TWO IS ENOUGH Family planning in Indonesia under the New Order 1968-1998 9067181978

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TWO IS ENOUGH

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Dedicated to the memory of Masri Singarimbun and Hans D. Speckmann

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VERHANDELINGEN VAN HET KONINKLIJK INSTITUUT VOOR TAAL-, LAND- EN VOLKENKUNDE

204

TWO IS ENOUGH Family planning in Indonesia under the New Order 1968-1998 Edited by

Anke Niehof and Firman Lubis

KITLVPress Leiden

2003

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Published by: KITLV Press Koninklijk Instituut voor Taal-, Land- en Volkenkunde (Royal Institute of Linguistics and Anthropology) P.O. Box 9515 2300 RA Leiden The Netherlands website: www.kitlv.nl e-mail: [email protected]

Cover: Creja Ontwerpen, Leiderdorp ISBN 90 6718 197 8 © 2003 Koninklijk Instituut voor Taal-, Land- en Volkenkunde No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission from the copyright owner. Printed in the Netherlands A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

Contents Acknowledgements

vii

Firman Lubis and Anke Niehof Introduction

1

II

Solita Sarwono Family planning in Indonesia under the Old Order

19

III

Firman Lubis History and structure of the national family planning program

31

IV

Terence H. Hull The political framework for family planning in Indonesia Three decades of development

57

V

David L. Piet The significance of foreign assistance to the Indonesian family planning program

83

VI

Ninuk Widyantoro NGO involvement in family planning

107

VII Anke Niehof and Firman Lubis Family planning in practice Cases from the field

119

VIII Gavin W. Jones Family planning, demographic change and economic development IX

Anke Niehof Women and the social context of fertility under the New Order

X

Karen Hardee, Elizabeth Eggleston, Siti Hidayati Amal, and Terence H. Hull Family planning and women's lives A synthesis of findings from the Women's Studies Project

151 163

185

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vi XI

Nancy J. Piet-Pelon, Setyawati Budiningsih and Joedo Prihartono Reproductive health Implementing a challenging agenda

225

XII Anke Niehof and Firman Lubis Discussion Looking back and looking ahead

245

Glossary

267

About the authors

271

Index

275

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Acknowledgements In preparing this book we were encouraged by several persons, including colleagues and friends. The authors we approached for contributions all responded positively and enthusiastically, and we would like to thank them for their wholehearted cooperation. From the start, we shared the feeling that the Indonesian family planning program as it developed under the New Order deserved a comprehensive description and analysis in which its multifaceted and, at the same time, typically Indonesian character would come to the fore. We are grateful to the contributors for their time, the work they put into the book, and their valuable suggestions. In putting together the book we also received support, in one way or another, from persons other than the contributing authors. Some of those we would like to mention by name. Jaap Erkelens searched for materials that could be used as illustrations in the book and for the cover, and provided hospitality when the Dutch editor came to Indonesia to discuss the manuscript with the Indonesian editor and the Indonesian authors. Roy Jordaan did the proofreading of the last version and put together the glossary. Piet Hein van Kessel provided us with papers on the Dutch government's assistance to the Indonesian family planning program. Gerry van Nieuwenhoven designed the figure in Chapter XII, in which the shift of the family planning program during 1968-1998 is depicted. Daphne Wittich-Rainey took care of the English editing. The help of all these people was most welcome, and we would like to thank them for it. We dedicate this book to two people who played an important role in our professional and personal lives and who were known for their work on social and demographic change in Indonesia. Masri Singarimbun initiated the research on fertility, family planning, and social development in Indonesia. He also founded the Population Studies Center of Gadjah Mada University in Yogyakarta. His death on 25 September 1997 was a great loss to the social sciences in Indonesia and to his many friends and colleagues for whom he was a source of inspiration. The late Hans D. Speckmann, professor of social science research at Leiden University, brought the editors together as members of the team in the first research and training project in family planning A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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viii

in Indonesia. Working together in the Serpong Project during 1971-1975 provided the basis for friendship and professional collaboration between us ever since. Hans Speckmann would have been very pleased that this book was written, and that it is published by KITLV, on the board of which he served for several years. To us, Masri Singarimbun and Hans Speckmann were mentors, friends, and a source of inspiration.

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CHAPTER I

Introduction Firman Lubis and Anke Niehof

In May 1998 President Suharto was forced to step down after a period of growing political and economic turmoil in Indonesia. This marked the end of an era, the so-called Orde Baru, or New Order, which had lasted for more than thirty years. In many respects the New Order represented a break with the Old Order, or Orde Lama, the preceding regime of President Soekarno. Table 1.1. Age-specific and total fertility rates, Indonesia, 1965 to 19971 Reference period 1965-1970 1971-1975 1976-1979 1980 1981-1984 1983-1987 1983-1987 1985 1985-1989 1988-1991 1991-1994 1995-1997 Percentage decline, 1965-1970 to 1994-1997

Age-specific fertility rates (ASFR) 15-19

20-24

25-29

30-34

35-39

158 127 116 90 95 75 78 46 71 67 61 62

290 265 248 226 220 189 188 176 179 162 148 143

277 256 232 213 206 174 172 173 171 157 150 149

224 199 177 163 154 130 126 134 129 117 109 108

146 118 104 105 89 75 75 83 75 73 68 66

75 57 46 43 37 32 29 32 31 23 31 24

12 18 13 14 10 10 10 10 9 7 4 6

60.8

50.7

46.2

51.8

54.8

68.0

50.0

40-44 45-49

TFR 5.91 5.20 4.68 4.27 4.06 3.43 3.39 3.26 3.33 3.02 2.86 2.78 53.0

Sources: 1971 Census, 1976 SUPAS, 1987 Contraceptive Prevalence Survey, 1991, 1994, and 1997 Indonesian Demographic and Health Surveys, and 1993 SUSENAS, all compiled and published by the Biro Pusat Statistik (Central Bureau of Statistics) in Jakarta. The tables in this chapter were compiled by Terence H. Hull. The authors wish to thaTik Terence H. Hull and Gavin W. Jones for their valuable comments on earlier drafts of this chapter. A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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2

Views on the importance of developing a population policy differed radically between the two regimes. Contrary to his predecessor, Suharto saw population as a key variable in economic development. In 1968, the national family planning program was designed as an instrument for implementing this population policy. While the development of the family planning program in Indonesia must be seen against this political background, it also merits attention in its own right. As can be seen in Table 1.1, under the New Order fertility declined substantially. From the moment the decline began, there has been an ongoing debate among experts on the extent to which this should be regarded as an accomplishment of the program. The question of whether and to what extent the fertility decline can be attributed to the family planning program is one of Table 1.2. Reported use of methods of birth control in successive surveys (percentages of currently married women aged 15-49) Methods

1976

1987

1991

1993*

1994

1997

Official program methods IUD Pill Injectable Implant Condom

17.2 4.1 11.6

40.7

43.7 13.3 14.8 11.7 3.1 0.8

48.6

48.4

10.3 17.1 15.2 4.9 0.9

51.3

1.5

13.2 16.1 9.4 0.4 1.6

8.1 15.4 21.1 6.0 0.7

Program promoted but nonofficial methods Female sterilization Male sterilization

0.1

3.3

3.3

3.0

3.8

3.4

0.1 0.0

3.1 0.2

2.7 0.6

2.3 0.7

3.1 0.7

3.0 0.4

1.4**

2.7 1.1 0.8 0.8

2.7 1.1 0.8 0.8

54.7 45.3

57.4 42.6

Traditional and folkloric methods Rhythm Withdrawal Traditional (herbs or massage) and other methods

0.8 0.1 0.1

1.0

6.0 1.2 1.3 3.5

2.7 1.1 0.7 0.9

Reported use of any method No method

18.3 81.7

49.8 52.3

49.7 50.3

12.0 17.5 15.5 3.0 0.6

53.1 46.9

Notes: A dash indicates that data are not available in the particular surveys reviewed to compile this table. *Data from the large-scale SUSENAS (National Social and Economic Surveys) conducted annually by the Biro Pusat Satistik in Jakarta. **Includes categories of 'other methods' and 'traditional methods'. Sources: 1976 SUPAS, 1987 Contraceptive Prevalence Survey, 1991, 1994, and 1997 Indonesian Demographic and Health Surveys, and 1993 SUSENAS, all compiled and published by the Central Bureau of Statistics. A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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the issues taken up in this book. Whatever one's views on this issue, it cannot be denied that the use of modern methods of birth control has increased steadily during recent decades. As Table 1.2 shows, the percentage of married women aged 15-49 who reported using official program methods rose from 17.2 in 1976 to 51.3 in 1997. If the (non-program) methods of vasectomy and tubectomy are added, the corresponding percentages are 17.3 and 54.7. The figures in Table 1.1 clearly chart the fertility transition that took place in Indonesia during the past decades. Although there is widespread debate about the causes, there have been few attempts to define the phenomenon. There is a consensus that the crucial indicator is the timing of the last birth. A fertility transition is brought about by cessation of childbearing well before the woman loses the physiological capacity to reproduce. Fertility control is practised once the desired family size has been achieved (McDonald 1993:5). A significant change in timing of the last birth implies not only the practice of birth control, but also its application at an early stage in a woman's reproductive life-span. There can be no doubt that Indonesia, like other Southeast Asian countries such as Thailand and Singapore, and, to a lesser extent, Malaysia and the Philippines, underwent a fertility transition, in the sense outlined above (Rele and Alam 1993). However, identifying a phenomenon is not the same as explaining it. In this book we venture an attempt at explanation for the Indonesian case. The demographer Ansley Coale (1973:65) once formulated three preconditions for the onset of fertility transition. The first one is that fertility is brought under the calculus of conscious choice. The second one is that lower fertility is perceived to be advantageous, and the third one is that the means to control fertility are available. At first glance one would say that the family planning program was instrumental in meeting only the third precondition. As said in a World Bank publication on effective family planning programs: 'Organized family planning programs have contributed significantly to contraceptive availability and acceptability and therefore to fertility reduction' (World Bank 1993:11). But, for various reasons, it can be assumed that the family planning program also played a role in meeting the second and even the first precondition. In order to substantiate this assumption it is necessary to look at family planning ideology and practice in terms of Indonesian society. Beyond the Indonesian context there is the context of the global debate on population, which also influenced Indonesian population and family planning policies. After explaining the justification for this book, we will sketch this contextual picture of family planning in Indonesia.

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Why this book and what are its objectives

Apart from the political momentum, there were several additional reasons for us to compile this book. First, we believe that it is relevant to document the fertility transition that took place in Indonesia and the role the family planning program played in this transition. By bringing together insights and research findings from several sources, we hope to shed light on the variables involved, their contextual nature, and their interrelationships. In the second place, the gradual acceptance of family planning and the decline of fertility in Indonesia can together be seen as an expression of, perhaps even a metaphor for, social change in Indonesia. This should be interesting for scholars of Indonesian studies. In the third place, the description of the Indonesian national family planning program, including the role women played in it, will be of interest to students and professionals in the fields of population, fertility, and women's roles, in Asia but also elsewhere. A fourth reason lies in the fact that the population policy designed at the beginning of the New Order reflect the belief in the efficacy of top-down, planned economic development which prevailed in capitalist economies at that time. The benefits of economic growth were assumed to 'trickle down' to the poor. To achieve this, the population growth had to be curbed, and the people had to be convinced that birth control would be in their own interest in the end. Family planning programs in countries like India and Indonesia can be seen as applications of this paradigm of the primacy of economic development. We believe that the Indonesian family planning program provides an interesting illustration of this. Several authors (for instance Robinson 1989) have stressed the character of family planning in Indonesia as orchestrated within the framework of the culture of development. As to why this book now, there is an easy answer. In May 1998 an era ended, and the family planning program was one of its markers. Indonesia's new leadership faces the task of building a new and hopefully more democratic society. At this point it is important to understand the nature, achievements, and biases of the family planning program as it was designed and implemented during and by the New Order regime. Given the justifications outlined above, two main objectives of the book can be identified. These objectives serve as central themes that order the chapters and their content. The first objective is to provide a comprehensive description of a family planning program that is unique. The description will largely proceed along chronological lines, which is why we start by describing family planning initiatives prior to the New Order, and also look at developments beyond it. Placing family planning in its various contexts is crucial to this comprehensive description. Hence, we will look at the historical, political, socio-economic, and cultural contexts in which the program A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

Introduction

5

evolved. At another level of description the historical angle is important. A picture of the history of the program itself will emerge in the course of the book. It should be placed against the international debate in which family planning programs were first seen as instruments for population control, and at a later stage - after the Cairo conference in 1994 - as tools for enhancing reproductive health and reproductive rights. The role of non-governmental organizations in the field shifts likewise. In the last chapter we summarize these developments under the subheading 'the sway of the pendulum'. The second objective of the book is to take a closer look at the fertility transition that took place in Indonesia during recent decades and the role of family planning in it. Human populations cannot be subjected to laboratory experiments. It is impossible to control the variables that are involved in social change, including fertility transition. At the macro level, correlations between variables and trends may be identified, but they do not tell us much about causality and the mechanisms involved. We try to identify the variables and issues involved in fertility decline in Indonesia, using Coale' s principles (see above) as a theoretical framework.

The context offamily planning There is an external and an internal context to family planning. By the external context we mean the factors impinging on the lives of women and families over which they have no control but which influence the reproductive choices they make. The dynamics of these factors derive from beyond the locus of the domestic domain. To women and families, the outcomes of these dynamics are more or less given. Such factors can include economic change, government policies, ideologies, political power struggles, international trends, international development assistance, and technological developments. By the internal context we mean the structure of the immediate environment of women and families, such as the household, the kinship network, and the neighbourhood. Household and family variables will influence reproductive decision-making, but the outcomes of this will, in turn, influence household and family variables. Family planning is an integrated part of this structure. Depending on how we look at family planning, it relates to 'the public issues of social structure' or to 'the personal troubles of milieu' (Wright Mills 1971). Policy-makers may emphasize the general or public interest or may appeal to elements of the internal context of family planning. As it is, the designers of Indonesia's family planning program did both. Both perspectives are represented in the two main objectives of the national family planning program. The first objective, curbing population growth and achieving A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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replacement-level fertility, is part of the external context of family planning and is an answer to a public concern. The second objective of institutionalizing the 'small, happy, and prosperous family' norm was made to appeal to the internal context of family planning and people's personal troubles and concerns. The formulation of population and family planning policy had this dual character from the start. Below, we explore the content of these two contexts of family planning.

The international context From the late 1950s up to the early 1970s, the global debate on population was neo-Malthusian in character. There was growing concern among politicians, intellectuals, and policy-makers about the capability of the earth and its food supplies to sustain the world's population, which was growing at an unprecedented rate. The rapid population growth, particularly in the so-called developing world, brought Malthus's gloomy scenario back into the limelight. Now that Malthus's 'positive checks' were not an option anymore, other ways to slow down population growth had to be found. Also, Malthus's 'preventive checks', which boiled down to postponement of marriage, were no solution in the short term. 2 Unlike his contemporary Condorset, Malthus did not believe in the rationality of people to try to limit their births voluntarily (Sen 1994). It was in this climate that the term 'population control' was coined. It reflected neo-Malthusian concerns. As instruments for population control, family planning programs and projects were set up in developing countries, and the rich countries were willing to fund these. At the first international population conference in Bucharest in 1974, a debate raged between rich countries emphasizing the need for population control on the one hand, and poor countries prioritizing poverty alleviation on the other. Once a certain level of welfare had been reached, population would take care of itself, was the line of thinking among the group of countries that saw poverty alleviation as a first priority. Indonesia had just entered the New Order at the time this debate was at its peak. For Suharto, economic development was indeed the first priority. But he did not think that population would take care of itself. The technocrats at the Bappenas (National Planning Board) warned against unchecked population growth in Indonesia, which would defeat all efforts at bringing about sustainable economic development (Aris Ananta 1997). Hence, a national population policy and the national family planning program were As explained in several chapters of this book, rise in age of first marriage during the period indeed proved to be an important factor in the decline of fertility.

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designed. Family planning was given high political priority and funding for it was secured. Donor countries were willing to put money into it. The next international population conference in Mexico City, in 1984, reflected increasing attention for women's issues. The second feminist wave had reached policy-makers worldwide. There was growing awareness of the importance of the role of women in family planning and population activities. Increasingly, feminists and women's groups criticized the way women were treated in family planning programs: as passive targets. Consequently, in the Indonesian family planning program too, more activities came to be specifically directed at women and (perceived) women's needs. The savings-and-credit programs and the income-generating programs for women, carried out within the framework of the family planning program, illustrate this change. But empowerment of women was never an objective of the family planning program, and critics pointed out that the interests and needs of women were still insufficiently taken into account. The most recent international population conference was the International Conference on Population and Development (ICPD) in Cairo, in 1994. Two concepts occupied centre stage at this conference: reproductive rights and reproductive health. The focus on reproductive rights reflected the growing importance of the global human rights lobby. A consensus was reached about reproductive rights as being part and parcel of human rights. For Indonesia, this called for a critical assessment of the implementation of the family planning program, among other things to guarantee free and informed choice of contraceptives. It also entailed taking the reproductive rights of individuals into account regardless of their marital or family status, which was at odds with the conservative attitudes of the leaders of the Indonesian family planning program at the time. The New Order family planning promoters could be called 'conservative revolutionaries'. 3 They promoted a huge change in birth control, but limited access by the unmarried. The consensus on the importance of reproductive health represented a challenge for Indonesia in several ways. In the first place it meant that Indonesia would now have to seriously tackle the high level of maternal mortality. The focus on reproductive health also challenged the family-based approach of reproductive health services in Indonesia, which had led to a neglect of the reproductive health needs of unmarried adults and adolescents. As to implementing the Cairo Plan of Action, there is still much to be done in Indonesia, but then, this holds true for other countries as well. Another element of the international context of family planning in Indonesia is the revolution in reproductive technology. The second half of the twentieth century witnessed an array of inventions in the field. The pill, 3

This term was suggested to us by Terence H. Hull (personal communication).

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the IUD, the injectable, and the implant, to mention the most important ones, provided women with far more options for fertility regulation than ever before. Through the family planning program Indonesian women gained access to these new contraceptive means. The other side of the coin is that, as the means became more sophisticated, this led to an increasing dependency on trained providers. The title of a book on the subject by Jyotsna Gupta (1996), New Freedoms, New Dependencies, reflects this dilemma. To Indonesian women these new contraceptive methods were attractive because they could offer a longer-lasting protection against pregnancy. Most important is that, for Indonesian men and women as well, the accomplishments of reproductive technology paved the way for the separation of sex and reproduction. As Gupta (1996:23) phrases it: 'The discovery of modem contraceptive technologies severed the automatic connection between active heterosexuality and conception - sexual intercourse between two people of different sexes need not necessarily lead to a pregnancy'.

The national context of family planning Although the national context of family planning in Indonesia is the principal theme of the whole book, we will reflect briefly on it here in general terms. The national political context is shaped by national policies and political structures. Both have been crucial for the development and achievements of the family planning program. Political commitment at the highest level to the cause of fertility decline has been cited by many observers as an important factor in the success of the program (McNicoll and Singarimbun 1986; Caldwell 1991:214). This book discusses the relationship between the objectives and form of the family planning program on the one hand, and political priorities and development policies on the other. Apart from the political context, macro-economic and social structures form part of the national context within which the family planning program was designed and implemented. Under the New Order, there was a steady rise in the levels of formal education and school emolment among the Indonesian population4 • Infant and child mortality declined significantly during the period (BPS 1994:58; Survey 1995:138). Furthermore, economic development led to an overall decline in poverty5 and a rise in people's aspirations. All these factors lent credibility to the family planning message. Whether directly or indirectly, they influenced the institutionalization of the 'small, happy, and prosperous family' norm. At the national level, prevailing gender and family ideology coloured the 4

UNICEF 1990; Hugo et al. 1987:281-3; Oey-Gardiner 1997. World Bank 1990:41; Ahuja et al. 1997:6-7; Booth 2000.

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approach of the national family planning program. The program had a very strong family focus from the start. Unmarried individuals were not admitted to family planning services. In this ideological framework, women were primarily seen as wives and mothers, in accordance with their kodrat, or destiny (Niehof 1998). With the establishment of the Ministry for the Empowerment of Women in 1978, women were also seen as important actors in the development process. Gradually, the balance shifted and women's needs came to be recognized in their own right. This was brought about by the post-Cairo emphasis on reproductive health and reproductive rights and by the increasing voice and legitimacy of new women's organizations. These were different from the government-initiated or government-supported women's organizations (such as the Dharma Wanita, and to a lesser extent KOWANI), which were strongly based on traditional gender ideology. In his discussion of the explanation of fertility decline in Asia, Peter McDonald (1993) points to the relevance of the theory formulated by Geoffrey McNicoll about the impact of institutional change. McNicoll (1980) argued that institutional change associated with the growth of the modern state may drastically alter relationships and institutions which are intrinsically related to reproductive behaviour. The institutional changes listed are: the advance of education, the ability of the state to control conservative religious forces, and direct state interventions in the promotion and organization of family planning. McDonald (1993:13) concludes that this theory of institutional change as being conducive to fertility decline seems applicable to Asia. It certainly seems applicable to Indonesia. However, changes in the institutional framework for health care delivery, which led to a significant decline in infant and child mortality, must be taken into account as well. At the interface between the institutional context and the domestic domain, institutional changes could directly affect intra-family and household relationships, women's roles, and the value of children.

The internal context offamily planning For the internal context of family planning we look at the role played by family planning ideas and practice in the domestic sphere. Two elements warrant particular attention. The first element is the value of children, the second the position of women. In the early 1970s, the Indonesian saying banyak anak, banyak rezeki (to have many children brings prosperity) would still be promptly quoted when the ideal number of children was the topic of discussion. Gradually the popularity of this saying, and the conviction behind it, waned. Nowadays you will rarely hear it. Apparently, the slogan of the family planning program, dua anak cukup, Zaki perempuan sama saja (two children is enough, whether A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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boys or girls), caught on. This represents a tremendous change in the valuation of children, which took place in a mere three decades. Coale' s second precondition for the onset of fertility transition, which refers to the perceived advantages of having fewer children, was thus met. The causes for this cultural shift are many and complex. In our opinion, there are at least two important factors. The first is the significant decline in infant and child mortality that took place during the period. Although the relationship between fertility and infant and child mortality is a complex one, it is fairly certain that high infant and child mortality have an inhibiting effect on the motivation to practise birth control. Generally, once people are confident that their children will survive, they will consider limiting the number of their offspring. They will no longer need children to replace the ones who die. Edmondson claims, on the basis of her research in Bali, that the initial phase of fertility decline in Bali is perhaps best explained as 'an adaptation to the previous drop in infant mortality' (Edmondson 1992:3). The second factor of importance is what Caldwell (1982) in his classic study has referred to as the change of direction in the intergenerational flows of wealth. In short, the theory claims that fertility will decline when children become a cost and a net loss to their parents instead of being an asset and a net gain. During recent decades in Indonesia, the significance of children's labour gradually diminished as a consequence of economic change and modernization in the agricultural sector. At the same time, it became more important to send children to school, boys as well as girls. Formal education became increasingly positively valued. School enrolment levels rose steadily under the New Order. In the valuation of children, quality, in terms of health and education, came to replace quantity. Edmondson (1992) tested Caldwell's hypothesis on her Bali material, which covers the period from 1977 to 1990. The hypothesis was supported to the extent that the growth of the Balinese economy provided both the financial means for and interest in children's education, leading to a desire for fewer children. However, contrary to Caldwell's hypothesis, the net flows from (educated) children to parents continued. In 1990, 'parents view their economic security as better served by fewer, more costly, but educated children who can find salaried employment and contribute substantially more income to the parental household' (Edmondson 1992:2). As McDonald (1993:9) notes, Caldwell's theory is basically a microeconomic model, partly based on the work of Gary Becker, though it relates to macro-level change as well. The theory seems applicable to the Indonesian situation as far as the increasing importance of education and the accompanying increasing cost of children are concerned. To what extent this leads to a reversed flow of wealth between the generations, and whether it is this reversal that triggers fertility decline, remains to be seen. As noted, this was A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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not so in Bali. In any case, the process presupposes a certain degree of rationality in thinking about the number and value of children, which indeed is apparent in statements of respondents in interviews. The following quotations illustrate the point: Before, people said all children would find some work to do. Banyak anak banyak rezeki (many children, much good fortune). Some will hoe, some will collect firewood, and so on. They didn't think about school. Now we think about school for our children. (Robinson 1989:34.) You know, I didn't really think about it before. The old folks had lots of children and I just didn't think about it. The old people said banyak anak banyak rezeki [... ], and their future was up to the will of God. It's only recently that I have begun thinking about my responsibility for my children's future, so they will be educated. (Robinson 1989:38.)

These quotations reveal not only a change in the value assigned to children, but also a different attitude toward parenthood. Responsible parents send their children to school. Implicitly, Coale' s first precondition for fertility decline is thus met. The number of children is no longer something to take for granted or leave up to the will of God, but has been brought under the calculus of conscious choice. The second element in the domestic context that relates closely to the issue of family planning is the position of women. Women's place in the family is an important determinant of family planning motivation and behaviour, and is closely related to the gender relationships in the society as a whole and the norms and values underpinning these. Although these vary greatly in Indonesia, depending on ethnic group and class, traditionally Indonesian women have always enjoyed a relatively large manoeuvring space. Though the national ideology of the family pictures the man as the head of the family and household, women in many areas of Indonesia have always contributed substantially to the household livelihood through productive labour and income generation. According to a study carried out in a Madurese fishing village during the late 1970s, women's economic autonomy there afforded them a high degree of social autonomy and power in reproductive decisionmaking, resulting in a comparatively low level of fertility (Niehof 1985). In the beginning, the positioning of women in the family planning program suffered from this rather conservative and middle-class bias of seeing women as wives and mothers only, ignoring their economic roles and their individual needs. Gradually, through special programs, women's economic roles received more attention, because women were seen as the key to enhancing family welfare. Promoting the keluarga sejahtera was an important goal in New Order policies. Today's Indonesian women are older and better educated when they start raising a family than were their A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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mothers thirty years ago. As a consequence, they have different fertility careers. As to women's individual needs, it remained problematic to attend adequately to women's reproductive rights and needs in a program that confined them to family roles. The new leaders in the post-New Order period seem to have acknowledged this dilemma of having to carry out the Cairo agenda of reproductive rights and reproductive health on the one hand, and the family-centred nature of the family planning program on the other. Badan Koordinasi Keluarga Berencana Nasional (BKKBN, National Family Planning Coordinating Board) has now been placed under the leadership of the Ministry for the Empowerment of Women.

The set-up and contents of the book The book, in part, follows a chronological line. Chapters II to VI place the family planning program primarily in a historical and political perspective. Chapter VII focuses on local family planning practices. In the second part of the book, beginning with Chapter VIII, the emphasis is on the accomplishments and impact of the family planning program. An important question dealt with in this part of the book is the meaning of family planning for women. The perspective shifts between macro and micro levels. The book concludes with a chapter in which an attempt is made at summarizing the developments and experiences documented in the chapters. The materials and findings presented in the chapters are assessed against the objectives of the book as formulated at the beginning of this chapter.

Short description of the following chapters Chapter II deals with the family planning movement in the pre-New Order period. This was a time when the global debate on population and development was emerging. At the same time, international organizations were founded to promote responsible parenthood and birth control. The International Planned Parenthood Federation (IPPF) is an example. The Indonesian pioneers in the field belonged to the social, medical, and political elite of that time. Through their international contacts they discovered and tried to implement these new ideas in Indonesia. The Perkumpulan Keluarga Berencana Indonesia (PKBI, Indonesian Family Planning Association) was founded and became the Indonesian chapter of the IPPF. Chapter II concludes with a section about the changing role of the PKBI in the transition to the New Order. The author was raised in a 'pioneer' family planning family. Part of the information presented in the chapter is based on interviews with her mother, Sophie Sarwono, who played an important role in the family planning movement during the Soekarno era. A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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Chapter III describes the origin, structure, and development of the national family planning program. Attention is paid to the way in which the program was founded at the end of the 1960s, and how population came to be an important variable in the development programs. Subsequently, the structure of the program, the role of family planning fieldworkers, and the decisive role of the BKKBN are discussed. The chapter describes how the program was implemented during the first phase, in the provinces of Java and Bali. After the first phase of implementation, the gradual extension to other provinces is discussed, as are rural-urban differences. The chapter concludes with a section on the impact of the economic crisis on family planning behaviour and a discussion of the issues and challenges at the end of the New Order. The author worked in the field of family planning as a researcher, as a civil servant (working at the BKKBN during the late 1970s), as a university lecturer, and finally in his capacity as founder and director of an NGO for mother-and-child health and family planning in urban areas. Chapter IV places family planning in a political framework. The political roots of the family planning movement in Indonesia are meticulously unveiled, followed by a discussion of the political evolution of the family planning program. A picture of the bureaucratic politics of developing a population program (1970-1988) is presented. The author also shows how family planning became involved in national and international political controversies. The chapter concludes by placing Indonesian family planning in a changing political context and looking at the future of reproductive health care in Indonesia. The chapter offers a wealth of detail and draws on a wide array of sources (including newspapers). It casts new light on important actors, including former governor of Jakarta Ali Sadikin, and on international connections. The author is a social demographer, internationally known for his work on Indonesia, who is presently attached to the Australian National University in Canberra. Chapter V focuses on the role of the international donor community in contributing to the means needed for developing the program. The focus of the chapter is the unique partnership role that foreign donors played in the Indonesian family planning program, in which foreign assistance was an important and constructive feature. It is conventional to distinguish between bilateral and multilateral aid. The chapter discusses assistance to the family planning program by four donor agencies in more detail: the bilateral assistance provided by the USA (AID) and the Netherlands, and the multilateral assistance provided by UNFPA and the World Bank. The author worked in Jakarta for several years, attached to the United States Embassy. Chapter VI begins where Chapter II leaves off. It starts with a discussion of the role of the PKBI under the New Order, noting that in the beginning, the PKBI training centres were important in training family planning personA. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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nel, but that gradually this was taken over by the BKKBN. Subsequently, the PKBI specialized in counselling, through their Wisma Panca Warga clinics. Counselling of young people and menstrual regulation were part of the package. Other NGOs (non-governmental organizations) in the field are discussed as well. The complementary role of NGOs in the field of family planning is an important issue. These organizations were relatively free to tackle sensitive issues or to take a critical stance toward the national family planning program. At the end of the chapter, their strong and weak points are reviewed. The author has longstanding experience working for family planning and women's NGOs, particularly in the field of family planning counselling. Chapter VII emphasizes the importance of the local, the personal, and the cultural in the dissemination of family planning ideas and practices. It focuses on what we earlier referred to as the internal context of family planning. To illustrate this perspective, four case studies are presented. The first concerns the Serpong Project. It provides an example of program implementation during the early days (1971-1975). The project was a joint Indonesian-Dutch project for family planning research and training. The project area was the sub-district of Serpong in Tangerang, West Java. At the start of the project a high level of fertility prevailed and contraceptive use was virtually negligible. The case describes how modem family planning was introduced in a then traditional rural society. The second case is about Bali. Family planning was surprisingly rapidly accepted in Bali. One of the main reasons given for this in the literature is the firm anchoring of the program in the traditional banjar (community) structure. Bali provides an interesting example of the community-based approach in the family planning program. The third case is based on a study of family planning among the Minangkabau of West Sumatra. Not only the area but also the time perspective differs from that of the first and second cases. In the Minangkabau case we see the operation of the family planning program during the early 1990s. The last case highlights the way family planning policy-makers tried to relate to economic roles of women in the family. It focuses on an income-generating project for family planning acceptors groups in West Java. At the base of the income-generating program of BKKBN is the discussion about the relationship between women's economic activities and their family planning motivation. The project was carried out at the end of the 1980s. The authors both have considerable expertise in fertility and family planning research in Indonesia. The first author worked for four years at BKKBN as a consultant and was at the time responsible for technical assistance to the income-generating project described in the fourth case. Chapter VIII is the first chapter in which the accomplishments and impact of the family planning program are systematically addressed. It discusses the measurable quantitative impact of the program. What has been the contribuA. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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tion of the program to fertility decline? How important has fertility decline been for economic development? These are the core questions of this chapter. The chapter starts with a discussion of key demographic trends in Indonesia, then deals with the questions mentioned above, and it concludes with a section on the longer-term consequences of fertility decline. The author is a wellknown scholar on the social demography of Indonesia and Southeast Asia, presently attached to the Australian National University in Canberra. Chapter IX focuses on Indonesian women and fertility patterns in their social context under the New Order. The central assumption is that clues for explaining the fertility transition in Indonesia can be found in the changes in Indonesian women's lives. It is shown how women's roles with regard to mothering and working have changed during the past decades. Combined with access to modern contraception, this led to changes in the fertility careers of Indonesian women. This becomes visible when looking at the position and options of young women now, compared to those of their mothers thirty years ago. The chapter also pays attention to the study of Indonesian women and the ideological frameworks in which women's roles were and are placed. The author worked in Indonesia for several years, as a researcher, university lecturer, and later as a consultant. Chapter X discusses the findings of the Women's Studies Project (WSP), a project of the Family Health International, an international US-based NGO, implemented during 1993-1999. One of the countries selected for field studies was Indonesia. The central topic was the impact of family planning on women's lives. Within this framework four research projects in different parts of Indonesia were carried out. In the first part of the chapter the findings of these projects are discussed. Topics include: reasons for participating in family planning; family planning, women, and work; family planning and women's autonomy; family planning and family welfare; patterns of reproductive decision-making. In the second part of the chapter the results of in-depth interviews on these subjects with women in Jakarta and Makassar are discussed. The findings show a weak association between empowerment and family planning in the first research location (Makassar) and virtually none in the second research location Q"akarta). The chapter provides an insightful view into the black box of the Indonesian family, focusing on the internal context of family planning. The chapter concludes with a discussion about making the family planning program responsive to women's concerns. The authors were all involved with the WSP as researchers or research supervisors. Chapter XI follows logically on the observation in the previous chapter about the lack of focus on women's needs in the family planning program. Indonesia was one of the signers of the Cairo Plan of Action (1994), in which reproductive rights and reproductive health care are key elements. In the first part of the chapter the state of reproductive health (care) in Indonesia is A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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assessed. The high level of maternal mortality in Indonesia is an important element in this assessment. The second part discusses the problems in securing reproductive health care, namely cultural biases and problems of access. The third part deals with requirements for a reproductive health agenda and future priorities. The authors all work in the field of what is now called reproductive health, as researcher, university lecturer, or consultant. In Chapter XII, the last chapter of the book, conclusions are drawn by the editors. The development of the family planning program through the years and in its various contexts is summarized under the heading 'the sway of the pendulum'. The concern about women's reproductive health, which is gaining ground today, resembles the concerns of the pioneers under the Old Order about responsible parenthood, women's health (the term 'reproductive health' had not yet been invented), and safe birth control: so we have come a full circle. Furthermore, the chapter draws conclusions on the second objective of the book, the explanation of the fertility transition in Indonesia and its relationship to social change. A separate section is devoted to the much-debated issue of family planning and gender equity under the New Order. The chapter concludes by looking ahead, to identify relevant trends in the post-New Order period.

