Indonesia - Demographic and Health Survey -1989

Publication date: 1989

Indonesia National Contraceptive Prevalence Survey 1987 Central Bureau of Statistics National Family Planning Coordinating Board @DHS / Demographic and Health Surveys Institute for Resource Development/Westinghouse National Indonesia Contraceptive Prevalence Survey 1987 Central Bureau of Statistics Jakarta, Indonesia and National Family Planning Coordinating Board Jakarta, Indonesia and Institute for Resource Development/Westinghouse Columbia, Maryland USA January 1989 In addition to the above organizations, the survey also received financial support from USAID/Jakarta and UNFPA/Jakarta. This report presents the findings of the National Indonesia Contraceptive Prevalence Survey (NICPS). The survey was a collaborative effort between the National Family Planning Coordinating Board, the Central Bureau of Statistics, and the Institute for Research Development (IRD), a subsidiary of Westinghouse Electric Corporation. The survey is part of the worldwide Demographic and Health Surveys (DHS) Program, which is designed to collect data on fertility, family planning, and maternal and child health. Funding for the survey was provided by the U.S. Agency for International Development (Contract No. DPE-3023-C-00-4083-00 through IRD, and Project 497-0327, PIL No.59 through USAID/Jakarta), the United Nations Fund for Population Activities (Project 1NS/86/PO3), and the Government of Indonesia. Additional information on this survey can be obtained from the Central Bureau of Statistics, Jl. Dr. Sutomo No. 8, P.O. Box 3, Jakarta, Indonesia (Telephone: 372808), or the National Family Planning Coordinating Board, P.O. Box 186, Jakarta, Indonesia (Telephone: 819-1308). Additional information about the DHS Program can be obtained by writing to: DHS Program, IRD/Westinghouse, 8850 Stanford Boulevard, Suite 4000, Columbia, MD 21045, USA (Telephone: 301-290-2800; Telex: 87775; Fax: 301-290-2999). TABLE OF CONTENTS Page TABLE OF CONTENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i L IST OF TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i i i L IST OF F IGURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x i i i PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv SUMMARY OF F INDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 MAP OF INDONESIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1. BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.1 Geography, Climate and History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.2 Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.3 Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.4 Population and Family Planning Policies and Programs . . . . . . . . . . . . . . . . . . . . . 5 1.5 Health Policies and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.6 Objectives of the National Indonesian Contraceptive Prevalence Survey . . . . . . . . . . 6 1.7 Survey Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.8 Background Characteristics of Surveyed Women . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.9 Exposure to Mass Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 1.10 Ownership of Household Amenities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . MARRIAGE, BREASTFEEDING, AND POSTPARTUM INSUSCEPT IB IL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.1 2.2 2.3 Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Factors Affecting Exposure to the Risk of Pregnancy . . . . . . . . . . . . . . . . . . . . . 16 . KNOWLEDGE AND EVER-USE OF FAMILY PLANNING METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 3.1 3.2 3.3 3.4 Knowledge of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Knowledge of Sources for Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . 23 Dissemination of Family Planning Information . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Ever-Use of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 4. CURRENT USE OF FAMILY PLANNING METHODS . . . . . . . . . . . . . . . . 33 4.1 4.2 4.3 Current Use of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Sources of Contraceptive Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Quality of Use of Pill, Injection, and Condom . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Fage 5. NONUSE AND INTENTIONS FOR USE OF FAMILY PLANNING . . . . . . 47 5.1 5.2 Reasons for Discontinuation and Nonuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Intention to Use Contraception in the Future . . . . . . . . . . . . . . . . . . . . . . . . . . 49 6. FERT IL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 6.1 6.2 6.3 6.4 6.5 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Fertility Levels and Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Pregnancy St~tt s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Children Ever BGrn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 7. FERT IL ITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 7.1 7.2 7.3 7.4 D(sire for Additional Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Futwe Need for Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Ideal Number cf Children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Unplanned and Unwanted Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 8. MORTAL ITY AND HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 8.1 8.2 8.3 8.4 8.5 8.6 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 T]ends in Infant and Childhood Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Mortality Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Pioportion D(ad Among Children Ever Born . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Assistance at Birth and Place of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Source of Water and Toilet Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 APPENDIX A SURVEY DES IGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 A.1 A.2 A.3 A.4 A.5 A.6 A.7 A.8 Geographic Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Sample Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Survey Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Survey Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 P~oest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Main Survey Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Data Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Daa Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 APPENDIX B EST IMATES OF SAMPL ING ERROR . . . . . . . . . . . . . . . . . . . . . . 87 APPENDIX C L IST OF PERSONS INVOLVED IN THE 1987 NAT IONAL INDONESIA CONTRACEPT IVE PREVALENCE SURVEY . . . . 97 APPENDIX D SURVEY QUEST IONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . lo5 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 ii LIST OF TABLES Page Table 1.1 Table 1.2 Table 1.3 Table 1.4 Table 2.1 Table 2.2 Table 2.3 Table 2.4 Table 2.5 Table 2.6 Table 3.1 Table 3.2 Table 3.3 Percent distribution of ever-married women 15-49 by selected background characteristics, 1980 Census, 1985 SUPAS, and 1987 NICPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Percent distribution of ever-married women by education, according to selected background characteristics, NICPS, 1987 . . . . . . . . . . . . . . 9 Percent of ever-married women who usually read a newspaper once a week, watch television once a week, or listen to a radio daily by background characteristics, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . 10 Percent of ever-married women who own or have access to selected household amenities, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Percent distribution of all women by current marital status, according to age, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Percent of all women who have never married, according to age, 1980 Census, 1985 SUPAS, and 1987 NICPS . . . . . . . . . . . . . . . . . . . . . . . . 14 Percent distribution of all women by age at first marriage and median age at first marriage, according to current age, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Median age at first marriage among all women aged 25-49, by current age and background characteristics, NICPS, 1987 . . . . . . . . . . . . . . . . 15 Percent of births in the last 36 months whose mothers are still breastfeeding, postpartum amenorrheic, abstaining, and insusceptible to pregnancy, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Mean number of months of breastfeeding, postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility, by background characteristics, NICPS, 1987 . . . . . . . . . . . . . . . 18 Percent of ever-married and currently married women knowing any method, knowing any modern method, and knowing specific family planning methods, by age, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . 20 Percent of currently married women knowing at least one modern family planning method, by number of living children and background characteristics, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . 21 Percent of ever-married women in Java and Bali knowing specific family planning methods, 1976 Indonesia Fertility Survey and 1987 NICPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 i i i Table 3.4 Table 3.5 Table 3.6 Table 3.7 Table 3.8 Table 3.9 Table 3.10 Table 3.11 Table 3.12 Table 3.13 Table 3.14 Table 3.15 Table 3.16 Page Percent of ever-married women who have ever heard of Dualima by background characteristics, NICPS, 1987 . . . . . . . . . . . . . . . . . . . 22 Percent of currently married women knowing specific family planning methods and knowing a source for obtaining that method, by method, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Percent of currently married women knowing any modern family planning method and knowing a source for obtaining that method, by background characteristics, NICPS, 1987 . . . . . . . . . . . . . . . . . . . 23 Percent distribution of women knowing a family planning method by supply source they would use if they wanted the method, according to method, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . 24 Percent of ever-married women who think specific sources of family planning information are acceptable, by background characteristics, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Percent distribution of ever-married women by main problem perceived in using particular family planning methods, according to method known, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Percent distribution of ever-married women by the method they think best to use to delay or limit births, NICPS, 1987 . . . . . . . . . . . . . . . . . 26 Percent distribution of ever-married women by the number of times they heard or saw a message about family planning on radio or television in the six months prior to survey, according to background characteristics, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Percent of currently married women who have been visited by a family planning field worker in the 6 months prior to the survey, by background variables and current contraceptive use status, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Percent of ever-married and currently married women who have ever used specified family planning methods, by age, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Percent of ever-married women who have ever used any method, and any modern method by background characteristics, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Percent distribution of ever-married women by number of living children at time of first use of family planning, according to current age, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Percent distribution of ever-married women and women who have ever used periodic abstinence by knowledge of the fertile period during the ovulatory cycle, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . 31 iv Page Table 4.1 Table 4.2 Table 4.3 Table 4.4 Table 4.5 Table 4.6 Table 4.7 Table 4.8 Table 4.9 Table 4.10 Table 4.11 Table 4.12 Table 4.13 Percent distribution of currently married women by family planning method currently used, according to background characteristics, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Percent of currently married women in Java-Bali who are currently using any family planning method by province, 1976 Indonesia Fertility Survey and 1987 NICPS . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Percent of currently married women in Java-Bali currently using family planning methods, 1976 Indonesia Fertility Survey and 1987 NICPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Percent distribution of currently married women by type of family planning method currently used, age, and number of living children according to region, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . 37 For all current users of supply or clinic methods, the percent distribution by most recent source of supply or information, according to urban-rural residence and method, NICPS, 1987 . . . . . . . . . . . . . 40 Percent distribution of current users who obtained a method at a source by type of dissatisfaction with the service (if any), according to type of source last visited, NICPS, 1987 . . . . . . . . . . . . . . . . . . . 41 For sterilized women, the percent distribution by age at the time of sterilization, according to the number of years since the operation, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 For sterilized women, the percent distribution by number of living children at the time of sterilization, according to number of years since the operation, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Percent of currently married women pill users who have a packet at home, have taken pills in order, and who took a pill less than two days ago, by background characteristics, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Percent distribution of currently married pill users by brand of pill used, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Percent of currently married women who are using injection and condom, percent of injection users who received an injection less than three months ago, and percent of condom users who can show a packet, by background characteristics, NICPS, 1987 . . . . . . . . . . . . 44 Percent distribution of current users by the type of problem experienced with the method, according to method, NICPS, 1987 . . . . . . . . . . . 45 Percent of current users who get their method free and the mean cost of the method (including services) for those who pay, by method and region, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Page Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 6.7 Table 6.8 Table 7.1 Table 7.2 Table 7.3 Percent distribution of women who have discontinued a method in the last five years by main reason for last discontinuation, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Among currently married non-pregnant nonusers, the percent distribution by reason for nonuse, according to broad age categories, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Percent distribution of currently married nonusers by intentions to use in the future, according to number of living children, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Percent distribution of currently married nonusers who intend to use in the future, by method preferred, according to whether they intend to use in the next 12 months or later, NICPS, 1987 . . . . . . . . . . . 49 Total fertility rates for calendar year periods and for the five years preceding the survey, and mean number of children ever born to women 40-49, by background characteristics, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Total fertility rates from several sources, Indonesia . . . . . . . . . . . . . . . . . . . . 53 Age-specific fertility rates for five-year periods, by age of women at birth, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Percent of currently married women who were pregnant at time of survey, by background characteristics, N1CPS, 1987 . . . . . . . . . . . . . . . . . . 54 Percent distribution of all, ever-married, and currently married women by number of children ever born and mean number of children ever born, according to age, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . 55 Mean number of children ever born to ever-married women, by age at first marriage and years since first marriage, NICPS, 1987 . . . . . . . . . . . 56 Percent distribution of all women by age at first birth according to current age, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Median age at first birth among all women 25-49 years, by current age and background characteristics, NICPS, 1987 . . . . . . . . . . . . . . . . 57 Percent distribution of currently married women by desire for children and the certainty of their preference, according to number of living children, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Percent distribution of currently married women by desire for children, according to number of living children, NICPS, 1987 . . . . . . . . . . . . . 60 Percent distribution of currently married women by desire for children, according to age, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 vi Page Table 7.4 Table 7.5 Table 7.6 Table 7.7 Table 7.8 Table 7.9 Table 7.10 Table 8.1 Table 8.2 Table 8.3 Table 8.4 Table 8.5 Table 8.6 Table 8.7 Percent of currently married women who want no more children by number of living children and background characteristics, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Percent of currently married women who are in need of family planning and the percentage who are in need and intend to use family planning in the future, by background characteristics, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Percent distribution of ever-married women by ideal number of children and mean ideal number of children for ever-married women and currently married women, according to number of living children, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Mean ideal number of children for ever-married women by age and background characteristics, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . 65 Percent distribution of births in the last five years and current pregnancies by contraceptive practice and planning status, according to birth order, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Percentage of women who had a birth in the last 12 months by fertility planing status and birth order, NICPS, 1987 . . . . . . . . . . . . . . . . . . . 67 Total wanted fertility rates and total fertility rates for the five years preceding the survey by background characteristics, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Infant and childhood mortality for five-year periods, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Infant and childhood mortality by socioeconomic characteristics of mother, 1977-1987, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Infant and childhood mortality by demographic characteristics, 1977-1987, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Mean number of children ever born, surviving, and dead, and proportion of children dead by age of mother, NICPS, 1987 . . . . . . . . . . . . . . 73 Percent distribution of births in the last five years by type of assistance at delivery, according to background characteristics of mother, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Percent distribution of births in the last five years by place of delivery, according to background characteristics, NICPS, 1987 . . . . . . . . . . . . 75 Percent distribution of ever-married women by sources of drinking water and of water for other household uses (washing, cooking, etc.) according to urban-rural residence, NICPS, 1987 . . . . . . . . . . . . 76 vii Table 8.8 APPENDIX A Table A.1 Table A.2 Table A.3 Table A.4 APPENDIX B Table B.1 Table B.2.1 Table B.2.2 Table B.2.3 Table B.2.4 Table B.2.5 Table B.2.6 Table B.2.7 Table B.2.8 Table B.2.9 Page Percent distribution of ever-married women by type of toilet facility in the household, according to urban-rural residence, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Sample coverage by province, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Information on training centers, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . 84 Results of household interviews by sample domain, NICPS, 1987 . . . . . . . . . . . 85 Results of individual interviews by sample domain, NICPS, 1987 . . . . . . . . . . . 85 List of selected variables with sampling errors, NICPS, 1987 . . . . . . . . . . . . . . 90 Sampling errors for the entire sample, N1CPS, 1987 . . . . . . . . . . . . . . . . . . . 91 Sampling errors for women aged 15-24, NICPS, 1987 . . . . . . . . . . . . . . . . . . . 91 Sampling errors for women aged 25-34, NICPS, 1987 . . . . . . . . . . . . . . . . . . . 92 Sampling errors for women aged 35-49, NICPS, 1987 . . . . . . . . . . . . . . . . . . . 92 Sampling errors for the urban population, NICPS, 1987 . . . . . . . . . . . . . . . . . 93 Sampling errors for the rural population, NICPS, 1987 . . . . . . . . . . . . . . . . . 93 Sampling errors for Java-Bali, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . . . . . . 94 Sampling errors for Outer Java-Bali I, NICPS, 1987 . . . . . . . . . . . . . . . . . . . . 94 Sampling errors for Outer Java-Bali I1, NICPS, 1987 . . . . . . . . . . . . . . . . . . . 95 viii LIST OF FIGURES Page Figure 4.1 Figure 4.2 Figure 4.3 Figure 4.4 Figure 7.1 Figure 7.2 Figure 8.1 Figure 8.2 Current Use of Family Planning by Residence and Education, Currently Married Women 15-49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Family Planning Use 1976-1987, Currently Married Women 15-49 . . . . . . . . . . . . . 36 Family Planning Knowledge and Use, Currently Married Women 15-49 . . . . . . . . . 38 Source of Family Planning Supply, Current Users . . . . . . . . . . . . . . . . . . . . . . . . 39 Fertility Preferences, Currently Married Women 15-49 . . . . . . . . . . . . . . . . . . . . . 