FERTILITY AND FAMILY PLANNING:

PROSPECT AND CHALLENGES FOR

SUSTAINABLE FERTILITY DECLINE
Sri Moertiningsih Adioetomo
REVIEW

This paper argued that there is substantial potential for further fertility decline in
Indonesia. Because much of the fertility decline can be attributed to the Indonesian family
planning program initiated in the early 1970s (Hull, Hull and Singarimbun 1977; Warwick
1986; Adioetomo, Kiting and Salman 1990). Efforts to legitimate the concept of fertility
control, followed by the distribution of contraceptives and family planning services, and the
promotion of a small family-size norn of two or three children have made the Indonesian
people family planning-literate. Nowadays, most women are able to name a number of
modern contraceptive methods, asa well as indicate where they maybe obtained. This is
congruent with the increased rate of contraceptive use, from firtually zero before the 1960s
to about half of married couples in 1994 (CBS et al. 1995). Values of small family size have
developed.

Educated middle-class women wanted to limit family sizes because of growing social
economic aspirations (Subandrio 1963; Hull 1975), and lower-class rural women wanted to
stop child bearing because of the health and economic burden presented by frequent
pregnancies. But, because means for fertility control were unavaible and the idea of birth
control was not socially accepted, the adoption of effective means of contraception was
limited. Nevertheless, during the 1950s and early 1960s, small groups of women and
dedicated medical personnel started to provide family planning services oriented to
improving mothers and children’s health (Hull, Hull and Singarimbun 1977). This provided
the foundation for implementation of a national family planning program to accommodate
the growing demand for fertility control among women and changed the people perception
from ‘family size is not matter for choice to ‘numeracy’ about preferred family size
(Adioetomo 1993).
 On the basis of the above trends and experiences, the shape of continued fertility
transition depend on government, BKKBN, and public awareness. In the early days the
Indonesia family planning program was characterized by high government subsidy for
contraceptive services to clients, Increasingly new and continuing acceptors are paying for
the supply and the provision of services since government alone can not afford to provide
free and subsidized contraception to all couples. Therefore, efforts to increase self-reliance
in family planning are being encouraged. Then in 1989 a policy of KB Mandiri (self-reliant FP)
was initiated ad promoted. The idea is to encourage those who have capacity and
willingness to pay for contraceptives to use private sources to obtain family planning
services. The private sector in this case consist of the private hospital, private clinics, private
doctors, private midwives, pharmacies, and drugstore, or voluntary community groups.

A comparison of women who obtained family planning services free of charge with
those who paid for the services found that rural women, having lower education and lower
economic status and working in agriculture, are less likely to pay for services than urban
women who has finished primary school and live in better houses. Younger women aged
less than 30 years old having not more than two children showed very high self-reliance:
they were twice as likely to pay for services. This pattern reinforces the better prospects for
privatization when the older generation are replaced by the younger, more urbane, more
educated and more economically secure cohort of women (Adioetomo, Ganiarto and
Hidayat 1996).

But not every women used this facility whether with subsidies or pay by herself. The
reason given by non-users were mainly desire to have children, but a substantial percentage
of women stated that they were not using contraception because of disapproval, or
religious reasons or lack knowledge. This category women can be considered as the hard-to-
reach or har-to-serve.

In summary, studies on quality of care have found that quality of family planning
services in Indonesia is far from satisfactory (Wibowo 1994; Raintung et al. 1995; Adioetomo
1996) in part because the quality of health services is so questionable. Standard operational
procedures are not properly followed, commitment and responsibilities of providers are
inadequate, and facilities and equipment are such low standard that they preclude
attainment of good quality of services. While these provider-perspective indicators are
important, indicators of quality of care in family planning in terms of clients satisfaction
need to be developed to give more discerning indicators of quality of care.
 ANALISYS

But in this global era, we can see many people use contraceptive especially in young
families. We are no need to worry because of uncontrolled population growth. So glad to
found that Indonesia still have fertility rates in high level, it just the opposite with Japan or
Netherland, who have the little fertility rate.

The high fertility rate is not a big problem, if we can compensated it with good
progress in every sector. Government should make more jobs, and used the domestic
workers. So it can help them to provide their family and improve the economic standard.

The amateur people can use this paper to learn about challenges in family planning.
However, as a student, we can use this paper to solve some problem based on the theories.
This paper examines whether current fertility levels and trends and family planning
institutions provide the basis for continuing fertility decline into the 21 st century.
 KEPENDUDUKAN

DEMOGRAPHICS JURNAL REVIEW

Grace Damaris Suradi

10/298014/TK/36522

Perencanaan Wilayah dan Kota

Universitas Gadjah Mada