Bibliography Ahuja, V., B. Bidani, F. Ferreira and M. Walton 1997 Everyone's miracle? Revisiting poverty and inequality in East Asia. Washington DC: World Bank. [Directions in Development.] ArisAnanta 'Letter from the year 2020', in: Gavin W. Jones and Terry H. Hull (eds}, 1997 Indonesia assessment; Population and social resources, pp. 334-7. Singapore: Institute of Southeast Asian Studies, Canberra: Research School for Asian and Pacific Studies, Australian National University. Booth, Anne 'Poverty and inequality in the Soeharto era; An assessment', Bulletin of 2000 Indonesian Economic Studies 36-1:73-104. BPS Profil statistik ibu dan anak di Indonesia 1993. Jakarta: Biro Pusat Statistik. 1994 Caldwell, John C. 1982 Theory offertility decline. New York: Academic Press. 1991 The soft underbelly of development; Demographic transition in conditions of limited economic change. Washington DC: World Bank. Coale, Ansley J. 1973 'The demographic transition reconsidered', Proceedings of the International Union for the Scientific Study of Population. Liege: IUSSP.

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Edmondson, Janet C. 1992 Bali revisited; Rural economy, intergenerational exchanges, and the transition to smaller family sizes, 1977-90. Den Pasar: Universitas Udayana. Gupta, Jyotsna Agnihotri 1996 New freedoms, new dependencies; New reproductive technologies, women's health and autonomy. [PhD thesis, Leiden University.] Hugo, G.J., T.H. Hull, V.J. Hull and G.W. Jones 1987 The demographic dimension in Indonesian development. Singapore: Oxford University Press. [East Asian Social Science Monographs.] McDonald, Peter 1993 'Fertility transition hypotheses', in: Richard Leete and Iqbal Alam (eds), The revolution in Asian fertility; Dimensions, causes, and implications, pp. 3-14. Oxford: Clarendon. [International Studies in Demography.] McNicoll, G. 1980 'Institutional determinants of fertility change', Population and Development Review 6:441-62. McNicoll, Geoffrey, and Masri Singarimbun Fertility decline in Indonesia; Analysis and interpretation. Yogyakarta: 1986 Gadjah Mada University Press. Niehof, Anke 1985 Women and fertility in Madura, Indonesia. [PhD thesis, Leiden University.] 1998 'The changing lives of Indonesian women; Contained emancipation under pressure', Bijdragen tot de Taal-, Land- en Volkenkunde 154:236-58. Oey-Gardiner, Mayling 1997 'Educational developments, achievements and challenges', in: Gavin W. Jones and Terence H. Hull (eds), Indonesia assessment; Population and social resources, pp. 135-67. Singapore: Institute of Southeast Asian Studies, Canberra: Research School of Asian and Pacific Studies, Australian National University. Rele, J.R. and Iqbal Alam 1993 'Fertility transition in Asia; The statistical evidence', in: Richard Leete and Iqbal Alam (eds), The revolution in Asian fertility; Dimensions, causes, and implications, pp. 15-37. Oxford: Clarendon. [International Studies in Demography.] Robinson, Kathryn 1989 'Choosing contraception; Cultural change and the Indonesian family planning programme', in: Paul Alexander (ed.), Creating Indonesian cultures, pp. 21-38. Sydney: Oceania Publications. [Oceania Ethnographies 3.] Sen, Amartya 1994 'Population and reasoned agency; Food, fertility, and economic development', in: Kerstin Lindahl-Kiessling and Hans Landberg (eds), Population, economic development, and the environment, pp. 51-73. Oxford: Oxford University Press. Survey 1995 Indonesia demographic and health survey 1994. Jakarta: Central Bureau of Statistics, National Family Planning Coordinating Board, Ministry of Health, Maryland: Macro International.

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The state of the world's children. Oxford: Oxford University Press. World development report 1990. Oxford/New York: Oxford University Press. Effective family planning programs. Washington DC: World Bank.

1993 Wright Mills, C. The sociological imagination. Harmondsworth: Pelican. 1971

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CHAPTER II

Family planning in Indonesia under the Old Order Solita Sarwono

In this chapter a detailed account is provided of the discourse about family planning activities under the Soekarno regime. This period prior to the Orde Baru, or New Order, is commonly referred to as Orde Lama, or Old Order. In spite of the implied opposition, the two periods show some continuity as regards the importance of family planning, especially in relation to motherand-child health. The story of family planning activities during the Old Order is much coloured by the private initiatives of individuals. These individual men and women belonged to the social, medical, and political elite of Indonesian society. The founding of the Perkumpulan Keluarga Berencana Indonesia (PKBI, Indonesian Family Planning Association) was the result of their efforts. In spite of President Soekarno' s discouraging attitude, they persisted in their activities of disseminating information and setting up delivery of services. When family planning became a policy priority of Suharto's New Orde~ the foundations had already been laid.

Demographic and health indicators in 1950-1965 During the first decade after Indonesia gained its independence in 1945, the overall health status of Indonesians was very poor and the range of health services delivered very limited. The crude death rate for 1950-1955 was 28.3 per thousand. It declined to 26.2 during the following five-year period. The infant mortality rate was 175 during the 1950s, declining to 150 during the 1960s. As noted in a World Bank Report (Hugo et al. 1987:117-20), these rates are higher than those of most of the neighbouring countries during the same period. In the Philippines, Thailand, Malaysia, and Singapore the infant mortality rates were 106, 103, 72, and 35 respectively. Only in Burma was the A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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infant mortality rate higher (158). Health care facilities and the number of health professionals were insufficient for serving a population of 97 million in 1961. There were only 976 physicians serving the entire population, resulting in a ratio of one doctor to 97,600 people. The total number of hospitals was 832 (one hospital for 114,494 people), with 75,819 beds (one bed per 1,156 people) (Hugo et al. 1987:111). The high mortality rates were paralleled by high birth and fertility rates. The crude birth rates were 47.31 and 46.58 in 1950-1955 and 1955-1960, respectively (Hugo et al. 1987:137), whereas the total fertility rate was 6.4 per woman in 1960 (PKBI 1982:6). Women tended to marry young. In Java in 1964 the mean age of women at first marriage was 18.l years and the average family size was 4.6 children per woman (Hugo et al. 1987:152-61; Jones 1994:80). In the early 1950s modern contraceptive methods were virtually unknown in Indonesia, and birth control practices were limited to a small proportion of the population, who used less effective, traditional methods. The term 'birth control' even had a negative connotation, because people associated it with pest control in agriculture and with eradication in general.

The social and political climate during the 1950s and 1960s In 1952, the Federation of Indonesian Women's Organizations (GOWI), meeting in Yogyakarta, passed a resolution firmly rejecting birth control. It did so on the grounds that birth control was an infringement of the basic human right to life, would result in the murder of unborn children, might increase prostitution, and would lead to a general decline in morality (Atmosiswoyo 1978:21). State law prohibited the distribution and use of all methods to prevent pregnancies as stated in Article 534 of the Criminal Code (KUHPI). 1 Soekarno, the first president of Indonesia, discouraged population control. In 1964 he stated: 'My solution is to exploit more land - because if you exploit all the land in Indonesia you can feed 250 million and I have only 103 million. In my country, the more [children] the better' (Hugo et al. 1987:26). He is reported to have said proudly in public that Indonesian women could reproduce like rabbits. Soekarno believed that to become a great nation, Indonesia needed a large population. Soekarno' s pro-natalist attitude is reflected in the demographic trends of the 1960s, with the population growing at a rate of 2.8% per year (Atmosiswoyo 1978:24). Throughout the country, marriage traditionally occurred early and birth rates were high, whereas life expectancy at birth was only 37.5 years in Since the acceptance of family planning as a national program this law has been amended.

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1955-1960 (Hugo et al. 1987:117). Contraceptive prevalence among women aged 15-49 was below 5%, abortion was illegal, and a large proportion of the population was under fifteen years (Ross and Poedjastuti 1983:70). Despite the pro-natalist climate during the Soekarno period, and even earlier during colonial times, there were organizations inside and outside the country that supported the dissemination of birth control methods in Indonesia. The credit for the first steps toward a national birth control program lay mainly with community leaders and influential women's groups, who perceived a need for family planning services among individuals and for raising awareness about contraception. In 1952, a group of prominent women in Yogyakarta established the Yayasan Kesejahteraan Keluarga (YKK, Family Welfare Foundation). The primary aim of this foundation was to improve mother and child health and welfare. Despite local opposition, the provision of contraception was included as one of the means to achieve this aim. In its education and promotion programs, YKK did not use the term 'birth control', because it would remind people of the word 'pest control'. Pest control was much practised in agriculture at the time, and it had the connotation of 'eradication'. Therefore, a more acceptable term was introduced instead: 'family planning'. Clients for these services were reported to be very few at the time, but the fact that the service could be provided at all, given the prevailing unfavourable climate, was an achievement. In 1953 a group of gynaecologists of the Central Hospital in Jakarta started a postnatal care program. Six weeks after childbirth the mothers were examined, and those falling in high-risk categories were advised to postpone their next pregnancy by means of contraception. The methods suggested were coitus interruptus, periodic abstinence, and the use of condoms. Discretely, to avoid negative reactions from the community and the government, this program was extended to other regions. However, as contraceptive devices were generally difficult to obtain and relatively expensive at the time, people often resorted to simple, rather ineffective, traditional methods (Atmosiswoyo 1978:21).

The founding of the Perkumpulan Keluarga Berencana Indonesia (PKBI) In early 1957, Mrs Dorothy Brush, the director of the Brush Foundation, visited Indonesia to explore the possibility of establishing a family planning organization. She got in contact with the private physician of President Soekarno, Dr Soeharto, who was also chair of the Indonesian Medical Association. With Dr Soeharto she discussed birth control, marriage counselling, and the feasibility of establishing a family planning organization. Some A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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time later, at her request, Dr Abraham Stone, from the Margaret Sanger Research Institute in New York, came to Jakarta to give further information on marriage counselling and birth control. These meetings encouraged Dr Soeharto to discuss these matters with his colleagues. Eventually, on 23 December of that year, the Perkumpulan Keluarga Berencana Indonesia (PKBI), or Indonesian Family Planning Association, was officially established, with Dr Soeharto as chair and Dr Hurustiati Subandrio (wife of the then Minister of Foreign Affairs Dr Subandrio) as deputy chair. Other board members were: the obstetrician and gynaecologist Prof. Joedono, Mrs Sjamsoeridjal (wife of the governor of Jakarta at the time), Mrs Pudjotomo (member of the Central Advisory Committee on Marriage and Divorce), Mrs Nani Suwondo (a lawyer and prominent figure in the women's movement) and Mrs M. Oentoeng, from the Indonesian Association of Midwives. With these board members the PKBI hoped to gain the support and trust of the community. As a non-governmental and non-profit organization, the PKBI started with 62 members. Eleven of these were medical. doctors. The others were concerned government officials and prominent community leaders. Since its inception, the PKBI has been popularly known as a pioneer in the family planning movement in Indonesia. It was the first Indonesian organization founded specifically for family planning. During its initial years of operation, its activities were mainly focused on family planning advocacy, IEC (information, education, and communication), and services. The services consisted of marriage counselling and therapy for infertility and birth spacing. PKBI had to be very careful in conducting its activities due to the government's opposition. Given this opposition, the activities were only carried out in its clinics, which were found in major cities in Java and Bali. From the start, the PKBI received support from international donors. The first organization to give financial support was the Pathfinder Fund.

Family planning pioneers In its operations2 the PKBI has always involved government officials who showed concern for population problems. Hurustiati Subandrio, an adviser to the minister of health, is an example. She became active by promoting family planning among wives of medical doctors. Her family planning advocacy went further, even reaching the president. As a minister's wife she had frequent opportunities to meet the president on an informal basis. Knowing The information about Hurustiati Subandrio and other PKBI pioneers was obtained from Sophie Sarwono.

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the president's pro-natalist views, and wanting to convince him of the importance of family planning, Hurustiati Subandrio refrained from mentioning 'population control'. Rather, she stressed the importance of improving the health of women and children. She emphasized that healthy women and children make for a strong nation. Indeed, given the high infant mortality rate at the time, there was a strong need to improve the health of women and children, as many of them suffered from disease and poor nutrition. In her friendly dinner conversations with Soekarno, in her jokes, and while dancing lenso with him, Hurustiati Subandrio persuaded Soekarno to permit the BKIA (mother-and-child clinics) to promote the health of mothers. Her approach was successful. In her position as adviser to the minister of health and wife of the minister of foreign affairs, Hurustiati Subandrio contacted various international organizations and asked them to support Indonesian family planning activities with contraceptives and medical supplies. Contraceptive devices, very scarce then, were brought into Indonesia in diplomatic bags. These diaphragms, IUDs, spermicidal jelly, pills, and condoms were distributed through the Ministry of Health to its BKIA clinics in major cities of Java and Bali, as well as to military clinics and general hospitals. Hurustiati Subandrio was very active, both in her capacity as a PKBI leader - deputy president in 1957-1963 and president in 1963-1965 - and as an adviser to the minister of health. She travelled to various cities, giving talks to groups of medical doctors, nurses, paramedics, and social workers. She encouraged her audiences to open local PKBl chapters, since BKIA clinics needed the support of a non-governmental organization to provide family planning services and to distribute the contraceptives. As a result of Hurustiati Subandrio's active promotion, by 1964 there were eight PKBI chapters and 59 family planning clinics in various cities in Java, Bali, and Sumatra (PKBI 1982:26). In promoting family planning in Indonesia, Hurustiati Subandrio' s activities worked as a double-edged sword, cutting both ways. Her contribution to the PKBI and to Indonesian family planning in general was indispensable. That is why, during the Suharto period, when nobody dared to mention the name Subandrio due to his presumed involvement in the communist coup d'etat in 1965, the PKBI never refrained from mentioning and acknowledging Hurustiati Subandrio as a pioneer in the family planning movement. Hurustiati Subandrio's efforts to convince President Soekarno were supported by Dr Soeharto, the president's private physician. Dr Soeharto had frequent contact with Soekarno. He always accompanied the president on his travels. During informal meetings, he told the president of his experiences helping women in delivery and spoke of the many women and babies who died during labour due to poor health. His contacts with experts in various countries had convinced Dr Soeharto of the importance of implementing A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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family planning in Indonesia. His position as founder and first chair of the Indonesian Medical Association (1950) enabled him to facilitate the PKBI in carrying out its activities. Another figure who contributed much to the promotion of family planning in Indonesia is Dr Sulianti Saroso, a high official at the Ministry of Health. She gave lectures on family planning to medical students at the University of Indonesia in Jakarta and students of Gadjah Mada University in Yogyakarta, and consistently supported family planning services at BKIA clinics. Soon afterwards, family planning was made a teaching subject at the medical schools of other universities. If Hurustiati Subandrio was known for her lobbying and diplomacy in promoting family planning ideas, Sulianti Saroso became known for supporting the implementation of family planning. Dr Koen Suparti Martiono, a gynaecologist serving at Jakarta's Municipal Health Office, was one of the founders of PKBI and was actively involved in the organization until the late 1970s. She was a member of the PKBI board in 1956-1964, treasurer in 1964-1967, and in charge of PKBI's medical and contraceptive supplies and facilities in 1967-1970. Koen Martiono played a significant role in promoting family planning and supporting PKBI later on. She was able to convince the governor of Jakarta, Ali Sadikin, to support family planning. Governor Ali Sadikin became the first high-ranking Indonesian official to publicly support family planning; he declared Jakarta open for family planning services. In 1967 he launched a family planning project for Jakarta, chaired by Dr Herman Susilo. Koen Martiono was appointed as the executive director. Governor Ali Sadikin donated a piece of land to PKBI. This became the present location of PKBI's head office and training centre. Following Jakarta's example, other major cities soon began to allow family planning activities. A young staff member at the Department of Population Statistics in the Jakarta Municipal Office performed outstandingly. His name was Haryono Suyono. Upon Koen Martiono's recommendation, Haryono received a grant from Ali Sadikin to study in the United States. Haryono completed his studies and received a doctorate in communication sciences from the University of Chicago. In 1985, Haryono Suyono was appointed chair of the BKKBN (National Family Planning Coordinating Board) and kept this position till 1998. During one of her trips to Bogar in 1959, Hurustiati Subandrio met Sophie Sarwono, an old friend from the students' association. Sophie Sarwono had heard of the PKBI in Jakarta and other cities. Being active in social organizations herself, she became interested when Hurustiati Subandrio asked her to open a branch in Bogar. Having seven children of her own, she knew how difficult it was to raise children and provide them with a good education. Besides, she had learnt from her husband, a gynaecologist, how multiple pregnancies A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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and deliveries, combined with poor nutrition, could affect a woman's health. She considered this request a big challenge, given the lack of support from the government and the opposition of the local community. With a number of friends, all women, Sophie Sarwono founded the Bogor chapter of the PKBI in 1964. The members of its first board were prominent members of the associations of wives of physicians and engineers, the association of midwives, and the Joint Women's Organizations of Bogor (GOWB). Sophie Sarwono chaired PKBI Bogor from 1964 to 1968. She expanded her activities and became a member of the West Java chapter, there representing the Bogor, Sukabumi, and Cianjur regions. To improve the quality of the programs she followed courses on family planning information, education, and communication (IEC). In 1967 she went abroad for her first family planning IEC course. The main objective of the PKBI was to promote family planning to all strata of society. In order to achieve this, Sophie Sarwono frequently visited family planning clinics in various cities in West Java and promoted family planning to women in rural areas. She worked closely with Dr Zu Rachman Masjhur, another old friend from USI, who then chaired the West Java chapter (1967-1970) in Bandung. The frequent field visits and close contact with members of PKBI branches apparently had increased the involvement of these members and the field staff. From her field tours with Zu Rachman Masjhur, Sophie Sarwono learned that Islamic leaders often cursed the PKBI. In their sermons and speeches these religious leaders declared the PKBI to be the work of the devil, since it obstructed pregnancy. 'Those who use the loop (IUD) will go to hell', said one of the imams. Sophie Sarwono continued participating in PKBI, becoming the PKBI general secretary in 1973-1976 and chairing the PKBI in 1976-1979. After completing her term as chair, she continued her involvement as adviser to the central board until the mid-1990s. The above mentioned Zu Rachrnan Masjhur was another pioneer at the local level. In 1957 she heard from her husband, a military officer serving at the presidential palace in Jakarta, that Abraham Stone had paid a visit to President Soekarno to discuss birth control. Interested in the matter, she took a special course on birth control at the Department of Obstetrics and Gynaecology of the University of Indonesia in Jakarta. In 1961 she opened the first family planning clinic in Bandung at her house. The clinic received contraceptives from the Bandung Municipal Health Office. To promote family planning she carried out numerous campaigns and organized seminars in West Java. The fact that she did not speak the local language, as she came from West Sumatra, did not prevent her from working in rural areas. As a result of her active participation, she was elected to chair the West Java chapter in 1967-1970. In 1976 Zu Rachman Masjhur accepted Sophie Sarwono's invitation to serve as PKBI executive director in Jakarta. Zu Rachrnan Masjhur was able to leave Bandung, as she had a private practice and was not attached to A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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any institution. She held this office until her retirement, and afterwards she was elected honorary secretary for one period. Several other names can be mentioned as PKBI pioneers. These are: Mrs Nani Suwondo (deputy president 1957-1970 and president 1970-1973), Mrs R. Oentoeng (general secretary 1957-1976), Mrs Sjamsoeridjal (treasurer 1957-1976), Prof. Dr Sarwono Prawirohardjo (board member 1957-1963, deputy president 1963-1965, president 1965-1970), Prof. Dr Hanifa Wiknjosastro (board member 1957-1967, deputy president 1967-1970, president 1970-1973), Mrs M. Hutasoit (board member 1963-1967, head of the information unit 1967-1973, deputy president 1973-1976), Mrs 0. Djoewari (board member 1963-1967, honorary secretary 1963-1973), Prof. Dr H.M. Joedono (board member 1957-1963, chair of Central Java chapter 1967-1970, chair of the medical experts committee 1970-1973, deputy chair 1973-1976). Taking a closer look at the composition of the first central board (19571963), the predominance of women is striking. The board had seven women and four men. These seven women were the PKBI' s 'founding mothers'. PKBI activities at the provincial level were mostly initiated by women too. The Bali chapter was established and chaired by Mrs Sutedjo, the governor's wife. Dr Kartini was the director of the first family planning clinic in Surabaya. In Palembang three women initiated the family planning movement: Mrs Gupito, Mrs Luki Irsan, and Mrs Bambang Oetojo (PKBI 1982:22-4). It can be concluded that women played a significant role in advocating, promoting, and implementing family planning in Indonesia. Moreover, they did their work on a voluntary basis. Their strong dedication was a key factor in the successful development of family planning in Indonesia.

PKBI activities in the 1960s In its early years the PKBI' s activities focused on family planning advocacy, information - education - communication (IEC), provision of services through its clinics, and training. To strengthen its capabilities PKBI sent its members to different countries to take part in conferences, seminars, and training programs. In 1959, for the first time, the PKBI sent representatives (Bambang Oentoeng and Koen S. Martiono) to the regional (Southeast Asia) conference of the IPPF in Singapore (PKBI 1982:22-3). They were financially sponsored by the Pathfinder Fund. Dr Wasito from East Java attended the National Conference on Family Planning in New Delhi. The Population Council also gave support, among other things, for conducting research on family planning attitudes and practice. In 1959, in Bali, Dr Esther Wowor, head of the PKBI' s medical committee and also head of the Department of Obstetrics and Gynaecology at Udayana University, started experimental A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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research on contraception, assisted by Sister Agustin Mambo. In the 1960s the PKBI wanted to promote family planning to a broader public, even though the family planning movement still had not gained government support. The PKBI decided to involve community leaders. To introduce family planning concepts, the PKBI held a seminar in Jakarta in February 1962. The seminar was attended by some 3,000 participants, among them religious leaders and community leaders. Its objective was to initiate discussion about family planning ideas and to implement family planning activities all over Indonesia. Due to the success of the Jakarta seminar, in the same year PKBI branches in various cities in Java and Bali conducted seminars to inform the public about family planning issues and concepts. Zu Rachman Masjhur gave a similar seminar in Bandung, for about 1,000 participants. In Semarang around 300 people came to a seminar given by Dr Farida Heyder, while in Bali Esther Wowor gave a seminar for about 500. In Yogyakarta about 500 people took part in a PKBI seminar given by H.M. Joedono, and in Surabaya Mrs Prayitno successfully managed such a seminar for 1,000 people. A family planning seminar was also given by Mrs 0. Djoewari for 200 employees of rubber and tea plantations in Subang, West Java (PKBI 1982:25). In promoting family planning practice, the PKBI's policy was to deliver services through its clinics. Apart from distributing contraceptives, the clinics provided married couples with counselling on birth spacing and infertility. They also held family planning meetings for small community groups. In 1964 the PKBI had 59 family planning clinics. In these clinics, services were delivered by altogether 28 physicians and 60 midwives, who had been trained to provide family planning IEC and counselling. In that year 4,980 people used the services of the clinics (PKBI 1982:26). The strength of the PKBI was the strong commitment and dedication of the organizers, members (all volunteers), and staff. The volunteers worked hard, often using their private facilities, such as their own house, car, and telephone. They were willing to spend energy, time, and money for the success of family planning. They felt that the community, particularly the women, needed them. The volunteers worked hand in hand with community leaders and religious leaders, and tried to get the support of the local government to promote their activities. The growing interest in family planning in other parts of the world had an impact on Indonesia, and numerous foreign officials and family planning advisers came to the country at the invitation of the PKBI. The PKBI continued to expand its services, obtaining funds mainly through the sale of contraceptives. In 1965, the intra-uterine device (IUD) was introduced by consultants from the Population Council. The PKBI sent its representatives to Geneva, to attend an international conference on the use of the IUD. A A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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number of general practitioners were trained by gynaecologists in IUD insertion. The PKBI designed projects to intensify the use of the IUD. In 1965 it opened a clinic to treat cases of infertility. In 1964 a research unit, led by Prof. Hanifa Wiknjosastro, was founded to evaluate the effectiveness of contraceptives. It carried out observation and supervision of 1,000 mothers who had been using contraceptives as long as ten months. In 1964 experiments with oral contraceptives were conducted. Despite the fact that this research unit was founded by the PKBI, it operated independently. It was feared that its activities might endanger the position of the PKBI. Only in 1966, when the climate was considered more favourable for the family planning movement, was the research unit integrated into the PKBI (PKBI 1982:26-7).

Transition to the New Order The declaration of the New Order government led by General Suharto marked the beginning of a change in national policy on population control and family planning. The role of the PKBI in the transitional period from the Old to the New Order is clearly described by Hugo et al. (1987:140-1). The positive change in the political climate encouraged the PKBI to reopen and restock its clinics. In 1967 the PKBI received legal status from the Ministry of Justice and it held its first national congress, attended by members from seven chapters. In 1965-1967 the PKBI became the driving force in the provision of family planning services and sponsored several research projects to determine the future course of the program. After nearly twenty years of being ignored or even disapproved of by the first post-independence government, the concept of family planning was finally accepted as the main pillar of the government's population policy. The changing climate of opinion on birth control corresponds to the emphasis on rational economic planning that characterized the New Order government. The government's role in family planning during the first two years of New Order can be summed up as 'benevolent encouragement and help to voluntary organizations', rather than as a direct commitment (Singarimbun 1968:102). Although an early proposal for an official national family planning board was rejected, an ad hoc committee on family planning was formed to advise the government on the drafting of a national program and to represent Indonesia in securing foreign funding for family planning. This committee drew heavily on members of the PKBI, who not only were conversant with the issue but also had long-established links with international aid organizations. At the time the PKBI was under the leadership of Sarwono Prawirohardjo. A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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In 1968 the ad hoc committee submitted a report recommending that the government initiate a national family planning program, which would concentrate its efforts on the distribution of contraceptives in Java and Bali. The strategy of initially limiting family planning activities to these densely populated islands was eventually adopted. Following this recommendation, the Lembaga Keluarga Berencana Nasional (LKBN, National Family Planning Institute) was established by presidential decree in October 1968. The LKBN' s main tasks were to promote voluntary family planning, to coordinate family planning activities, and to advise the government on population issues (Atmosiswoyo 1978:26; PKBI 1982:30). The 1969 Presidential Decree no. 8 states that the president assumes full responsibility for the family planning program (Atmosiswoyo 1978:26). However, the semi-official status of the LKBN reflects the supportive, yet still not fully committed, attitude of the government. In addition, in the government's first five-year development plan, family planning was mentioned in the context of mother-and-child welfare rather than population control. In his speech to an IPPF-sponsored conference on family planning held in Indonesia in 1969, President Suharto mentioned the social and religious sensitivity surrounding the subject. Only when the evaluation of foreign experts sponsored by the UN, the World Bank, and the WHO reported the lack of impact of the current family planning program did the government begin to pay more serious attention to the matter. Based on the recommendation of the evaluation team, in 1970 the LKBN was transformed by presidential decree into the National Family Planning Coordinating Board, or BKKBN (Hugo et al. 1987:141). After the government took family planning activities into its own hands, the PKBI was no longer the main actor in the field. Still, rather than closing its offices, the PKBI expanded its services. In September 1968 it opened its National Training Centre in Jakarta (funded by NOVIB, a Dutch NGO), and provincial training centres in Bandung, Semarang, Yogyakarta, and Bali the year after. In September 1969 the director of the National Training Centre went to India to explore the possibilities of sending Indonesian family planning workers to follow relevant training courses in India. In 1969 the PKBI was officially accepted as a full member of the International Planned Parenthood Federation (IPPF), after functioning as an associate member for two years. In June of that year the PKBI held an IPPF regional conference for Southeast Asia and Oceania with the theme: 'Family Planning and National Development'. The PKBI received a mobile clinic unit from the IPPF and this unit was used to promote family planning at the first Jakarta Fair in 1969. PKBI branches and clinics continued to expand. While in 1964 the PKBI had only eight chapters and 59 clinics, in 1970 there were 122 PKBI branches and 170 clinics spread over all the main islands of the Indonesian archipelago, including Ambon and western Nusa Tenggara (PKBI 1982:33). The A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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impact of the PKBI' s activities is reflected in the reduction of fertility rates from 6.4 children per woman in 1960 to 5.61in1967-1970 (Hugo et al. 1987: 152). Once every three years the PKBI convenes a so-called national consultation to give the branches, chapters, and central office the opportunity to exchange experiences and ideas. The convention is also used to assess results achieved, to decide on organizational policies for the following three years, and to elect members for the central board (IPPA 1986). Since the establishment of the BKKBN, a government-supported organization, international funding has been flowing into the BKKBN as a coordinating body. In its first years of operation the BKKBN recruited quite a number of PKBI volunteers and employees. The PKBI never objected to its volunteers and employees working for the BKKBN, since the BKKBN offered more job security. Besides, having its people working at the BKKBN enables the PKBI to share their experience and contribute ideas for the planning and implementation of family planning activities at the national level. Bibliography Atmosiswoyo, S. 1978 'The family planning program in Indonesia', in: Lida C.L. Zuidberg (ed.), Family planning in rural West Java; The Serpong project, pp. 21-32. Leiden: Institute of Cultural and Social Studies, Jakarta: Djambatan. Hugo, G.J., T.H. Hull, V.J. Hull, and G.W. Jones 1987 The demographic dimension in Indonesian development. Singapore: Oxford University Press. [East Asian Social Science Monographs.] IPPA What is IPPA? Jakarta: Perkumpulan Keluarga Berencana Indonesia. 1986 Jones, Gavin W. 1994 Marriage and divorce in Islamic South-East Asia. Kuala Lumpur: Oxford University Press. [South-East Asian Social Science Monographs.] PKBI 1982 Duapuluh Zima tahun gerakan KB di Indonesia. Jakarta: Perkumpulan Keluarga Berencana Indonesia. Ross, J.A. and S. Poedjastuti 1983 'Contraceptive use and program development; New information from Indonesia', International Family Planning Perspectives 9-3:68-77. Singarimbun, Masri 1968 'Family planning in Indonesia', Bulletin of Indonesian Economic Studies 6-3:102-5.

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CHAPTER III

History and structure of the national family planning program Firman Lubis

To better understand the development of the national family planning program in Indonesia during the Orde Baru (New Order), it is important to look at it from a historical perspective. A historical perspective can be applied in two ways, both of which are relevant here. The first way is to place the founding and development of the program in historical time, viewing it against the background of social and political change. This was done in Chapter II, in which family planning prior to the New Order and the conditions that led to the founding of the national family planning program are discussed in detail. In this chapter we pick up this thread and apply a historical perspective in the second sense, by describing the internal history of the national family planning program. The concept of family planning was introduced in the mid-1950s, with the establishment of the PKBL However, the national family planning program of the New Order differs considerably from the PKBI programs as regards political status, scope, objectives, impact, organizational structure, and management. This chapter presents the development of the national program, looking at its motivational background, the creation of the government body responsible for the program, the government's strong commitment and support, the structure and the implementation of the program, and its strategies, expansion, and evolution. At the end of the chapter we note the situation at the end of the New Order and the impact of the economic crisis on the program, as well as the issues and challenges of the program beyond the New Order.

The New Order and development planning One of the main reasons for people's dissatisfaction with the government during the turbulent period of 1965-1966 was the economic situation. This A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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was reflected in the slogan turunkan harga, which means 'lower the prices', a slogan used by students in their demonstrations against Soekamo. It was one of the tritura (acronym for tri tuntutan rakyat), or the three demands of the people. At that time, Indonesian economic conditions were pretty bad. The majority of people were very poor. Per capita income was only US$ 50 per year. The inflation rate reached 400%, which put a heavy burden on the common people struggling to meet their basic needs. Many people had to queue to buy low-priced food and subsidized clothing. The use of bad economic conditions as a tool to bring the sentiment of the people against the ruling government at that time was apparently effective. Entering the New Order after 1966, the new government under President Suharto directed its policies toward a development program emphasizing economic development. These new policies were a response to the deplorable economic state of the country at the end of the Old Order. Suharto recruited a group of prominent economists to design the development program. The leader of this team was a professor of economics from the University of Indonesia, Dr Widjojo Nitisastro, who did his PhD on the Indonesian population problem at the University of California at Berkeley (Nitisastro 1970). He was the founder and first chair of the Demographic Institute of the Faculty of Economics at the University of Indonesia. In 1969, Indonesia launched its first Five-Year Development Plan (Repelita I). The office in charge of coordinating and overseeing the development plan was the National Development Planning Board, or Bappenas (Badan Perencanaan dan Pembangunan Nasional). This body played an important role in development during the New Order.

Population as a variable in the Indonesian development program The development policy of the New Order regime was aimed at accelerating economic growth in order to improve the people's welfare. The dominance of the economic sector in its development policies became the trademark of the New Order government. One of the basic strategies for the nation's longterm development plan designed by the technocrats was to curb the rate of population growth. The technocrats considered population an important variable in economic development. They were convinced of the inverse relationship between population growth and economic growth. A demographic survey held in 1963 showed a population growth rate of approximately 2.8% per year, while according to available data, the economic growth of Indonesia during 1960-1965 was less than 1.6%. From a simple economic point of view, this meant negative per capita growth. Therefore, to realize economic growth, population growth would have to be reduced. A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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A clear sign that the New Order regime had the political will to tackle the population problem in Indonesia was that President Suharto, in 1967, together with 29 other heads of state, signed the UN Declaration of Heads of State on the World Population. It should be noted that in the late 1960s, the population boom was widely perceived as a serious threat to the life of humankind and was of great concern to the international community.