61 Fertility Preferences by Number of Living Children, Currently Married Women 15-49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Trends in Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Differentials in Infant Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 ix FOREWORD The National Indonesia Contraceptive Prevalence Survey (NICPS) was a collaborative effort between the Indonesian National Family Planning Coordinating Board (NFPCB), the Institute for Resource Development of Westinghouse and the Central Bureau of Statistics (CBS). The survey was part of an international program in which similar surveys are being implemented in developing countries in Asia, Africa, and Latin America. The NICPS was carried out from September through December 1987 in 20 of the 27 provinces in the country. Estimates were derived for each province in Java-Bali, and the Outer Islands I and Outer Islands II regions. This geographical classification was made on the basis of the timing of each region's inclusion in the national family planning program. According to the survey design, 93 percent of the total population was represented in the survey. The Preliminary Report presented highlights of the material covered in the survey, while the current publication provides the reader with more detailed information gathered in NICPS. Further analyses of the data will be released later, each of which will discuss specific issues. Data and analyses coming out of NICPS are expected to enrich sources of information on Indonesian population, particularly those related to family planning and fertility. Some data presented in the Preliminary Report differ from the findings presented in this publication because of mostly minor changes that occurred during later stages of data processing. Caution should be exercised by readers who wish to study trends over time using NICPS data and data from past censuses and surveys, due to differences in coverage, definition, classification and survey method. The success of the entire operation was made possible by hard work and dedication of all parties involved. For the active participation of those whose names are too many to be listed here I would like to extend my sincere thanks and appreciation. Central Bureau of Statistics Azwar Rasjid Director General xi PREFACE This National Indonesian Contraceptive Prevalence Survey is a welcome addition to demographic data sources in Indonesia. It provides us with a complete set of statistics about contraceptive prevalence and method-mix rates, the characteristics, knowledge, and attitudes of contraceptive users, ferlility rates, breastfeeding, and infant mortality rates. Given its scope and representativeness, it can stand with census and intercensal survey data to provide social scientists and poficymakers with a clear picture about the Indonesian demographic trends in the recent past and likely directions for the future. The Indonesian economy has advanced rapidly under the New Order government. Over the past year, for example, the Gross National Product rose at a healthy rate of over four percent. This is a continuation of the economic performance the year before, and it comes at a time of rapid diversification and change. Yet the impact of this growth would be diluted if population increase consumed all the gain. Fortunately, as shown by the results of this survey, the efforts of the Indonesian government to head off this potential demographic problem have been successful. This is not to say that profound challenges do not lie ahead of us. First, the effects of high past population increases are such that the population will continue to grow despite recent fertility declines. The government will thus need to continue its efforts to upgrade education, create job opportunities, contain environmental degradation, and improve the welfare and health of mothers and children. Second, the government is fully committed to turning greater family planning responsibilities over to communities and individuals. This shift toward self-sufficiency will mean substantially greater personal and local control over key demographic matters, a move both exciting and pioneering. The challenge for the National Family Planning Program is to continue to provide reliable, high-quality services to meet the needs of growing numbers of potential contraceptive users under conditions of self-sufficiency. Having good data sources, such as the National Indonesian Contraceptive Prevalence Survey, to track demographic trends certainly expedites this mission. I would like to thank the National Family Planning Coordinating Board, the Central Bureau of Statisfics, and the Institute for Resource Development/Westinghouse for their cooperative efforts in conducting this study. Their dedication and hard work are reflected in the high quality of this information. I would also like to thank the donor agencies, USAID and UNFPA, whose generous financial support made this study possible. State Minister of Population and Environment Professor Dr. Emil Salim xiii PREFACE The National Family Planning Coordinating Board (NFPCB) has coordinated the Indonesian family planning program since 1970. Various exercises have evaluated the progress of the program over this time period. These exercises include: the World Fertility Survey conducted in Java and Bali in 1976; the Population Census in 1980; the Indonesian Contraceptive Prevalence Survey conducted in five urban areas- -Jakarta, Surabaya, Medan, Semarang, and Ujung Pandang--in 1984; the Intercensal Population Survey in 1985; and the National Social and Economic Survey (SUSENAS) in 1987. In addition, in 1986, the Family Planning and Nutrition Survey was conducted in East Java and Bali and the Variation of Achievement Study was conducted in five provinces in 1987. However, program managers still need more data related to family planning, such as fertility levels and differentials, level of use of various contraceptive methods, and the extent of use of private sources for methods, in order to support program development in general and especially to assist family planning policymakers in determining the future direction and strategy--both short-term and long-term--in family planning. I am pleased that the National Indonesian Contraceptive Prevalence Survey, which was carried out by the Indonesian Central Bureau of Statistics with technical assistance from the Demographic and Health Survey Program satisfied most of our needs for more detailed data. The survey provides past and current staff of the family planning program reasons to be proud, as well as better definition of future goals. The data clearly show that their tireless and continuous efforts to encourage married couples to use contraceptives have contributed to the indisputable decline in fertility. The data also indicate what still needs to be done. Forty-one percent of married women are currently in need of family planning; they do not want another birth or want to delay their next birth, but they are not using any family planning method. The percentage of long-term method users is already high but still can be made higher. The number of self-reliant users is growing and we want them to be double or triple in the next five years. Finally, I would like to thank USAID, the UNFPA, the CBS, the Institue for Resource Development, the Steering Committee, and the Office of Programme Development at NFPCB for their contributions to the survey. The relatively short time in conducting and presenting the first country report of the survey is indeed an outstanding achievement. National Family Planning Coordinating Board Haryono Suyono, Ph.D. Chairman XV SUMMARY OF FINDINGS The National Indonesia Contraceptive Prevalence Survey (NICPS) was conducted from Septembcr to December, 1987 to collect data on fertility and family planning. The survey covered 11,884 ever-married women aged 15-49 from 20 provinces that represent 93 percent of the national population. The purpose of the survey was to provide planners and policymakers with data useful in making informed program decisions. The survey data can also be used to evaluate the efforts of the National Family Planning Program to date, and the picture that emerges is largely one of success. Fertility in Indonesia has been declining rapidly and if young women continue to have children at current rates, they will have an average of 3.3 births in their lifetime. This is far fewer than the average of 5.4 children born to women now at the end of their childbearing years. The survey shows that the decline in fertility holds true for all women, irrespective of residence or education. Undoubtedly, the most important determinant of the decline in fertility is the increased use of contraceptives. Survey data indicate that 48 percent of currently married women in Indonesia are using a contraceptive method, 92 percent of which are modern methods, namely, the pill, IUD, and injection. Contraceptive use is higher among urban and better-educated women. It is also higher among women who live in Java and particularly in Bali, where almost 70 percent of the women are practicing contraception. These higher rates in Java-Bali are undoubtedly due to the fact that these two islands are where the government launched its family planning activities. In fact, in the eleven years between 1976 and 1987, contraceptive use in Java-Bali has doubled, from 26 percent to 51 percent of currently married women. In West Java, the rates increased threefold over the same period. Survey data also show that knowledge of modern methods and places to obtain them is nearly universal and that 65 percent of women have ever used a contraceptive method. These findings indicate that a transformation of reproductive behavior has been taking place in Indonesia over the last decade. Survey data can be used to assess the success of the National Family Planning Program in upholding its principles (Panca Karya). With regard to the goal of encouraging smaller families, data indicate that the two-child norm has taken hold in Indonesia. Forty-three percent of women with two children do not want any more and over half of women with no children or one child say that ideally they would like to have two children. Another program guideline is to encourage the postponement of marriage and childbearing. Survey data indicate trends towards increasing age at first marriage and first birth. Despite these sucx:esses, there is still much to be done. Perhaps because the desire for smaller families has grown, the need for family planning services, either to space or to limit births, is still great. Forty-one percent of married women are currently in need of family planning, that is, they are not using contraception and they either do not want another birth at all or want to delay their next birth for two years or more. Despite high rates of use of effective methods, only about one in five women age 30 or over is using a long-term method. The same proportion of women with three or more children are using long- term methods. Survey data also document a decline in infant mortality to a rate of about 70 per thousand births for the period 1982-87. Large differences were observed between infant mortality rates for children born after intervals of less than 2 years (109 per thousand) and four or more years (51 per thousand). t~ " \ % N + MAP OF INDONESIA , • ,>, j ~ .', ,.¢, . . . . V. . . ,"-~,o~/~.-~-m, ~ . _ . , ~ 1, j ~ ~ ~~ .~ .~,~_ ,°~ . . "C) . i ' ' / / 1 ~,~. - ~.--"--~ i ~2-~- - -~-~4/L . j F~, ,~, "~Z-~:~ ~'" ~ "I- 14 ~ 15 //~" 16 2 7 " . . . . " " OI .01 Aceh 02 . North Sumatra 03 .West Sumatra 04 .R iou 05 . JQmbi 06 . South Sumatra 07 . Bsngku lu 08 . Lampung 09 .OK I Jakar ta I 0 . Wast Java I I . Cent ra l Java PROVINCE CODE 12 . DI Yogyakarta 23 . South Su lawes i i3 . East Java 24 . SOuth East Su lams i 14 . Ba l i 25 . Malaku 15 . Wast Nusa Tenggaro 26 . I r ian Jaya 16 . East Nasa Tanggaro 27 . East T imor 17 . West Ka l imanton 18 . Cent ra l Ka l imohton 19 . South Ka l imanton 20 . East Ko l imontan 21 . Nor th Su la lms i 22 . Centra l Su iawes i 1. BACKGROUND 1.1 Geography, Climate and History The Indonesian archipelago lies between Asia and Australia, covering an area of approximately 1.9 million square kilometers. Superimposed on a map of North America, Indonesia stretches from Oregon all the way to Bermuda. Physically, there are five major islands, starting from the west with Sumatra, Java in the south, Kalimantan which straddles the equator, Sulawesi which resembles the letter K, and lrian Jaya to the west of Papua New Guinea. In addition to those, there are more than 13,0(10 smaller islands, 6,000 of which are inhabited. The large number of islands and their dispersion over a wide area result in diverse cultures and hundreds of ethnic groups with their own languages. This is the basis of the national motto "Unity in Diversity. ~ Indonesia consists of 27 geopolitical areas called provinces. The next lower administrative units are district or regency/municipality, sub-district, and village. Altogether there are 300 districts, about 3,500 sub-districts and more than 66,000 villages. All the islands in Indonesia lie in the tropical zone and the surrounding oceans have a moderating impact on the archipelago's temperature and humidity. The climate of each area is determined more by topography, altitude, and precipitation than by latitude. Throughout the year, the Indonesian islands enjoy stable temperatures which range from 25 ° to 28°C (78°-82°F). Most of the islands are located in the moist equator region; no month passes without some rainfall. From November through April there is more precipitation, while the months of May through October are considered the "dry season," when the southeast monsoon brings hot, dry air up from Australia. Since Indonesia proclaimed its independence in 1945, the Republic has experienced several political setbacks. Until late 1949, when the Dutch gave up control over the Indonesian archipelago, there were fights against the ruling democratic republic. Some factions with assistance from the Dutch wanted to form a federation. In some areas, rebellion continued until the early 1960s. The history of the Republic of Indonesia reached a turning point after the aborted coup by the Communist Party in September 1965. In 1966, President Suharto began a new era with the establishment of the New Order government which is oriented toward overall development. 1.2 Economy Twenty years after its inauguration, the New Order has achieved substantial progress, particularly in stabilizing political and economic conditions in the country. Measured by per capita income, there has been a jump from Rp. 18,230 in 1968 to Rp. 492,886 in 1986. In comparison, the exchange rate for US dollars was Rp. 365 in 1968 and Rp. 1,283 in 1986. In the early 80s, Indonesia enjoyed an accumulation of foreign exchange, as a result of the international oil boom. By 1981, more than 60 percent of the country's foreign exchange came from the sale of oil. The drop in the price of crude oil and natural gas in 1985 forced the government to look for alternatives. This effort seems to be successful. In 1986, income from exports other than crude oil constituted more than half of the total foreign exchange received from exports. In Indonesia, as in many countries, development programs are implemented in five-year stages. Development plans initially favored strong support for the promotion of agricultural products, then gradually shifted support to the manufacturing and trade sectors. At the moment, the focus of development is placed on manufacturing industries, especially those which produce export commodities. Under the four development plans since 1969, transportation and communication facilities were built which have reduced the disparities that existed between provinces in their ability to benefit from development programs. Social development closely follows economic progress. The government's policy on this issue is to improve the people's welfare by ensuring the availability of adequate food, clothing and housing. Indonesia's success in achieving self-sufficiency in food is encouraging. The government's efforts in providing mass housing for low-income families are notable. Education and health are areas which have also received considerable attention. Today, almost all children 7-12 years old are in school and immunization programs have covered at least 40 percent of all children under 14 months. 1.3 Popu la t ion Size and structure In terms of the size of its population, Indonesia stands fifth in the world after the People's Republic of China, India, the Soviet Union, and the United States of America. Data from the 1985 lntercensal Population Survey (SUPAS), conducted by the Central Bureau of Statistics (CBS), indicate that the total population of Indonesia is 164 million, and that it is growing at a rate of 2.2 percent annually. At this rate, the population of Indonesia will be 216 million in the year 2000. The Indonesian population has some distinct characteristics. It is unevenly distributed among islands/provinces, and birth and death rates are high in comparison with neighboring ASEAN countries. The 1985 SUPAS data indicate that the population density at the national level is 85 persons per square kilometer. This figure varies across regions--not only among islands, but also among provinces in the same island. For example, Jakarta, the seat of government, has a density of over 13,500 persons per square kilometer which is more than 20 times the density of other provinces in Java such as West Java and East Java. Comparison among islands shows that density ranges from 755 persons per square kilometer in Java to 3 persons per square kilometer in Irian Jaya. Fertility The 1985 SUPAS data indicated a total fertility rate (TFR) of 4.1 children per woman for the period 1981-1984. Results of the 1971 Population Census show that the TFR was 5.6 in the mid-60s. Thus, in less than 15 years there has been a decline of 28 percent. Fertility rates vary by region. In general, the rates in Java are lowest, and in Sumatra highest. There is considerable variation in fertility among provinces in Java, from a high of 4.3 in West Java to a low of 2.9 in Yogyakarta. The highest fertility in Indonesia (5.7 per woman) occurs in the province of Nusa Tenggara Barat. It is interesting to note that this province also has the highest infant mortality rate in the country. Mortality While mortality rates in Indonesia, particularly of infants and children, remain relatively high, data from the 1971 and 1980 Population Censuses demonstrate that there has been a significant decline in the level of mortality. Based on the 1971 Population Census, the infant mortality rate was estimated to be 142 deaths per 1000 live births. This figure dropped to 112, according to the 1980 Census, and declined to 71 per 1000 live births in 1985. The decline no doubt reflects efforts in the field of health promotion, particularly those specially designed to reduce infant and child mortality through integrated health and family planning services. Internal migration In an effort to bring about a more equitable population distribution, the government has sponsored a transmigration program to move people from densely populated areas to less populated ones. This program was initiated by the government of Indonesia in the 1950s after independence, but did not gain momentum until 20 years later, when, under the third development plan (Repelita) 500,000 families were resettled in islands outside Java. However, people continue 1o be attracted to Java which offers better employment opportunities as well as education and health facilities, and government-sponsored transmigration out of Java is offset by a counter-stream of migrants into Java. 4 Education In the past 15 years, the Indonesian educational system has undergone major improvements. The 1985 SUPAS data show that the literacy rate of persons 10 years and over was 88 percent for males and 74 percent for females. The percentage of persons who never attended school has declined, and the number of graduates at all levels of education has increased. The percentage of primary school graduates climbed from 21 percent in 1980 to 27 percent in 1985, whereas persons who completed junior high school and higher increased from 11 to 16 percent during the same period. At all levels the improvement in female education has been greater than for males. One possible effect of the improvement in female education is the rise in the age at first marriage. Data from the 1985 SUPAS show that the average age at first marriage of Indonesian women increased from 20.0 in 1980 to 21.2 in 1985. Another probable effect of more widespread education is the increase in labor force participation among females, particularly those 20 years and over. While the female labor force participation rate in 1980 was 32.4 percent, it had climbed to 37.6 percent by 1985. This trend is expected to continue. 1.4 Populat ion and Family Planning Policies and Programs The government of Indonesia has devoted many of its development programs to population-related issues since President Suharto joined other Heads of State in signing the Declaration of the World Leaders in 1969. In this Declaration, rapid population growth was considered an obstacle to economic development. Family planning activities were initiated in Indonesia in 1956 by a private organization, working under the auspices of the International Planned Parenthood Federation. It provided birth control advice and services, as well as maternal and child care. In 1968, the government established a National Family Planning Institute, which two years later was reorganized as the National Family Planning Coordinating Board (NFPCB). Since the NFPCB is a non-departmental body, the Chairman reports directly to the President. Thus, the government has made a strong political commitment to family planning and works with religious and community leaders to develop programs to promote family planning. These programs were not initiated simultaneously throughout the country. In the first five-year development plan (Repelita) which covered the period 1969/1970 to 1973/1974, programs began in the six provinces of Java and Bali. In the next five-year plan, the program was expanded to the provinces of D.I. Aceh, North Sumatra, West Sumatra, South Sumatra, Lampung, Nusa Tenggara Barat, West Kalimantan, South Kalimantan, North Sulawesi, and South Sulawesi. In the development of the family planning program, these provinces are classified as the "Outer Java-Bali I Region." In the third Repelita, the programs were further expanded to include the rest of the provinces which are grouped as the "Outer Java-Bali 1I Region." The goals of the program according to the Broad Guidelines for State Policy are: to reduce the birth rate, to establish the small family norm, and to improve the health of mothers and children. To achieve these goals, the family planning program has defined three dimensions: program extension, program maintenance, and program institutionalization. Program extension involves increasing the number of accepters; it is conducted through the information, education, and communication (IEC) activities throughout the country, that are implemented particularly by community organizations and religious leaders at the village level. Program maintenance involves stabilizing the acceptance of family planning and improving the quality of services; it is implemented by expanding the involvement of people in running family planning programs and its success is measured by the number of accepters of more effective, long- term methods. Program institutionalization is achieved by the acceptance of the small family norm and the greater participation of government, community and private institutions in managing the program. The policy to achieve the goals of the family planning program has been established in the "Panca Karya," the five principles or targets. They are: 1) Women under the age of 30 and those with fewer than two children should plan a maximum of two children; women should delay their first birth to age 20 by postponing marriage and planning births. 2) Women over age 30 and those with three or more children should plan to have no more children and should be offerred the most effective means of fertility regulation. 3) Young people should be encouraged to postpone marriage and childbearing through the creation of programs that deemphasize marriage and children as the only means of providing recognition and personal security. 4) In areas with higher rates of contraceptive use, education, basic health services and income generating activities are needed to institutionalize the social benefits of family planning. 5) Communities should be assisted in assuming responsibility for care of the aged, so as to reduce the desire for many children for security in old age. Lately, the program has been shifted toward the establishment of a family planning movement. As the program develops, various activities are carried out in cooperaiton with other government agencies, forming an integrated effort. 1.5 Hea l th Policies and Programs A National Health System was developed in 1982 which provides overall policy for the health sector until the year 2000. The system has established targets to be achieved in the remaining years of the century. They are stated in terms of life expectancy, infant mortality, birth weight, eradication of infectious diseases, immunization, and other health measures. Various programs were initiated to encourage active community involvement. They are primarily directed toward reducing the mortality of children under age five through intensified efforts in immunization, reduction of diarrheal diseases, improvement of nutrition, delivery of family planning services, and provision of maternal/child health services. 