Muhadjir Darwin, Dewi Haryani Susilastuti,Populasi Yam’ah Tsalatsa, Triyastuti Setianingrum, & Sumini

Volume 23 Nomor 1 2015 Halaman 50-70 THE INHIBITING FACTORS OF FERTILITY RATE DECREASE AND THE DIRECTION OF FAMILY PLANNING PROGRAM REVITALIZATION

Muhadjir Darwin1, Dewi Haryani Susilastuti2, Yam’ah Tsalatsa3, Triyastuti Setianingrum4, and Sumini5

Intisari

Tulisan ini menganalisis stagnasi penurunan angka kelahiran di . Keseimbangan penduduk salah satunya dapat dicapai dengan mengontrol angka kelahiran. Namun survei demografi dan kesehatan In- donesia tahun 2012 mengungkapkan tentang jumlah kelahiran yang tidak jauh berbeda dengan survei tahun 2002 dan 2007. Di samping itu, terdapat faktor-faktor seperti pergeseran paradigma politik di negara berkembang, perubahan tata kelola pemerintah daerah dan perubahan institusional yang mempengaruhi stagnansi dalam menurunkan angka kelahiran. Rekomendasi tulisan ini adalah perlu menemukan cara dalam mengakomodasi keseimbangan sistem demokrasi dan efektivitas capaian. Selain itu penu- runan angka kelahiran juga memerlukan keseriusan dan keikutsertaan pemerintah daerah dalam berparti- sipasi. Untuk tujuan ini, model pendekatan kultural dan sosiologis dapat digunakan sebagai alternatif dalam mempengaruhi perilaku masyarakat.

Kata Kunci: stagnasi TFR, kontrasepsi, keluarga berencana, desentralisasi

Abstract

This paper analyzes stagnation of fertility rate decrease in Indonesia. Population balance can be achieved by controlling fertility. Indonesian survey of demography and health in 2012, however, shows no signifi cant difference of fertility rates from similar surveys in 2002 and 2007. In addition to that, there are factors such as the shifting political paradigm in the developing world, change of local governance, and institutional change that infl uence the stagnation of fertility rate decrease. This writing recommends ways to accom- modate balance between democratic system and effective achievement. Besides, the decrease of fertility rate also requires serious commitment and determination of local government to participate. For this goal, sociological and cultural model can be used as an alternative to transform the behavior of society.

Kata Kunci: TFR stagnation, contraceptives, family planning, decentralization

1 Profesor, Fakultas Ilmu Sosial & Politik, Universitas Gadjah Mada. Email: [email protected] 2 Dosen Sekolah Pascasarjana UGM 3 Dosen Akademi Sekretaris & Manajemen Indonesia 4 Peneliti Pusat Studi Kependudukan & Kebijakan UGM 5 Peneliti Pusat Studi Kependudukan & Kebijakan UGM

50 Qpqvmbtj Volume 23 Nomor 1 2015 The Inhibiting Factors of the Fertility Rate Decrease

Introduction intends to formulate recommendations for the policymakers of population and family planning One of the aims of the 2010-2014 National so that, in the future, the family planning program Medium-Term Development Plan (RPJMN) is will be stronger and will be able to achieve the to control the Population Growth Rate (LPP) to determined goals or targets. In order to arrange achieve a target with the poverty rate declining accurate policy recommendations, a prior to 5 percent at the end of 2025. Population analysis on the failure of the efforts to maintain development and family planning are targeted the sustainability of fertility decrease needs to to achieve a balanced population growth in 2015. be conducted. There are several questions that It is designated with the net reproduction rate need to be answered in this study. What are (NRR) equal to 1, or the total fertility rate (TFR) the factors that did not make the fertility rate equal to 2.1. decrease in the last ten years? Is there a situation It appears that Indonesia is facing in a number of variables that can explain the diffi culties in reaching the target. The temporary absence of fertility decrease? Is this trend due result of the Indonesia Demographic and Health to the change of the management structure and Survey (SDKI) 2012 indicates that the fertility population policy since the political reformation number has remained at 2.6, never decreasing occurred? from the results of the previous two SDKI surveys In order to answer these questions, an (2002/2003 and 2007). The analysis conducted analysis of the results of a number of national by Terence Hull using the data of the 2010 surveys, such as the 2005 Intercensal Population census results and the last three SDKIs even Survey (Supas), 2010 Population Census, indicates a fertility increase in the last 10 years 2007 and 2012 Indonesia Demographic and (Hull, 2013: 15). Health Survey (SDKI), and 2002/2003 and 2007 Observing the result of the SDKI Small and Cottage Industry Survey (SKKR) is introduction report, the RPJMN 2010-2014 conducted. This study also utilizes research target is a lofty, if not impossible goal. However, results and government documents on relevant this achievement cannot be ignored since issues, such as contraceptive use, sexual Indonesia also has an interest in achieving the behavior in children and adolescents, and early target Millennium Development Goals (MDGs) marriage. as follows: The maternal mortality rate must decrease to 102/100,000 live births; child Factors Affecting Fertility mortality rate must decrease to 23/1,000 live There are some variables among those births; population growth rate must decrease to that are assumed to contribute to the limited 1.1 percent; TFR must decrease to 2.1 percent; fertility decrease in Indonesia. Table 1 explains and unmet needs must be suppressed to 5 a number of achievements of the 2010- percent. 2014 RPJMN targets. Only six of the eight 2010-2014 RPJMN targets are in the form of In order to achieve these goals, or, at least, numbers (quantitative) as seen in the table. If in order to decrease population growth, ministries the situation development until 2010/2012 is and institutions at the central level of government, observed, those six targets will not be reached and provinces, regencies, and local governments or will be diffi cult to reach. need to strengthen their commitment, sharpen their strategy, and strengthen their actions. What The 1.1 population growth target is diffi cult kind of strategy should they apply? This study to achieve, since the last situation based on the

