Indonesia - Demographic and Health Survey -1991

Publication date: 1991

Demographic and Health Survey 1991 Central Bureau of Statistics National Family Planning Coordinating Board ® Ministry of Health ®DHS Demographic and Health Surveys Macro International Inc. Indonesia Indonesia Demographic and Health Survey 1991 Central Bureau of Statistics Jakarta, Indonesia National Family Planning Coordinating Board Jakarta, Indonesia Ministry of Health Jakarta, Indonesia Macro International Inc. Columbia, Maryland USA October 1992 This report summarizes the findings of the 1991 Indonesia Demographic and Health Survey (IDHS) conducted by the Indonesia Central Bureau of Statistics, the National Family Planning Coordinating Board and the Ministry of Health. Macro International provided funding and technical assistance. Additional funding for the survey was provided by USAID/Jakarta, UNFPA, and the Government of Indonesia. The IDHS is part of the worldwide Demographic and Health Surveys program, which is designed to collect data on fertility, family planning, and maternal and child health. Additional information on the Indonesia survey may be obtained from the Central Bureau of Statistics, Jl. Dr. Sutomo 8, Jakarta 10710, Indonesia (Telephone 372808, 374908, 3810291-5), or the National Family Planning Coordinating Board, Jl. Let. Jen. M.T. Haryono, Jakarta 10002, Indonesia (Telephone 8009029), or the Ministry of Health, Institute for Health Research and Development, Jl. Percetakan Negara 29, P.O. Box 1226, Jakarta 10440, Indonesia (Telephone 414146, Ext. 31). Additional information about the DHS program may be obtained by writing to: DHS, Macro International Inc., 8850 Stanford Boulevard, Suite 4000, Columbia, Maryland 21045, U.S.A. (Telephone 410-290-2800; Telex 198116; Fax 410-290- 2999). CONTENTS Page Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi Map of Indonesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiv CHAPTER1. INTRODUCTION 1.1 1.2 1.3 1.4 1.5 1.6 Geography, History and Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Population and Family Planning Policies and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Health Priorities and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Objectives of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Organization of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 CHAPTER 2. BACKGROUND CHARACTERIST ICS OF HOUSEHOLDS AND RESPONDENTS 2.1 Population by Age and Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.2 Population by Age from Selected Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.3 Household Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.4 Educational Level of Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.5 School Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.6 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.7 Presence of Durable Goods in the Household . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2.8 Background Characteristics of Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.9 Respondent's Level of Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 2. I0 Exposure to Mass Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 CHAPTER 3. FERT IL ITY 3.1 Fertility Levels and Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 3.2 Fertility Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3.2 Children Ever Bom and Liv ing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 3.4 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 3.5 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 3.6 Teenage Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 iil Page CHAPTER 4. KNOWLEDGE AND EVER USE OF FAMILY PLANNING 4.1 4.2 4.3 4.4 Knowledge of Family Planning Methods and Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Knowledge of Blue Circle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Dissemination of Family Planning Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 4.3.1 Knowledge of the Best Methods for Delaying and Limiting Births . . . . . . . . . . . . . . . 46 4.3.2 Provision of Information by Family Planning Field Workers . . . . . . . . . . . . . . . . . . . 47 4.3.3 Appropriate Sources of Family Planning Information . . . . . . . . . . . . . . . . . . . . . . . . . 50 Ever Use of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 CHAPTER 5. CURRENT USE OF FAMILY PLANNING 5.1 Current Use of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 5.2 Trends in Contraceptive Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 5.3 Contraceptive Use Among Women Over 30 and Among Those With Three or More Children 59 5.4 Reasons for Choice of Contraceptive Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 5.5 Quality of Use of PiU, Injection, and Condom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 5.6 Problems With Current Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 5.7 Cost and Accessibility of Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 5.8 Source of Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 CHAPTER 6. FERTILITY PREFERENCES 6.1 6.2 6.3 6.4 Desire for Additional Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Ideal Number of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Unmet Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Unplanned and Unwanted Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 CHAPTER 7. NONUSE AND INTENTION TO USE FAMILY PLANNING 7.1 7.2 7.3 7.4 7.5 Discontinuation Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Reasons for Discontinuation of Contraceptive Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Intention to Use Contraception in the Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Reasons for Nonuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Preferred Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 CHAPTER 8. OTHER PROXIMATE DETERMINANTS OF FERTILITY 8.1 8.2 8.3 8.4 8.5 8.6 8.7 Current Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Marital Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Age at First Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Postpartum Amenorrhea, Abstinence and Insusceptibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Termination of Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 iv Page CHAPTER 9. INFANT AND CHILD MORTAL ITY 9.1 9.2 9.3 9.4 9.5 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Assessment of Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Levels and Trends in Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Mortality Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 High-Risk Fertility Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 CHAPTER 10. MATERNAL AND CHILD HEALTH 10.1 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 10.1.1 Tetanus Immunization of Pregnant Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 10.2 Delivery Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 10.3 Immunization of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 10.4 Acute Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 10.5 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 10.6 Diarrheal Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 10.6.1 Prevalence of Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 10.6.2 Incidence of Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 10.6.3 Treatment with Oral Rehydration Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 10.6.4 Medical Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 CHAPTER 11. INFANT FEEDING 11.1 Prevalence of Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 11.2 Duration of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 APPENDIX A: SURVEY DES IGN A.1 Sample Design and Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 A.2 Pretest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 A.3 Field Staff Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 A.4 Fieldwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 A.5 Data Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 APPENDIX B: EST IMATES OF SAMPL ING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 APPENDIX C: DATA QUAL ITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 APPENDIX D: PERSONS INVOLVED IN THE 1991 IDHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 APPENDIX E: SURVEY QUEST IONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 V TABLES CHAPTER 1. Table 1.1 Table 1.2 CHAPTER 2. Table 2.1 Table 2.2 Table 2.3 Table 2.4.1 Table 2.4.2 Table 2.4.3 Table 2.5 Table 2.6 Table 2.7 Table 2.8.1 Table 2.8.2 Table 2.9.1 Table 2.9.2 Table 2.9.3 Table 2.10.1 Table 2.10.2 CHAPTER 3. Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 3.5 Table 3.6 Table 3.7 Page INTRODUCTION Basic demographic indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Results o f the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . . . . 7 BACKGROUND CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Household population by age, residence and sex . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Population by age from selected sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Educational level of the household population . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Educational level of the male household population: region and province . . . . . . 15 Educational level of the female household population: region and province . . . . . 16 School enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Background characteristics of respondents: region and province . . . . . . . . . . . . . . 20 Level of education: age and residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Level of education among ever-married women: region and province . . . . . . . . . 22 Level of education among currently married women: region and province . . . . . . 23 Exposure to mass media: age, residence and education . . . . . . . . . . . . . . . . . . . . . 24 Exposure to mass media: region and province . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 FERTILITY Fertility rates from various sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Total fertility rates for provinces in Java-Bali . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 vii Table 3.8 Table 3.9 Table 3.10 Table 3.11 CHAPTER 4. Table 4.1 Table 4.2.1 Table 4.2.2 Table 4.3 Table 4.4.1 Table 4.4.2 Table 4.5 Table 4.6.1 Table 4.6.2 Table 4.7.1 Table 4.7.2 Table 4.8 CHAPTER 5. Table 5.1 Table 5.2.1 Table 5.2.2 Table 5.2.3 Table 5.2.4 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7 Table 5.8 Page Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Teenage fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Children born to teenagers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 KNOWLEDGE AND EVER USE OF FAMILY PLANNING Knowledge of contraceptive methods and souroe for methods . . . . . . . . . . . . . . . . 39 Knowledge of modem contraceptive methods and source for methods: age, residence, and education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Knowledge of modem contraceptive methods and source for methods: region and province . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Potential source of supply for contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . 43 Knowledge of Blue Circle: age, residence, and education . . . . . . . . . . . . . . . . . . . 44 Knowledge of Blue Circle: region and province . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Perceived best method to delay or limit births . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Visits by family planning field workers: age, residence, and education . . . . . . . . 48 Visits by family planning field workers: region and province . . . . . . . . . . . . . . . . 49 Appropriate sources for family planning information: age, residence, and education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Appropriate sources for family planning information: region and province . . . . . 51 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 CURRENT USE OF FAMILY PLANNING Current use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Current use of contraception: background characteristics . . . . . . . . . . . . . . . . . . . 54 Current use of contraception: Java-Bali . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Current use of contraception: Outer Java-Bali I . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Current use of contraception: Outer Java-Bali II . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Trends in contraceptive use by province: Java-Bali . . . . . . . . . . . . . . . . . . . . . . . . 57 Trends in contraceptive use by specific methods: Java-Bali . . . . . . . . . . . . . . . . . 58 Trends in contraceptive use by specific methods: 20 provinces . . . . . . . . . . . . . . . 59 Contraceptive use status and number of children . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Reasons for using current method of contraception . . . . . . . . . . . . . . . . . . . . . . . . 60 Pill use compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 viii Table 5.9 Table 5.10 Table 5.11 Table 5.12 Table 5.13 Table 5.14 Table 5.15 Table 5.16 Table 5.17 Table 5.18 CHAPTER 6. Table 6.1 Table 6.2 Table 6.3.1 Table 6.3.2 Table 6.4 Table 6.5.1 Table 6.5.2 Table 6.6.1 Table 6.6.2 Table 6.7 Table 6.8 CHAPTER 7. Table 7.1 Table 7.2 Table 7.3 Table 7.4 Table 7.5 Page Use of pill and condom brands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Use of injection and the condom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Problems with current method of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Payment for contraceptive methods and services . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Mean cost of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Time to source of supply for users/nonusers of modem contraceptive methods. . 67 Median time to source of supply for users/nonusers of modem contraceptive methods: region and province . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Median time to source of supply for users/nonusers of modem contraceptive methods: type of source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . 69 Timing of sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 FERTILITY PREFERENCES Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . 72 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Desire to have no more children: residence and education . . . . . . . . . . . . . . . . . . 74 Desire to have no more children: region and province . . . . . . . . . . . . . . . . . . . . . . 75 Ideal number o f children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Ideal number of children: residence and education . . . . . . . . . . . . . . . . . . . . . . . . 77 Ideal number of children: region and province . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Need for family planning services: age, residence, and education . . . . . . . . . . . . . 79 Need for family planning services: region and province . . . . . . . . . . . . . . . . . . . . 80 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 NONUSE AND INTENTION TO USE FAMILY PLANNING Contraceptive discontinuation rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Reasons for discontinuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Reasons for not intending to use contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Preferred method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 ix CHAPTER 8. Table 8.1 Table 8.2 Table 8.3 Table 8A Table 8.5 Table 8.6 Table 8.7 Table 8.8 Table 8.9 Table 8.10 CHAPTER 9. Table 9.1 Table 9.2 Table 9.3 Table 9.4 Table 9.5 "Iabte 9.6 CHAPTER 10. Table 10.1.1 Table 10.1.2 Table 10.2 Table 10.3.1 Table 10.3.2 Table 10.4.1 T~ble 10A.2 Table 10.5.1 Table 10.5.2 Table 10.6 Table 10.7.1 Table 10.7.2 Page OTHER PROXIMATE DETERMINANTS OF FERTILITY Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Marital exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Median age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Recent sexual activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Postpartum amenorrhea, abstinence and insusceptibility . . . . . . . . . . . . . . . . . . . . 96 Median duration of postpartum insusceptibility . