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eflect a provider bias (e.g., <strong>the</strong> heavy reliance on <strong>in</strong>jectablesprovided by private midwives).F<strong>in</strong>ally, <strong>the</strong>re are sensitive questions about just how selfreliant<strong>the</strong> private sector really is, <strong>and</strong> how much it relies on<strong>in</strong>direct or hidden government subsidies, for example <strong>the</strong>well-known “leakage” of subsidized FP commodities from<strong>the</strong> public sector <strong>in</strong>to <strong>the</strong> private sector, <strong>and</strong> <strong>the</strong> fact thatprivate providers still get tra<strong>in</strong>ed (<strong>and</strong> retra<strong>in</strong>ed) at publicexpense <strong>and</strong> often use publicly provided facilities <strong>and</strong>equipment (Lubis, 2003: 46-48). Most of <strong>the</strong>se “exchanges”across <strong>the</strong> public-private divide may be legitimate butsome can be shown to underm<strong>in</strong>e <strong>the</strong> government’s statedcommitment to privatization.Regional <strong>and</strong> socio-economicdifferencesAno<strong>the</strong>r area of concern for programme managers is thatconsiderable regional differences <strong>in</strong> <strong>the</strong> practice of FPstill exist <strong>in</strong> Indonesia (see Table 6). In some prov<strong>in</strong>cesCPR for modern methods is higher than 60 per cent( Jambi, 62.5%; South Sumatra, 62.6%; Bengkulu, 70.4%;Lampung, 66.0%; Bangka-Belitung, 64.7%; West Java,60.3%; Central Java, 60.0%; East Java, 62.3%; Bali, 65.4%;West Kamilantan, 61.2%; Central Kalimantan, 65.2%;South Kalimantan, 63.2%; <strong>and</strong> North Sulawesi, 66.7%);o<strong>the</strong>rs are under 45 per cent (notably North Sumatra,42.6%; East Nusa Tenggara, 30.1%; South Sulawesi,42.9%; Sou<strong>the</strong>ast Sulawesi, 44.4%; West Sulawesi, 44.5%;Maluku, 29.4%; Papua, 24.5%; <strong>and</strong> West Papua, 39.6%).It is important to focus on unmet dem<strong>and</strong> <strong>in</strong> <strong>the</strong> last eightprov<strong>in</strong>ces if universal access to FP services is to be achievedby 2015.The 2002/03 DHS also <strong>in</strong>cluded a household wealth<strong>in</strong>dex. 7 While CPR for modern methods for all currentlymarried women aged 15-49 was found to be 56.7 per cent,it was only 43.4 per cent for extremely poor women (lowestqu<strong>in</strong>tile) <strong>and</strong> 53.2 per cent for those moderately poor(second lowest decile) (Schoemaker, 2004: 8). Schoemakershowed that this is predom<strong>in</strong>antly not because <strong>the</strong> poorhave more unmet need but because <strong>the</strong>y want morechildren than <strong>the</strong> non-poor. Schoemaker’s analysis alsohighlights questions that programme managers need toaddress about <strong>the</strong> target<strong>in</strong>g of subsidized FP services <strong>and</strong>supplies: even among <strong>the</strong> extremely poor, more womenrely on <strong>the</strong> private sector than <strong>the</strong> public sector for sourceof supply, while among <strong>the</strong> non-poor just over 25 per centuse <strong>the</strong> public sector (Schoemaker, 2004: 17). The DHSwealth <strong>in</strong>dex cannot be taken as a def<strong>in</strong>itive def<strong>in</strong>ition ofpoverty, but Schoemaker’s analysis is consistent with thatof o<strong>the</strong>rs, such as Ross (2003) <strong>and</strong> Strauss et al. (2004),which suggested that <strong>the</strong> government’s subsidized FPservices are largely not benefit<strong>in</strong>g <strong>the</strong> poor <strong>in</strong> <strong>the</strong> way<strong>in</strong>tended.F<strong>in</strong>ish<strong>in</strong>g <strong>the</strong> jobThese <strong>the</strong>n are some of <strong>the</strong> challenges fac<strong>in</strong>g <strong>the</strong> FPprogramme <strong>in</strong> Indonesia today result<strong>in</strong>g from chang<strong>in</strong>gdemographics as <strong>the</strong> country goes through <strong>the</strong> advancedstages of its demographic transition. The consensus amongfriends <strong>and</strong> observers of <strong>the</strong> programme is that <strong>the</strong> FPprogramme is not tackl<strong>in</strong>g <strong>the</strong>se challenges especially well,<strong>and</strong> that BKKBN is certa<strong>in</strong>ly not formulat<strong>in</strong>g <strong>in</strong>novativesolutions <strong>and</strong> coord<strong>in</strong>at<strong>in</strong>g <strong>the</strong>ir implementation with<strong>the</strong> focus <strong>and</strong> determ<strong>in</strong>ation that <strong>the</strong> organization haddisplayed dur<strong>in</strong>g <strong>the</strong> 1970s <strong>and</strong> 1980s. Why?The overall goals of <strong>the</strong> programme – giv<strong>in</strong>g couples<strong>the</strong> <strong>in</strong>formation <strong>and</strong> means <strong>the</strong>y need to control <strong>the</strong>irown fertility, reduc<strong>in</strong>g high fertility to br<strong>in</strong>g populationgrowth more <strong>in</strong> l<strong>in</strong>e with <strong>the</strong> country’s developmentgoals, support<strong>in</strong>g <strong>the</strong> norm of <strong>the</strong> small prosperousfamily – have rema<strong>in</strong>ed remarkably stable s<strong>in</strong>ce <strong>the</strong>programme was launched <strong>in</strong> 1970. Policymakers haveTableTable6232
