Indonesia may see baby boom

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.