruption and trade barriers, to natural disasters, hunger, education and climate change. For each case, 'Alternative Perspectives' are also included to provide a critique and make other suggestions for investment. In addition, a panel of senior economists, including four Nobel Laureates, rank the attractiveness of each policy proposal in terms of its anticipated cost-benefit ratio. This thought-provoking book opens up debate, encouraging readers to come up with their own rankings and decide which solutions are smarter than others.
Every four years since 2004, the Copenhagen Consensus Center has organized and hosted a high profile thought experiment about how a hypothetical extra $75 billion of development assistance money might best be spent to solve twelve of the major crises facing the world today. Collated in this specially commissioned book, a group of more than 50 experts make their cases for investment, discussing how to combat problems ranging from armed conflicts, corruption and trade barriers, to natural disasters, hunger, education and climate change. For each case, 'Alternative Perspectives' are also included to provide a critique and make other suggestions for investment. In addition, a panel of senior economists, including four Nobel Laureates, rank the attractiveness of each policy proposal in terms of its anticipated cost-benefit ratio. This thought-provoking book opens up debate, encouraging readers to come up with their own rankings and decide which solutions are smarter than others.
Every four years since 2004, the Copenhagen Consensus Center has organized and hosted a high profile thought experiment about how a hypothetical extra $75 billion of development assistance money might best be spent to solve twelve of the major crises facing the world today. Collated in this specially commissioned book, a group of more than 50 experts make their cases for investment, discussing how to combat problems ranging from armed conflicts, corruption and trade barriers, to natural disasters, hunger, education and climate change. For each case, 'Alternative Perspectives' are also included to provide a critique and make other suggestions for investment. In addition, a panel of senior economists, including four Nobel Laureates, rank the attractiveness of each policy proposal in terms of its anticipated cost-benefit ratio. This thought-provoking book opens up debate, encouraging readers to come up with their own rankings and decide which solutions are smarter than others.
The midwives play an important role in maternal and child health in developing countries, but they are rarely involved in providing family planning services, except in Indonesia. This article underscores the midwives’ crucial role in supplying modern contraceptive methods in Indonesia. Data for this analysis came from 8 waves of the Indonesia Demographic and Health Survey (IDHS). The main analysis was confined to 17 216 current users of modern methods from the 2017 IDHS. The midwives delivered contraceptives to 53% of the modern-method users in Indonesia. Multinomial logistic regression shows that the odds of users obtaining their contraceptive supplies from the midwives was significantly associated with age, parity, urban-rural location, region, education, wealth, exposure to family planning, and method type. The midwives help to reduce the doctors’ workload for them to focus on specialized services. Developing countries can learn from the Indonesian experience to ensure equitable access to family planning services.
Hacyl Indonesia Demographic and Health Survey (IDHS) in 2017 showed that 40% of married women (15-49) using a tool or means of family planning (KB). The use of contraceptive has also increased from 62% (2012 IDHS) to 64% (2017 IDHS). This study aimed to examine the use of contraceptive in urban and rural areas in Indonesia. Methods: The secondary data analysis in this study sourced from secondary data of IDHS in 2017 with a cross-sectional approach. The research instrument was structured questionnaires that had been tested for validity and reliability. Data analysis used Binner SPSS 22 Logistic Regression for windows. The results of this study indicated that women of childbearing age in urban areas (OR 0.988; 95% CI: 0.955-1.023), women of childbearing age 20-24 years (OR 0.741; 95% CI: 0.591-0.929), working women (OR 1.195 95% CI: 1.158-1.233), secondary educational level (OR 2.172 95% CI: 1.992-2,369), married/living with partner (OR 32,995; 95% CI: 29,247-37,223), richest (OR 1,487; 95% CI: 1,405-1,574), health insurance (OR 1,049; 95% CI: 1,016-1,083), and multiparous (OR 3.5117; 95% CI: 2,946-3,297) were variables that influenced women of childbearing age in using contraceptives at home in Indonesia. There was no difference between urban and rural areas in the use of hormonal and non-hormonal contraceptive drugs in Indonesia by women of childbearing age (15-49 years). Recommendations are addressed to policymakers in Indonesia to improve family planning services both in rural areas, in densely populated and slum areas.