had to adjust <strong>the</strong> <strong>in</strong>termediate objectives periodically,however, <strong>in</strong> response to chang<strong>in</strong>g circumstances. Indeedas <strong>the</strong> programme exp<strong>and</strong>ed rapidly dur<strong>in</strong>g <strong>the</strong> 1970s <strong>and</strong>1980s new approaches were constantly be<strong>in</strong>g tested <strong>and</strong>applied to <strong>in</strong>crease coverage <strong>and</strong> <strong>in</strong>stitutionalize FP as asocial norm. By <strong>the</strong> 1990s <strong>the</strong> majority of couples werealready practis<strong>in</strong>g FP, <strong>and</strong> <strong>the</strong> depth of <strong>the</strong>ir commitmentwas demonstrated by <strong>the</strong>ir resolve to cont<strong>in</strong>ue even whensome supplies were disrupted for awhile dur<strong>in</strong>g <strong>the</strong> heightof <strong>the</strong> <strong>Asia</strong>n f<strong>in</strong>ancial crisis. The programme seemed tobe on track to deliver universal access to services by 2015<strong>and</strong> to br<strong>in</strong>g about <strong>the</strong> programme’s orig<strong>in</strong>al goal of longtermpopulation stabilization. Paradoxically it was at thisjuncture that <strong>the</strong> programme first appeared to lose itsfocus <strong>and</strong> stall.We argue <strong>in</strong> <strong>the</strong> next section that this was largely becauseof changes <strong>in</strong> <strong>the</strong> <strong>in</strong>ternational <strong>and</strong> <strong>in</strong>stitutional context<strong>in</strong> which BKKBN operates. BKKBN has not beenable to take a conv<strong>in</strong>c<strong>in</strong>g leadership role <strong>in</strong> tackl<strong>in</strong>g <strong>the</strong>challenges listed above – what many would argue shouldbe regarded as its “core bus<strong>in</strong>ess” – because o<strong>the</strong>r changes<strong>in</strong> its <strong>in</strong>stitutional context have effectively neutralizedmany of <strong>the</strong> non-programme factors which were vitalto its organizational success <strong>in</strong> <strong>the</strong> past. BKKBN hasnot been able to focus dur<strong>in</strong>g <strong>the</strong> last 15 years on howits “core bus<strong>in</strong>ess” has evolved separately from tackl<strong>in</strong>go<strong>the</strong>r formidable challenges which have arisen regard<strong>in</strong>g<strong>the</strong> <strong>in</strong>ternational agenda, political decentralization <strong>and</strong>governance reform.In <strong>the</strong> longer term <strong>the</strong> central government’s responsibilitywill likely change <strong>in</strong> o<strong>the</strong>r ways too. Governmentsponsorednational FP programmes have f<strong>in</strong>ite lifespans.“<strong>Family</strong> plann<strong>in</strong>g programs, like <strong>the</strong> fertility transition that<strong>the</strong>y have helped to drive, will be a transient phenomenon”(Caldwell et al., 2002: 1). More than a dozen countries <strong>in</strong><strong>Asia</strong> have by now a TFR at or below <strong>the</strong> replacement level,<strong>and</strong> have already disb<strong>and</strong>ed, or are consider<strong>in</strong>g disb<strong>and</strong><strong>in</strong>g,<strong>the</strong>ir FP programmes. It is only a matter of time before <strong>the</strong>Government of Indonesia will want to phase out much ofits programme support for FP services, except perhaps for<strong>the</strong> poor <strong>and</strong> o<strong>the</strong>r vulnerable groups, <strong>and</strong> for areas where<strong>the</strong>re is still a demonstrable need (cf. Jones <strong>and</strong> Leete,2002).That does not mean <strong>the</strong> government <strong>the</strong>n will have nofur<strong>the</strong>r role to play regard<strong>in</strong>g <strong>the</strong> delivery of services.The government will still need to develop national FPpolicy <strong>and</strong> guidel<strong>in</strong>es, protect people’s reproductiverights, monitor districts’ performance of essential FP/RHservices <strong>and</strong> ensure that satisfactory quality st<strong>and</strong>ards arefollowed by service providers <strong>in</strong> all parts of <strong>the</strong> countryetc. The government will also still need to monitor fertilitybehaviour <strong>and</strong> perhaps do what it can to make sure thatfertility <strong>in</strong> Indonesia does not eventually fall too far belowreplacement, as it has <strong>in</strong> some neighbour<strong>in</strong>g countries(<strong>and</strong> most of Europe). However, <strong>the</strong> publicly funded FPprogramme as we know it will likely be eventually phasedout or significantly refocused <strong>and</strong> reduced <strong>in</strong> scale. In factas we saw <strong>in</strong> Table 6, this process is already far along, withonly a m<strong>in</strong>ority of clients depend<strong>in</strong>g on <strong>the</strong> governmentfor <strong>the</strong>ir rout<strong>in</strong>e FP services.Senior BKKBN officials are, of course, aware of thissituation, whereby “success” can imply redundancy for<strong>the</strong> organization, <strong>and</strong> are carefully weigh<strong>in</strong>g alternativescenarios. (We give our own recommendation on thispo<strong>in</strong>t towards <strong>the</strong> end of <strong>the</strong> paper.)Underst<strong>and</strong><strong>in</strong>g <strong>the</strong> currentsituationChang<strong>in</strong>g <strong>in</strong>ternational agendaOne set of challenges for <strong>the</strong> FP programme arises becauseof vicissitudes <strong>in</strong> <strong>the</strong> <strong>in</strong>ternational agenda. The Programmeof Action adopted at ICPD <strong>in</strong> Cairo <strong>in</strong> 1994 is recognizedas mark<strong>in</strong>g a def<strong>in</strong>itive shift <strong>in</strong> family plann<strong>in</strong>g ideology,away from an approach oriented towards populationcontrol <strong>and</strong> demographic targets towards a client-orientedRH approach emphasiz<strong>in</strong>g good-quality services grounded<strong>in</strong> human rights. 8 S<strong>in</strong>d<strong>in</strong>g (2007: 10) characterized <strong>the</strong>situation as follows:Cairo was truly a watershed. Some havealready seen it as <strong>the</strong> end of <strong>the</strong> familyplann<strong>in</strong>g movement, an event celebratedby many fem<strong>in</strong>ists <strong>and</strong> women’s rightsactivists as a paradigm shift <strong>and</strong> equallyregretted by traditional populationadvocates, <strong>in</strong>clud<strong>in</strong>g many demographers<strong>and</strong> o<strong>the</strong>rs concerned about high fertilityrates, as ab<strong>and</strong>onment of a decades-longcommitment to population stabilization.In <strong>the</strong> years s<strong>in</strong>ce <strong>the</strong> conference, globalattention has <strong>in</strong>creas<strong>in</strong>gly shifted awayfrom population growth as a centralpolitical or development concern, while<strong>the</strong> ris<strong>in</strong>g toll of HIV <strong>in</strong>fection <strong>and</strong> AIDSdeaths has captured <strong>the</strong> attention of policymakers.233