The national family planning program and the BKKBN The New Order government realized that a national family planning program could be a major instrument for reducing population growth. The concept of family planning had actually already been introduced at that time, but not to the population at large. Soekarno's government did not give any political support to the family planning movement. The private organization PKBI was the main actor in the field at that time (see Chapter II). The period 1967-1969 was a transitional one, during which political changes eventually resulted in the development of a national family planning program. After President Suharto had signed the UN Declaration on the World Population in 1967, he addressed parliament in early 1968. In the spirit of the declaration, he stated that the government approved of family planning activities conducted by the community, with the aid and guidance of the government. At this early stage, the government was very careful in promoting the family planning program. This caution was to prevent provoking opposition from religious groups, such as orthodox Muslims. In connection with this, President Suharto issued Presidential Instruction no. 26, 1968. Based on this Presidential Decree, after several meetings between the government and community leaders, especially from Muslim groups and those involved in family planning activities, the Lembaga Keluarga Berencana Nasional (LKBN, National Family Planning Institute) was established. Its main function was to develop the national family planning program and manage foreign aid (NFPCB 1982). The family planning program was included in the first Repelita (1969-1973). Thus, family planning was now officially a national program, an integral part of national development planning. Repelita I set a target of three million acceptors by 1973-1974. It stated that family planning was not only important to reduce the rate of population growth in comparison to the rate of economic growth, so as to raise per capita income, but that it was also beneficial for the health of mothers and the well-being of families. Thus, although the national family planning program was initiated by the New Order mainly to limit population growth in support of its economic development program, it had a dual objective from the start. The health aspect was included not just to avoid A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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opposition to the family planning program (as being merely an instrument for population control), but also because it was believed that reducing fertility would indeed have a positive impact on maternal health. During the LKBN period, the introduction of the family planning program to the community proceeded favourably and no significant opposition was encountered. The government came to the conclusion that the people were ready to receive the family planning program. It was now time to strengthen the organizational structure and management of the program. Presidential Decree no. 8 in 1970 changed LKBN into the National Family Planning Coordinating Board (BKKBN), a government institution directly reporting to the president on family planning activities. From then on, the government showed full commitment to the family planning program. In 1972, by Presidential Decree no. 33, the Board became responsible for the program's policy, coordination, supervision, and evaluation (NFPCB 1982). The BKKBN was managed by a chair who reported directly to the president and was to be assisted by three deputies: Deputy Chair I: responsible for program implementation, the divisions Planning and Logistics, Supervision, and the Bureau for Special Projects (for instance the Family Planning Fieldworker Project); Deputy Chair II: responsible for program design, and guiding and coordinating activities in information and motivation, education and training, and medical services; Deputy Chair III: responsible for guiding and coordinating research and for evaluation, reporting, and documentation. It is interesting to note that the first to be appointed chair of BKKBN, Dr Suwardjono Surjaningrat, was an obstetrician-gynaecologist from the military health service. He was sent to the Margaret Sanger Institute for a family planning training course. His deputy chair II, Dr H.M. Joedono, was also a senior obstetrician-gynaecologist, who had played an active role in the PKBI. The appointment of these two prominent gynaecologists as the key leaders of BKKBN initially reflected a policy to place family planning in a health or clinical perspective. Deputy chair III was a young social scientist, Dr Haryono Suyono, who had just returned from his PhD education at the University of Chicago. He became prominent in developing innovative approaches during the course of the program and later became the BKKBN' s chair as well as Coordinating Minister for the People's Welfare in Suharto's cabinet. Furthermore, Presidential Decree no. 33 stated that in the provinces and regencies the governor and regency heads (bupati) were responsible for the implementation of the family planning program. BKKBN chairs at these two levels reported to the governor and the bupati respectively. From this presidential decree it is clear that the government intended to play an active role in the implementation of the family planning program. The presidential A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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decrees were meant to strengthen the organizational structure of the BKKBN and support the expanding family planning program. In 1978, Presidential Decree no. 38 was issued. Based on this decree, the task of the BKKBN was broadened to include coordination of the implementation of the national family planning program, supporting the population program, as well as conducting operations in the field. Consequently, the organizational structure of the BKKBN was adapted. Four deputies were appointed with the following portfolios: program management, family planning, population, and supervision and control. In addition, for population and family planning education and training, the chair would be assisted by a team, the Tim Pertimbangan Pelaksana Program or TP3 (Advisory Team For Program Execution). The members of this team consisted of officials of several departments and community leaders who were directly involved with the implementation of the population and family planning program. Carrying out the operations of the program was entrusted to the implementing units (unit pelaksana), consisting of relevant departments, government agencies and associations, and community organizations. This so-called inter-sectoral approach sometimes gave rise to tensions (Warwick 1986). With the 1978 presidential decree, the family planning program was extended to cover all Indonesian provinces. From year to year, the program expanded and extended to villages all over Indonesia. The basic principles of program implementation and the status of the BKKBN did not change much in the course of time (Nurhayati and Sudjianto 1990).

Program strategies The New Order government saw family planning activities as an integral part of the national development plan. National development policy aimed to accelerate economic growth, in order to improve the welfare of the people. At the same time, efforts were directed at reducing the birth rate, in order to achieve a better balance between population and economic development. In 1969 the family planning program was adopted as part of the first five-year development plan. The plan stated the following two main objectives of the family planning program: Improvement of the health and welfare of mother and child, and of the family and the nation in general. Improvement of the standard of living by means of a decline in the birth rate, to prevent the rate of population growth exceeding the increase in production. To safeguard the program from possible opposition of Muslim groups, the approach adopted was that family planning should be on a strictly voluntary A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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basis and should be in accordance with the national values (Pancasila) and the rules of religion, particularly Islam (Atmosiswoyo 1978). Initially, family planning services were rendered in mother-and-child health clinics in combination with MCH (mother-and-child health) services. As the number of 'acceptors' increased, these clinics opened twice a week solely for family planning services. At first there was only a passive policy of awaiting requests from clients who frequented the clinics. This was followed by a more active policy of motivating those who came for MCH care and of visiting MCH clients at home. In 1970, family planning fieldworkers (PLKB) were appointed. They were responsible for motivational activities outside the clinics. The male and female fieldworkers, who had a non-medical background, were recruited, trained, and employed in their home areas. PLKB were required to have at least a junior high school education and be between 22 and 45 years of age. The planning was to have one fieldworker per 10,000 inhabitants, so that all eligible couples in the area could be visited at home. There was one group leader per five fieldworkers in every sub-district. At regency level, a supervisor guided the group leaders. The family planning program benefited significantly from the work of these fieldworkers. Jay Parsons, a long-time observer of the Indonesian program and for several years resident-representative of UNFPA in Indonesia, says: 'The success of the fieldworker as an effective motivator for family planning has never been formally evaluated. However, despite low pay, no formal government civil servant status until recently, 1 tremendous hardships imposed by difficult terrain and inadequate transportation facilities, there has been, with the exception of Jakarta, considerably high morale, esprit de corps and a relatively low rate of turnover' (Parsons 1984:6). As a result of the work of the PLKB, many couples became convinced of the advantages of family planning and were prepared to go to the clinic for family planning services (Atmosiswoyo 1978). A target system for the yearly recruitment of new acceptors was adopted at the beginning of the national family planning program. The first Repelita (1969-1974) set the initial target at three million acceptors, with the aim of preventing 600,000 to 700,000 births. The targets for this period are given in Table 3.1. The target figures presented in Table 3.1. are somewhat different from the original targets set by the program. For example, for fiscal year 19711972, the target was first set at 200,000, but as a result of the rapid increase of acceptors registered during that year, it was changed to 550,000. In addition, during that period, the BKKBN recruitment policy was still based on a Ms (Dra) Soejatni always fought for 'her' fieldworkers, while working as policy staff at BKKBN. She succeeded in securing for them the much desired status of civil servant. Bu Yatni, as friends used to call her, passed away in October 2000. A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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Table 3.1. Targets and registered new acceptors of the national family planning program during the first Five-Year Plan (1969-1974) Fiscal year 1969-1970 1970-1971 1971-1972 1972-1973 1973-1974

Target 100,000 125,000 550,000 1,000,000 1,250,000

Number of registered acceptors 53,103 181,059 519,330 1,078,889 1,369,077

Percent of target reached 53.1 144.8 94.4 107.9 109.5

Source: BKKBN /NFPCB, Bureau of Reporting and Documentation.

system of incentives, and they thus faced the problem of having to find the money to pay incentives for a much larger number of acceptors than had been expected. This required a revision of the budget for the following fiscal year. For 1972-1973 the target was almost doubled, from 550,000 to 1,000,000 acceptors (Atmosiswoyo 1978:29). The target system, originally intended for management purposes, was the subject of criticism. Some critics saw it as suiting the - in their eyes authoritarian and coercive approaches used by the program. In response, the target system was abolished and replaced in 1993 by the so-called demand fulfilment system. However, in the field, targets continued to be used for a number of years by local BKKBN offices for their operations and as a method to evaluate the performance of administrative officials. From the start, the BKKBN did not directly provide contraceptive services to the public. Instead, it coordinated the work of the implementing units or unit pelaksana. The biggest implementing unit is the Ministry of Health. With more than 3,000 public health centres over the country, MOH is the largest family planning service provider of the program. At village level, the work of the implementing units is complemented by the activities of BKKBN fieldworkers.

The clinic-based program During Repelita I, the national family planning program was clinic-oriented and confined to Java and Bali. The clinical approach, begun by the PKBI, was in line with programs in other countries and with the initial perception of family planning as a health-care problem. The fact that most officials initially perceived the population problem as the problem of the densely populated islands of Java and Bali explains the concentration of the program on Java and Bali during the first phase. A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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The clinic-based program had been able to provide family planning services to couples to a certain degree. The number of acceptors in Java and Bali rose from just over 50,000 in 1969-1970 to nearly 1.5 million in 1974-1975 (UNFPA n.d.). However, BKKBN officials realized during Repelita I that the clinics would not be able to reach the great majority of the estimated 14 million eligible couples in the 22,000 villages of Java and Bali. If the people were not reached, the BKKBN knew it would be impossible to substantially reduce fertility. Furthermore, officials became worried that the reserve of receptive couples was rapidly being depleted during Repelita I, leaving a more resistant group less willing to overcome cost and other problems in obtaining contraceptive services from clinics. In addition to this, new acceptors in the early 1970s increasingly preferred the pill and condom (from 5% pill use and 3% condom in 1972-1973 to 69% pill and 19% condom in 1974-1975). This suggested that supplying increasing numbers of users over larger areas would become more difficult. It was feared that drop-out rates, already estimated to be high, would rise (UNFPA n.d.).2 Consequently, family planning officials decided in 1974, at the beginning of the second Five-Year Plan (Repelita II), to step up efforts to achieve the long-term goal of reducing fertility by 50% by the year 2000 (compared to 1971). This required a change in strategy.

The community-based or village FP Program The new strategy developed by program policy-makers was to base the family planning program in villages, to decentralize it, and to give responsibility to village officials and volunteers. A key element in the new strategy was the use of trained fieldworkers, who would promote family planning in their home communities (see above). This was considered a more effective approach than relying on clinic personnel, who would not always be known and trusted by the people. Another key element in the community-based strategy was the idea of making use of traditional village institutions to promote the new concepts of family planning and the 'small family norm'. One example is the use of the traditional institution of the banjar in Bali.

The banjar model in Bali Implementing the community-based approach in Bali, family planning officials decided to make use of the traditional institution of the banjar. UNFPA Population Profiles 14: Indonesia. New York: UNFPA. This publication was probably issued in the late 1970s or early 1980s.

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Traditionally hamlets in Bali are grouped into banjar, of which Bali has more than 3,500. The banjar is a unit for mutual aid and cooperative work, and the gathering point for recreation and ceremony. Every month the heads of every household in a banjar meet to discuss community matters (UNFPA n.d.). In late 1974, BKKBN provincial authorities in Bali began a program to promote family planning through the banjar by training fieldworkers and banjar heads. As a result, contraception became a regular topic at banjar monthly meetings. Potential acceptors were identified in these meetings and a certain amount of peer group pressure encouraged non-acceptors to begin using some form of birth control. Since the introduction of this idea, increasing responsibility has been placed on the banjar to manage its own family planning effort. For example, each head of a household is required to publicly report the family planning and pregnancy status of every married woman of reproductive age in the household. Banjar registers are compiled, listing all eligible couples, their location in the hamlet, and their use of contraception. The registers also contain logistic information on pill and condom supplies. The provision of supplies has become largely a banjar responsibility and is another activity of the monthly meeting. Each banjar displays a map of all houses in the district, based on information collected from household heads. Houses of IUD users are outlined in blue, those of pill users in red, and those of condom users in green, while houses of non-users are left blank. The use of the banjar as a vehicle to promote family planning is considered a key factor in Bali's 'success story' (Haryono Suyono 1976; Hull et al. 1977).

Community involvement in family planning in Java The situation in Java is quite different from that in Bali. Unlike Bali, Java is predominantly Muslim. Furthermore, the Javanese hamlet is a less closelyknit unit than the Balinese banjar. Traditional parts of Java do have a system of community meetings, called the paguyuban, but it is not as important and well rooted as the banjar. Monthly community meetings such as those occurring on Bali rarely occur in Java. Furthermore, Bali is geographically more compact and culturally more homogeneous than Java. For all these reasons, program policy-makers decided that the approach in Java had to be different. Java, especially East Java, is known for its strong administrative hierarchy. Officials down the line tend to respond quickly to orders sent through the chain of command from higher levels. So if the provincial leadership decides that a program like family planning is to be promoted, officials of districts and villages get the message quickly and follow suit. This is what happened, particularly in East Java. Support for family planning has been consistently strong from the governor down to the A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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bupati, camat, and village head. In fact, family planning became an important indicator in evaluating the performance of these officials. Official encouragement was implemented in different ways, such as in the form of competition among regencies (UNFPA n.d.). Strong efforts by the administration were supplemented by the use of village structures and institutions. One example is the arisan, a monthly gathering and lottery held among women in many villages. BKKBN provincial authorities quickly realized that discussion of family planning at arisan gatherings could encourage villagers to become acceptors. Another village institution made use of is the Pembinaan Kesejahteraan Keluarga (PKK), the Family Welfare Organization supported by the Ministry of Internal Affairs. PKK chapters were set up in villages after the establishment of the New Order. Nation-wide, the chapters follow a ten-point program aimed at promoting the welfare of women and families. The tenth point, added in the early 1970s, is family planning. PKK meetings are essentially social gatherings, but important topics such as family planning are discussed as well. Village contraceptive distribution centres (VCDCs) Besides the recruitment of new acceptors, ensuring continued use of contraceptives and the prevention of acceptors becoming 'drop-outs' had to be addressed as well. Well-trained and highly dedicated personnel are required to instruct (new) acceptors and to motivate acceptors to continue their practice. With the rapid expansion of the program, this became a problem that fieldworkers could no longer handle. Moreover, research had indicated that one reason for discontinuation was the distance between the acceptor's home and the clinic where contraceptives could be obtained. The mobile family planning clinic certainly helped, but not enough. One solution for the problem of distance was the establishment of village contraceptive distribution centres, or VCDC (Haryono Suyono 1976). Started in 1975, the VCDCs are full-fledged community family planning posts, which enlist local volunteers who recruit and instruct acceptors as well as distribute pills and condoms. VCDCs were set up in most villages in Java and Bali. In some areas the VCDC is known as Pos KB, or Family Planning Post. In Bali, it is run by the banjar. In Java, the scheme varies, depending on the culture of the area. In West Java, for example, centres have been placed in the homes of community leaders who are also successful acceptors. In Central and East Java, local officials were made responsible. Altogether, there are presently more than 25,000 posts in Java and Bali, and another 4,000 in ten provinces of the Outer Islands. Wherever it is located, the family planning post is usually staffed by a village volunteer, such as a member of the village head's staff, his wife, or A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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another acceptor. Pill and condom supplies are directly available from this village source, rather than solely from the more remote clinics. An extra 25% above known needed supplies are kept on hand in each VCDC. Each month, fieldworkers bring supplies from the clinics to the VCDC. They also assist the family planning volunteer in keeping the list of current users who obtain supplies from the post, and they make a note of the names of acceptors who have not returned for their supply, so that a follow-up visit can be made by the midwife or PLKB. The fieldworkers also fill out simple monthly reporting forms, which are sent to BKKBN national headquarters. The village volunteer may distribute supplies directly to users in the village, often by organizing a monthly meeting of all acceptors. During such meetings, motivation is provided by the family planning fieldworker or clinic staff, the monthly arisan (lottery) is held, and special courses, such as nutrition or sewing, may be offered. In some cases, the family planning post serves as a depot for hamlet-level acceptor groups. These groups have formed spontaneously, for the convenience of the acceptors in their area (UNFPA n.d.; Haryono Suyono and Reese 1978).

Reporting and recording system of the program The organizational effectiveness of the program has always been rated highly by observers. The BKKBN is considered to have been remarkably successful in two basic activities: the logistics of contraceptive supply and the system of monthly feedback service statistics (Hull and Singarimbun 1989:33). The monthly service statistics are collected at field level mainly by PLKB and from the health centres (puskesmas). Through the BKKBN infrastructure at the different administrative levels, these routine monthly reports, which mainly contain numbers of new acceptors according to variables such as age and number of children, go to the Reporting and Recording Bureau at BKKBN headquarters in Jakarta, to be used for monitoring the program. These routine monthly service statistics have been criticized as being unreliable and unprofessionally kept, having a bias toward over-reporting, and serving only 'to please the superiors'. However, these routine data can be compared to data from census and survey research. National data on the results and impact of the program, such as contraceptive prevalence rates and fertility statistics, can be considered sufficiently reliable since these data are obtained from periodic studies conducted by the Central Bureau of Statistics. Such studies are often carried out in close collaboration with reputable international organizations, such as the Population Council, RAND, and Macro International. In his analysis of the reliability of the 1980 BKKBN prevalence statistics, Streatfield (1984, 1985) concludes that, compared to national statistics and corrected for the denominator, the BKKBN prevalence A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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rate for Indonesia as a whole and for all methods in 1980 is 3% higher (the adjusted prevalence rate of the service statistics is 30.2% and the rate according to the census 27.2%). However, this overall difference hides considerable variation as to method and among provinces.

NKKBS: from family planning to family welfare From the beginning, one objective of the national family planning program was to institutionalize the 'small, happy and prosperous family norm' (abbreviated in Indonesian as NKKBS). Promoting contraceptive use and reducing fertility would not be enough. Instead, the program would have to include activities aimed at enhancing family welfare and prosperity, referred to as 'beyond family planning' activities. The high levels of infant and child mortality at the time were considered an impediment to family happiness and prosperity. The family planning program would have to include activities aimed at enhancing children's health. To meet the goal of NKKBS, in the late 1970s a pilot program in nutrition was launched by the BKKBN in East Java. This integrated family-planningand-nutrition program, known. as Usaha Perbaikan Gizi Keluarga (UPGK, Family Nutrition Improvement Program), was incorporated into village family planning, using clinic staff, PLKB, and community acceptors groups. It was an integrated program of child weighing, nutrition instruction, and primary health care. In collaboration with the Ministry of Health and the Family Welfare Movement (PKK), the program launched the posyandu (acronym for Pos Pelayanan Terpadu, or Integrated Services Post). The posyandu is a monthly activity at hamlet level, run by the community and focusing on primary health, nutrition, and family planning. Monthly weighing of children under the age of five helps to identify children whose weight gain is inadequate, long before the permanent effects of malnutrition have taken hold. Each child has an easily understandable record of the progress of his/ her nutrition status as shown on the KMS (Kartu Menuju Sehat) or weight chart, originally developed by UNICEF. The posyandu became another forum where mothers and expecting mothers could gather to discuss family planning and maternal and child health. In focusing on the linkages between family size and family happiness and prosperity, the BKKBN also developed an income-generating project: UPPKA (abbreviation of Usaha Peningkatan Pendapatan Keluarga Akseptor). The program started in the 1980s and aimed at helping women acceptors to increase their family's income. An example of a UPPKA project in West Java is described in Chapter VIL

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Family welfare In line with the NKKBS concept, in the early 1990s, the BKKBN set up a program to enhance family welfare (keluarga sejahtera) through community action, according to a family-community interactive model. Families and communities jointly gather and analyse data on family welfare, and take action together. The analysis is to identify strengths and weaknesses, and actions that can be taken to improve family welfare (Hamidjojo and Chauls 1996). Using the results of the analysis, families are rated on a five-point scale. The scale ranges from keluarga pra-sejahtera ('pre-welfare families'), who are unable to provide for even the minimum of their own basic needs, to keluarga sejahtera 3-plus, families who are capable of meeting all their needs - basic, socio-psychological, developmental and social needs. The task of identifying and listing families according to their position on the welfare scale was mainly given to the PLKB. This added a new item to their workload. Data from the Keluarga Sejahtera program have been used by government agencies for poverty alleviation programs, and later for the Jaringan Pengaman Sosial (Social Safety Net) program that was initiated after the onset of the economic crisis in 1997. The Keluarga Sejahtera program was implemented till the end of the New Order in 1998 and continued afterwards.

Geographical expansion: from Java and Bali to all provinces While the family planning program was initially implemented in the six provinces of Java and Bali - OKI Jakarta, West Java, Central Java, DI Yogyakarta, East Java, and Bali- in 1974, at the start of the second Five-Year Development Plan (Repelita II), ten provinces were added to the program. These provinces, in the Outer Islands Group I, were: Aceh, North Sumatra, West Sumatra, South Sumatra, Lampung, North Sulawesi, South Sulawesi, South Kalimantan, West Kalimantan, and West Nusa Tenggara. Indonesia's islands outside Java and Bali are relatively sparsely populated, but their population is growing at a faster rate than that of Java and Bali. Between 1961 and 1971, the Outer Islands grew at a rate of 2.4% per year compared to 1.9% for Java. In the late 1960s, the total fertility rate was over 6 in most of the islands, compared to less than 5 in Java and Bali. And, even though sparsely populated, the Outer Islands together had a sizeable population: about 47 million in 1978, which was larger than any other Southeast Asian nation (UNFPA n.d.). The BKKBN decided that in the Outer Islands the use of fieldworkers, as in Java and Bali, would not be feasible because of the problem of distance. A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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However, it was still desirable to make the program community-based. Therefore, as an alternative, the BKKBN gave program responsibility to local government officials. The camat (head of the sub-district) was made the focal point, so that the local communities themselves would become involved and eventually take over the management of family planning activities. To ensure that the camat was capable of carrying out such family planning duties effectively, the BKKBN began a training program, following a training-of-trainers model, in each of the ten provinces. Headquarters staff trained a provinciallevel team that included members of the governor's staff. This team in tum trained a similar group at the kabupaten (regency) level, which in tum trained the camat staff. In his capacity as a government representative, the camat is expected to supervise the training of village and hamlet officials, formal and informal leaders. He is also expected to involve various community institutions in promoting family planning. In short, the BKKBN used its training program not only as an educational tool, but also as a mechanism for securing the commitment of the entire administrative structure, from provincial level down to hamlet level. In contrast to Java and Bali, where family planning has been primarily the responsibility of various units under the BKKBN' s direction, in the Outer Islands the responsibility came to rest more squarely on the administrative structure. Put another way, for the Outer Islands, the fieldworker stage was skipped, and the program moved directly to a community distribution model. At the start of Repelita III (1979-1980 to 1983-1984), the family planning program was further expanded to the remaining provinces of Indonesia. These provinces are known as Outer Islands II, to distinguish them from Outer Islands I, the ten provinces included at the start of Repelita IL Outer Islands II is comprised of more remote and less populated areas such as Irian Jaya, Central Kalimantan, and East Timor. The expansion raised questions as to the importance and necessity of the program in these areas. Particularly in 'special' provinces such as Irian Jaya, East Timor3 and Aceh, population is a sensitive issue. But since the family planning program was a national program, it had to be implemented in all provinces. The inclusion of the Outer Islands II provinces gave rise in certain political circles to the suspicion of a hidden agenda of' ethnic cleansing'. This allegation was not new. In the beginning, critics charged that the program was directed only at the poor; later the issue was raised of native Indonesians (pribumi) versus the Chinese minority; still later the program was charged with being aimed at regions with separatist movements. However, the allegations have never been substantiated and have not become a major obstacle in implementing the program. See Chapter IV on the East Timor case.

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Rural-urban differences and urban family planning While in rural Java and Bali the family planning program made great progress during the first decade, in urban areas family planning acceptance lagged behind. By late 1978, official estimates for current use of program methods was 18.8% of married women of reproductive age in Jakarta, which was less than half the levels of East Java (39.0) and Bali (43.3) (UNFPA n.d.). This situation was a major concern to program managers. Conventional thinking was that family planning would be easier to promote and more readily accepted in the cities, because of higher levels of education and better communications. The rural areas, it was argued, would be more difficult because of poorer communications, lower literacy, and stronger religious feelings. However, acceptance came more quickly in rural areas, perhaps because of the relative cultural homogeneity of village populations and their greater amenability to peer pressure. In 1980, a survey conducted for the BKKBN by a market research company provided information on several aspects of family planning practice in Jakarta from a client's perspective. An important finding was that women in urban areas were not reached by the traditional clinic-based approach. The community-based approach, such as used in the villages, did not work either. Women did not welcome fieldworkers into their homes. They often did not know when, where, or at what cost services were available. There were many private doctors and midwives and other private facilities who were potential service points, but women did not seek services from these private sources, since they did not think they would be available or they were afraid of high costs. The government family planning services were not favourably viewed, as it was hard to get information, the facilities were crowded, and the choice of contraceptives limited. Some respondents simply did not know where the nearest facility was located. Women responded positively to a 'fee-for-service' program, provided the hours were compatible with their free hours and provided there was a choice of modern methods. Furthermore, the service point would have to be well located and the personnel should be friendly (Pelon and Lubis 1984). Based on the 1980 survey results, the BKKBN developed a strategy to improve government services and private ones at the same time. The strategy was based on a division of the urban population into three categories: The lowest socio-economic strata of the urban society. These people would not be able to pay for family planning services, and are dependent upon free services provided by the government. The lower middle class, a category that could be reached through semicommercial clinics and private doctors and midwives. A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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The upper middle class and the rich, who could afford to seek the services of specialists, of whom there were sufficient numbers in the big cities. To reach the first group, BKKBN refurbished the government family planning facilities and trained or gave refresher courses to clinic staff. At the same time, an effort was made to offer the widest possible range of available contraceptives. A mass media campaign advertising the available service points was contracted out to a commercial firm, which included outdoor media, mass distribution of leaflets, and newspaper, magazine, radio, and television advertising. To reach the second group, a foundation called Yayasan Kusuma Buana (YKB) set up a semi-commercial family planning clinic model in Pisangan Baru, East Jakarta, under the auspices of BKKBN and with funding from UNFPA. This fee-for-service clinic became popular in the surrounding community. It became self-sufficient after four years of operation. Based on this model, YKB received further support from USAID to set up a network of clinics in several densely populated areas of Jakarta to provide mainly family planning and MCH services. Presently, these clinics provide reproductive health services as well. A network of private practitioners was set up to recruit doctors and midwives for delivering family planning services in their own private practice. Practical training was provided for these practitioners, for example, in IUD insertion.

The development of KB Mandiri and privatization Since the national family planning program started, the public sector has been its main source of funding. For more than a decade, acceptors obtained services free of charge from government family planning service points. But with increasing numbers of acceptors, the government realized that this could not go on indefinitely. Government funding was insufficient to maintain around 22 million users every year with the annual addition of one million new acceptors. Besides, funds from international donor agencies began to decline, though this was in line with the government's policy to use international donor funds as supplementary to national funding. In the long run, the program should not depend on foreign aid. The government then came to the conclusion that privatization of family planning services was inevitable. The fee-for-service clinics in the urban family planning program demonstrated that people were willing to pay for family planning services. Based on these experiences, a policy of KB Mandiri (Self-Reliant Family Planning) was initiated in 1989. It focused on urban areas. The idea was to encourage those who had the capacity and willingness to pay for contraceptives to use private channels to obtain family planning servA. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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ices. The private sector in this case consisted of private hospitals, clinics, doctors and midwives, pharmacies and drugstores, and voluntary community groups using their qwn resources to serve paying clients. To support privatization, subsidized Blue Circle contraceptives were distributed through these private channels. In this way, private providers and a choice of contraceptives at subsidized prices came within reach of many low-income clients. When the KB Mandiri program was launched, there was pessimism about whether the target of 50% privatization in 1994 could be achieved. But findings from surveys showed an increasing percentage of clients obtaining their services through private-sector channels. The percentage of acceptors using subsidized government services decreased from 81% in 1987 to 75% in 1991, and further to 49% in 1994 (Adioetomo 1997; CBS et al. 1995). The percentage of women using private-sector channels increased from 12% to 22% and finally to 49% in 1987, 1991, and 1994 respectively. Normally it is expected that government family planning services are free of charge and private sources provide services only on receipt of payment. But results from the 1994 Indonesia Demographic and Health Survey (IDHS) show that about 31% out of the 48% of acceptors obtaining family planning services from the public sector made some payment. A small portion of women (2.4%) obtained free services from private-sector sources. A change in the categorization of services provided by the posyandu and family planning posts (comprising 18% of all users) led to the impression that contraceptive supplies from these sources were no longer given free to clients. In 1991 the posyandu were recorded as government channels, but in 1994 as private channels. In 1994, three-quarters of acceptors demonstrated self-reliance in meeting their fertility control needs (CBS et al. 1995). A comparison of women obtaining family planning services free of charge with those paying for it, revealed that rural women are less likely to pay for services than urban women. Younger women under 30 with no more than two children showed high levels of self-reliance. They were twice as likely to pay for services. This pattern indicates better prospects for privatization once older acceptors are replaced by cohorts of women who are younger, increasingly urban, more educated, and more economically secure (Adioetomo et al. 1996). However, two questions remain. The first is whether the price that users pay constitutes full payment or is still (partly) subsidized by the government. The second is whether the quarter of acceptors who obtain family planning services without payment are unable to pay or are not willing to pay. A further study was done to find out whether payment for services consisted of only paying the registration fee or included paying for other components. The findings were similar to those of the earlier study. But it was also found that once women pay more than the registration fee, they tend to seek out A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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delivery points that give better quality of care, rather than just going to a place nearby. Again, this indicates that demand for better-quality care in family planning services is increasing. This is consistent with the 1994 IDHS findings that those who live in urban areas and are more educated are willing to pay for better services. Prices that government providers charge are usually lower than those charged by private providers. So it is to be expected that acceptors from the lower socio-economic strata will choose government providers. However, about 40% of middle and upper-middle class acceptors still obtain family planning services from government providers (Adioetomo 1997). This indicates a lack of willingness to pay for private services. The finding is consistent with that of the 1994 Indonesian Demographic and Health Survey, namely that better-educated and richer women who are members of groups of villagers receiving family planning activities obtain family planning services for free, even though they can clearly afford to pay (CBS et al. 1995). The above suggests that efforts to increase privatization in family planning services are hampered by the government's own bureaucratic system. The existence of subsidized services for all women, irrespective of economic status, makes it more difficult to bring about a shift from free to fee-for-service arrangements. Therefore, it is suggested that subsidies should be restricted to poor women, while those able to pay should bear the costs of the services they use. However, it appears to be more than a matter of cost. Especially for lower-educated clients from rural areas, the main reasons for choosing particular sources for contraceptive services were found to be proximity, low cost, and availability of transport. Although for the urban and educated people accessibility is still deemed important, privacy and competent friendly staff proved to be the major considerations for choosing a particular service provider (CBS et al. 1995). This indicates that the issue of cost is not the only issue involved. Quality of care in family planning is considered important as well. Therefore, efforts to increase prevalence rates and to reduce discontinuation rates should incorporate efforts to increase the quality of care.

Impact of the economic crisis As part of the Asian-economic crisis, in mid-1997 Indonesia entered a period of sustained economic instability. The first sign of the Indonesian economic crisis was the fall in value of the rupiah toward the end of July 1997. In January 1998, the inflation rate had reached 6.9%. In February 1998, the rupiah fell to 15,000 to the US dollar (less than 20% of its July value of 2,470). Conditions continued to worsen as inflation reached 47% in April 1998 and 59% in July 1998. By early 1999 the rupiah had stabilized somewhat, at A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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around 8,000 to the US dollar. Fluctuations continue to be common, however (Gardner and Amaliah 1999). The instability of the economy had a profound and sustained impact on both macro- and microeconomic conditions. Many experts have been concerned with the social and health impact of the economic crisis, including family planning. Studies were undertaken in an attempt to assess the impact on the family planning program. These studies have been reviewed (Gardner and Amaliah 1999). Some key findings of this review are the following. Most of the reviewed data show very little change in the overall contraceptive prevalence between early 1997 and late 1998. One study shows a very slight rise, and two show a very slight decline. There seems to be little change in the choice of methods, but the evidence is somewhat conflicting on this point. Some studies report declining stocks of contraceptives at both public and private facilities. In 1997 and 1998, the BKKBN received supplies of contraceptives from donor agencies such as USAID, UNFPA, and the World Bank, which helped BKKBN to keep up its supplies. From the review study, it can be concluded that the impact of the economic crisis on the family planning program is not yet clear. But fears of a high level of drop-out among contraceptive users as a result of the economic crisis are apparently unfounded. Still, many people have suggested resuming free contraceptive services for couples, as in the early days of the family planning program, as long as the crisis lasts.

Issues and challenges of the family planning program at the end of the New Order In June 1989, President Suharto received the Population Award from the UNFPA in New York for the achievements of the Indonesian family planning program. But despite its remarkable achievements, the national family planning program under the New Order is not free of criticism. Most of the criticism comes from international sources, but some of it is domestic. The criticism focuses mainly on the way the program has been implemented. It has been said that it was too heavily driven by the government, using a target-driven approach and an authoritarian style, and ignored the issue of quality in the provision of services. To some extent these criticisms have been taken seriously by the BKKBN. Important policy changes have been made in response to them. The KB Mandiri program was launched, which aimed at involving the private sector. Aside from enhancing sustainability, privatization is also expected to improve the quality of the services. In 1993, the target system was replaced by the so-called demand-fulfilment approach. Efforts to improve the quality of care in family planning services are also being made, for instance by the development of appropriate manuals, trainA. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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ing in clinical procedures, infection prevention and counselling for informed choice, development of information materials for clients, and procuring new medical equipment. Current discussions about the national family planning program in Indonesia tend to focus quite specifically on the role and nature of the family planning program after the fall of the New Order regime and during the new period of Reformasi. For instance, can the BKKBN as an institution continue to aim at the goal of replacement-level fertility, as it has been doing for thirty years? What changes need to be made to secure a more sustainable fertility decline? What has been the impact of the economic crisis on family planning behaviour? What are the implications of the broader reproductive health goals adopted in Cairo at the ICPD (1994)? These basic questions can serve as starting points for considering the major issues and challenges faced by the national family planning program beyond the New Order.