Climate change is likely to induce a large range of household- and individual-level responses, including changes in human fertility behaviors and outcomes. These responses may have important implications for human and economic development and women's empowerment. Drawing on the literature linking climate conditions to rice cultivation in Indonesia, we use longitudinal household survey and high-resolution climate data to explore changes in childbearing intentions, family planning use, and births following community-level climate shocks from 1993 to 2015. We find that fertility intentions increase and family planning use declines in response to delays in monsoon onset occurring within the previous year, particularly for wealthier populations. However, women on farms are significantly more likely to use family planning and less likely to give birth following abnormally high temperatures during the previous five years. We also measure parallel shifts in household well-being as measured by rice, food, and non-food consumption expenditures. Our findings advance the environmental fertility literature by showing that longer duration environmental shocks can have impacts on fertility behaviors and outcomes. Collectively, our results illustrate human fertility responses to climate change in a country vulnerable to its effects, and demonstrate that in some cases, climate shocks can constrain human fertility.
Every four years since 2004, the Copenhagen Consensus Center has organized and hosted a high profile thought experiment about how a hypothetical extra $75 billion of development assistance money might best be spent to solve twelve of the major crises facing the world today. Collated in this specially commissioned book, a group of more than 50 experts make their cases for investment, discussing how to combat problems ranging from armed conflicts, corruption and trade barriers, to natural disasters, hunger, education and climate change. For each case, 'Alternative Perspectives' are also included to provide a critique and make other suggestions for investment. In addition, a panel of senior economists, including four Nobel Laureates, rank the attractiveness of each policy proposal in terms of its anticipated cost-benefit ratio. This thought-provoking book opens up debate, encouraging readers to come up with their own rankings and decide which solutions are smarter than others.
While the majority of the population is now estimated to live in regions with below replacement fertility, high fertility, poor reproductive health outcomes and relatively rapid population growth remain an important concern in several low income countries. International and national spending devoted to family planning, however, has declined significantly in recent years. Recent research has brought about a revision in the understanding of the interactions between population growth and economic development, as well as the effects of family planning programs in terms of reduced fertility, improved reproductive health outcomes and other life-cycle and intergenerational consequences. This paper discusses recent evidence about the benefits of family planning programs and the interactions between population growth and developments, and it attempts to estimate benefit-cost ratios for increased spending on family planning.
Every four years since 2004, the Copenhagen Consensus Center has organized and hosted a high profile thought experiment about how a hypothetical extra $75 billion of development assistance money might best be spent to solve twelve of the major crises facing the world today. Collated in this specially commissioned book, a group of more than 50 experts make their cases for investment, discussing how to combat problems ranging from armed conflicts, corruption and trade barriers, to natural disasters, hunger, education and climate change. For each case, 'Alternative Perspectives' are also included to provide a critique and make other suggestions for investment. In addition, a panel of senior economists, including four Nobel Laureates, rank the attractiveness of each policy proposal in terms of its anticipated cost-benefit ratio. This thought-provoking book opens up debate, encouraging readers to come up with their own rankings and decide which solutions are smarter than others.
Health card program aims to protect the poor in Indonesia during the Asian economic crisis. Health cards were targeted and allocated exclusively to the poor that would provide free access to public health services. The impact of health card program to reproductive health services was rarely discussed by previous studies that pay more attention on health card utilization for both inpatient and outpatient. Using Indonesian family life survey (IFLS) data 1997-2000 from RAND Corporation, this study aims to evaluate the impact of health card program during Asian economic crisis on access to reproductive health services and answer the question whether who had health card really have better access to reproductive health services. Discussion in this paper limit on antenatal care, place of delivery and contraceptive use which are only reproductive health components that covered by health card program. Using combination between descriptive analysis and multivariate analysis, this study found that the health cards were not well targeted and distributed. The study also found that, generally, there is no significant effect of health card ownership to access to reproductive health services.