Qpqvmbtj Volume 23 Nomor 1 2015 51 Muhadjir Darwin, Dewi Haryani Susilastuti, Yam’ah Tsalatsa, Triyastuti Setianingrum, & Sumini

Table 1 RPJMN Achievement Targets in 2014 and Situation of 2005-2012 Program Targets in A Number

2005/7 2010/12 2014 Targets Situation Situation Targets The decrease of regional population growth rate (% per year) 1.3* 1.49* 1.1 The decrease of TFR per every woman of reproductive age 2.6** 2.6** 2.1 The increase of modern methods of CPR (5) 57** 58** 65 The decrease of unmet needs of family planning for couples of childbearing 9.1** 8.5** 5.0 age (%) The decrease of ASFR 15-19 years old per 1,000 women 35** 48** 30 The increase of the median age at first marriage for women (years old) 19.8* 19.8** 21 The increase of the compatibility of population control policy The increase of the availability and the quality of demographic data and information derived from demographic census, surveys, and vital registrations Data sources: * 2005 SUPAS or 2010 Census ** 2007 or 2012 SDKI

2010 census indicates that the population growth In order to achieve a better description, was still 1.49. That number is even higher than some variables which are assumed to contribute the Supas number, 1.3. The 2.1 Total Fertility to the fertility increase will be analyzed further. Rate (TFR) decrease target is also still too far As stated previously, the rate for contraception to reach since the last SDKI result indicates use is still lower than the target, so it is that the TFR number did not move from some necessary to conduct further discussion about previous SDKI results, which remained at 2.6. the trend of the use of contraceptives and oral The three targets below it are the determinants contraceptives. Theoretically, it can be said of population growth rate and fertility rate. that the fertility rate will be low if the number of Those three targets are also diffi cult to reach. children in the community is low (all the women The declared target of the modern method or the couples desire to have a limited number contraceptive prevalence rate (CPR) is 65. The of children) and all the women or the couples unmet need of contraception was targeted to who do not desire to have children anymore be able to be suppressed to 5 percent for the use contraceptives (perfect contraceptive couples of childbearing age, while the temporary society). Therefore, if there is a higher use of result reached until 2012 was still 8.5 percent. contraceptives, the fertility rate will lower. In The adolescent fertility rate (15-19) was targeted order to approach the situation of a perfect to be suppressed to 30. However, instead of contraceptive society, the concern needs to be decreasing, the number actually increased from directed to the marginal groups by analyzing 35 in 2005 to 48 in 2012. The median age at fi rst the diffi culty marginal groups face in accessing marriage is still lower than the declared target, contraceptive services. The analysis on this which is 21 years old. From the last two SDKIs, it matter is important since they often cannot is indicated that the median age at fi rst marriage reach contraceptive services. remained at 19.8.

52 Qpqvmbtj Volume 23 Nomor 1 2015 The Inhibiting Factors of the Fertility Rate Decrease

Another important aspect that needs to as a result, there are many injection users who be emphasized in the analysis is the sexual quit using this method so they face the risk of behavior of unmarried adults. The analysis on unplanned pregnancy. The rate of quitting and this population group is important since, so the unplanned pregnancy risks among injection far, the group that the family planning program users is relatively higher compared to the users targets are couples of childbearing age who of IUDs and implants (Statistics Indonesia & are legally married. Meanwhile, there are many Macro International, 2008; Steele & Curtis, sexually active women who have not been 2003; Withers, et.al., 2012). Another risk faced married or are not married, so they have a high by injection users is that they are susceptible to chance of pregnancy. The high proportion of disturbances in the supply chain for injections the adolescents who are sexually active and (Ross, 2003). Discontinuing the use of family the young age when people fi rst marry causes planning methods is a concern in Indonesia. high age-specifi c fertility rate (ASFR) in female Based on the data of the 2007 SDKI, the most adolescents (15-19 years old). Therefore, it is common reasons stated by women who quit very important to conduct an analysis on the using family planning methods were health population group. considerations, side effects, and the desire for pregnancy (BPS & Macro International, 2008). Trend of Use of Contraceptives and Oral The data of the 2012 SDKI indicates that the Contraceptives reasons for quitting the use of family planning Based on the data of 2012 SDKI, the tools were similar to the reasons stated by use of all methods of contraceptives and women in the 2007 SDKI (BPS, BKKBN, oral contraceptives among the couples of Kemenkes, and ICF International, 2013). childbearing age reached 61.7 percent. This The decisions regarding contraceptives number indicates a very small increase from – for instance, deciding whether someone the use of contraceptives in 2007, which was wants to use them, or deciding what kind of 61.4 percent. In addition, the newest SDKI data contraceptive will be used – are related to various does not indicate a signifi cant development in factors. Many policymakers assume that the the use of the long-term family planning method use of contraceptives positively correlates with (see Figure 1). The data are a refl ection of the access and costs. Although access and costs low success rate of the Institution of National often obstruct the use of contraceptives, other Demographics and Family Planning (BKKBN) things that are just as important to be concerned in encouraging the use of the long-term family about include behavioral factors, such as the planning methods (intrauterine device or IUD, desire to have more children, disagreeing with vasectomy, and tubectomy) among the couples the family planning program, and the worries of childbearing age (Jakarta Post, December 12, about the effects of the contraceptive methods on 2012). Most of the women at reproductive age the user’s health (Schoemaker, 2012). Cultural use pills and injections as their family planning factors also play an important role among the method, although for long-term planning, these users, the potential users of contraceptive methods tend to be more expensive compared methods, and the contraceptive service providers to the long-term family planning methods. Also, (Amnesty International, 2010; Herartri, 2004). using pills and injections carries a higher risk of unplanned pregnancy. Although injections have The family planning program does not a longer effect compared to pills, injections are operate in a norm-less context. Culturally, the considered a hormonal resupply method and, main purpose of marriage is family formation

