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

Figurebut rema<strong>in</strong>ed about 9 per cent dur<strong>in</strong>g <strong>the</strong> period 1997-2007 (see Table 2). In absolute terms <strong>the</strong> number ofcurrently married women 15-49 years of age with unmetneed cont<strong>in</strong>ued to <strong>in</strong>crease. In short, <strong>the</strong> plateau<strong>in</strong>g ofCPR around 60 per cent was not consistent with <strong>the</strong>government’s stated policy objective of ensur<strong>in</strong>g that FPservices would be available to all married couples whoneeded <strong>the</strong>m. 5Method choiceEven if changes <strong>in</strong> CPR are currently slow this does notmean that FP is static. There are strik<strong>in</strong>g trends <strong>in</strong> methodmix, especially <strong>in</strong>creas<strong>in</strong>g reliance on <strong>in</strong>jectables <strong>and</strong> a shiftaway from IUDs (see Table 3). By 2007, 45.0 per cent of allcurrently married women were us<strong>in</strong>g short-term hormonalmethods, or more than two thirds of those practis<strong>in</strong>g FP.Sterilization meanwhile rema<strong>in</strong>ed below 5 per cent.These trends <strong>in</strong> method mix warrant attention. Although<strong>the</strong> medical evidence overwhelm<strong>in</strong>gly suggests that lowdosemodern hormonal methods pose no serious healthrisk (except for those with contra<strong>in</strong>dications), some healthpractitioners still caution whe<strong>the</strong>r it is wise for a womanto take hormones for decades, especially when o<strong>the</strong>r nonhormonallong-term methods are available. 6 Second, someFP programme experts (e.g., Ross, 2003) argue that itmay be additionally difficult to reach <strong>the</strong> high levels ofCPR needed to atta<strong>in</strong> long-term population stabilizationif a programme relies heavily on short-term “resupplymethods” because of <strong>the</strong> “churn<strong>in</strong>g effect” among <strong>the</strong>programme’s clients. A programme that depends heavilyon short-term methods requir<strong>in</strong>g constant resupply isespecially vulnerable to disruption dur<strong>in</strong>g turbulent times(e.g., dur<strong>in</strong>g a transition to decentralization). A programmewith more clients on long-term methods can focus moreattention on reach<strong>in</strong>g those couples who still have unmetneed.Adolescents <strong>and</strong> <strong>the</strong> unmarriedO<strong>the</strong>r significant trends <strong>the</strong> FP programme must respondto concern about chang<strong>in</strong>g patterns <strong>in</strong> family formation. At<strong>the</strong> time of <strong>the</strong> 2000 population census almost one thirdof all women aged 15-49 (32.9% of that age group, or 18.5million women) were not currently married. Table 4 shows<strong>the</strong> sharp rise <strong>in</strong> <strong>the</strong> percentage never married for females<strong>in</strong> age groups under age 30. For both sexes, 92 per cent ofall young people aged 15-19 were s<strong>in</strong>gle <strong>in</strong> 2000; <strong>the</strong> figurewas 58 per cent for those aged 20-24. Most (84%) youngpeople aged 10-24 have never been married.Accord<strong>in</strong>g to <strong>the</strong> 2002/03 DHS, among women currently25-29 years old <strong>the</strong> median age at first marriage was 20.2years, compared with 17.9 years reported by womencurrently 45-49. Among women currently aged 20-24,only 4 of 10 were married by age 20, while for thosecurrently aged 45-49, 7 of 10 were married by age 20.Urban women marry later than rural women, <strong>and</strong> thosewith more education marry later than those with less. Themedian age at first marriage among women currently aged25-29 who have some education above <strong>the</strong> secondary levelis 23.9 years.The long <strong>in</strong>terval common nowadays between puberty<strong>and</strong> marriage represents an <strong>in</strong>tensely challeng<strong>in</strong>g period<strong>in</strong> <strong>the</strong> development of a young person’s life, <strong>and</strong> <strong>the</strong> wayshe or he deals with that period helps to determ<strong>in</strong>e her orhis future life chances <strong>and</strong> adult personality. Young peopleneed <strong>in</strong>formation <strong>and</strong> o<strong>the</strong>r services to help <strong>the</strong>m navigatethis stretch of <strong>the</strong>ir life, <strong>and</strong> most importantly <strong>the</strong>y need<strong>in</strong>formation <strong>and</strong> services to help protect <strong>the</strong>ir reproductivehealth. The chang<strong>in</strong>g demographics of Indonesia as itcompletes its demographic transition are plac<strong>in</strong>g grow<strong>in</strong>gFigure3Challenges fac<strong>in</strong>g Indonesia’s FP programChang<strong>in</strong>gDemographicsChang<strong>in</strong>g<strong>International</strong>AgendaFP/RHPolicymakersDecentralizationGoodGovernanceSource: Indonesian Demographic <strong>and</strong> Health Surveys.229