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

TableTable1TableTable2For spac<strong>in</strong>gFor limit<strong>in</strong>gTotal25.437.963.328.138.366.330.037.467.430.037.467.429.541.170.6Percentage of dem<strong>and</strong> satisfied 79.9 84.0 876.4 87.6 87.2Source: Indonesian Demographic <strong>and</strong> Health Surveys.pressure on FP programme managers to provide additionalservices for <strong>the</strong> grow<strong>in</strong>g proportion of <strong>the</strong> population thatis currently unmarried. However, an FP programme thatcont<strong>in</strong>ues to restrict itself to provid<strong>in</strong>g services almostexclusively to married couples will necessarily miss a vital,<strong>and</strong> <strong>in</strong>creas<strong>in</strong>gly large, part of <strong>the</strong> action.Sources of supplyAno<strong>the</strong>r major trend is that FP clients have been shift<strong>in</strong>gto <strong>the</strong> private sector at a rapid rate <strong>in</strong> recent years (seeTable 5). The 2007 DHS reported that 69.1 per cent ofclients were us<strong>in</strong>g a “private medical” source of supply, afigure that rose to more than 75.0 per cent when “o<strong>the</strong>rprivate” sources were <strong>in</strong>cluded. Government-provided“public” sources account for only 22.2 per cent of <strong>the</strong> total.The trend towards <strong>the</strong> private sector was, if anyth<strong>in</strong>g,accelerated by <strong>the</strong> 1997/98 <strong>Asia</strong>n f<strong>in</strong>ancial crisis (Strausset al., 2004). The precise details are complicated because<strong>the</strong> public-private dist<strong>in</strong>ction is not clear-cut, with manyprivate practitioners also work<strong>in</strong>g <strong>in</strong> <strong>the</strong> public sector,<strong>and</strong> because what gets listed under each category head<strong>in</strong>gof “source” <strong>in</strong> <strong>the</strong> DHS has changed over <strong>the</strong> years (e.g.,posy<strong>and</strong>u was listed as a “Government source” <strong>in</strong> 1991, as“O<strong>the</strong>r private” <strong>in</strong> 1994 <strong>and</strong> 1997, <strong>and</strong> as “O<strong>the</strong>r source”<strong>in</strong> 2002/03: see Table 5). None<strong>the</strong>less, <strong>the</strong> overall trend<strong>in</strong> privatization is clear <strong>and</strong> corroborated by o<strong>the</strong>r datasources, such as <strong>the</strong> annual National Socio-EconomicSurvey <strong>and</strong> <strong>the</strong> Indonesia <strong>Family</strong> Life Survey.This trend <strong>in</strong> privatization is broadly consistent with <strong>the</strong>government’s objectives; <strong>the</strong> policy of KB M<strong>and</strong>iri (“selfreliantfamily plann<strong>in</strong>g”) was first <strong>in</strong>troduced <strong>in</strong> 1989.Policymakers still need to question some of <strong>the</strong> nuancesof this trend, however. One obvious question is whe<strong>the</strong>r,as <strong>the</strong> programme becomes <strong>in</strong>creas<strong>in</strong>gly privatized, thiswould lead to a rise <strong>in</strong> clients’ out-of-pocket costs so as tocause many among <strong>the</strong> poor to lose access to services. O<strong>the</strong>rquestions are whe<strong>the</strong>r <strong>the</strong> private sector is adequatelyregulated to guarantee a satisfactory m<strong>in</strong>imum st<strong>and</strong>ardof services, <strong>and</strong> whe<strong>the</strong>r adequate systems of redress are<strong>in</strong> place when needed. There are also questions regard<strong>in</strong>gwhe<strong>the</strong>r providers <strong>in</strong> <strong>the</strong> private sector are equipped <strong>and</strong>motivated to provide clients with an adequate choice ofmethods, or whe<strong>the</strong>r <strong>the</strong> method mix to some extent may230