Achieving MDGs by Strengthening Family Planning A Prespective from Indonesia Shela Putri Sundawa, UI

MDGs stands for Millenium Development Goals. It was declared in UN Millenium Summit in September 2000. MDGs has spesific and inter-related targets with time frames in 2015. MDGs contains of some points and many kind of issues, it is: 1. 2. 3. 4. Eradicate extreme poverty and hunger Achieve universal primary education Promote gender equality and empower women Reduce child mortality

5. Improve maternal health 6. Combat HIV/AIDS, malaria & other diseases 7. Ensure environmental sustainability 8. Develop a global partnership for developmentby 2015

Indonesia as one of the most populated country in the world faces so many problems which may caused by the number of its citizens. According to World Bank, there are more than 229 million people live in Indonesia. As we all know, larger number of people live in a country brings more problem for the country. Maltus once said that the power of population is indefinitely greater than the power in the earth to produce subsistence for man. In other words, the problems of this country will continue to be worse unless theres something that has been done to control the total population. In late 1970s, Indonesian government began to introduce family planning program. This program thought to be succesful since it can decrease the population growth from 2.1% to 1.1%. By controlling the birth control which will affect population growth and total population, the problems which appears because of the large number of total population can be decrease, such as: poverty and hunger, child mortality, low maternal health, low education background and also infectious diseases. This article will give brief description about those five issues in MDGs and more focus on the role of family planning in sexual transmitted disease (includes in point 6 of MDGs). 1. Poverty and hunger Since gross national product is the total income per total population, the more population in a country the less GNP that it has. GNP resembles the economy condition of a country and its population. Low GNP can be translated as a low economy condition of the people in a country. In other word, it means that if a country has less population, the GNP is higher and the economy condition of the people and the country are in a better condition than the other country who has more population and less GNP. 2. Child mortality

Child especially infant is the most fragile of all mankind. A common disease which does not threaten adult can be a life threatening for an infant. It may be caused by their low immunity. Therefore a proper health facility must be given to infant to lower their risk to get diseases and even mortality. 3. Low maternal health Maternal mortality is mainly caused by hemorrhage, eclampsia, obstructed labor, complication due to abortion, and infections. Hemorrhage contributes to be the biggest cause of maternal mortality. In family plan program, space between 2 birth should be 2-4 years. This suggestion has been made by considering the Mexico City Declaration on Population and Development that said, Too many, too close, too early and too late pregnancies are a major cause of maternal, infant, and childhood mortality and morbidity. In conclusions, applying family plan can reduce the risk of maternal mortality by controlling the birth spacing. 4. Low education background Bigger amount of population has a bigger burden for a country. Based on Indonesias Undang-Undang Dasar 1945, to provide and fascilitate education is the government duty. This duty will get heavier as the total population continue to grow day by day. Therefore family plan is one of many ways to help the government realism education for all. 5. Infectious diseases Infectious diseases may be spread from human to human, vector to human, or environment to human. One of the risk factor of infectious diseases is the crowdness and the sanity of the neighborhood. People in the country with a large number of population live closely to each other house especially in for them who live in the city. The condition of living each other too close in a neighberhood fascilitate infectious disease to spread easily from a people, a vector, or environmnet to infect people nearby. Sexual transmitted disease is one of many tipes of infectious disease. Contraception, barrier type, which also the part of family planning may decrease the spread of sexual transmitted diseases including HIV/AIDS. Before we discuss more about the barrier contraception, it is better to understand about STD first. STD has became a problem since hunders years ago. There are some ancient literatures described about a very similar disease with STD characteristic. In the 20th century, classic STD like syphilis, gonnorhea, chancroid, lympogranuloma venereum, and inguinale granuloma had been known widely. However, the incidents of STD increased in the late 1900s where there were the beginning of moral degradation. Other problem which increase the complexity of STD management is resistency of pathogen in common used antibiotics and newly found spectrums of STD. Diseases included in STD is summarized in the table below. Pathogen Herpes simpex virus Diseases or Syndrome and Population Infected Male Both Female Primary and recurrent herpes, neonates herpes Hepatitis Penis cancer Condilloma Servix dysplasia and

Hepatitis B virus Human Papiloma

virus Human Immunodeficiency virus Chlamydia trachomatis Ureaplasma urealyticum Neisseria gonorrhea

Uretritis, epididimitis, proktitis Uretritis Epididimitis, prostatitis, stricture

acuminata Acquired Imuunodeficiency syndrome Lymphogranuloma venereum

cancer, vulva cancer

Uretra syndrome, servisitis, bartolinitis, saphyngitis, sekuele

uretra

Uretritis, proktitis, pharyngitis, diseminata gonococcal infection Syphilis Chancroid Inguinale granuloma

servisitis, bartolinitis, endometritis, sekuele (infertility, ectopic pregnancy, recurrent salphyngitis)