Previous studies suggest that access to modern contraceptives can reduce breast-feeding rates because women who had been using breast-feeding to avoid pregnancy substitute away from it. This article shows that contraceptive use can also have a positive effect on breast-feeding. A mother often weans a child if she becomes pregnant again, which can occur sooner than desired if she lacks access to contraceptives. Thus, by enabling longer birth spacing and preventing unwanted pregnancies, contraceptive use allows for a longer duration of breast-feeding. This positive effect should primarily affect infants who are past the first few months of life because their mothers are more fecund then, and the negative effect should affect infants who are very young because the contraceptive property of breast-feeding is strongest then. I test for these dual effects using Demographic and Health Survey data for Indonesia. I find evidence of the positive birth-spacing effect: contraceptive use increases the likelihood that children continue to be breast-fed past age 1. There is also suggestive evidence of a negative substitution effect among infants age 3 months and younger.
Indonesia established its Village Midwife Program in 1989 to combat high rates of maternal mortality. The program's goals were to address gaps in access to reproductive health care for rural women, increase access to and use of family planning services, and broaden the mix of available contraceptive methods. In this study, we use longitudinal data from the Indonesia Family Life Survey to examine the program's effect on contraceptive practice. We find that the program did not affect overall contraceptive prevalence but did affect method choice. Over time, for women using contraceptives, midwives were associated with increased odds of injectable contraceptive use and decreased odds of oral contraceptive and implant use. Although the Indonesian government had hoped that the Village Midwife Program would channel women into using longer-lasting methods, the women's "switching behavior" indicates that the program succeeded in providing additional outlets for and promoting the use of injectable contraceptives.
Using the 2000 wave of the Indonesian Family Life Survey (IFLS3), this study attempts to examine the relationship between migration and contraceptive method switch and discontinuation in Indonesia. The major conclusion from the multinomial logistic regression is that repeated migrants are more likely than one-time migrants to discontinue use of the same method. However, the differentials in the likelihood of discontinuing use of the same method among women migrants is eliminated after controlling for the quality of health centre/family planning programme and the degree of infrastructure development in a community. The results of this study will contribute important foundational knowledge about the extent of contraceptive use dynamics by women of different migration experiences in Indonesia. This knowledge will provide guidance to policymakers to employ effective means to incorporate migration and issues that are sensitive to women migrants in their family planning and reproductive health programmes. Copyright © 2009 John Wiley & Sons, Ltd.
This study was conducted to examine access to contraception and change in contraceptive methods before and after the disaster in Bantul area, and to evaluate the prevalence of unplanned pregnancy.
In total, 450 married women participated. Questionnaires, which included participants' background, contraceptive methods, difficulties in accessing contraceptive method, and unplanned pregnancy, were completed.
Within 1 year of the disaster, the percentage of participants who used injections and implants tended to decrease, while the percentage of participants who used pills tended to increase. Use of coitus interruptus significantly increased after the disaster. The prevalence of unplanned pregnancy was significantly higher in a group of participants who had difficulty accessing contraceptive methods compared to a group that did not.
Health personnel should not only actively deliver contraceptive methods in a disaster situation but also educate couples to prevent unplanned pregnancy.
SUMMARY Three decades after the establishment of a government sponsored family planning program in Indonesia attempts to predict the course of transition in fertili ty are frustrated by the complexity and opaqueness of demographic analyses. Economic crisis, political turmoil and social breakdown have undermined the optimistic scenarios painted a mere decade ago. The lack of reliable demographic data has been exacerbated by the impact of major budget cuts on the national census of 2000 and the radical decentralization plans implemented in 2001. Speculations about growing poverty, declining social institutions and political uncertainties abound, and commentators read potential demographic reverses into their prognoses about this, the fourth largest population, and largest Muslim majority nation in the world. Against such a contradictory backdrop demographers can only point to two basic arguments. First, detailed examinations of the available data indicate a possible slowing but not a reversal of trends. Specifically the 'proximate' determinants of contraceptive use and delayed marriage have been robust in the face of dramatic economic decline. Second, the rising cohorts of women of childbearing age continue to show higher levels of education, increasing involvement in both the formal and informal workforces, and firm resolution to control their fertility at comparatively low levels. When looking forward to 2025 it is well to remember that Indonesia is well past the half-way point in the transition from high to low fertility, and there is every indication that the decline in family sizes will continue. INDONESIAN FAMILY PLANNING IN A CHANGING POLITICAL ORDER Twenty years ago Indonesia was depicted as a case where rapid fertility decline preceded major economic improvement and thus could justifiably be attributed to the efforts of the government family planning program (Sinquefield and Sungkono, 1979; Freedman and others, 1981). While many demographers interpreted the role of the government program (with the Indonesian acronym BKKBN) as that of a catalyst rather than the prime causative mechanism of fertility change, the political and popular interpretation of the situation was simplified down to the notion that government had engineered a remarkable change through force of policy, planning and logistic management. This rather naïve idea was welcomed by the financers of the program - the World Bank and the US Agency for International Development - and Indonesia was embraced as the model for other developing countries, with the award of numerous prizes and awards to the BKKBN and to President Suharto.