Increasing contraceptive prevalence rate Despite Indonesia's success in reducing its total fertility rate by half in the 25 years since the program started, the contraceptive prevalence rate appears to have reached a plateau over the last decade at just over 50%. This is still well below the 70% level needed to reach a total fertility rate of 2.1, or replacement-level fertility. Innovative approaches are needed to achieve that level, one of them being to respond to the unmet need for contraception, shown by surveys to be approximately 12% of married couples (CBS 1995). This level of unmet need will not remain constant over time, but rather is likely to increase as the desire for smaller families becomes increasingly established. Thus, there appears to be a potential for further fertility decline, based on meeting the spontaneous demand for contraception and based on further rise of age at first marriage. The answer to the question of how to increase contraceptive prevalence depends heavily on how the program can improve the quality and the expansion of services to meet the demands of clients.

Improving the quality of service delivery The two current objectives of family planning service delivery are improving the quality of care and expanding family planning services. Given the level of success and the maturity of the family planning movement, it is now important to look at specific ways to improve the quality of care. Through rising levels of education and increased awareness of quality, largely due to improved communications, there will be increasing pressure from the public to improve quality. This changing environment provides both a challenge and an opportunity. Indonesia gained world acclaim in being able to provide a A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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large population with family planning services and enlisting strong community involvement, resulting in increased contraceptive prevalence and lower fertility levels. The challenge now is to demonstrate the feasibility of achieving further fertility decline through a strong emphasis on quality of care. This requires catering to the client's choice of method, counselling on side effects, improved interpersonal relations and technical skills on the part of health providers, and client satisfaction with services. In other words, the program needs to be based on a client's or user's perspective (Hull and Hull 1996).

Expansion of services Besides addressing the unmet need, the expansion of services should include widening the range of methods couples use. At this moment, for instance, the acceptance of voluntary sterilization is relatively low (less than 5%). Younger couples who have completed their families and older couples in general (those with wives over 35 years old) should be offered permanent contraceptive methods. Not only are such methods safer, cheaper, and easier for them, but in addition they can help reduce the maternal mortality rate among women over 35 years of age. No developing country, except Mauritius, has attained contraceptive prevalence of 65% without at least 13% of couples using voluntary sterilization. Also, when contraceptive use rests heavily on temporary methods that have significant failure rates, the backstop of safe abortion is needed. Unfortunately, voluntary sterilization in Indonesia is still not officially included in the program due to Muslim opposition. However, sterilization has been long offered by public and private service facilities with some support from the government. So far there has been no opposition to it. The 'rule of 100' for being entitled to sterilization (age times number of children should be more than 100), which was adopted in the late 1970s and 1980s, has lately been applied more flexibly. Another important area in the expansion of services is the challenge of increasing male involvement. About 95% of family planning users are female. Increasing active male participation in family planning will not only balance reproductive responsibility more evenly between men and women, but can also increase the overall level of active contraceptive use. Effective family planning services for men should be designed to suit their needs. The BKKBN's new organizational structure includes a new directorate for male participation.

Strengthening family planning institutionalization Since the start of the national family planning program, BKKBN has set its long-term course in three stages: expansion, maintenance, and institutionalization. With fertility rates being what they are now, many consider the A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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program to have already reached the institutionalization phase. This means that the majority of Indonesian families already perceive family planning as a need. In this phase, the strong role of government in promoting family planning should be phased out, and services should gradually be transferred to the private sector. Acting on an evaluation of the program, the BKKBN developed SelfReliant Family Planning, or KB Mandiri, in the mid-1980s. The essence of KB Mandiri is privatization of the program. Also, some years ago, the BKKBN changed the word 'program' into 'movement'. A movement is supposed to be people-centred, as opposed to government-centred. According to the chair of BKKBN at that time, it is not simply for the people but by the people (Haryono Suyono et al. 1995). The shift toward privatization and a clientcentred policy should be further strengthened by the involvement of more NGOs and other private institutions. They should be the leading actors. The role of the BKKBN should be that of a facilitator.

Implementing the Cairo plan of action Indonesia is considered in the forefront of Third World countries in family planning. It serves as a centre for international training and it is a founding member of the South-to-South Partners Initiative to foster cooperation in family planning training and development. As an active participant of the International Conference of Population and Development in Cairo (ICPD, 1994), Indonesia is to implement the adopted Cairo Plan of Action. This implies broadening the family planning program to include efforts in the field of reproductive health care and reproductive rights. Other points on the agenda are quality of care, client satisfaction, attention to women's health, and the inclusion of youth as part of a broader reproductive health mandate (Lubis 1998).

National family planning program beyond the New Order The fall of the New Order was triggered by the economic crisis that started in mid-1997. However, the undemocratic character of the New Order regime and the corruption and nepotism of the Suharto family were additional themes used by the masses and by students during the demonstrations against Suharto that ended his 32 years of power in May 1998. The era after the New Order is called the Reformasi (Reform) era. The Reformasi government under Habibie was considered an extension of the New Order government, to serve only as a transition government until the general elections scheduled in mid-1999. In Habibie' s cabinet, the chair of A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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BKKBN was Ida Bagus Oka, the former governor of the province of Bali. He maintained the BKKBN organization and personnel more or less as it was. Haryono Suyono, who was the previous chair and well-known architect of the program since the beginning, still retained his position as the coordinating minister for people's welfare. During the Habibie administration the economic crisis was not resolved, but conditions improved slightly. In October 1999, a new president was elected. The new president, Abdurahman Wahid, popularly called Gus Dur, then formed his new cabinet. He appointed Mrs Khofifah Indar Parawangsa as chair of the BKKBN. She was a close associate from his own ranks, the Islamic organization Nahdlatul Ulama (NU), and was also state minister for the Empowerment of Women (MEW) in the new cabinet. The appointment of this minister as BKKBN chair reflected the concern of the new government about the criticism that the family planning program pushed the agenda of population control at the expense of women. By appointing a woman and the MEW as head of the BKKBN, it was hoped that such criticism, coming mainly from feminist groups, could be countered. As soon as she took up her position as head of the BKKBN, Mrs Khofifah set new policies for what she called the new era of the national family planning program. These new policies were to be in line with the new sociopolitical environment of the Reformasi era. For instance, in the new BKKBN organizational structure, the deputy for family planning was also responsible for reproductive health. It indicated the commitment of the BKKBN under her leadership to the Cairo Agenda and to promoting family planning in the framework of reproductive health. In the new policies many ICPD 1994 recommendations were included, such as protection of reproductive rights as an integral part of universal human rights, enhancing quality of services, gender equity, focus on women's health, and informed choice. In the implementation of the program, the role of the BKKBN was to be more that of a facilitator, and the role of NGOs and the private sector was to increase. It was stressed that the main objective of the program is to promote family welfare (BKKBN 2000). With regard to the new national policy of regional autonomy and decentralization starting in 2001, the BKKBN has proposed to retain central responsibility until local governments are ready to carry out their own programs. To push the decentralization of the program while local governments are not yet prepared to take over, might be detrimental to the ongoing program. This program reorientation will of course need time and adaptation within the BKKBN structure before it can be fully implemented. At this moment it is too early to see the impact of these new policies on program implementation.

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Bibliography Adioetomo, Sri Moertiningsih, Ganiarto and Hidayat The quality of care in family planning services; Indonesian Family Life Survey 1993. Jakarta: Demographic Institute, Faculty of Economics, University of Indonesia. Adioetomo, Sri Moertiningsih 1997 'Fertility and family planning; Prospects and challenges for sustainable fertility decline', in: Gavin W. Jones and Terence H. Hull (eds), Indonesia assessment; Population and social resources, pp. 232-46. Singapore: Institute of Southeast Asian Studies, Canberra: Research School of Pacific and Asian Studies, Australian National University. Atmosiswoyo, Subyakto 1978 'The family planning program in Indonesia', in: Lida C.L. Zuidberg (ed.), Family planning in rural West Java; The Serpong project, pp. 21-32. Leiden: Institute of Cultural and Social Studies, Jakarta: Djambatan. BK.KBN 2000 Era baru Program Keluarga Berencana Nasional. Bahan masukan diskusi interaktif tentang kesejahteraan dan keadilan jender dan program KB nasional pada era. Jakarta: Kantor Menteri Negara Pemberdayaan Perempuan, Badan Koordinasi Keluarga Berencana Nasional. CBS et al. 1995 Indonesia demographic and health survey 1994. Jakarta: CBS, NFPCB, Ministry of Health, Macro International. Gardner, Michelle and Lila Amaliah 1999 An analysis of conflicting crisis-related research results. Jakarta: Frontiers in Reproductive Health Cooperative Agreement, The Population Council, USAID. Hamidjojo, Santoso S. and Donald Chauls 1996 Change amidst continuity; The Indonesian 'prosperous' family of the 21st century. Jakarta: NFPCB. Haryono Suyono 1976 Village family planning; The Indonesian model (Institutionalizing contraceptive practice). Jakarta: NFPCB. Haryono Suyono and Thomas H. Reese 1978 Integrating village family planning and primary health service; The Indonesian perspective. Jakarta: NFPCB. Haryono Suyono, Lukas Hendrata, and John Rohde 1995 The family planning movement in Indonesia. Jakarta: NFPCB. Hull, Terence H., Valerie J. Hull and Masri Singarimbun 1977 'Indonesia's family planning story; Success and challenge', Population Bulletin 32-6:4-51. Hull, Terence H. and Masri Singarimbun, 1989 The sociocultural determinants of fertility decline in Indonesia, 1965-1976. Yogyakarta: Population Studies Center, Gadjah Mada University. 1996

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Hull, Terence H. and Valerie J. Hull 1996 Improving quality of care in family planning; How far have we come? Jakarta: Population Council. [South-East Asia Regional Working Papers.] Lubis, Firman 1998 'Mortality and fertility; The challenges', in: Gavin W. Jones and Terence H. Hull (eds), Indonesia assessment; Population and human resources, pp. 246-56. Singapore: Institute of Southeast Asian Studies, Canberra: Research School of Pacific and Asian Studies, Australian National University. NF PCB 1982 Basic information on the population and family planning program. Jakarta: NFPCB. Nitisastro, Widjojo 1970 Population trends in Indonesia. Ithaca: Cornell University Press. Nurhayati and Gandung Sudjianto 1990 History of the family planning movement in Indonesia. Jakarta: NFPCB. Parson, J.S. 1984 'What makes the Indonesian family planning program tick', Populi 113:5-9. Pelon, Nancy and Firman Lubis 1984 'Family planning services in urban Indonesia; Focus on Jakarta 19801984'. [Paper Yayasan Kusuma Buana, Jakarta.] Streatfield, P.K. 1984 Reliability of BKKBN prevalence statistics; A comparison of BKKBN and census figures, 1980. Yogyakarta: Population Studies Center, Gadjah Mada University. [Indonesian Population Dynamics Project. Working Paper Series 27.) 1985 'A comparison of census and family planning program data on contraceptive prevalence, Indonesia', Studies in Family Planning 16-6:342-50. UNFPA n.d. Population Profiles 14: Indonesia. New York: UNFPA. Warwick, Donald 1986 'The Indonesian family planning program; Government influence and client's choice', Population and Development Review 12-3:453-90.

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CHAPTER IV

The political framework for family planning in Indonesia Three decades of development Terence H. Hull

In this chapter the roots of the family planning movement and the later family planning program are painted against the backdrop of the succeeding political orders and the changing bureaucratic and administrative structures in Indonesia. The period that is the focus of this book, the Orde Baru, or New Order, is placed in a historical-political sequence. Thinking about birth control, population growth, and family planning in Indonesia did not start with the Suharto regime, but - as is shown in this chapter - can be traced to the period prior to the Japanese occupation and was continued under Soekarno. During Suharto's New Order, the subject acquired political prominence and became an important policy issue. When Suharto had to step down, the political history of family planning took another turn, as will be reflected upon at the end of the chapter. The chapter looks first at late colonial Indonesia and the newly independent Indonesia under the nation-builder Soekarno. Soekarno' s views. on population growth and the role of women are reconstructed on the basis of evidence derived from various sources. The second part of the chapter looks at the first half of the New Order, during which the population policy and the family planning program were developed and anchored in the 'bureaucratic polity' of Indonesia (Jackson 1978). The third part of the chapter discusses how family planning figured in national and international political disputes. A detailed account of the political manipulation of the picture of family planning practice in East Timor is provided. The chapter concludes by looking at family planning in the changing political order at the end of the New Order and attempts to predict the future for the reproductive health movement in the post-New Order period. The emergent picture shows that family planning is not just about birth control practices by private individuals, but that it has political ramifications, impacts, and significance. A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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The political roots of the family planning movement in Indonesia Modern Indonesia was born in the rejection of an attempt to re-impose Dutch colonial rule following the overthrow of the Japanese occupation at the end of World War II. Later to be called the 'Old Order', the rise of an ideology of liberation and nationalism in the 1950s and 1960s marked the first important political stage for the independent country. Nationalist leaders drawn from across the archipelago, but with heavy representation from Java and Sumatra, had formulated their hopes for an Indonesian identity and state during the 1920s and 1930s in a series of declarations, speeches, and books. Their movement was systematically suppressed by colonial authorities, who imprisoned many nationalist leaders, including the man who later became the first president of the Republic, Soekarno. After four years of Japanese occupation, 1945 brought the opportunity nationalists needed for a declaration of independence from a reasserted Dutch colonial rule. They created a republic with a constitution (UUD 45) setting out a form of government which has produced a strong presidency and relatively weak legislature, drawing heavily on the forms used in the constitutions of Western nations. They also formulated the unique Pancasila, or five basic principles of the state, designed to promote a unified Indonesian identity in a nation composed of highly varied religious, ethnic, and political groups. The 'New Order' Indonesian government of President Suharto was established in 1966 after an abortive coup in September 1965. The military-backed regime that ruled the country over the next three decades took great pride in an ideological system centred on the Pancasila. With declared belief in one God, and commitment to humanity, equity, social justice, and political unity, the government claimed to encompass all the basic values of different religions and ethnic groups of the archipelago within a single set of principles. This precluded the legitimacy of divisive party politics that would set competing interests against one another. Pancasila values were said to underlie the decisions in the 1970s and 1980s to remove political party activities from the villages, creating a 'floating mass' undistracted by political wrangling. It further created an umbrella organization of interest groups to formally support the government and to field candidates in elections (Golkar), and consolidated all opposition parties into two official parties. These were required, as a condition of their existence, to accept the government's interpretation of Pancasila democracy. In addition to the formal statements of ideology and national ideals, there are a number of cultural beliefs and practices which have been important in shaping Indonesian political, social, and economic institutions over the 'Old', 'New', and 'Reform' order regimes. Among these are the practices of musyawarah-mufakat (consultation-consensus) in group decision-making, A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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gotong royong (mutual assistance) in community works, and long traditions of courtly traditions devetoped over centuries of successive sultanates and empires. Indonesian peasants tend to follow the advice and directions of their village leaders, and this has been generalized into a tendency to accept the leadership of higher levels of government with a minimum of questioning and very little non-compliance with regard to issues seriously pursued by the leaders. Although three paragraphs can hardly do justice to the rich and varied patterns of belief and thought existing among the many cultures, religions, and social groups of Indonesia, they may help to understand something of the nature of government in Indonesia. Specifically for this study they can help explain how the official family planning program was so successful in mobilizing people in their villages to comply with advice and instructions concerning birth control. Not surprisingly, the government, and specifically the policy-makers involved in the family planning program, have had a sensitive understanding of Indonesian thinking, and have used that understanding to good effect in setting the strategies, and recognizing the limits, of the family planning program. The implications of the ideological changes between 1945 and 1995 for the structure of governance have been consistent in a number of areas. There has been a major expansion in the size and functions of the government bureaucracy. The armed forces took an active role in the government and the economy, in line with their declared policy of dwi-fungsi (dual military and civilian action roles). Vertical lines of authority were strengthened and extended to ensure that orders and responses flowed easily between the different levels of government down to the village. These changes were not without trauma or opposition, as the political upheavals of the 1950s and 1960s attest. After 1965 the Indonesian Communist Party was destroyed and hundreds of thousands of people were killed. Throughout the period large numbers of people were gaoled as political prisoners, and the interests of many political, ethnic, and economic groups were compromised for the sake of political stability and national economic growth. The political evolution of a family planning program There is a tendency in recent accounts of the development of family planning programs in Asia to characterize the period before 1950 as 'traditional' times with unrelenting ignorance of or opposition to contraception. While the period did lack general community support for birth control in Asia, and in many countries an overt legal hostility to the concept, it is important to recognize the influence of individuals and institutions who were challenging A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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this situation. These are the people who, in a sense, were the precursors to the family planning programs formed decades later. In Indonesia the historical record on pioneers of population policy and contraception is thin, but suggestive. During the 1920s and 1930s, as the struggle to promote birth control was being carried out in the courts and the clinics of Europe and America, the Netherlands Indies was also caught up in a debate on the issues of overpopulation and sexual morality. A series of academics and government officials from as early as the nineteenth century warned of the dire consequences of Java's rapidly growing and very densely settled population. However, the response of the Dutch government was to concentrate on the 'development' side of the equation, advocating more intense cultivation practices, planned industrialization, and resettlement of Javanese to the less densely settled Outer Islands. Birth control was either condemned as being immoral, or rejected as being impractical in a country with low educational levels and religious objections to contraception - including both the Christianity of the colonizers and the Islam of the colonized. The prominent American scholar Amry Vandenbosch commented on the dilemma in his influential 1933 volume The Dutch East Indies; Its government, problems, and politics. Citing the very rapid growth rate revealed in the 1930 population census, he declared that 'a population crisis has been reached' in Java, and the island had 'reached the limits of agricultural extension' (Vandenbosch 1933:258). Summarizing the conventional wisdom of the time, he concluded that: 'The increase of population in Java came from an intense colonization and Western peace and hygiene, and the social awakening is only now taking place after the population has already become very dense and the problem acute' (1933:259). While hinting that the 'social awakening' might have something to do with reducing fertility, and hence dampening the rate of population growth, Vandenbosch, like most intellectuals of the period, was very circumspect in discussing birth control. After all, abortion was addressed in the criminal code in very strict terms, and contraceptives were discouraged through various import regulations and restrictive medical practices. Still, a few academics, journalists, and medical practitioners did speak out in favour of fertility control. The American Samuel Van Valkenburg reflected a growing feeling among analysts in 1930 when he concluded a detailed review of the geographic potential of Java with despair over the population problem, and a call for the immediate promotion of birth control to reduce fertility. While a minority voice, he was not alone, either internationally or within Indonesia. But he was going against a general hostility to contraception. Magnus Hirschfeld, the founder of the Institute of Sexual Science in Berlin and a major figure in European studies of sexual behaviour, commented after a six-week lecture tour in 1931 that 'in Java, as in the rest of Asia, I was asked A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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more often for a means of preventing sterility than for preventing conception, although there were some questions concerning the latter' (Hirschfeld 1935: 119). His Javanese audiences were also greatly concerned with the issues of co-education and Western dancing, both of which were assumed to promote uncontrollable sexual arousal. To this progressive German professor, the pattern of questions in Asia indicated a great anxiety over sexual issues, matched by embarrassment over birth control. 'People', he contended, 'would rather keep silence than be compelled to talk about contraception' (1935:55). While the mood of the colony was certainly subdued about contraception, Hirschfeld met many kindred spirits who shared his concern for fertility control and sexuality, both among medical professionals and members of the large and enthusiastic audiences attracted to his lectures (Wolff 1986). One of the people who refused to keep silent on the issue was a journalist of Chinese ancestry who published the Central Java Review in Semarang. Chan Kok Cheng began writing on the issue of birth control - which he called 'neomalthusianism' - in March 1927, and he produced a steady stream of articles in his monthly magazine over the next seven years. His writings attracted a large audience among intellectuals in Java and Sumatra. In 1934 he brought out a collection of the articles in a book titled Neo-Malthusianisme atawa birth control (perwatasan kelahiran); Theorie dan praktijk (Neo-Malthusianism or birth control; Theory and practice). The impact was immediate and strong (Budiman 1975:8). Newspapers in Medan (Perwarta-Deli) and Padang (Sinar Sumatra) welcomed the publication as the first book about birth control ever published in Indonesia. The Medan paper called it a welcome addition to the vigorous debate about population which had been engaging the public for the previous few years -that is, since the results of the 1930 census had been released, and following Hirschfeld's lecture tour in 1931. Conversely, Inyo Beng Goat, the influential editor of Keng Po, an Indonesian-language but Chinese-oriented newspaper in Jakarta, totally rejected both Cheng's arguments about overpopulation, and the promotion of birth control. But, he said, the issue would not be resolved quickly. It would take a hundred years to provide the proof of who was correct over birth control, and by that time 'Chan and I will both have been turned into raja cacing (king worms)' (Budiman 1975:9). Cheng's suggested methods of birth control were those common in Europe at the time, and promoted in birth control clinics in America: pessaries, foaming tablets, sponges and cotton swabs, and condoms. Evidence for the availability of such materials in Indonesia is very difficult to obtain, since the Dutch regulations forbade advertisement and promotion of contraceptives. Nonetheless, a few medical supply catalogues survive, such as the 1931 R. Ogawa and Company import catalogue that offered shops and individuals Nyonya Ayu brand condoms for the purpose of preventing both infections A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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and pregnancy. A box of six cost 0.80 guilders, or about half the price of Cheng's birth control book People who might have been customers for such devices in the 1930s are today very old, or no longer around to report the experiences and attitudes of their youth. Anecdotal evidence from a limited number of older Indonesians indicates that purchase of contraceptives in the 1930s was a matter to be concealed, and was frequently condemned by religious and government leaders, who linked contraception with prostitution and adultery in the public mind. The only places where contraceptives were promoted as normal means of family planning were in the very few doctors' surgeries where married women with large families or particular gynaecological problems were encouraged to use contraceptives to prevent pregnancies. One of the methods promoted by Indonesian doctors practising in the cities was the diaphragm, but there is no evidence remaining as to the frequency of use of such methods, or the attitudes of the users. The Second World War interrupted the streams of development which were producing a larger medical establishment and more liberal attitudes on sexual and population issues in the 1930s. During the Japanese occupation between 1942 and 1945, Dutch institutions were destroyed, or replaced by Japanese-controlled and Indonesian-staffed organizations. Indonesian nationalists who had been repressed or imprisoned in the colonial period suddenly found themselves heading bureaucracies, leading military units, and formulating plans for eventual liberation. Though their nationalistic ideas might have seemed mere dreams in 1943 and 1944, the defeat of Japan in 1945 created a vacuum into which Soekarno and other nationalists quickly moved to declare the independence of Indonesia. They were committed to a unitary, socialist-nationalist state under the five leading principles of the Pancasila and a constitution providing for a presidential/ congressional system of government. The Dutch fought against this development and attempted to reclaim their former colony. Five years of struggle and acrimonious negotiation finally resulted in the success of the nationalists, and Soekarno led his country into the family of nations as both the first president, and the dominant architect of the new government. In this position he faced the challenges of reconstructing the economic infrastructure of the country, facing up to problems of agricultural degradation and rural poverty, and maintaining unity in the face of regional revolts, serious conflicts among political parties, and great tensions between military, communist, and religious groups. In 1950 the question of fertility and population growth was not on his mind at all. At the same time, a number of developing countries were beginning to acknowledge the problems that high rates of population growth posed for development planning, and that high rates of fertility posed for maternal and child health. India and China established family planning policies in A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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1953 with the goals of reducing fertility and growth rates. Gradually other countries followed suit. The effort was not without difficulty, and it was soon apparent that while ·some people were interested in controlling fertility, many others had either strong preferences for large families or strong distaste for contraceptive methods. Culture, religion, and education shaped community responses to these issues, and leaders caught in early phases of nation building were often sensitive to issues that might provoke divisions in their constituencies. This was exemplified in Indonesia, where President Soekarno, with characteristic bravado, rejected community and visitors' requests to institute a program of population control, declaring that Indonesia could support a population double or treble the 97 million of the 1961 census. The context in which these statements were made is interesting. The most frequently cited evidence on Soekarno's 'pro-natalism' comes from foreign journalists who enjoyed very close and open access to the president during times of particularly sensitive international relations. Louis Fischer conducted a running debate over birth control with the president as they visited run-down military complexes, poor neighbourhoods, and rural villages in Java, Bali, and Sulawesi (1959:150-7, 165-6). Fischer found the poverty all the more upsetting because it was reflected in the weariness of young mothers with five, eight, or even thirteen children, while Soekarno pointed to the same women as models of strength, beauty, and resilience. As they argued their way across the archipelago, Soekarno repeatedly said that 'We could feed two hundred fifty million' (Fischer 1959: 156), and that the problem facing the government was one of providing the people with better housing, education, and jobs. Fischer was unable to convince Soekarno by using arguments based on linkages between population growth and economic development, but found Soekarno able to accept arguments for birth spacing to protect the health of mothers and reduce the burden on the family. 'But', said the president,' don't write that I favour birth control' (1959:157). In his mind the whole issue of contraception was too tightly linked with the 'moral laxity' which he saw in Western societies (1959: 161). Later, Fischer learned that Soekarno's wife had recently been warned not to have another birth until at least three years after the birth of her second child, and that the president thus understood the issue of fertility and women's health in a personal as well as theoretical context. Nonetheless, as president, he did not want to be seen to be accepting advice from foreigners on population control, nor did he want to be pressed into advocating mass programs that would be identified with immorality. Five years later, the Newsweek regional correspondent pressed Soekarno again on the issue of population growth and birth control. By this time Soekarno was seen by the West as a dictator, perhaps a bit mad, and an A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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unpredictable force on the world stage. In the face of international boycotts called as a result of Indonesia's confrontation with British and American power over the issue of Malaysia, Soekarno rejected Bernard Krishner' s view that population growth was exacerbating Indonesia's evident poverty and creating serious domestic problems. 'What problems?' replied the president, 'I have no headaches. Food problem? Nobody is starving[ ... ]. I am not afraid of the inflation. Inflation is only bad if it makes the people poor, if it makes people starve.' (Krishner 1964:84.) As the interview progressed, Krishner returned to the question of birth control. The president replied entirely in the context of population control: I still believe we ought not to have birth control here. My solution is exploit more land, because if you exploit all the land in Indonesia you can feed 250 million people, and I now have only 103 million. It was President Mohammed Ayub Khan [of Pakistan], who, seeing so many children in Indonesia, said: Sukarno, I tremble when I see children. Children create problems. Yes, your country is poor, I said. In my country the more the better. Q. 'How do you visualize the Indonesia of twenty years from now?' A. (Laughing) 'Ohhh. The richest country in the world.' (Krishner 1964:84.)

It is this kind of banter that gave Soekarno the reputation for being pro-natal-

ist and anti-family planning. However, his meetings with Fischer and Krishner can be interpreted in another context. Here we see the president of a volatile regime projecting an image of nation-building ambition to the world. He is defiant in the face of tense confrontation with rich Western nations, proud and obstreperous in claiming a leadership role in the developing world. Soekarno seems more to be making extravagant claims for Indonesia's place in the world than making an assessment of either the need for reduction of the population growth rate or the desirability of family planning services. In more reflective moments when talking to his confidants, Soekarno admitted that the major problem of family planning was the probability that it would give offence to Muslims, and would fail to have an impact on the growth rates of a largely illiterate population (R. Soeharto 1984:204). One of Indonesia's most prominent economists also noted that a 'population control policy has an undertone of pessimism concerning the potential of the nation', which was a notion at odds with the nationalism of the time (Sadli 1963:22). This linking of population issues with a sense of despair was by no means limited to Indonesian leaders. A well-known Dutch commentator of the period wrote: 'Children are born far in excess of the means of subsistence and so they have to die by the millions. Even so far as there is birth control, it is chiefly from a primitive individual feeling of factual impotence to extort from nature even a minimum existence for one's self and for a child at the A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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same time.' (Boeke 1953:77.) In contrast to the often repeated quote from Soekarno that the nation could support 250 million people, Sadli noted that the president 'on occasion expressed concern over the problem of food production for this expanding population' (1963:21). In common with many other developing countries in the 1950s and 1960s, the terms population control and family planning were unsettling and unwelcome concepts in national debates concentrating on nation-building. It seemed to the politicians that these ideas were in some way opposed to the concept of 'the people' and thus suspect. Despite Soekarno' s public and private attitudes and the laws inherited from the Dutch which restricted the import or sale of contraceptives, women's groups and doctors had quietly promoted birth control from the early 1950s. In 1957 the Indonesian Family Planning Association (PKBI) was formed, and later associated with the International Planned Parenthood Federation (IPPF). The head of the new organization was Soekarno's personal physician, Dr R. Soeharto, and the vice-head was Dr Hirustiati Subandrio, whose husband was Foreign Minister and former ambassador to England. While posted in London in 1950, the Subandrios had discussed issues of birth control with the IPPF and had helped to arrange for Indonesian medical specialists to travel abroad for training in maternal and child health and family planning. Over the tumultuous years from 1959 to 1965, the political balance shifted dramatically; democracy waxed and waned, authoritarian rule and violent reactions and revolts unsettled the people. Finally a bloody attempted coup in September 1965 was resolved by the destruction of the communist party, and the murder of a huge number of accused communist party members or sympathizers. Among those jailed was Subandrio, and his wife was forced out of many positions, including her role in the family planning movement. Soekarno remained the nominal president for a few more years, but effective power was gradually taken by General Suharto, who formally became acting-president in March 1967 and president a year later. As Soekarno's power declined, so his personal physician, Dr R. Soeharto, gradually retired from various responsibilities, including leadership of the PKBI. The period of government transition following the attempted coup and counter-coup in 1965-1966 marks the crucial nexus in the politics of family planning in Indonesia. The histories of the period written today reduce events to a simple series: President Soekarno had forbidden family planning. Under the New Order, President Suharto signed the World Leaders' Declaration on Population in 1967. He then formed the Family Planning Institute (LKBN) in 1968, and eventually in 1970 raised the status of the LKBN to that of a coordinating board (BKKBN) with a chairman directly responsible to the president. Like many simple stories, this one personalized differences and set the contrasts in extreme 'black and white' terms, but the true history was neither so simple nor so clear-cut. A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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President Suharto's central role in the formation of the family planning program, and his unswerving support for its implementation was internationally recognized with the 1989 presentation of the UN Population Award. While there is no doubt that Suharto made an outstanding contribution to the program over the years, the details of the events surrounding the initiation of the government program are important for the insight they give into the real difficulties of overcoming government inertia or hostility toward family planning. They also clarify some of the dynamics encountered in Indonesian politics during a time when the structures of governance were undergoing substantial renovation. Two actors in the period of the initiation of a government family planning program were particularly important: General (later president) Suharto and Governor of Jakarta Haji Ali Sadikin. In April 1966 a besieged President Soekarno appointed Sadikin as governor of Jakarta. A marine, whose previous responsibilities had been in the area of logistics and formulation of battle strategy, Sadikin took a no-nonsense approach to the management of the nation's capital. The city offered a substantial challenge, and he approached it with the zeal of a military campaigner, assembling his 'troops', setting his goals, and making frequent tours of the 'battlefield'. In 1966-1968 General Suharto was engaged in an enormously delicate attempt to gradually assume de jure recognition for the de facto power he had obtained in the aftermath of the attempted coup (see Liddle 1985:74-85). High on his priorities was the resumption of formal relations with the United Nations, broken off at the time of Indonesian confrontation with Malaysia and attempts to expel the Dutch from West Irian. Such diplomatic recognition was also needed to increase the flow of foreign assistance from capitalist countries and agencies. The advice from both the technocrats staffing his planning board and the various donors returning to Jakarta was the same: to gain development he must control the growth of population. Suharto, like Soekarno, thought this would be impossible given religious problems, but it was advice he could not simply ignore. In contrast to General Suharto, whose problems involved political jockeying and grand strategy, the other key player, Jakarta governor Ali Sadikin, was daily confronted with the practical problems of administering a city's needs. The rapidly growing capital city posed even more rapidly multiplying demands for housing, sanitation, water, education, and infrastructure. Population issues, though relevant to both, had a very different meaning in the two settings (see Sadli 1963). Economic growth and political stability were the basis for the assumption of the title 'New Order' for the regime that included both Suharto and Sadikin, though each with a very different role. The stress was on economic restructuring and social control. Street demonstrators instrumental in pushing Soekarno aside and crushing communism A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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in 1966 were reined in and told to resume their normal activities under the guidance of the military-dominated government. Political competition was regarded as the enemy of economic growth; all political parties were told to toe the government line and most were eventually eliminated. Recalling the period, a former US ambassador to Indonesia was reportedly disappointed that his first meeting with Suharto, in May 1966, was related to the latter's request for a 500 million dollar grant for the problematic population resettlement program as a means of controlling Java's population growth rate. In turning down the request, the ambassador commented that movement of merely the increment of Java's population would require a daily departure of a ship far larger than the Queen Mary, and suggested that birth control might be a more efficient option to reduce the growth rate (Green, personal communication). At that meeting, and over the next year, Suharto indicated no interest in birth control policies, primarily because of concern over the potential religious sensitivities related to the issue. In addition to the occasional suggestions of the American ambassador, there were numerous other people in Jakarta pressing for birth control, including US-trained planning officials (technocrats), Ford Foundation advisers, PKBI leaders, medical doctors, and visiting World Bank missions. The president was cautious in his consideration of these calls. At the same time the hard-driving governor of Jakarta was quickly learning the lessons of population in his attempts to renovate a city with poor housing, schooling, transport, and basic services. The rapidly growing population meant that no matter how fast the new administration worked, the problems always seemed to grow at a faster rate. By mid-1966 Sadikin was regularly making speeches linking urban problems to rapid population growth, citing floods in Pluit (north Jakarta), large numbers of unsuccessful applicants for school entrance, and growing slums as being evidence of the 'population problem'. Toward the end of 1966 he issued a challenge to the PKBI to work up a project which would help to slow the rate of natural increase in the capital. The 'Jakarta Pilot Project' was up and running by April 1967, and constituted the first government-funded family planning program in Indonesia (Sadikin 1977:103). The governor frequently assisted these activities by giving strong speeches of support at the opening of clinics and seminars, and by encouraging the integration of family planning activities in the city's health department. Between 1966 and 1968 most governmental family planning initiatives were taken under the aegis of the Jakarta administration. Later, as programs moved to other areas, the example of Jakarta was cited as proof that a strong, responsive top leadership could overcome the problems of religious opposition and community intransigence (Hull 1987). In his reflections on the program a decade later, Ali Sadikin pointed out that the issue of leadership was not merely a question of the top person, but rather A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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the issue of consistent involvement from the top down to the grassroots: I had the impression that the implementation of the program wasn't a technical or medical service problem. It was more the challenge of changing attitudes and awareness of the community with regard to the population problem in general and family planning in particular. For this reason, in addition to the effort to improve technical medical services, it required the active involvement of the local leadership and all community leaders. Consequently I developed policies to strengthen the involvement of local leaders and community organizations by requiring them to carry out family planning training and motivation which would both explain the purposes of the program and maintain the involvement of acceptors. (Sadikin 1977:103-4.)