Qpqvmbtj Volume 23 Nomor 1 2015 53 Muhadjir Darwin, Dewi Haryani Susilastuti, Yam’ah Tsalatsa, Triyastuti Setianingrum, & Sumini

Figure 1 The Percentage of the Use of Modern Contraceptives & Oral Contraceptives

35,0 31.8 31.9

30,0 27.8

25,0 21.1 20,0 17.1 15.4 14.8 13.6 15.2 13.2 13.2 15,0 13.3

11.7 10.3 10,0 8.1

6 6.2 4.9 5,0 4.3 4.9 3.3 3.3 3.8 3.4 4.1 4 3.1 3.6 3.4 3.9 2.7 2.7 2.7 3.2 2.8 3.4 1.3 1.8 0,0 0.8 0.9 0.7 0.9 1991 1994 1997 2002-2003 2007 2012

Sterilisasi Pil IUD Suntik Implant Kondom Tradisional

Source: Processed from 2012 SDKI or procreation. This view is often held by the afraid of being blamed because they provided who provide family planning services. modern family planning services. The solution As a result, they refuse to provide modern family used by the midwives is by giving advice to use planning services to young women who have traditional methods, such as withdrawal or coitus not had children. At the cognitive level, they interruptus, even though this traditional method understand that the use of contraceptives and oral is susceptible to unplanned pregnancy (Amnesty contraceptives will not cause infertility. However, International, 2010). their cultural background makes them worried about the infertility of the family planning users The assumption of the purpose of family since they know that women will be automatically planning is a very important factor to understand considered infertile for couples of childbearing why the fertility rate in Indonesia stagnates. A age, even though it might be the man who is case study by Herartri (2004) in two villages infertile. As a result, women who do not have in West indicates that the majority of the children tend to be pitied or even given certain informants stated that their participation in stigmas. If the women who use contraceptives the family planning program was encouraged fi nally cannot have children, the midwives are by the desire to have distance between their

54 Qpqvmbtj Volume 23 Nomor 1 2015 The Inhibiting Factors of the Fertility Rate Decrease children’s ages. This reason was also stated BKKBN considers the lack of the use of by women who did not want to have children the long-term family planning method as an anymore. They assumed that family planning impact of the reduced number of family planning is a good program since it enables them to fi eld offi cers (PLKB). Until 2000, the number control the birth of their children so the age of PLKB was around 36,000. This number difference between children is not too close. decreased to 21,000 at the beginning stage of Most likely, this matter is a refl ection of the decentralization. The lowered priority for the message from religious fi gures who emphasize family planning program after decentralization that the purpose of family planning is to give encouraged a number of PLKB to change space between children’s ages, not as a fertility careers. Since then, one PLKB, who is on duty limitation. Fertility limitation is considered to in the fi eld for the education of family planning, oppose God’s will. This perception is a key has to cover four villages. Ideally, one PLKB of family planning acceptance among the should be on duty only in two villages. The community with strong religious beliefs. Even number of villages covered by PLKB varies though the research by Herartri (2004) cannot between different areas in Indonesia. In , be generalized for Indonesia, it is important for instance, one PLKB has to cover 42 villages since it can open the door for understanding (Jakarta Post, December 12, 2012). various perceptions on the purpose of family planning at a grassroots level. Marginal Communities or Communities Outside The Target Communities’ Access Another cultural factor is the strong pa- to Contraceptives and Oral Contraceptives triarchal culture which sometimes limits the In recent decades, the status and role of choices of family planning methods. Normally, has changed dramatically, women must consult their husbands before us- particularly in relation to the participation of ing family planning methods (Amnesty Inter- women in work. However, if it is more deeply national, 2010; Herartri, 2004). Generally, the observed, the status and role of women is still husband will agree with the wife’s desire to use strongly related to marriage and parenting a family planning method, even though there (Bennet, 2004; Utomo, 2005). Getting married are some husbands who are worried about the and having children are considered as two side effects of certain family planning methods. inseparable and important things for women. However, since family planning is considered There is a very strong social hope that all “women’s business,” women are eventually women get married and have children. In considered to be “more appropriate” to decide contrast, all women who have children should whether to use family planning methods rather get married. The importance of marriage for than their husbands (Herartri, 2004). Perhaps, adults and young females is one of the factors this assumption contributes to the small num- encouraging early marriage in Indonesia. ber of men using family planning methods. Although there is a decrease in the number The research by Herartri (2004) in West of early marriages, this social phenomenon is Java indicates that the low use of IUD and still commonly seen in rural areas and around sterilization methods is strongly related to the poor areas (WHO, without date). In 2009, the lack of socialization of the family planning number of couples marrying under 18 years programs. The lack of socialization creates old reached 690,000. This number is equal to rumors that makes women increasingly unsure one third of the total marriages in Indonesia about using the methods. (Jakarta Globe, May 17, 2010).

Qpqvmbtj Volume 23 Nomor 1 2015 55 Muhadjir Darwin, Dewi Haryani Susilastuti, Yam’ah Tsalatsa, Triyastuti Setianingrum, & Sumini