We use data from the Indonesia Family Life Survey to investigate the impact of a major expansion in access to midwifery services
on health and pregnancy outcomes for women of reproductive age. Between 1990 and 1998 Indonesia trained some 50,000 midwives.
Between 1993 and 1997 these midwives tended to be placed in relatively poor communities that were relatively distant from
health centers. We show that additions of village midwives to communities between 1993 and 1997 are associated with a significant
increase in body mass index in 1997 relative to 1993 for women of reproductive age, but not for men or for older women. The
presence of a village midwife during pregnancy is also associated with increased birthweight. Both results are robust to the
inclusion of community-level fixed effects, a strategy that addresses many of the concerns about biases because of nonrandom
program placement.
This study illustrates the use of panel data and a fixed-effects estimator to investigate the impact of family planning program inputs on contraceptive utilization in Morocco during the 1992–1995 period. By controlling the potential bias resulting from common unobserved determinants of program resource allocation decisions and program outcomes, the methodology helps overcome an important constraint to the use of non-experimental study designs in undertaking meaningful impact assessments. Data from a panel of women interviewed in both the 1992 and 1995 Morocco Demographic and Health Surveys were used in the study, along with program data from Service Availability Modules undertaken in conjunction with each survey round. The results indicate that changes in the family planning supply environment, in particular increased presence of nurses trained in family planning and the level of infrastructure at public clinics, played a significant role in the increased use of modern contraceptives during the study period.
We examine how informants’reports on community perceptions of the quality and accessibility offamily planningfacilities relate
to the use of modern contraceptives by individuals in rural Tanzania. Using information on individual-level contraceptive
use in conjunction with community-level information on the accessibility and quality of family planning facilities, we employ
two distinct statistical procedures to illustrate the impacts of accessibility and quality on contraceptive use. Both procedures
treat the community-level variables as imperfect indicators of characteristics of the facilities, and they yield nearly identical
implications. Wefind that a communitylevel, subjective perception of a family planning facility s quality has a significant
impact on community members’ contraceptive use whereas other community measures such as time, distance, and subjective perception
of accessibility have trivial and insignificant direct impacts, net of the control variables. Future research that uncovers
the determinants of perceptions of both community-level and individual-level quality could provide key insights for developing
effective and efficientfamily planning programs.
Indonesia is at the center of dramatic political and economic upheaval. This study presents information on changes in a number of dimensions of family and individual well-being between 1997 and 1998.
We use household and community data from the Philippines to estimate a multilevel model of contraceptive use. We go beyond previous efforts in this field by developing a structural model that recognizes joint endogeneity and the temporal ordering of variables. by considering a wider range of community influences on fertility behavior, and by employing an econometric procedure allowing for a multilevel error structure. The results suggest that there are significant effects on fertility behavior of community-level family planning services, labor-conditions, and infrastructure development. These results provide insights regarding the structural determinants of contraceptive use and fertility that are useful for drawing policy implications.
We use surveys of households and health-care facilities conducted in the same area at the same time to determine which characteristics of providers attract users of contraceptives. By using the full-information maximum-likelihood technique to jointly estimate choice of contraceptive method and choice of provider, we avoid self-selection bias. Results support the need for modeling quality and for jointly estimating the choice of contraceptive method and the choice of provider to avoid biased estimates of coefficients. The results suggest that for the Cebu, Philippines region, small local clinics that focus on family planning tend to be most favored by clients.