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Termination of exposure to the risk of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . 98 INFANT AND CHILD MORTALITY Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Infant and child mortality (ten-year rates) by region: NICPS and IDHS . . . . . . . 102 Infant mortality for five-year periods by region . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Infant and child mortality by background characteristics . . . . . . . . . . . . . . . . . . . 104 Infant and child mortality by demographic characteristics . . . . . . . . . . . . . . . . . . 105 High-risk fertility behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 MATERNAL AND CHILD HEALTH Antenatal care: background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Antenatal care: region and province . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . . . . 112 Tetanus toxoid vaccinations: background characteristics . . . . . . . . . . . . . . . . . . . 114 Tetanus toxoid vaccinations: region and province . . . . . . . . . . . . . . . . . . . . . . . . 115 Place of delivery: background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Place of delivery: region and province . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Assistance during delivery: background characteristics . . . . . . . . . . . . . . . . . . . . 118 Assistance during delivery: region and province . . . . . . . . . . . . . . . . . . . . . . . . . 119 Characteristics of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Vaccination cards: background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Vaccination cards: region and province . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Table 10.8 Table 10.9 Table 10.10.1 Table 10.10.2 Table I0. I I Table 10.12.1 Table 10.12.2 Table 10.13 Table 10.14.1 Table 10.14.2 Table 10.15 Table 10.16.1 Table 10.16.2 Table 10.17 Table 10.18 Table 10.19 CHAPTER 11. Table 11.1 Table 11.2 Table 11.3 Table 11.4 APPENDIX A: Table A.1 Table A.2 APPENDIX B: Table B.1 Table B.2.1 Table B.2.2 Table B.2.3 Table B.2.4 Page Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Prevalence and treatment of acute respiratory infection: background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Prevalence and treatment of acute respiratory infection: region and province. . 127 Treatment of acute respiratory infection by type of facility or provider . . . . . . . . 128 Prevalence and treatment of fever: background characteristics . . . . . . . . . . . . . . . 129 Prevalence and treatment of fever: region and province . . . . . . . . . . . . . . . . . . . 130 Treatment of fever by type of facility or provider . . . . . . . . . . . . . . . . . . . . . . . . . 131 Prevalence of diarrhea: background characteristics . . . . . . . . . . . . . . . . . . . . . . . 132 Prevalence of diarrhea: region and province . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Duration, prevalence and incidence of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Knowledge and use of ORS packets: age, residence, and education . . . . . . . . . . 136 Knowledge and use of ORS packets: region and province . . . . . . . . . . . . . . . . . . 136 Treatment of diarrhea: oral rehydration therapy and other treatments . . . . . . . . . 137 Treatment of diarrhea: background characteristics . . . . . . . . . . . . . . . . . . . . . . . . 139 Treatment of diarrhea by type of facility or provider . . . . . . . . . . . . . . . . . . . . . . 140 INFANT FEEDING Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Breastfeeding and supplementation by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . 146 SURVEY DESIGN Sample implementation: results of the household interview . . . . . . . . . . . . . . . . 152 Sample implementation: results of the individual interview . . . . . . . . . . . . . . . . 153 DATA QUALITY TABLES List of selected variables for sampling errors, Indonesia 1991 . . . . . . . . . . . . . . . 161 Sampling errors for entire sample, Indonesia 1991 . . . . . . . . . . . . . . . . . . . . . . . . 162 Sampling errors for urban areas, Indonesia 1991 . . . . . . . . . . . . . . . . . . . . . . . . . 163 Sampling errors for rural areas, Indonesia 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Sampling errors for Java-Bali, Indonesia 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 xi Table B.2.5 Table B.2.6 Table B.2.7 Table B.2.8 Table B.2.9 Table B.2.10 Table B.2. I 1 Table B.2.12 Table B.2.13 Table B.2.14 Table B.2.15 APPENDIX C: Table C. 1 Table C.2 Table C.3 Table C.4 Table C.5 Table C.6 Page Sampling errors for Outer Java-Bali I, Indonesia 1991 . . . . . . . . . . . . . . . . . . . . . 166 Sampling errois for Outer Java-Bali II, Indonesia 1991 . . . . . . . . . . . . . . . . . . . . 167 Sampling errors for Jakarta, Indonesia 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 Sampling errors for West Java, Indonesia 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Sampling errors for Central Java, Indonesia 1991 . . . . . . . . . . . . . . . . . . . . . . . . . 170 Sampling errors for Yogyakarta, Indonesia 1991 . . . . . . . . . . . . . . . . . . . . . . . . . 171 Sampling errors for East Java, Indonesia 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 Sampling errors for Bali, Indonesia 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Sampling errors for ages 15-24, Indonesia 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . 174 Sampling errors for ages 25-34, Indonesia 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Sampling errors for ages 35-49, Indonesia 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . 176 DATA QUALITY TABLES Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . . . . 180 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Births by calendar year since birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 xii FIGURES Figure 2.1 Figure 2.2 Figure 3.1 Figure 3.2 Figure 4.1 Figure 4.2 Figure 5.1 Figure 5.2 Figure 5.3 Figure 6.1 Figure 7.1 Figure 8.1 Figure 8.2 Figure 9.1 Figure 9.2 Figure 9.3 Figure 10.1 Figure 10.2 Figure 10.3 Figure 11.1 Page Number of Persons Reported at Each Age by Sex, Indonesia 1991 . . . . . . . . . . . . 10 Distribution of the Household Population by Age, Indonesia 1991 . . . . . . . . . . . . 11 Age-Specific Fertility Rates, Indonesia 1967-1991 . . . . . . . . . . . . . . . . . . . . . . . . . 28 Total Fertility Rates by Province, Java-Bali 1967-1991 . . . . . . . . . . . . . . . . . . . . . 31 Percentage of Currently Married Women Who Know Specific Contraceptive Methods, Indonesia, 1987 and 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Percentage of Ever-Married Women Who Have Heard of Blue Circle Program and Who Know It Is Private Family Planning Program . . . . . . . . . . . . . . . . . . . . . 46 Percentage of Currently Married Women Using a Contraceptive Method . . . . . . . 54 Percentage of Currently Married Women Using Specific Contraceptive Methods, Java-Bali, 1987 and 1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Distribution of Current Users of Contraception by Source of Supply . . . . . . . . . . . 70 Fertility Preferences of Currently Married Women 15-49 . . . . . . . . . . . . . . . . . . . 72 Reasons for Discontinuation of Contraceptive Methods . . . . . . . . . . . . . . . . . . . . . 85 Median Age at Marriage by Region, 1987 NICPS and 1991 1DHS . . . . . . . . . . . . 92 Percentage of Births Whose Mothers Are Amenorrheic or Abstaining . . . . . . . . . 97 Number of Reported Deaths Among Children Under Two Years by Age at Death in Months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Infant Mortality Rates, Various Sources, Indonesia 1971-1991 . . . . . . . . . . . . . . 101 Infant Mortality by Province, Java-Bali 1976-1991 . . . . . . . . . . . . . . . . . . . . . . . 103 Number of Antenatal Care Visits and Stage of Pregnancy at First Visit . . . . . . . . 113 Delivery Characteristics of Births in the Five Years Preceding the Survey . . . . . 121 Feeding Practices Among Children Under Five with Diarrhea . . . . . . . . . . . . . . . 