Indonesia's family planning program is challenged by religious conservatives

(The Christian Science Monitor) The village of Wonosari, nestled in the hills above the Javanese city of Yogya­karta, is experiencing a baby boom.

Infants wail and coo in several of the tile-roofed, one-story houses lining the main dirt road. In one of the homes, 19-year-old newlywed Wadianti listens as a midwife from a Yogyakarta health clinic explains to her and her 21-year-old husband, Anggit Bayu, how to prepare for the birth of their first child, only weeks away.

The young couple hadn’t planned to become parents so soon after marrying—Anggit had hoped to wait until he was 26 and had finished his studies at Islamic University in Yogyakarta, and Wadianti had wanted to complete her studies as well. But the couple, devout Muslims, were suspicious of most contraceptive methods, convinced they could cause disease and make getting pregnant more difficult later on.

“So I decided we’d try following her menstrual cycle,” Anggit said with a sigh and a grin. “Now we’re going to have a baby.”

Wadianti and Anggit’s story is no tragedy, but it speaks to the challenge Indonesia’s government faces as it seeks to shore up its globally admired family planning program.

Over the course of an aggressive 30-year policy that aimed to limit families to two children, Indonesia cut its fertility rate by more than half, to 2.37 births per woman in 2012. The centralized policy extended maternal health and family planning clinics across this nation of 255 million people, leading to a sharp dip in maternal mortality.

But now Indonesia is seeing its progress slow, and in some areas of the country even reversed, mirroring a trend that demographers and international health experts say can be seen in other nations. Any setback to reducing fertility and maternal mortality rates could have a significant impact in some developing countries.

­After nearly five decades of international efforts administered by the United Nations, development experts concur that family planning programs have been a key tool in reducing global poverty and in empowering women—an undisputed path to development for poor countries.

“Family planning is the most effective human development intervention there is today—it’s a point we don’t make often enough,” said Babatunde Oso­timehin, executive director of the United Nations Population Fund (UNFPA). “Women who have access [to family planning services] are able to make choices—about spacing their children, about education, about their economic activity. . . . That adds up to increased development and well-being.”

Despite that, nearly 250 million married women worldwide still lack access to such services, Osotimehin said—a point he underscored at a recent international family planning conference in Bali, Indonesia. A key challenge is to “encourage more developing countries to committing their own resources to family planning programs,” he said.

The need for local funding for domestic programs has become all the more urgent as Planned Parenthood in particular and family planning budgets in general have come under attack from conservative political forces in the United States, a major source of international funding. At the same time, other high-profile policy decisions and global trends—from China’s easing of its longtime one-child policy to heightened concern over the economic impact of graying populations—are putting family planning advocates on the defensive.

“The international family planning movement, or at least certain elements within it, have a lot to answer for,” said Nicholas Eberstadt, a political economist and development policy specialist at the conservative American Enterprise Insti­tute in Washington, D.C. “What do they have to say about China and coercive birth control, and how that fits with respect for basic human rights? . . . Then there is the challenge of aging populations and the fact that aside from sub-Saharan Africa, the rest of the world is pretty much below replacement [rate].”

In Indonesia, some religious conservatives are challenging adherence to the secular policy designed to limit family size. And among young people, shifting attitudes toward sex are leading to more unintended pregnancies. Strict policies mean many young people have little or no access to either contraceptives or family planning facts, according to researchers.

“The government tries to limit reproductive health programs to married couples,” said Martha Santoso Ismail, UNFPA’s assistant representative in Jakarta. Providing “information to adolescents remains controversial.”

To revitalize Indonesia’s family planning efforts, the government is focused on expanding access to services and on sending out more health-care workers—like the midwives who showed up in Wonosari to visit Wadianti and Anggit.

But others say that given Indonesia’s heightened religious conservatism, it would do well to return to the roots of its family planning success.

“Right now our fertility rate is stuck, and to address that I think we need to remember what made Indonesia’s effort successful in the first place,” said Amin Abdullah.

Abdullah is rector of Sunan Kalijaga Islamic State University in Yogyakarta and a professor of Islamic studies.

“Our program was a success story [because] the government and UNFPA worked together with . . . people with an Islamic worldview,” he said. “They introduced a program with a religious ap­proach.”

This article was edited on March 15, 2016.

Howard LaFranchi

Howard LaFranchi writes for The Christian Science Monitor.

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