There are some interesting differences between the Family Planning Program in Indonesia and the family planning in Cairo Action Program. The FP Program has larger actions, such as the society's attention to the increasing age limit of marriage, family resistance building, increasing the family welfare, and birth control. While, the family planningin Cairo Action Program is only limited to the birthcontrol. This writing tries to describe those differences as well as to clarify the direction and the implementation of the FP Program which increasingly become an FP movement.
The Indonesian family planning program has attained field success through implementation strategies centering on communities and clients. It seeks to make communities favorably disposed to family planning, persuade clients, provide adequate medical support, and maintain strong pressure for results. Quantitative data from 48 villages show that such strategies have been effective means of promoting and maintaining contraceptive use. The program now has problems in developing quantitative measures of its success, in balancing external influences on clients with free choice, in deciding how much pressure to exert on other government agencies, and in maintaining the commitment of local implementers. A question for the future is whether Indonesia will maintain the strong support it has shown for this program since 1970.
Most studies evaluating the impact of family planning on fertility treat the presence of family planning clinics as being “randomly” assigned among the areas included in the study. They tend to ignore the possibility that the distribution of services may be related to the fertility level observed in a particular area. In some cases the distribution of services may respond to a conscious effort by public authorities or funding agencies to target areas with observed higher fertility. Even in absence of program planning, the factors determining service placement might be related to the determinants of high, or low, fertility in a particular area. If that is the case, and one fails to account for the endogeneity of family planning services, then the estimated impact of family planning programs will be biased. This article presents a modeling approach to address this issue. The model extends the simultaneous equation framework by integrating an individual-level model of timing and spacing of children with the dynamic process of program placement. Individual-level data from the 1991/1992 Tanzania Demographic and Health Survey are augmented with data on the timing of, and factors influencing, family planning service placement to demonstrate the approach. The empirical results show that standard methods yield misleading results on the impact of different components of the family planning program on fertility. In particular, the effect of access to family planning hospitals on births is overstated, and the impact of access to health centers that offer family planning is understated significantly. We quantify the size of these effects through simulations.
Indonesia is the world's fifth most populous nation. Its population is still growing at 2 per cent per annum and will exceed 200 million in another 10 years' time. This is the first detailed analysis of population growth in Indonesia as it affects national development, written by 4 authors who have been intimately involved in population research and planning in Indonesia over the past 15 years. The book takes an historical approach in recognition of the continuities between problems of population growth and distribution in colonial times, and those faced today. Because of the remarkable diversity of Indonesia, a regional approach is also stressed, and regional differences are highlighted through the skilful use of maps.
Most of the countries caught up in the Asian financial crisis appear to have weathered the storm. But Indonesia's prospects are far more uncertain. In this Innocenti Insight, development journalist and writer Peter Stalker describes how the financial turbulence of the Krisis Moneter, or Krismon, set off a dramatic social and political chain reaction, with effects on children that could reverberate for years to come. Beyond Krismon examines the legacy of Soeharto's New Order regime in terms of child well-being, the impact of the financial crisis on areas essential to their survival and development and the crippling burden of debt that may jeopardize the nation's hopes for the future.
Analysis of World Fertility Survey data from five countries--Colombia, Costa Rica, Korea, Malaysia and Nepal--shows that the availability of contraceptive services and supplies is a major determinant of use. In Nepal, where few women know where to obtain supplies, only two percent are contracepting. In Costa Rica, where almost all married women know an outlet nearby, 53 percent use effective methods.
This article argues for attention to a neglected dimension of family planning services--their quality. A framework for assessing quality from the client's perspective is offered, consisting of six parts (choice of methods, information given to clients, technical competence, interpersonal relations, follow-up and continuity mechanisms, and the appropriate constellation of services). The literature is reviewed regarding evidence that improvements in these various dimensions of care result in gains at the individual level; an even scarcer body of literature is reviewed for evidence of gains at the level of program efficiency and impact. A concluding section discusses how to make practical use of the framework and distinguishes three vantage points from which to view quality: the structure of the program, the service-giving process itself, and the outcome of care, particularly with respect to individual knowledge, behavior, and satisfaction with services.
