Women’s Position on Family Planning Program in Indonesia

Theresia Pratiwi Elingsetyo Sanubari1*

1
Universitas Kristen Satya Wacana
*pratiwi.elingsetyo@staff.uksw.edu

Abstract

Indonesia in 1957 under Soeharto’s regime established a bureau called National Population and Family Planning Board
(BKKBN) to regulate Family Planning (FP) program. In 1998, BKKBN encountered deterioration because of political reformation in
Indonesia and declining in 2000 since Indonesia applied decentralization system. However, the changes didn’t even make BKKBN shift
its concern to women’s rights on FP program. The concepts of FP program were built using the concepts of reproductive rights to regulate
bodily rights and the sexuality itself had never been main concept in the implementation of FP program. Therefore government needs to
review FP program in order not to generate more violence toward women, such as reviewing the existing regulations and analyzing them
using women’s right principle; increasing men’s involvement and regulate it with laws; improving the number of field officers and/or
midwives; coordinating with stakeholders to formulate FP program; and improving reporting and recording systems.
Keywords: family planning, women’s rights, Indonesia, government, decentralization

INTRODUCTION Methods such as IUD, injections, and also to improve the

Family Planning (FP) program in Indonesia is
regulated by an institution namely National Population and
Family Planning Board (BKKBN). The institution was
established in Indonesia in 1957 as an authentically private
organization. In 1968 BKKBN changed into semi-
governmental organization and in 1970 it officially became
governmental organization which functioned as the
administrator and management of National FP Program.
At the beginning, FP program implemented by
BKKBN only concentrated on contraceptives supply. The
effort was conducted by establishing capacity of
contraceptive service and allocating one personnel in
healthcare clinics with an expectation that men and women
could come and filled their needs toward contraceptives. If
the capacity of contraceptive services were continuously
established in every healthcare clinic nation wide, it might
be assumed that the demands of contraceptives as well as
the users were increasing. The program was also predicted
would be an effective strategy since there was maternal and
child health network where FP program could be
collaborated. The result of the strategy in 1969 – 1973 was
there were 2.200 clinics in Java and Bali regions.
However, each clinic was only targeted to have 8 new
acceptors every month. The other strategies were an
approach to society through field officers, the promotion of
pill and IUD to be used which was only conducted in
several selected regions1.
The success of the program was also supported
by the number of Family Planning Field Officers (PLKB)
that was increasing every time. The field officers were
established to make door to door contact; to motivate
current users for using contraceptives and to get new
acceptors. The activity was conducted was promoted to
improve the promotion of Long Term Contraception
number of users who visit healthcare clinics 2
The use of pill as long term contraceptive
method wasn’t recommended since there were difficulties
in monitoring old users and the use of pill continuation,
therefore BKKBN replaced the strategy. In 1974, BKKBN
established the village family planning group to control this
matter. However, BKKBN gave autonomy for every
province to manage their strategy in handling this matter.
The strategy was used by province to include regional
government in implementing FP program. The arrangement
resulted in the increase of contraceptives users. In 1976, the
accomplishment BKKBN made brought about the concept
of the village family planning group as national policy. The
system also enabled central government to control the
number of contraceptives in the entire Indonesia.
The accomplishment resulted in the bigger
responsibility of BKKBN as an institution that regulate FP
program. In 1980, in addition to monitoring the
contraceptives users and providing contraceptives, BKKBN
also developed its work by recruiting new users, helped
users who suffered side effect, mentored the development
of communities’ activities such as nutrition, income
generation also maternal and child health. During 1980, the
population policy issue in Indonesia wasn’t merely about
contraception.
In 1987, government issued policy related to
hospital privatization, which meant there would not be any
allocated fund for government hospitals. The policy
resulted in the stipulation of contraceptives prices which
were applied for the selected users groups. In 1990,
BKKBN improved its work by improving the quality of the
village planning groups. There were 7 obligations had to be
done namely effective self – management; motivating
others to use contraception; the provision of contraceptive
service and advice; regular meetings; data collection on the