1.6 Objectives of the National Indonesian Contracept ive Prevalence Survey In 1984 the U.S. Agency for International Development (USAID) initiated the Demographic and Health Survey (DHS) program. The Institute for Resource Development which is part of the Westinghouse Electric Corporation was selected to coordinate the world-wide project, which involves conducting surveys in over 25 developing countries in five years. The DHS is intended to serve as a primary source for international population and health information for policymakers and for the research community. In general, DHS has four objectives: To provide participating countries with a database and analysis useful for informed choices, To expand the international population and health database, To advance survey methodology, and To help develop in participating countries technical skills and resources necessary to conduct demographic and health surveys. Apart from estimating fertility and contraceptive prevalence rates, DHS also covers the topic of child health, which has become the focus of many development programs aimed at improving the quality of life in general. The Indonesian DHS survey did not include health-related questions because this information was collected in the 1987 SUSENAS in more detail and with wider geographic coverage. Hence, the Indonesian DHS was named the "National Indonesian Contraceptive Prevalence Survey" (NICPS). The 1987 NICPS was specifically designed to meet the following objectives: To provide data on the family planning and fertility behavior of the Indonesian population necessary for program organizers and policymakers in evaluating and enhancing the national family planning program, and To measure changes in fertility and contraceptive prevalence rates and at the same time study factors which affect the change, such as marriage patterns, urban/rural residence, education, breastfeeding habits, and availability of contraception. 1.7 Survey Organ izat ion At the request of the NFPCB, the Central Bureau of Statistics (CBS) was appointed as the implementing institution for the DHS in Indonesia. Funds to carry out the survey came from four sources, the government of Indonesia, USAID/Jakarta and UNFPA/Jakarta through the NFPCB, and from IRD/Westinghouse directly to CBS. In addition, IRD also provided technical assistance throughout all stages of the survey. A steering committee was formed to give direction in the implementation of the survey. Members of the steering committee include representatives from various components within NFPCB, related government agencies, and experts in the topics covered by the NICPS. Representatives from USAID/ Jakarta and UNFPA/Jakarta serve as ex-officio members of the steering committee. A technical team was established at the CBS. The team's membership includes staff whose responsibilities are associated with population statistics and those whose duties involve survey activities. The directors of the statistics offices in the provinces were responsible for the technical as well as the administrative aspects of the survey in their area. They were assisted by field coordinators, most of whom were chiefs of the social and population sections in the provincial statistics offices. The NICPS covered 20 of Indonesia's 27 provinces, omitting the logistically more difficult and less densely populated provinces of Jambi, East Nusa Tenggara, East Timor, Central Kalimantan, East Kalimantan, Maluku, and Man Jaya. These excluded areas account for less than 7 percent of the total population, but they account for more than two-thirds of the population of the area denoted as "Outer Java- Bali I1." The sample was non-self-weighting, and therefore all estimates in this report are based on weighted figures. The sample design is presented in Appendix A. DHS model questionnaires and manuals were modified to suit the needs of Indonesia and were translated into Bahasa Indonesian. Over 90 female interviewers were trained for 15 days in five training centers during September, 1987 and data collection took place from mid-September to the third week of December. Data from the questionnaires were entered on microcomputers at the CBS headquarters in Jakarta, using the ISSA program, which was specially designed for the DHS project. Details of the methodology and organization of the survey are presented in Appendix A. 1.8 Background Character is t ics o f the Surveyed Women The NICPS covered a sample of nearly 15,000 households to interview 11,884 respondents. Respondents for the individual interview were ever-married women aged 15-49. During the data collection, 14,141 out of the 14,227 existing households and 11,884 out of 12,065 eligible women were successfully interviewed. In general, few problems were encountered during interviewing, and the response rate was high--99 percent for households and 99 percent for individual respondents (see Appendix A). This section of the report presents the distribution of these women by selected demographic and socioeconomic characteristics as well as a comparison with the same information from previous sources as a measure of the NICPS data quality. 7 Table 1.1 shows that the distribution of the women in the sample fits the pattern established by the 1980 Census and 1985 SUPAS. The decrease in the percent of ever-married women in the younger age groups from 1980 to 1987 is no doubt due to the rising age at marriage. The increase in the proportion urban over time is also evident in Table 1.1. Table 1.1 Percent distribution of ever-married woa)en 15-49 by selected background characteristics, 1980 Census, 1985 SUPAS, and 1987 NICPS Weighted Unweighted number of nLwnber of Background 1980 1985 1987 women wccnen characteristic Census SUPAS NICPS NICPS NICPS Age 15-19 8.3 5.1 5.3 635 547 I 20-24 19.3 18.2 16.8 1998 1932 25-29 18.8 21.7 21.2 2520 2565 30-34 14.2 16.3 17.8 2110 2183 35-39 15.2 14.6 14.2 1690 1712 40-44 13.2 12.6 12.0 1430 1468 45-49 11.0 11.5 12.6 1501 1477 Residence Urban 20.6 24.1 27.5 3272 4474 Rural 79.4 75.9 72.5 8612 7410 Region Java-Bali 71.2 69.9 67.0 7962 8435 Outer Java-Bali I 25.4 26.4 28.9 3430 2379 Outer Java-Bali II* 3.4 3.7 4.1 492 1070 Province Jakarta 4.5 4.9 5.1 600 1729 West Java 21.2 21.4 20.2 2405 1654 Central Java 18.7 17.6 17.6 2096 1370 Yogyakarta 1.8 1.7 1.9 226 1059 East Java 23.4 22.7 20.5 2433 1581 Bali 1.6 1.6 1.7 202 1042 Total 100.0 100.0 I00.0 11884 11884 * For the NICPS, not representative of entire region. Sources: 1980 Census-Central Bureau of Statistics, 1983, Series S No. 2, Table 03. 1985 SUPAS-Central Bureau of Statistics, 1987, No. 5, Table 02. Except for the distribution of women by province/region, the weighted and unweighted numbers for the NICPS seem to be similar. A significant difference is shown by the women's composition by area of residence. This is brought about because some areas are oversampled to yield provincial estimates. For example, in Yogyakarta and Bali, after taking into account the relative contribution of these provinces' population, the weighted number of cases turned out to be one-fourth of the actual number in the sample. Another example is in the Outer Java-Bali 1I region where more than 1,000 respondents were interviewed to produce fewer than 500 cases in the weighted sample. In this report all data have been weighted to produce a representative sample of the various geographical units. Table 1.2 shows the distribution of the surveyed women by education and other selected characteristics. In general, more than one-fifth of the women in the NICPS sample did not go to school, 2 out of 5 had only some primary school, 23 percent graduated from primary school with no further education, and 13 percent had secondary or higher education. These numbers vary depending on age group, urban/rural residence, and religion. 8 Table 1.2 Percent d is t r ibut ion of ever-married women by education, according to selected background characteristics, NICPS, 1987 Level of education completed Background character is t ic Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Java-Bail Outer Java-gati I Outer Java-Bali I I Province Jakarta West Java Central Java Yogyakarta East Java Bali Religion Muslim Protestant Catholic Hindu Buddhist Other Total SO~ None primary 8.1 37.8 12.5 43.0 17.0 43.5 19.2 42.3 24.7 40.4 35.3 35.7 46 .8 33 .7 12.4 32.1 27.3 43.4 23.4 38.5 24.1 45.3 14.3 34.9 11.9 23.0 18.0 44.4 23.7 39.4 24.6 32.1 29.8 37.0 40.8 29.1 23.9 41.3 6.2 25.1 2.8 22.0 40.1 32.2 13.2 33.6 21.4 61.8 23.2 40.3 Primary completed 44.7 28.7 25.2 22.4 21.3 19.1 12.1 26.0 22.4 25.0 18.5 30.2 28.3 27.7 24.9 22.8 22. I 22.3 23.2 27.6 27.8 20.4 25.9 4.5 23.4 Weighted number i Secondary of or more Iota[ women 9.4 100.0 635 15.8 100.0 1998 14.3 100.0 2520 16.1 100.0 2110 13.6 100.0 1690 9.9 100.0 1430 7.3 100.0 1501 29.5 100.0 3272 6.9 100.0 8612 13.1 I00.0 7962 12.1 100.0 3430 20.6 100.0 492 36.7 100.0 600 9.9 100.0 2405 12.0 100.0 2096 20.5 100.0 226 11.1 100.0 2433 7.7 100.0 202 11.6 100.0 10966 41.0 100.0 403 47.4 100.0 143 7.3 100.0 227 27.3 100.0 120 12.3 100.0 25 i 13.1 100.0 11884 The first panel of the table demonstrates an inverse relationship between age and education-- evidence of the improvement in the educational attainment of women. Young women have received more education than older women. This is denoted by the high percentage of young women who have primary education or higher, and the high percentage of older women who have no education. Women who reside in urban areas have considerably higher education than those living in rural areas. Although the percentages of womcn who completed only primary education are similar, in the urban areas the percentage of women who never attended school is much lower, and that of women who finished secondary school is more than four times as high as in the rural areas. Variation among provinces deserves some comment. Of the areas covered in the survey, Jakarta, the seat of the government, has the highest level of educational attainment, whereas Bali has the lowest. In Bali, 41 percent of the women in the sample did not go to school, and only 30 percent completed primary school. The NICPS data show that educational achievement of women in Outer Java-Bali II is highest among all major regions--only 14 percent of women never attended school, 51 percent completed primary school, and 21 percent graduated from secondary school. This is contrary to expectations, but it should be pointed out that, due to the sampling design, the results do not reflect the entire Outer Java- Bali II region. 9 The composition of the women by educational attainment and religious affiliation is presented in the last panel of Table 1.2. Almost all (92 percent) of respondents are Muslim. Overall, Christian women are better educated than women of other religions. Hindu women, most of whom reside on the island of Bali, are similarly distributed across the educational levels as the Balinese women. 1.9 Exposure to Mass Med ia The survey collected information on the respondents' exposure to mass media in order to study how respondents might be affected by their habits of reading newspapers, watching television, and listening Io the radio. Table 1.3 shows that 27 percent of respondents read a newspaper every week, 57 percent watch television every week, and 60 percent listen to the radio every day. The lower percentage of rural respondents who read a newspaper is due to the larger proportion of illiterate women in those areas and perhaps to a lack in printed materials, as well. Table 1.3 Percent of ever -marr ied wocen who usua l ly read a newspaper once a week, watch te lev is ion once a week, or l i s ten to a rad io da i ly by background character ist ics , NICP$, 1987 Background character is t ic Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Read a news- paper weekly 31.5 29.4 29.5 30.2 27.6 22.4 16.1 Watch te le - v i s ion weekly 59.3 59.0 59.5 58.0 55.5 54.0 51,7 Listen to the rad io da i ly 66.6 64.3 60.6 60.7 60.3 57.6 54.7 Number of women 635 1998 2520 2110 1690 1430 1501 Residence Urban 49.4 80.9 70.4 3272 Rural 18.3 47.8 56.6 8612 Region Java-Bali 27.0 56.4 61.3 7962 Outer Java-Bali I 25.6 58.7 59.7 3430 Outer Java-Bali II 33.5 53.1 50.2 492 Province Jakarta 63.9 89.8 79,2 600 gest Java 32,1 60.2 68.7 2405 Central Java 20.4 54.6 55.6 2096 Yogyakarta 25.1 56.9 64.0 226 East Java 20,2 46.1 54.0 2433 Bali 10.5 53.3 65.3 202 Education None 0,8 32.0 41.9 2760 some primary 16,3 53.2 58.4 4788 Primary completed 41.9 69.5 70.9 2779 Secondary or more 78.9 89.7 80.6 1557 Total 26.9 56.9 60.4 11884 10 An inverse relationship between exposure to media and age is apparent in the first panel of Table 1.3. In all columns there is a pattern of modest decline with age in the percentage of women who read a newspaper, watch television, and listen to the radio. The difference in media exposure between women residing in the urban and rural areas is striking. In the urban areas, half of respondents read a newspaper weekly, 4 out of 5 watch television weekly, and 70 percent listen to the radio daily. The figures for the rural areas are 18 percent, 48 percent, and 57 percent, respectively. Differences among regions in the proportions of women who usually read a newspaper (between 26 and 34 percent) and watch television (53 to 56 percent) are small, but are somewhat greater for women who listen to the radio (50 percent in Outer Java-Bali II and 61 percent in Java-Bali). Among provinces in Java, the respondents in Jakarta had the widest exposure to mass media. West Java and Yogyakarta follow Jakarta, while Central Java and East Java had almost identical rates, slightly lower than other areas in Java. Women in Bali are about as likely as women in other provinces to watch television and listen to the radio, however only 10 percent of the women read a newspaper weekly. The last panel shows clearly that women with more education tend to have more contact with mass media. 1.10 Ownersh ip o f Househo ld Ameni t ies Table 1.4 presents the respondents' distribution by the household goods they owned or had access to. Overall, almost half have electricity and a bicycle or other non-motor vehicle, and 60 percent have a radio or cassette player. There is a substantial difference between urban and rural areas. Except for bicycles, urban women are more likely than rural women to have the household goods inquired about in the survey. Access to electricity is 2.6 times greater among urban than rural women, radio 1.4 times, television 3.4 times, stove 3.7 times, and motorcycle 2.6 times. As these amenities can be regarded as economic indicators, one may say that urban women tend to be better off than rural women. Table 1.4 Percent of ever-married women who own or have access to selected household amenit ies, NICPS 1987 Househotd amenity Urban Rura[ TotaL E tect r i c i ty 84.5 32.0 46.4 Radio/cassette p layer 75,9 54.4 60.4 Tetevis ion 59.1 17.3 28.8 Stove 81.4 21.9 38.3 Non-motor vehicte 46.4 50.2 49.2 Motor vehicte 33.3 12.6 18.3 Number of women 3272 8612 11884 11 2. MARRIAGE, BREASTFEEDING, AND POSTPARTUM INSUSCEPTIBILITY Marriage is a primary indicator of exposure of women to the risk of pregnancy, and therefore is important in understanding fertility. Populations in which age at marriage is low tend to be those with early childbearing and high fertility. Therefore, efforts to encourage later marriage often form part of policies to reduce fertility. In the NICPS, a woman was assumed to be married if she was married by state law, religion, or custom, or was considered to be married by the community. Only women who were 15-49 years of age and who had ever been married were interviewed with the individual questionnaire. In this report, trends in age at marriage are investigated by comparing the age at marriage of different age cohorts. The chapter also presents measures of several proximate determinants of fertility which influence exposure to pregnancy within marriage--breastfeeding, postpartum amenorrhea, and postpartum sexual abstinence. The joint impact of amenorrhea and abstinence is the length of postpartum insusceptibility, defined as the elapsed time between birth and the resumption of either menstruation or sexual intercourse. In this chapter, several tables are based on all women, as opposed to only ever-married women. Since only the latter were interviewed individually, the number of never-married women bad to be estimated. The number of never-married women enumerated in the household interview can not simply be added to the number of ever-married respondents to the individual interview, since the latter is subject to some degree of non-response, and the resulting denominator would be biased somewhat. Instead, the ratio of all women to ever-married women enumerated on the household schedule was calculated at each single year of age and for each category of background characteristic (e.g., urban-rural residence, education level). These ratios were then applied to the number of ever-married women interviewed individually so as to expand the denominators to represent all women. 2.1 Mar i ta l S ta tus Table 2.1 shows that among women of childbearing age, 26 percent have not married, 68 percent are currently married, 3 percent are divorced, and 3 percent are widowed. The data by age group indicate that marriage in Indonesia occurs at an early age, with one out of five teenagers and more than three out Tabte 2.1 Percent distribution of ai[ women by current marital status, according to age, NICPS, 1987 Current marital status Never Age married Married 15-19 81.0 17.9 20-24 34.8 61.6 25-29 10.5 85.4 30-34 4.1 90.0 35-39 3.0 88.6 40-44 1.1 87.9 45-49 1.4 80.I Tota( 26.4 67.6 Divorced Widowed Total 1.0 0.1 100.0 3.1 0.4 100.0 3.2 0.9 100.0 4.2 1.7 100.0 3.2 5.2 100.0 3.4 7.6 100.0 4.0 14.4 I00.0 3.0 3.1 , 100.0 Weightea number of worn 3342 3066 2818 2200 1742 1445 1523 16136 Note: The total number of won~en is derived by weighting each respondent proportionally to the number of never-married women in the same age, education, region, and urban-rural residence group, using data from the household questionnaire. 13 of five women 20-24 having married. By the time women reach the 25-29 age group, 90 percent have married; this increases to 99 percent for women in their 40s. While the proportion divorced is relatively constant for all age groups, the proportion widowed is lower for younger women and higher for older women, reaching 14 percent of women 45-49 years old. Table 2.2 presents a comparison of data on proportions ever-married by age from the 1980 Population Census, the 1985 SUPAS, and the 1987 NICPS. The table indicates a regular pattern over time from 1980 to 1987. On the whole, the percentage of never-married women increases continuously from 22 percent in 1980 to 25 percent in 1985 and 26 percent in 1987. Of particular note is the sharp increase in the percentage of never-married women in the younger age groups, especially women 20-24 years; between 1980 and 1987, the percentage of never-married women increased from 22 to 35 percent. This is evidence of increasing age at first marriage, which is supported by other data in this chapter. Tabte 2.2 Percent of art women who have never married, according to age, 1980 Census, 1985 SUPAS, and 1987 NICPS 1980 1985 1987 Age Census SUPAS NICPS 15-19 70.0 81.2 81.0 20-24 22.3 i 29.7 ; 34.8 25-29 7.4 8.9 ~ 10.5 30-34 3.4 4.1 4.1 35-39 1.9 2.5 3.0 40-44 1.4 1.7 I .I 45-49 i 1.2 1.4 1.4 i Totat I 21.5 24.9 26.4 Sources: 1980 Census-Central Bureau of Statistics, 1983, Table 03.3. 1985 SUPAS-Central Bureau of Statistics. 1987, Table 02.3. 2.2 Age at F i r s t Mar r iage Table 2.3 shows that about 19 percent of women aged 15-49 in Indonesia married before 15 years of age, and nearly half married before 18. It should be noted that, while in some provinces, girls traditionally marry at extremely young ages, not all of them immediately live with their husbands in a household. Some couples stay with their respective parents, often for several years. For example, in the province of Aceh in northern Sumatra, it is customary for the bridegroom to go away as soon as the wedding ceremony is over. Thus, in many cases of very early marriage, there is an interval between marriage and first sexual intercourse. The percentage of women marrying at younger ages decreases among younger women, implying that age at marriage is increasing. Thus, while 79 percent of women aged 45-49 married before they reached age 20, only 53 percent of women 20-24 have married before reaching 20. Another index of the rising age at marriage is the trend in the median age at marriage which has increased steadily from 16.5 among women 45-49 to 19.6 among women 20-24. Still, the fact that 5 percent of women 15-19 and 12 percent of women 20-24 married before they were 15 is surprising, since the Marriage Law that was put into effect in 1974, sets the minimum age at marriage at 16 years for women and 18 years for men and stipulates that permission from the parents is required for marriages of anyone under 21 years of age. 14 Tabte 2.3 Percent d i s t r ibut ion of a l l women by age at f i r s t marriage and median age at f i r s t marr iage, according to cur rent age, NICPS, 1987 Current Never Less age marr ied than 15 J i 15-19 81.0 4.8 20-24 34.8 11.8 25-29 10.5 19.2 30-34 4.1 24.8 35-39 310 28.8 40-44 1.1 32.1 45-49 1.4 31.8 i Total 26.4 18.9 J - Omitted due to censoring * See note at Table 2.1 Age at f i r s t marriage 15-17 18-19 20-21 Number i I 25 or of 22-24 over Total women* 11.0 3.3 - - 100.0 3342 24.9 16.7 8.8 3.0 100.0 3066 30.3 16.2 11.4 8.8 3.6 100.0 2818 29.6 15.8 ! 10.4 9.5 5.8 100.0 ~ 2200 33.7 13.8 8.1 7.0 5.7 100.0 1742 34.9 13.5 7.5 6.6 4.3 100.0 1445 31.7 15.7 8.5 6.0 4.8 100.0 1523 26.1 13.0 7.4 5.3 2.9 100.0 16136 Median** age at f i r s t marriage 19.6 18.1 17.6 16.8 16.4 16.5 ** Defined in th i s tab le as the exact age by which 50 percent of women have experienced marr iage. Table 2.4 presents the median age at first marriage by selected socioeconomic characteristics of respondents. Only women aged 25-49 are included in this table since the median age at marriage for younger women is influenced by the large proportion that have not yet married. Table 2.4 Median age at first marriage among air women aged 25-49, by current age and background characteristics, NICPS, 1987 Current age Background Total character i s t i c 25-29 30-34 35°39 40-44 45-49 25-49 Residence Urban 20.3 19.1 18.0 17,7 17.7 18.8 Rural 17.3 17.0 16.2 15.9 16.1 16.6 Region Java-Bal i 17.6 17.0 16.3 16.0 16.0 16.5 Outer Java-Bal i ! 19.3 18.5 17.8 17.0 17.7 17.8 Outer Java-Bal i %% 19.2 18.8 17.9 17.8 17.3 18.3 Province I Jakarta 20.6 19.6 19.5 18.9 18.0 19.0 West Java 16.8 16.1 15.8 15.3 15.7 15.9 Central Java 17.9 17.5 16.7 16.2 16.4 16.9 Yogyakarta 20.3 19.6 19.2 18.6 19.0 19.0 East Java 16.9 16.0 15.5 15.5 15.2 15.7 Bali 19.7 19.0 19.5 19.3 20.6 19.2 Education None 17.1 15.9 15.8 15.7 15.7 15.8 So~ primary 16.9 16.5 16.0 15.8 16.1 16.2 Primary completed 18.2 17.7 17.0 17.1 17,4 17.5 ! Secondary or more 23.3 21.8 22.2 20.8 21.0 21.3 Total 18.1 17.6 16.8 16.4 16.5 = Note: Median age at f i r s t marriage is def ined as the exact age by which 50 percent of women have experienced marr iage. Omitted due to censoring 15 The data show that women in urban areas generally marry two years later than women in rural areas. While younger women in both urban and rural areas are getting married later than older women did, the change is more pronounced among urban women. For example, while the difference in the median ages at marriage between urban and rural women is 1.6 years for women aged 45-49, the difference is 3 years among women aged 25-29. Comparison between major regions and provinces also provides interesting results. Surprisingly, women in Outer Islands II marry later (18.3) than women in Outer Islands I (17.8), who in turn, marry later than women in Java-Bali (16.5). It appears that age at marriage has been increasing comparably in all three regions. As has been well documented, the median age at marriage in West Java is relatively low (15.9). However, it is surprising that East Java has the lowest median age among the six provinces (15.7). When the comparison is made across cohorts, East Java still has the lowest median age at marriage in almost every age group. Bali, Yogyakarta and Jakarta have the highest median ages at marriage. It is interesting to note the fluctuations in median age at marriage across age groups in Bali, where the highest median age is found in the oldest cohort (20.6). This result deserves further investigation to find out if it is caused by a real change in the pattern of marriage or is simply the effect of memory lapse and/or different calendar systems used among cohorts. The strongest differentials in age at marriage are by education. As Table 2.4 demonstrates, the higher the level of education, the higher the median age at marriage, and the pattern is remarkably consistent across cohorts. The differences in median age at marriage between women with no education, those with some primary school, and those who completed primary school are considerably smaller than the difference between these women and those with secondary education. This implies that to have a major impact on age at marriage, women need to have at least a secondary school education. 