The 1978 National Survey of Fertility, Family Planning, and Communication of Guatemala provided the opportunity to study the effect of accessibility to contraceptive source on contraceptive prevalence. The survey found that a substantially lower proportion of Indian couples (4 percent) than Ladino couples (27 percent) was using contraception. However, approximately one-half of the observed difference was accounted for by demographic and socioeconomic factors. To measure the independent impact of accessibility on contraceptive prevalence, the relationship between ethnicity, demographic factors, and socioeconomic factors was examined using multiple-classification analysis. For Ladinos the use of reversible modern methods consistently decreased with an increase in average traveling time to the source of contraception, but Indians' use of contraception apparently bears little relationship to accessibility. Thus, community-based contraceptive distribution programs may be effective for Ladinos, but different strategies may be required for Indians, including an independent design of information, education, and communications programs for either clinic or community-based programs.
Begins with an overview of the recent research on contraceptive availability and use followed by a discussion of several proposed analytic refinements designed to isolate more carefully the availability-use relationship. These include: 1) focusing analysis on current users and 'potential users'; and 2) disaggregating the analysis of the contraceptive accesibility and use relationship by general level of availability, urban/rural residence, and method type. The paper then applies multiple classification analysis to test these analytic approaches using recent contraceptive prevalence survey data for Costa Rica, Thailand, Colombia, Honduras, and Nepal. Findings suggest that, after controlling for several socioeconomic variables, contraceptive accessibility has its strongest impact on current use in medium and low availability countries, in rural areas, and among users/potential users of supply methods. Some implications of these findings for future research are discussed.-from Authors
This study examines the impact of contraceptive service availability on contraceptive use in Korea, Mexico, and Bangladesh. Using World Fertility Survey Data on once-married females and their communities of residence, the multivariate analysis finds that the community level of contraceptive availability directly affects the likelihood of current use, net of the effects of community development, education, parity, and marital duration. The results are supportive of the recent policy emphasis on maximizing the geographic availability of contraceptive services.
This paper examines the contributions of family planning programs, economic development, and women's status to Indonesian fertility decline from 1982 to 1987. Methodologically we unify seemingly conflicting demographic and economic frameworks into a single "structural" proximate-cause model as well as controlling statistically for the targeted (nonrandom) placement of family planning program inputs. The results are consistent with both frameworks: 75% of the fertility decline resulted from increased contraceptive use, but was induced primarily through economic development and improved education and economic opportunities for females. Even so, the dramatic impact of the changes in demand-side factors (education and economic development) on contraceptive use was possible only because there already existed a highly responsive contraceptive supply delivery system.
This paper blends quantitative with qualitative data in an investigation of community and contraceptive choice in Nang Rong, Thailand. Specifically, it develops an explanation of 1) method dominance within villages, coupled with 2) marked differences between villages in the popularity of particular methods. The quantitative analysis demonstrates the importance of village location and placement of family planning services for patterns of contraceptive choice. The qualitative data provide a complementary perspective, emphasizing the importance of social as well as physical space and giving particular attention to the structure of conversational networks.
Through linkage of a Demographic and Health Survey to a situation analysis, this article explores whether current contraceptive use in Peru is affected by the service environment in which a woman resides. The investigation focuses explicitly on the impact of the quality of family planning services and finds that, net of personal and household characteristics, a significant, albeit small, effect exists for one specification of quality in the total sample and for the other specification a nearly significant (p = .053) effect exists. The analysis reveals that contraceptive prevalence would be 16 to 23 percent greater if all women lived in a cluster with the highest quality of care compared with the lowest. Methodological problems that arise in measuring quality of care at the cluster level and in linking quality to individual contraceptive use are also addressed.
Clinic-based distribution of contraceptive commodities is expensive per unit distributed. This situation has fueled the search for alternative means of delivery. Comparing the performance of alternatives is straightforward if the output measure is a count of commodities distributed, but comparing actual fertility impacts is another matter. I use data from the 1991 Indonesia Demographic and Health Survey to assess the extent of difference among the eventual fertility outcomes of users supplied with similar commodities through varying sources. When the "modern" methods of pill, IUD, and injection are grouped together, the fertility of users supplied with these commodities differs markedly according to their source of supply. I find little evidence for self-selecting of users into supply channels. This result implies that fertility differentials by source are likely due to characteristics of the distribution channels.