Today, sex is considered a taboo subject 2001; Utomo & McDonald, 2009). The topic and is seldom talked about openly. The attitude about sexuality becomes marginalized in towards women’s sexuality and women’s roles the agenda of education and health. Sexual in the context of social relationships is relatively education in schools, if it exists, is not adjusted conservative in general. Virginity is something to the needs and sophisticated challenges faced considered very precious (Bennet, 2004) and by youth. Meanwhile, parents have relatively adults and young women who have pre-marital limited experience and knowledge related to sexual intercourse will be heavily punished sexuality. In addition, parents generally feel in social ways, such as being shunned and uncomfortable to talk about sexuality with their considered to be “cheap women”, “naughty children. Meanwhile, children and adolescents women”, and “bad women”. have a limited capacity to face emotional and personal dimensions in intimate relationships The social-cultural construction on the with the opposite gender, such as dating (Utomo relationship between sexuality and marriage and McDonald, 2009). The combination of has a big impact on policy formation. The Law those various factors mentioned above cause on Population Growth and Family Development children and youth to have limited knowledge (Law No. 52 of 2009) and the Law on Health (Law No. 36 of 2009) state that access to sexual of sexual and reproductive health which could and reproductive health services are only given enable them to avoid the serious problems to legally married couples. Particularly, Article such as unwanted pregnancies, abortions, and 72 and 78 of the Law on Health mention that sexually transmitted diseases, including HIV access to sexual and reproductive health and AIDS (Hidayat, 2005). services will be given only to legal couples and Unmarried youth who are sexually couples of childbearing age. The implication of actively seldom use contraceptives and oral this statement is that in practice, only married contraceptives because they have a very limited couples can get access to family planning knowledge of sexual and reproductive health services. According to the Law on Population (Situmorang, 2003). The absence of access to Growth and Family Development, the rights on contraceptives also causes a high abortion rate reproduction and service provision regarding among youth, which is 33 abortions per 100 family planning are aimed at couples bound live births per year (Utomo and MacDonald, with legal marriage. In Article 21, Section 1, 2008). The result of the survey on health the Law on Population Growth and Family and reproduction among youth in Indonesia Development states that family planning (Indonesia Young Adult Reproductive Survey/ policies are meant to support husbands and SKRRI) in 2007 indicates that 60 percent of wives in making good decisions in regards to unwanted pregnancies ended with abortions, their rights on reproduction. Article 24, Section while the remaining 40 percent carried out their 1 and Article 25, Section 2 emphasize that pregnancies to birth (Central Statistics Agency contraceptive services are aimed at legally (BPS), 2008). Abortion is often conducted in a married couples who are husband and wife. medically unsafe environment and, as a result, The laws and regulations mentioned this kind of abortion is a contributor to high above have brought negative impacts to access maternal mortality rate (Amnesty International, to contraceptive services for men and women 2010). Out of marriage pregnancy is also a out of the target group. Adolescents, youth, factor encouraging early marriage because if and single men and women have very limited two young adults are facing out of marriage access to contraceptive services (Pangkahila, pregnancy, getting married is a solution that

56 Qpqvmbtj Volume 23 Nomor 1 2015 The Inhibiting Factors of the Fertility Rate Decrease the public can accept (Moeliono, without date; The government has some programs for Utomo, et.al, 2012). youth covering information about reproductive health. However, the existing programs refl ect Sexual Behavior among Unmarried People a gap between what information the youth should know and the real information that is Nowadays, children go through puberty provided in these programs. This gap refl ects at an earlier age. The ages of fi rst sexual culturally-based thoughts and legal limitations intercourse is also getting younger (see Figure in providing access and information regarding 2). This contrasts with the age when people family planning to those who are unmarried. get married in Indonesia, which has become There is a strong disinclination among various relatively older. As a result, youth in Indonesia stakeholders to provide information regarding face a higher risk of pregnancy outside of contraceptives and oral contraceptives such as marriage (Hidayat, 2005). Unemployment condoms to unmarried adolescents because among youth in Indonesia is also a factor there are worries that this action would be encouraging youth to get married at an older seen as a promotion of casual sex (Amnesty age. Socially, youth are expected to have International, 2010, Utomo et. al., 2012). a permanent job before they decide to get married. In 2011, the World Bank reminded Nowadays, youth in Indonesia are that the unemployment rate among 19-24 year- continuously bombarded with information that is old youth reached 30 percent (Jakarta Globe, full of sexuality by mass media, the internet, the March 27, 2011). Unemployment also has an entertainment world, and even by their friends impact on the possibility of pre-marital sexual of the same age. Media also encourages youth intercourse and pregnancy. Sexual intercourse to fi nd out about sex for recreational purposes. outside of marriage happens because there is On the other hand, as mentioned above, their only limited information and limited adequate access to information about sexual health and services of sexual and reproductive health. reproductive health is very limited (Amnesty

Figure 2 Percentage of 15-24 Year-Old Youth According to Ages at First Sexual Intercourse

Source: processed from 2002/2003 and 2007 SKRR.

Qpqvmbtj Volume 23 Nomor 1 2015 57 Muhadjir Darwin, Dewi Haryani Susilastuti, Yam’ah Tsalatsa, Triyastuti Setianingrum, & Sumini

International, 2012; Utomo and McDonald, without year). The study by Moeliono (without 2009, Utomo et. al., 2012). The research by year) is very important for the study on sexual Holzner and Oetomo (2004) indicates that the behavior among youth because this study dominant discourse regarding sexuality in East covers rarely-researched groups, such as Java is colored by the tendency to forbid and marginalized youth groups. Their status is out of describe adolescent sexuality as something school, while most education about sexual and unhealthy. This discourse is strengthened by the reproductive health is conducted in schools. intimidation about the dangers of sex because In the more updated data from 2010, the sex can lead to unwanted consequences, such 2010 Greater Jakarta Transition to Adulthood as pregnancy outside of marriage. However, Survey among respondents of 20-34 years old limited access to information about sexuality indicates that 14 percent of men and 7 percent does not stop youth from fi nding information of women who date have sexual intercourses regarding sexuality on their own (Holzner and with their partner. Furthermore, this survey Oetomo, 2004). Some of them successfully discovered that 15 percent of married men who obtain precise information and widen their dated their fi ance for more than twelve months knowledge about sexual and reproductive had sex before their marriage. Meanwhile, 8 health (Holzner and Oetomo, 2004). percent of married men who dated their fi ance The youth who are socially marginalized for less than six months had sex with their because of their social status tend to obtain fi ance before their marriage. imprecise or incorrect knowledge. The case The above research indicates that the study by Moeliono (without date) among absence of access for youth about information the youth in the slums of Duri Utara, Jakarta and services regarding sexual health and indicates that the social group of those at reproductive health did not reach its primary the same age whom they meet in places to goal of preventing them from being sexually hang out opens the chance for youth who are active. In contrast, they still wanted to know poor, unemployed, or work part time to share about sexuality, still wanted to experiment, knowledge about unhealthy sexuality. They and they did these activities without enough encourage each other to show their masculinity knowledge about sexual and reproductive through risky behaviors, such as using drugs health. As a result, many of them engaged and having sexual intercourse with more than in high-risk sexual activities, which caused one partner, including with commercial sex sexually transmitted infections, unwanted workers, without using condoms. As a result, pregnancies, abortions, and early marriages. infection and out of marriage pregnancy is common among them. Instead of making them The Impact of Political, Governmental, and shy or sad, sexually transmitted infections or Institutional Factors out of marriage pregnancies can even become their source of pride. Pregnancies outside of Global Environmental Changes marriage are sometimes used as a strategy to force parents to allow their son to marry his The beginning of population and family girlfriend, even though they might disagree with planning policies resulted from the global their son’s choice of girlfriend. If the son does challenges that occurred in the 1960s that not want to marry the girl who gets pregnant included the issue of the global population out of marriage, then abortion is a solution that explosion. At that time, population and family is widely accepted among them (Moeliono, planning became part of the international

