Birth control program faces test of time

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.