2.3 Factors Affecting Exposure to the Risk of Pregnancy This section presents data regarding breastfeeding, postpartum amenorrhea, and postpartum sexual abstinence. The purpose of describing these three birth-related variables is to estimate the proportion of women who are exposed to the risk of getting pregnant. Table 2.5 shows that not only are almost all Indonesian babies breastfed, but they are breastfed for a relatively long period of time. Almost 80 percent of babies are still being breastfed by the time they reach their first birthday, and 40 percent are breastfed for two years. The median duration of breastfeeding is 22 months. As expected, almost all mothers experience postpartum amenorrhea until the second month after birth. The proportion drops considerably by the fourth month after birth and reaches 35 percent among mothers who delivered twelve months before the survey. The median duration of amenorrhea is 9 months. There is a clear relationship between breastfeeding and amenorrhea. For both variables, as the age of the baby increases, the proportion of women breastfeeding and amenorrheic decreases (with some fluctuation), but the decrease is faster in the proportion of women experiencing amenorrhea. This is no doubt due to the fact that duration of amenorrhea is related to the intensity of breastfeeding. The proportions of women practicing sexual abstinence after a birth decrease even faster than for those breastfeeding and amenorrheic. Less than half of mothers are still abstaining 2-3 months after a birth and the median duration is only 2 months, considerably lower than for breastfeeding or amenorrhea. This probably reflects the Islamic custom of observing sexual abstinence for 40 days following birth. Table 2.5 also provides information about the proportion of mothers who are insusceptible to pregnancy either because they have not had their period since their last birth or because they are practicing sexual abstinence. The table shows that up to nine months after giving birth, more than 50 percent of 16 Table 2.5 Percent of b i r ths in the last 36 months whose mothers are s t i l t breastfeeding, postpartum amenorrheic, abstaining, and insusceptibLe to pregnancy, by months since b i r th , NICPS e 1987 Months Still Still Still Still Number since breast- amen- abstain- , insus- of birth ceptibLe* births Less than 2 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 24-25 26-27 28-29 30-31 32-33 34-35 feeding orrheic 88.2 93.9 95.2 82.2 90.6 66.6 86.9 i 63.7 89.3 53.6 81.9 39.1 78.7 35.7 74.6 31.5 72.9 23.0 71.0 15.4 60.8 11.0 50.9 6.2 39.7 5.8 38.9 3.6 33.5 3.2 32.2 3.4 27.2 2.5 23.6 2.7 r ing ce~ 88.6 95.6 46.2 85.2 19.6 69.8 21. I 68.4 10.8 54.1 10.1 41.8 9.7 40.6 8.6 33.7 5.3 25.2 6.6 20.8 3.2 13.1 2.0 8.1 3.3 8.6 4.0 6.6 3.7 6.9 5.1 7.6 0.9 3.4 2.4 4.5 225 267 297 270 265 214 249 267 284 272 188 196 293 300 306 243 251 265 Total 62.8 30.1 13.6 32.9 4652 Median** 22.0 i 9.2 2.3 9.4 * Either amenorrheic or abstaining ** Calculated from the distribution by single months mothers are still insusceptible. The proportion of mothers who are insusceptible drops off rapidly, and at two years after birth, less than 10 percent of mothers are insusceptible. Table 2.6 provides estimates of the mean duration in months of breastfeeding, postpartum amenorrhea and postpartum abstinence by selected background characteristics. These estimates were calculated using the "current status" or "prevalence/incidence" method, borrowed from epidemiology. Thus, the duration of breastfeeding is defined here as the prevalence (number of women breastfeeding at the time of the survey), divided by the incidence (average number of births per month over the last 36 months). There is no clear trend in breastfeeding durations by age of mother, which is encouraging in itself, since a decrease in the duration of postpartum insusceptibility among younger women--which is commonly found in developing countries--would put a greater burden on the family planning program to compensate for the increased risk of unwanted pregnancies and short birth intervals. Comparison between rural and urban women provides results which are consistent with previous findings in Indonesia, namely, that rural women tend to have longer periods of breastfeeding, postpartum amenorrhea, and abstinence than urban women. Variations among provinces and regions are also interesting. Jakarta, which is totally urban has the shortest length of breastfeeding and amenorrhea. Jakarta also has a short period of abstinence, but West Java and Bali have even shorter durations of abstinence. As reported by other researchers (e.g., Singarimbun and Manning), the length of postpartum abstinence is relatively high in provinces where the Javanese ethnic group predominates (Central Java, East Java, and Yogyakarta). In these areas, couples refrain from sexual intercourse, which is traditionally believed to spoil the milk from the mother's breast. 17 Level of education seems to have a negative relationship with these four postpartum-related variables--the higher the education, the shorter the durations of breastfeeding, amenorrhea, abstinence and insusceptibility. There are some plausible explanations for this relationship. Women with higher education tend to have occupations in the formal sector with regular working hours that force them to be away from home and unable to breastfeed their children regularly. These women also tend not to observe cultural taboos related to sexual abstinence after birth. They prefer using modern contraceptives rather than prolonged breastfeeding to protect them from pregnancy. Table 2.6 Mean number of months of breastfeeding, postpartum amenorrhea, postpartum abst inence, and postpartum insuscept ib i l i ty , by background character i s t i cs , NICPS, 1987 StiLL StiLL S t i l l S t i l l Number Background breast - amen- absta in- insus- of character i s t i c feeding or rhe ic ing cept ib le* b i r ths Age Less than 20 26.3 12.8 8.0 14.6 292 20-29 24.2 10.8 4.9 12.2 2844 30 or over 26.7 10.9 5.7 12.6 1582 Residence urban 21.3 9.4 4.3 10.6 1278 RuraL 26.6 11.5 5.7 13.2 3440 Region Java-BaLi 26.7 11.8 6.1 13.8 2766 Outer Java-BaLi ! 23.2 9.9 4.3 10.6 1683 Outer Java-BaLi I I 21.3 8.4 4.0 10.1 269 i Province Jakarta 19.0 7.2 3.4 8.3 228 West Java 25.4 12.0 2.7 12.8 930 Centra l Java 29.9 13.8 7.2 16.4 793 Yogyakarta 27.3 9.7 11.6 15.4 65 East Java 27.3 11.3 10.0 14.3 684 BaLi 25.3 10.4 2.2 10.8 66 i Education None 28.1 12.1 6.8 14.2 803 Some pr imary 26.0 11.5 5.4 13.0 2000 Primary compLeted 25.4 10.8 5.2 12.5 1214 Secondary or mere 19.0 8.3 3.7 9.0 701 TotaL 25,I 11.0 5.3 12,5 4718 Note: The mean number of months is based on current status estimates * Either amenorrheic or abstaining 18 3. KNOWLEDGE AND EVER USE OF FAMILY PLANNING METHODS 3.1 Knowledge o f Fami ly P lann ing Knowledge of family planning methods and of places to obtain them are crucial elements in the decision of whether and which methods to use. Presumably, a higher level of knowledge of family planning methods will be followed by higher use which ultimately might contribute to reducing fertility rates. Data on knowledge of family planning methods were obtained by first asking respondents to name the ways that a couple can delay or avoid a pregnancy or birth. If a respondent did not spontaneously mention a particular method, the method was described by the interviewer and the respondent was asked if she recognized the method. Descriptions were included in the questionnaire for eleven methods (pill, IUD, injection, diaphragm/foam/jelly, condom, female sterilization, male sterilization, Norplant, abortion, periodic abstinence (rhythm) and withdrawal). In addition, other methods mentioned by the respondent such as herbs (jamu), abdominal massage (pijat), and prolonged abstinence, were recorded. For any method that she recognized, the respondent was asked if she had ever used it. Finally, for all modern methods that she recognized, she was also asked where she would go to obtain the method if she wanted to use it and what main problem, if any, was associated with using the method. If the respondent recognized periodic abstinence, she was asked where she would go to obtain advice about the method if she wanted to use it. As Table 3.1 indicates, knowledge of at least one method of family planning is practically universal among married women of reproductive age in Indonesia. Almost identical percentages of ever-married (94 percent) and currently married women (95 percent) recognize at least one method and virtually all of these women recognize at least one modern method. Knowledge of family planning is very uneven across methods, with three methods widely known and the others much less so. The most widely known methods are the pill, injection, and the IUD, known by 91, 84, and 82 percent of currently married women, respectively. It is interesting that injectables are more widely known than the IUD, even though they were introduced into the Indonesian program later than the IUD. The next most widely known methods are condom and female sterilization, known by 65 and 53 percent of currently married women, respectively. The relatively high level of knowledge of condom deserves mention, considering that it is a male method and respondents were female. A recent social marketing campaign to promote condom use (discussed in more detail below) may have contributed to its widespread recognition. The fact that 30 percent of respondents recognize Norplant is also remarkable, considering that it was introduced less than five years before the survey on a limited basis. Although included on the list of methods read to respondents, only 19 percent of women reported knowing about abortion, which may reflect the fact that it is socially unacceptable and is not a family planning program method in Indonesia. Traditional methods are known by 20 percent of women or less. Knowledge of methods such as herbs, massage and prolonged abstinence would doubtless be higher if these methods had been specifically probed with respondents. Differences in knowledge of family planning methods by age of the woman are small. The youngest and oldest women are slightly less likely to have heard of methods and this pattern holds true for each method. Differences in levels of knowledge of at least one modern method are shown in Table 3.2 according to the number of living children a woman has and selected background characteristics. Women with no children are slightly less likely to have heard of modern methods than are women with children. 19 Table 3.1 Percent of ever-m~rried and currently married women knowing any method, knowing any modern method, and knowing specific family planning methods, by age, N|CPS, 1987 Family planning method known Oiaph- Female ~a[e + Period Pro[- Abdo- Any ragm/ ster + ster- ! ic ab- onged Herbs minat Ho. Any modern Injec- foam/ i t i za - i t i za - Nor- Abor- s t in - With- absti (Ja- mass- of Age method method P i l l IUD t ion je t ty Condom t ion t ion plant Lion ence drawat nence rnu) age Other women Ever-married ~omen 15-19 93.2 93.2 89.2 71.9 79.9 2.9 55.6 37.0 16.5 20.3 12.5 10.0 6.5 0.3 8.2 2.7 0.5 635 20-24 96.1 96.1 93.6 84.5 88.4 2.6 67.8 52.4 22.4 31.0 17.8 19.8 13.4 0.7 10.8 4.9 1.5 1998 25-29 96.0 95.9 93.3 85.3 87.1 3.3 69.3 55.5 27.9 34.6 19.7 23.5 17.3 0.8 12.8 5.0 1.4 2520 30*34 95.5 94.7 92.6 84.4 86.4 4.6 68.2 56.4 29.9 33.3 21.8 24.8 17.7 1.2 13.5 5.2 1.7 2110 35-39 94.6 94.1 90.8 82.5 84.1 4.8 66.1 53.1 29.7 31.7 21.7 23.9 16.4 0.7 14.0 5.6 2.1 1690 40-44 90.2 89.1 86.3 76.9 77.2 3.8 57.6 48.7 25.2 25.I 15.4 18.3 13.8 1.5 12.5 6.4 1.5 1430 45-49 86.5 85.3 79.7 70.8 70.4 4.1 51.0 42.5 21.5 18.7 i 13.6 14.5 10.0 0.9 12.1 4.9 2.1 1501 Total 93.7 93.1 90.1 81.1 83.1 3.8 63.9 51.3 25.8 29.2 18.4 20.7 14.7 0.9 12.4 5.1 1.6 11884 Currently Married Women 15-19 93.4 93.4 89.1 71.5 80.2 3.1 56.1 36.9 16.0 20.0 12.7 10.0 6.6 0.4 8.3 2.9 0.6 600 20-24 96.9 96.8 94.2 85.1 89.5 2.8 68.2 53.4 22.5 31.6 18.2 20.0 14.0 0.7 10.9 5.2 1.5 1888 25-29 96.4 96.4 93.8 85.7 87.7 3.4 69.7 55.0 20.I 35.0 19.7 23.7 17.8 0.8 12.8 5.2 1.5 2406 30-34 95.7 95.0 92.8 85.3 87.1 4.9 69.0 57.5 30.4 33.8 22.3 25.4 18.2 1.2 13.6 5.4 1.8 1979 35-39 95.3 95.0 91.9 84.2 85.5 5.0 67.6 54.8 31.0 32.7 22.3 25.2 17.2 0.7 13.9 5.5 2.0 1543 40-44 91.9 90.8 87.8 78.5 78.0 4.1 58.9 49.9 25.9 23.9 16.2 19.6 14.4 1.7 12.7 6.5 1.7 1271 45-49 88.2 87.3 81.5 73.9 73.2 4.8 53.3 44.5 23.2 19.2 14.3 14.8 11.0 1.0 12.1 5.3 2.4 1220 i i i i i i i i i i i i -~ Total 94.6 94.2 91.1 82.4 84.4 4.0 65.2 52.5 26.5 30.0 18.9 21.4 15.4 0.9 12.4 5.3 1.7J I0907 i Table 3.2 Percent of currently married women knowing at least one modern family planning method, by number of Living children and background characteristics, NICPS, 1987 Background character i s t i c None Res idence Urban : 93.5 Rural 86.9 Number of living children I 2 3 4 5 6+ Total 96.7 97 .9 i 98.5 97 .9 98.4 98.1 97.5 93.6 94 .7 I 94.4 ; 94.5 91.4 91 ,5 I 92 .9 Region Java-Bali 89.4 95.9 96.4 97.2 95.5 95.4 95.6 95.4 Outer Java-Bali I 85.6 89.6 93.3 91.6 96.0 90.5 90.9 91.5 Outer Java-Bali II 90.0 94.2 i 94.5 95.2 93.5 90.3 90.0 92.9 Prov ince i J akar ta : 97.7 98.5 99.3 I 98 .7 97 .6 97 .7 98 .7 98.5 West Java 97.7 98.4 98.3 I 99.3 97.4 97.2 97.3 98.1 Central Java 91.8 : 97.6 98.0 99.1 96.3 99.0 98.7 97.5 Yogyakarta 97.7 i 99.6 99.3 100.0 100.0 98.9 98.9 99.4 East Java 78.3 91.6 92.3 92.7 91.3 85.8 87.7 89.7 Bali 83.4 97.7 98.8 97.5 95.8 93.5 98.5 96.7 Education None 68.1 80.3 85.7 83.6 85.7 83.8 ~5.4 82.9 Some primary 89.8 94.9 i 95.9 98.1 98.3 95.I 94.6 95.6 Primary completed 95.4 99.0 i 99.9 98.2 100.0 99.6 99.5 98.9 Secondary or more 99.9 IOO.O 100.0 100.0 99.5 100.0 98.5 99.8 i i i i i i i Tara[ 88.6 94.4 95.5 95.6 95.5 93.4 93.3 94.2 More women in urban areas know about modern family planning methods than women in rural areas, although the difference is not large (98 vs. 93 percent). Regional differences in knowledge are also small. Ninety-five percent of married women in Java-Bali have heard of at least one modern method of family planning, compared to 92 percent of women in Outer Java-Bali l and 93 percent of women in Outer Java-Bali II. With the exception of East Java, where only 90 percent of women know about a modern method, knowledge levels in the provinces of Java-Bali are all 97 percent or higher. Education has the strongest relationship with knowledge levels. While only 83 percent of women with no education have heard of a modern method, the proportion rises to 96 percent among women with some primary school, 99 percent of women who completed primary school, and almost 100 percent of women with secondary school. Table 3.3 shows that knowledge of family planning methods has increased dramatically in Indonesia in the last decade. The table compares data on the proportions of ever-married women who know specific family planning methods from the Indonesia Fertility Survey (IFS) conducted in 1976 and the 1987 NICPS. Because the IFS covered only the Java-Bali region, the NICPS data have been limited to that region as well. The data show that the proportion of women who have heard of any method has increased from 77 percent in 1976 to 95 percent in 1987. While knowledge levels increased for virtually all methods, the largest increase is for female sterilization. In 1976, only 11 percent of women had heard of female sterilization; by 1987, that proportion had increased to 57 percent, a five-fold increase. Almost as dramatic is the increase in knowledge of injection, from 17 to 84 percent. From April-August 1986, a social marketing campaign for condoms was test marketed in three cities--Bandung in West Java, Mcdan in North Sumatra, and Surabaya in East Java. In September 1986, the campaign was extended to seven more cities--Jakarta, Semarang and Solo in Central Java, Ujung Pandang in South Sulawesi, Palembang in South Sumatra, Malang in East Java, and Padang in West Sumatra. In order to evaluate the success of early marketing efforts, the NICPS included a question as 21 Table 3.3 Percent of ever-married women in Java and Bali knowing speci f ic fami ly planning methods, 1976 Indonesia Fer t i l i ty Survey and 1987 NICPS Method Any method P i l l IUO I n jec t ion Diaphragm/foam/jet [y Condom Female s ter i l i za t ion Mate s ter i l i za t ion Norplant Periodic abstinence Wi thdrawa I 1976 I 1987 IFS NICPS 77 95 71 91 50 82 17 84 4 4 41 63 11 57 8 32 32 12 20 7 14 Nulrd~er of women 9136 7962 Source: Central Bureau of Statistics, 1978, Table 5.2. to whether respondents had ever heard of DuaLima, the brand name of the condom, and if SO, what it was. As Table 3.4 indicates, only 17 percent of ever-married women have heard of DuaLima. Not surprisingly, almost three times as many urban women as rural women have heard of DuaLima, and the proportion is highest (57 percent) in Jakarta. Women who live in areas not targetted by the campaign, such as Yogyakarta, Bali, and Outer Java-Bali II, are far less likely to have heard of DuaLima. Perhaps in part because better educated women are more concentrated in urban areas, knowledge of DuaLima is positively related to the level of education. There does not appear to be much difference in knowledge of DuaLima by either age or number of living children. One encouraging piece of information is that over 90 percent of those women who reported that they had heard of DuaLima correctly identified it as either a condom or family planning method. Table 3.4 Percent of ever-married women who have ever heard of Ouatima by background character is t ics , NICPS, 1987 Background character is t ic Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Percent who have heard of OuaLim~ 17.9 21.4 19.3 18.3 15.8 11.4 7.5 Residence Urban : 32.8 Rural 10.3 Region Java-Bali 17.3 Outer Java-Bali I 16.1 Outer Java-Bali 11 6.1 J 4 i Total , 16.5 Background character is t ic Province Jakarta West Java Central Java Yogyakarta East Java Bali Education None Some primary Primary completed Secondary or more NUmber of Living children None I 2 3 4 or more Percent who have heard of DuaLima 57.1 17.9 13.7 8.8 12.0 1.8 3.3 10.6 22.2 47,7 17.6 19.3 17.3 16.7 13.9 22 3.2 Knowledge o f Sources for Fami ly P lann ing Methods Before a woman can adopt family planning, she must not only have heard of a method, but also must know of a place to obtain it. Table 3.5 shows that most women who know a method also know where to obtain it. This table suggests that lack of knowledge of sources for methods is probably not a major obstacle to use in Indonesia. If knowledge is a barrier at all, it is the lack of knowledge of certain methods themselves, and not lack of knowledge of sources that is the obstacle to use. As Table 3.6 indicates, knowledge of at least some source for modern methods is widespread among all subgroups. Table 3.5 Percent of currently married women knowing specif ic family planning methods and knowing a source for obtaining that method, by method, NICPB, 1987 Know Know Method method source Pill 1u0 Injection Diaphragm/foam/jetty Condom Female s ter i l i za t ion Mate s ter i l i za t ion Norptant Periodic abstinence 91.1 82.4 84.4 4.0 65.2 52.5 26.5 30.0 21.4 88.4 76.2 81.4 3.1 52.3 4B.7 24.2 24.7 19.7 Number of women 10907 10907 Table 3.6 Percent of currently married women knowing any modern family planning method and knowing a source fo r obtaining that method, by background characterist ics, NICP$, 1987 Know Background a modern Know characterist ic method a source Residence Urban 97.5 96.6 Rural 92.9 91.2 Region Java-Bali 95.4 94.1 Outer Java-Bali I 91.5 89.6 Outer Java-Bali I[ 92.9 91.4 Province Jakarta 98.5 98.0 West Java 98.1 96.3 Central Java 97.5 96.7 Yogyakarta 99.4 99.1 East Java 89.7 88,1 Bali 96.7 95.8 Education None 82.9 80,1 Some primary 95.6 94,0 Primary co~oteted 98.9 98,3 Secondary or more 99.8 99,6 Totai 94.2 92,7 23 Table 3.7 shows the specific sources where women would get methods if they wanted to use them. For most methods, the large majority of women would use public sources such as hospitals, health centers, and family planning clinics. Private services such as private doctors, midwives, and pharmacies, were mentioned less frequently (generally by 5 to 10 percent of women) than public sources, and represented a significant proportion only for the diaphragm/foam/jelly and condoms (29 and 20 percent, respectively). Table 3.7 Percent d i s t r ibut ion of women knowing a fami ly planning method by supply source they would use i f they wanted the method, according to method, NICPS, 1987 Family planning method known Diaph- FemaLe Male Period ragm/ ster- ster- ic ab- Supply source ln jec- foam/ i l i za - i l i za - Nor- s t in - named P i l l IUD t ion j e t ty condom l ion t ion p lant ence* FP clinic/hospital/health center 50.5 77.1 75.4 44.5 45.6 86.6 83.2 70.4 16.6 FP field worker (PLKB) 7.8 1.4 1.5 1.8 3,1 0.1 0.1 0.4 3.0 FP post (Pos KB) 19.3 3.7 4,2 1.6 6.7 0.1 0.1 0.9 1.8 Mobile clinic (TKBK/TMK) 0.5 0.3 0.1 0.0 0.1 0,0 0.1 0,0 0.1 Safari campaign dr ive 0.0 0.5 0,2 0.0 0.1 0.0 O.O 0.7 0.4 Integrated serv ice post (posyandu) 4.2 1.5 2.5 0.6 2.4 0.1 0.1 0.4 0.8 Pharmacy/shop 1.1 0.0 0,0 13.9 17.7 0.0 0.0 0.0 0.0 Private doctor 1,8 4.0 6,1 12.5 0.6 4.7 6,9 6.8 7,8 Private midwife 2.2 2,8 4.7 2.3 1.3 0.6 0.2 1.1 4.6 Other 9.4 1.1 1.5 1.5 2.4 0,I 0.1 1,6 57.6 Don't know 3.2 7.6 3.8 21.3 20,0 7.7 9.2 17.7 7.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 NO. of wotnen who know method 10705 9633 9873 449 7597 6102 3072 3470 2460 Refers to source for information about method In an effort to discover which actual or potential sources of family planning information are acceptable to Indonesian women, the NICPS included a set of questions on this subject, the results of which are presented in Table 3.8. At least three out of four women feel that family planning field workers, private doctors and midwives, village officials, staff of the women's movement (PKK), television, and radio are acceptable sources of family planning information. Far fewer women (about half) find religious leaders, pharmacists, and teachers acceptable family planning educators. The most widely accepted source is family planning field workers, followed by private midwives. Generally, women in the middle age groups (25-44), urban and better educated women are somewhat more likely to consider the sources acceptable. Women in Outer Java-Bali II are generally more accepting of sources than women in the other two regions, and women in Yogyakarta, Jakarta and Central Java tend to be more accepting of these sources of family planning information than women in the other provinces in Java-Bali. The acceptability of religious leaders as family planning communicators is particularly low in Bali (20 percent), perhaps due to the influence of Hinduism in this province. 