58 Qpqvmbtj Volume 23 Nomor 1 2015 The Inhibiting Factors of the Fertility Rate Decrease agenda. International donor institutions provided of SKPD. The budget to support this program aid for developing countries in an effort to control from the division for those concerns was more population growth. Indonesia and a number limited. Besides, family planning fi eld offi cers of developing countries in the world gave a (PLKB) in the reformation era were included as political commitment to control their population local apparatuses and their numbers continued growth through family planning programs. to decrease due to several factors. First, a part The country formed an institution called the of PLKB was assigned to a new job or position National Family Planning Coordinating Board outside of family planning affairs. Second, the (BKKBN), which is responsible for organizing number of PLKB decreased because of job demographic and family planning programs. relocation or retirement and were not being Through this program, the government replaced by new PLKB soon after. Because encourages changes for community behavior, of that, overall, there was a crisis for the such as the acceptance of small family norms, continuation of PLKB’s existence. This situation the willingness to get married at older ages, certainly had a great impact on the ability of the and controlling fertility by using contraceptives. family planning service unit to reach the target The purpose of all these efforts is to decrease groups in various places. the fertility rate. Besides that, human rights, reproductive In the fi rst three decades (1970-2000) health, and gender, which have been global of the implementation of demographic and agenda issues since the 1990s, also contributed family planning programs, there was proof in narrowing the space for the application of of a signifi cant fertility decrease from 5.6 in coercive ways in the implementation of family 1970 to 2.4 in 2000. However, after that, the planning. Meanwhile, in the middle of the fertility trend moved in the opposite direction. democratic political climate, and also when In the last three SDKIs, fertility rate remained human rights and gender become important at 2.7. Interestingly, the trend change occurred criteria in the implementation of development after Indonesia experienced a great political programs, the coercive ways that were transformation from an authoritative political conducted in the era are no longer system to a democratic political system and possible to conduct. At the same time, family from a centralized governance system to a planning faces new challenges, including the new, decentralized governance system. rise of larger family values which is shown by the celebrity community, and the anti-family In this era of democracy and planning attitude which is clearly stated by decentralization, the institution in charge of the radical groups. implementation of family planning programs has had structural changes that make it weaker Decentralization in Family Planning in dealing with family planning issues. BKKBN, Management which previously had offi ces at the provincial and district levels, had to willingly let them go. In the last ten years, signifi cant changes Local/District BKKBN was removed and the in the family planning management system implementation of family planning became the took place. The fi rst is regarding the legal responsibility of the Local/District Government status of family planning affairs in governance. Task Force (SKPD). Even in many cases, family For instance, if we observe Law No. 32 of 2004 planning concerns were only settled in a sub- on Local Governance, it does not mention that institutional status, which certainly had a lower family planning is a compulsory affair delegated capacity than previously as a main mandate to the province and regency/city. Article 13-14

Qpqvmbtj Volume 23 Nomor 1 2015 59 Muhadjir Darwin, Dewi Haryani Susilastuti, Yam’ah Tsalatsa, Triyastuti Setianingrum, & Sumini only refers to demographic and civil registry women’s empowerment and family planning services as a compulsory affair. are placed in one institution. However, the government institution is not fully operated by the The implication is that not all territories local government. In the implementation, there have the same commitment to family planning are many institutions in regencies/municipalities programs. The responses of the regency/local working in the fi eld of family planning which are government to family program institutions also united with women’s empowerment. However, vary. There are various governmental institution some of them are independent and some are nomenclatures at the local level which handle also united with the other fi elds that are not family planning. They are in the form of an related to women’s empowerment. agency, board, or offi ce, or associated with other fi eld institutions. The basis of the formation In its development, family planning issues also varies. Some of them are based on local become a concern of the government. This can regulation, local decree, etc. Budget effi ciency be seen from Law No. 36 of 2009 regarding or human resources also often become a Health which states that family planning is an reason to decide the form of the institution. aspect which needs to be concerned about in the implementation of health efforts (Article From all the regencies/municipalities 48). In Article 73, it is also stated that the in Indonesia, there are 208 institutions at the government must guarantee the availability of regency/city level handling family planning the means of reproductive health services that which are in the form of an agency. 150 are in are safe, excellent, and affordable, including the form of a board, and 65 are in the form of family planning services. Particularly, in the an offi ce. 371 institutions are based on local Law on Health that regulates family planning, regulation, 52 are based on local decree, and Article 78 states that health and family planning 10 are based on other regulations (Table 3). services are meant to control pregnancies for Three years after July 9, 2007, Government couples of childbearing age in order to form a Regulation No. 38 of 2007 regarding the healthy and intelligent next generation (Section Distribution of Governmental Affairs between the 1). Therefore, the government is responsible for Government, Provincial Regional Government, and guarantees the availability of staff, service facilities, tools, and in providing family and Regency/Municipality Regional Government planning services that are safe, excellent, and was created as an implementation of Law No. affordable for the community (Section 2). The 32 of 2004. In that Governmental Regulation, implementation of family planning services is it is clearly stated that family planning and a regulated with special laws (Section 3). prosperous family are one of the 26 compulsory affairs delegated to provinces and regencies/ In the same year, the government issued a municipalities as a form of basic services (Article law on demography and family planning which is 7). Besides, the government also created Law No. 52 of 2009 regarding Population Growth Government Regulation No. 41 of 2007 regarding and Family Development as a replacement the Organizational Structure of Regional for Law No. 10 of 1992 regarding Population Governments. Article 22, Section 5, Point i states Growth and Prosperous Family Development that one of the supports to the affairs placed in which was no longer suitable to the recent the form of a board, offi ce, inspectorate, and demographic developmental conditions, either at , is the fi eld of women’s empowerment the national or international level. In the new law, and family planning. It means, organizationally, family planning is understood in the perspective this regulation gives mandates that the fi eld of of rights. It is mentioned that family planning