This instruction to strengthen the resolve and involvement of government officials came in June 1973 as the program was expanding nationally and moving increasingly beyond a traditional clinic base. Later Sadikin was to encounter serious opposition to his dynamic attempts to promote growth in Jakarta, and after stepping down as governor in 1977 he suffered a major falling-out with the regime. Until 1998 he was a virtual 'non-person' in the official histories of the period. In considering the politics of the initiation of a family planning program it is important to see the crucial role he played in breaking through the imagined barriers that inhibited other policy-makers from taking up the cause of population control. His impassioned calls for reduced growth rates, stemming from the pragmatic demands of his position, carried weight not only with other leaders but also with the people. His conservative Muslim background gave him credibility when he declared that family planning would not be promoted in a way that could undermine the morals of the community. Evidence of the hesitancy with which the central government viewed the issue of family planning goes beyond the contrast with the Jakarta municipal administration. Even as the president was signing the World Leaders' Declaration on Population in December 1967, Sarwono, the new head of the PKBI, was advocating 'a slow cautious approach to family planning'. As he told a New York Times reporter: 'You have to go very carefully, because if you fail, there will be a setback of many, many years' (10 April 1967:22).

The bureaucratic politics of developing a population program (1970-1988) Following the successful example of Jakarta in 1967 and 1968, political decisions were made to initiate a national family planning program. As a result, a whole new set of political issues came to the fore as the program established its place in the bureaucracy (see Saparin 1977 for a description of the administrative complexities involved). Most obvious were questions of A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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budgets and staffing. There were also important issues related to the exercise of authority, including the determination of who was to control clinics and outreach services, how research priorities were to be set, who would set the terms of evaluation and have the right to administer foreign assistance. In a general sense the answers to these questions in Indonesia are contained in the description of the National Family Planning Coordinating Board (BKKBN) as the agency charged with coordinating activities implemented by line departments and non-governmental organizations. However, from the outset the BKKBN was much more than a coordinating agency. In 1968 the private affiliate of the IPPF, the PKBI, transferred its clinics, equipment, and supplies in Java and Bali to the BKKBN through the Department of Health, and training continued to focus on the needs of health personnel (IPPA 1970). Foreign donors invested heavily in the BKKBN to build a strong bureaucracy capable of handling the logistic, training, and promotional tasks they believed were beyond the capability of established departments of Health and Information or the PKBI. As the BKKBN took on more responsibility for implementation, the 'coordination' took on characteristics of 'control', with a growing staff becoming increasingly involved in setting up and running projects, often with very generous foreign funding. Family planning fieldworkers were hired and outfitted by the BKKBN rather than the Department of Health, and as time passed, and they numbered over 6,000, they pressed for and received permanency within the government structure. The growing staff establishment justified an expansion of BKKBN presence in provincial and regency-level government. After a decade of growth, the BKKBN had become a quasidepartmental institution with a large staff, a huge fleet of vehicles, and impressive buildings in Jakarta, the provincial capitals, and many kabupaten (regency) and kecamatan (sub-district) towns. Understandably, the rapid growth of the BKKBN, and the organization's ready access to foreign assistance were causes of jealousy among the more established government departments, in particular the Department of Health and the Central Bureau of Statistics. From ministerial suites to district offices and clinics, complaints were voiced about the tendency of the BKKBN to push into territory far beyond the needs of' coordination' (Warwick 1986:45760). On the other hand, the BKKBN saw its mission as addressing a problem of great urgency - a population explosion - and justified its activism as a necessary expedient to circumvent complex and moribund bureaucracies. Foreign review teams regularly reinforced the BKKBN argument, though over time it became clear that long-term development would require the program to be well integrated into line departments, and strongly rooted in the community (Snodgrass 1978). At the end of the 1970s, the BKKBN made greater efforts to involve departments and community groups in the impleA. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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mentation of foreign-financed projects. It utilized USAID and UNFPA assistance to train the staff of departments and non-governmental organizations at both central and provincial levels. 1 This did not fully eliminate the bases of conflict. Rivalry was displayed between the BKKBN and the Central Bureau of Statistics (BPS) concerning the methods and purposes of measuring fertility levels and rates of contraceptive use. The gap between BKKBN and BPS estimates of current use was huge, at times a contrast of around 60% claimed by the BKKBN to 40% estimated by the BPS, with little attempt by either organization to adjust their estimation techniques to facilitate valid comparisons. In response to demands of international funding agencies, the BKKBN stakes its reputation on estimates of the proportion of women actually using contraceptives, so these differences are of more than academic interest. In fact, Indonesian and foreign academics involved in evaluating such data sometimes find their efforts thwarted, ignored, or inhibited by leaders of both organizations who do not welcome discomforting critiques while they are engaged in such a basic bureaucratic conflict. In the early 1980s the BKKBN presumed to be the central authority on all forms of population policy and were actively pursuing an agenda formulated by the BKKBN Deputy for Population, which included integrated policy formation on population and development. BKKBN became involved in issues of labour force, mobility, urbanization, and resettlement. The establishment in 1984 of a State Ministry of Population and Environment (KLH) under the leadership of a feisty and experienced minister (Emil Salim) soon reduced the BKKBN to a narrow mandate of coordinating efforts of fertility control. This could have been a masterful stroke of bureaucratic politics by the president, for in one decision he both reinforced BKKBN responsibility in family planning and reduced wrangles on policy between the BKKBN and the Departments of Labour, Transmigration, and Public Works, the BPS, and the National Planning Board (Bappenas). In some areas the BKKBN consistently maintained substantial control over implementing agencies. Though nominally university research institutes had autonomy in the implementation of demographic research, with 'coordinating' control over population funds, and especially over all foreignsourced funds, the BKKBN determined research priorities. It distributed funds to approved researchers, directed funds away from unfriendly critics, and occasionally prevented the release of research findings that presented the program in an 'inaccurate' way, or threatened to create sensitive issues. This censorious power was, of course, constrained by demands of funding agencies that research be carried out and published. Another countervailing Moebramsjah et al. 1982; Moebramsjah 1983; Haryono and Shutt 1989; Sumbung 1989.

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power rested with the complex net of steering committees set up for major projects, which had representation from respected senior researchers, officials, and aid agencies. Nonetheless, creative, critical demographic research in Indonesia (as in many other fields) was the exception rather than the rule under the New Order government. The BKKBN achieved legitimacy through the development of a large establishment, and the vertical and horizontal integration of its activities in the government structure, often involving connections with sectors not normally associated with family planning service delivery. Over three decades it became an ubiquitous feature of Indonesian society, with the blue BKKBN 'small and happy family' symbol adorning posters, houses, and vehicles across the archipelago. Family planning slogans appeared daily on Tv, radio, in traditional forms of theatre, among scouts, women's groups, and school classes, and regularly in presidential speeches. A wide range of social organizations, such as religious groups, manufacturing establishments, cultural groups, and youth groups, were active in promoting the messages of family planning, and assisting in the organization of services. The Indonesian program represented one of the most effective syncopations between government and society in Southeast Asia. The term syncopation is appropriate here because program emphasis is placed on those institutions not normally associated with family planning, but designed in a way that is both socially acceptable and socially invigorating. Though program messages frequently originated from the Departments of Information, Education, Health, or Women's Affairs, it is a sign of the entrenchment of the BKKBN that, whatever the source, people identified them merely as 'KB', the acronym for Family Planning- and saw them as a seamless fabric. Far from seamless, the program was often torn and stretched in the tussle of bureaucratic politics, but the BKKBN was brilliant in repairing the outward signs of damage and maintaining the illusion of perfect balance between governmental and social.interests. This success was recognized in 1993 with the elevation of the head of the BKKBN, Haryono Suyono - a social scientist by training - to the sixth development cabinet of President Suharto, as state minister of population and head of BKKBN. With this promotion he effectively regained control over those areas of population policy transferred to the State Ministry of Population and Environment ten years earlier. In many ways this decision marked the recognition of the central role family planning achieved in the New Order regime, and in particular Haryono' s success in implementing an agenda rife with political sensitivities and complexities. His success is particularly impressive when seen against the backdrop of major social conflicts that transformed Indonesian society over the period after independence in 1950.

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Family planning as a tool in national and international political disputes Islamic groups denied legitimate outlets to directly criticize the secularist Suharto government sometimes turned to family planning as an issue that could be questioned on religious and moral rather than political grounds. They forced the government to at least appear to be taking action in response to religious sensitivities (Aidid 1987). This has been seen in a variety of contexts. The so-called 'Priok affair' of 1984 consisted of large street demonstrations, violent military intervention, and numerous arrests and killings following critical sermons by religious leaders in the port area of Jakarta who, among other things, criticized the implementation of the family planning program. A few years later, police in East Java banned a number of critical Islamic books that contained phrases condemning certain birth control practices. As a prominent government program, family planning was a tempting target for any group opposed to the New Order regime. But the situation became particularly important as the government pushed Islamic political parties into a single powerless conglomerate political grouping (PPP, or United Development Party), and major Islamic religious groupings (Nahdlatul Ulama and Muhammadiyah) withdrew from formal political activity in the 1980s. From the early days of the government's involvement in birth control, various religious leaders expressed dissatisfaction with specific family planning methods, especially the IUD, condoms, and abortion. Some conservative leaders questioned the presumptuousness revealed in the notion that parents, rather than God, would decide family size (Akbar 1959:213). As the program became more widely accepted in the society, and as the BKKBN became larger and more powerful, religious objections shifted to specific actions or policies. Indications of this are contained in articles in the widely distributed Islamic magazine Panji Masyarakat in 1983 (Numbers 408, 413) making serious allegations against the BKKBN of coercion and the use of inappropriate birth control methods. In one article, Ahmad Tohari objected to the 'Smile Safari' campaign, which aimed at gathering large numbers of potential family planning acceptors through various techniques of bureaucratic mobilization. Under the title 'Hunting', he compared the BKKBN's treatment of Indonesian women with the fate of the bison, African slaves, and Native Americans 'hunted' by Europeans in 'safaris' of a different age. Panji Masyarakat reports of decisions of the November 1983 Munas Ulama Indonesia ( (MUI, Congress of Ulama Indonesia), including condemnation of sterilization and pregnancy termination except in emergency cases, despite government financial support for the former, and tacit acceptance of menstrual regulation techniques of abortion in private clinics. In a reversal of a decision made in the mid-1970s, the MUI accepted the IUD as a method of A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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birth control (Panji Masjarakat Number 412:22-4). They did, however, attach the condition that the insertion should be made by a woman doctor, or, in emergencies, by a male doctor in the presence of the woman's husband or another woman. Such concerns not only served to shape public attitudes about the family planning services, they also established notional boundaries on the policies and activities of the BKKBN, preventing official acceptance of sterilization, and moderating program strategies of community mobilization using campaigns of incentives and disincentives. They also highlighted the potential danger to the program of a major change in the domestic political constellation through the re-emergence of conservative Islamic political parties. Though the government was active in building up the secular strength of Islam through the financing of mosques, promotion of religious education in government schools, and injection of Islamic ritual into secular ceremonies, Muslim leaders remained critical of many aspects of the New Order.2 There was no particularly strong Muslim opposition between 1980 and 1998, but conservative Islam emerged as a major force to be reckoned with as pressures built up around the issue of the succession to President Suharto at the outbreak of the financial crisis of 1997. When this occurred, the family planning program almost immediately came under more critical domestic scrutiny, as I discuss below. Family planning was also the focus of international political conflict. Since the 1975 invasion and absorption of the former Portuguese colony of ·East Timor, Indonesia had been the target of attacks from the Portuguese government and indigenous Fretilin forces fighting for the national liberation of Timor. While a small band of guerrilla fighters in the central mountains engaged the Indonesian army in sporadic combat, Fretilin officials at the United Nations and various international meetings sought to discredit Indonesia in the eyes of the world. In 1987 rumours began to circulate that Indonesia was practising genocide against the Timorese. In March 1987 the US Catholic Bishops' Conference charged that Indonesia had 'forced birth control' on a 'largely Catholic population'. In July, forty senators sent a letter to Secretary of State George Schultz questioning US support for a regime which, they contended, had used coercive means to promote birth control in a nation which had experienced a large reduction of population as a result of war and famine. Just over a year later Australian politicians picked up the charge, with the additional twist that Indonesia was accused of forcing 57% of the women of Timor to use Depo Provera, which they claimed was an unsafe method of contraception causing long-term infertility. In May See Suryadinata 1989 for an incisive analysis of the complex relations between the government party GOLKAR and various Muslim political and secular groups at the peak of New Order power.

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1989, just prior to the presentation of the UN Population Award to President Suharto, the Portuguese Diario de Noticias revived the story, and added that there had been forced sterilizations and clandestine use of Depa Provera in Timar. They cited a report from the PKBI which, they said, was 'critical of family planning practice' in Timar. These serious accusations would have been very disturbing from the viewpoint of human rights were it not for the fact that they were based on a misinterpretation and misrepresentation of a single report prepared by the PKBI in July 1986. That report was in turn based on data from Timar supplied by the BKKBN. The errors were very basic. The 57% figure referred to the portion of current contraceptive users who had accepted Depa Provera, rather than all women. Taking account of the fact that only 7% of women were reported as using any contraceptive method at that time, this meant that just under 3% of women resident in Timar were using the injectable. Rather than contraceptive use of genocidal proportions, the figures for Timar revealed the lowest rates of current use in Indonesia, and very low rates by Southeast Asian standards in general. Moreover, these figures were based on all women resident in Timar, including the recent migrants from Java, Bali, and other islands of eastern Indonesia, many of whom had taken up family planning in their home provinces before moving to Timar as part of the government, military, or commercial presence. Current use among ethnic Timorese was presumably even lower than the province-wide estimate of 7%. Finally, it should be noted that prior to 1976 only 38% of the Timorese population were registered as Roman Catholic, the rest being animists or practising other indigenous religions. With the absorption of Timar into Indonesia, people were required to adopt one of the five officially sanctioned monotheistic religions approved under the state ideology of Pancasila and Indonesian laws on religion. As a result, by 1988 over 86% of Timorese residents had registered as Roman Catholics and in the 1990s the proportion of the indigenous Timorese listed as Catholics exceeded 90%. The 'majority Catholicism' of the Timorese was the product of Indonesian colonialism, even more than Portuguese colonialism, and did not reflect spontaneous conversions. BKKBN and PKBI officials were puzzled and hurt by the repeated accusations relating to family planning in Timar. They felt they had offered a valuable service to an impoverished people, and could not understand the charges of coercion. As one remarked in interviews in the early 1990s: 'With less than 10% prevalence, it is obvious that coercion is the one approach we haven't used.' It was also obvious that the charges of genocide through birth control were baseless. The frequent reference to 'a largely Catholic population' is a red herring diverting attention from a far more complicated set of changes to Timor's religious composition. The coming of freedom to East Timar in 1999 was accompanied by the A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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near total destruction of governmental, health, and educational infrastructure, including the destruction of the provincial family planning program. Now the question in East Timor is whether family planning will be rejected as a discarded tool of colonialism, or adopted as a vital contribution to the empowerment and welfare of Timorese women. It is clear from the politics of family planning in the last two decades that Indonesia is unlikely to be regarded as a model or inspiration in the resolution of that question in East Timor.

Indonesian family planning in a changing political order Indonesia has often been depicted as a case where rapid fertility decline preceded major economic improvement and thus could justifiably be attributed to the efforts of the family planning program (Sinquefield and Sungkono 1979; Freedman et al. 1981). Later, as the rapid pace of economic progress of the nation became more obvious, and the social changes accompanying that progress more dramatic, evaluations continued to treat the family planning program in isolation (Khoo 1982). When treated in a broader perspective, it was seen as instrumental in achieving other economic and social changes, through stressing income-generating projects, family welfare goals, or 'acceptor groups' (Warwick 1986:458). Only rarely was the program seen in the context of political change in Indonesia (Hull and Hull 1998). This is strange, since the political setting, and especially the ideological underpinnings of political changes, were crucial in determining the establishment, development, and results of the program. Even those elements of the program credited with carrying contraception and population education to villages, such as the establishment of community-based distribution systems, were ultimately products of changes to village structures, rooted in the last century and developed in an accelerated form under the New Order (Warren 1986; MacAndrews 1986). The family planning program can thus be said to represent development at the margin, albeit an important margin, of new formations of governance and socialization. There is no doubt that change was incremental, and should be conceived as a process of transformation via a series of marginal movements. But the engine of that change was less the family planning program than it was the oil boom which fuelled development, the political controls which purchased stability and authority, and the bureaucratic reforms and communications innovations that made regions responsive to central direction. In Indonesia these changes were attributable to the nature of the postcoup New Order regime. The change from the old to the new order involved a rearrangement of political power, in such a way that the major inhibitions to family planning - political Islam and nationalistic economic planning A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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- were replaced by forces supporting birth control, that is, secularist authoritarianism and technocratic planners. On the new agenda was high profile 'institution building', with large investments made in improving central government departments, strengthening control of regional and local government, and directing all social organizations to a common goal of development under the common ideological banner of Pancasila (Quarles van Ufford 1987). Through the entire period, social changes related to marriage and family relations rode on the wave of 'modernism', which was the hallmark of 'developmentalism' and consumerism in the society. As Indonesia entered the 1990s, the family planning program was again transformed in response to changing political ideologies and structures. Moves to deregulate and privatize state enterprises and the financial sector were mirrored in the KB Mandiri (Self-reliant Family Planning) program for privatizing contraceptive services, and a variety of initiatives to reduce government spending on health care in favour of private-sector developments. The rise of private and secular forces challenged the exclusionary type of authoritarianism of the early New Order period, and accompanied calls after 1989 for more openness in government, a greater role for parliament, and increased pluralization of power (Macintyre 1989:232-3). The demand for greater participation in government and responsiveness from the bureaucracy spawned an investigative attitude in the press and among professionals. It also led to the public airing of charges of undue pressure to ensure public compliance with family planning targets (Hull 1991). It was thus not a surprise to see the BKKBN taking a 'quality of care' (QOC) line in defining a more comprehensive reproductive health approach in the years leading up to and following the 1994 International Conference on Population and Development in Cairo. It was also not surprising to hear complaints from donors and NGOs that the QOC initiatives seemed to be more window dressing than commitments. Habits of authoritarianism could not be overcome by slogans. It was only in 1997-1999 that the political forces could be mobilized to challenge and ultimately defeat the New Order and usher in a reform agenda. Yet the fall of Suharto, the interregnum of Habibie, and the election of Wahid and Sukarnoputri seemed, in 2000, to have placed Indonesia in unstable and unpredictable times.

Predicting futures for reproductive health in unpredictable times If the past is 'plural' depending on the interpretation of events, then the future

is also plural, but in accord with the wide variety of reasonable assumptions that can be made about the likely course of events. This reflection seems all the more apt as Indonesia faces the challenges of building democracy on the A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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ashes of authoritarianism. It requires more time and a fuller revelation of the potentialities of the current political processes to make guesses at the political future of reproductive health, but already there are signs that the valuable legacies of the New Order may be preserved, and the more egregious errors may be corrected. The health reform initiatives of the Ministry of Health offer the strongest hope that women and men will be able to preserve their access to good contraceptive services. After all, in the development of the national family planning program, services were provided by medical personnel assisted by paid or volunteer outreach workers. The training and organization invested in these groups can be utilized in the construction of a more client-oriented, less authoritarian approach. The commitment to preventative health care offers a firm foundation to continue family planning services, and could be used to improve services for prevention of sexually transmitted diseases and peri-natal morbidity and mortality. A network of factories and distribution channels that make a wide variety of contraceptives available to all Indonesians constitutes a major industrial resource worthy of preservation. The maintenance of a specialized family planning promotional service in the BKKBN could in time be questioned, but the work of such an organization as a facilitator of community mobilization is generally welcomed by society, even when some of specific activities are questioned. These legacies have meant that the Indonesian reproductive health program has attracted international admiration and emulation. Errors arising out of paternalism and authoritarianism may be resistant to correction, to the extent that cultural factors underpin many unhealthy practices. Complaints of coercion, insensitivity, lack of male participation or responsibility, lack of adequate information, and disrespectful treatment of clients can often be traced back to gender relations, class relations and organizational cultures that may require years, if not generations to redress. Nonetheless, when President Wahid appointed Khofifah Indar Parawansa as Minister for Women's Affairs in 1999, many observers were startled that two of her first actions were to rename her position as the Minister for Women's Empowerment, and to claim authority to oversee the BKKBN. It seemed clear that she had the desire to face issues of gender and morality in providing directions for the reproductive health program, and that she would clearly set out a feminist agenda to ensure that women take an active role in shaping the program. Time will tell if the direction will remain straight, or whether politics will affect the compass. Beyond the correction of errors and the preservation of valuable legacies of family planning, are the challenges of big-arena politics facing Indonesia. Discussions of reproductive health go quiet when newspapers headline murders in city streets, religious wars in neighbouring centres, and intractable A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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corruption of enormous scale. Loss of self-confidence is a problem for an individual, but it can become a tragedy for a nation. It not only drains away resources needed to address the reproductive health needs of citizens, but worse, the loss of a sense of common purpose erases all realistic formulations of health goals from the national consciousness. In eastern Indonesia and Aceh, the new millennium was greeted with demands for separation from the unitary state rather than plans for cooperation to overcome HIV I AIDS, maternal mortality, or unwanted pregnancies. While unemployable youths fought in the streets over ethnic and religious slights, spectators to the violence took the lesson that brotherhood was fragile, humanity conditional, equity problematic, and unity impossible. For many people the only pillar of the Pancasila left standing was belief in God, and with all the other pillars weakened, that belief could be manipulated in unpredictable directions. Without brotherhood, equity, or humanity, religion could justify intolerance. Without unity it could promote destruction. Hope lies in the fact that Indonesia's futures remain open, the five pillars set out in the 1945 revolution could be restored, and the commitment to citizens' welfare could become a reality, if both the leadership and the citizenry are committed to these values. If that were to happen, the reproductive health program could return to the politics of improving the implementation of activities, rather than the politics of dealing with the threats of disintegration. Bibiliography Aidid, Hasyim 1987 Islamic leaders' attitudes towards family planning in Indonesia (1950s-1980s). [MA thesis, Australian National University, Canberra.] Akbar, Ali 1959 'Birth control di Indonesia', Madjalah Kedoktoran Indonesia 9-4:198-215. Boeke, J.H. 1953 'Population increase', in: S. Hofstra (ed.), Eastern and Western world; Selected readings, pp. 69-83. The Hague/Bandung: Van Boeve. Budiman, Amen 1975 '40 Tahun lahirnya buku KB pertama di Indonesia', Kompas 12 November, pp. 8-9. Fischer, Louis 1959 The story of Indonesia. London: Hamish Hamilton. Freedman, Ronald, Siew-Ean Khoo and B. Supraptilah 1981 Modern contraceptive use in Indonesia; A challenge to conventional wisdom. Voorburg: International Statistical Institute, London: World Fertility Service. [Scientific Reports International Statistical Institute 20.] Haryono Suyono and Merrill M. Shutt 1989 'Strategic planning and management; An Indonesian case study', in: A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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Gayl Ness and Ellen Sattar (eds), Strategic management of population programmes, pp. 257-84. Kuala Lumpur: ICOMP. Hirschfeld, Magnus Women east and west; Impressions of a sex expert. London: Heinemann. 1935 Hull, Terence H. 'Fertility decline in Indonesia; An institutionalist interpretation', Inter1987 national Family Planning Perspectives 13-3:90-5. Reports of coercion in the Indonesian vasectomy program; A report to 1991 AIDAB. Canberra: Australian International Development Assistance Bureau. [Development Paper 1991No.1.] IPPA IPPA 1969 yearly report. Jakarta: Indonesian Planned Parenthood Asso1970 ciation. Hull, Terence H. and Valerie J. Hull 'Politics, culture and fertility; Transitions in Indonesia', in: G.W. Jones, 1998 R.M. Douglas, J.C. Caldwell and R.M. D'Souza (eds), The continuing demographic transition, pp. 383-421. Oxford: Clarendon Press. Jackson, K.D. 'Bureaucratic polity; A theoretical framework for the analysis of power 1978 and communications in Indonesia', in: K.D. Jackson and L.W. Pye (eds), Political power and communications in Indonesia, pp. 3-22. Berkeley: University of California Press. Khoo, Siew-Ean The determinants of modern contraceptive use in Indonesia; Analyses of the 1982 effect of program effort. Honolulu: East-West Population Institute, East West Center. [Working Paper 23.] Krishner, Bernard 'A talk with Sukarno; I am Indoneia', Newsweek, 5 October 1964, p. 56. 1964 Liddle, R.W. 'Soeharto's Indonesia; Personal rule and political institutions', Pacific 1985 Affairs 58-1:68-90. MacAndrews, Colin (ed.) Central government and local development in Indonesia. Singapore: Oxford 1986 University Press. [East Asian Social Science Monographs.] Macintyre, Andrew 'Corporatism, control and political change in "New Order" Indonesia', 1989 in: R.J. May and William J. O'Malley (eds), Observing change in Asia; Essays in honour of J.A.C. Mackie. Bathurst, NSW: Crawford House. Moebramsjah, J. 'Management of the family planning programme in Indonesia', in: 1983 Ellen Sattar (ed.), Views from three continents, pp. 6-21. Kuala Lumpur: International Committee on the Management of Population Programmes. [Edited reprint of Moebramsjah et al. 1982.] Moebramsjah, H., Thomas R. D' Agnes and Slamet Tjiptorahardjo The national family planning program in Indonesia; A management approach 1982 to a complex social issue. Jakarta: National Family Planning Coordinat-

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ing Board. [Report to an ICOMP Conference, Kuala Lumpur, July 1982.] Quarles van Ufford, Philip Local leadership and programme implementation in Indonesia. Amsterdam: 1987 Free University Press. Sadikin, Ali Gita Jaya. Jakarta: Government of the Special Region of Jakarta. 1977 Sadli,Mohammad 'Indonesia's hundred millions', Far Eastern Economic Review 42:21-3. 1963 Saparin, Sumber Tata pemerintahan dan administrasi pemerintahan desa. Jakarta: Ghalia 1977 Indonesia. Sinquefield, J.C. and Bambang Sungkono 'Fertility and family planning trends in Java and Bali', International 1979 Family Planning Perspectives 5-2:43-58. Snodgrass, D.R. The integration of population policy into developmnet planning; A progress 1978 report. Cambridge Mass.: Harvard University. [Development Discussion Paper.] Soeharto, Raden Saksi sejarah; Mengikuti perjuangan dwitunggal. Jakarta: Gunung 1984 Agung. Sumbung, Peter 'Management information system; The Indonesian experience', in: G. 1989 Giridhar, E.M. Sattar, and J.S. Kang (eds), Readings in population programme management, pp. 13-28. Singapore: ICOMP. Suryadinata, Leo Military ascendancy and political culture; A study of Indonesia's Golkar. 1989 Athens OH: Ohio University Center for International Studies. [Southeast Asia Series 85.] Tohari, Ahmad 'Perburuan', Panji Masyarakat 408:35. 1983 Van Valkenburg, Samuel 'Java; A study in population', Michigan Academy of Science, Arts and 1930 Letters 14:399-415. Vandenbosch, Arnry The Dutch East Indies; Its government, problems and politics. Grand Rap1933 ids, MI: Eerdmans. Warren, Carol 'Indonesian development policy and community organization in Bali', 1986 Contemporary Southeast Asia 8:213-30. Warwick, Donald 'The Indonesian family planning programme; Government influence 1986 and client choice', Population and Development Review 12:453-90.

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Wolff, Charlotte Magnus Hirschfeld; A portrait of a pioneer in sexology. London: Quartet 1986 Books.

Newspapers and popular periodicals 1978 1978 1983 1983 1984 1984 1984 1984 1984 1984 1984 1993 1994 1994 1994 1994 1994 1994 1994 1994 1995

'Shame is the best contraceptive', The Economist, 25 November:74. 'Family planning work has surprising success in Indonesian villages', Asian Wall Street Journal, 15 July:l-2. 'Denda bagi anak ketiga', Tempo 25 June:23. Series of articles on family planning in: Panji Masyarakat 408 (21 September) and 413 (11 November). 'Angka "keberhasilan" BKKBN segera diperbaiki', Kompas, 4 July. 'Pengujian ulang laporan BKKBN', Kompas, 6 July. 'Metode BKKBN menaksir jumlah akseptor baru disangsikan', Terbit, 13 July:l, 7. 'Sukses dan ekses KB', Tempo, 14 July. 'Doubts cast over success in family planning programmes', Jakarta Post, 14 July. 'Sistem target justru perlemah "keberhasilan" BKKBN', Kompas, 14 July:l. 'BKKBN tetap perlukan data dan target', Kompas, 17 July:l/8.17 July. 'Hak kesehatan reproduksi; Sudahkah dimiliki wanita Indonesia?', Femina 41-21:1-15. 'Minat besar ke lingkaran, Tempo, 12 February:103. 'Gerakan KB bukan hanya memasang kontrasepsi', Suara Pembaruan, 22 March:B-9. 'Indonesia harus tolak gagasan yang bertentangan dengan moral dan agama', Kompas, 30 August:8. 'Indonesia tolak aborsi, homoseks sebagai cara2 ber-KB', Pos Kota, 30 August:l. 'Controversial Cairo meeting', Jakarta Post, 31 August:4. 'Religious leaders support Indonesia's stand on abortion in Cairo', Jakarta Post, 2 September:2. 'Tolak aborsi, sekaligus berikrar kompak', Republika, 6 September. 'Homo, lesbi dan abortus, hancurkan masa depan', Republika, 10 September:16. 'Program KB; banyak melanggar hak perempuan sebagai konsumen KB', Warta Konsumen 1 January:41-4.

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CHAPTER V

The significance of foreign assistance to the Indonesian family planning program David L. Piet

We must use what is already in the human mind. The roads in the [Javanese] villager's mind are already paved. We must follow those roads. [... ] All of our ideas, if they are to work, must be based on our culture. What we must do is make contraceptives an integral part of our own culture, not some strange Western innovation. - Dr R. Wasito 1

The Indonesian family planning program is widely recognized as one of the most successful in the world. From its inception in the late 1960s, and throughout its more than thirty-year history, the program has benefited from committed and dynamic leadership and the full support of the president. In his 1967 Independence Day speech, President Suharto stated: Looking far into the future, we should courageously face the fact that the increase in the rate of population will not be in balance with the rate of available food supplies, whether produced at home or imported. We should, therefore, pay serious attention to efforts in birth control with the idea of planned parenthood [... ] which can be justified by the ethics of religion and the ethics of Pantjasila. 2 This is a principal problem related to the fate of our future generations. So it should be done thoroughly and according to plan. (Country profiles 1971:7.)

In line with this statement, President Suharto, along with 29 other world Memorandum No. 6 1979. Dr Wasito, a physician, was an early leader in the public health campaigns in Indonesia and the East Java BKKBN provincial chairman. 2 Pancasila: the five pillars on which the Republic of Indonesia is based: belief in God, nationalism, humanism, democracy, and social justice.

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leaders, in 1967 signed the United Nations Declaration on Population. The Declaration affirmed the belief of the signatories that 'the population problem must be recognized as a principal element in long-range national planning if governments were to achieve their economic goals and fulfil the aspirations of their people' (Country profiles 1971:6). The Indonesian program has been successful in large part because it has had strong political support from the New Order government, with its unambiguous commitment to fertility reduction as an integral part of overall national economic development. Since the program's inception in 1968, it could also count on supportive donors and an abundant and uninterrupted flow of foreign assistance. This chapter discusses four cases of important donor relationships: two bilateral donors, the United States and the Netherlands, and two multilateral donors, the World Bank and the United Nations Population Fund (UNFPA). In the case of the bilateral donors, I do not take the conventional approach by describing the official rationale for foreign assistance. For example, the stated purpose of US foreign assistance is 'to create a more secure, prosperous, and democratic world for the benefit of the American people'. In general, most Western nations officially state the purpose of foreign assistance in terms of national security, political and socio-economic self-interest, and the promotion of certain values like democracy. I also do not attempt to rationalize or justify the political or strategic importance of Indonesia to the West. Rather, the primary objective of this chapter is to trace the significance of foreign assistance and the unique partnership role that foreign donors played in the Indonesian family planning program. I outline why foreign assistance, past and present, has been such an important and constructive feature of the Indonesian program. In the final section, I suggest a number of lessons learned from the program that have relevance for current and future foreign assistance. It is important to tell the Indonesian 'story' as it developed in true partnership with donors, rather than weighing it down with the official 'foreign assistance language and baggage' of collective governments and institutions. Thus, this chapter focuses on how and why that assistance was unique and what lessons can be learned from it. As noted, two of the cases in this chapter concern bilateral donors. There is always a political dimension to bilateral development assistance, which has a dual and even ambiguous character. A development bureaucracy is linked to two spheres of interest simultaneously. On the one hand there is the political context of the donor country, in which the development bureaucracy is held accountable by the political structures and the constituencies of that country. On the other hand is the context of the effectiveness of the development efforts and the political and administrative framework of the recipient country. To quote Quarles van Ufford (1988:20): 'Development goals, then, must relate with equal ease to quite different social worlds'. The story of how A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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the family planning collaboration between the Netherlands and Indonesia ended, described below, must be seen in this light.