138 Distribution of Children by Breastfeeding (BF) Status, According to Age . . . . . . 144 xiii PREFACE The Indonesia Demographic and Health Survey (IDHS) was a project designed as a collaborative effort of four institutions----the National Family Planning Coordinating Board, the Central Bureau of Statistics, the Ministry of Health, and Macro Intemational Inc. The survey received financial assistance from the Government of Indonesia, the U.S. Agency for International Development (USAID)/Jakarta, and the United Nations Population Fund. Technical assistance as well as funds for the survey were provided by Macro International through its Demographic and Health Surveys Program (DHS), a USAID-funded project in many developing countries. The Central Bureau of Statistics (CBS) had the responsibility of conducting the survey. CBS activities included survey design, fieldwork, and data processing. The IDHS was carried out from May to July 1991 in selected areas of the 27 provinces in Indonesia. The IDHS sample is a subsample of the 1990 Population Census, and was designed to produce reliable estimates of major survey variables for each of the 27 provinces and for urban and rural areas of the three family planning program development areas (Java- Bali, Outer Islands I and Outer Islands II). As a follow-on to the 1987 National Indonesia Contraceptive Prevalence Survey 0NICPS), the IDHS questionnaire is an expanded version of those used in the NICPS. The IDHS will provide important information for program managers and policymakers to evaluate existing programs. A comparison of IDHS and NICPS data provides a picture of the development as well as the achievement of program goals in the field of family planning, population, and health. This final report is a completed and elaborated version of the earlier preliminary report. The relatively short time required to produce the survey results would not have been possible without the hard work and dedication of all parties involved. To those who gave their active contribution to this project, I would like to extend my sincere thanks and appreciation. Central Bureau of Statistics Azwar Rasjid Director General XV PREFACE Since its inception in 1970, the Indonesian National Family Planning Coordinating Board (NFPCB) has given high priority to monitoring and evaluating family planning program activities throughout the country. The first national survey providing detailed measures of family planning performance was the 1987 National Indonesia Contraceptive Prevalence Survey (NICPS). Results from this survey confirmed that the use of contraception in Indonesia had increased rapidly since 1970 and that fertility had fallen from around 5.6 births per woman in 1970 to 3.3 by 1987. The 1991 Indonesia Demographic and Health Survey (IDHS) is the second and most recent national survey providing Indnnesia's program managers and policymakers with nationally representative information on fertility, infant and child mortality, contraceptive use dynamics, and patterns of family planning service utilization. For the first time, the 1991 IDHS also provides extensive data on the knowledge and use of maternal and child health (MCH) services throughout the country--information that should prove highly useful to Indonesia's Ministry of Health (MOH) and the NFPCB in assessing the coverage and quality of current MCH interventions, and developing new program initiatives designed to further enhance the welfare of mothers and their children. Results from the 1991 IDHS confirm that Indonesia has continued to make considerable progress in providing effective, high quality family planning services to its people. As of 1991, 49.7 percent of all currently married women were using some form of contraception. By 1991, women were having an average of 3.0 children, a decline of 9 percent since 1987 and 46 percent since 1970. These outcomes clearly indicate that Indonesia' s family planning movement is achieving even greater success throughout much of the country. A particularly encouraging development documented by the 1991 IDHS is the rapid expansion of self-reliant family planning (KB Mandiri) over the past four years. For example, the percentage of clients acquiring family planning services through private sector outlets has increased from 11 percent in 1987 to 22 percent in 1991. This dramatic shift in the composition of Indonesia's service delivery system has exceeded all expectations, and provides confirmation that KB Mandiri is achieving widespread acceptance among family planning clients. While the 1991 IDHS indicates that Indonesia's family planning program is providing for the needs of more couples than ever before, it should also be recognized that even greater effort will be required to lower Indonesia's fertility rate to replacement level (around 2.1 births per woman). Encouraging women to begin practicing family planning at younger ages and promoting greater use of effective contraception will become increasingly important program priorities in the coming years. In addition, enhancing the quality of family planning and MCH services (especially client counselling and fonow-up) and providing more service delivery options for clients willbe essential ingredients in the future expansion of Indonesia's family planning program. However, beyond the need to recruit more family planning acceptors and promote greater use effectiveness, there is an overriding need to develop program strategies that enhance the welfare of mothers and children and promote greater economic opportunities for families. This holistic approach to development will help ensure that future generations of Indonesians reap a full reward from their country's dramatic demographic transition and rapid economic expansion. xvii In conclusion, I would like to thank the Central Bureau of Statistics, Macro Intemationai Inc. in Columbia, Maryland (USA), the IDHS Steering Committee, and the Office of Program Development at the NFPCB for their efforts in conducting the 1991 IDHS. In addition, USAID and UNFPA made substantial financial and technical contributions that helped ensure the ultimate success of this important undertaking. The high quality of the IDHS f'mal country report is indicative of the professional manner in which this project was designed and implemented. I trust that future demographic and health surveys will be conducted with the same impressive dedication to hard work and technical competence. National Family Planning Coordinating Board Haryono Suyono, Ph.D. Chairman xviii PREFACE The evaluation of the effectiveness of health programs rests on the ability to demonstrate changes in the health and nutritional status of the targeted population following the implementation of certain health strategies. Population-based measures of change in mortality and morbidity rates along with changes in objective measures of nutritional status are required. Since coverage by health services is not complete, institution-based data does not provide valid measures of effectiveness forprogram evaluation purposes. One way of making population-based data available is to conduct household surveys using scientifically acceptable sampling techniques. The 1991 Indonesia Demographic and Health Survey (IDHS) is such a survey. It was designed to meet the requirements of measuring family planning and health program attainment. The 1991 IDHS has as its objectives, among others, to provide data conceming fertility, family planning, and maternal and child health and to measure the development and achievements of programs related to health policy, particularly those concerning the maternal and child health development program. With these broad objectives and a sample covering all 27 provinces of Indonesia, the 1991 IDHS is indeed a valuable source of data. Indonesia is now facing demographic and epidemiological transitions. The implications for the health sector are that there will be changes in the types of services needed. Changes in mortality and morbidity patterns will require increased attention