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demographics and family planning practices of the
community; social and economic development activities for
the community, and activities to become financially
independent. “Beginning groups” would carry on two first
obligations, “basic group” would carry on one to five,
“developing group” would carry on six obligations, “self-
sufficient” group would do all obligations. The activity
succeeded in increasing the number of groups from 14,073
in 1975 to 1,102,124 in 19961.
BKKBN success did not last long, especially
after economic crisis and political change in Indonesia in
1998. The laws that regulated BKKBN was also changed.
In its glorious era, BKKBN was directly under the
president in organizing FP program in Indonesia according
to Presidential Decree No. 33/ 1972. It enabled the
authority of BKKBN to directly reach up to regions.
Unfortunately after the fall of Suharto and Indonesian
political change, BKKBN was responsible to the President
through the coordination of Minister of Health in
accordance with Presidential Decree No. 110/2001. The
change made BKKBN no longer the only institution that
was responsible for FP program and in its activity BKKBN
must coordinate with Minister of Health.
The change of system in Indonesia into
decentralization system since 2000 based on political
power to shift the centralistic system in Soeharto era also
shifted the role of BKKBN in FP program especially after
the emerge of village midwives. The decentralization
system made BKKBN no longer had power over regional
government since regional government had their own
authority and right to make policies as well as the budget.
BKKBN was no longer able to order regional governments
to increase the budget for FP program. It made BKKBN no
longer easily promoted FP program also regional
governments’ support toward FP program depended on
each regional government’s perception toward the
importance of FP program in their respective region 3.
The change in BKKBN political brings change
also in the implementation of FP program. FP program is
no longer fully conducted by BKKBN only, but also there
is the involvement of health minister in running the
program. Meanwhile, BKKBN isn’t able anymore to
control the program up to the regions, whereas regional
governments have their own authority to run the program
in accordance with their respective needs. However, the
position of women in FP program is never changed.
Women always become the victim of violence for the sake
of various interests in implement the program.
FAMILY PLANNING’S PROGRAM IN INDONESIA
Family Planning Program is built by taking
concepts of reproductive health which also becomes the
perspective in women’s rights. The perspective foundation
of the principle is that every woman has a right to
reproductive health, that is, to regulate her fertility safety
and effectively; to understand and enjoy her own sexuality;
to remain free of disease, disability, or death associated
with her sexuality and reproduction; and to bear and rear
healthy children4. Unfortunately, the concept has never
been actually implemented in the implementation of FP
program. FP program is always applied to help the nation
to fix national economic situation, decrease the national
poverty level5, improve education, employment
fulfillment6, and focuses in declining women and children
mortality7. In its regulation, it is also seen that FP program
only focuses in the population that doesn’t include the
understanding on human rights8 therefore a question
emerges on how the position of women in the program?
FP program as a biopolitic like it is told by
Foucault is centered in the government who tries to control
the population, no longer the individuals and tries to
discipline the body of the individuals (anatomic-politics).
Although in the beginning Foucault argued that bio politic
can be conciliated with individual rights however what
actually happened was the opposite. It is supported by the
statement of Professor Sandra Bartky in Stopler (2015)8
that conveys that unique position of women with the
respect toward the regulation of sexuality works raises to
ways contradictions. In one side, it makes women weaker
for the violation on their bodily integrity and basic rights
through oppressing regulations. In the other side, at the
same time, it also makes women weaker on the non
existing regulation. If the government doesn’t make
regulation to support women’s needs related to their
reproductive functions and their needs, especially
pregnancy and child labor, then it will make women don’t
understand their reproductive rights and other liberal rights.
The situation is seen from FP program that
focuses only to lower down the phase of fertility rate (Total
Fertility Rate) and to increase Contraceptive Prevalence
Rate (CPR). Both matters are always used as indicators by
BKKBN to makes FP program and also used as success
indicators. The focus of government put women in a
position only as target. Women become unaware of their
reproductive health and only made as object to fill
government’s desire. The urges to make the program
successful by BKKBN is also increased after
decentralization system is implemented in Indonesia. In
addition, the difference of goals between BKKBN and
Health Minister, which both handle FP program, make
women’s violation is getting bigger to fulfill nation’s
targets.
Another fact is that the existing FP programs
don’t only belong to the government to regulate. FP
programs also involve donor and non-governmental
organization in planning, discussing and event mutual
attack on the effectiveness, purpose and the budget of the
program9. The participation of many parties in the
programs is the result of idea of globalization, mobile
capital and multiple subjectivities. This matter is in
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accordance with what is conveyed by Grewal and Kaplan
(1994) in Richey (2004) with scattered hegemonies who try
to describe the relationship between the power simulating
from population hegemony and FP program also plural.
Simultaneously act with other patriarchy patterns in
controlling women’s bodies, population hegemony as a
problem and FP programs as solution become ambiguous