Achievements of the family planning program This chapter is devoted to the significance of foreign assistance. However, a short description of program approaches and achievements is useful. While the Indonesian family planning program is widely recognized as one of the most successful in the world, it is the Indonesians themselves that should receive the major credit for the success of their family planning program. A review of the various elements that contributed to this success is instructive. Success can be measured by a declining fertility rate, the steadily increasing prevalence of contraceptive use over the last thirty years (1968-1998), and a growing number of outlets for family planning information and services. Success can also be measured by the increase in awareness in society at large of the disadvantages of rapid population growth and the consequent cultural shift across the country toward the small-family norm. These aspects are discussed in the various chapters of this book. In Indonesia's case, with a vision of the future as articulated by Dr Wasito (see above), success occurred mainly because program leaders and managers had the common sense to navigate the 'paved roads in the villager's mind'. Success over the last three decades has been achieved primarily because the program was an individual-couple-village blend. The urban-based program that began in 1980 also used the two-pronged approach of information and services. By utilizing all administrative levels and socio-cultural structures and institutions, tremendous normative change has occurred across the 3,400-mile-long archipelago since the inception of the program in 1968. According to senior BKKBN officials, the introduction of village family planning in the mid-1970s and its gradual expansion over the years, as well as the later addition of the urban program, are major factors in the success of community outreach. 3 Through its administrative and managerial hierarchy, and its mandate to coordinate, BKKBN succeeded in reaching millions of married couples throughout the approximately 67,000 villages in the 27 provinces of the country. Perhaps the best example of the BKKBN' s innovative approach is the Village Family Planning Program (see Chapter III). Initiated first in the six Java and Bali provinces in the 1970s, the BKKBN rapidly expanded this USAID was the primary funder of the Village Family Planning Program, both in the initiation of VFP on Java and Bali and in its expansion to the remaining 21 provinces in the Outer Islands.

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approach to the other provinces in the early 1980s. To a certain extent, the so-called 'Java model' was unsuitable in the 21 more sparsely populated Outer Islands inhabited by many diverse ethnic groups. Over time, however, adaptations were made for those areas, and the basic approach remained at the core of the program. Village family planning, simply stated, is an information, motivation, and contraceptive services program centred on the village (desa) level and run by village residents. Since clinic-based services did not reach the majority of villages, village family planning gave villagers the responsibility of managing their own program. This approach, facilitated by the BKKBN, helped to rapidly institutionalize family planning behaviour as a local social process (USAID 1980, 1982). Both non-program and program factors contributed to the success of the program, and are internationally recognized as such. For developing countries and donors alike, these factors comprise the core lessons to be learned from the 'Indonesian model'. Non-program factors include: - Sustained government commitment and thirty years of political stability; - The program being a national program, domestically funded from the national development budget; - Strong latent demand for fertility control; - Steady socio-economic development and growth (until the economic crisis starting in 1997); - A cohesive village structure, especially on the densely populated islands of Java and Bali. Program factors include: - Creative leadership both within and outside the BKKBN; - A well-organized, capably staffed, and adequately funded national program; - Population policy development coupled with strategic planning; - A two-pronged information/ education/ communication and services approach; - Flexible and innovative approaches; - The early enlistment and continued use of Islamic leaders and organizations in support of the program; - Strong and continuous foreign donor support. Other factors, specifically related to BKKBN, include: dynamic leadership and a career path for staff, organizational commitment and flexibility, an open management system, and widespread participation in the program at the community level. The BKKBN created a program that operates effectively at every adminisA. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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trative level, from national to hamlet level. The architects of the BKKBN created a government entity with two major characteristics: flexibility and decentralization. This is especially unique when compared with other government bureaucracies of the time. The BKKBN was kept independent of the Ministry of Health. It could utilize foreign donor assistance without operational control of Bappenas, the National Planning Board. As a coordinating rather than an implementing entity, BKKBN' s major functions were to provide broad policy and program guidelines, coordinate activities, channel funds, and monitor the work of the so-called implementing units. This work was greatly facilitated by a network of provincial and regency offices and a professional staff, and a large cadre of full-time family planning fieldworkers. BKKBN's flexibility permitted and encouraged local initiative from provincial offices and other provincial leaders. While headquarters took an active role in brokering the proposals and in the final decisions, BKKBN' s functions were truly decentralized. The Indonesian program comes closer than any other national program to achieving the goal of countrywide, community-based coverage. While many family planning programs espouse the goal of a nationwide, community-based program, Indonesia is one of the few developing countries in which this became a reality. It is a well-established fact that donor nations have played a critical role in the success of family planning programs around the world. Indonesia offers a perfect case in point, since donor support was critically important for the creation and functioning of the Indonesian family planning program. However, a precise explanation of the role of donors and foreign assistance in the Indonesian family planning program, or for that matter in its general development program, is extremely difficult due to the complexity of the political, economic, and socio-cultural development forces at work over the past three decades (1968-1998). For example, changes in marital and reproductive health values and behaviour under the influence of a complex and dynamic family planning program, as well as social and economic development in a culturally and economically diverse country, cannot easily be disentangled. Likewise, donor influence or interventions, especially in terms of cause and effect, are virtually impossible to quantify. The best that can be done is to review the lessons learned over the past three decades, identify plausible influences of the program and assess how foreign assistance fits within that policy and programmatic context. While this chapter focuses on foreign donor assistance to the Indonesian national family planning program, it must also take into account several other factors that contributed to the success of the program. Total government commitment has been a constant in the program, with continuing strong support from the president and, through him, the whole politicaladministrative system from national level through provincial and down to A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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village level. Because of this robust system, coupled with effective leadership and its unique corporate culture, the BKKBN successfully engaged the support of many ministries, institutions, and agencies, and in turn has supported them through what the BKKBN called 'horizontal and vertical coordination' .4 The achievements of the Indonesian family planning program have depended to a substantial degree on the stable and effective administrative system developed under President Suharto's New Order government. They cannot be understood without reference to the administrative-political system within which the program operated. In the bureaucratic-political context outlined above, several factors can be identified that have been crucial to the success of the program. The most important ones are: The program was a national program, carried out by a well-organized, capably staffed, and adequately funded organization, the BKKBN. - The stable and effective leadership of BKKBN. - The unusually effective administrative structure for a developing country that facilitated communication and mobilization of action at the grassroots level for a wide range of development activities, including family planning and, more recently, reproductive health. - Steady economic growth during the period 1968-1997. Significant social and economic development affected attitudes about marriage, family life, and reproduction and created a transportation and communication infrastructure through which the family planning program could function throughout the Indonesian archipelago. At the same time, fertility decline contributed to economic development. As Gavin Jones states in Chapter VIII: 'Economists are in general agreement that in poor countries with high fertility, a decline in fertility contributes to achievement of faster economic growth'. He goes on to list a number of key mechanisms through which fertility decline is likely to lead to faster economic development. - Flexible and innovative approaches. The basis for flexible and innovative approaches has been the Indonesian way of consensus decision-making through musyawarah and mufakat (consultation and consensus) and BKKBN' s stress on rapid implementation rather than lengthy planning or research. For example, rather than spend valuable time on operations or applied research on model projects, the tendency at BKKBN was to try out an innovation. If successful, the innovation was expanded as rapidly as time and resources would allow. The earlier example of village family

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Horizontal: across all ministries and institutions; and vertical: down through the administrative layers of each ministry and institution finally ending at the family planning acceptor groups (see Chapter VIII).

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planning falls squarely in this category of innovation followed immediately by expansion. These factors should be seen in relation to the role played by strong foreign donor support, a willingness on the side of donors to fund flexible and innovative approaches and to view their funding as contributions to the Indonesian family planning program rather than as discrete donor projects. While both bilateral and multilateral organizations and donors provided considerable financial and technical support, the Indonesian government steadily contributed an increasing share of program costs, starting with 1.3% in 1970 and rising to 49.7% by 1980(USAID1982). The BKKBN has been generally successful in gaining and coordinating donor assistance for its policies, in contrast to the domination by donor direction characteristic of some other countries. Another important factor was that the donors worked closely with the BKKBN in developing new and creative initiatives, monitoring the program, and providing a variety of technical assistance and support. This last point is important in understanding the strong and unique partnership that developed between the BKKBN and its donor partners and goes a long way in explaining the amazing history of that program.

The role offoreign assistance Prior to and throughout the program's history, donors have been involved and steadfast partners. Counter to the conventional wisdom, however, regarding the advent of donor assistance for family planning in Indonesia, there is evidence that family planning in Java did not begin with the USAID-assisted BKKBN program in 1969-1971. The concern of Dutch colonial officials about population pressures on Java began in the early 1800s (Gooszen 1999). While not exactly a 'donor' in the conventional sense of the term, the Dutch could be considered the earliest proponents and founders of population and public health activities, including population redistribution. According to Hull et al. (1977:4-5), as early as 1802 Dutch colonial officials considered Java 'overcrowded'. Yet it took a full century for the colonial government to address the problem. The policy adopted was then referred to as 'colonization'. After independence, the Indonesian government continued it under the term 'transmigration' (Hardjono 1977). Transmigration is the transfer of people or entire communities from crowded areas of Java and Bali to the sparsely populated Outer Islands. The program is still ongoing. A specific example of a Dutch public health program is the work of a Rockefeller Foundationfunded physician, J.L. Hydrick, who was active in Java promoting public health and family planning in the 1930s (Hydrick 1937). A concerted effort A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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started in 1953, when small groups of concerned private citizens in Indonesia began to promote family planning (see Chapter II). It took until 1967 and the assumption of power by the New Order government for official and unreserved recognition that population growth was an important national development issue, and that a national family planning effort should be initiated. In January 1970 the National Family Planning Coordinating Board (BKKBN) was formed. The family planning program was officially launched and off and running. The remainder of this chapter focuses on the role of foreign assistance to the Indonesian national family planning program.

Bilateral and multilateral donors: the division of labour Donor assistance and their areas of program support to the Indonesian program are predominantly shaped by the donor nation's foreign assistance policies, and the development agency or organization's corporate culture, operating style, experience, type of funding (grant or loan), and the availability and capability of staff. Thus, support of BKKBN was marked by a de facto division of labour among donors such as USAID, the World Bank, UNFPA, the Dutch, and several others over the years. The broadest definition of this division of labour is in the provision of 'hardware' such as buildings and furnishings, equipment, and vehicles; or 'software' such as technical assistance, contraceptives and commodities, operational costs, training programs, local cost support to indigenous institutions and non-governmental organizations. Another important distinction, and one that often dictated the funded activity, was whether the funds were grants or loans.

Magnitude of donor assistance to Indonesia Since the late 1960s, donors have contributed an enormous amount of technical and monetary assistance to the Indonesian program. While it is impossible to quantify either the impact or the monetary value of the variety of technical assistance over the years, Table 5.1 estimates the larger monetary contributions made to the program. Table 5.1. Foreign donor contributions to the Indonesian family planning program (in millions of US dollars) Donor

1968-1991 (estimated)

USAID (1968-1998) The Netherlands (1975-1991) World Bank (1970-1998) UNFPA (1972-1998)

$ 250 (excluding contraceptives) $ 46.5 (including contraceptives) $ 223 ($190 after cancellations) $83 A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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Examples of donors This section discusses four selected cases, beginning with the US Agency for International Development (USAID), the largest and most influential foreign donor to the Indonesian family planning program. Another bilateral donor, the Netherlands, although a much smaller donor, is an interesting case, because it exemplifies the political edge that is always present in foreign assistance relationships, even more so when the assistance is in the politically sensitive field of family planning. Subsequently, we will discuss two important multilateral donors: the World Bank and UNFPA. Their assistance differs in scope. Besides, while the World Bank was an actor in a number of fields to which foreign assistance to Indonesia was channelled, UNFPA assistance to Indonesia was, in accordance with its mandate, limited to population and family planning.

The US Agency for International Development In an increasingly interdependent and rapidly changing world, international events affect every American. Under the direction of the president and the secretary of state, the United States conducts relations with foreign governments, international organizations, and others to pursue US national interests and promote American values. Many national interests and strategic goals focus on security, economic prosperity, law enforcement, and democracy. Others, more related to international socio-economic development, are focused on a sustainable global environment, stabilization of world population growth, protection of human health, and reduction in the spread of infectious diseases. As the federal agency charged with the implementation of US foreign assistance, one of five long-term goals of USAID remains the stabilization of world population and the protection of human health (USAID 1999). Historically, the United States has been the largest contributor to population programs around the world and the most significant provider of technical assistance. Between 1965 and 1998 the United States allocated almost seven billion dollars for international population assistance. USAID remains the largest single donor to population and family planning programs, having contributed roughly one-third of the total assistance from all sources - bilateral, multilateral, and private. However, beginning in the mid-1990s, the United States began to relinquish its role as world leader in family planning assistance. Starting in 1996 and continuing through the late 1990s, Congress reduced funds for bilateral international family planning assistance and imposed burdensome legislative restrictions that exacerbated these cuts. This made implementation of A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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programs and activities in the field more difficult. Although some of this funding was restored the following year, the 1997 USAID funding of 385 million dollars was well below its 1995 peak of 542 million dollars. Furthermore, US support for UNFPA and other multilateral organizations declined. The effect of these declines on the global funding environment is uncertain. While it is not clear whether other donor nations such as Japan and the European Union are willing or able to make up the difference, several private foundations such as Gates, Mellon, and Hewlett-Packard have begun to provide substantial funding to fill the gap. Reduced support for family planning risks eroding decades of progress enabled by US support for population and family planning (RAND 1998:5). But, since family planning services are the most cost-effective reproductive health intervention, they will continue to be the predominant focus of USAID' s global population assistance program. In 1965, immediately after President Johnson's State of the Union address, 5 USAID sent to all its field missions a policy directive stating that 'USAID would entertain requests for technical, commodity, and local currency assistance in support of family planning programs initiated by host governments' (Green 1993:305). It is also noteworthy that USAID, with strong support of Congress and the visionary leadership of key senior officers of the Office of Population and the Asia Bureau, had already articulated a population strategy. USAID established population-relevant training programs for its staff, and carefully considered such assistance on a country-bycountry basis in the Asian region. The basic population and family planning strategy was carefully stated early in its development. While embellished and refined in various ways over the last thirty years, to include reproductive health and safe motherhood, the essence of the strategy has remained unchanged. In the words of R.T. Ravenholt, a long-time director of USAID's Office of Population: 'The ultimate goal of this program is to improve the health, well-being, and economic status of the peoples of the developing countries by improving the conditions of reproduction in these societies. We propose to move toward this goal by support of broad-gauge population and family planning programs, designed to make family planning information and services fully available to all elements of these societies so that women everywhere need reproduce only if and when they choose.' (Ravenholt 1969: 124.) Important elements of this strategy are: a. USAID's development of a fundamental strategy of global population program assistance, implementation, and monitoring; b. Purchase and delivery of vast quantities of contraceptives and supplies; c. Strong support for the United Nations Population Fund (UNFPA) through 'I will seek new ways to use our knowledge to help deal with the explosion in world population and the growing scarcity in world resources' (Public papers 1965:4).

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the mid-1980s, when, in 1986 the US withheld funds until President Clinton restored funding in 1992. Support for the International Planned Parenthood Federation (IPPF) and for US-based universities; d. The development of and support for training programs in the United States and developing countries. And, of course, major support for national family planning programs on a bilateral basis. Thus, USAID was ready to respond immediately to programs initiated by host governments. From the start, the Indonesian national family planning program benefited from USAID' s strategy and assistance. International population program assistance is neither an exact science nor is it without risk. For successful results, 'all essential links in the action chain must be available and of adequate strength. In other words, international assistance must be timely, appropriate in nature, of adequate magnitude, readily available, and well used by indigenous program personnel operating under strong leadership.' (Ravenholt 1979:7.) With the USAID-Washington strategy and staff backup in the background, USAID-Indonesia was ready to assist the Indonesian program at its inception in 1968. It is fair to state that, of all donors, USAID in particular contributed significantly to BKKBN' s remarkable strengths of flexibility, decentralization, diversity, and service statistics and logistics systems. Certainly over the first twenty or so years of the program, 1968 through the late 1980s, the nature and magnitude of USAID support helped the BKKBN to function as it did. Additional to important programmatic and technical support, USAID' s financial flexibility and rapid administrative responsiveness to a variety of initiatives was a key to the program's success and expansion. The creation of the BKKBN and the Indonesian conditions presented above certainly facilitated the development of effective USAID assistance. But much of that effectiveness was intrinsic to the specific character of the USAID operation that was established in the late 1960s and to the ways it was strengthened and refined over the years. This was not the product of a blueprint determined in Washington and transplanted to Indonesia. Neither was it a passive response to Indonesian requests. Rather, the Mission's style of population assistance evolved as successive Mission directors and their population staff came to grips with the Indonesian situation and made a series of important decisions in attempting to carry out the various mandates of foreign assistance. These decisions were taken deliberately, based on careful analysis and review of the situation and options, as well as extensive cooperation both within and outside the Mission. To understand the USAID-Indonesia situation, one must understand the Mission structure and mode of population assistance. What made this set of circumstances so special and what shaped the character of this particularly A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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successful foreign assistance effort? Essential elements in this effort were the USAID organizational structure, personnel policies, leadership styles, resources and patterns of resource flow, and inter-organizational linkages. Each of these is outlined below: - Organizational structure: Starting in 1968 in USAID-Indonesia, population was the responsibility of an office that reported directly to the Mission director. This organizational structure and direct reporting has remained in place over the years. - Personnel policies: A high quality, technically competent, culturally sensitive and bilingual population staff (in later years, health and nutrition staff) has been a critical element. The selection and retention of high-quality staff was the result of deliberate decisions governing selection, training, and tenure. Often, staff was virtually handpicked by Mission leadership. - Leadership style: While leadership styles have changed over the years, the leadership style of early Mission directors and population office directors was one of strong performance goals, delegation of responsibility to both American and Indonesian staff, participatory problem solving, and a major focus on field travel, implementation, and monitoring. - Resources and resource flow: Of all organizational conditions, the one that most clearly defined its character and the overall success of the program was the level and type of both human and financial resources available and the pattern of allocating resources to specific activities. USAID's assistance to the Indonesian program was particularly successful due to the high levels of grant funds it was able to obtain. Grant funds were advantageous in three ways. They came at little or no cost to the host government, thus activities would not have to compete with other programs. They could quickly be made available to the BKKBN, and they provided flexibility (USAID 1979). USAID has been a steadfast partner since 1968. At one point in the mid-1990s, USAID initiated a phase-out of its assistance to Indonesia. However, the economic and political crises reversed this thinking and USAID continues to provide substantial resources - technical assistance and operational support - to Indonesia.

The Netherlands Dutch involvement in family planning in Indonesia started with the Dutch NGO Novib's support of the building of the PKBI Training Centre in Jakarta (see Chapter 11).6 This was during the Soekarno regime, at a time when rela6

This section is by Anke Niehof.

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tions between Indonesia and the Netherlands were still tense. The so-called Bersiap period (1945-1950), during which the Dutch government contested the self-proclaimed independence of Indonesia and sent troops in an effort to re-establish the colonial relationship, was still fresh in the memory of the Indonesian leadership. The confrontation between Indonesia and the Netherlands on the issue of the autonomy of Irian Jaya, which was initially not part of the newly independent Republic of Indonesia but still a Dutch colony, occurred as late as 1963. Due to this history, and the fact that President Soekarno's pro-natalist policies would not have favoured official assistance for family planning anyway, official Dutch assistance in the field at that time was neither possible nor welcome. Once the New Order government of Suharto was established, during the early 1970s, relations between the governments of Indonesia and the Netherlands were gradually extended beyond merely the diplomatic to include development assistance. In 1971 a project of cooperation was launched between Leiden University in the Netherlands and the University of Indonesia in Jakarta. This family planning research and training project was the first official project of international collaboration of Leiden University under the umbrella of NUFFIC. 7 The project aimed at cooperation in family planning research and training. It came to be known as the Serpong Project, after the name of the sub-district where it was located. Its activities and results are described in Chapter VII. Bilateral assistance in the field of family planning was initially rare within the framework of Dutch development assistance. For a long time family planning was considered a sensitive subject in Dutch politics. There were successful initiatives in the private sphere, such as the founding of the Dutch Association for Sexual Reform (NVSH), but the government did not formulate an official population policy, neither for domestic use nor for international assistance. This is related to the Dutch political structure. Until recently there were always Christian parties, notably the Roman Catholic Party, represented in the coalition governments. Politicians did not want to deal directly with the issue of population for fear of alienating their own constituency. Not until 1988 was an official policy document presented to the Dutch parliament, which outlined population policy in the framework of international cooperation and development assistance. During the 1970s, official development assistance expenditures showed a rapid increase (Erath and Kruijt 1988:40). For reasons relating to the political background sketched above, assistance for population and family planning was initially channelled through multilateral organizations such as UNFPA. The Netherlands soon became one of the largest donors to UNFPA, and 7

NUFFIC stands for: Netherlands Universities Foundation for International Cooperation.

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remains so. Thus, up to 1975, Dutch assistance to Indonesia for population and family planning was provided multilaterally, except for the Serpong Project referred to above. In 1975, bilateral assistance to the Indonesian family planning program was started by supporting the purchase, production, and distribution of contraceptives, notably pills, and to a lesser extent intra-uterine devices (IUDs). Up to 1984 about nine million dollars was invested in this project. A new project was started in 1985. A total of 50 million Dutch guilders (about 25 million dollars) was allocated for the procurement of contraceptives. Half of the budget was used for buying about 37.2 million cycles of Marvelon, a low-dose oral contraceptive produced in Jakarta by the Dutch company Organon; the other half to procure variously sized Multiload 250 Cu IUDs (Van Kessel et al. 1987). Between 1989 and 1991 about ten million dollars was made available by the Netherlands to support the local production of contraceptive pills at PT Kimia Parma in Bandung (Van Kessel 1991). At the end of the 1980s Dutch assistance included activities other than the procurement or production of contraceptives. During 1988-1991, a project of providing credit for incomegenerating activities of women's groups, under the umbrella of the family planning program, was supported. This project is described in Chapter VIL Other examples include the preparation of a project for strengthening family planning services in the special province of Aceh and support to the Jakartabased NGO Yayasan Kusuma Buana for its urban family planning program in 1990. Table 6.2 summarizes Dutch support during the years 1975-1991. Dutch assistance to the program ends in 1991. The Aceh project was formulated but never implemented. The reasons for this rather abrupt end to assistance in family planning between Indonesia and the Netherlands are political, as explained below. Table 6.2. Dutch assistance to the Indonesian family planning program during 19751991 Period

Activity

1975-1984 1985-1989 1981-1991 1987 1988-1991 1990-1991

Procurement of contraceptives Procurement of contraceptives Local production of pills Cost-effectiveness study Income-generating project Support to YKB

Amount in millions of US $ 9

25

10 0.3 2 0.45

Source: Van Kessel 1991. [Conversion rate: NLG 2 = US$1]

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In 1984, for example, the popular weekly Tempo published a cover story on family planning. The cover read: 'Success and excess in family planning' (Sukses dan ekses KB). In the Netherlands, a strong feminist-oriented lobby argued that Indonesian women were being coerced into accepting family planning and that their interests and health were not properly being taken into account. Leftist critics of the Suharto regime pointed to alleged abuses in the Indonesian family planning program (see Niehof 1996). The Dutch Minister for Development Cooperation, Jan Pronk, could not ignore these voices from his own constituency and increasing domestic pressure was brought to bear to stop family planning assistance to Indonesia. At the same time, reports on alleged coercion and other abuses also reached the Australian parliament. The Australians decided to send a mission to investigate these reports. The mission, led by Terence Hull, found that the program did indeed have certain problems, but that these were primarily problems of implementation rather than policy (Hull 1991). The report recommended that instead of ending the funding of the family planning program, the donors could provide critical assistance ~ such as financing staff training, or other means to promote voluntarism, choice, and quality - to overcome authoritarian practices. The Dutch, however, reacted differently. In February 1991, the Dutch delegation to the annual bilateral discussions with Bappenas on development assistance informed the Indonesian host that there had been a decision in The Hague to suspend all collaboration in the field of family planning because of reports of alleged coercion. The Indonesians were surprised and angered by the decision, especially since only six months earlier an official Dutch mission had argued in favour of continuation of the assistance, albeit not uncritically. When at a graveyard in Dili, East Timor, in November 1991, a large number of civilians were massacred by the Indonesian military, the Dutch parliament demanded a critical reassessment of all development assistance to Indonesia. Nevertheless, in January 1992, in The Hague, the decision was made to resume assistance in the field of family planning. But in March 1992, the Indonesian government decided to renounce all development assistance from the Netherlands. Only after Abdurahman Wahid had been elected president were bilateral consultations on Dutch development assistance to Indonesia resumed. There is evidence that the family planning controversy definitely contributed to the deterioration of the Indonesian-Dutch bilateral relationship (Niehof 1996). The breach in the relationship also ended the office of Minister Pronk as chairman of the IGGI, the Inter-Governmental Group on Indonesia, a consortium of donors. The episode illustrates the political sensitivity of policy on population and family planning, whether in a domestic or in an international context. A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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The World Bank

From the start of the World Bank's involvement with the Indonesian program in 1968, its program emphasis was determined by its corporate culture, operating style, and experience. From the late 1960s through the 1980s, the Bank had no significant resident field staff for population projects. Instead, projects were designed and monitored by missions on recurrent visits and the responsibility for implementation essentially left to resident consultants housed within the BKKBN. Since loan funds were more acceptable than grant funds for capital costs and other hardware, especially to the Indonesian government, the Bank's donor niche was thereby established. Finally, because of the loan funding, Bappenas, the national planning agency, as well as the BKKBN had to be involved in the decision-making regarding the use of these funds. There is no doubt that this bureaucratic triangle of decision-making among the World Bank, Bappenas, and the BKKBN complicated project development and implementation. The factors of lack of resident staff, type of funding, and bureaucratic decision-making in the Bank's population work in support of the BKKBN resulted in a de facto division of labour with other donors. The World Bank contributed in three main ways. First, loans in the population sector strengthened the program by providing buildings, project vehicles, and communications equipment as well as funds for sizeable education and communication programs and materials production. Two-thirds of all loan funding went for basic program infrastructure, such as buildings, equipment, and vehicles, and this input is regarded as the Bank's distinctive and principal contribution to program operations. The BKKBN utilized this part of Bank funding to build headquarters and supply warehouses in Jakarta, the 27 provinces, and 301 district capitals. The headquarters and provincial buildings are impressive and significantly better than other line ministry buildings, particularly in the provinces and regencies. There is little question that the impact of the Bank's inputs for infrastructure and vehicles helped to speed up the expansion of the program as well as helped it achieve important status in the eyes of its own staff and the general public. Funds were also used to construct a network of critically important training facilities. As the major provider of infrastructure and vehicles, the Bank made possible the physical base and mobility essential for administration, field services, supplies, training, and education and communication work as the program expanded throughout the archipelago. Additionally, the BKKBN also utilized these funds for specific operational program components such as training, population education, hospital post-natal programs, research and evaluation, and information/ education/ communications. The Bank generally did not play a leading role in such 'software' components of A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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program operations. While the Bank provided limited support for routine field service operations, it is significant that they did provide important initial support for salaries of fieldworkers when the program made the transition from a clinic-based to a community-based approach in the mid-1970s. Second, the larger portfolio of Bank loans in other development sectors contributed to a variety of socio-cultural and economic changes, which appear to have had a synergistic effect on the desired number of children and the demand for family planning services. Development in these other sectors changed Indonesian society in ways that probably affected people's interest in smaller families and family planning. For fiscal years 1968-1989, with spending through 1992, the Bank contributed 14.8 billion dollars to Indonesia's development program. Of that amount, population lending per se constituted only 0.8%, with another 1% for health and nutrition. However, for the same period, 26% went for agriculture and rural development, 14% to transportation, 10% for education, 5% for small-scale enterprise, and the remainder to the major economic sectors - industry, power and energy, and communications (World Bank 1992:153). While none of these loans were justified in terms of their possible effects on fertility, it can be surmised that improved socio-economic development creates a climate that encourages reduced family size and a willingness to practise family planning. Finally, the Bank's role in Indonesia's general development program contributed to the credibility of the population program. Substantial social and economic change in Indonesia may have contributed to the fertility decline in two important ways. In the first place by decreasing the demand for children and increasing the demand for contraception. And in the second place by greatly improving the infrastructure, which facilitated the work of the national family planning program. In this developmental context, the BKKBN promoted small planned families and provided the information, contraceptive supplies, and services to make them possible. While difficult to quantify, there is little doubt that both the favourable developmental trends and the effective family planning program contributed to the fertility decline. Indonesia's broad development program, with continued Bank support, should facilitate continuing social and economic change, which in turn will facilitate the continuing success of the family planning program and fertility decline. 8 Such indirect support in other sectors complemented the Bank's strong support to the BKKBN and the family planning program.

Funding in the 1990s assisted the Ministry of Population and Environment with training, research, population policy development, and other activities.

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The United Nations Population Fund UNFPA has been a partner with the Indonesian government in population and development since 1972 when it joined the World Bank in financing the country's first five-year population project. Since then, UNFPA has been supporting population assistance programs in Indonesia through a series of multi-year 'country programs', providing more than US$ 83 million. From 1972 to the present, UNFPA has supported family planning service expansion, physical infrastructure development, training, family planning promotion, and a wide variety of other population and family planning activities. During the fourth country program (1991-1994), UNFPA programmed US$ 22 million from its regular resources and US$ 3 million from multilateral sources, but this was later revised to a total of about US$ 16 million in line with strengthened financial capabilities within the Indonesian government. The fourth country program supported the Indonesian government's population objectives and programs in the following areas: - Improving family planning and closely associated information, education and communication (IEC) services; - Strengthening research capabilities in the fields of biomedical technology, demography, family planning management and operations research; - Developing population studies centres at regional universities; strengthening the BKKBN' s International Training Program; - Supporting the development and implementation of the Law on Population Development and the development of BKKBN' s strategy to promote happy and prosperous families. UNFPA assistance for the fourth country program helped to provide training opportunities for master's degree candidates within the country, strengthen ties between provincial policy-makers and researchers, and provide opportunities for university research centres to conduct social and biomedical studies relevant to policy development. The program supported the decentralized implementation of the family planning program at provincial and district levels, contributed to the improvement of the quality of care in family planning services, including the development and provision of training for counsellors, and provided assistance for research on reproductive health needs of adolescents. The program stressed decentralization of IEC efforts to ensure not only that the materials developed reflected the country's cultural diversity and specific local needs, but also that local organizations and religious leaders were involved in the process. It assisted the government in preparing the 1992 Indonesian Population Law and provided support for the development A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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of management systems. The program also helped Indonesia to play a leading role in the promotion of 'South-South' collaboration in population matters. The 1995-2000 UNFPA assisted country program supported a comprehensive population program in the amount of US$ 30 million, 25 million of which was programmed from UNFPA's regular resources, to assist the government of Indonesia in reaching its population and development objectives. The general objectives of this program were: - To support the government in its efforts to reduce maternal and infant mortality by improving the quality and coverage of reproductive health services; - To reduce the national birth rate through the provision of high-quality, user-oriented family planning services; - To improve the well-being of families and individuals, especially of the elderly, children, and women. Additionally, the program was to address issues related to the environment and to the HIV/AIDS concerns of the government. The program represents a transition to a stage of self-reliance on the part of Indonesia. For this reason, a great deal of the proposed resources was designed to support relatively sophisticated activities related to reproductive health and family planning, women, population and development; youth, and the country's growing elderly population. Given Indonesia's success, an important element of the program is the continued development of 'SouthSouth' capabilities, so that Indonesia can further share its experiences with other developing countries.9

Conclusions A precise explanation of the role of donors and foreign assistance in the Indonesian family planning program, or in its general development program, is extremely difficult due to the complexity of the political, economic, and socio-cultural development forces at work over the past three decades. However, it is important to try to understand the importance and synergistic effect of overall development on a single sector like family planning. Knowledge, attitudes, practices, and values change over time within the context of a complex and dynamic family planning program and within the social and economic development context of a culturally and economically diverse country such as Indonesia's. Through the synergistic interplay of fertility control measures with other socio-economic interventions, val nee (official program meth ds)

Figure 12.1. The shifting character of the family planning program under the New Order

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During the more than three decades of the New Order, at the start of which the Indonesian family planning program was designed and a few years later implemented, Indonesia experienced enormous change. The family planning program itself underwent changes as well. Started as a conventional clinic-based program, it moved rather quickly to a community-based one. Apart from that, the emphasis in the program shifted. While the family planning movement under the Old Order focused on responsible parenthood and women's health, the planning economy of the New Order put the objective of population control at the forefront. Gradually, the issues of family welfare and maternal health regained prominence. At the end of the New Order, the ICPD 1 themes of reproductive health and reproductive rights were incorporated into the program. In the following section, we will describe these processes.

The swing of the pendulum Prior to the start of the national family planning program, under the Soekarno regime, several initiatives were undertaken by influential individuals to set up family planning services and disseminate information about family planning. This culminated in the founding of the PKBI, the Indonesian Family Planning Association. Its activities were aimed at improving people's - particularly women's - situation by enabling them to plan their families and reduce unwanted pregnancies and women's health problems as a consequence of too frequent childbearing. Today, we would refer to the latter issue as reproductive health concerns. When in the late 1960s the New Order regime of former president Suharto came into power, the country's economy was in a deplorable state. Hence, economic growth and development became the first priority of the new government. Political control was thought essential to accomplish this. In line with international thinking at the time, the new leadership was convinced that a fast-growing population was a liability to economic development. The term 'population control' was a key word in those days, and population control became an important pillar of the Indonesian family planning program. At the same time, the second pillar was the institutionalization of the 'small, happy and prosperous family' norm. However, the continuing importance of the objective of curbing population growth, or 'population control', was reflected in the growing emphasis on targets to be met and in the campaign for durable contraception (kontrasepsi mantap), which was launched in the second half of the 1980s. International Conference on Population and Development, held in Cairo, 1994.

