Family Planning in Asia and the Pacific - International Council on ...

FigureAims of <strong>the</strong> reportIndonesia has a mature national family plann<strong>in</strong>g programmewith many successes to its credit. Now that it has realizedmany of <strong>the</strong> objectives it set out to achieve, however, manycommentators believe it lacks a central motivat<strong>in</strong>g vision<strong>and</strong> has lost its sense of direction. The aims of this report areto provide a succ<strong>in</strong>ct review of <strong>the</strong> overall status of familyplann<strong>in</strong>g (FP) <strong>and</strong> related reproductive health programmes<strong>in</strong> Indonesia today; identify key issues <strong>and</strong> obstacles whichmay be limit<strong>in</strong>g universal access to quality FP services; <strong>and</strong>make recommendations (where appropriate) regard<strong>in</strong>ghow <strong>the</strong> provision of services <strong>and</strong> practice of FP can beimproved by “reposition<strong>in</strong>g”, “revitaliz<strong>in</strong>g” or o<strong>the</strong>rwiseadjust<strong>in</strong>g <strong>the</strong> national FP programme.Past achievements <strong>in</strong> familyplann<strong>in</strong>g <strong>and</strong> reproductivehealthPresident Suharto <strong>in</strong>troduced <strong>the</strong> national family plann<strong>in</strong>gprogramme <strong>in</strong> 1968 <strong>and</strong> established <strong>the</strong> National <strong>Family</strong><strong>Plann<strong>in</strong>g</strong> Programme – well known around <strong>the</strong> world byits Indonesian acronym, BKKBN – <strong>in</strong> 1970. BKKBNwas charged with develop<strong>in</strong>g a national FP programme<strong>and</strong> manag<strong>in</strong>g foreign aid provided for this purpose. Theprogramme was a great success <strong>and</strong> fertility levels droppeddramatically (see Figure 1). Accord<strong>in</strong>g to <strong>the</strong> latest UnitedNations estimates, <strong>the</strong> total fertility rate (TFR) decl<strong>in</strong>edfrom 5.6 live births per woman <strong>in</strong> <strong>the</strong> period 1965-1970to 3.4 <strong>in</strong> <strong>the</strong> period 1985-1990 (United Nations, 2009).President Suharto was presented with <strong>the</strong> United NationsPopulation Award <strong>in</strong> 1989 <strong>in</strong> recognition of this success.The Indonesian FP programme was “widely recognized asone of <strong>the</strong> most successful <strong>in</strong> <strong>the</strong> world” (Piet, 2003: 83).The latest United Nations estimate for TFR (2005-2010)<strong>in</strong> Indonesia is 2.2 (see also Hartanto <strong>and</strong> Hull, 2009).If <strong>the</strong> current status of FP is to be assessed accurately,it is important to underst<strong>and</strong> <strong>the</strong> factors underly<strong>in</strong>g <strong>the</strong>country’s early success. Those work<strong>in</strong>g <strong>in</strong> <strong>the</strong> FP programmecommitted to solv<strong>in</strong>g <strong>the</strong> country’s “population problem”often spoke (<strong>and</strong> wrote) at <strong>the</strong> time as if success derivedexclusively from “programme effort”. It is true that <strong>the</strong>programme enjoyed <strong>in</strong>spired leadership dur<strong>in</strong>g most of itsfirst quarter century <strong>and</strong> that BKKBN was able to recruitmany of <strong>the</strong> best new entrants <strong>in</strong>to <strong>the</strong> civil service toproduce an impressive <strong>and</strong> effective “can-do” organization(Hull, 2007). On top of <strong>the</strong>se factors <strong>the</strong> programme had<strong>the</strong> strong <strong>and</strong> enthusiastic support of President Suharto,which guaranteed generous resources (<strong>in</strong>clud<strong>in</strong>g foreignassistance) <strong>and</strong> political leverage.However, <strong>the</strong>re were o<strong>the</strong>r important non-programmefactors at work too. Suharto’s authoritarian New Ordergovernment established a highly centralized state apparatuswhich reached down <strong>in</strong>to villages <strong>and</strong> tolerated no organizedopposition; had this broader political-adm<strong>in</strong>istrative systemnot been <strong>in</strong> place it is difficult to believe that BKKBNcould have exp<strong>and</strong>ed <strong>and</strong> coord<strong>in</strong>ated <strong>the</strong> FP programmeso effectively (Hull <strong>and</strong> Hull, 1997). 2 The New Ordergovernment ma<strong>in</strong>ta<strong>in</strong>ed political stability <strong>and</strong> impressiveFigure1Total fertility rate, Indonesia, 1950-2010654TFR32101950-55 1960-65 1970-75 1980-85 1990-95 2000-05Source: United Nations (2009).227