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Family Pla
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ForewordThe Asia <
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Part 1Part 1Asia <
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Ensuring that <str
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of methods for all, in</str
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and undertake <str
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Report on the Regi
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SESSION 1: Changin
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that improving <st
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at a hospital would be offered post
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Bounkoung Phichit, Deputy M
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medicines
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Thus, while knowledge of modern met
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Hon. Mr. Malakai Tabar, Chairman, P
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curricula. If the
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dialogue as well as regional <stron
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BackgroundGlobal development effort
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TableTable1EventNational policyYear
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A third observation is that reporte
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TableTable2Current Contraceptive Pr
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Figure(-1.2), Cook Island</
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FigureTableTable3Trends in<
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Nam. Nearly all economies i
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2008 2009% Bilateral % Multilateral
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family planning wi
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IntroductionFamily
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The advent of the
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FigureFigure1Oceania and</s
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next 25 years, however, TFR fluctua
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FigureFigureFigure2Total fertility
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family planning pr
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esponsible for the
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that estimates of CPR for earlier p
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Figuremarried at an older age compa
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As previously mentioned most <stron
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FigureFigure945Relationship between
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The concept of “unmet need” has
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TableTable8Percentage of th
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TableTable9Percentage of reasons fo
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family planning pr
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As far as the supp
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Socio-cultural challenges tofamily
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likely to use contraception than yo
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15 Tests of statistical significanc
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of the South <stro
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104
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Figurewill exceed the</stro
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in urban (67%) tha
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ased service delivery poin<
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Most FWAs who were recruited two to
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are considered, unmet need for effe
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Households pay the
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Effective public-private partnershi
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ConclusionThe Bangladesh Fa
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the Family
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National Institute for Population R
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IndiaIndiaFamily <
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IntroductionThe use of contraceptiv
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TableTable2Indicators of tra<strong
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FigureFigureFigure1Contraceptive pr
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TableTable5Indicators of contracept
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TableTable6Adjusted odds ratios for
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FigureFigure3Contraceptive prevalen
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TableTable7Adjusted and</st
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the north
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TableTable10Differences between nor
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TableTable11 Total fertility rate <
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End Note1The first camp was success
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152
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154
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Figure1980s and ex
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health care and ed
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assistance from UNFPA and</
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in CPR. Likewise,
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International supp