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The two-pronged approach of the program was its greatest strength. An exclusive concern with population control would have been self-defeating, as the fate of the sterilization campaigns in India during the 1970s had shown. The balance, however, was a precarious one. While meeting targets became increasingly important, concerns with maternal health and family welfare also became more explicit. In 1985, the family planning program became one of the five programs of the posyandu, the integrated services post. The relationship between mother-and-child health on the one hand and family planning on the other, which had provided an important justification for the early family planning movement, was given a structural place in the posyandu. Although the implementation of the posyandu was not unproblematic (Koesoebjono-Sarwono 1993; Kollmann and Van Veggel 1996), at least family planning needs and women's health needs could now be addressed at a practical level and in a unified context. Later, enhancing family welfare became the objective of the Keluarga Sejahtera program that was launched by BKKBN during the early 1990s. Thus, the pendulum gradually swayed toward concerns of women's health and family welfare, away from population control. However, two disclaimers have to be made here. The first one is that 'target thinking' was far too entrenched in the administrative-political culture of New Order officials to be easily done away with. One could call this an institutional lag. The second one is that women were still primarily seen as wives and mothers. The relevance and urgency of their health needs were assessed within this context. Women were addressed as wives and mothers and as guardians of their family's welfare. Feminist critique of the family planning program has labelled this an instrumental approach to women. Still, by the end of the 1980s, women's interests and concerns were far more visible in the program than was the case at earlier stages, when the pendulum swayed closer to the objective of population control. In Figure 12.1 the shifts through time in priorities and approach are made visible by different shades of grey. The International Conference on Population and Development (ICPD) in Cairo, in 1994, set up a reproductive health and reproductive rights agenda. The Cairo agenda specified the reproductive rights and health needs of individuals - men, women, and adolescents. Adopting the reproductive health perspective provides a more encompassing scope for addressing women's needs than a family planning perspective. In Indonesia, at the end of the New Order, policy-makers began to realize this. However, at the time of the fall of the Suharto regime, the BKKBN had not yet formulated a comprehensive policy for implementing the Cairo Plan of Action regarding reproductive rights and reproductive health. But, by the end of the New Order, the BKKBN publicly acknowledged the necessity of tackling the issue of quality of care. A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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The swing of the pendulum in Indonesia reflects international developments as well. International influence was considerable, not only at the end of the New Order, when the ICPD and international women's movements created new commitments, but also at earlier stages of the program. During the early 1970s, when the then new regime became eligible for foreign assistance, donors had their own agendas. The 'population problem', as it was then called, was a definite priority. When the BKKBN proved to be a dynamic and efficient organization, both bilateral (USAID) and multilateral (UNFPA, World Bank) donors were willing to support the program. To a certain extent the program at that time could be called donor-driven. The international paradigm shift, brought about by the failure of population control-oriented family planning programs (as in India) and the increasing influence of the international feminist lobby, also had an impact on Indonesian policies, partly through changed priorities in donor funding.

Unravelling the enigma offertility transition The gradual but steady decline of the birth rate and of population growth during the period under discussion (1968-1998) reflects several demographic, structural, and cultural changes in Indonesian society. An important demographic factor is the rise in age at marriage, especially in Java. Although this factor itself reflects underlying societal change, it explains a large part differing according to ethnic group - of the decline of the birth rate in Indonesia. In the explanatory framework of Davis and Blake (1956), age at marriage belongs to the cluster of exposure variables, one of three clusters of intermediate variables. In the framework of Bongaarts (1978), age at first marriage is one of the proximate determinants of fertility. The main explanatory variable, however, is the decline in marital fertility. As shown in Chapter 1, during 1965-1997 the total fertility rate declined from 5.91to2.78. As nonmarital fertility in Indonesia is negligible, these rates reflect a substantial decline in marital fertility. This implies that in thirty years' time, couples committed themselves to having smaller families and used contraceptive means once the desired family size was achieved. We speak of fertility transition when there is a cessation of childbearing well before the woman loses the physiological capacity to reproduce (McDonald 1993:5). Fertility transitions are realized as a consequence of the deliberate choices and behaviour of women and couples. The title of this section refers to fertility transition as an enigma. Fertility decline has been studied for many years now, starting with the Princeton University project to analyse historical sources to find explanations for the fertility transition in Europe (McDonald 1993). During recent decades the A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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geographical focus has shifted to Asia. In spite of all the work done in the field, it has not been possible to identify universal thresholds for the onset of fertility transitions or to pinpoint specific variables universally determining the onset and pace of fertility decline. In this sense, fertility transition remains an enigma. Fertility decline cannot be studied in a laboratory setting. We cannot artificially control the variables, keeping some constant and varying others. What we can do is to compare the timing of fertility decline in different circumstances and societies. So far, however, all hypotheses stating one single causal factor have been refuted. The conclusion must be that fertility transitions are multifaceted phenomena, moulded by their specific social and historical circumstances. In this section, we place the fertility transition in Indonesia in the context of the societal conditions and changes under the New Order. Though in this way we can point out concurrent changes, we cannot prove causality. In our analysis we use Coale' s three preconditions for fertility decline as a point of departure. They are: first, fertility must be within the 'calculus of conscious choice'; second, having fewer children must be viewed as advantageous; third, the means to control fertility must be available. These conditions were increasingly met during the period under discussion. The key to explaining the fertility transition has to be looked for here. Hull and Singarimbun attempted to identify the socio-cultural determinants of fertility decline in Indonesia during 1965-1976. Their explanation is relevant to the continuing decline of fertility beyond 1976 as well. The first explanatory cluster they identify is the modernization of thinking and family relations. They cite the expansion of formal education, a priority of Soekarno' s during his regime, as a central force in these processes. 'The school can thus be seen as an agency which serves both to modernize thinking, albeit with formal regard to basic traditional values, and alter relationships between parents and children' (Hull and Singarimbun 1989:23). The specific role of formal schooling in fertility decline, according to Hull and Singaribum, is located in two mechanisms. The first one is the effect of schooling on age at first marriage. 2 Second, when the family planning program was implemented almost half of the target group (married women 20 to 39 years of age) was by then literate in the Latin alphabet (Hull and Singarimbun 1989:25). Hull and Singarimbun see formal education as being conducive to meeting Coale's first precondition: bringing fertility within the calculus of conscious choice. The second cluster of explanatory variables they discuss is the reorganization of political structures. Under the New Order, the vertical chains of Several studies have indicated that a higher age at first marriage generally has a depressing effect on marital fertility, especially when the higher age at marriage is a consequence of increased formal education of women. 2

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command, modelled after military structures, effectively reached the villages. The authors see this as crucial, not so much in terms of motivation, but for logistics and the distribution of supplies (notably contraceptive pills and IUDs during that period). In this way, the political structures contributed to Coale' s third precondition: the availability of contraceptive means. The third cluster constitutes the material and technological dimension of social change. The authors warn that this dimension cannot be interpreted simply in terms of material changes per se, but must take account of concomitant changes in values. They also hypothesize that there might have been 'a build-up of an unobserved, possibly unconscious, latent demand for fertility control over the 1950s and 1960s' (Hull and Singarimbun 1989:42). This latent demand was met when the BKKBN began to distribute effective birth control devices for free. In this explanation, the change of values takes precedence over technological change. Two questions may be raised with respect to Hull and Singarimbun' s analysis. The first concerns the validity of their explanation for the period under discussion, the second its explanatory power for the period beyond 1976. We will discuss these questions with reference to Coale's three preconditions.

Fertility within the calculus of conscious choice The mental shift from seeing having children as being up to God's will or to fate, to seeing having children as a conscious choice (Coale's first precondition), was undoubtedly influenced by the expansion of formal schooling. However, there are other factors that should be taken into account as well. For one, Hull and Singarimbun neglect the religious factor. Religious leaders are generally not inclined to let people take their destiny into their own hands. Thirty to forty years ago, children were seen as a gift of God. Islamic leaders stressed the blessings of children. The popular saying banyak anak, banyak rezeki (many children, much good fortune) underlined this. This saying gradually lost popularity. The pro-natalist attitude of religious leaders faded likewise. Family planning policy-makers sought a dialogue with religious leaders from the start. We will pay further attention to the relationship between the family planning program and religious leaders in the next section. Here, it suffices to say that not only through the expansion of formal education, but also through a policy of sensitizing the religious leadership, from national to village level, fertility in people's minds was being brought within 'the calculus of conscious choice'. In thirty years' time banyak anak, banyak rezeki was gradually replaced by dua anak cukup (two children is enough). There are two other factors to consider as supporting this shift. One is the decline of infant and child mortality. At the start of the New Order, infant A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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and child mortality were alarmingly high, much higher than in neighbouring Southeast Asian countries. Once these figures began to fall and immunization campaigns were successful and reaching national coverage (Iskandar 1997), people must have become aware that the chances of survival of their children had not only increased, but could also be controlled to an unprecedented degree. If the survival of your children is no longer determined by fate, then why should having children or not be a matter of fate or God's will? Fear of the death of one's children works as a mental obstacle to planning births and limiting family size. This obstacle was gradually removed. The second factor to consider is gender. There are good reasons to suppose that male and female consciousness work differently with regard to fertility and fertility control. Women carry the burden of childbearing and it is their health that is affected by having one child after another. They are much more susceptible to the idea that they need not comply with such conditions and that they can and should do something about it. A gender perspective on fertility acknowledges women's agency (Greenhalgh 1995). In the Serpong Project,3 the traditional birth attendants (TBA) in the area were trained by the project in family planning motivation. In their communication with local women they urged them to use contraception at least to postpone the next pregnancy, thus safeguarding their health (Niehof and Sastramihardja 1978). In this way, TBAs were instrumental in strengthening the idea that women are allowed to regulate their own fertility. Of course, judging from the evidence on the use of traditional means of preventing conception or causing abortion, 4 many women had tried to regulate their fertility long before effective and safe contraceptives became available through the family planning program. Women more than men have always been more inclined to consciously try to control their fertility, and not only in Indonesia, accepting fate only when their efforts failed. In this sense, Hull and Singarimbun's assumption of an existing latent demand for contraception prior to the implementation of the family planning program may indeed apply to a large number of Indonesian women. Having said this, the gender perspective also implies taking into account the different positions of men and women. Women might try to regulate their fertility, often without their husbands' knowledge. But at the start of the New Order, the norm still was that children are God-given and bring prosperity. For husbands to let their wives participate in a public program aiming at fertility control, they needed the approval of religious leaders. Education Described in Chapter VII. Such as massage to accomplish retroflexion of the uterus (angkat perut in Indonesiar or walik dada in Javanese) or various herb medicines (jamu). For a discussion see Niehof and Sastramihardja 1978:209-10. 3 4

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was also an important factor here. The increasing literacy of women gave them leverage against their husbands to become acceptors and go against the grain of tradition. While we agree with Hull and Singarimbun on the impact of educational expansion on the relationship between parents and children, we think that its impact on the relationship between husbands and wives should not be underestimated. Increasing female participation in the labour force is another factor in the change of the relationship between the sexes that contributed to fertility decline. Women began to acquire a place of their own, not only in the informal sector, in which Indonesian women had always played an important role, but also in the formal sector. Working mothers had to strike a balance between their reproductive and their productive tasks.

The perceived advantages of having fewer children Education is also a major factor in fulfilling Coale' s second precondition, that having fewer children should be perceived as advantageous. Throughout this book instances have been cited of Indonesian people pointing to the importance of giving their children a proper education. In discussing the case of Bali in Chapter VII, the significance attached to children's education by Balinese parents is presented as an important explanatory variable in the Balinese fertility transition. For the large majority of Indonesian people to be able to bear the costs of educating their children, it was necessary to limit their number. Under the New Order educational aspirations were also rising. It was no longer sufficient for one's children to complete primary school and just be able to read and write. One's children should at least go to secondary school. Continuation rates from primary to secondary education were approaching 90% by 1993 (Dey-Gardiner 1997:150). This applied to boys, but increasingly to girls as well. During the period 1976-1993 sex ratios (females per 100 males) show an increasing trend for all levels of education, reaching 93.3, 87.0, and 84.0 for primary, lower secondary, and upper secondary education respectively (Dey-Gardiner 1997:149). This particular effect of education was thus not limited to the period discussed by Hull and Singarimbun (1965-1976), but has had a continuing impact on family size. The terms of thinking about the ideal family gradually shifted from quantitative to qualitative. In a society in transformation, with the rural agricultural base gradually declining in significance, children became a cost factor instead of contributing to the family's wealth through their labour. Caldwell (1982) has labelled this phenomenon the reversal of the intergenerational flows of wealth. Judging from the pace of urbanization in Indonesia (Firman 1997), children have certainly largely lost their value as agricultural labourers, especially in Java. At the same time, the increasing participation of especially girls and unmarried women in factory labour in A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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the industrializing areas did not replace the earlier contribution of children to the household income. Research has shown that the income earned by these girls was barely enough to support themselves, and certainly not enough to contribute to the income of the parental household in a meaningful way, even if they had wanted to (Wolf 1993). As Hull and Singarimbun (1989:245) conclude for the period they discuss: 'As children marry later and are in school longer, they sometimes constitute a significant burden on the family economy. Even if they leave school and work, parents do not gain the benefits of their productivity.[ ... ] Parents and potential parents are thus learning that children can be expensive and are giving more thought to the trade-off between numbers of children and the quality of the lifesty~e each child can enjoy.' This trend is not limited to the period 1965-1976. It has continued, and has contributed to the ongoing decline in the desired number of children. With economic development, at least up to the economic crisis starting in 1998, people's aspirations and ambitions have also risen. Having many children has become a liability.

The availability of means The national family planning program provided the means.needed to fulfil Coale' s third precondition. Seen against an international background, the national family planning program was founded at a timely moment. As Hull and Singarimbun note: 'When the New Order government was formed in 1966, and re-established links with outside aid agencies, foundations and the United Nations, it found itself swept up in a tide of commitment to fertility limitation. The fortuitous nature of this coincidence is remarkable. [... ] It is hard to avoid the impression that Indonesia's program was formulated at a time when faith in a technological answer to population problems was at its peak.' (Hull and Singarimbun 1989:51.) Given this promising start, the question arises to what extent the structure of the program contributed to the availability and accessibility of contraceptive means. For one thing, the policy to transform the program from clinicbased to community-based has certainly contributed to accessibility. Apart from this, the organizational effectiveness of the program has always been rated by observers as a strong point. In retrospect, the decision to base the program not in an existing ministry but in an autonomous board (BKKBN) must be judged positively. As Hull and Singarimbun note: 'The BKKBN has been remarkably successful in organizing two basic activities: the logistics of contraceptive supplies and the system of rapid feedback monthly service statistics' (Hull and Singarimbun 1989:33). The BKKBN soon acquired an image of competence and efficiency. This made foreign donor agencies more inclined to support the family planning program. In this way, foreign donor A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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agencies contributed to the availability of contraceptives. A feature of the program that greatly contributed to the accessibility of family planning means and information at the village level is the family planning fieldworker (PLKB). The PLKB as an institution was established in 1970 and became officially attached to the BKKBN in 1971. In 1976, in Java and Bali, there was about one PLKB per 13,000 inhabitants, which means about one PLKB to three or four desa (Haryono Suyono 1979:21). The ideal was to allocate fieldworkers as much as possible in or near their region of origin, and to have twice as many female as male fieldworkers (Soejatni 1972). Although during the first years of the program the fieldworkers received incentives according to the number of acceptors recruited, the incentive system was soon abolished because it gave rise to undesirable forms of competition (Hull et al. 1977). Jay Parsons, a long-time observer of the Indonesian program and for several years resident-representative of UNFPA, points to 'the success of the fieldworker as an effective motivator for family planning', although this was never formally evaluated (Parsons 1984:6). Once a network of volunteers, such as PPKBD or Pos KB (Family Planning Posts) and acceptors' groups, was in place, the job of the PLKB became easier. They now had to motivate and support the motivators, and coordinate logistics. This unique, locally rooted feature of the Indonesian family planning program has certainly contributed to accessibility and availability of contraceptives. To what extent it was a trade-off to quality of care, as no medical professionals were involved in these processes, is a question that cannot be easily answered. As long as everything was going well, it was also a question no one bothered to ask. When contraception became increasingly sophisticated, such as with the implant, the dependency on medical providers likewise increased. Special drives were a way to reach remote areas to provide services, particularly for inserting IUDs and implants. In this way, women were spared the bother and costs of travelling to the nearest health centre. However, once the caravan of medical personnel left the area, there would be no medical professional to turn to in case of complications or complaints. Taking all these pros and cons into account, however, the overall conclusion is that the national family planning program has displayed remarkable creativity in getting contraceptive means to acceptors, as much as possible according to their wishes. Chapman points out that Western-based critics of the family planning program tend to 'disregard the difficult logistic considerations in providing family planning services', apart from the fact that they 'fail to consider the alternative for women in Indonesia if there were no family planning program' (Chapman 1996:12).

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Family planning and gender equity In this section we address whether the family planning program contributed to gender equity and whether it was a 'success story for women' (Smyth 1991). These questions were not posed when the program was founded. As explained above, during the initial stage of the program the paramount issue was that of curbing population growth. Neither does the second objective of the program, enhancing family welfare, specifically address women's welfare and gender equity. However, during the later phases of the program the pendulum swung back, and women's needs became increasingly recognized. Still, we cannot hold the program accountable for not achieving an objective it never held. In our opinion, Smyth (1991) makes this mistake when she notes that the program did not succeed in decreasing maternal mortality in Indonesia. The observation is right, but the implication is wrong. As explained in Chapter XI, the reasons for the comparatively high level of maternal mortality in Indonesia lie mainly in the inadequacies of natal and prenatal care services. These are beyond the mandate and scope of the family planning program. In spite of the fact that enhancing gender equity was never an explicit aim of the family planning program, it is legitimate to ask the question in retrospect. The evidence presented in Chapter X is not unequivocal. Before looking into this further, it should be noted that gender equity can be assessed by looking at gender roles and the way in which gender inequality is institutionalized. McDonald notes that 'in societies undergoing fertility transition, gender stratification and gender roles within a given society can become inconsistent with each other' (McDonald 2000:428). The findings of the Women's Studies Project (Chapter X) seem to corroborate McDonald's observation. While in several sectors, such as education and employment, gender inequality decreased under the New Order, the ideologically underpinned division of labour between men and women within the family did not change much. Women's empowerment in the family is little influenced by family planning, and women who have never used family planning and have never worked seem to have the weakest bargaining position vis-a-vis their husbands. While family planning enabled women to work and contribute to the household income, it did not bring about a change in the gendered division of responsibilities for household management and household chores. Gender equity in the family relates to deep cultural and psychological structures in society, which the family planning program touched upon but did not significantly alter. The other question concerns the significance of the family planning program for women. Smyth (1991) claims it did not significantly enhance gender equity. Chapman (1996) is more balanced in her assessment. She points to the A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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family planning-linked programs, like the family nutrition program (UPGK) and the income-generating program (UPPKA), which, although not aimed at empowering women, are important to them. Women find support from such programs in fulfilling their roles as mothers and housewives, and often in enlarging their social networks as well (Niehof 1992). Though this may not seem very impressive from a feminist point of view, to the women concerned these programs are beneficial. Obviously, the most important benefit of the family planning program to women is the increased control over their own fertility. As is apparent from several studies and statements of women that we recorded first-hand, women are aware of this and value it positively. Chapman concludes that 'if one looks at the practicalities of women's position as a result of the family planning program, rather than at their theoretical position in family planning policy, many increases in women's empowerment and prosperity are evident' (Chapman 1996:vi). We tend to agree with Chapman's conclusion. At the same time, however, it must be noted that a reproductive health focus in family planning service delivery is crucial to women's health and welfare. If the family planning program can accomplish this shift of emphasis, future generations of Indonesian women will benefit even more. As explained in Chapter X, these women will have different fertility careers from those their mothers had when the family planning program was launched. They will be more critical clients and more demanding of high-quality services. They will take for granted the availability of effective fertility regulation, while to their mothers this represented a break with the past. Also in judging the significance of the family planning program for women, the historical perspective cannot be omitted.

Family planning, politics, and religion As discussed in Chapter IY, the conceptualization and development of the national family planning program must be viewed in a political framework. Not only was the New Order government able to place population policy on the political agenda, thus paving the way for a national family planning program, but it could also rely on a stable bureaucratic structure, backed up by the military, which was needed for implementation. The family planning program became part and parcel of the planning economy and the development culture. However, there is a certain hybrid feature to the program. On the one hand, its design and implementation bore the stamp of top-down planning. These were part of what Jackson called the 'bureaucratic polity', in which there is 'no regular participation or mobilization of the people' (Jackson 1978:4). On the other hand, fairly soon after its initiation, the program aimed at local participation and began to use community structures for A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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its implementation. There was a conscious effort to transfer 'ownership' of the program to the people in the villages, and indeed to society at large. This has been crucial for the spread of family planning motivation and the distribution of contraceptive means. It resulted in the program having an impact on Indonesian culture and society, and it complemented the formal logistic structures. Another important factor is the way policy-makers dealt with the religious factor, as reviewed below. When the Indonesian Family Planning Association (PKBI) was founded (1957) and expanded its activities, several persons of religious prominence were involved or were sympathetic to the goals of the PKBI. Some of them continued to be active in giving the newly developing family planning program a religious justification. The former head of the Extension Department of the Ministry of Religion (1968-1972), the late K.H. Nasaruddin Latif (BKKBN 1990:118), was an example. At the beginning of the New Order, during the process of formulating a national population policy and a national family planning program (1968-1970), discussions with national religious leaders on the subject of family planning were held behind closed doors. The objective was to reach a consensus, according to the good Indonesian tradition of musyawarah, on an approach that would be acceptable to religious leaders.5 Policy-makers wanted to have the support of religious leaders from the start. Arguments pro and con were debated with reference to religious texts. Available contraceptive means were scrutinized from a religious point of view. Abortion and sterilization were deemed unacceptable, and therefore were never made part of the official program. The IUD raised a lot of questions. These were gradually sorted out. Discussions on the view of Islam on family planning at the national level were conducted by approaching the leaders of the two major Islamic organizations: the more traditional Nahdlatul Ulama and the reformist Muhammadiyah (BKKBN 1990). Once influential leaders at the national level were committed to the family planning program, they were supposed to use their influence at the regional and local levels. At these levels, family planning personnel were instructed to involve religious leaders in their motivational and extension activities. In known bulwarks of orthodox Islam, such as East Java, Madura, and Aceh, the legitimizing power of religious leaders was consciously sought (see Niehof 1987 on Madura). For the believers in the villages, the moral acceptability of modern contraception depended a lot on the attitude of local religious leaders, at least during the early days of the program. 6 The local religious leader, or kyai, in his role as broker between Islam Personal communication Haryono Suyono. As the Minangkabau case in Chapter VII shows, at some point women realize that their own village kiyai is more conservative than religious leaders seen on national television. This

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as a world religion and the local 'little tradition' of the 'fragmented, barely conceptualized, practical religion of the ordinary peasant' (Geertz 1960), could contribute substantially to the acceptance of family planning. Hence, the switch to fertility being brought under the calculus of conscious choice had to be, and eventually was, supported by the moral force of religion.

Looking ahead When looking ahead, several points come to mind. First, it has to be acknowledged that the pace of fertility decline seems to be slackening. As noted in Chapter VIII, fertility has shown some signs of 'stalling' over the past decade. So far, fertility is still well above replacement level. The reasons for this phenomenon are not yet clear. If the average level of fertility has reached a certain plateau, is this because the current fertility pattern suits present-day Indonesian women and fits present-day Indonesian society? Is it a temporary phenomenon? In the post-New Order period, fertility might remain at the same level, it might rise again, or it might further decline to reach replacement-level fertility in the near future. It is difficult to tell. More research is needed. We do not even know yet what the impact of the post-1998 economic crisis on fertility behaviour has been. Regardless of the duration of the plateau in fertility decline, the fertility transition has proceeded far enough to change the age structure of the Indonesian population irreversibly. In the near future, population ageing will be one of the population issues demanding attention from policy-makers. In the coming years the dependency ratio7 will steadily fall. The period during which the dependency ratio decreases before it rises again - as it is estimated to do around the year 2010 - has been referred to by the Indonesian demographer Djuhari (1993) as a golden opportunity for national development. As yet this golden opportunity has not been used to advantage. One should keep in mind that, since 1998, the economic crisis has been an enormous drawback. Only very recently has there been a discussion of the impact of fertility decline in terms of population ageing and its accompanying demands for elderly care. The example of Thailand illustrates that although present-day may cause them to no longer accept the moral leadership of the local religious leader. However, this study was not done during the early days of the program but much later (1993). At the time of the Serpong Project in the early 1970s (see Chapter VII), kyai in the more orthodox villages were still very influential and warned against family planning. One of their arguments was that the information leaflets from the Ministry of Religion could not be trusted because they were not in Arabic (Niehof and Sastramihardja 1978). 7 The dependency ratio is the sum of the population under 15 and the population over 65 divided by the population aged 15-64.

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and future elderly people have fewer children to care for them in their old age, this should not be taken to mean that children do not provide care for their ageing parents (Knodel et al. 1992). Still, the problem of future elderly care needs serious consideration. New research is urgently needed. An example of a current research project on this topic is Keasberry (1998).

Challenges ahead As noted above, fertility decline seems to be stalling, while replacementlevel fertility has not yet been reached. However, several surveys seem to indicate that there is still a large unmet need for contraception. Therefore, it is important to increase contraceptive availability, to be sure that couples and individuals have access to safe and effective contraception if and when they want to. This still represents a major challenge. Throughout the New Order, an extensive family planning infrastructure was gradually put in place. For numerous women in the fertile ages in numerous villages, family planning activities became part of daily life. Whether as a user or a client, as a member of an acceptors' group, a motivator, or a volunteer, one way or another many women were involved. This will not change overnight. The challenge now is to bring about a change of perspective without losing the local infrastructure and these valuable local networks. This change of perspective should include three basic elements. The first one is bringing men into the picture. Family planning in Indonesia has been too exclusively the business and responsibility of women. Increasing active male participation in family planning will not only balance reproductive responsibilities between men and women, but may also increase contraceptive use. The second basic element is a reorientation toward a reproductive health perspective. The third element is commitment to quality of service delivery. As regards the last point, another challenge lies in the fact that the presentday acceptor is a different woman from the acceptor of thirty years ago. Quality of care is, not only from a political point of view, a serious issue now. Women will demand good services and more information now, as compared to the days when they were happy to have access to contraceptives at all. As the urban family planning initiative has shown, when they can, women are also willing to pay for good services (see Chapter III). The concept of reproductive health is a powerful tool for making the program more user-oriented in family planning information and services. The fact that NGOs may have a more significant role to play in the new political constellation may help in bringing this about. Also in this sense the pendulum has completed a full swing. An interesting point is made by a publication describing a consumer's perspective on thirty years of KB. The point is that not only does quality of services have to be improved, but that increasingly self-confident family A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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planning clients will expect a level of quality of services that exceeds that which the government is able to provide. At the same time, it is observed that some service providers use approaches that are 'not respectful toward the client as a human being' (Juliantoro 2000:169). The latter statement brings us to the final point. The first elected president of the Reformasi era, Abdurachman Wahid, was not adverse to family planning. On the contrary, he had been an adviser to the PKBI, and at one time was even adviser to the BKKBN. By bringing the BKKBN under the responsibility of the Minister for Empowerment of Women (MEW), however, he clearly indicated that in the future the family planning program should take women's needs and interests into account more seriously. A new, less autocratic and less authoritarian style of government, in which there is more room for individual choice and private initiative, would fit in with the new profile of the 'modern acceptor' or the 'modern client'. This requires not only a new message, but also a new approach. We think it is important to distinguish between message and approach. The message has clearly changed to emphasizing the needs of women, reproductive health, reproductive rights, and family welfare. But has the government approach changed as well? Is it now seeing acceptors as clients with a mind of their own? Has the approach become less autocratic? It seems that the message is easier to change than the approach. In an article in a wellknown daily (Kompas 2001), Khofifah Indar Parawansa (MEW) is quoted. She says that in the future the BKKBN should be less concerned with distributing contraceptives and more with changing the way people think, so that they will be able to plan their family life in a good way. During the past thirty years the BKKBN has been trying to change the way people think about family size. It has been criticized for that. Juliantoro speaks about 'indirect coercion' by changing the values in society through socialization and the use of mass media (Juliantoro 2000:166). Khofifah's statements show that this kind of cultural engineering did not end with the demise of the New Order. It can be questioned whether a government can be blamed for trying to educate its people in a direction that it thinks is for the better. In a country like the Netherlands, for example, the government uses the mass media and other means to make people more aware of environmental issues and also tries to influence people's behaviour in a certain direction. Why should it be unethical to do the same when it concerns family size and family life? And, does it matter how it is done? These are questions rather than answers that we offer at this point. It should also be noted here that paternalism - and maternalism, for that matter - are engraved in Indonesian society, especially in the dominant Javanese culture. This will not change easily. It has facilitated cultural engineering by the government on the one hand, and it reduces the scope for individual thinking and individual choice on the other. A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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In spite of what Khofifah says, the BKKBN still has, and for some time will have, an important task in making contraception available to large numbers of people all over the archipelago. There are still millions of women and families who are dependent upon government efforts for affordable reproductive health services and means of contraception. Though the evidence on this issue is not unequivocal, it looks as though the economic crisis has aggravated the situation, partly because there was a considerable drop in the welfare of Indonesian households during the first year of the economic crisis (Skoufias et al. 2000). This represents both an enormous challenge and a huge bill to pay. Indonesia can use the support of donors to meet this challenge and its implied costs. In meeting it, BKKBN should play the role of facilitator and, together with other actors in the field, should enable couples and individuals to make responsible reproductive choices and act upon those choices. Through its policies and its networks, it should contribute to the provision of good-quality means and services in which clients' needs are the focus. The gradual acceptance of family planning and the decline of fertility in Indonesia can be seen as an expression of, and perhaps even a metaphor for, social change in Indonesia. In the post-New Order period, the strengthening of civil society has come to the fore. The major challenge for family planning policy-makers in Indonesia is to make family planning part of this kind of society. Paternalistic and authoritarian thinking and practices must make way for democratic and client-centred approaches. If this can be accomplished, then changes in family planning will provide a metaphor for change in the society at large. Bibliography BKKBN 1990

Umat Islam dan gerakan keluarga berencana di Indonesia. Jakarta: BKKBN, Ministry of Religion. Bongaarts, John 1978 'A framework for analysing the proximate determinants of fertility', Population and Development Review 4:105-32. Caldwell, J. 1982 Theory offertility decline. London: Academic Press. Chapman, Rebecca Jane 1996 The significance offamily planning for women in Indonesia. Clayton, Australia: Monash Asia Institute. [Working Paper 99.] Coale, Ansley J. 1973 'The demographic transition reconsidered', Proceedings of the International Union for the Scientific Study of Population. Liege: IUSSP.

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Davis, Kingsley and Judith Blake 1956 'Social structure and fertility; An analytical framework', Economic Development and Cultural Change 4:211-35. Djuhari Wirakartakusumah, M. 1993 'Demographic transition in Indonesia and its implications in the 21st century', [Proceedings of the] International Population Conference, vol. 2, pp. 259-77. Montreal: International Union for the Study of Population. Firman, Tommy 1997 'Patterns and trends of urbanisation', in: Gavin W. Jones and Terence H. Hull (eds), Indonesia assessment; Population and human resources, pp. 101-18. Singapore: Institute of Southeast Asian Studies, Canberra: Research School of Asian and Pacific Studies Australian National University. Geertz, Clifford 1960 'The Javanese "kijaji"; The changing role of a cultural broker', Comparative Studies in Society and History II, pp. 228-50. Greenhalgh, Susan (ed.) 1995 Situating fertility; Anthropology and demographic inquiry. Cambridge, New York, Melbourne: Cambridge University Press. Haryono Suyono 1979 Pokok-pokok strategi program nasional KB, bidang kommunikasi, informasi dan edukasi. Jakarta: B.KKBN. Hull, T.H., V.J. Hull, and Masri Singarimbun 1977 'Indonesia's family planning story; Success and challenge', Population Bulletin no. 6:1-52. Washington DC: Population Reference Bureau. Hull, Terence H. and Masri Singarimbun The sociocultural determinants of fertility decline in Indonesia, 1965-1976. 1989 Yogyakarta: Population Studies Center, Gadjah Mada University. [Working Paper Series 31.) Iskandar, Meiwita B. 1997 'Health and mortality', in: Gavin W. Jones and Terence H. Hull (eds), Indonesia assessment; Population and human resources, pp. 205-32. Singapore: Institute of Southeast Asian Studies, Canberra: Research School of Asian and Pacific Studies Australian National University. Jackson, K.D. 1978 'Bureaucratic polity; A theoretical framework for the analysis of power and communications in Indonesia', in: K.D. Jackson and L.W. Pye (eds), Political power and communications in Indonesia, pp. 1-10. Berkeley: University of California Press. Juliantoro, Dadang 2000 'Pendekatan baru dan tantangan perubahan', in: Dadang Juliantoro (ed.), 30 Tahun cukup; Keluarga berencana dan hak konsumen, pp. 163-80. Jakarta: Pustaka Sinar Harapan, Ford Foundation, Yogyakarta: PKBI. [Seri Kesehatan Reproduksi, Kebudayaan, dan Masyarakat.]

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Keasberry, Iris N. 1998 'The implications of social change for elderly care in rural Java; A theoretical framework', Journal of Population 4-1:23-55. Knodel, John, Napapom Chayovan and Siriwan Siriboon 1992 'The impact of fertility decline on familial support for the elderly; An illustration from Thailand', Population and Development Review 18:79105.

Kollmann, Nathalie and Corrie van Veggel 1996 'Posyandu', in: P. Boomgaard, R. Sciortino and I. Smyth (eds), Health care in Java; Past and present, pp. 95-111. Leiden: KITLV Press. [Proceedings 3.] Koesoebjono-Sarwono, Solita 1993 Community participation in primary health care in an Indonesian setting. [PhD thesis, Leiden University.] Kompas 2001 'Program baru KB nasional: "Keluarga Berkualitas 2015"'. Kompas, 8 February. McDonald, Peter 1993 'Fertility transition hypotheses', in: Richard Leete and Iqbal Alam (eds), The revolution in Asian fertility; Dimensions, causes and implications, pp. 3-14. Oxford: Clarendon. [International Studies in Demography.] 2000 'Gender equity in theories of fertility transition', Population and Development Review 26-3:427-39. Niehof, Anke 1987 'The family planning fieldworker and local leaders in rural Madura', in: Philip Quarles van Ufford (ed.), Local leadership and programme implementation in Indonesia, pp. 119-39. Amsterdam: Free University Press. 1992 'The Indonesian family planning program; Between acceptors and adversaries', Working Group on Indonesian Women's Studies. Leiden: WIVS.