60 Qpqvmbtj Volume 23 Nomor 1 2015 The Inhibiting Factors of the Fertility Rate Decrease

Table 3 The Institution of Family Planning Division of the Local Government Task Force (SKPDKB) in Each Province in July, 2007

Basis of Formation Form of Institution Province Local Local Etc. Agency Board Office Regulation Decree Nanggroe Aceh D. 19 2 0 13 2 6 North Sumatera 23 2 0 15 7 3 West Sumatera 19 0 0 10 2 7 Riau 6 4 1 6 4 0 Jambi 10 0 0 5 5 0 South Sumatera 14 0 0 3 9 2 Bengkulu 9 0 0 5 3 1 Lampung 9 1 0 2 6 2 Bangka Belitung 6 1 0 2 0 5 Riau Islands 4 1 0 4 1 0 Special Capital Territory of Jakarta ------West Java 24 1 0 13 9 3 Central Java 32 3 0 22 8 5 Special District of Yogyakarta 5 0 0 3 2 0 East Java 35 2 1 19 14 4 Banten 6 0 0 4 2 0 7 2 0 3 3 3 3 6 0 2 3 4 13 3 0 9 6 1 West 8 3 1 8 2 1 Central Kalimantan 13 1 0 8 6 0 South Kalimantan 12 1 0 2 9 2 East Kalimantan 10 3 0 8 2 3 North 8 1 0 1 7 1 Central Sulawesi 8 2 0 4 5 1 23 0 0 12 11 0 South East Sulawesi 8 2 0 5 5 0 Gorontalo 5 0 0 2 3 0 West Sulawesi 5 0 0 4 0 1 Maluku 7 1 0 2 6 0 North Maluku 8 0 0 1 4 3 Papua 11 3 6 10 3 1 West Papua 1 7 1 1 1 6 Total 371 52 10 208 150 65 Source: Bureau of Law, Organization, and Management of Central National Demographic and Family Planning Board (BKKBN), July, 2007

Qpqvmbtj Volume 23 Nomor 1 2015 61 Muhadjir Darwin, Dewi Haryani Susilastuti, Yam’ah Tsalatsa, Triyastuti Setianingrum, & Sumini is an effort to control child births, spacing of charged to the National Budget (APBN), and in births, and the ideal age for giving birth, and local areas it is charged to the Regional Budget controlling pregnancies through protection and (APBD) (Article 15-16). This means that local help according to reproductive rights in order to areas do not receive any budget support from realize a quality family. the central government in implementing the programs regarding population growth and In order to implement the family planning family development. Therefore, the success program, this law controls the government’s of family planning becomes very dependent authority and responsibility, either at the to the commitment of the regional head and central or local level (provinces and regencies/ legislative members, which is visible from the municipalities). The central government has budget support for demographic and family responsibilities in creating national policies while provincial governments are responsible planning programs. Remembering that the for creating local policies (Article 12-13) which local area commitment to the national program are inherent in national policies. Meanwhile, of family planning widely varies, likewise the the government of regencies/municipalities is APBD fund allocated for implementing the responsible for creating the implementation national program also varies. of population growth and family development In relation to the new duty and functions in regencies/municipalities or acting as the of BKKBN, the government has enacted implementer of the policy made by BKKBN Presidential Decree No. 62 of 2010 regarding the (Article 14). The authority at the regency/ National Family Planning Coordinating Board. municipality level can be seen as a chance for In that decree, it is regulated that BKKBN is a family planning policy in local areas to work non-ministerial government institution which in the same way with national policy (and/or is responsible to the president through the 6 provincial policy). minister who is responsible in the fi eld of health. Through Article 53, the National Family BKKBN has a duty to conduct governmental Planning Coordinating Board (BKKBN) was tasks in the fi eld of population growth and formed as a non-ministerial government family planning provisions. In implementing its institution at the central level. Furthermore, duties and functions, BKKBN is coordinated at the local level, the Local Family Planning by the minister who is responsible in the fi eld Coordinating Board (BKKBD) was formed, of health (Article 5). Chapter 2 regulates the either at the province or regency/municipality organizational structure of the new BKKBN. In level. In implementing its duty and functions, order to implement the Presidential Decree, the BKKBD has a functional relationship with Decree of BKKBN’s Head No. 72/PER/B5/2011 BKKBN (Article 54), which means that between regarding the Organization and Management BKKBN and BKKBD, either province or regency, of Provincial Representatives of the National there is no vertical relationship. However, the Family Planning Coordinating Board was functions of the coordination among them are enacted. not clear. The Presidential Decree regulating the From the aspect of funding, the funding same matters is Presidential Decree No. 3 of of the family planning program is nationally 2013 regarding the Seventh Amendment of

6 However, this is not separated from the affairs of the formation of local government which is regulated in Law No. 32 of 2004 regarding Local Government.