Troponema pallidum Haemophilus ducreyi Calymmatobacterium granulomatis Shigella Campylobacter Trichomonas vaginallis Entamoeba hystolitica Giardia Lamblia

*Enterocollitis *Enterocollitis Vaginitis *Amoebiasis *Giardiasis Table 1 Sex transmitted diseases

*Most important in homosexual population Adapted from: Cotran RS, Rennke H, Kumar V. Ginjal dan Sistem Penyalurannya. Dalam: Kumar V, Cotran RS,
Robbins SL, editor. Buku Ajar Patologi Robbins Volume 1 edisi 7. Jakarta: Penerbit Buku Kedokteran EGC. 2004.

To decrease the spread of sexual transmitted disease, barrier contraception can be used as protection. Here is some types of barrier contraception.

a) Condom Condom might be the most well-known barrier contraception among people. There are two types of condom, condom for male and condom for female. Female condom seems to be less popular than male condom. Condom for female must be proven to prevent pregnancy and STD before thrown to the market. The only female condom which availble is FC female condom. This condom made from Polyuretan with flexible polyuretan ring in each of its end. However the pregnancy value is higher compared to male condom.

Figure 1 How to use female condom Taken from: Cunnigham FG, Gant F, Leveno KJ, Gilstap LC, Hauth JC, Wensrom KD eds. Williams obstetrics. 22nd ed. New York: McGraw-Hill. 2007.

Properly use of condoms will provide considerable but not absolute protection against a broad range of sexually transmitted diseases, including HIV, gonorrhea, syphilis, herpes, chlamydia, and trichomoniasis. Condoms may prevent and ameliorate premalignant cervical changes, probably by blocking transmission of human papillomavirus. The Centers for Disease Control and Prevention recommend condoms for couples at risk for HIV infection, including those with multiple sex partners.
b) Diafragma Vaginal diafragma contains of rubber pouch shaped in bowl with elastic spiral spring in the edge. The spiral is made from thin stainless iron, or a very fine spiral wire. The size of diafragma might be different in each acceptor. Diafragma is placed inside vagina just before coitus, to prevent entering of sperm to uterus. To increase its effect on birth control, spermicide is inserted inside the bowl and rubbed in ithe edge. The placement of diafragma inside vagina may not be longer than 6 hours. Since the various size of it, diafragma can only be gotten by prescription.

Figure 2 Placemnt of vaginal diafragma Taken from: Cunnigham FG, Gant F, Leveno KJ, Gilstap LC, Hauth JC, Wensrom KD eds. Williams obstetrics. 22nd ed. New York: McGraw-Hill. 2007. c) Cervical cap Cervical cap is made from flexible rubber. It is placed in the bottom of servix and it can stays there until 48 hours. The use of cervical cap must ne used with spermicide. Howeever, its expensive enough, and if it is not place properly, the effectiveness in birth control is less than diafragma used together with spermicide. Any types of barrier contraception which will be used as protection through the STD must also be choose wisely since there might be some people who sensitive to the material. A toxic shock syndome has also been reported. However the use of barrier contraception can decrease the risk of getting sexual transmitted disease including HIV/AIDS. Therefore, the implementing of family planning can help a country achieve point 6 in MDGs. A conclusion, family Planning which has been introduced four decades ago should be our magnificent weapon to help achieving MDGs. As we listed above, minimum five of all MDGs targets can be achieved if we can effectively implement family plan in our life. So the government and all health provider should strenghtening family planning program so that we can reach the MDGs target by 2015.

References 1. Affandi B. Reproductive Health : Problems and Technology . Module of Reproduction Faculty of Medicine University of Indonesia , 18 Oct 2010 2. Bank dunia, indikator perkembangan dunia. Bank dunia. 2010. 3. Affandi B. Upaya Peningkatan Kesehatan Ibu, Bayi dan Anak melalui penggunaan kontrasepsi , BKKBN Jawa Tengah , Semarang , 15 Oktober 2010 4. Malthus TR. An essay on the principle of population. 1798. In: oxford worlds classic. 5. Fathalla, Rosenfield, Indriso, et al., Reproductive Health Global Issues, 1990 6. Cotran RS, Rennke H, Kumar V. Ginjal dan Sistem Penyalurannya. Dalam: Kumar V, Cotran RS, Robbins SL, editor.
Buku Ajar Patologi Robbins Volume 1 edisi 7. Jakarta: Penerbit Buku Kedokteran EGC. 2004.

7.

Cunnigham FG, Gant F, Leveno KJ, Gilstap LC, Hauth JC, Wensrom KD eds. Williams obstetrics. 22nd ed. New York: McGraw-Hill. 2007. Ch 33