3.3 D isseminat ion o f Fami ly P lann ing In fo rmat ion In an effort to identify obstacles to the wider use of family planning methods, NICPS interviewers asked women who reported knowing about a method what they thought was the main problem, if any, with using the method. On the whole, few respondents reported knowing of problems with methods. As shown in Table 3.9, a substantial minority of women (16 to 41 percent) reported "no problem" and an even larger 24 Table 3.8 Percent of ever-married women who think specific sources of family planning information are acceptable, by background characteristics, NICPS, 1987 Wo41~n~s Private Field- Relig- move- Number Background Private mid- worker vi l lage ious ment Phar- Teach- tele- of characteristic Doctor wife (PLKB) Head leader (PKK) macist er vision Radio women i i i i i i i i i i i Age 15-19 66.1 72.9 76.8 68.6 49.1 67.6 45.3 46.2 77.0 80.5 635 20-24 75.6 83.2 85,0 74.1 55.7 78.2 51.3 54.0 80.1 82.9 1998 25-29 77.5 83.4 85.5 77.7 59.7 77.5 50.4 55.8 79.8 81.7 2520 30-34 78.1 84.1 85.3 75,6 59.1 77.6 50.9 56,7 80.3 81.8 2110 35-39 73.3 79.8 81.2 74.3 59.9 74.3 49,0 55.3 77.8 80.3 1690 40-44 70.2 75,4 78.9 71.1 57.5 69.9 45,9 55.3 71,8 74,2 1430 45-49 64.9 68,9 73.0 67.2 55.8 67.5 42.5 51.5 68.3 70.1 1501 Residence Urban 81.7 85.7 86.8 67.2 57.5 80.5 54.4 53.4 88.4 87.8 3272 Rural 70.6 77.3 80.1 76.1 57.7 72.2 46.4 54.9 72.8 76.1 8612 Region Java-Bali 70.7 77.2 80,8 74.2 59.2 74.8 49.1 54.0 75.7 78.3 7962 Outer Java-Bali I 78.4 83.6 83.0 72.4 54.9 72.8 48.1 55.2 79.8 81.1 3430 Outer Java-Bali II 88.2 91.3 93.4 72.6 49.7 80.2 45.0 56.6 79.8 83.4 492 Province Jakarta 89.4 92.3 94.8 57.1 58.2 88.7 51.6 44.5 94.7 94.9 600 West Java 64.2 73.7 76.2 73.4 62.4 70.3 45.3 53.6 76.3 80.0 2405 Central Java 77.9 83.7 92.8 83.2 63.2 84.6 55.5 60.3 78.5 82.5 2096 Yogyakarta 89.6 92.2 95.5 88,1 67.0 87.9 59.6 72.3 84,9 89.7 226 East Java 63.5 69.0 70.4 70.9 55.5 67.8 46.8 51.5 67.2 67.6 2433 Bali 81.5 88.8 77,2 65.7 19.5 56.0 34.1 33.1 76.0 80.2 202 Education None 56.8 64.6 66.5 67.0 48.7 56.4 34.1 45.0 56.9 60.5 2760 Some primary 73.9 79.7 81.7 77.4 60,8 75.2 50.7 57.9 75.3 78.3 4788 Primary completed 81.0 88.3 90.2 77.0 59.4 83.9 55.0 56.6 89.1 90.6 2779 Secondary or more 89.4 90.5 95.2 67.8 60.4 87.6 56.5 57.1 96.6 95.7 1557 i i , i i i , i ~ u Total 73.6 79.6 81.9 73.6 57.6 74.5 48.6 54.5 77.1 79.3 11884 proportion (22 to 69 percent) answered "don't know," when asked about problems in using methods. It is likely that many of the women in the latter category should be included in the former, since "don't know" could be interpreted as either that the respondent does not know of any problems (therefore they do not exist--"no problem"), or that she does not know enough about the method to give an answer about problems with it. Of those reporting perceived problems with methods, "health concerns" is the largest category. One out of three women who know of the pill and roughly one in five women who know of the IUD and injection reported health-related concerns as the main problem with using these methods. Comparatively few women found methods to be ineffective or inconvenient. Ineffectiveness was cited more frequently as a problem for periodic abstinence, the IUD, withdrawal, and condom, than it was for other methods, while inconvenience was mentioned more frequently for periodic abstinence, withdrawal, and condom. In interpreting the data in Table 3.9, one should keep in mind that the question on perceived problems with methods also measures the depth of knowledge about the methods. It is likely that many women who have heard of a method do not really know much about it and are lhus more likely to answer "don't know" to the question. Thus, the larger proportion of women reporting problems for the better- known methods such as pill, IUD and injection may merely reflect the fact that they are better known-- not that women think of them as causing more problems than other methods. Furthermore, it appears that respondents think in terms of the more "physical" aspects of problems in using methods, e.g., health 25 Table 3.9 Percent d i s t r ibut ion of ever -n~rr ied women by main problem perceived in using par t i cu la r fami ly p lann ing methods, according to method known, HICPS, 1987 Main problem In jec - perceived N i t : IUD t ion No problem 41.2 ! 35.6 38.8 Not e f fec t ive 1.3 i~ 6 .6 1.2 Husband disapproves 0.1 i 0 .5 0.1 Health concerns 33.4 i 21.2 23.4 Access /ava i lab iL i ty 0.0 0.0 0.1 Costs too much 0.0 0.0 0.4 Inconvenient 0.6 1.3 0.8 Re l ig ious/mora l 0.0 0.1 0.0 Other 1.2 1.1 2.0 Don't know 22.0 33.5 33.0 Missing 0.2 0.1 0.1 Total 100.0 100.0 100.0 wo~en who know method 10705 9633 9873 Family planning mthod known Dia l - ; Female Male Period ragm/ I ster- i ster- ic ab- foam/ i t i za - , i l i za - Nor- s t in - With- j e l l y Cond~ t ion t ion pLant ence drawaL i i 15.8 19.2 41.3 37.5 28.5 40.0 33.4 2.0 4.8 2.0 0.7 0.6 12.8 5.4 0.7 2.3 0.3 0.9 0.0 1.0 6.9 5.3 1.0 5.0 2.8 4.9 0.1 1.2 0.7 0.0 0.0 0.0 0.1 0.0 0.0 0.2 0.0 0.5 0.7 0,6 0.0 0.0 4.1 4.7 0.4 0.9 0.4 6.2 4.6 0.0 0.1 0.2 0.3 0.3 0.0 0.2 1.3 4.2 2.2 1.5 0.7 2.2 11.3 69.2 63.4 47.9 54.5 63.4 37.4 35.5 0.7 0.3 0.2 0.2 0.4 0.3 1.5 i i i i i i 100.0 100.0 100.0 100.0 100.0 100.0 100.0 449 7597 6102 3072 3470 2460 1742 concerns, ineffectiveness, and inconvenience, as opposed to problems of cost, availability, and religious or moral objections. Although it is tempting to conclude that cost, disapproval of husbands, access/availability, and religious objections are not obstacles to contraceptive use in Indonesia, data on reasons for nonuse (see Chapter 5) give a somewhat different picture. In order to ascertain whether women know which methods are best for limiting or spacing births, the NICPS included two questions: "If a woman wants to delay the next birth, which method do you think would be best for her to use?" and "If a woman has all the children she wants, which method do you think would be best for her to use?" The results are given in Table 3.10. TabLe 3.10 Percent distribution of ever-married women by the method they think best to use to delay or limit births, HICPS, 1987 Method P i i t IUO In jec t ion Condom Best for Best for de lay ing l im i t ing b i r ths b i r ths 30.7 18.7 21.2 15.1 20.8 13.8 1.4 0.8 Female s ter i l i za t ion MaLe s ter i l i za t ion Norptant Periodic abstinence Withdrawal Prolonged abstinence Herbs (Jamu) Abdominal massage (P i ja t ) Other Don=t know 0.5 0.0 0.7 1.1 1.0 0.3 2.2 0.4 1.0 18.7 21.9 0.7 0.7 0.4 0.6 0.4 1.6 0.4 0.7 24.2 Total 100.0 100.0 Number of women 11884 11884 26 Most women (70 percent) think that the pill, IUD, or injection is best for spacing births, despite the fact that the program recommends that the IUD be used only when women have all the children they want. Almost one in five women says she doesn't know which method is best for spacing births. While 22 percent of women identify sterilization as a good method for women who do not want more children, substantial proportions say that the pill (19 percent) and injections (14 percent) are best for this purpose. Almost one in four women does not know which method is best for limiting births. It appears that more education about methods appropriate for different circumstances might be useful in Indonesia. Two types of mass media used to disseminate information about family planning in Indonesia are radio and television. Programs include spot shows, dramas, reports, discussions, and regular series. Some are aired monthly, while others are periodic. As shown in Table 3.11, 72 percent of respondents did not hear or see a family planning message on radio or television in the month before the survey. One possible reason for this high percentage is that many family planning messages are inserted into reports on other development activities such as agriculture, health, rural development, and transmigration. Most women who reported having seen or heard a family planning message in the previous month said that they saw or heard a message more than once. Exposure to family planning messages is higher among urban women, and women in Jakarta, Yogyakarta, and West Java. Level of education is directly related to exposure to family planning messages--the higher the education, the greater the likelihood that a woman has heard or seen a message. Another important means of disseminating family planning information (and providing motivation and services) in Indonesia is the family planning field worker system, which operates in all parts of the country. Field workers focus their efforts on motivating family planning use, providing family planning information and recording service statistics. An important aspect of the field worker's job is Table 3.11 Percent d i s t r ibut ion of ever -marr ied women by the number of t imes they heard or saw a message about fami ly p lanning on rad io or te lev i s ion in the s ix months pr io r to survey, according to background character i s t i cs , NICPB, 1987 Background characteristic Residence Urban Rural Region Java-Bal i Outer Java-Bal i I Outer Java-Bal i I I Province Jakarta West Java Central Java Yogyakarta East Java Bal i Number of times heard message Total More than Never Once once 61.0 10.0 29.0 76.7 6.9 16.4 73.0 8.0 19.0 70.6 7.0 22.4 74.5 8.5 17.0 54.0 10.5 35.5 67.8 10.6 21.6 73.3 8.9 17.8 67.9 6.3 25.8 82.6 4.5 12.9 76.3 5.5 18.2 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 NufdDer of women 3272 8612 7962 3430 492 600 2405 2096 226 2433 202 Education None 88.0 4.3 7.7 100.0 2760 Some primary 76.3 7.6 16.1 100.0 4788 Primary completed ~.0 8.9 25.1 100.0 2779 Secondary or more 44.0 12.4 43.6 100.0 1557 Total 72.4 7.7 19.9 100.0 11884 27 institutionalization, or working through community organizations such as the mothers' clubs, religious groups, women's movement (PKK), and the organization for wives of civil servants (Dharma Wanita). Through such groups, field workers introduce family planning and maintain motivation by such things as initiating income-generating programs and rewarding long-term users, etc. As shown in Table 3.12, one out of five currently married women reported that she was visited by someone from the family planning program in the previous six months. Although this appears low, it should be mentioned that field workers are not expected to visit all the women in the areas assigned to them, as the number is too large. The data indicate that field workers visited more than one out of four contraceptive users in the six months before the survey. Since pill and condom users comprise roughly one- third of all users (see Chapter 4), this suggests that field workers are successfully fulfilling their function to support current users. However, only about one in seven nonusers was visited by someone from the program in the previous six months, which implies that field workers are relying on their institutional contacts to fulfill their motivational functions. The largest differentials in field worker visits occur by place of residence. Women in Java-Bali are almost twice as likely to have been visited by a field worker as women in Outer Java-Bali I or Outer Java- Bali 1I. Within Java-Bali, Central Java has by far the highest level of field worker visits, with 45 percent Tabte 3.12 Percent of currentty married women who have been v is i ted by a famity planning f ie td worker in the 6 months pr ior to the survey, by background variabtes and current contracep- t ive use status, NICPS, 1987 Famity ptanning use status ,Number Background : Not of character ist ic Using using Total wc~en Age 15-19 24,4 13.1 16.0 600 20-24 26.1 18.5 22.1 1888 25-29 25.7 17.6 22.0 2406 30-34 26,9 15.4 22.2 1979 35-39 25.8 16.0 21.4 1543 40-44 27.8 13.7 19.7 1271 45-49 27,4 11.6 15.4 1220 Residence Urban 24.9 16.8 21.2 2977 Rural 27.0 15.0 20.4 7930 Region Java-Bali 29.9 18.8 24,5 7265 Outer Java-Bali | 17.1 9.7 12.8 3191 Outer Java-gati 1! 20.0 10.7 14,4 451 Province Jakarta 11.1 7.4 9.4 543 West Java 24.6 14.8 19,3 2208 Centra[ Java 51.3 37.7 45.0 1934 Yogyakarta 30.0 20.0 26.8 207 East Java 21.8 10.7 16.3 2182 Bali 11,5 9,6 I0.9 191 Education Bone 22.1 10.5 14.3 2406 SOme primary 23.8 15.9 19.6 4426 Primary conxoleted 31.8 20.5 26.6 2605 Secondary or more 27.2 17,3 23.6 1470 Tota[ 26.3 15.4 20.6 10907 28 Table 3.13 Percent of ever-ntarriod and currently married worsen who have ever used specifiod family planning methods, by age, NICPS, 1987 Fa~nity ptanning method ever used Diaph- Female Mate Period Prot- Abdo- i Any ragm/ ster- ster- ic ab- ongecl Herbs minat NO. Any modern tnjec- foam/ i t i za - i t i za* Nor- Abor- s t in - With- absti (Ja- mass- ' of Age method method P i t t IUO t ion je t ty Condon~ t ion t ion ptant t ion ence drawat nence mu) age Other women Ever-married goe)en 15-19 35.6 32.7 21.6 5.4 9.7 0.0 0.5 0.0 0.0 0.2 0.0 0.8 2.1 0.3 0.7 0.3 0.0 635 20-24 62.0 58.2 32.0 16.2 23.6 0.0 3.3 0.6 0.0 0.4 0.1 2.5 4.2 0.3 2.1 0.6 0.3 1998 25-29 71,3 67.5 40,0 22.4 24.9 0.2 5.3 1.2 0.1 0.6 0.5 4.5 5.2 0.5 2.7 0.6 0.3 2520 30-34 72.8 69.9 44.1 26.2 22.9 0.2 8.7 3.6 0.3 0.4 0,5 5.7 5.9 0.7 3.2 0.6 0.4 2110 35-39 68.4 64.4 40.8 25.0 17.5 0.4 8.7 6.5 0.2 0.5 0.9 5.3 5.8 0,6 3.8 1.4 0.5 1690 40-44 56.7 52.5 33.4 18.7 10.0 0.1 6,4 4,7 0.3 0.3 0.3 5.2 4.2 0.8 3.3 1.3 0.3 1430 45-49 40.4 35.5 20.6 14.1 5.4 0,3 5,1 3,9 0,2 0.1 0.4 3.9 2.9 0.7 3.4 1.5 0.6 1501 l , , , , , , , , , , Totat 62.0 58.2 35.3 20.0 18,2 0.2 5.9 3.0 0.2 0.4 0.4 4.3 4.7 0.6 2.9 0.9 0.4 11884 I Currentty Married Wo~en 15-19 36.4 33,4 21.7 5.7 10.3 0.0 0.5 0.0 0.0 0.3 0.0 0.9 2.1 0.4 0.7 0.4 0,0 600 20-24 63.9 60.3 33.0 16,9 24.3 0,0 3.5 0.7 0.0 0.4 0.1 2.5 4,4 0.3 2.1 0.6 0.3 1888 25-29 73.1 69.3 41.1 22.8 25.7 0.2 5.5 1.2 0.1 0.6 0.6 4.8 5.5 0.5 2.8 0.7 0.3 2406 30-34 75.4 72.4 45.6 27.3 ' 23.9 0.2 9.2 3.7 0.3 0.5 0.5 6.0 6.2 0.7 3.2 0.7 0.5 1979 35-39 71.3 67.3 42.1 26.6 18.9 0.4 9.3 6.8 0.2 0.6 0.9 5.8 6.1 0.6 3.8 1.4 0.5 = 1543 40-44 60,8 56.7 36.2 20.3 10.8 0.1 7.0 5.1 0.3 0.3 0.4 5.8 4.5 0.8 3.0 1.4 0,3 i 1271 45-49 43.8 39.3 22,8 15.7 6.2 0.4 5.9 4,7 0.3 0.1 0.5 4,1 3.3 0.8 3.1 1.5 0.7 1220 Totat 65.0 61.2 37.0 21.1 19.4 0.2 6.3 3.1 0.2 0.4 0.5 4.6 5.0 0.6 2.8 0.9 0.4 10907 of women having been visited; Jakarta with 9 percent and Bali with 11 percent, have the lowest levels. Also, better educated women are somewhat more likely than less educated women to have been visited by a member of the family planning program. 3 .4 Ever -Use o f Fami ly P lann ing Methods For each method that a respondent said she had heard of, she was also asked if she bad ever used it. As shown in Table 3.13, 62 percent of ever-married women and 65 percent of currently married women have used some method of family planning. Almost all of those who have used family planning have used a modern method at some time. Reflecting the same pattern as knowledge of methods, the pill is by far the most common method ever used, with 35 percent of ever-married women indicating they have used it. The next most widely used methods are the IUD and injection, with respectively, 20 and 18 percent of ever- married women reporting use. Much smaller proportions of women report having used other methods-- condom (6 percent), withdrawal (5 percent), periodic abstinence (4 percent) and female sterilization (3 percent). Less than one percent of ever-married women have used diaphragm, foam, jelly, male sterilization, Norplant, or abortion. Ever-use is highest in the middle age groups for all methods. Table 3.14 shows the variation in ever use of any method and of any modern method by background characteristics of ever-married women. As expected, ever-use is higher among urban women and women in Java-Bali, where the government program was first introduced. The lack of a difference between women in Outer Java-Bali I and Outer Java-Bali II may be caused by the fact that the survey omitted some of the more logistically difficult provinces in the latter region, which also have presumably lower rates of ever use. Table 3 .14 Percent of ever -marr ied women who have ever used any method, and any modern method by background character i s t i cs , NICPS, 1987 Percent who ever used: Number Background Any Any modern of characteristic method method women Residence Urban 67.1 62.2 3272 Rural 60.1 56.7 8(>12 Region Java-Bali 64.8 62.5 7962 Outer Java-Bali I 56.4 49.5 3430 Outer Java-Bali II 55.9 49.8 492 Province Jakarta 65.6 61.7 600 West Java 64,7 62.7 2405 Central Java 67.8 66.3 ; 2096 Yogyakarta 79.6 69.0 il 226 East Java 59.9 57.5 j 2433 Bal i 77.4 76.1 202 I Education Bone 44.0 41.7 2760 Some primary 63.5 59.5 4788 Primary con~)leted 69.0 65.4 2779 Secondary or more 77.0 71.1 1557 No. of living children None 15.6 13.2 1225 I 55.6 i 51.9 2327 2 71,0 67.8 2420 3 73.0 69.3 ! 1984 4 or more 69.1 64.6 3928 Total 62.0 58.2 11884 30 The highest level of ever use is in Yogyakarta, where 80 percent of ever-married women have used some method of family planning; Bali shows the highest level of use of any modern method (76 percent). East Java shows the smallest proportion of ever-users, both for any method and for any modern method. As expected, both education and the number of living children have a strong positive correlation with ever use of family planning. The number of living children at the time of first use of family planning is a useful indicator of the acceptance of the small family norm and of the adoption of family planning for spacing purposes. Table 3.15 presents the percent distribution of ever-married women by the number of living children at the time they first used family planning, according to current age. The data indicate a dramatic shift in the timing of first contraceptive use. Only one percent of ever-married women 45-49 first used when they had no children, compared to 15 percent of women 15-19. The proportion of women who first used when they had no child or one child has increased from 6 percent of women 45-49 to 46 percent of women 20-24. Since most Indonesian women want at least two children (see Chapter 7), those who use contraception before having two children are presumably doing so to space their births. This pattern is indicative of the change from viewing contraceptive use as primarily a means to limit family size to viewing it as a means to space children. The increase in initiation of use with only 2 or 3 living children may also indicate a change towards smaller family norms. A basic knowledge of the reproductive cycle and the fertile period are important for the successful practice of periodic abstinence. Table 3.16 presents the distribution of all ever-married women and those women who have ever used periodic abstinence by the time during the ovulatory cycle that they think a Table 3.15 Percent d i s t r ibut ion of ever -marr ied women by number of l i v ing ch i ld ren at t ime of f i r s t use of fami ly plann ing , according to current age, NICPS, 1987 age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Number of l i v ing ch i ld ren Number of used None 1 2 3 4+ Total women 64.4 14.8 18.9 1.8 0,I 0.0 100.0 635 38.0 7,5 38.0 13.3 2.7 0.5 100.0 1998 28.7 ; 3.7 31.1 21.5 10.5 4.5 100.0 2520 27.2 1.8 19.0 20.4 14.8 16.8 100.0 2110 31.6 1.8 11.9 13.5 14.0 27.2 100.0 1690 43.3 1.0 7.1 8.0 9.1 31.5 100.0 1430 59.6 1.0 5.1 3.2 3.8 27.3 100.0 1501 38.0 3.6 20.6 13.8 8.9 15.1 100.0 11884 Table 3.16 Percent d i s t r ibut ion of ever -marr ied women and women who have ever used per iod ic abst inence by knowledge of the fe r t i l e per iod dur ing the ovu la tory cyc le , NICPS, 1987 Ever- Per iod{c marr ied abst inence Fer t i l e per iod women users During her per iod 0.1 0.0 Just af ter her per iod has ended 30.6 32.1 Midd le of the cyc le 18.0 52.4 Just before her per iod begins 7.1 6.7 At any t ime = 4.2 1.7 Other 0.8 1.0 Donlt know 39.2 6.1 I I Total 100.0 100.0 Number of women 11884 513 31 woman is most likely to get pregnant. The data indicate that knowledge of the reproductive cycle is very limited. Almost 40 percent of all ever-married women say that they do not know when the fertile period is and only 18 percent gave the "correct" response ("in the middle of the cycle"). Women who have used periodic abstinence, however, are considerably more knowledgable about their reproductive cycles. Over half of these women know when they are most fertile, and only 6 percent said they did not know. It should be noted the response categories developed for this question are one attempt at dividing the ovulatory cycle into distinct periods. It is possible that women who gave an answer of, say, *one week after her period* were coded in the category "just after her period has ended,* instead of in the category *in the middle of her cycle." Thus, women may actually have a more accurate understanding of their fertility cycles than is reflected in Table 3.16. 32 4. CURRENT USE OF FAMILY PLANNING METHODS This chapter is especially useful for the National Family Planning Program, because an important measure of program success is the level of family planning use. Use in this context is defined as the proportion of currently married women 15-49 who were using some method of family planning at the time of the survey. This chapter presents data concerning levels and differentials in current use, sources of family planning methods, age at time of first contraceptive use, cost of methods, and some indication of the quality of pill, injection, and condom use. 4.1 Cur rent Use o f Fami ly P lann ing Methods Table 4.1 shows that 48 percent of currently married women are using contraception in Indonesia, 44 percent using modern methods and 4 percent using traditional methods (periodic abstinence, withdrawal, and other methods such as pijat, herbs, and abstinence). As with ever-use, the pill (16 percent), IUD (13 percent), and injection (9 percent) are the most commonly used methods, together accounting for over 80 percent of current users. Other contraceptive methods account for lower percentages--female sterilization (3 percent), condom (2 percent), periodic abstinence and withdrawal (1 percent each), and male sterilization and Norplant (less than 1 percent each). The high proportion of modern method use is true for virtually all categories of background characteristics; however clear differences in the overall level of use are observed among subgroups. Younger and older women are less likely to be using contraception than women in the mid-childbearing years; the highest rate of use is reported for women aged 30-34 (59 percent). The pill and injection are more common among younger women (15-30 years), whereas the IUD, condom, male sterilization, and female sterilization are more commonly used by women over 30. Family planning use is higher among urban women than rural women (see Figure 4.1). Over half (54 percent) of currently married urban women are using a method, compared to 45 percent of rural women. The mix of methods also differs, with urban women relying more heavily on use of condoms, injection, female sterilization, and periodic abstinence, and rural women relying more heavily on the pill and the IUD. It is interesting to see that there is no difference between urban and rural areas in the proportion of women using Norplant. It is not surprising that contraceptive use is highest in Java-Bali (51 percent), intermediate in Outer Java-Bali I (42 percent) and lowest in Outer Java-Bali II (40 percent), since this is the order in which the family planning program was initiated. Women in Java-Bali tend to rely more heavily on the IUD, injection, and female sterilization than women in the outer islands. In the Java-Bali region, contraceptive use is highest in Bali and Yogyakarta, and lowest in West and East Java. Almost 70 percent of currently married women in Bali are using contraceptive methods, 97 percent of which are modern methods. This level of contraceptive use is similar to that found in more urbanized, industrial countries, such as Thailand and Brazil, where the prevalence rate is 66 percent (Chayovan, et al. 1988 and Arruda, et al. 1987). The mix of methods varies considerably by province. Interestingly, the provinces with the highest overall prevalence rate have the smallest proportion of pill users and those with the lowest prevalence rates have the highest proportion of pill users. For example, in Bali and Yogyakarta, pill users account for only 7 and 10 percent of contraceptive use, respectively, while in East and West Java, 36 and 39 percent of users depend on the pill. In Bali, almost half (49 percent) of currently married women--accounting for 72 percent of users--are using the IUD. Injection is the second most widely used contraceptive method in Bali. Yogyakarta shows a pattern similar to that in Bali, with the IUD predominating, and injection and the pill running a distant second and third. In Central Java and Jakarta, the IUD is also the most popular method, but the pill and injection follow more closely behind. Finally, in East and West Java, as already mentioned, 33 Table 4.1 Percent d i s t r ibut ion of cur rent ly marr ied women by fami ly p lanning method cur rent ly used, according to background character i s t i cs , NICPS, 1987 Family p lanning method cur rent ly used Female Mate Period Not Any s ter - s te r - ic ab- cur r - No. Background Any modern ln jec - i t i za - i l i za - Nor- s t in - With- ent ry of character i s t i c metho< method PJ i [ IUO t ion condom t ion t ion p lant ence drama[ Other us ing Total women Age 15-19 25.5 23.3 12.7 3 .7 6.5 0.1 0.0 0.0 0.3 0.1 0.9 1.2 74.5 100.0 600 20-24 47.2 43.8 17.0 10.8 13.8 1.1 0.7 0.0 0.4 0.9 1.2 1.3 52.8 100.0 1888 25-29 54.0 50.1 21.0 12.8 13.2 1.2 1.2 0.1 0.6 13 1.2 1.4 46.0 100.0 2406 30-34 58.7 54.0 19.8 17.2 10.1 2.6 3.7 0.2 0.4 13 1.9 1.5 41.3 100.0 1979 35-39 55.9 51.0 15.1 17.8 8.1 2.5 6.7 0.2 0.6 1.6 1.2 2.1 44.1 100.0 1543 40-44 42.7 38.2 13.1 13.6 4.1 1.7 5.1 0.3 0.3 1.8 1.1 1.6 57.3 100.0 1271 45-49 24.4 22.7 4.7 9.8 2.3 0.9 4.6 0.3 0.1 0.4 0.7 0.6 75.6 100.0 j 1220 i i i i i i i i i i i [ h i I Residence Urban 54.3 48.1 12.6 12.9 11.8 4.2 5.9 0.3 0.4 2.8 1.4 2.0 45.7 100.0 2977 Rural 45.3 42.3 17.4 13.3 8.4 0.6 2.1 0.I 0.4 0.6 1.2 1.2 54.7 100.0 7930 Region Java-Bal i 50.9 48.1 16.0 15.5 10.7 1.8 3.5 0.2 0.4 1.1 0.7 1.0 49.1 100.0 ! 