Efforts to develop quantitative indicators of quality of care for family planning services, and to evaluate its role in contraceptive behavior, remain at an early stage. The present study, based upon an analysis of prospective data from a sample of 7,800 reproductive-aged rural Bangladeshi women, provides empirical evidence on the importance of quality of care for contraceptive practice. The results demonstrate that the perceptions of women regarding the quality of field-worker care were significantly related to the probability of subsequent adoption of a family planning method. Women who were not using a method and who scored high on an index of perceived quality of care were 27 percent more likely to adopt a method subsequently, compared with women with a low score. Effects were even more pronounced for contraceptive continuation; high quality of care was associated with a 72 percent greater likelihood of continued use of any method of contraception.
Indonesia's family planning program has been one of the most effective in the developing world in promoting contraceptive use and contributing to fertility transition. In evaluating why the program has worked, analysts have given much credit to a network of village family planning groups that developed from the 1970s to the 1990s and that blanketed the archipelago. These groups, composed primarily of female volunteers, made contraception available to women in even the most remote parts of the country, and acted as agents of family planning motivation. They have been labeled by the Indonesian state family planning agency as an example of effective community participation on a national scale. In this paper, I investigate this claim and find it to be simplistic. I provide extensive evidence that the creation of this network was orchestrated by the Indonesian state. On the other hand, I show that these groups are not fully state entities, as they have several characteristics that mark them as socially embedded institutions. They are best labeled as unusual state-society hybrids. In my investigation I draw on one of the newest paradigms in the discipline of political science--the state-society approach--to uncover the odd nature of this family planning network. More deeply, I argue that the state-society approach ought to be adopted in family planning analysis on a comprehensive basis. The traditional organizational and social-demographic approaches that have dominated the field offer only limited understanding of the nature of family planning programs in developing countries. The state-society approach is ideally suited to identifying how family planning programs are institutions of a political nature, embedded in states and societies, and transformed by and transformative of each.
In 1957, the Indonesian Planned Parenthood Federation was established. In 1970, the National Family Planning Board (BKKBN) was created. The current contraceptive prevalence rate is 45-50%. The family planning program began with a health-oriented approach. To promote acceptance, religious leaders were asked to provide legitimacy to the program. Through their efforts, it became possible to include all the means and medication used for family planning services within the program. In developing an IEC strategy to encourage couples to accept family planning, 3 main factors were studied: 1) the types of innovations that were to be introduced, 2) the characteristics of the Indonesian community, and 3) the need for an IEC strategy to convey the programs messages the community and make the community itself the agent of the innovation being introduced. The elements of the strategy were introduced stage by stage to avoid unnecessary debate. Another strategic step was the introduction of family planning using a community approach. A 3rd strategic step was a shift from couples as family planning acceptors to the introduction of the norm of a small, happy, and prosperous family. The 1st stage, expansion of program coverage, 1) promoted the need for and desirability of family planning to make the small and happy family the norm and 2) supplied contraceptives and information about contraceptives throughout Indonesia. The 2nd stage, the program maintenance approach, included 1) an increase in the frequency of visits to villages by mobile family planning teams, 2) the integration of family planning activities with other health-related activities, and 3) giving people a wider choice of methods and helping them to choose the most suitable method for them. The 3rd stage made family planning a community activity, integrated within the economic and social fabric of community life. The general strategy of the IEC program is to make the various target groups full family planning participants, who will in turn, help to draw nonacceptors into the program. Social marketing is being used to 1) reach those as yet uninformed about family planning, 2) promote the quality of various information and motivation activities so that they will become behaviorally oriented, and 3) provide an opportunity for the private sector to participate in the program professionally.
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Acknowledgments This work was supported by grants from the William and Flora Hewlett Foundation, the National Institute of Child Health and Human Development, and by a contract awarded to the Uni-versity of North Carolina by the United States Agency for In-ternational Development
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