to life style and personal choices. Emerging needs of the elderly and other groups will require changes in the way health care is delivered. To afford all the changes, we need to utilize all of our resources in providing needed information for planning and evaluation in health. The IDHS is an example of the collaborative efforts of several institutions in providing good population-based data. We hope that such collaboration can be expanded in the near future to meet the need for high quality data. This report is the first comprehensive analysis derived from the 1991 IDHS. Further reports of in- depth analyses will hopefully appear soon. We believe that all of the outputs of the 1991 IDHS can be used to complement existing health information. They can be used by program managers, policymakers, as well as researchers to evaluate and improve existing programs. Ministry of Health Dr. Adhyatma, MPH Minister of Health Republic of Indonesia xix SUMMARY OF FINDINGS The 1991 Indonesia Demographic and Health Survey (IDHS) is a nationally representative survey of ever-married women age 15-49. It was conducted between May and July 1991. The survey was designed to provide information on levels and trends of fertility, infant and child mortality, family planning, and maternal and child health. The IDHS was carried out as a collaboration between the Central Bureau of Statistics, the National Family Planning Coordinating Board, and the Ministry of Health. The IDHS is a follow-on to the National Indonesia Contraceptive Prevalence Survey conducted in 1987. More than 27,000 households throughout the 27 provinces of Indonesia were visited during the survey and 22,909 women were interviewed. The results show that fertility in Indonesia continues to decline. At current levels, Indonesian women will have an average of 3.0 children during their reproductive years. Since 1985, the total fertility rate (TFR) has declined by one child. Fertility has reached close to replacement level in a few provinces, including Jakarta, Yogyakarta, East Java, and Bali. In the Java-Bali region, the TFR is 2.7 children per woman while it is 3.5 in Outer Java-Bali I and 3.8 in Outer Java-Bali II. Half of all currently married women in Indonesia are using contraception. The pill ( 15 percent), IUD (13 percent) and injection (12 percent) are the most commonly used methods, together accounting for over 80 percent of current use. Norplant (3 percent) and female sterilization (3 percent) account for most of the remaining users. Contraceptive use is highest in Java-Bali at 53 percent and is approximately 43 percent in the Outer Islands. Fifty-sixpercentofurban women use contraception compared to 47 pereent ofmralwomen. Also, contraceptive use increases as women's education level increases. Slightly over one-third of married women with no education are using a method while 59 percent of those with secondary or higher education do so. Government facilities are the most important sources of family planning, supplying 76 percent of contraceptive users. Approximately 39 percent of users get their method from a government health center and 16 percent from a health post; the remaining users of government sources obtain their methods mostly from family planning posts and govemment hospitals. Twenty-two percent of users receive family planning supplies or information from private sources, the most significant being private midwives and doctors. Women in Indonesia are marrying later than they did previously. The median age at marriage among women age 40-44 was 17.1 years compared to 19.8 years among those age 20-24. There are large differences in age at marriage across regions and provinces. Within Java-Bali, the median age at first marriage ranges from 15.9 years in West Java to 20.2 years in Bali. Compared to results from the 1987 NICPS, the age at marriage has increased in all of the provinces in Java-Bali, except West Java, and in the Outer Islands. One-half of married women in Indonesia say that they do not want any more children. An additional 25 percent want to wait at least two years before having another child. Among women with three or more children, almost three-quarters want no more children or are sterilized. The average desired family size among married Indonesian women is 3.1 children, varying from 2.5 children among women age 15-19 to 3.7 among women age 45-49. About 34 percent of women say that a two-child family is ideal while 22 percent state that their ideal family size is three children. A significant number of women (16 percent) did not specify the number of children they desire but said that it was "up to God" or gave some other non-numeric response. xxi Results from the survey suggest that, if all unwanted births were eliminated, the fertility rate at the national level would be 2.5 births per woman or 15 percent lower than its current level. In addition, six percent of married women want no more children but are not using family planning and an additional six percent want to wait two or more years before having their next birth but am not using family planning. Infant and child mortality in Indonesia has declined dramatically in the past two decades. Estimates suggest that infant mortality decreased by about half during the 20-year period from 1968 to 1988. In the five-year period preceding the IDHS, 68 of every 1000 Indonesian children died before reaching their first birthday and 91 of every 1000 children died before reaching age five. The level of infant mortality varies significantly according to the age of the mother at the time of the birth and the length of the interval between births. During the ten-year period prior to the IDHS, the infant mortality rate among women age less than 20 at the time of the birth was 60 deaths per 10~0 births compared to 29 among women age 20-29 and 25 among women age 30-39. Children born less than two years after a preceding birth were 2.5 times more likely to die during the first year of life than children born at least four years after a preceding birth. Information on various aspects of matemal and child health--antenatal care, vaccinations, breastfeeding and food supplementation, and illness---was collected in the IDHS on births in the five years prior to the survey. The findings show that 80 percent of children born in the five years preceding the survey had mothers who received antenatal care during pregnancy. The most common providers of antenatal care are health centers, followed by private midwives and health posts. Tetanus, a major cause of infant death, can be prevented by immunization of the mother during pregnancy. Forty-three percent of children under five had mothers who received two or more injections of tetanus toxoid vaccine during pregnancy. Based on information obtained from health cards and the reports of mothers, 74 percent of children age 12-23 months have been vaccinated for tuberculosis (BCG) and 58 percent for measles. Seventy-three percent have received at least one dose of polio vaccine and one dose of DPT vaccine but the percentage receiving the full three-dose series is only 56 percent. Overall, 48 percent of children age 12-23 months are fully immunized and 24 percent have received no immunizations. Almost all children in Indonesia (97 percent) are breastfed. The median duration of breastfeeding is relatively long--23 months--but supplemental liquids and foods are introduced at an early age. By the age of 2-3 months, half of all children are being given supplementary foods or liquids. During the two weeks preceding the survey, 10 percent of children under age five had symptoms of acute lower respiratory infection (cough with fast breathing). Sixty-five percent of these children were taken to a health facility for treatment. Over the same two-week period, 27 percent of children suffered from fever and 7 percent had a fever only unaccompanied by cough, fast breathing, or diarrhea. Of those with fever only, half were taken to a health facility and 27 percent went to a dispensary or drug store for treaUuent. Eleven percent of children under age five had diarrhea during the two weeks preceding the survey. Forty-three percent of these children were given a solution prepared from ORS packets (oral rehydration salts) and 33 percent received a recommended home fluid prepared from ingredients at home (e.g., sugar-salt-water solution). Knowledge and use of ORS packets is widespread in Indonesia. Overall, 85 percent of mothers of children under age five know about these packets and 59 percent have used them at some time. xxii X x ".