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in development has
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__________ (2007). Population <stro
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170
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TableTable2What has the</st
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174
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per cent of women reported us<stron
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is provider bias that such methods
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TableTable7skewed distribution of h
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Page 212 and 213: acceptable. From an NGO perspective
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Page 226 and 227: Policy Management.__________ (n.d.,
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Page 230 and 231: Population Activities (UNFPA) for a
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Page 238 and 239: Figureeconomic growth durin
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Page 250 and 251: (Ministry of Healt
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Page 256 and 257: FigureTrends and p
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Page 262 and 263: TableTable8TableTable9Malaysia, abo
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Page 268 and 269: FigureFigure3TRF54.5Scatter plots o
Page 270 and 271: ReferencesAng, Eng Suan (2007). Stu
Page 272 and 273: Demographic data sheet: population
Page 274 and 275: population size, with just 336,000
Page 276 and 277: NuptialityIn Myanmar nuptiality is
Page 278 and 279: FigureIn Myanmar, birth-spac<strong
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Page 282 and 283: FigureIn Myanmar, out of six select
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National Population PolicyMyanmar i
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Linkages with o<st
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TableTable4Achievements of Myanmar
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monitoring <strong
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Nay Pyi Taw, 26 October 2010.53 Sit
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294
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TableTableA296
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dispense and adm<s
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(1) I am against a
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FigureFigureFigure3Use of modern co
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FigureFigure7Traditional method use
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Figureprojection, and</stro
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Figure 11 summarizes the</s
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correlating <stron
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Figurethe use of c
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FigureFigure15Sexual behaviour <str
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track the distribu
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Figureservices, which should <stron
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FigureFigureFigure18 Population <st
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National Statistics Office, <strong
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TableTable6TableTable7TableTable832
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TableTable11326
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TableTable14TableTable15TableTable1
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TableTable19Laws and</stron
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worker and hours w
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334
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336
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includin</
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TableTable1Contraceptive prevalence
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These results suggest that about 70
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2 The (period) TFR is the</
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346
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FigureThe existence of traditional
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Guinea case by <st
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The establishment of provin
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provide family plannin</str
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Figurelegal requirement nor a condi
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FigureTableTable5TableTable6Figure4
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modern method and
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married or in unio
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Figureolder. Both the</stro
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TableTable15The immediate past Nati
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out that the “ne
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Commodity securitySupply cha<strong
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is able to achieve. In Papua New Gu
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Qualitative assessments by a number
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increasin<
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service delivery poin</stro
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Population: Views from Men
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1545-1730Day 2: December 9Session 2
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Day 3, December 10Session 50830-100
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15Mr. Tong Sithen1
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54Ms. Shadiya IbrahimAssistant Repr
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93Mr. Melkie AntonProject OfficerUn
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131Dr. John P. SkibiakDirectorRepro
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International <str
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