7265 Outer Java-Bal i I 41.7 35.7 16.2 8.7 6.6 1.1 2.6 0.0 0.5 1.3 2.5 2.2 58.3 : 100.0 ! 3191 Outer Java-Bali II 39.6 33.8 15.3 8.4 7.1 1.4 1.5 0.1 0.0 2.0 1.8 2.0 60.4 100.0 451 Province Jakarta 54.0 48.5 10.6 14.8 11.7 4.9 5.7 0.4 0,4 3.3 0.4 1.8 46.0 100.0 543 West Java 45.8 43.3 18.0 8.8 13.3 0.8 2.2 0.1 0.1 1.1 0.5 0.9 54.2 100.0 2208 Central Java 53.5 51.8 15.3 18.8 10.8 2.3 3.6 0.5 0.5 0.6 1.0 0.1 46.5 100.0 1934 Yogyakarta 68.1 55.7 7.0 31.3 7.3 4.1 5.1 0.9 0.0 4.5 2.6 5.3 31.9 100.0 207 East Java 49.8 47.5 17.8 15.1 8.5 1.5 3.8 0.0 0.8 0.6 0.5 1.2 50.2 100.0 2182 Bali 68.5 66.5 5.0 49.1 5.8 1.6 4.6 0.4 0.0 1.4 0.0 0.6 31.5 100.0 191 Education I None 32.8 ~ 31.3 14.4 10.2 4.5 0.4 1.4 0.0 i 0.4 0.1 0.5 0.9 67.2 100.0 2406 Some primary 46.8 43.4 18.3 12.2 9.2 0.8 2.4 0.1 I 0.4 0,6 1.2 1.6 53.2 100.0 4426 Primary completed 54.0 49.7 16.3 14.0 12.9 1.7 4,2 0.3 i 0,3 1.5 1.2 1.6 46.0 100.0 2605 Secondary or more 64.1 56.0 11.5 19.9 11.7 5.8 6.2 0.5 0.4 4.2 2.6 1.3 35.9 100.0 1470 i No. of t i r ing ch i ld ren None 7.7 6.5 5.6 0.3 0.4 0.2 0.0 0.0 0.0 0.7 0.2 0.3 92.3 100.0 1053 I 42.9 39.7 17.7 11.1 9.5 1,0 0.2 0.1 0.1 1.1 i 1.0 1.1 57.1 100.0 2101 2 56.8 52.9 20.6 16.6 12.0 1.5 1.4 0.2 0.6 1.1 1.6 1.2 i 43.2 100.0 2245 3 60.4 55.6 18.4 18.4 11.5 2.7 3.8 0.1 0.7 1.4 1.5 1.9 39.6 100.0 1840 4 or more 50.2 45.6 14,1 13.5 9.1 1.8 6.4 0.3 0.4 1.3 1.3 2.0 49.8 100.0 3668 Total 47.7 44.0 16.1 13.2 9.4 1.6 3.1 0.2 0.4 1.2 1.3 1.2 52.3 100.0 10907 Note: No cur rent users of diaphragm, foam, or je l l y were reported in the survey. P e r c e R t 7O 5O 40 30 20 ]0 54 Figure 4.1 Current Use of Family Planning by Residence and Education Currently Married Women 15-49 0 Urban Rural None Some pr Primary Secondary Residence Education the pill takes precedence. Aside from these three methods, no more than about five percent of women are using any other method in any of the provinces. Contraceptive use increases with level of education. One-third of currently married women with no education are using a method, compared to two-thirds of those with secondary education. While pill use does not vary much by education level, use of almost all other methods is higher for better educated women. Traditional methods also account for a higher proportion of users among the better educated women than among less educated women. As with age, contraceptive use increases rapidly with the number of living children a woman has, however it reaches a peak among wome0 with 3 children, after which it declines among women with 4 or more children. Eight percent of childless women are using, presumably to space their first birth. They tend to rely almost exclusively on the pill. As the number of children increases, the reliance on the pill diminishes relative to the IUD and injection. Use of female sterilization also increases with number of children. Some idea of the extent to which .contraceptive practice has changed in Indonesia over the past decade can be seen in Table 4.2 and Figure 4.2 which show the contraceptive prevalence rates for the provinces of Java-Bali in 1976 and 1987. In the 11 years between the two surveys, contraceptive use has doubled, from 26 to 51 percent. The greatest increase has occurred in West Java, which, despite the increase, still has the lowest rate in both years. As Table 4.3 indicates, most of the difference in the overall levels of use between 1976 and 1987 can be attributed to increased use of injection, the IUD, and female sterilization. 35 Table 4.2 Percent of currently married wocnen in Java-Bali who are currently using any family planning method by province, 1976 Indonesia Fer t i l i ty Survey and 1987 NICPS Ratio 1976 1987 1987/ Province IFS NICPS 1976 Province Jakarta 28 54 1.9 West Java 16 46 2.9 Central Java 28 54 1.9 Yogyakarta 40 68 1,7 East Java 32 50 1.6 Bali ]8 69 1.8 Total 26 51 2.0 Source: Central Bureau of Statistics, 1978, Table 5.6. Figure 4.2 Family Planning Use 1976-1987 Current ly Mar r ied Women 15-49 J akar ta West Java Cent ra l Java Yogyakar ta East Java Bali 0 10 20 30 40 50 60 70 Percenl 19/6 rFS ~ 1987 NIOPS T k. 8O 90 100 36 Table 4.3 Percent of cur rent ly married women in Java- Bal i cur rent ly using fami ly planning methods, 1976 Indonesia Fer t i l i ty Survey and 1987 NICPS 1976 1987 Method iFS NICPS Any method P i l l IUD In jec t ion Diaphragm/foam/jel ly Condom Female s ter i l i za t ion Male s ter i l i za t ion NorpLant Periodic abstinence Withdrawal Other 26.3 14.9 5.6 0.2 0.1 1.8 0.3 0.0 0.8 0.3 2.3 50.9 16.0 15.5 10.7 0.0 1.8 3.5 0.2 0.4 1.1 0.7 1.0 ~unioer of women 7974 7265 Source: Carrasco, 1981, Table 4.1. Table 4.4 Percent d i s t r ibut ion of cur rent ly merriod women by type of fami ly planning method cur rent ly used, age, and number of l i v ing chi ldren according to region, NICPS, 1987 Region Age/number of l i v ing Outer Outer ch i ld ren/ type of method Java- Java- Java- used Bali Bali I Bal i 1! Total Under 30 Not using any method I 48.3 59.5 62.7 52.1 Using ten~oorary methods 37.0 32.9 30.0 35.5 Using long-term methods 14.7 7.6 7.4 12.3 30 or over Not using any method 49.7 57.4 58.2 52.3 Using temporary methods 26.5 27.7 29.3 27.0 Using tong-term methods 23.7 14.9 12.6 20.7 Fewer than 3 chitdren Not using any method 50.6 60.2 62.4 53.5 Using ter~porary methods 31.7 31.0 28.5 31.4 Using long-term methods 17.7 8.8 ; 9.1 15.1 Three or more ch i ldren Not using any method 45.4 55.8 57.4 49.8 Using ten~oorary methods i 30.1 28.6 31.3 29.6 Using Long-term methods 24.5 15.7 11.3 20.5 Total Not using any method 49.1 58.3 60.4 52.3 Using temporary methods 31.3 30.0 29.6 30.8 Using Long-term methods 19.6 11.7 10.0 16.9 Total I00,0 100.0 100.0 I00,0 Note: Long-term methods are male or female s ter i l i za t ion , Norplant and IUO, whi le temporary are a l l others. 3"7 As mentioned in Chapter 1, the National Family Planning Program's policy toward contraceptive use is based upon its "Pancakarya" (five principles), a set of guidelines for maintaining the family planning program. One of the principles involves a specific goal for family planning use, namely, that women over 30 and those with 3 or more children should be using the most effective means of fertility control available. Table 4.4 presents some NICPS data that can be used to evaluate the success of this effort. The data show that for women 30 and over, only about 20 percent are using long-term methods, and over half are not using any method at all. The results for women with three or more children is very similar to that for women 30 and above--21 percent are using long-term methods and half are not using any method. These results are undoubtedly due to the relatively low rates of sterilization in Indonesia (3 percent of currently married women), since appropriate methods for women 30 and over and women with 3 or more children are the long-term methods such as sterilization, IUD, and Norplant. The Java-Bali region has been much more successful than the outer islands in getting women to use methods appropriate for their status. Twice as many women 30 and over in Java-Bali are using long-term methods than in Outer Java-Bali II. The same ratios apply for women with three or more children. Figure 4.3 shows the relationship between knowledge and use of family planning among Indonesian women. While 95 percent of married women know at least one contraceptive method and 93 percent know of a source for contraceptives, only 65 percent have ever used a method and only 48 percent are currently using. The proportion of women who know about family planning and know a source but have never used any method is relatively high--28 percent. Figure 4.3 Family Planning Knowledge and Use Current ly Mar r ied Women 15-49 100 90 80 70 60 50 40 30 20 10 0 Knows Method ihOws b~ource X 48 Ever Used Family P lanning / / urr ni l Usin P annln8 38 4.2 Sources o f Cont racept ive Methods Information concerning sources of contraceptive services is important for family planning administrators, especially given the current emphasis on making programs self-sustaining. As shown in Table 4.5 and Figure 4.4, family planning clinics, hospitals and health centers are the most important source, supplying 57 percent of all users. Family planning posts provide 13 percent of services, family planning field workers supply 5 percent, and integrated service posts (posyandu) account for 4 percent of all users. Private sources include doctors (6 percent), midwives (4 percent), and pharmacies and shops (3 percent). Sources vary by the method used. Pill users rely on clinics, hospitals and health centers, but also are likely to use family planning posts considerably more than users of other methods. Family planning posts include village family planning posts, which in Bali are carried out through "Banjar," and in other regions through women's clubs with various names. This means that community participation in delivering the pill is high. The proportion of pill users whose source is "other" is high as well (17 percent). It is unclear what this category might consist of, except possibly friends or relatives. Surprisingly, less than 2 percent of pill users obtain their supplies from pharmacies or shops. On the other hand, most condom users are supplied by pharmacies, with hospitals and clinics the second most widely used source. Users of injection, IUD, sterilization and Norplant primarily use clinics, hospitals and health centers. Private doctors and midwives supply about one in 4 injection users, while mobile clinics supply one in 10 Norplant users. Private sources of supply are mentioned more frequently by urban users than by rural users. As illustrated in Table 4.5, 22 percent of urban users indicate private doctors, midwives, or pharmacists to be Figure 4.4 Source of Family Planning Supply Current Unre Hosp i ta l / c l in i c 57 O lher 18% ~ete sources 1255 Family p lanning post 13% 39 their source of family planning, as opposed to 7 percent of rural respondents. In addition to private sources being more available in urban areas, this may reflect the national family planning program's recent efforts to market the use of private providers for family planning services in the urban areas. Also, probably due to greater availability and accessibility, clinics and hospitals were more frequently mentioned by urban than rural respondents. Table 4.5 For a l l cur rent users of supply or c l in i c metheds, the percent d i s t r ibut ion by most recent source of supply or information, according to urban-rural residence and method, NICPS, 1987 Source of supply Urban Users Supply methods CLinic methods Female Male [n jec - s te r i l - s te r i l - Nor- Total P i l l Condom l ion Total IUB i za t ion i za t ion p lant Total users FP clinic/hospital/health center 49.7 20.9 62.8 50.9 70.5 88.1 91.5 73.3 76.2 61.2 FP fietdworker (PLKB) 4.9 3.5 1.0 3.1 0.1 0.0 0.0 0.0 0.I 1.9 FP post (Pos KB) 14.3 9.7 0.6 7.9 2.8 0.0 0.0 0.0 1.8 5.4 Mobile clinic (TKBK/TMK) 0.0 0.0 0.0 0.0 0.9 0.0 0.0 0.0 0.6 0.2 safari campaign drive 0.0 0.0 0.0 0.0 1.1 0.0 0.0 0.0 0.7 0.3 %ntegrated service post (posyaedu) 7.3 1.3 0.9 3.8 0.4 0.0 0.0 13.8 0.5 2.5 Pharmacy/shop 6.7 57.5 0.0 11.4 0.0 0.0 0.0 0.0 0.0 6.8 Private doctor 2.7 1.3 19.9 9.6 19.5 9.9 0.0 9.9 16.1 12.2 Private midwife 4.1 3.6 14.7 8.4 4.3 0.5 0.0 0.0 3.0 6.2 Other 10.2 1.6 0.0 4.7 0.4 1.4 8.5 0.0 0.8 3.1 Don't know 0.0 0.6 0.0 0.1 0.0 0.2 0.0 0.0 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 374 124 351 849 385 177 9 12 583 1432 Rural Users FP ciiniclhospitat/health center 25.8 28.7 66.1 38.7 77.8 98.8 100.0 59.7 80.2 54.4 FP fie[dworker (PLKB) 13.4 6.2 1.6 9.5 3.2 0.0 0.0 4.5 2.8 7.0 FP post (Pos KB) 33.5 9.3 4.7 23.7 5.6 0.0 0.0 4.2 4.8 16.6 Mobile clinic (TKBK/TMK) 0.3 0.4 0.9 0.5 1.6 0.0 0.0 13.6 1.7 1.0 Safari campaign drive 0.0 0.0 0.0 0.0 1.8 0.0 0.0 4.3 1.6 0.6 Integrated service post (posyaedu) 5.6 1.5 6.1 5.7 3.3 0.0 0.0 0.0 2.8 4.6 Pharmacy/shop 0.2 43.4 0.0 1.1 0.0 0.0 0.0 0.0 0.0 0.7 Private doctor 0.5 0.0 7.4 2.7 2.5 1.1 0.0 0.0 2.2 2.5 Private midwife 1.9 4.1 9.9 4.5 2.3 0.0 0.0 0.0 1.9 3.5 Other 18.9 3.6 2.4 13.3 1.6 0.1 0.0 13.6 1.7 9.0 Don't know 0.0 3.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1378 48 670 2096 1057 163 9 34 1263 3359 ALl Users FP clinic/hospital/health center 30.9 23.1 65.2 42.5 76.0 93.5 95.6 63.3 79.1 56.6 FP fieldworker (PLK@) 11.6 4.3 1.5 7.6 2.3 0.0 0.0 3.5 2.0 5.4 FP post (Pos KB) 29.3 9.6 3.3 19.2 4.9 0.0 0.0 3.2 4.0 13.3 Mobile clinic (TKBK/TMK) 0.3 0.1 0.6 0.4 1.4 0.0 0.0 10.3 1.3 0.7 Safar i campaign dr ive 0.0 0.0 0.0 0.0 1.6 0.0 0.0 3.5 1.3 0.5 Integrated service post (posyandu) 6.0 1.3 4.4 5.1 2.5 0.0 0.0 3.6 2.1 3.8 Pharmacy/shop 1.6 53.6 0.0 4.1 0.0 0.0 0.0 0.0 0.0 2.5 Private doctor 1.0 0.9 11.8 4.7 ~ 7.1 i 5.6 0.0 2.6 6.6 5.5 Private midwife 2.4 3.7 11.6 5.6 i 2.8 0.2 0.0 0.0 2.3 4.4 Other 16.9 2.1 1.6 10.7 ~ 1.3 0.5 0.0 10.2 1.3 7.1 Don't know 0.0 1.3 0.0 0.1 0.0 0.1 4.4 0.0 0.0 0.I Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Nun~oer 1752 172 1021 2945 1442 340 18 45 1846 4791 40 Another government program at the village level is the integrated health post (posyandu) which provides five services, including family planning, usually once a month. As expected, slightly more rural (5 percent) than urban users (3 percent) mentioned the posyandu as a source of family planning services. Also, as expected, family planning fieldworkers and village contraceptive distribution centers (FP post) were mentioned more frequently by rural respondents (24 percent) than urban (7 percent). As stated previously, satisfaction with contraceptive service is an important issue in retaining acceptors. In order to try to measure dissatisfaction with services, NICPS interviewers asked all current users if there was anything they disliked about the service they received at the last place they obtained their methods. Table 4.6 shows that 97 percent of users said they had no problem with the source of service. This is true for all service delivery types except mobile clinics, which had a large proportion in the "other" category. None of the specific problems listed, such as, discourteous staff, long waiting period for service, high cost, inability to get desired method, or use of male staff were cited by more than two percent of users. Table 4.6 Percent d i s t r ibut ion of cur rent users who obtained a method at a source by type of d i ssat i s fac t ion w i th the serv ice ( i f any), according to type of source las t v i s i ted , NICPS, 1987 Source of supply FP c l in i c /hosp i ta l /hea l th center FP f ie ld worker (PLKB) FP post tPos KB) Mobile cl inic (TKBK/TMK) Safar i campaign dr ive I n tegrated serv ice post (posyandu) Pharmacy/shop Pr ivate doctor Pr ivate midwife Total Nature of d i ssat i s fac t ion w i th serv ice Wait No too problem long I 97.0 1.3 97.3 0.6 99.3 0.1 76.1 1.2 100.0 0.0 96.9 0.0 95.3 0.0 99.0 1.0 98.5 0.2 I 97.4 Staf f Unable Number d is - to get of cour t - Expen- des i red Mate cur rent eous sive method s ta f f Other Total users 0.7 0.4 0.0 0.1 0.5 100.0 2702 0.0 0.3 1.3 0.0 0.5 100.0 259 0.0 0.0 0.1 0.0 0.5 100.0 636 0.0 0.0 I 22.7 100.0 35 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 25 i 1.5 0.7 0.8 0.0 0.1 100.0 189 0.0 0.0 1.5 0.0 3.2 100.0 120 0.0 0.0 i 0.0 0.0 0.0 100.0 261 0.0 0.0 0.0 0.7 0.6 100.0 207 I 0.9 0.5 0.3 0.2 0.1 0.6 100.0 4434 Although only 3 percent of currently married women have been sterilized, making it the fourth most widely used method, it is interesting to note changes over time in the age of women at the time they choose sterilization. Table 4.7 shows that, except for operations performed in the past two years, there has been a general decline in the median age of women at the time that they were sterilized, from 33 years for those sterilized 8 or more years ago, to 31 for those sterilized 2 or 3 years before the survey. Table 4.7 For s te r i l i zed women, the percent d i s t r ibut ion by age at the time of s te r i l i za t ion , according to the number of years s ince the operat ion, NICPS, 1987 Years Age at time of operation No. ~h,~c . of Median operation Under 25 25-29 30-34 35-39 40-49 Total women age Less than 2 13.2 12.8 42.8 23.2 8.0 100.0 72 32.5 2-3 11.6 30.1 36.2 13.8 8.3 100.0 86 30.6 4-5 8.5 23.9 38.8 18.3 10.4 100.0 66 31.5 6-7 3.1 27.1 38.2 22.2 9.4 100.0 36 31.7 8-9 3.5 14.3 38.9 43.0 0.3 I00.0 46 33.4 10 or more 3.4 20.3 59.8 16.5 i, 100.0 . 34 32.9 Total 8.5 21.8 41.0 21.8 6.9 100.0 340 32.1 - Data not ava i lab le due to cuto f f age of 49 in survey. 41 Table 4.8 is similar to Table 4.7 except that it shows the number of living children that sterilization acceptors had at the time of the operation instead of their age. The median number of children at time of operation shows an uneven pattern over time, with a slight decline recently. Women have about five children at the time they or their husbands are sterilized. It is interesting that 10 percent chose sterilization when they have only one or two living children. Table 4.8 For s te r i l i zed women, the percent d i s t r ibut ion by number of l i v ing ch i ldren at the time of s te r i l i za t ion , according to number of years since the operation, NICPS, 1987 Years Number of l i v ing chi ldren No. Median operation 1 2 3 4+ Total women chi ldren i Less than 2 2.0 16.5 23.5 58.0 100.0 72 4.4 2-3 0.0 9.3 22.6 68.1 100.0 86 4.8 4-5 0.0 2.4 26.2 71.4 100.0 66 5.3 6-7 0.0 17.5 17.5 65.0 100.0 36 4.8 8-9 0.0 3.3 14.6 82.1 100.0 46 5.9 10 or more 7.9 3.1 11.8 77.2 100.0 34 5.4 Total 1.2 8.9 20.8 69.1 100.0 340 5.0 4.3 Quality of Use of Pill, Injection, and Condom As stated previously, the pill is the most popular method of contraception used in Indonesia. In order to study the "quality" of pill use, the NICPS included a series of questions for women who said they were using pill. These women were first asked if they had a package of pills in the house. If not, women were asked why they did not have a package and were requested to identify the brand of pills they use from a brand chart that interviewers carried with them. If respondents said they did have a package of pills in the house, the interviewer asked to see one, from which she recorded the brand and noted on the questionnaire whether pills were missing in order. If either no pills were missing or pills were missing out of order, the interviewer asked why. Finally, all pill users were asked when they last took a pill. Table 4.9 shows results from some of these questions on the quality of pill use. About 94 percent of pill users were able to show the interviewer a packet of their pills. Although not included in the table, virtually all users who could not show a packet gave the reason that they had run out of supplies. Of the users who did produce a pill packet, 91 percent had pills missing in order. About 40 percent of women whose packets showed pills not missing or missing out of order said that the reason for this was that the packets were new, while the remainder of such women gave other reasons. It is rather disconcerting that only 87 percent of all pill users actually took a pill less than two days before the survey. Most women who had not taken a pill less than two days before said that the reason was either that they were having their menstrual periods or that they had run out of pills. A few women said they were not taking because their husbands were away. Although many of the women who have not taken a pill in the last two days can be considered to be still protected by the pill, the data imply that effective pill use is somewhat lower than the reported number of pill users. Differentials in quality of pill use by background characteristics are small. The only consistent difference is that quality of pill use appears to be higher in Outer Java-Bali II than in either Java-Bali or Outer Java-Bali I. As mentioned above, all pill users were asked about the brand of pill they used. As shown in Table 4.10, almost 90 percent of pill users are using a brand from the national family planning program (Pil Keluarga Berencana). The only other brands which have a sizable number of users are Marvelon-28 and Ovostat-28. 42 Table 4.9 Percent of cur rent ly married women p i t t users who have a packet at home, have taken p i l l s in order, and who took a p i t t tess than two days ago, by background character ist ics , N!CPS, 1987 Background character is t ic Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Percent using p i l l 12.7 17.0 21.0 19.8 15.1 13.1 4.7 Percent of p i l l users who can show package 97.4 95.4 93.3 96.2 89.3 91.9 89.3 Percent of packets with piLLs missing in order 92.2 92.8 90.7 90.4 90.7 90.5 96.2 Percent of pill users who took p i l l less than 2 days ago 92.9 90.1 85.7 87.8 83.9 86.6 90.1 Number of pill users 76 322 506 391 233 167 57 Residence urban 12.6 94.3 93.1 86.8 374 Rural 17,4 I 93.5 90.8 87.4 1378 i i Region Java-Bali 16.0 93.6 90.3 86.9 1166 Outer Java-Sati I 16.2 93.4 92.5 87.4 517 Outer Java-Bali I! 15.3 98.4 96,8 92.1 69 Province Jakarta 10.6 98.2 96.3 92.8 58 West Java 18.0 95.3 90.6 90.5 398 Central Java 15.3 90.4 88.7 82.5 296 Yogyakarta 7.0 85.1 95.5 73.9 15 East Java 17.8 93.7 89.9 86.2 389 Bal i 5.0 100.0 98.6 90.5 10 Education None 14.4 92.1 90.4 87.1 346 Some primary 18.3 94.9 91.6 89.1 811 Primary completed 16.3 92.6 90.5 84.8 426 Secondary or more 11.5 93,7 93.5 85.3 169 Total 16.1 93.7 91,2 87.3 1752 Table 4.10 Percent d i s t r ibut ion of cur rent ly married p i l l users by brand of p i l l used e NICPS, 1987 Brand of Number of p i t t Percent p i l l users Eugynon Microgynon 30 ED Neogynon ED Tr iqu i ta r ED Lyndiol Marvelon 28 Ovostat 28 Nordette 28 NordioL 28 Ovulen Fe-28 Ovulen 50 Fe-28 Pi t Keluarga Berenc. Other Don~t know, missing 0.3 0.7 0.5 0.3 0,2 2.7 1.4 0.2 0.1 0.1 0.2 89.1 3.5 0.7 5 12 8 6 3 48 25 3 2 2 3 1562 61 12 Total 100.0 1752 43 All current contraceptive users in the NICPS were asked whether they had experienced problems with the method they were using and if so, what the problems were. As Table 4.12 indicates, 90 percent or more of users of all methods did not report any problems with the methods they were using. Table 4.11 Percent of currently married women who are using injection and condom, percent of injection users who received an injection tess than three months ago, and percent of condom users who can show a packet, by background characteristics, N]CPS, 1987 Number of I n jec t ion users Condom users % of users i n jec ted Similar to questions on quality of pill use, NICPS interviewers asked all injection users when they received their last injection and all condom users to show a package of condoms. The results are shown in Table 4.11 by background characteristics of women. Ninety-four percent of injection users received an injection less than three months ago, which means that 6 percent of injection users may actually be at risk of pregnancy. Since one brand of injection used in Indonesia requires bimonthly inoculations, the proportion of women at risk may actually be slightly higher, although this brand is not as widely used as the three-month brand. Differences by background characteristics are small. Percent of users who Background Percent tess than in jec t ion Percent can show character i s t i c us ing 3 mos. ago users using package users Age 15-19 6.5 88.7 39 0,1 (50.0) 1 20-24 13.8 95.1 261 1.1 100.0 20 25-29 13.2 94.7 317 1.2 74.7 30 30-34 10.1 92.8 199 2.6 97.1 52 35-39 8.1 94.8 125 2.5 86.7 38 40-44 4.1 97.1 52 1.7 90.3 21 45-49 2.3 91.7 28 0.9 (92.5) 10 Residence Urban 11.8 94.5 351 4.2 88.5 124 Rural 8.4 94.2 670 0.6 94.1 48 Region Java-Bal i 10,7 95,8 777 1.8 92.8 132 Outer Java-Bal i | 6.6 89.2 212 1.1 79.6 34 Outer Java-Bal i I ! 