% N INDONESIA ,,, .; "~o ~ ~.~' _ '~ / ~ ' " J ~ ~ L ~ .~.~'~.'~--~-°,~ . • I 12 o o ~ : ~ " ~ ~ ~' ~" , 14 ~15 ~ 16 ~/T J27 . " . . . . . " . + OI .D I Aceh 02 .Nor th Sumatra 03 .West Sumatca 04 .R iau 05 . Jambi 06 ,South Sumatra 07 .Bsngku lu OB. Lompung 09 .D K I J akar ta I0 ,West Java I I .Cent ra l Java PROVINCE CODE 12 . 01Yogyakarto 23 . South Su la~es i 13 . East Java 24 . South East Su lams i 14 . Bal i 25 , Moluku 15 . West Nusa Tenqgnro 26 . I r ian Jaya 16 . East Nusa Tenggara 27 . East T imor 17 . West Ka l imanton IB , Cent ra l Ko l imantan 19 . So~th Ka l imantan 20 . East Ka l imantan 21 . Nor th Su lawa l i 22 .Cent ra l Su lawes i CHAPTER 1 INTRODUCTION 1.1 GEOGRAPHY, H ISTORY AND ECONOMY The Indonesian archipelago lies between Asia and Australia, between the Indian and Pacific Oceans, and covers an area of approximately 1.9 million square kilometers. 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 Irian Jaya to the west of Papua New Guinea. In addition to these, there are more than 13,000 smaller islands, few of which are inhabited. Most of the islands are located in the equatorial region; no month passes without some rainfall. From November through April there is more precipitation, while the months of May through October are the dry season. The large number of islands and their dispersion over a wide area result in a diverse culture and hundreds of ethnic groups with their own languages. This is the basis of the national motto, "Unity in Diversity." Since Indonesia proclaimed independence in 1945, the Republic has experienced several political shifts. In 1948, a rebellion of the Communist Party took place in Madiun. Since its independence until De- cember 1949, when the Dutch gave up control over Indonesia, there were disputes against the ruling democratic republic. Some factions, supported by the Dutch, formed the Federation of Indonesian Republics which lasted less than one year. During the period 1950-1959, Indonesia faced several political problems, including a multi-party system which influenced political and economic stability, and several rebellions caused by ideological and ethnic/race differences. The history of the Republic of Indonesia reached a turning point after an aborted coup by the Communist Party in September 1965. In 1966, President Snharto began a new era with the establishment of the New Order Govemment which is orienteti toward overall develop- ment. Indonesia consists of 27 provinces. The next lower administrative units are regency or municipality, sub-district, and village. Classification of urban and mral areas is made at the village level. In 1990, there were 241 regencies, 56 municipalities, 3,623 sub-districts, 6,670 urban villages and 62,065 rural villages. Development programs in Indonesia are implemented in five-year stages. The first four Development Plans which started in 1969, initially supported the promotion of agricultural products, then gradually shifted to the manufacturing anti service sectors. The focus of the current plan is on manufacturing industries, espe- cially those that produce export commodities. At the same time, transportation and communication facilities were built to reduce the disparity that existed between provinces in their ability to benefit from development programs. Since the inauguration of the New Order Government, Indonesia has achieved substantial progress, particularly in stabilizing political and economic conditions. Per capita income has increased sharply, jumping from about US$ 50 in 1968 to US$ 385 in 1986. In the early 1980s Indonesia enjoyed an accumu- lation of foreign exchange as a result of the international oil boom. At the time, 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 govemment to look for alternatives. This effort seems to have been successful. In recent years, per capita income has increased from US$ 400 in 1988 to around US$ 500 in 1990, whereas income from exports other than crude oil has increased from about 55 percent in 1986 to 61 percent in 1988 of the total foreign exchange received from exports. Social development closely follows economic progress. The government policy on this issue is aimed at improving the people's welfare by ensuring the availability of adequate food, clothing and housing. Education and health are areas which have also received considerable attention. In the last two decades, the Indonesian educational system has undergone major improvements. The literacy rate of persons 10 years of age and over lias increased from 61 percent in 1970 to 84 percent in 1990. The percentage of children 7 to 12 years of age who are attending school has also increased from 1971 to 1990. The figures for males are 62 percent in 1971 and 91 percent in 1990, whereas for females, the figures are 58 percent in 1971 and 92 percent in 1990. The percentage of persons who never attended school has decreased, and the percentage of graduates at all levels of education has increased. The percentage of primary school graduates increased from 20 percent in 1971 to 36 percent in 1990, whereas persons who completed junior high school and higher increased from 26 percent in 1971 to 61 percent 1990. At all levels of education, 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. The singulate mean age at first marriage increased from 19.6 in 1971 to 21.6 in 1990. In urban areas, these figures are 21.1 in 1971 and 23.5 in 1990, whereas for rural areas these figures are 18.8 in 1971 and 20.5 in 1990. The increase in age at first marriage in urban areas has been greater than for rural areas. Another probable effect of more widespread education is the increase in labor force participation among females; while the female labor force participation rate in 1980 was 32.4 percent, it increased to 39.2 percent in 1990. This trend is expected to continue. 1.2 POPULAT ION In terms of the size of its population, Indonesia stands fourth in the world after the People's Republic of China, India, and the United States of America. Data from the 1990 Population Census show that the total population of Indonesia is 179.3 million. About 31 percent (55.4 million people) live in urban areas, an increase of 8 percentage points since 1980. The rate of growth has been declining in the last two decades. Between 1971 and 1980 the average annual rate of population growth was 2.32 percent, while between 1980 and 1990 it was only 1.97 percent. The rate of growth has declined in all islands, except Kalimantan. There is significant variation in the rate of growth among provinces in Indonesia. In the period 1980-1990, the rate ofgrewth in Java was only 1.66 percent. While Jakarta and West Java show rates of growth greater than 2 percent, in Yogyakarta, the rate of growth was only 0.35 percent per annum. Among the five provinces in Java, Jakarta shows the greatest decline in the growth rate. This is partly because in the last decade many people moved from Jakarta to West Java, especially in the regencies around Jakarta. Other characteristics of Indnnesia's population are its uneven distribution among islands/provinces, and higher birth and death rates than other ASEAN (Association of South East Asian Nations) countries. According to the 1990 Population Census, population density at the national level is 93 persons per square kilometer. This figure varies across regions, not only among islands, but also among provinces in the same island. Java has the highest population density (814), whereas Kalimantan has the lowest density (17). Comparison of provinces in Java shows that population density ranges from 12,500 