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Presidential Decree No. 103 of 2001 regarding demographic and family planning become one the Position, Duty, Function, Authority, of the priorities of regional development. Organizational Structure, and Management of Non-Ministerial Government Institutions. Family Planning Services after Law That Presidential Decree regulates the change No. 52 of 2009 of BKKBN nomenclature, from the National It is necessary to emphasize that family Family Planning Coordinating Board into the planning services after Law No. 52 of 2009 Demographic and Family Planning Board. As a have had a number of new innovations. On consequence, its duty, function, and structure June 18, 2012, the BKKBN Head enacted The of the new BKKBN organization also changed. Decree of BKKBN Head No. 232/PER/E4/2012 According to Presidential Decree No. 62 regarding Guidelines for the Participation of 2010 (Article 55), Representatives of the of Family Planning in Maternity Insurance. National Family Planning Coordinating Board The counseling for the participation of family (BKKBN) become Provincial Representatives planning in Maternity Insurance has a purpose of the National Family Planning Coordinating to improve the access, quality, and to guarantee Board (BKKBN) until the formation of all Local the participation of family planning after Family Planning Coordinating Boards (BKKBD) delivery or after miscarriage in all health service of the Province and Local Family Planning facilities which provide Maternity Insurance Coordinating Board (BKKBD) of the Regency/ services. The counseling target population for Municipality as meant in Law No. 52 of 2009. the participation of family planning in Maternity BKKBN through Provincial Representatives of Insurance are pregnant mothers, delivering BKKBN implement counseling and facilitate mothers, post-delivery mothers, and post- the formation of BKKBD of the Province and miscarriage mothers. This also includes the BKKBD of the Regency/Municipality according service providers and managers of the family to the provision of law and regulation. The planning program. Provincial Representatives of BKKBN have a duty to implement some tasks of Provincial In order to accelerate the revitalization BKKBN. of demographic and family planning programs, BKKBN cooperated with the Indonesian However, it has been three years since National Armed Forces (TNI) by signing the the enactment of Law No. 52 of 2009 and there Joint Regulation between the Head of the have not been many regencies/municipalities that have formed BKKBD. It indicates that the National Family Planning Coordinating Board commitment of many regions to the issues and the Commander of the Indonesian National on demographic and family planning is still Armed Forces, Number 72/Per/G2/2013 and low. BKKBN targeted that until 2014, there Kerma/5/V/2013, regarding the Directions for would be at least 66 representative offi ces of the Acceleration of the Revitalization for the BKKBD which independently operate and are Implementation of the Demographic and Family not united with other institutions.7 Through the Planning Programs of the 2013 Cooperation formation of a special board that handles the between BKKBN and TNI on May 7, 2013. The issues on demographic and family planning, it purpose of this cooperation is to be able to is expected that every region can solve them reach family planning movements and services comprehensively. Therefore, it is necessary to in all territories and community levels in order devise a signifi cant innovation so the issues on to accelerate the National Joint Security

7 The statement of the head of BKKBN in Pos Kota, August 20, 2013.

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Committee (KKB) toward achieving the 2015 15-19 year old ASFR, ages at fi rst sexual Millennium Development Goals (MDGs). This intercourse, and ages at fi rst marriage, have cooperation was protested by some NGOs. not reached the declared targets. They were worried that the cooperation would In the last fi fteen years, there was a bring about the return of a model of forceful movement from global and demographic issues family planning services which happened in the to issues on gender, human rights, reproductive, New Order era. However, these worries were and sexual health. As a consequence, the repelled by the head of BKKBN by stating that direction of international aid for developing this cooperation had a purpose of improving the countries moved from efforts to respond to participation of family planning from the family demographic issues to the new issues listed of TNI/Indonesian National Police (Polri), not to above. It created an unfavorable environmental scare the community. situation for the implementation of an effective national family planning program. Conclusions and Policy Recommendations

This fi nal report presents the analysis and At the national level, there have results on family planning policies in Indonesia been signifi cant changes from authoritative and addresses the temporary results of the governance to democratic governance, and 2012 SDKI. This analysis was conducted to from centralization to decentralization. As a respond to the Introduction Report of the 2012 consequence of these political changes, there SDKI which states that the fertility rate has not were structural changes in the handling of family decreased from the previous two SDKIs, which planning in Indonesia. BKKBN which, in the were 2.6, although the 2010-2015 RPJM has era of the New Order, was the main institution declared 2.1 as the fertility decrease target of in national family planning management, 2015. The remaining two years are too short. became the key institution behind the success Without the basic changes on the orientation of of the family planning program at that time. family planning policies, the RPJM target will be It disappeared when the nomenclature of very diffi cult to reach. Therefore, it is necessary this institution changed, which was when the to conduct a serious study to fi nd what solutions fi rst ‘K’ of BKKBN was no longer ‘Koordinasi the government should implement so that (coordination)’ but rather ‘Kependudukan fertility decrease can be actualized. (demographic)’.