7.1 91.5 32 1.4 (88.9) 6 Province Jakarta 11.7 94.5 64 4.9 94.8 27 West Java 13.3 98.1 293 0.8 (100.0) 17 Central Java 10.8 96.2 209 2.3 91.9 44 Yogyakarta 7.3 97.7 15 4.1 85.2 9 East Java 8.5 92.5 185 1.5 90.3 32 Bali 5.8 85.6 11 1.6 (92.9) 3 Education None 4.5 94.7 108 0.4 (100.0) 9 Some primary 9.2 94.9 405 0.8 79.9 34 Primary completed 12.9 94.5 336 1.7 89.2 44 Secondary or more 11.7 91.9 172 5.8 93.5 85 Total 9.4 94.3 1021 1.6 90.0 172 Note: Numbers in parentheses are based on fewer than 20 unweighted cases. The proportion of condom users who can show the interviewer a packet is surprisingly high (90 percent), considering that this is a method used by men. In interpreting the data, one should remember that the condom is not widely used in Indonesia, with less than 2 percent of currently married women relying on it. The most popular brands used are Young Young, KB, and DuaLima. Differences by background characteristics in the proportion of condom users who can show a packet are mostly caused by small numbers. Number of condom 44 Although the national family planning program is essentially a government program, it is strongly supported by community participation. One indicator of the level of this support is the "self-sustainability" of the community in the provision of contraceptive services. One means of measuring self-sustainability is the proportion of users who themselves pay for services. In the NICPS, all users were asked how much the method cost, including any costs for service. The results are given in Table 4.13. The data show that overall, 64 percent of users obtain their methods free of charge. The injection has the highest proportion of self-sustaining users, with only 28 percent of users getting the method free, followed by female sterilization (40 percent), condom (50 percent), Norplant (71 percent), IUD (76 percent), and the pill (84 percent). Generally, a larger percentage of women outside Java-Bali get their methods free. The data show that female sterilization is the most costly method, with a mean cost of Rp. 121,000, followed by the pill at Rp. 17,500, and the IUD at Rp. 15,000. Data on cost of methods should be regarded cautiously. Although the instructions were to put the cost of the method plus service costs, it is not always clear what the cost actually included; for example, users of supply methods, such as the pill and condom, might have given the cost of more than one month's supply. Also, it is particularly easy for interviewers and/or data entry clerks to be off by one column when entering the figures. Table 4.12 Percent distribution of current users by the type of problem experienced with the methed, according to method, NICPS, 1987 Problem experienced with method: N~- her Method HUB- Access Incon- of not bend HeaLth avail- Costs veni- curr- effec- disap- con- abit- too ent Don't ent Method None tive proves cerns ity much to use Other know Total users Pitt 91.9 0.0 0.0 7.2 0.2 0.0 0.1 0.2 0.4 100.0 1752 IUD 93.7 0.I 0.1 5.5 0.0 0.0 0.1 0.5 0.0 100.0 1442 Injection 89.9 0.1 0.0 9.0 0.0 0.0 0.0 0.9 0.I 100.0 1021 Condom 90.3 0.0 1.9 0.4 0.0 0.0 3.9 3.5 0.0 100.0 172 Female sterilization 91.7 0.0 0.0 7.2 0.0 0.1 0.0 1.0 0.0 100.0 340 Mate sterilization 89.9 0.0 0.0 8.9 0.0 0.0 0.0 1.2 0.0 100.0 18 Norptant 97.5 0.0 0.0 2.5 0.0 0.0 0.0 0.0 0.0 100.0 45 Periodic abstinence 97.0 0.2 0.2 0.0 0.0 0.0 2.1 0.5 0.0 100.0 127 ~Jithdrawat 92.0 0.0 0.0 0.I 0.0 0.0 2.4 5.5 0.0 100.0 136 Total 92.3 0.1 0.1 6.3 0.1 0.0 0.3 0.7 0.1 100.0 5207 Note: Excludes methods with fewer than 20 users ; to ta l inc ludes a l l users . Table 4.13 Percent of current users who get their method free and the mean cost of the method (including services) for those who pay, by method and region, NICPS, 1987 J ava -Ba l i Percent Mean Betting cost Method free (Rp.) = P i t t 83.2 11300 IUD 75.2 10960 I n jec t ion 25.3 1823 Condom 47.8 1385 Female ster. 35.9 68678 Norptant 82.9 * Total 61.6 8179 NO. of users 1166 443 775 115 83 31 2613 Outer J ava -Ba l i 1 Percent Mean No. getting cost of f ree (Rp . ) users 85.1 26082 516 78.2 29340 117 31.1 2489 212 57.3 * 26 52.2 * 24 45.4 * 14 69.3 26264 910 Outer Java- Ba l i I I * Percent NO. getting of free users 98.3 69 74.5 19 55.7 32 51.2 6 0 0 81.8 126 Note: Women who have been using IUD or female sterilization for more than three to keep cost estimates current. In 1988, U.S.$I = about Rp.1650. * Based on fewer than 20 cases. Total Percent Mean NO. get t ing cost o f f ree (Rp . ) users i 84.3 17502 1751 75.8 14956 579 27.5 1961 1019 49.6 1494 147 39.8 121230 107 70.9 * 45 64.2 12481 3649 years have been excluded 45 5. NONUSE AND INTENTIONS FOR USE OF FAMILY PLANNING This chapter covers information about those who are not using family planning (nonusers), whether or not they have used in the past. Four topics are discussed: reasons for discontinuing contraception, reasons for nonuse, intentions about using contraception in the future, and methods potential users intend to use. These issues are important to family planning decisionmakers in determining future policies. 5.1 Reasons for D iscont inuat ion and Nonuse Of primary importance to policymakers are the reasons why family planning users drop out. In the NICPS, data were collected for women who stopped using a contraceptive method within the five years before the survey on the reasons they stopped using. The percent distribution of women who discontinued family planning use by reason for discontinuing and by method discontinued is given in Table 5.1. As might be expected, the main reason for stopping use of family planning is to become pregnant. This is true for all methods except injection, for which the main reason for termination was health concerns. For the pill and the IUD, the second most common reason for discontinuation is health concerns. Nineteen percent of IUD discontinuation was due to method failure and it would be useful to know which brands of IUD had been used. It should be noted that, although the code was labeled *method failed," respondents may have interpreted outcomes other than pregnancy as failure, such as, for example, expulsion of the IUD. About 7 percent of women who stopped using injection said that they did so because of the high cost. This is interesting in view of the fact that, as discussed in Chapter 4, about one-quarter of current injection users obtain the method free and the other three-quarters pay on average about Rp. 2000. Not surprisingly, health concerns are less frequently cited as reasons for discontinuation of the condom, periodic abstinence, and withdrawal as they are for the pill, IUD, and injection. Instead, substantial proportions of women who discontinue the former three methods cite method failure, inconvenience, and husband disapproval as reasons for discontinuation. Method failure is also cited as a reason for discontinuing herbs. Tabte 5.1 Percent d i s t r ibut ion of women who have d iscont inued a n~thod in the las t f i ve years by main reason for las t d i scont inuat ion , NICPS, 1987 Period ic ab- Reason for In jec o s t in - With- Herbs d i scont inuat ion P i t t IUD t ion Condom ence drawal (Jamu) Other Total To become pregnant 39.3 30.6 22.2 29.3 40.1 49.0 44.4 30.9 33.5 Method failed 6.4 17.7 4.3 12.8 29.9 13.1 9.9 23.6 9.7 Husband disapproves 1.4 0.5 1.3 7.5 4.5 7.1 1,8 2.3 2.0 Health concerns 29.2 26.9 37.4 5.4 3.5 2.5 8.3 7.8 26.3 Access /ava i lab i l i ty 1.6 0.6 4.3 1.8 0.0 0.0 0.4 0.0 1.9 Cost too much 0.1 0,0 6.6 0.0 0.0 0.0 3.6 0.0 1.7 Inconvenient 3.4 2.2 3.5 15.8 10.2 7.3 0.9 2.8 4.2 Infrequent sex 1.4 0.5 0.9 2.8 1.0 0.9 2.0 0.3 1.1 Fatalistic 2.0 1.1 2.0 0.0 0.6 0.6 0.9 0.0 1.5 Other 14.5 18.5 16.9 24.1 10.2 19.5 25.3 29.2 17,3 Don't know 0.4 0.0 0.2 0.3 0.0 0.0 2.5 0,0 0.3 Missing 0.3 1.4 0.4 0.2 0.0 0.0 0.0 3.0 O.S Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1481 609 849 169 130 161 94 63 3611 Note: Total inc ludes data for methods which had fewer than 20 wo~nen d iscont inu ing . 47 Probably the best way of assessing obstacles to family planning use is to ask nonusers why they are not using; this was done in the NICPS. Table 5.2 gives the distribution of currently married, non-pregnant, nonusers by age and reason for nonuse. As with reasons for discontinuation discussed in the previous table, the major reason for nonuse is a desire to get pregnant. Overall, one-quarter of nonusers cite this reason. As expected, the proportion is greater among younger than older women. Excessive cost is the next most commonly given reason for nonuse, but this is important only among older nonusers and is mentioned by only a small proportion of younger nonusers. Similarly, inconvenience and religious constraints are cited more frequently by older than younger nonusers. On the other hand, difficulties in access and availability of contraception are mentioned more frequently by younger nonusers. Lack of knowledge and health concerns do not appear to be major reasons for nonuse. Drawing conclusions from the three questions used in the NICPS to attempt to identify obstacles to contraceptive use is not straightforward. Data in Table 3.8 imply that most women who have heard of methods do not think there are problems in using them, and the only commonly cited problem is health concerns about the pill, IUD, and injection. Health concerns are also frequently mentioned as reasons for discontinuing these methods (Table 5.1). However, among nonusers, health concerns are rarely cited as reasons for nonuse, while reasons such as access/availability, cost, and religion appear to be more important obstacles for nonusers than for women who discontinued methods or who were merely giving their opinions on methods they had heard of. In interpreting the results, it is important to keep in mind the denominators of the various tables and the wording of the questions. Respondents to the first question on perceived problems with methods were all women who had heard of the particular method. It seems they tended to focus on the more "physical" problems with using methods. Women who had used methods and stopped also tended to cite "physical" reasons for discontinuing. If access/availability, cost, or religion had been concerns, they would have been less likely to have started using in the first place, and thus would not tend to cite them as reasons for terminating use. On the other hand, these may be more important obstacles to those who are not using. Finally, all these data should be viewed cautiously since collecting accurate data on reasons for making decisions is difficult in a short, rather impersonal interview. TabLe 5.2 Among currently married non-pregnant nonusers, the percent distribution by reason for nonuse, according to broad age categories, NXCPS, 1987 Reason for nonuse Desires pregnancy Lack of knowledge Opposed to famity planning Husband disapproves Others disapprove Xnfrequent sexuaL activity Postpartum/breastfeeding Menopausal/subfecund Health concerns Access /ava i lab iL i ty Costs too much Fata l i s t i c Re l ig ion inconvenient Other Don't know Less than 20 Age 48.4 2.0 0.0 4.0 0.0 0.5 0.0 0.7 1.7 13.0 1.6 1.0 4.6 3.5 14.4 4.6 30 or over Total 15.1 24.3 4.1 2.9 0.6 0.5 4.9 5.3 0.2 0.3 0.7 0.9 0.6 0.4 2.0 1.6 2.1 2.2 4.3 9.7 17.9 11.8 0.7 0.7 10.9 8.9 11.1 9.8 18.1 15.1 6.7 5.6 100.0 100.0 2965 4954 20-29 36.0 1.0 0.5 6.3 0.6 1.4 0.0 1.0 2.4 18.6 2.8 0.6 6.3 8.7 9.8 4.0 Total 100.0 100.0 Number of women 328 1661 48 5.2 In tent ion to Use Cont racept ion in the Future All respondents who were not using contraception at the time of the interview were asked if they intended to use at any time in the future. Table 5.3 shows that 40 percent of currently married nonusers intend to use, 46 percent do not intend to use and 14 percent are undecided. Of those who do intend to use, about half (21 percent of all nonusers) intend to use in the next 12 months. Unfortunately, women with 4 or more children are less likely to intend to use than women with fewer children. The reason may be that many consider themselves "not at risk" due to menopause or subfecundity, and therefore not in need of family planning. Half or more of nonusers with no child or only one child intend to use; however, most of these women do not intend to use in the next 12 months, perhaps because they want to have another child soon. Table 5.4 presents data on the methods that women intend to use. Almost all nonusers who intend to use, plan to use either the pill (40 percent), injection (34 percent), or the IUD (12 percent). There are almost no differences in potential method choice between those who intend to use in the next 12 months, those who intend to use after the next 12 months and those who are uncertain of when they intend to use. This pattern differs only slightly from the distribution of current users by method. Table 5.3 Percent d i s t r ibut ion of cur rent ly marr ied nonusers by in tent ions to use in the fu ture , according to number of ( i v ing ch i ld ren , NICPS, 1987 Intention to use in future Intend to use in next 12 months Intend to use tater Intend to use, not sure when Unsure about whether to use Does not intend to use Total Number of women Number of l i v ing ch i ld ren None I 2 3 4+ Total 14.4 22.3 28.4 26.7 17.5 21.0 16.9 12.9 7.0 4.5 2.5 8.2 19.0 16.4 9.5 8.1 4.9 10.9 19.3 15.2 15.2 14.4 9.9 14.1 30.4 33.2 39.9 46.3 65.2 45.8 100.0 100.0 100.0 100.0 100.0 100.0 972 1200 970 729 1828 5699 Table 5.4 Percent distribution of currently married nonusers who intend to use in the future, by method preferred, according to whether they intend to use in the next 12 months or tater, N[CPS, 1987 Intends Intends to use Intends to use, in next to use not sure Intended method 12 mos. ta ter when Tote( P i [ [ (UO i n jec t ion D iaphragm/ foam/ je l l y Condemn Fe~[e s ter i [ i za t ion Norp[ant Periodic abstinence Withdrawal Herbs (Jemu) Abdominal massage Other Don't know 41.7 11.0 34.9 0.3 1.4 3.5 1.2 1.0 0.5 1.3 0.3 1.4 1.5 41.6 13.1 34.4 0.0 0.5 2.5 0.5 0.8 0.2 1.3 0.0 2.0 3.1 36.5 13.9 30.8 0.0 0.8 2.6 1.7 0.9 0.6 0.4 0.0 3.4 8.4 40.3 12.2 33.7 0.2 1.1 3.0 1.2 0.9 0.4 1.1 0.2 2.0 3.7 Total 100.0 100.0 100.0 100.0 Number of women 1199 466 622 2267 49 6. FERTILITY 6.1 Background This chapter contains a discussion of levels, trends and differentials in fertility in Indonesia. Fertility information was gathered by two procedures in the NICPS. First, each respondent was asked to report aggregate information about her children in terms of the number of sons and daughters living with her, sons and daughters living elsewhere, and sons and daughters who had died. Then she was asked a full birth history in which the following was collected for each birth: name, date of birth, sex, survivorship status, and age at last birthday, or age at death, as appropriate. The general questions on the total number of children ever born and surviving are often used in population censuses and surveys in Indonesia to calculate indirect fertility and mortality estimates, particularly of infants and children. The birth history is used infrequently, because it is more complicated and takes longer to collect; however, because of the more detailed information collected in the birth history, it offers a richer set of data for analysis. Because the fertility rates presented in this chapter are all based on direct measures derived from the birth history section of the NICPS questionnaire, it is appropriate to note some potential drawbacks of the method. First of all, of course, only those women surviving until the survey date were interviewed in the survey, and, therefore, there is no record of the fertility of women who did not survive. This would only bias the rates if mortality of women in childbearing ages were high and if fertility of surviving and non-surviving women differed substantially, neither of which is probably true for Indonesia. A second issue has to do with the limitation of the respondents to ever-married women. However, since most births in Indonesia occur within marriage, the number of births to single women is quite small. The most important disadvantage of the birth history approach is in the difficulty in obtaining accurate data on the timing of all births. Errors in reporting the number of children affect the estimate of fertility level, whereas errors in the timing of births may shift the trend. If these errors vary by the socio-economic background of the women, the differentials will also be affected. 6.2 Fer t i l i ty Leve ls and Trends Table 6.1 presents data on current and cumulative fertility by background characteristics of the women. The measure of current fertility presented is the total fertility rate, which is the sum of the age- specific fertility rates. It represents the average total number of births a hypothetical group of women would have at the end of their reproductive life if they were subject to these rates from age 15 to 49. The first two columns of Table 6.1 show total fertility rates for two 3-year periods (1981-83 and 1984-87), although the latter period covers almost four years, since it includes most of 1987 up to the date of the survey. The fourth column of Table 6.1 shows the total fertility rates for the 5-year period before the survey. The last column shows cumulative fertility in the form of the mean number of children ever born to women at the end of their reproductive period. The data show a total fertility rate of 3.4 children per woman for the five-year period prior to the survey. Some idea of the magnitude of the fertility decline that Indonesia has been experiencing can be gained from comparing the total fertility rate with the mean number of children born to women 40-49 (5.4), a decline of two children per woman. Further evidence of a fertility decline is apparent in the drop from 4.3 children per woman in the 1981-1983 period to 3.3 children in the next 3-year period, a decline of 23 percent. This is an exceptionally steep rate of decline and the possibility that the data are affected by displacement of events in time or some other error of recall can not be ruled out (see discussion of Table 6.2). Regardless of the rate of decline, the data indicate that it has affected all women irrespective of their area of residence or education. 51 TabLe 6.1 Total fe r t i l i ty rates for catendar year periods and for the f ive years preceding the survey, and mean number of chi(dren ever born to women 40-49, by background characteristics, NICPS, 1987 Total fe r t i l i ty rates* Mean number of I Percent ch i ldren Background i 1981- 1984- i decl ine 0-4 years ever born 1981-83/ before to women character is t ic 1983 1987"* 1984-87 survey aged 40-49 r Residence I 24 2.9 5.2 Urban 3.7 2.8 i Rural 4.5 3.6 ! 20 3.7 5.5 Region Java-Bali 3.8 3.0 21 3.1 5.0 Outer Java-BaLi I 4.9 3.7 24 3,8 6.2 Outer Java-Bali II 5.4 4.1 24 4,4 6.3 Province Jakarta 3.6 2.6 28 2.8 4.8 West Java 4.5 3.4 24 3.6 5,8 Central Java 3.9 3.1 21 3.2 5.2 Yogyakarta 2,9 2.1 28 2.3 4.4 East Java 3.4 2.6 24 2.7 4.1 Bati 3.5 2.5 29 2,6 4.8 Education None 4.4 I 3.7 16 3.8 5.2 Some primary 4.6 i 3.7 20 3.8 5.9 Primary completed 4.3 i 3.4 21 3.5 5.5 Secondary or more 3.2 i 2.4 25 2,5 4.6 t Total 4 .3 I 3 .3 23 3.4 5.4 * Based on births to women 15-49 years ** Includes 1987 up to the survey date of age Table 6.1 also shows that fertility of urban women is lower than fertility of women in the rural areas (2.9 vs 3.7 in the five years before the survey), which is consistent with their greater use of family planning methods (see Chapter 4). Fertility of urban women declined slightly faster than fertility of rural women between the periods 1981-1983 to 1984-1987. Regionally, Java-Bali has the lowest fertility, followed by Outer Java-Bali I and Outer Java-Bali II. For the five-year period before the survey, fertility in Java-Bali was 18 percent lower than in Outer Java- Bali I, and 30 percent lower than in Outer Java-Bali II. The pace of fertility decline was similar in the three regions. Comparing total fertility rates for the provinces in Java-Bali, one notices that Yogyakarta consistently maintains the lowest fertility. On the other hand, West Java has the highest fertility among all provinces in Java-Bali. There are only slight differences between provinces in the rate of fertility decline between 1981-83 and 1984-87. Generally, there is an inverse relationship between fertility and education, that is, fertility decreases as education increases. However, this relationship does not hold for the women with no education, who have either the same level or lower fertility than women with some primary education. The decline over time, however, is positively related to the level of educational attainment; namely, better educated women have experienced a faster fertility decline than those who have less education. This is true for the decline in total fertility rates from 1981-83 to 1984-87, as well as for the decline evidenced by the difference between the mean number of children born to women 40-49 and the total fertility rate 0-4 years before the survey. 52 Cumulative fertility shows a similar pattern of differentials as the total fertility rates. Rural women, those who live in the Outer Java-Bali II region and in West Java, and women with some primary education have the highest fertility compared to women in other major groups. Table 6.2 presents total fertility rates derived from various previous data sources for comparison with the NICPS data. Strictly speaking, the rates are not comparable, since they were collected under different circumstances, calculated using different methods, and refer to different time periods; however, they do provide a broad picture of the recent decline in Indonesian fertility. Several things are apparent from this table. First, the rate of 5.6 from the 1971 Census for 1967-70 is very similar to the average number of children born to women 40-49 (5.4) interviewed in the NICPS (Table 6.1); this is consistent since these women were at their peak childbearing ages in the late 60s. Second, the NICPS value for 1981-83 is suspect, since it is the only one that does not fit in the general pattern of decline. A more detailed analysis of the birth history data is needed to examine possible sources of error. Third, the pace of fertility decline appears to have increased somewhat in recent years. Information from the 1976 Indonesia Fertility Survey was not included in Table 6.2, because it does not refer to the whole country, but rather to the Java-Bali region only. Data from the survey show a total fertility rate of 4.2 for 1975, which can be compared to the rate of 3.0 for 1984-87 for Java-Bali from the NICPS. The two rates indicate a decline of 29 percent over a period of about ten years. Since contraceptive use almost doubled during the same period (Table 4.2), a steep decline in fertility would be expected. Table 6.3 presents age-specific fertility rates for five-year periods preceding the survey. In reading the table, one should note that the figures in parentheses represent partial fertility rates due to truncation. Table 6.2 Total fe r t i l i ty rates from several sources, Indonesia Source 1971 Census 1976 SUPAS 1980 Census 1980 Census 1985 SUPAS 1987 NICPS 1985 SUPAS 1987 NICPS Estimated usin Period of Total fe r t i l i ty fe r t i l i ty estimate rate 1967-1970 5.5* 1971-1975 5,1" 1976-1979 4.6* 1980 4.3** 1981-1984 4.0* 1981-1983 4.3*** 1985 3.3** 1984-1987 3.3*** the Own Children method ** Calculated from data on date of last live birth ***Calculated directiy from birth history data Table 6.3 Age-specif ic fe r t i l i ty rates for f ive-year periods, by age of wccnan at birth, NICPS, 1987 Age 0-4 15-19 75 120 159 148 20-24 189 236 260 275 25-29 174 223 248 268 30-34 130 170 213 t249) 35-39 75 115 (150) 40-44 32 (61) 45-49 (10) Number of years preceding survey 5-9 10-14 15-19 20-24 25-29 171 156 268 (276) (291) Note: Figures in parentheses are partialiy truncated rates. got avaitabie due to age truncation. 