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Indonesia-Family Planning in Hospitals, 15 Aug 1994

THE EARTH TIMES/FIELD REPORT

AUGUST 15-31, 1994

Indonesia: Working at Family Planning

By Ashali Varma

MERANGGI, Indonesia—Once a month, mothers with small children and some fathers gather at a Posyandu, a community – run event place in the village center, and provides health and family planning services.  Five portable tables are set up, some outdoors some partly shaded, where the infants are weighed and immunized and parents are provided with family planning counseling and nutritional and hygienic advice.

Staffed entirely by volunteers from a family welfare movement called PKK, the Posyandu has been cited as a major factor in the success of rural family planning programs.  It has also contributed to the overall improvement in maternal health and child care.  More than one million trained volunteers are scattered throughout 66,744 villages on Indonesia’s 6,000 inhabited islands.

Today, 95 percent of Indonesian women know about modern contraceptive methods and more than half of the eligible couples are using family planning.  Since the early 1970s, Indonesia’s fertility rate has declined by 46 percent.

Wardani, a 23-year-old woman who is a PKK volunteer in Meranggi, said, “I took on this responsibility because I would like to participate in the development of my community and motivate other families to improve their lives.  Here mothers learn how to take care of their babies and about nutrition, health and immunization. They are also given information on family planning.”

Wardani has a 3-year-old child, whom she is waiting to send to school before planning her second child.  She works with her husband making bricks.

Unpaid volunteers such as Wardani come from all walks of life.  They are the backbone of the family-planning movement started by President Soeharto over two decades ago.  Even at that time, organizers felt that without the grassroots participation of people, family planning programs would not succeed.  An all-out campaign to engage the cooperation of the media, religious leaders, heads of communities and the people was developed.

“The most challenging task,” said Dr. Haryono Suyono, Minister of State for Population and the architect of Indonesia’s family planning movement, “was to change the people’s mentality that family-planning was not a medical problem… We overcame this step by step, by showing the community that the local leaders, village heads, religious persons could speak with authority on family planning.   And this became the accepted norm (that) helped to spread information, awareness and educated the villagers.”

Another important aspect of the movement was to promote the role of women. “In communities we made them leaders. We focused on mothers, who are often the weakest links and the most vulnerable since they bear the greatest burdens. Apart from  establishing a health infrastructure, we also started income generating schemes for them,” said Dr. Haryono.

In the city of Yogyakarta, in Central Java, leaders from the local communities, successful entrepreneurs and officials from the Family Planning Program (BKKBN) gathered to celebrate the third anniversary of the region’s income generating activities. Women’s clubs set up festive stalls to sell cooked food, fresh vegetables, sauces, handicrafts and leather goods. Each group had been given low-interest loans to encourage young wives to start small businesses. In this way, villagers can have successful employment and income generating activities in their own areas and not have to migrate to already overcrowded cities to work. One woman persuaded the minister to buy some food and then hitched up her sleeve to proudly display a Norplant implant saying, “I have one child and am now busy earning an income.” Dr. Haryono later told The Earth Times that 20 years ago women would not even look directly at a man, but that today they had no reservations about discussing their choice of contraception with the minister.

At this event, individuals and corporations will donate in cash and kind. A decree by President Soeharto makes it mandatory for all public sector companies to loan, 1 percent to 5 percent of their profits to community development. Some institutions will donate 1,000 sheep and 300 cows to low-income families. To make them financially independent, farmers are allowed to keep two-thirds of their profits. One-third is given back to a social foundation to help others in need.

Equally important to the success of the family planning program in Indonesia was the access and free availability of counseling and contraceptives to families both in rural and urban centers.

The Radensaleh Clinic in Jakarta, specializes in reproductive health services, and is affiliated to the General Hospital. Dr. Suryono, who works in the clinic, said, “We cater to about 60,000 clients a year and offer IUDs, pills, injectibles, Norplant and even sterilizations. People with problems who cannot be served by rural clinics are referred to us. We also train doctors, midwives, paramedics and medical personnel from foreign countries.”

The clinic collaborates with The John Hopkins Institute and the World Health Organization. Over 5,000 midwives from rural areas are trained in counseling and family planning care. Treatment is free for those who cannot afford to pay.

At the Jakarta Islamic Hospital, Dr. Lathifahsati,  a lady doctor specializing in. general medicine, spoke about the change in attitudes towards family planning. “Now women feel that family planning is a basic need,” she said. “They want to plan their families and have time to pursue careers and give their children the best of education. The fact that couples come on their own and want to pay for contraception shows that they really want these services.”

According to Indonesian government rules, all hospitals must offer basic family planning facilities. At the St. Carolus  Catholic Hospital in Jakarta which is the largest of 53 Catholic hospitals in Indonesia.  Sister Christophora  said the hospital offered family planning consultations, counselling and contraceptives. “We tell mothers to return here 40 days after delivery and at that time we inform them of the family planning options that we offer,” she said.

The Mother and Child Clinic at St. Carolus hospital provides pills, implants, injectibles and condoms  as well as information on the natural method.  She added that, “The natural method is not easy for uneducated women.  And all women indicate a preference for more reliable forms of contraception.”

Dr. Endang, who works in the Mother and  Child Clinic, said, “Over 200 women a month, who have never used contraceptives before, request the hospital’s services.”

She also said: “We give these women general information on our program and counsel them on how to have smaller and healthier families.”

Dr Endang added that “This hospital is one of the motivating hospitals where we train midwives to care for women in rural areas, especially in the areas of family planning health, and education.”  In an interview with The Earth times, Ginanjar Kartasasmita, Indonesia’s Minister for Planning and Development, said “Population is a very important element of our development plan.  In fact all development plans should be based on population projections –and the most important objective of the plan is to create jobs.

“It is also important to decentralize the government and try to develop plan away from urban areas and to empower regional governmental institutions.”

According to Sister Christophora of Saint Carolus Catholic Hospital, some women seek religious counselling to help them in making family planning decisions.  She said “Sometimes the midwife will call the religious leaders for a panel discussion so the women can ask whether a specific family planning method adheres to the tenets of their beliefs.”  She noted that priests in the Catholic Church offered motivational and educational assistance in addition to pre-marriage counselling, where they explain the benefits of regulating pregnancies, managing households, and on how to raise a happy family.

Some experts in the population debate contend that population growth rates cannot be reduced until the general economic condition of the people is raised.

But the Indonesia family planning movement proves that a constructive, cohesive, and committed approach to family planning can be very successful.

All that’s needed is that people at the grassroots level are actively involved in the programs and that there is a political commitment to improve their lives.