during the implementation of FP program as it happens
now. There are a lot of parties involves in deciding how the
programs run, it means that those parties negotiate about
the best expectation for women’s bodies in the programs.
When the expectation doesn’t fit then they will change the
existing program, in the other words they will make women
body as a laboratory10.
Seeing how fragile the FP program is,
government should be able to regulate it by considering
women’s bodily rights also. Government often only thinks
about profit and forgets about the women’s rights as the
first party that is affected by the implementation of FP
program. Government often doesn’t use human rights
principles in running the program that related to various
parties, which eventually results in the disparities. If it is
seen from the side of human rights principles then it is
clearly written that one of the principles is indivisibility.
The principle explains that whether they relate to civil,
cultural, economic, political, or social issues, human rights
are inherent to the dignity of every human person.
Consequently, all human rights have equal status, and
cannot be positioned in a hierarchical order. Denial of one
right invariably impedes enjoyment of other rights. Thus,
the right of everyone to an adequate standard of living
cannot be compromised at the expense of other rights, such
as the right to health or the right to education 11.
In the other side, FP program in Indonesia can’t
be separated from government that uses cultural and
religious values also norms. The values used by the
government also affect women which are directly involved
in FP programs. For example, religious beliefs, women’s
position that is limited in making decisions, and strong
culture12 will affect the implementation of FP programs. In
Indonesia, the limits from the government are seen from
the fact that only married women that can get contraceptive
services. The limits show how women’s bodies become
functional anatomic system that simply shows social
construction is cultural system that is continuously de-
constructed and reconstructed13. Norms, cultural values,
and religions have never put women as subject whereas
only as individuals who have social position as wives or in
maternal functions. The point of view makes women are
only considered from moral judgment as good or bad. The
government’s effort that only gives contraceptive services
for married women is also the effort of the government to
make women looked good so they are proper to be situated
in society. Furthermore, the effort also wants to build
society that is morally virtuous.
Government’s control in FP programs is also
implemented on the use of contraceptives that are
considered excellent to lower down birth rate and the best
ways to give the methods. In other words, FP programs
emphasize more on economy and social development14.
The control is illustrated by government that
makes regulations to bind women in FP program. For
example, in article 23 to 26 Governmental Regulation No.
87/2104 about population and family development, family
planning and family information system, it regulates the
pregnancy and rules in FP participation that burden more
on women, such as rules to undergo tubectomy (MOW). To
undergo MOW, there are conditions need to be met, a
woman of 26 years old or more, having 2 children, feel
certain of having expected number of family members,
serious health risk if having pregnant, post partum women,
or post miscarriage. Meanwhile the conditions to undergo
vasectomy on men (MOP) are only 2, a fertile man, with 2
children and married to a woman who considered high
risked15.
Meanwhile, the change on program conducted by
government through Ministry of Health tends to demand
women to change, such as to change the contraceptives
used with injected contraceptives done by village
midwives3. Injection method seems to be more effective
since it lasts for 2-3 months and there is no treatment
needed during the period, it is possible to be used during
breastfeeding, decrease the risk of cancer, and it doesn’t
need to get doctor’s help to cease using it 16. Unfortunately,
the demand is followed by the target for village midwives
to get new injection acceptors, or make acceptors to change
their contraceptives to injection. It causes the information
about benefits and side effects of injected contraceptives
can’t be obtained completely. Therefore, it is unsurprising,
if this idea is useless since there are many who drop in
using injected contraceptives. The irregularity is also can
be caused by village midviwes who can’t conduct the
advocacy well3.
Government control over the use of
contraceptives on women can be categorized as violence
against women in health sector as it is conveyed by Naomi
Wolf in her book, The Beauty Myth. In her book, Naomi
Wolf writes:
Contraception, for example, is defined by the medical
profession, depending on the social mood, as making
women ill or “beautiful” ……..it was considered
“distinctly dangerous to health”, sterility, and “mental
degeneration in subsequent offspring” being among its
supposed effects. But when society needed sexuality
available women, although questions about safety and
side effects arose at once, women’s magazines
nonetheless ran enthusiastic stories suggesting that the
Pill would keep women young, and make them more
“sexy”. 17
3
 The reasons of young and beautiful are always
used as reasons to control women. The perspective is also
built by society so that both of them become measuring rod
to see women. In other words the control over
contraceptives use makes women hurt their own bodies for
manipulative reasons made.
SUGGESTION TO GOVERNMENT FOR BETTER
FAMILY PLANNING PROGRAM IN INDONESIA
Seeing a lot of disparities happen on FP program,
government should use the human rights principle to
control program. Especially, this program has many
disparities happen that harm women’s position.
Firstly, government should review the policies
made and reanalyze using human rights principles,
women’s rights and bodily rights of women, especially
those related to FP program and women. Governmental
Regulation No. 87/2014 about The Population and Family
Development, Family Planning and Family Information