30-34 (127) 53 Women 50 years and over were not included in the survey, and the farther back into time rates are calculated, the more severe is the truncation. For example, rates cannot be calculated for women aged 45- 49 for the period 5-9 years before the survey, because those women would have been aged 50-54 at the time of the survey and were not interviewed. The table indicates two things; first, there is an obvious decline in fertility, and second, the decline has been faster in recent years. 6.3 P regnancy Sta tus Table 6.4 presents the pregnancy status of currently married women, as it is an indication of immediate future fertility. In total, 7 percent of currently married women are pregnant. As expected, the rates decline with age. There does not seem to be much variation between urban and rural residents. Comparison between regions show an interesting picture, because the rates for women in the Outer Java-Bali II region are more than twice that in Java-Bali (12 vs. 6 percent). In Java, West Java shows the highest pregnancy rate at 7 percent, while Central Java has the lowest rate at 4 percent. These figures parallel the pattern of fertility in Java, in which West Java is highest. There is a positive association between pregnancy status and education, that is, the higher the education level, the higher the percent of women who are pregnant. Higher percentages for women with more education could be due to the fact that many of these women are young and are thus in the prime childbearing years. The last panel shows that 23 percent of currently married childless women are pregnant. The pattern of pregnancy status by number of living children is similar to that by age, in other words, younger, lower parity women are more likely to be pregnant. Table 6.4 Percent of currently married women who were pregnant at t ime of survey, by background characteristics, N%CPS, 1987 Percent Background preg- characteristic rant Age 15-19 19.7 20-24 12.9 25-29 8.4 30-34 5.2 35-39 4.2 40-44 0.8 45-49 0.2 Residence Urban 6.1 Rural 7.1 Region Java-Bal i 5.6 Outer Java-Bali ! 8.9 Outer Java-Bali I I 12.2 Total 6.8 Percent Background preg- character i s t i c nant Province Jakarta 5,8 West Java 7.0 Centra l Java 4.4 Yogyakarta 5.2 East Java 5.2 BaLi 5.4 Education None 5.1 Some pr imary 6.9 Pr imary completed 7.7 Secondary or more 7.9 Number of living children None 22.8 I 8.8 2 4.9 3 4.7 4 or more 3.4 6.4 Ch i ld ren Ever Born Table 6.5 shows the distribution of all, ever-married, and currently married women by the number of children they have given birth to. Since marriage in Indonesia is almost universal and marital dissolution is usually followed by remarriage, differences between the three groups of women are small from the middle age groups on. 54 The table shows that 9 percent of women 15-19 and 55 percent of women 20-24 have had at least one child. Childlessness by age 40 or above can be taken as evidence of the extent of primary infertility which in the NICPS represents less than 5 percent of ever-married women. It is interesting to note that of women aged 45-49, 11 percent have had 10 or more births, around 30 percent have had 8 or more, and over 60 percent have had 5 or more births. The last column in Table 6.5 displays the mean number of children ever born by women's age, which increases among older women. Among all women the range is from 0.1 births for women 15-19 to 5.6 births for women 45-49. Table 6.6 shows the mean number of children ever born to ever-married women by age at first marriage and number of years since marriage. The data in each column display the expected pattern, namely that women have more children with longer duration of marriage. Thirty years after first marrying these women have an average cumulative fertility of about 6 children. The effect of later age at marriage is indicated by the figures in the last line of Table 6.6; women who marry young tend to have more children than those who marry later. These data, however, are Table 6.5 Percent d is t r ibut ion of a l l , ever -marr ied , and cur rent ly marr ied women by number of ch i ld ren ever born and mean number of ch i ld ren ever born, according to age, NICPS, 1987 Number of children ever born Num- Mean ber number I 2 3 4 5 6 7 of ever Age None 8 9 10+ Total women born At[ Women* 15-19 91.0 7.5 1.3 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 3342 0.11 20-24 44.6 26.3 20.5 6.3 2.0 0.3 0.0 0.0 0,0 0.0 0.0 100.0 3066 0.96 25-29 15,5 18.1 26.8 21.1 11.4 4.9 1.5 0.5 0,2 0.0 O.O 100.0 2818 2.20 30-34 8.9 8.3 15.6 22.7 17.9 12.3 8.4 2.9 1.8 0.9 0.3 100.0 2200 3.37 35-39 7,2 6.2 12.1 15,0 15.8 13.1 11.7 7.8 5.4 3.2 2.5 100.0 1742 4.27 40-44 5.0 6.0 7.4 10.9 11.5 14.1 12.4 10.3 10.0 6.1 6.3 100.0 1445 5,19 45-49 6.1 5.0 7.1 8.5 10.7 11.3 11.6 I0.4 11.4 7.1 10.8 100.0 1523 5.61 Total 33.0 12.5 13.6 11.4 8.6 6.4 4.9 3.2 2.8 1.7 1,9 100.0 16136 2,50 Ever-Married Women 15-19 52.6 39.2 7.0 1.2 0.0 0.0 O.O 0.0 0.0 0.0 0.0 100.0 635 0.57 20-24 15.0 40.3 31.5 9.6 3.1 0.5 0.0 O.O 0.0 0.0 0.0 100.0 1998 1.47 25-29 5.5 20.2 30.0 23.5 12.7 5.5 1.7 0.6 0.2 0.1 0.0 100.0 2520 2.45 30-34 5,0 8.6 16,3 23,7 18,7 12.8 8.8 3.0 1.9 1.0 0.2 I00.0 2110 3.51 35-39 4.3 6.4 12.4 15.5 16.3 13.6 12.0 8.0 5.6 3.3 2.6 100.0 1690 4.41 40-44 4.0 6.0 7.5 11.0 11.6 14.3 12.5 10.4 10.2 6.1 6,4 100.0 1430 5.25 45-49 4.7 5.1 7.2 8.6 10.9 11.5 11.7 I0.6 11.5 7.2 11.0 100.0 1501 5.69 Total 9.1 17,0 18.5 15,5 11,6 8,6 6.6 4.4 3.9 2.3 2.5 100.0 11884 3.40 Current ly Mar r ied Women 15-19 51.3 40.2 7.4 1.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 600 0.58 20-24 14.0 40.1 32.1 9.9 3.3 0.5 0.1 0,0 0.0 0.0 0,0 100.0 1888 1.50 25-29 4.9 19.1 30.1 24.4 13.2 5.7 1.7 0.6 0.2 0.1 0.0 100.0 2406 2.51 30-34 4.3 7.2 15.9 24,3 19.3 13.4 9,2 3,1 2.0 1.0 0.3 I00,0 1979 3.61 35-39 3.8 5,6 12.0 15,4 16.6 14.1 12,2 8,4 5.6 3.3 3.0 100.0 1543 4.49 40-44 i 4.0 5.3 7,0 I0,6 10.9 14.5 13.3 10.5 10.5 6.2 7,2 100.0 1271 5.37 45-49 4.5 4.5 6.2 7.6 9.3 11.7 12.2 12.1 12,3 7.7 11,9 100.0 1220 5,91 Total 8.6 16.6 18.7 15.9 11.6 8.8 6.7 4.5 3.8 2.2 2.6 100.0 10907 3.42 Der ived by app ly ing a mul t ip l i ca t ion fac tor based on the household quest ionna i re to the ind iv idua l respondents 55 influenced by the fact that women who married before age 15 tend to be older and therefore have had more time to have more children. Within each duration category, the pattern is mixed, generally rising, then falling with age at marriage. This may reflect in part, some adolescent infecundity of those who married in their teen-age years. Differences are small at shorter marriage durations, but for the longer durations, there is some evidence that women who marry later have fewer children. Tabte 6.6 Mean nunVoer of children ever born to ever-married women, by age at first marriage and years since first marriage, NICPS, 1987 Years s ince f i r s t marr iage 0-4 5-9 10-14 15-19 20-24 25-29 30 or more Total Age at f i r s t marr iage Less than 15 0.7 1.7 2.7 3.6 4.5 5.0 5.8 4.0 15-17 18-19 20-21 1.0 2.3 3.1 3.5 5.3 5.3 25 or 22-24 over 0.8 0.8 2.2 1.9 3.1 3.0 4.2 2.7 4.7 4.3 4.8 2.5 2.0 0.7 0.8 2.1 2.2 3.1 3.5 4.3 4.3 5.2 5.0 5.8 5.3 6.2 6.0 3.6 3.0 2.8 All ages 0.8 2.1 3.1 4.0 4.9 5.4 5.9 3.4 6.5 Age at F i rs t B i r th Table 6.7 presents the percent distribution of all women (including single women) by current age and age at first birth. Figures for younger women should be used with caution, since many have not yet married and thus have not had a chance to have children. Comparing women 25 years of age and over-- by which time most have married--the table shows that the percentage of women who gave birth before age 15 decreased from 10 percent of women 45-49 to 5 percent of women 25-29. The proportion of women giving birth at ages 15-17 also declined among younger women. TabLe 6.7 Current age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Percent distribution of all women by age at first birth according to current age, NICPS, 1987 No b i r ths 91.0 44.6 15.5 8.9 7.2 5.0 6.1 33.0 Age at first birth Less 25 or than 15 15-17 18-19 20-21 22-24 over 1.0 5.4 2.6 2.8 16.6 18.6 12.9 4.5 - 5.1 22.0 21.4 16.5 13.7 5.8 6.2 23.9 21.0 15.2 14.7 10.1 8.6 25.1 20.0 14.8 14.2 10.1 9.2 27.5 19.9 16.0 13.3 9.1 9.6 i 23.0 19.0 15.6 14.0 12.7 i 5.1 I 18.7 16.4 11.9 9.3 5.6 Median Number age at of first Total women birth 100.0 3342 100.0 3066 - 100.0 2818 20.2 100.0 2200 19.9 100.0 1742 19.6 100.0 1445 19.3 100.0 1523 19.8 100.0 16136 Note: Table is based on al l women, including the never-married, who are assumed to have had no births. Median age is defined as the age at which 50 percent of women had a birth. 56 The last column in Table 6.7 shows that, except for women 45-49, the median age at first birth has increased among younger women. Given the increase in age at marriage (see Chapter 2), this increase in age at first birth is not surprising. The high median age for women 45-49 should be viewed carefully because older women may not accurately recall dates of their births. A more complete picture of differentials in median age at first birth is presented in Table 6.8. The differentials in age at first birth seem to be associated with those in age at first marriage (see Chapter 2), and with fertility (see previous tables in this chapter). Urban women, those who live in Jakarta, Yogyakarta, and Bali, and women with more education, tend to marry later, have their first birth at a later age, and have lower fertility rates. Table 6 .8 Median age at f i r s t b i r th among a l l women 25-49 years, by cur rent age and background character i s t i cs , NICPS, 1987 Current age Background character i s t i c 25-29 30-34 35-39 40-44 45-49 Total Residence Urban 21.7 21.1 20.5 20.3 20.4 20.9 Rural 19.6 19.5 19.1 19.0 19.7 19.4 Region Java-Rail 19.9 19.6 19.4 19.1 19.8 19.7 Outer Java-BaLi I 21.3 20.5 19.9 19,5 19.9 20.3 Outer Java-BaLi ]] 20.5 21.0 20.4 20,4 20.1 20.5 Province Jakarta 22.3 21,8 21.7 20.8 21.2 21.7 West Java 19.4 18.7 18,6 18.1 18.8 18.8 Central Java 20,0 19.7 19.4 19.1 20.1 19,8 Yogyakarta 21.8 21.2 21.7 20.9 21.6 21.5 East Java 19,5 19.8 19.5 19.9 19.9 19.7 BaLi 20.8 20.6 20.0 21.1 22.7 21.0 Education None 19.8 19.5 19.2 19.3 19.7 19.6 Some primary 19.2 19.0 18.9 18.4 19.5 19.0 Primary completed 20.1 19.6 19.2 19.6 19.8 19.7 Secondary or more 24.9 23.4 23.5 22.5 22.6 23.7 i i l i Total 20.2 19.9 19.6 19.3 19.8 19,8 57 7. FERTILITY PREFERENCES This chapter addresses questions which allow an assessment of the need for contraception, acceptance of the two-child family norm, and the extent of unwanted fertility. The questions concern whether the respondent wants more children; if so, how long she would prefer to wait before the next child; and if she could start afresh, how many children in all she would want. Two other issues are examined here as well--the extent to which unwanted or mistimed births occur and the effect that the prevention of such births would have on fertility rates. Since an underlying rationale of the Indonesian family planning program is to persuade couples to have only two children and to space them five years apart, it is important to gauge to what extent these fertility preferences have been adopted. Survey questions on fertility preferences have been criticized on the grounds that answers reflect unformed, ephemeral views, which are held with little conviction, and that they do not take into account the effect of social pressures or the attitudes of other family members, particularly the husband, who may exert a major influence on reproductive decisions. The first objection probably has little relevance in Indonesia, where widespread public exposure to the family planning program has probably caused most people to establish their opinions regarding fertility regulation prior to the interview. The second objection is correct in principle, however, evidence from surveys in which both husbands and wives are interviewed suggests that there are generaUy no major differences between the views of the two sexes. It should be noted that women who were pregnant at the time of interview were asked if they wanted more children after the one they were expecting. To take into account the way in which the preference variable is defined for pregnant women, the results are classified by number of living children, including the current pregnancy as equivalent to a living child. Women who have been sterilized also require special analytic treatment. The strategy is to classify them as wanting no more children. The validity of this assumption can be ascertained by referring to the proportions sterilized who regret their sterilizations because they want more children (Table 7.1). Table 7.1 Percent d i s t r ibut ion of cur rent ly marr ied women by des i re fo r ch i ld ren and the cer ta in ty of the i r preference, according to number of l i v ing ch i ld ren , NICPS, 1987 Desi re fo r ch i ld ren and cer ta in ty of preference Have another: Def in i te ly Hot sure Undecided: Inc l ined to have another Inc l ined not to have another Not sure Have no more : Hot sure Def in i te ly have no more S ter i l i zed : Regret, want another ch i ld Regret, want no more, unsure Do not regret Data missing Declared infecund Total Number of women * Inc ludes cur rent pregnancy Number of l i v ing ch i ld ren * Hone 1 2 3 4 5 6+ Total 81.8 81.1 45.5 21.4 9.8 7.8 3.5 37.8 3.7 3.5 3.6 3.3 2.4 2.1 1.1 2.9 0.5 0.6 1.1 1.3 1.1 0.9 0.2 0.8 0.3 0.2 0.7 0.4 1.1 0.3 0,4 0.5 2.7 1.5 4.9 5.1 3.7 4.8 3.7 3.8 0.2 1.7 6.1 9.7 10.6 8.6 7.0 6.3 4.8 9.6 34.8 53.1 62.2 63.1 69.7 41.3 0.0 0.0 0.1 0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.1 0.0 0.0 0.1 0.4 0.1 0.0 0.3 1.2 3.7 5.3 5.5 7.3 3.0 0.0 0.0 0.1 0.1 0.0 0.4 0.3 0.1 6.0 1.5 1.8 1.8 3.8 6.4 6.4 3.3 100.0 100.0 100.0 I00.0 100.0 100.0 100.0 100.0 813 2157 2320 1862 1363 890 1502 10907 59 7.1 Des i re fo r Add i t iona l Ch i ld ren Table 7.1 displays the distribution of currently married women by desire for children and the certainty of their preference, according to the number of living children. The last column indicates that slightly fewer women definitely want another child than definitely want no more, though both categories are close to 40 percent. The remaining 20 percent are composed primarily of 14 percent who arc unsure, as well as six percent who are either infecund or sterilized. Data in the first row suggest the extent of acceptance of the two-child family norm in Indonesia. Over 80 percent of women with no children or one child definitely want another child, while less than half of those with two children do. It is interesting to note that the proportions definitely desiring more children roughly halve with each additional child for women with one, two, three and four children--in these groups the rates drop from 81 to 46 to 21 to 10 percent, respectively. The sharp reduction after the second child suggests widespread agreement with the two-child family norm. However, the data indicate that many women still desire more than two children. The table also shows that only a tiny fraction of sterilized women regret having the operation. Table 7.2 is similar to Table 7.1 except that the fertility preference classification is simplified and women wanting another birth are grouped according to when they want their next birth. The table allows the potential need for contraceptive services--for spacing as well as limiting births--to be examined. Over one-half of married women in Indonesia do not want any more children or have been sterilized (Figure 7.1). An additional 27 percent wish to delay their next birth h)r two or more years. Summing these two figures indicates that 78 percent of women are potentially in need of family planning services either to delay or limit births. Less than 10 percent of women want another child within two years and 9 percent are undecided either about whether or when to have another child. An additional 3 percent of women stated that they were infecund. Table 7.2 Percent distribution of currently married women by desire for children, according to nulnl~r of living children, NICPS, 1987 Desire for ch i ld ren and t iming Have another w i th in 2 years Have another a f te r 2 or more years Have another, undecided when Undecided** Want no more /s ter i l i zed Declared infecund Total Mumber of women Number of Living children* Total None I 2 3 4 5 6+ 48.9 15.4 8.7 4.4 1.9 1.6 0.6 9.7 17.1 61.2 37.7 19.0 9.9 6.9 2.6 26.8 19.9 8.5 3.9 2.6 1.5 2.3 1.5 5.0 2.7 1.5 4.9 5.1 3.7 4.8 3.7 3.9 5.4 11.9 43.0 67.1 79.2 78.0 85.2 51.3 6.0 1.5 1.8 1.8 3.8 6.4 6.4 3.3 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 813 2157 2320 1862 1363 890 1502 10907 * Includes current pregnancy ** Includes only wo~nen listed as "Undecided, not sure" in Table 7.1. As shown in Figure 7.2 and Table 7.2, desire for additional children is strongly related to the number of living children. Almost all childless women want to have a child at some time and half of them want a child soon (within two years). While most women with one child also want another, the majority want to wait two or more years. Among women with two children, half want another child and the other half either do not want more, are undecided, or are infecund. Among women with four or more children, at least 80 percent want to stop childbearing. 60 Figure 7.1 Fertility Preferences Currently Married Women 15-49 Want NO More 51% Want to Space (2 or more yrs) 27% )eolared Infeound 3% Undecided If Want Mere 4% Want Soon v i th in 2 yre) 10% . . . . . . Another, Undecided When 5% Figure 7.2 Fertility Preferences by Number of Living Children Current ly Married Women 15-49 100~ 809t 609t 409~ 20~ 0% 0 1 2 3 4 Number of L iv ing Ch i ld ren ~ lwant No More ~Want to Space ~Want Soon Infecund included in want no more 5 6+ Undecided 61 Table 7.3 shows the distribution of women by desire for children, according to age category. It indicates that older women are much more likely to want no more children than are younger women. The desire to space children is concentrated among younger women. Sixty percent of women 15-24 want to delay having their next child. Table 7.4 shows the percent of women who want no more children by background characteristics. Urban women are generally more likely than rural women to want no more children (58 percent and 49 percent, respectively), and the urban-rural differential increases with the number of living children; while the proportion of urban women who want no more children is only slightly higher than that for rural women among childless women, it is considerably higher among women with four or more children. Table 7.3 Percent d i s t r ibut ion of cur rent ly married women by desire for ch i ldren, according to age, N1CPS, 1987 Desire for ch i ld ren and t iming 15-19 Have another w i th in 2 years 18.0 Have another a f te r 2 or more years 60.7 Have another, undecided when 13.9 Undecided * 1.9 Want no more /s ter i l i zed 5.5 Declared infecund 0.0 Total 100.0 Number of wo~en 600 * Includes only women l i s ted as ,,Undecided, Age 20-24 25-29 30-34 13.0 13.1 9.4 59.5 39.0 18,5 6.3 5.8 4,3 3.5 3.8 5.3 17.7 38.2 62.3 0.0 0.1 0.2 J 100.0 100.0 100.0 1888 2406 1979 not sure" in Table 7.1. 35-39 40-44 45-49 Total 7.8 4.9 1.8 9.7 6.7 2.4 0.0 26.8 4.2 3.4 1.2 5.0 4.2 4.0 1.7 3.8 ~. I 78.8 74.3 51.4 1.0 6.5 21.0 3.3 100.0 100.0 100.0 100.0 1543 1271 1220 10907 Table 7.4 Percentage of currently married women who want no more children by number of living children and background characteristics, NICPS, 1987 Number of l i v ing ch i ldren * Background character i s t i c None 1 2 3 4+ Total Residence Urban 6,9 12.4 46.3 74.8 90.3 58.3 Rural 4.8 11.7 41.9 63.8 77.7 48.7 Region Java-Bali 6.3 13.9 50.9 76.1 89.3 55.0 Outer Jave-8ati I 2.8 6.5 26.3 46.6 69.9 44.1 Outer Java-Bali ZI 0.0 4.1 16.6 50.4 73.0 43.8 Province Jakarta 3.8 13.1 47.9 78.8 92.5 58.4 West Java 2.9 9.5 43.1 69.0 84.2 50.6 Central Java 4.5 14.4 50.2 73.6 92.5 56.6 Yogyakarta 3.I 9.2 57.3 85.4 84.0 57.7 East Java 10.9 17.9 55.7 83.0 92.0 55.7 Bali 3.4 15.0 72.9 84.5 90.7 67.6 Education None 14,5 26.2 49.1 59.9 74.6 55.8 Some primary 3,2 12.3 37.8 65,0 82.2 51.4 Primary cof~pleted 2.5 7.5 42.3 70.9 84.3 48.2 Secondary or more 0.4 4.8 50.7 76.4 90.4 49.1 J i Total 5.4 11.9 43.0 67.1 81.3 51.3 Note: Ster i l i zed women are included * includes current pregnancy as wanting no more ch i ldren. 62 Women in Java and Bali are leading the transition to smaller family preferences in Indonesia. While half of the women with two children in Java and Bali want no more children, the proportions in Outer Java-Bali I and II are 26 and 17 percent. At other parities, a larger proportion of women in Java and Bali also want to stop childbearing, though the differences are not as dramatic as those for women with two children. Among the provinces in Java-Bali, Balinese women stand out as more widely adopting a two-child norm than women in the other provinces. Where nearly three-quarters of Balinese women are ready to stop childbearing after two children, only about half of women in the other provinces are ready to do so. There is an odd twist in the data on proportions wanting no more children by education. In general, women who have completed primary or secondary education are more likely to want to continue childbearing than are less educated women. The data by number of living children, however, indicate that at parities above two, the standard patterns are observed--those with higher levels of education are generally less likely to want more children. 7 .2 Future Need for Fami ly P lann ing Table 7.5 shows the percentage of currently married women who are in need of family planning (i.e., who are not using contraception and who either want no more children or want to delay their next birth for two or more years) as well as those in need who intend to use family planning. These are tabulated by background characteristics. Among those in need, the table distinguishes between those in need because they want no more children (limiters) and those who want to postpone their next birth (spacers). Table 7.5 Percentage of cur rent ly marr ied women who are in need of fami ly p lanning and the percentage who are in need and intend to use fami ly p lann ing in the fu ture , by background character i s t i cs , NICPS, 1987 In need* In need and intend to use I Background Wants Wants to I Wants no Wants to character i s t i c no more postpone** ! Total more postpone** Total Residence Urban 21.2 14.3 35.4 5.3 5.9 11.2 Rural 21.5 21.8 43.4 5.8 8.1 13.9 Region Java-Bal i 22.1 16.8 38.9 5.1 6.3 11.4 Outer Java-Bali ! 19.9 25.3 45.2 6.4 9.2 15.6 Outer Java-Bali It 21.6 28.8 50.4 8.9 i 15.6 24.5 Province Jakarta 21.4 14.0 35.4 5.1 4.5 9.6 West Java 24.7 17.8 42.5 5.2 7.3 12.4 Central Java 20.6 18.2 38.8 5.4 6.7 12.1 Yogyakarta 11.0 7.3 18.3 4.6 3.8 8.4 East Java 22.7 16.9 39.6 4.8 5,6 10.4 Bali 14.4 7.9 22.3 6.7 4.7 11.4 Education None 33.1 19,1 52.2 3.8 4.3 8.1 Sc~ primary 21.7 20.6 42,3 6.4 7.7 14.1 Primary completed 16.1 20.5 36.5 6.2 9.4 15.7 Secondary or more 11.1 17.1 28.2 5.4 8.7 14.1 Total 21.4 19.8 41.2 5.7 7.5 13.2 * inc ludes women who are not cont racept ing and who e i ther want postpone the i r next b i r th fo r two or more years ** Inc ludes women undecided about whether to have another b i r th next b i r th no more b i r ths or want to or undecided about t im ing fo r 63 Overall, 41 percent of currently married women in Indonesia are in need of family planning. Slightly over half of them want no more children, while slightly under half want to space their next child. Only one-third of those in need intend to use family planning in the future and the proportion who intend to use is greater among spacers than among those who want no more children. A larger proportion of rural than urban women are in need, primarily because of the greater desire for spacing births. Of those who are in need, the proportion who intend to use is almost identical for urban and rural women--one-third. A larger proportion of women outside Java-Bali are in need of family planning, again due mostly to the greater desire for spacing children. The proportion of women in need who intend to use is greatest in Outer Java-Bali II, followed by Outer Java-Bali I and then, Java-Bali. Among the provinces in Java and Bali, the three main provinces, West, Central, and East Java report the highest percentages of women in need. Yogyaka

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