persons per square kilometer in Jakarta to 678 persons per square kilometer in East Java. Table 1.1 presents the basic demographic indicators derived from the 1971, 1980, and 1990 Population Censuses and the 1985 lntercensal Population Survey. The first three indicators have already been discussed. Table 1.1 Basic demographic indicators Demographic indicators from selected sources. Indonesia 1971-1990 1985 1971 1980 Intercensal 1990 Index Census Census survey Census Population (millions) 119.2 147,5 164.6 179.4 Density (pop/kin z) 62.4 77.0 85.0 93,0 Percent urban 17.3 22.3 26.2 30.9 Reference period 1967-70 1976-79 1981-84 1986-89 Crude birth rate (CBR) l 40.6 35.5 32.0 27.9 Crude death rate (CDR) 3 19.1 13. l 11.4 8.9 Growth rate ((3R)" 2.2 2.2 2.1 1.9 Total fertility rate (TFR) 4 5.6 4.7 4.1 3.3 Infant mortality rate s (per 1000 births) 142 112 71 70 Life expectanc~ Male 45.0 50.9 57.9 57.9 Female 48.0 54.0 61.5 61.5 IEsfimated using the formula CBR = 9.48968 + 0.00555 TFR 2Interpolated from growth rates: 1961-70 = 2.10; 1971-80 = 2.32; 1980-90 = 1.98 3CDR = CBR - GR 4Estimated based on own children method SEsfimated using indirect estimation techniques Source: Cenla'al B~eau of Statistics (1987a, 1987b. 1989, 1992) Based on the 1971 Population Census, the crude birth rate (CBR) for the period 1967-1970 was estimated to be 41 per 1000 population. Results of the 1980 Population Census show that the CBR was 36 per 1000 for the period 1976-1979. The 1985 Intercensal Population Survey indicated that the CBR was 32 p~ 1000 for the period 1981-1984, and the CBR based on the 1990 Population Census was 28 for the period 1986-1989. Thus, the annual percentage decline in the CBR has continued steadily since the late 1960s. During the same period, the total fertility rate (TFR) declined from 5.6 children per woman to 3.3 children per woman. The average annual decline in the "I'I~R. during the period covered by these estimates is 2.2 percent. The crude death rate (CDR) has decreased from 19 per 1000 population to 9 per 1000 in the most recent period. The average annual rate of decrease in the CDR is 2.8 percent. Data from the 1971 and 1980 Population Censuses demonstrate that there has been a significant decline in the level o f infant mortality. Based on the 1971 Population Census, the infant mortality rate (IMR) was estimated to be 142 deaths per 1000 live births. The figure dropped to 112 deaths per 1,000 live births according to the 1980 Population Census, and declined to around 70 per 1,000 live births for the period 1986- 1989. 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. 1.3 POPULAT ION AND FAMILY PLANNING POL IC IES 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 family planning 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 (BKKBN). Since the BKKBN 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 1969/70 to 1973/74, programs began in the six provinces of Java and Bali. In the next five-year plan, the program was expanded to the provinces of Aceh, North Sumatra, West Sumatra, South Sumatra, Lampung, West Nusa Tenggara, 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 II 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 acceptors; 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 acceptors 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. Therefore, it is recommended that program strategies be aimed toward sustaining the achievement of the program through the following five-point strategy ("Panca Karya") for action: 1. Eligible couples with wives 20 to 30 years of age should have no more than two children, with sufficient birth spacing for the health and well-being of the mother and her children, in order to reduce fertility and to encourage development of a happy and prosperous family at the early stages of its formation. 2. Eligible couples with wives age 30 years or over, or who have had two or more children, should stop having children, as this is good for the mother's health and well-being; preventing pregnancy or stopping childbearing will also increase life expectancy and eliminate high-risk pregnancies associated with older ages. 3. Youth are to be provided with sufficient knowledge to prepare them to be responsible parents and citizens. Equal socialization of boys and girls, improvement of the role and status of women, and preparation to participate in program activities, will be encouraged. 4 4. Community institutions will support and participate actively in population and family planning efforts, as these are for the benefit of communities and the whole nation. Emphasis will be placed on institutional development to sustain family planning activities. 5. New or reformulated norms and values concerning family and communitylife willbe developed, such that these norms and values support family planning as a part of the daily life of individuals and families. The program emphasis has been shifted toward the establishment of a family planning movement. As the program develops, various activities are carried out in cooperation with other government agencies, in an integrated effort. Safe motherhood and self-sustained family planning campaigns are the priorities of the movement. 1.4 HEALTH PRIORITIES AND PROGRAMS The National Health System (NHS) was developed in 1982 to provide a basic framework for general health development activities on a nationwide basis. The NHS includes the Long-term Health Development Plan, covering a period of 20 years through the year 2000. The main objective is to improve the individual's ability to achieve an optimal health status. Specific goals contained in the "Panca Karsa Husada," or Five Major Objectives, are as follows: To enable people to take care of their own health and live a healthy and productive life; To promote an appropriate environment in support of the health of the people; • To improve the nutritional status of the people; • to decrease morbidity and mortality rates; and To promote a healthy and prosperous family life through the acceptance of the small and happy family norm. To reach these objectives, health development activities are designed to be integrated into the community, evenly distributed, acceptable and accessible to the community, and are carried out with the active participation of the community. The NHS aims to apply appropriate technology at a cost that the government and the community can afford. Realizing differences in opportunities between population subgroups and in the availability of health services, health development activities are specifically aimed to reach the rural population, low-income citizens in urban areas, persons living in isolated orborder areas, new settlements and transmigration areas. The National Health System has established targets to be achieved in the remaining years of the century. They are stated in terms of life expectancy, infant and child mortality and maternal mortality, birth weight, eradication of infectious diseases, immunization coverage and antenatal care, and other health measures. Various programs were developed to encourage active community involvement through Integrated Service Posts (Pos Pelayanan Terpadu, popularly called Posyandu) which are established and administered by the community with the technical support of the public health center staff. The Posyandu activities are directed primarily toward reducing the mortality of children under five through the provision of maternal and child care, improvement of nutrition, intensified efforts in immunization, delivery of family planning, and reduction of diarrheal diseases. 