Niehof, Anke and Hatta Sastramihardja 1978 'The community-based channels for the diffusion of family planning', in: Lida C.L. Zuidberg (ed.), Family planning in West Java; The Serpong project, pp. 178-222. Leiden: Institute of Cultural and Social Studies, Jakarta: Djambatan. Oey-Gardiner, Mayling 1997 'Educational developments, achievements and challenges', in: Gavin W. Jones and Terence H. Hull (eds), Indonesia assessment; Population and human resources, pp. 135-67. Singapore: Institute of Southeast Asian Studies, Canberra: Research School of Asian and Pacific Studies Australian National University. Parsons, J.S. 1984 'What makes the Indonesian family planning programme tick?', Populi 11-3:5-9.

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Smyth, I. 1991

'The Indonesian family planning programme; A success story for women?', Development and Change 22:781-805. Skoufias, Emmanual, Asep Suryahadi and Sudarno Sumarto 2000 'Changes in household welfare, poverty and inequality during the crisis', Bulletin of Indonesian Economic Studies 36-2:97-114. Soejatni 1972 Tindjauan performance dan training PLKB. Jakarta: BKKBN. Wolf, Diane L. 1993 'Women and industrialisation in Indonesia', in: Jan Paul Dirkse et al. (eds), Development and social welfare; Indonesia's experiences under the New Order, pp. 135-59. Leiden: KITLV Press. [Verhandelingen 156.]

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Glossary adat ani-ani arisan AVSC Banyak anak, banyak rezeki Dua anak cukup Laki perempuan sama saja Bappenas BKIA BKKBN BPS banjar bawon besan bupa ti camat CPR DPR Dharma Wanita dwifungsi FWCW

Golkar gotong royong GOWI ibu ICPD IDHS

tradition and customary law bamboo knife to cut heads of rice, only to be used by women local rotating savings and credit association Indonesian NGO (Association for Voluntary Surgical Contraception) (many) Children bring much prosperity Two children is enough (family planning slogan) Boys and girls are just the same (family planning slogan) Badan Perencanaan Pembangunan Nasional (National Development Planning Board) Badan Kesehatan lbu dan Anak (Mother-and-child health clinic) Badan Kordinasi Keluarga Berencana Nasional (National Family Planning Coordinating Board) Biro Pusat Statistik (Central Bureau of Statistics) Balinese village council traditional system of paying harvesters (women and children) with a share of the harvest the parents of one's son- or daughter-in-law regency or district head sub-district head contraceptive prevalence rate Dewan Perwakilan Rakyat (the Indonesian parliament) official organization of wives of civil servants dual role of the military {both military and political) Fourth World Conference on Women (Beijing 1995) Golongan Karya (Indonesian political party) traditional mutual assistance Gabungan Organisasi Wanita Indonesia (Federation of Indonesian Women's Organizations) mother; term of address for adult women International Conference on Population and Development (Cairo, 1994) Indonesian Demographic and Health Survey A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

268 IEC

IPPA IPPF IUD kampung KB KB Mandiri kaumibu keluarga keluarga sejahtera KMS

kodrat wanita kontrasepsi mantap KUHPI LKBN LKKNU lurah MCH MOH MPK Muhammadiyah MUI musyawarah-mufakat Nahdlatul Ulama NF PCB NGO NKKBS NOVIB Puskesmas PUSSI Orde Barn OrdeLama pagayuban Pancasila pembangunan pengajian perkumpulan pesantren PKBI

Glossary information, education, and communication Indonesian Family Planning Association International Planned Parenthood Federation intra-uterine device neighbourhood, hamlet, part of a village Keluarga Berencana (family planning) Self-reliant Family Planning the women of Indonesia family family welfare Kartu Menuju Sehat (health nutrition status card) women's natural destiny long-lasting contraception Kitab Undang-Undang Hukum Pidana (criminal code) Lembaga Keluarga Berencana Nasional (National Family Planning Institute) family welfare unit of the Nahdlatul Ulama (NU) village head, head of the neighbourhood mother-and-child health Ministry of Health Majelis Pembina Kesehatan (health development division of the Muhammadiyah) Islamic movement Munas Ulama Indonesia (congress of Indonesian Islamic scholars) decision-making through consultation and consensus Islamic political movement National Family Planning Coordinating Board non-governmental organization Norma keluarga kecil, bersejahtera dan sehat ('small, happy and prosperous family norm', a family planning slogan) Dutch NGO Pusat Kesehatan Masyarakat (government health centre) Indonesian Association for Voluntary Sterilization New Order government under Suharto Old Order government under Soekamo communal meeting of villagers state ideology of Indonesia ('5 principles of the state') development Koran recital and religious education (in groups) association Islamic theological boarding school Perkumpulan Keluarga Berencana Indonesia (Indonesian Family Planning Association)

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Glossary PKMI

PKK PLKB PosKB posyandu PPKBD PPM PPP priyayi Repelita Sahabat Remaja sawah songket

STD

tebasan TFS TP3

UN UNICEF UNFPA unit pelaksana UPGK UPPKA USAID UUD45 VCDC

warung WHO WKBT Wisma Panca Warga yayasan YKB

269

Perkumpulan Kontrasepsi Mantap Indonesia (Indonesian NGO active in the field of family planning and durable contraception) Pembinaan Kesejahteraan Keluarga (family welfare movement) Petugas Lapangan KB (family planning fieldworker) family planning services post (staffed by volunteers) Pos Pelayanan Terpadu (integrated health services post) family planning assistant in the village (volunteer) pemenuhan permintaan masyarakat (social demand approach) Partai Persatuan Pembangunan ('Unity for development party', Indonesian Islamic political party) Javanese nobility, bureaucratic elite Rencana Pembangunan Lima Tahun (Five-year Development Plan) Friend of Youth (Indonesian NGO, founded by the PKBI wet-rice field cloth, hand-woven textile (Bali) sexually transmitted disease system of credit by buying the produce before harvest total fertility rate Tim Pertimbangan Pelaksana Program (advisory team for program execution) United Nations United Nations Children's Emergency Fund United Nations Fund for Population Activities implementing unit Usaha Perbaikan Gizi Keluarga (family nutrition improvement program) Usaha Peningkatan Pendapatan Keluarga Akseptor (income-generating program for family planning acceptors' families) United States Agency for International Development Undang-undang Dasar 45 (Indonesian Constitution of 1945) village contraceptives distribution centre coffeeshop, small local shop for daily necessities World Health Organization Wisma KB Terpadu (non-governmental integrated family planning services post) Indonesian NGO ('home of five family members'), affiliated with the PKBI foundation Yayasan Kusuma Buana (Indonesian NGO for urban MCH and family planning) A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

270

YKK

Glossary ·Yayasan Kesejahteraan Keluarga (Family Welfare Foundation)

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About the authors Setyawati Budiningsih was trained as a medical doctor and obtained her master's degree in public health from the University of Hawaii, USA, in 1979. From 1974 to 1978 she worked at a family planning clinic. She is now a senior lecturer at the Department of Community Medicine, Medical School, University of Indonesia. Since 1983, she has been the director of the committee for family planning and reproductive health (FP-RH) of the Indonesian Medical Association. Her e-mail address is [email protected]. Elizabeth Eggleston is an expert on health behaviour with a PhD in maternal and child health from the University of North Carolina at Chapel Hill, USA. From 1994 to 1999, she worked at Family Health International (Research Triangle Park, NC, USA) on sub-projects of the Women's Studies Project in Indonesia and Jamaica. She currently works at Research Triangle Institute in Washington DC, USA. Her e-mail address is [email protected]. Si ti Hidayati Amal, a sociologist, obtained her master's degree in sociology from the University of Essex, United Kingdom, in 1990. She teaches in the Department of Sociology at the University of Indonesia. For four years she worked as gender mainstreaming consultant with the Women Support Project (Phase II), a CIDA project in collaboration with the Indonesian Ministry of Women's Empowerment in Jakarta. Her e-mail address is [email protected]. Karen Hardee is director of research for the POLICY Project, at the Futures Group. She has a PhD in development sociology from the Population and Development Program at Cornell University. She specializes in reproductive health/HIV and gender issues. Hardee directed the Indonesia program of Family Health International's Women's Studies Project from 1993 to 1998. She collaborated in four studies to assess the impact of family planning on women's lives in Indonesia. Her e-mail address is [email protected]. A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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About the authors

Terence H. Hull has worked on issues of family planning in Indonesia since 1972, when he undertook a village study on the value of children in Yogyakarta. In collaboration with Valerie Hull, he has written extensively on behavioural, demographic, and political aspects of fertility and health. His current research focuses on issues of gender and sexuality in Indonesia and other countries of Southeast Asia, and on the problems of interpreting official statistics during a time of rapid governmental change in Indonesia. Presently, he holds the John C. Caldwell Chair in Population, Health and Development at the Australian National University. His e-mail address is [email protected]. Gavin W. Jones is professor in the Demography and Sociology Program of the Research School of Social Sciences, Australian National University. He has spent eleven years in various parts of Southeast Asia, including six years in Indonesia, where he taught at the University of Indonesia and served as a consultant to the Ministry of Population and the Environment. He has written extensively on population policy, human development issues, urbanization, and marriage and the family. His publications include a comprehensive work on marriage and divorce in Islamic Southeast Asia (Marriage and divorce in Islamic South-east Asia, 1994, Oxford University Press, South-East Asian Social Science Monographs). His e-mail address is [email protected]. Firman Lubis has been working in family planning since 1970, when he was the Indonesian team leader of the Serpong Project for family planning research and training. In 1975 he obtained his master's degree in public health from the University of Hawaii, USA. From 1975 to 1979 he was a research consultant to the National Family Planning Coordinating Board (BKKBN). In 1979 he founded an NGO, called Yayasan Kusuma Buana, working in family planning and reproductive health care, of which he is still the director. From 1987 to 1996 he served as a steering committee member of a task force under the Human Reproduction Programme of the WHO. Presently he is teaching family medicine at the Faculty of Medicine, University of Indonesia. His e-mail address is [email protected]. Anke Niehof was trained as an anthropologist and demographer. She did her PhD on women and fertility in Madura, Indonesia (Leiden University, 1985). She has ten years of work experience in Indonesia, including being a team member of the Serpong Project (1972-1975) and working as a consultant at the BKKBN head office in Jakarta (1988-1991). In 1993 she was named full professor of household and family sociology at Wageningen University, the Netherlands. Her current research focuses on issues of household livelihood and food security in various countries and on elder care in rural Yogyakarta, A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

About the authors

273

Indonesia. She is a member of the board of the World Population Foundation and chaired the national Dutch NGO platform on ICPD, Cairo (1994). Her e-mail address is [email protected].

David L. Piet has a master's of public health from the University of North Carolina at Chapel Hill, USA. He has lived and worked in a variety of overseas settings, including India, Cambodia, Egypt, Bangladesh, Pakistan, Nepal, and Indonesia (twelve years). He has over thirty years of experience in providing technical assistance and managing international assistance for population/ family planning, child survival, maternal and child health, reproductive health, HIV I AIDS, infectious diseases, and related public health programs. During 1974-1977, while working for The Asia Foundation, he worked with Indonesia's National Family Planning Program. During 1980-85, he was responsible for USAID's assistance to the BKKBN's Outer Islands I and II programs. He has extensive knowledge of the BKKBN's administration, management, and field operations. His e-mail address is [email protected]. Nancy J. Piet-Pelon has thirty years of experience in reproductive health and family planning programs, mainly in Asia. Her professional work has focused on changing opportunities for couples who require reproductive health or family planning services, services that ensure both free choice and individual dignity. This work has led to positions in governments, as well as with technical assistance agencies and NGOs. Program evaluations and assessments, project development and monitoring, training, research, and writing are all part of her work. Her publications cluster around two main topics: reproductive health and population issues, and cross-cultural adjustment for expatriate families. Her e-mail address is [email protected].

f oedo Prihartono was trained as a medical doctor and epidemiologist and

obtained his master's degree in public health from the University of Hawaii, USA (1979). Currently, he is research coordinator of the Community Medicine Department, Medical School, University of Indonesia. He has actively participated in national programs on safe motherhood and family planning for more than 25 years, and is involved in various in-country WHO consultations. He has published on reproductive health issues. His e-mail address is [email protected].

Solita Sarwono is a psychologist and medical sociologist. She did her PhD on community participation in primary health care (Leiden University, 1993). Her fields of expertise include public health education and gender issues. From 1976 to 1987 she lectured at the School of Public Health of the A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

274

About the authors

University of Indonesia and conducted training for the Indonesian Ministry of Health, the National Family Planning Coordinating Board (BKKBN), and the Indonesian Family Planning Association (PKBI). Since moving to the Netherlands in 1987 she has done advisory work and is a guest lecturer at the University of Indonesia. She is a freelance consultant in public health, social and behavioural sciences, and gender. Her e-mail address is [email protected].

Ninuk Widyantoro is a psychologist, working in family planning and repro-

ductive health. She has her own psychological consulting office and publishes counselling books and manuals especially on issues related to safe abortion, HIV I AIDS prevention, and adolescent reproductive health. She is a consultant and counselling trainer not only in her own country, but also in a number of other developing countries in Asia and Central Asia. She chairs the Women's Health Foundation, an NGO that strives to make safe abortion available, accessible, and affordable for women in Indonesia. Her e-mail address is [email protected].

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Index For an explanation of the abbreviations used in the index, see the glossary. abortion 51, 60, 72, 110, 115, 131, 169, 179, 232-34, 252, 258 abstinence 21, 124, 153, 207, 238-9 acceptor 36-42, 46, 48, 72, 75, 88, 122, 126-9, 134-5, 138-40, 146, 196-7, 200-1, 227-8, 236, 255, 260-1 A.ceh 44,78,96, 136,258 adolescence 163, 166-7 adolescents 110-1, 114-5, 117, 168-9, 2326, 248 age bias 234 A.isyiyah 177 A.mbon 29 arisan 40-1, 138, 177 asepsis 228, 238 A.tma Jaya University 187 A.ustralian National University 13, 15 A.ustralians 97 autonomy 11, 15, 186-7, 191, 194-6, 226 Bali 10-1, 13-4, 22-3, 27, 29, 37-40, 43, 45, 53, 63, 74, 85-6, 121, 123, 130-1, 147, 152, 171, 175, 178, 190,231,253,255 Bandung 25, 27, 29 Bangladesh 241 banjar 14, 38-40, 132-3 banyak anak, banyak rezeki 9, 11, 148, 174, 251 BA.PPENA.S 6, 32, 70, 97-8 Batak 147 Beijing conference 113, 115, 246 Bekasi 139 Belo, Jane 164, 180 besan 170 beyond family planning activities 42, 115

bilateral aid/ assistance 13, 95 bilateral donor 84, 90-1 birth control 3, 7, 16, 20-2, 28, 57, 59-65, 67, 72-3, 76, 83, 134, 180, 185 birth control methods 2-3, 61 birth interval 179 birth rate 35, 249 BKIA. 23-4 BKKBN 12-4, 24, 29-30, 34-6, 39-46, 49-54, 69, 74, 77, 83, 85-9, 93-4, 98-103, 107-8, 111, 114-6, 119-20, 127, 139-41, 143-5, 147, 202-3, 210-1, 214-5, 223, 237-8, 240, 246, 248-9, 251, 254, 261-2 BKKBN-deputy 34-5, 70 Bogor 24-5, 119, 139, 144 Botabek project 120, 139, 145 BPS see Central Bureau of Statistics BRI 141-2 Brush Foundation 21 Bucharest conference 6, 246 Burma 19, 152 Cairo conference/ICPD plan of action 5, 7, 12, 15, 50, 52-3, 76, 113, 115, 216, 225, 233, 246-9 Caldwell's hypothesis 10, 131 Central Bureau of Statistics 41, 69-70 Chan Kok Cheng 61 Chapman, Rebecca Jane 255-7 child health 35, 42, 62, 65, 225 child marriage 169 child mortality 8, 10, 123, 165, 251-2 China 62, 152, 229 CIP 139 client fees 109, 111

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276

Index

client-centred/ oriented I perspective 512, 77, 116, 225, 229, 236, 241, 262 clinic-based 38, 45, 86, 121, 124-5, 228, 246-7, 254 Coale, Ansley 3, 5, 11, 16, 245, 250-1, 253-4 coitus interruptus 21 commitment 8, 83-4, 86-7, 103, 116, 229 community-based 14, 38, 44-5, 75, 87, 121, 125, 127, 129-30, 132, 216, 228, 246-7, 254 community development 155, 160 communityleaders 27,33 community orientation 138 comprehensive family planning 108 condom 21, 23, 38-9, 41, 61, 72, 123, 134, 215, 235, 238-9 contraception 112, 120, 122, 155, 201, 207, 211, 214-5, 247, 252, 262 contraceptive I devices I methods 20-1, 23, 28, 46, 60-3, 73, 77, 104, 120, 123, 125-6, 138, 169, 185, 188, 206-7, 209, 212, 228, 239, 249-50, 258, 261 contraceptive failure 108, 210 contraceptive prevalence 21, 41, 48-51, 85, 156, 211, 226, 246 contraceptive use 14, 70, 74, 104, 152, 186-8, 195-6, 201, 203, 207-9, 224 cost of children 10 counselling 21-2, 108-9, 115, 169 credit 141-2, 177 Davis and Blake model 122, 249 death rate 19 decentralization 53, 87, 93, 100 demographic change 151 demographic impact 151, 155-6 demographic transition 154 dependency rate/ratio 153, 158-9, 259 Depo Provera 73-4 Dewey, Alice 164 Dharma Wanita 9, 117, 166, 176 diaphragm 23,62 Djoewari, Mrs. 0. 26-7 donor (agency, support) 46, 66, 84, 87-8, 90-1, 97, 101-4, 112-3, 140, 165, 249, 254,262 drop-out 40, 49, 236

dua anak cukup 9, 251 economic development/ growth 4, 32, 35, 63, 86, 88, 103, 151, 154-8, 160, 165, 246-7 Edmondson, J.C. 10, 17, 131 empowerment of women 7, 75, 139, 1867, 191, 195, 201-2, 214, 220, 246, 256 European Union 92 family bias 234 Family Health International 15, 186 family planning concept 28, 31, 38, 102, family planning fieldworker 13, 36-43, 45, 69, 87, 107, 119, 123-7, 129, 133-4, 138, 146, 255, 257 family planning movement 22, 28, 33, 57 family planning organization 21 family planning post 41, 46, 134 family size 20, 227, 261 family welfare 42-3, 53, 155, 189, 199, 202-3, 205, 207-8, 214-6, 227, 247-8, 256, 261 female autonomy 164, 166 female factory workers 167 female workforce participation 175, 253 feminist 7, 53, 77, 97, 146, 16, 248-9, 257 fertility career 12, 163, 178-80, 245, 257 fertility control 3, 60-1, 63, 104, 187, 252 fertility decline 2, 4-6, 9-11, 15, 50-1, 75, 85, 88, 104, 130-1, 139, 147, 151-60, 174, 177, 185, 202, 245, 249-50, 253, 259-60, 262 fertility level 14, 51, 70, 122, 152, 179 fertility patterns 15, 120 fertility rate 1, 20, 30, 50, 62, 123, 130, 151-5, 226, 246, 249 fertility statistics 41 fertility transition 3-5, 10, 15-6, 119, 147, 163, 245, 249-50, 253, 256, 259 Fischer, Louis 63 Ford Foundation 67, 108-9 foreign assistance 83-106, 151 foreign donor 13, 86 formal education 10 Gadjah Mada University vii, 24 Gates (foundation) 92 A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

Index Geertz, Hildred 164, 181 gender/jender 166, 168, 233, 252 gender barrier 215 gender-based 200-1, 214 gender bias 235 gender equity 53, 216, 245, 256 gender gap 167 gender ideology 9, 164, 166 gender issue 77 gender norms 224 gender perspective 163, 252 gender relationship 11 gender roles 132, 214, 216, 235, 256 gender studies 163 gender values 120 Geneva 27 Germany 160 Golkar 58, 73 gongo 117

GOWB 25 GOWI 20

Gupito, Mrs. 26 Gupta, Jyotsna 7, 17 Habibie, B.J. 52, 76 health care facilities 20 health centre 41 health professionals 20 Hewlett-Packard 92 Heyder, Farida 27 Hirschfeld, Magnus 60

HIV I AIDS 78, 101, 111, 117, 169, 226, 228, 231-2, 240 housewife 173-4 Hull, Terence 97, 250, 253-4 Hull, Valerie 164, 181 human rights 7, 20, 53, 74 Hutasoit, Mrs. M. 26 Hydrick, J.L. 89, 105

ibu I ibuism 171 IEC (Information, Education, Communication) 26-7, 100, 104, 111, 113, 237 IGGI 97 Ihromi, Omas T. 164, 182 immunization 165,252 implant 7, 113, 119-20, 134-6, 142, 144, 189-90, 255

277

incentive system 126 income-expenditure ratio 203-4 income-generating activity I project 7, 14, 42, 75, 119, 138-40, 256

India 4, 29, 62, 248-9 Indonesian studies 164 infant mortality 8, 10, 19, 23, 42, 101, 151, 165, 251

infertility 22, 27-8, 73, 108-9 informal leader 128 informal sector 175, 190-1, 253 injectable/injection 7, 74, 120, 142, 144, 188-9, 227-8, 238

intellectual bias 147 inter-sectoral approach 35 Inyo Beng Goat 61 IPPF 12, 26, 29, 65, 69, 93, 246 Irian Jaya 44, 95 Irsan, Mrs. Luki 26 Islam 36, 114, 120, 124, 133, 136, 178, 191, 258

Islamic leaders 25, 86, 251

IUD 7, 23, 27, 39, 46, 72, 96, 113, 120, 123, 126, 131, 134-5, 142, 144, 147, 188-90, 207, 210, 212-3, 215, 227-8, 238, 251, 255,258 IWHC 109

Jakarta 13, 15, 22, 24-5, 29, 43-6, 66-8,

94-6, 108-12, 121-2, 139-40, 142, 152, 188-9, 192-3, 195-6, 198-202, 205, 210-3, 221, 231-2, 237 Japan 92,160,239 Japanese occupation 57-8, 62 Java 20, 22-3, 29, 37, 39-40, 42-3, 58, 61, 63, 72, 74, 83, 85-6, 89, 120, 122-3, 130-1, 138, 146, 152, 164, 167-70, 174-6, 188-94, 201-5, 210-2, 221, 230, 249, 258 Joedono, H.M. 22, 26-7, 34, 108, 112, 114, 117 Johnson, L.B. 92

Kalimantan 44, 152 Kalyanamitra 112 Kartini, Dr 26 KB 71, 97, 188, 260 KB Mandiri 46, 49, 52, 76, 139, 246 Keluarga Sejahtera 11, 199, 246, 248 A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

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Index

KITLV viii kodrat wanita 8, 166, 176, 178 KOWANI 9 Krishner, Bernard 64 labour force 158, 188 lactation 124 Lampung 168, 188-9, 206, 209, 211-2, 223 Latif, K.H. Nasaruddin 258 Leiden University vii, 95, 120 life expectancy 20 LKBN 29, 33-4, 65, 246 Lombok 231 Lubis, Firman 111 Macro International 41 Madura/Madurese 11, 120, 132, 169, 171, 179, 258 Makassar (Ujung Pandang) 15, 188, 1928, 200, 204-5, 210-3, 221 Malaysia 3, 19, 64, 229 male participation 51, 112, 115, 215, 235, 239,260 Malthus 6, 61 Mambo, Sister Agustin 27 Margaret Sanger Research Institute 22, 34 Martiono, Koen Suparti 24, 26 Marvelon 96 Masjhur, Zu Rachman 25, 27 maternal health 42, 62-3, 65, 125, 225, 247 maternal morbidity 231, 241 maternal mortality 7, 16, 51, 77, 101, 225-6, 229, 232, 256 Mather, Celia 167, 182 Mauritius 51 McDonald, Peter 9-10, 17 Mellon (foundation) 92 menstrual regulation 108-10, 114-5, 231-2 Mexico City conference 7 Minahasa 168 Minangkabau 14,133-7, 148,258 Minister /Ministry /Departement - Education 71 - Empowerment of Women 9, 12, 53, 71, 117, 261

- Health 23-4, 37, 42, 69, 71, 77, 87, 116, 124-5, 210, 228, 235-6, 238, 240 - Information 69, 71 - Interior I Internal Affairs 40 -Justice 28 - Labour 70 - People's Welfare 34, 53 - Population and Environment 70-1,

99

- Public Works 70 - Religion 258-9 - Transmigration 70 - Women's Affairs 166 mobile family planning clinic 40, 127 Moluccas 165 mortality rate 20, 151 mother-and-child clinic 23, 36, 124 mother-and-child health/welfare 29, 35, 46, 111, 113, 123, 129, 139, 185, 248 motivation 157 Muhammadiyah 114, 258 MUI 72 multilateral aid 13 multilateral donor 84, 90 Muslim opposition 35, 51, 73 musyawarah-mufakat 58, 88, 258 National Training Centre 29 Netherlands, the 84-5, 90, 94-7, 121, 139, 261 New Delhi conference 26 New Order regime see Orde Baru NGO (non-governmental organization) 5, 13-4, 15, 22-3, 29, 53, 76, 94-6, 107-7, 140, 151,240,260 Nitisastro, Widjojo 32 NOVIB 29, 94 NU 53, 72, 113, 258 NUFFIC 95 Nusa Tenggara 29 NVSH 95 Oentoeng, Bambang 26 Oentoeng, M. 22, 26 Oetojo, Mrs. Bambang 26 Oka, Ida Bagus 53 Orde Baru (New Order) 1, 4, 6-8, 10-3, 16, 19, 28, 31-3, 35, 40, 43, 49-50, 52, A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

Index 57-8, 66, 71-3, 75-7, 83, 88, 90, 95, 107, 117, 148, 160, 163, 165-77, 180, 185, 245-4, 256-8, 260-1 Orde Lama (Old Order) 1, 16, 19, 28, 32, 58, 176, 247

Organon 96 Outer Islands 40, 43, 60, 85-6, 89, 246 overpopulation 60-1

Palembang 26 Pancasila 36, 58, 62, 74, 76, 78, 83 Parawansa, Khofifah Indar 53, 77, 261-2 Parsons, Jay 36, 255 Pathfinder Fund/International 22, 26, 113-4, 117

Philippines 3, 19, 229 pill (contraceptive) 7, 23, 38-9, 41, 120,

123, 126, 134-5, 138, 188, 207, 210-1, 215-6, 238, 251 pioneers 22, 25-6, 60, 234 PKBI 12-4, 21-31, 37, 65, 67-9, 74, 94, 10710, 115, 118, 246, 258, 261 PKK 40,42, 172, 174, 176 PKMI 112, 115-6

PLKB see family planning fieldworker political commitment 8 population ageing 178 population boom/ explosion 33, 69, 92 population control 5, 20, 23, 34, 53, 57,

63-5, 68, 185, 246-8 Population Council 26, 27, 41 population growth 6, 32, 60, 62-4, 85, 90-1, 113, 151-3, 157, 160, 256 population policy 2, 28 population problem 60, 67 population resettlement 67

Population Studies Center vii Pos KB 40, 134, 255 position of women 9, 11 posyandu 42,47,248 PPKBD 134-7 PPP 72 Prajitno, Mrs. 27 Prawirohardjo, Sarwono 26, 28 pregnancy termination 108 pregnancy unintended/unwanted 78, 110, 115, 189, 232, 234 prenatal care 230, 234, 239-40, 256

279

privatization 46-8, 52, 76 program-based channels 124, 127-9 projection 153-5 pro-natalist 20-1, 23, 63-4, 95, 151, 251 Pronk, J. 97 PUSSI 112 quality I quality of care/ quality of services 48, 50, 76, 97, 116, 211, 215, 237-8, 248, 255, 260-1

Raden Saleh Clinic 108, 232 Rahardjo, Yulfita 164, 182

RAND 41

rationality 6, 11 Ravenholt, R.T. 92-3 Reformasi (Reform era) 50, 52-3, 261 religious groups 33 religious leaders 137, 168, 251-2, 258-9 religious objections/ opposition 60, 67, 115

Repelita 32, 36, 38, 43-4 replacement-level fertility 6, 50, 152-3, 259-60

reproductive control 207 reproductive decision-making 5, 187, 206, 233

reproductive health 5, 7, 9, 12-3, 15-6, 50,

52-3, 77-8, 87, 92, 107, 110-1, 113, 1156, 120, 186-7, 213, 220, 224-7, 234-6, 239-41, 247, 257, 260-2 reproductive morbidity 231 reproductive rights 5, 7, 9, 12, 15, 25, 120, 233-5, 247-8, 261 reproductive technology 7-8

reproductive tract disease I infection 225-7, 231, 237, 240-1

rhythm method 189, 215 Robinson, Kathryn 166, 173, 182 Rockefeller Foundation 89, 186, Rogers, E.M. 122-3 role of women 4, 7, 14, 26, 57, 130, 164, 166, 173, 176

Rudie, Ingrid 172, 183 rural areas 25, 45, 121, 166, 178, 188, 208, 230

rural-urban differences 45, 47 rural women 209 A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

280

Index

Sadikin, Ali 13, 24, 66-8, 79 Sadli, M. 64-5, 80 Sadli, Saparinah 164 safari 72, 135-7, 210, Sahabat Remaja 110 Sajogyo, Pudjiwati 164, 183 Salim, Emil 70 Saptari, Ratna 167-9, 172-3, 176, 183 Saroso, Sulianti 24 Sarwono 68 Sarwono, Sophie 12, 22, 24-5 saving-and-credit program 7 school-based projects 216 Schultz, George 73 self-reliant/reliance 109, 116, 139, 228, 240 Semarang 27, 29 Serpong Project viii, 14, 95-6, 121-9, 252, 259 service delivery point 237 sex education 110 sexually transmitted disease (STD) 1101, 115-6, 225-6, 231, 234-5, 239, 241 side effects 115, 125, 147, 210-2, 216, 237-8 Singapore 3, 19 Singarimbun, Masri vii-viii, 30, 250, 253-4 Sjamsoeridjal 22, 26 small family norm 38, 42, 85, 148, 157, 160, 214, 227-8, 239 small, happy and prosperous family 6, 8, 42, 113, 138, 146, 148, 180, 185, 214, 247 Smyth 256 social change 4-5, 16, 31, 99, 102, 131, 156, 163-4, 251, 262 Soeharto (medical doctor) 21-3, 65 Soejatni, Ms 36 Soekamo, President 1, 12, 19-21, 25, 32, 57, 62-6, 94-5, 107, 151, 157, 250 spacing of birth/ pregnancy 22, 27, 63, 113, 214 Speckmann, Hans vii-viii Sri Lanka 229 stalling 152, 259 state ideology 178 sterilization 51, 72, 74, 112, 115, 120, 134,

142, 144, 189-90, 210, 239, 258 Stoler, Ann 183 Subandrio 22, 65 Subandrio, Hurustiati 22-4, 65 Subang 27 Suharto, President 1-2, 6, 19, 29, 32, 49, 52, 57-8, 65-7, 71, 73, 76, 83, 88, 95, 97, 245-8 Sukarnoputri, Megawati 76 Sulawesi 63, 152, 170, 173-4, 178, 221 Sumapradja, Sudraji 108 Sumatra 14, 23, 25, 58, 61, 188, 191, 194, 206, 209-11, 223 Surabaya 26-7, 109 Surjaningrat, Suwardjono 34 Susilo, Herman 24 Sutejo 26 Suwondo, Nani 22, 26 Suyono, Haryono 24, 34, 53-4, 71, 116-7, 246, 258 syncopation 71 Tangerang 122,168 target system 36-7, 49, 108, 135, 185, 199, 248, 250 Thailand 3, 19, 152, 229, 259 Timor 44, 73-5, 97, 112 traditional birth attendant/ midwife 123, 125, 128-9, 132, 141, 230, 236 traditional methods 21 transmigration 89 trial adoption 147 tubectomy 3, 112, 115-6 Udayana University 26 UN 29, 66, 73-4, 84, 153-5, 254 UNFPA 13, 36, 46, 49, 55, 70, 84, 90-2, 95, 100-1, 111, 249, 255 UNICEF 18, 42 United Kingdom 160 United States 84, 91, 93 Universitas Gadjah Mada 187, 202, 222 Universitas Indonesia 24-5, 32, 96, 108, 112, 121, 187, 220, 222 University of California 32 University of Chicago 24, 34 unmet need 157, 260 UPPKA 138-40, 145-6 A. Niehof - 978-90-04-45457-6 Downloaded from Brill.com09/25/2023 03:25:01AM via Universiteit of Groningen

Index urban area/population 45, 48, 111, 178, 188, 207-9, 230 urban family planning 96, 111 USAID 13, 49, 70, 85, 89-93, 105, 111, 112, 186,249 user-oriented 101, 260 value of children 9-11, 253 Van Valkenburg, Samuel 60 Vandenbosch, Amry 60, 80 vasectomy 3, 112, 115-6, 235, 238-9 VCDC 40-1, 133 volunteer 108-10, 116, 134, 255, 260 Vreede-de Stuers, C. 164, 183 Wahid, Abdurahman 53, 76-7, 97, 261 Wasito , R. 26, 83, 85, 104 WestJava 14,25,25 WHO 29 WID (officer) 165 Wiknjosastro, Hanifa 26, 28, 112

281

Wisma Panca Warga 14, 108 WKBT 108-10 Wolf, Diane 167, 183 woman-oriented 121 women in development 185 Women's Health Forum 112 women's rights 112, 120 Women's Studies Project 15, 185-224, 256 women studies 163 World Bank 13, 18, 29, 67, 84, 90-1, 98-9, 102, 105, 139, 249 Wowor, Esther 26-7 YKB 46, 96, 110-1, 115, 226, 231 YKK 21 Yogyakarta 27, 29, 109, 138, 152, 165, 175, 178 zero population growth 159

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