Indonesia may see baby boom
By Stevie Emilia
JAKARTA (JP): The crippling economic crisis is threatening the state's successful family planing program as prices of contraceptives have soared nearly five-fold, observers warn.
Many fear the crisis will trigger a baby boom over the next several years as more and more families struggle to cover the costs of their daily necessities.
Since its introduction in 1969, the family planning program's success in slowing down the country's population growth has been internationally recognized.
Annual population growth fell from 2.32 percent recorded in the 1970s to 1.66 percent in the first half of the 1990s. Had the growth rate continued at its 1970 level, Indonesia's population would have exceeded 200 million in 1991 instead of in 1997.
The most serious threat to the program's success is the skyrocketing prices of birth control devices, of which 80 percent of their raw materials are imported.
Ida, a mother of two and one of many participants in the program, deeply feels the pinch of the crisis. She was compelled to switch from using an intravenous contraceptive to the pill three months ago.
"I only pay a mere Rp 1,000 at a community health center for the pills, but for the injection I had to pay Rp 9,000," the 29- year-old housewife in Central Jakarta said.
At first, she was reluctant to make the switch. "I like the injection method better because I only had to do it once in three months. But it's getting expensive."
A pack of contraceptive pills effectively covers a 28-day period, while one injection protects for a three-month period. But doctors have warned that the pill is only effective if the woman is disciplined in taking it every day.
Ida is only one of many of the 25.6 million active participants in the program -- out of over 33.7 million couples in the country -- who has had to switch their birth control method due to economic circumstances.
A survey conducted by the University of Indonesia's School of Medicine between July 1997 and July 1998 in Pisangan Baru subdistrict, East Jakarta, found that out of 98 family planning participants surveyed, 26 had changed their contraceptives, while seven had been forced to quit the program. The remaining 65 had not changed their contraceptive.
Of the 26 who had switched to a new method, 69 percent said they had done it because of the original method's side-effects, 19 percent because of financial reasons and the remaining 12 percent due to other reasons.
The seven who dropped out of the program cited, among others, side-effects, financial problems and wanting more children.
"But I believe many of the participants changed their contraceptive because of economic pressures but just won't admit it," Corrie Wawolumaya, the university's lecturer on research methodology and one of the students' tutors on the survey, told The Jakarta Post.
The survey also found that many family planning participants now preferred taking the pill instead of an injection.
"The switch from injection to pill is a set-back to the family planning program because it's hard to monitor women using pills. Other devices necessitate doctors' care, which makes it easier to monitor," Corrie said.
Price controls
Former chairman of the Indonesia Planned Parenthood Association (PKBI), Kartono Mohamad, warns that if the prices of birth control devices remain high, more and more participants will be unable to afford buying them anymore.
"People face too many problems already and if they have to make a choice between buying food and birth control devices, they will certainly prioritize food," Kartono told the Post.
PKBI, a non-profit organization, has played an important role in educating the public about population growth since it was set up in 1957.
Kartono said that unlike those using implants and intra- uterine devices (IUD), which need to be replaced only after three years to 10 years, pill and injection users are the most affected by the hike in the prices of contraceptives.
"They feel the impact most because they have to buy pills or injections regularly," said the former chairman of the Indonesian Medical Association.
Data at the National Family Planning Board (BKKBN) in February and March shows the use of IUD dropped 3.93 percent, while those using injections decreased 6.28 percent, pills 7.31 percent and vaginal contraceptive devices 11.4 percent.
According to BKKBN's 1998 family survey report, 40.01 percent of active family planning participants use the injection method, 28.07 percent use the pill and 17.78 percent use IUDs. The rest look to other methods, such as condoms, vasectomy, tubectomy and traditional methods.
Kartono urges the government to do more to provide birth control devices which can be produced locally.
"The manufacturers are complaining they can no longer produce birth control devices because the raw materials are getting too expensive," he said.
The government can promote the use of long-term birth control devices, such as implants and IUDs, to prevent a decline in the number of participants due to the crisis.
If nothing is done to control birth control prices in two years, he warned that it might result in a baby boom within the next five years.
The fear of a baby boom has also been voiced by State Minister of Population and BKKBN chairman Ida Bagus Oka.
Kartono predicted that a baby boom might come out of the middle class, who think they still can afford raising children.
For people in the low-income bracket who suffer most from the crisis, a lucky few might be able to receive a permanent form of birth control, such as a vasectomy or sterilization, while others might have to resort to the worst option: abortion.
"So, high contraceptive prices might not only lead to a baby boom, but it might also raise the number of abortions and at the same time, increase the maternal mortality rate. That's what we fear most," Kartono said.
The government has managed to lower the maternal mortality rate from 390 per 100,000 births in 1994 to 295 per 100,000 births today.
Supply
BKKBN's deputy for family planning, A. Muchyi M.M., brushes aside the possible impact of high contraceptive prices.
"In my opinion, there might be an increase in births. But a baby boom sounds too pessimistic. We still have enough of a supply of contraceptives to last at least until March 1999," he told the Post.
But he revealed that there would be a slight change in the program's long-term targets. Earlier, the program was expected to lead to a "balanced growth" by 2005, or 2010 at the latest.
"Instead of reaching a balanced growth by the year 2005, or 2010, experts project that we will reach a balanced growth by 2008, or 2013 at the latest," Muchyi said.
The latter prediction, he said, was made based on the result of a health and demography survey in 1997. The survey recorded a total fertility rate of 2.79, or 0.2 point higher than targeted.
"It's impossible to reduce the 0.2 point rate in a short time, that's why the experts changed the projection," Muchyi said.
With the program, the country's population was expected to stabilize at 350 million people by the middle of 21st century.
BKKBN, he said, was still studying about those dropping out of the programs, adding that dropping out meant the women wanted to have children or were already pregnant.
"We will also examine whether there are participants who quit the programs because of high contraceptive prices," Muchyi said.
But BKKBN does not close its eyes to the high birth control prices. "We know it's difficult to lower the price of contraceptives because most of raw materials are still being imported."
For instance, he said, an implant, which was earlier sold at Rp 75,000, was now sold at Rp 365,000 each.
The sale of contraceptives is subsidized by the government and efforts are made to supply free contraceptives to seven million low-income participants.
BKKBN's data from February and March show an apparent rise in the number of people relying on vasectomy, tubal ligation, implants and condoms.
The data showed a 10.15 percent rise in those performing vasectomies, a 35.64 percent rise in tubal ligation, a 61.4 percent rise in those using implants and a 0.42 percent increase in the reported use of condoms.