Birth control program faces test of time

Stevie Emilia, The Jakarta Post, Jakarta

"Anita", a mother of two who has been on the pill for two and a half years, panicked when she missed her period and thought she was pregnant.

"I thought I'd never missed taking a single pill ... but I wasn't really sure," the 33-year-old working mother said. "But I know, I don't want to have another child, at least not now. I was so scared."

Fortunately, a week later, what she had hoped for finally came: She got her period. "I felt so relieved," Anita said.

Indonesia has had a family planning program for years, enjoying success with the "Two children are enough" campaign implemented during the 32-year rule of president Soeharto.

Women are no longer forced to join the program but many, particularly educated women, still want to limit the size of their families.

But when birth control fails, couples suddenly find themselves having to make room for additional children.

Two years ago, Dewi, a housewife, was shocked to discover she was four weeks pregnant with her third child.

The mother of a four-year-old girl and a two-year-old boy was already overwhelmed with her daily chores, and raising another child had not featured in her plans.

"I ran all the way up and down the stairs at home, jumping ... everything ... anything to stop my pregnancy," said Dewi, who had used the "rhythm" method to calculate when she was ovulating.

"I even ate pineapple, durian and drank jamu (traditional herbal medicines), but all of them did not work."

Coming from a Muslim family where abortion is out of the question, she found herself alone in dealing with the problem, even unable to tell her husband for fear it would upset him.

"I finally gave up after three months of trying," said the graduate of a teaching institute. She had to postpone her dream of finding a job to take care of her children.

With an estimated 215 million people, Indonesia -- as the fourth most populous country in the world -- relies on birth control to prevent the population from exploding further.

The number of reproductive couples aged between 15 and 49 years, according to the National Family Planning Coordinating Board (BKKBN), stands at 36 million, or 16.74 percent of the country's population. The number of reproductive-aged women who use contraceptives is only around 57.4 percent.

Most women taking part in the family planning program prefer injections, followed by pills, intra-uterine devices or IUDs while the remainder use either implants or tubectomy.

However, the United Nations Population Fund (UNFPA) says that less than 2 percent of males take part in family planning in Indonesia -- leaving women with the burden of using contraceptives.

"Dedi", 33, a father of two, has no plans to start using contraceptives as he is hoping to have a third child with his wife of five years.

Using contraceptives is an option later -- only he has no plans for them himself.

"It's usually a wife (who uses contraceptives), besides, I don't really trust condoms or even vasectomy ..."

Under the present economic climate, birth control failures are hard to accept as more children means more money.

But the once popular family planning program is now facing serious problems.

Indonesian Planned Parenthood Association (PKBI) chairman Azrul Azwar said the program was suffering as it lacked political support, had lower participation rates and did not have enough contraceptive supplies.

"Back then, all government officials would talk about was family planning, but it's not anymore, even regents find it unimportant," Azrul said.

"... Many family planning clinics do not have contraceptives, and suggest people buy contraceptives at pharmacies on their own. In this economic climate, many cannot afford to do it."

According to the Central Statistics Agency (BPS), the country experienced a 20 percent drop in contraceptive use. Jakarta led the decline, with a 22.24 percent decrease from the 71.72 percent of reproductive-aged women who used contraception in 1997.

Azrul said birth control failure could be avoided by undergoing permanent contraceptive procedures like a vasectomy or tubectomy.

Birth control failures happen for a number of reasons, including people's preference to use temporary birth control methods that require strong discipline, the government's family planning program policy that does not encourage permanent methods and poor family planning services, he said.

"But the thing that worries me most is that, many people, due to economic hardship cannot get family planning services -- like paying for the services, buying contraceptives or even going to clinics," Azrul said.

Facing possible birth control failures, he suggested family planning participants avoid unsafe and illegal abortions -- one of many factors that contribute to the country's high maternal mortality rate, currently 373 for every 1,000 births.

"But if (one) experiences birth control failure, my advice is accept the unborn child ... if it's unacceptable, go to the right clinic, like the one runs by the PKBI," he said.

The PKBI, a nonprofit organization founded in 1957 to educate the public about population growth, offers comprehensive family planning services, including abortions conducted after strict screening tests.

"Couples who want to do it (abortion) must go through counseling where we can select and explore their reasons for doing it, as well as providing them with information so they are given the opportunity and time to make up their minds," Dr. Ramona, the organization's division head of contraceptive and reproduction, said.

The PKBI estimates birth control failure at 3 percent of the 8,000 to 9,000 cases dealt with by the organization each year, with most of the failures from the pill or condoms.