In the broad outline, this analysis In other words, the task coverage of this elaborates two possible answers to the fertility institution was widened to all demographic issues mentioned above: First, by analyzing the aspects (population quantity and quality). changes on a number of mediating variables; However, the central role of this institution and second, by analyzing the institutional was narrowed, which was when the function reformation of family planning conducted in the of ‘coordinating’ was removed and the era of democracy and decentralization. In the implementing institutions at the regency and matters of mediating variables, this analysis municipality levels were dismissed. In other discovers that the changes that happened words, BKKBN, an institution which was very did not support the efforts to decrease fertility. central in the New Order era for implementing The goals in some analyzed variables, such population growth control, had been dwarfed as family planning usage, the proportion of and lost its authority to conduct the coordinating the use of long-term contraceptives and oral functions and the program implementation. contraceptives or secure contraceptives, the The extension of BKKBN roles to sectors

64 Qpqvmbtj Volume 23 Nomor 1 2015 The Inhibiting Factors of the Fertility Rate Decrease outside of family planning (migration, mortality, them. In the New Order era, there were some education, and health) does not have any NGOs which paid special attention to the meaning because, in fact, BKKBN does not issues of demography and family planning. have control in program implementation for the Some of them included the Indonesian Family sectors of non-family planning. It also failed to Planning Association (PKBI) and the ZPG implement the horizontal coordinating function, (Zero Population Growth) student organization. which is with related institutions at the central These organizations are considered to be level, due to the absence of a mandate to dissolved because the focus of their projects coordinate with those institutions. Meanwhile, has moved from family planning issues to the ability to implement the vertical controlling issues of gender, reproductive health, and function, which is aimed at the implementation sexuality. of local family planning programs, has also In order to strengthen the solutions for become weaker since there is no implementing the issues of demography and family planning, institution at the local level. it is necessary to conduct new strategic steps: Nowadays, the local institutions handling 1. It is necessary to conduct serious efforts family planning tend to be weak because of the to strengthen demographic institutions, limited local budget support. The mandated law particularly in conducting the functional that states that BKKBD should be established implementations at the basic level. in every region has not been followed by most of the local governments. The number of a. It is necessary to conduct serious efforts PLKB, which in the era of the New Order was with a clear deadline and establish BKKBD the strength of BKKBN in reaching rural areas, in the province and regency/municipality tends to decrease and the available budget to levels. support their duties tends to be limited. Besides b. It is necessary to make efforts so that the that, in the last fi fteen years, the attention of new institution will be have reliable human politicians, media, and the public no longer resources, including reliable family planning goes focuses on the issues of demography and fi eld offi cers and reliable fi nancial supports family planning. Those issues and the actors for local family planning programs. playing them are also not celebrities that fulfi ll news in mass media. c. The leader of the new institution must be able to mobilize the resources in the Universities no longer focus on conducting institution and act in a ‘brokering’ role by studies or publications on demography. Many establishing institutional collaborations with demographic experts in universities, in the non-government parties in order to make era of the New Order, who were very active in the implementation of local family planning researching and writing their views to respond program smoother. to various developing issues of demography and family planning, were no longer interested d. Providing optimum facilities for the in staying in the fi eld of demography. In contrast, institution so that it is able to conduct some new pro-natal demographic experts important actions as follows: appeared by stating that population growth has i. Socializing family planning positive contributions to economic growth. by establishing positive assumptions The recent issues of family planning do toward small family norms and modern not “call” the civil public to participate in handling contraceptive use in the community. This

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socialization is necessary to be introduced be extended to 24 hours a day. Therefore, to children through school educative the compensation system of Puskesmas media, to adolescents through various offi cers needs to be improved. available media, to new couples when they - Reactivating the family planning mobile are getting married, and to young families car service team as an effort to extend that still expect to have children. contraceptive service coverage to villages, ii. Conducting sociological particularly to rural areas which are far approaches toward religious groups which away from health and family planning still oppose the idea of small family values, service centers. The function of the mobile which refuse the idea of waiting to get service team is extended not only for family married at a later age (preventing early planning services, but also for community marriages), or which resist the idea of health services (outpatient care, family planning and contraceptive use. immunization to infants, weighing infants, and birth certifi cate services). Therefore, iii. In order to make sure these cooperation with related institutions is sociological approaches succeed, family necessary for the mobile service team. planning offi cers need clear knowledge, directions, and guidelines so that they will - Providing education on sexuality, be able to explain how important family reproductive health, and family planning planning is, utilize arguments that can be to adolescents and creating a condition accepted by religious groups, explain the so that sexually active, unmarried women basis of religious considerations of the can get access to contraceptives and oral need for family planning, and accurately contraceptives and family planning. respond the thoughts or arguments of the e. Developing a strong monitoring and parties opposing family planning programs. evaluating system to monitor and evaluate iv. Improving the quality of the quality of the local family planning contraceptive services: process and implementation and creating a reward and punishment system for local - Replacing choices of contraceptives from conducting units in order to implement hormonal to non-hormonal and from short- the functions of the local family planning term contraceptives and oral contraceptives program. to long-term contraceptives and oral contraceptives. 2. Improving the political commitment of political institutions or politicians in order to - Providing reliable services about revitalize the demographic/family planning contraceptive side effects and possible program. The politicians, whose position contraceptive failures. is in the central and local executive board and central and local parliament, need to - Optimizing the role of Community improve their commitment to the efforts of Health Center (Puskesmas) in providing population growth control. contraceptive services. In order to handle the private practices of and a. Demography and family planning need family planning services by state doctors to be focused as a main agenda in the and paramedics out of their working hours, education of political party cadres and as the service hours of Puskesmas need to a public agenda for every political party to

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fi ght for. socialize the idea of family planning and extending community access (particularly b. Political education for citizens needs to for women) to contraceptive use. emphasize to the voter the importance of voting for politicians or governmental ii. Encouraging the establishment leaders who are committed to demography of new organizations, such as family and family planning. planning user associations in villages, and making them as a medium to strengthen 3. Developing a synergic relationship to the motivation for citizens to practice family governmental elements out of government planning. which are: c. Business sectors: a. NGOs at the central and local level: i. Raising cooperation with the i. NGOs need to have business world so that they will facilitate nomenclatures of family planning. For their employees to practice family planning. instance, PKBI needs to be approached so that they will return to their main ii. Encouraging companies that mission, which is family planning, and can have company social responsibilities, or be a partner of BKKBN and BKKBD (or corporate social responsibility (CSR), to other local institutions that can carry out direct some of their programs to support family planning mandates) in socializing national family planning programs. and implementing local family planning programs. References

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