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

<strong>in</strong>-country <strong>and</strong> <strong>in</strong>ternationally, <strong>and</strong> which, if accomplished,will help <strong>the</strong> country reach its MDGs as well as achieve <strong>the</strong>ICPD target of universal access to FP by 2015.Recommendation 2Can primary responsibility for FP policybe transferred to <strong>the</strong> M<strong>in</strong>istry of Healthwith<strong>in</strong> <strong>the</strong> next few years?BKKBN was established at a time when <strong>the</strong>re was arecognized massive “population problem” <strong>in</strong> <strong>the</strong> country,which related to very high fertility levels <strong>and</strong> a highpopulation growth rate, <strong>and</strong> <strong>the</strong> <strong>in</strong>ternational communitysupported population control programmes at <strong>the</strong> time.Nei<strong>the</strong>r condition is true today.Thanks largely to <strong>the</strong> successful efforts of BKKBN <strong>the</strong>orig<strong>in</strong>al “population problem” has been brought undercontrol. <strong>Family</strong> plann<strong>in</strong>g is now <strong>the</strong> prevail<strong>in</strong>g norm <strong>in</strong>Indonesia, although responsible practice is low for somegroups <strong>and</strong> for some parts of <strong>the</strong> country. Less than aquarter of <strong>the</strong> couples practis<strong>in</strong>g FP rely on <strong>the</strong> governmentto provide <strong>the</strong>m with <strong>the</strong>ir services. The country as awhole is close to replacement-level fertility. For most of <strong>the</strong>population whe<strong>the</strong>r fertility cont<strong>in</strong>ues to fall or whe<strong>the</strong>r itedges up aga<strong>in</strong> will depend more on social <strong>and</strong> economicconditions than actions <strong>in</strong>troduced by BKKBN. Fertilitylevels need to be monitored carefully but so far <strong>the</strong>reis no compell<strong>in</strong>g evidence to suggest that <strong>the</strong>re will be amajor baby boom if BKKBN no longer manages <strong>the</strong> FPprogramme. 14 In short, <strong>the</strong>re is no conv<strong>in</strong>c<strong>in</strong>g argument forma<strong>in</strong>ta<strong>in</strong><strong>in</strong>g <strong>in</strong>def<strong>in</strong>itely a separate agency with primaryresponsibility for family plann<strong>in</strong>g policy formulationoutside <strong>the</strong> M<strong>in</strong>istry of Health.Giv<strong>in</strong>g <strong>the</strong> M<strong>in</strong>istry responsibility for FP policy wouldfacilitate <strong>the</strong> <strong>in</strong>tegration of FP <strong>in</strong>to <strong>the</strong> broader clusterof reproductive <strong>and</strong> maternal health services <strong>in</strong> <strong>the</strong> wayenvisioned by ICPD. Without “reposition<strong>in</strong>g” <strong>the</strong> FPprogramme <strong>in</strong> this way, it is difficult to see how it couldever be revitalized.Recommendation 3Can a new vision <strong>and</strong> mission bedeveloped for BKKBN which satisfiesthree requirements: (a) it is centredon a holistic vision of populationpolicy <strong>and</strong> its role <strong>in</strong> development; (b)it is acceptable to o<strong>the</strong>r parts of <strong>the</strong>government if <strong>the</strong> mission is assumedby BKKBN; <strong>and</strong> (c) it is a vision <strong>and</strong>mission which is attractive to BKKBNitself <strong>and</strong> which gives <strong>the</strong> organizationan excit<strong>in</strong>g future?The new population law (Law 52/2009 on <strong>Family</strong><strong>Plann<strong>in</strong>g</strong> <strong>and</strong> Population Development) gives BKKBNexplicit responsibility for population policy, <strong>and</strong> <strong>the</strong>name of BKKBN has been changed accord<strong>in</strong>gly (whilestill conveniently keep<strong>in</strong>g <strong>the</strong> same acronym). 15 BKKBNas an organization is not happy with <strong>the</strong> way <strong>the</strong> newresponsibility has been assigned to it because <strong>the</strong>mission is not associated with sufficient status with<strong>in</strong> <strong>the</strong>government structure for BKKBN to be able to fulfill thisresponsibility effectively. However, <strong>the</strong>re is <strong>the</strong> seed of apromis<strong>in</strong>g core mission here. If BKKBN embraces it <strong>and</strong>advocates with <strong>the</strong> skill <strong>and</strong> persuasion it has traditionallydisplayed for <strong>the</strong> status <strong>and</strong> resources it needs to do <strong>the</strong> jobwell, <strong>the</strong>n this could be a new <strong>and</strong> excit<strong>in</strong>g beg<strong>in</strong>n<strong>in</strong>g foran <strong>in</strong>stitution that is already a legend <strong>in</strong> population policycircles around <strong>the</strong> world.ConclusionIndonesia has a mature FP programme which appearsto have lost its way now that it has substantially realizedits orig<strong>in</strong>al objective. Nei<strong>the</strong>r BKKBN nor <strong>the</strong> M<strong>in</strong>istryof Health is happy with <strong>the</strong> present status of FP <strong>in</strong> <strong>the</strong>country. Plenty of “b<strong>and</strong>-aid” solutions have been suggested<strong>in</strong> recent years, but if <strong>the</strong> FP programme is to be revitalized<strong>and</strong> responsive to <strong>the</strong> evolv<strong>in</strong>g needs <strong>and</strong> aspirations of <strong>the</strong>238