System explains that family planning is the effort to
arrange the birth of children, spacing and ideal age to give
birth, to arrange pregnancy, through promotions,
protections and assistance in accordance with reproductive
rights to create quality family. The description shows that
family planning is only to arrange population and it doesn’t
consider yet the protection nor help women, as the purpose
of FP program should be. The definition of family
planning, finally influences government obligation that is
mentioned in articles 4 to 16, that eventually only balances
the condition without considering women’s interests
within. Government’s perspectives, that only sees from
program point of view, needs to be changed.
Secondly, government should start to increase
men’s participation in FP program. The participation should
be conducted thoroughly. Men’s participation in FP
program happens at the moment is still in question, since
the participation is only seen from the men’s percentage
who undergo vasectomy (MOP). Whereas there are still
few men who undergo MOP, therefore government needs to
regulate the contraceptives for men through policies by
realizing that men’s role is indeed important. Men should
also have awareness to use condom if they don’t want to
have anymore child or want to postpone having child.
When men have commitment to use condom, then women
don’t have to use any contraceptives. The policy doesn’t
only make men to directly participate, but also consider
women’s rights over their bodies. The men’s participation
needs to be regulated into a policy since without
government involvement; the arrangement will be in
accordance with the culture of the society, that men are
always dominant in their decisions, including over sexual
contentment.
Thirdly, government should increase the number
of Family Planning Field Officers (PLKB) and village
midwives. It is undeniable that PLKB is the main milestone
of FP implementation since they can directly interact with
clients. The pressures given to PLKB to always fill the
targets sometimes make them unable to give
comprehensive information about FP programs. Besides,
the number of PLKB themselves isn’t sufficient so that
heavy work load indirectly influences the transfer of
information. As one of the source of information and is
able to do it directly, PLKB whatsoever should be able to
give comprehensive information so that women can choose
anything which isn’t the result of government’s coercion. If
the number of PLKB is increasing, the information will be
more effectively given, so that it can support the fulfillment
of women’s health rights. The number of village midwives
also need to be increased because they are who give
services in primary healthcare service. Their role needs to
be intensified by giving correct information about benefit
and effect for using contraceptive methods. To increase the
number of PLKB and village midwives, government should
regulate it in regulation and prepare adequate budget for
them.
Fourthly, the government should coordinate with
stakeholders about FP programs. The government should
realize how big the power of FP program is in politics way.
Coordination from government must be made to control
stakeholders or it will raise a lot of interests and will make
women’s bodies as the media to fulfill those interests. To
coordinating with the stakeholders, government should
make the system works in synergy to implement FP
program.
Fifthly, government, through BKKBN, must be
aware to fix the reporting and recording system more
toward FP data. Nowadays unqualified recording and
reporting system often cause a lot of problems, such as the
availability of contraceptives that is insufficient in certain
region, insufficient healthcare services because of
inconsistent reported data, insufficient budget given by
government or inappropriate supervision’s target conducted
since the data reports the opposite facts. Inappropriateness
should be seen by BKKBN to fix the system including the
use of data and the quality of data toward FP data. Quality
and appropriately used data will be able to help
government in maximally allocating the budget and helping
society to fulfill their needs.
Conclusion
In 1975, FP program was started in Indonesia by
establishing BKKBN or National Population and Family
Planning Board. Various FP programs conducted by
BKKBN always come to their success, such as the
existence of Family Planning Field Officers (PLKB) and
the village family planning group. Unfortunately, the
success did not last long, after the fall of Soeharto and the
implementation of decentralization system that make
BKKBN no longer had its authority up to villages. The
4
changes happen in BKKBN actually don’t shift the position
of women in FP program. FP program that adopts
reproductive health concept to make women able to arrange
the wellbeing of their fertility effectively, to understand and
enjoy their sexuality, to stay protected from diseases,
disability, or death related to sexuality and reproduction,
and to have children and raise healthy children, is actually
only used by government as means to set up the population,
economic situation, poverty rate, education and
employment fulfillment. In running FP programs,
government often against or doesn’t consider women’s
rights over their bodily and reproductive rights; donor and
non government organization who also conduct FP
program only assume women’s bodies as laboratories;
religious, norms, cultural value are used by government in
running FP program; and government control toward
contraceptives used is a form of violence against women’s
bodies with manipulative effort that contraceptives make
women stay younger and sexier. To overcome that problem,
there are efforts to conduct as follow: (1) making
government reviews the regulations made related to FP
program; (2) government should involve the role of men
and regulate it in regulations; (3) government should
increase the number of PLKB and village midwives;
government should be able to coordinate with stakeholders
to regulate FP programs, and (5) government through
BKKBN should be able to improve data recording and
reporting system.
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