Injectable contraceptives still sought out despite cost

By Yogita Tahil Ramani

JAKARTA (JP): Skyrocketing contraceptives prices aside, a baby boom fear is not something obstetrician Lestari suffers from.

The obstetrician of a community health center (Puskesmas) at Bendungan Hilir, Central Jakarta, agreed that prices of injectable contraceptives, used by 80 percent of the center's 100 or so family planning program participants each month, has risen by nearly 400 percent.

Lestari gave the examples of Depo Progestin and Depo Provera of Organon and Apjon Laboratories. Both injectable contraceptives initially cost Rp 29,000 and Rp 34,000 a box respectively in 1997.

"Today, a box of 20 vials, each vial containing 3 cc of Depo Progestin could cost Rp 95,000. Depo Provera costs between Rp 125,000 and Rp 130,000 per box (20 vials)," Lestari said.

She added that formerly, the National Family Planning Board (BKKBN) would "drop in" the needed amounts of contraceptives every three months.

"Of the nine kinds of contraceptive pills, they only provided us with 100 packs of Nordetta (one of the brands) last month. BKKBN cannot afford to drop in the pills or boxes of vials (injectable contraceptives) anymore."

So how do they manage?

Midwife Siti Mutmainah said that they charged all patients Rp 8,000 per injection. "This includes the disposable syringe, which costs Rp 2,500," Siti said. She added, however, that this has not deterred patients from having the injections.

"We still have the old stocks of IUDs and implants. We offer them for free, but no one will take them," Siti said, adding that the participants are mostly people from nearby slum areas.

Doctors and midwives say that the injection method is the most popular among the poor people.

Tuti, a fishmonger, said that she did not use an IUD because she was simply "not used to them".

"I am used to injections. Before, we paid nothing and now we have to pay Rp 8,000," she said. Tuti lives with her husband and two children in a slum area in Tanah Abang.

"My husband works at a garment factory. He earns Rp 250,000 (US$29) a month. His transport allowance of Rp 7,500 a day was reduced to Rp 5,000 two months ago."

She added that she was serious about family planning and just could not afford another baby.

"As long as I can afford injections, I will pay Rp 8,000. But, if prices increase, I might have to consider using a spiral (IUD)," Tuti said.

"It may be safe but I still have to get used to the idea of spirals ... it's not funny having something stuck inside of you, you know," the 34-year-old said laughing.

Lia, of Penas Baru, East Jakarta, said that with injectable contraceptives having to be paid for, she got them occasionally but now preferred taking pills. She felt that injectable contraceptives were still the safest.

"I always recommend them to my friends as well," said the maid, who works for a middle-class Indonesian family which pays her Rp 80,000 a month.

"For us, going out with our boyfriends is the only way we can relax and have a good time. We need injections because we cannot afford babies," the 20-year-old said.

"Now I take the injections once in a while. I always get condoms from here (Petojo Selatan subdistrict) for my boyfriend, and I take pills," Lia said.

Midwife Nana said that even as IUD-use among the women of low- income bracket was seldom, she was pleased with the use of IUDs.

"Women do not want to be bothered with free spirals, whether they are renewable after three years or eight years. They are very expensive today, you know," Nana said.

"One of the three-year ones used to cost Rp 120,000. Now, it's Rp 160,000. The Lippes Loop with the black thread is for the woman with one child, yellow for women with two, and white for women with three or more children."

According to Lestari, injectable contraceptives are becoming popular among women of the middle-class bracket as well. She said that those who normally visited specialists at big hospitals for injectable contraceptives, had shifted recently to community health centers.

"More and more people who go to private hospitals and have to pay specialists Rp 15,000 or more for an injection, are now coming here."

In September, the Bendungan Hilir center saw 103 patients coming in for injections. Only two came in for condoms, which are provided free of charge by BKKBN. None came for implants or IUDs.

A harried midwife from the small community health center at Petamburan subdistrict also mentioned the lowering levels of contraceptive awareness.

"We supply the Lippes Loop and Copper T spirals for free but the participants want their injections," she said. Adding that on the average, some 80 participants visited her clinic a month.

When asked about the decline in the number of patients in recent months, she said that many people living in the Petamburan slums were nonpermanent residents.

"They come from far-off villages and stay here off and on. They get themselves contraceptives here and then go back and get themselves contraceptives in their villages," she said.

This, however, was not the case with Lestari and Nana. Nana had her account books from 1991 onward intact. Her 1998 books show a neat account of the number of regular and new patients who have come in from January. September showed a drop of 10 regular patients from 62 in August.

Of the 52 regular patients who visited the Gambir clinic last month, eight chose IUDs, 10 pills and 34 injections. Of the eight new ones, four chose injectable contraceptives and four IUDs.