1.5 OBJECT IVES OF THE SURVEY In 1984, the U.S. Agency for International Development (USAID) initiated the Demographic and Health Surveys (DHS) program. Macro International was selected to coordinate the worldwide project under which more than 50 surveys will be conducted by 1993. The DHS program has four general objectives: To provide participating countries with data and analysis useful for informed policy choices; • To expand the international population and health database; To advance survey methodology; and To help develop in participating countries the technical skills and resources necessary to conduct demographic and health surveys. In 1987 the National Indonesia Contraceptive Prevalence Survey (NICPS) was conducted in 20 of the 27 provinces in Indonesia, as part of Phase I of the DHS program. This survey did not include questions related to health since the Central Bureau of Statistics (CBS) had collected that information in the 1987 National Socioeconomic Household Survey (SUSENAS). The 1991 Indonesia Demographic and Health Survey (IDHS) was conducted in all 27 provinces of Indonesia as part of Phase II of the DHS program. The IDHS received financial assistance from several sources. The BKKBN provided funds through grants from the U.S. Agency for International Development (USAID)/Jakarta and the UN Population Fund (UNFPA). The BKKBN and the Ministry of Health contributed funding from their Government of Indonesia development budgets. Macro Intemational furnished technical assistance as well as funds to the project through its Demographic and Health Surveys Program. The 1991 IDHS was specifically designed to meet the foUowing objectives: • To provide data conceming fertility, family planning, and matemal and child health that can be used by program managers, policymakers, and researchers to evaluate and improve existing programs; • 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 the availability of contraception; To measure the development and achievements of programs related to health policy, particularly those concerning the maternal and child health development program implemented through public health clinics in Indonesia. 1.6 ORGANIZATION OF THE SURVEY As in the 1987 NICPS, at the request of the BKKBN, the CBS was appointed as the implementing institution for the IDHS in Indonesia. A steering committee was formed to give direction in the imple- mentation of the survey. Members of the steering committee included representatives from various components within BKKBN, the Center for Development and Research of the Ministry of Health, related government agencies, and experts in topics covered by the IDHS. Representatives from USAID/Jakarta and UNFPA/Jakarta served as ex-officio members of the steering committee. A technical team was established within the CBS, including staff members whose responsibilities were associated with population statistics and survey activities. The directors of the regional statistical 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 regional office. The DHS model "A" questionnaire and manuals were modified to meet the requirements of measuring family planning and health program attainment, and were translated into Bahasa Indonesia. Over 170 female interviewers were trained for 15 days in nine training centers during May 1991, and data collection took place from the end of May to the end of July 1991. For more information about the fieldwork, see Appendix A. Table 1.2 is a summary of the results of the fieldwork for the IDHS, from both the household and individual interviews by urban-rural residence. Of 28,141 households sampled, 27,109 were eligible to be interviewed (excluding those that were absent, vacant, or destroyed), and of these, 26,858 or 99 percent of eligible households were successfully interviewed. In the interviewed households, 23,470 eligible women were found and complete interviews were obtained with 98 percent of these women. Table 1.2 Results of the household and individual interviews Number of households, number of interviews and response rates, according to urban-rural residence, Indonesia 1991 Residence Type of interview Urban Rural Total Households Sampled households 8911 19230 28141 Households found 8515 18594 27109 Households interviewed 8408 18450 26858 Response rate 98.7 99.2 99.1 Women Eligible women 7233 16237 23470 Interviewed women 7051 15858 22909 Response rate 97.5 97.7 97.6 7 CHAPTER 2 BACKGROUND CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Throughout this report, data on various topics are presented for different subgroups of the population. One purpose of this chapter is to describe the general characteristics of the sample population, such as age and sex composition, residence, education, housing facilities, and access to mass media. These provide information which, when combined with previous data sources, can be used to evaluate the IDHS data quality and to monitor changes over time. The second purpose is to describe the environment in which the respondents and their children live. Important characteristics of the respondents, particularly those which are believed to influence nuptiality, fertility, and contraceptive behavior, as well as maternal care and child morbidity and mortality, are highlighted. 2.1 POPULAT ION BY AGE AND SEX In the household questionnaire utilized in the IDHS, information was collected on all usual members of the interviewed household. In addition to providing a background against which various demographic processes are occurring, the age structure of the population also incorporates the past history of the population. Recognizing problems in ascertaining the correct age of the respondents, due to ignorance of their age by the general population, the IDHS interviewers were instructed to do the following in order to obtain accurate age information: (1) ask for legal documents or identity cards, (2) relate the respondent's age to the age of another household member whose age is known or to a household event whose date has been ascertained, or (3) relate the respondent's age to local or national events well known in the area. A chart used to convert reported dates from the Javanese, Sundanese and Muslim calendars to the Gregorian calendar was appended to the interviewers' manual. The Javanese and Sundanese calendars are actually the same as the Muslim calendar except for the names of the months. Figure 2.1 shows the number of persons enumerated in the household questionnaire by single years of age. The graph indicates that a preference for certain digits persists in Indonesia, particularly for ages ending in 0 and 5. The errors are more obvious among people age 20 and over, implying that recent educational improvements may have contributed to greater awareness of birth dates among younger people. Table 2.1 and Figure 2.2 present the age distribution of the population by five-year age groups according to sex. The pattern is typical of a country with relatively high fertility in the recent past--a narrow top and a wide base. The decline in fertility and mortality may be observed from the narrowing of the base over time. Figure 2,1 Number of Persons Reported at Each Age by Sex, Indonesia 1991 Number 2ooo o ; 2o 3'0 3; 4o 4; & 7o Age IDHS 1991 Table 2.1 Household populatlon by ag% residence and sex Percent distribution of the de jure household population by five-year age group, according to urban-rural residence and sex, Indonesia 1991 Age group Urban Rural Total Male Female Total Male Female Total Male Female Total 0-4 10.5 10.3 10.4 12.2 10.9 11.5 11,7 10.7 11.2 5-9 12.6 11.0 11.8 13.5 12.8 13.1 13.2 12.2 12.7 10-14 11.6 11.5 11.5 12.9 12.3 12.6 12.5 12.0 12.3 15-19 10.8 11.9 11.4 10.0 10.5 10.3 10.3 10.9 10.6 20-24 10.0 10.7 10.4 7.3 8.5 7.9 8.1 9.2 8.7 25-29 9.1 9.6 9.3 7.7 8.5 8.1 8.1 8.8 8.5 30-34 7,8 8.1 7.9 6.7 7.0 6.8 7.1 7.3 7.2 35-39 7.2 6.4 6.8 6.3 6.1 6.2 6.6 6.2 6,4 40-44 4.7 4.1 4.4 4.9 4.4 4,7 4.8 4.3 4.6 45-49 4.2 4.2 4.2 4.3 4.9 4.6 4.3 4.7 4.5 50-54 3,4 3,2 3.3 4.1 4.2 4.1 3.9 3.9 3.9 55-59 2.5 2.7 2.6 2.9 3.1 3.0 2.8 2.9 2.9 60-64 2.2 2.6 2.4 3.1 2.8 2.9 2.8 2.7 2.8 65-69 1.4 1.4 1.4 1.6 1.5 1.6 1.5 1.5 1,5 70-74 1.0 1.2 1.1 1.3 1.3 1.3 1.2 1.3 1.3 75-79 0.3 0.5 0.4 0.5 0.5 0.5 0.4 0.5 0.5 80 + 0.5 0.7 0.6 0.7 0.g 0.8 0.6 0.8 0.7 Total 100.0 100,0 100.0 100.0 100.0 100.0 100,0 100,0 100.0 Number 18998 19584 38582 42883 43018 85903 61880 62604 124488 10 Age 8o+ 75 70 65 60 55 50 45 40 35 3o 25 20 15 lO 5 (1 7 Figure 2.2 Distribution of the Household Population by Age, Indonesia 1991 5 4 3 2 1 0 1 2 3 4 5 6 7 Percent IDHS 1 991 2.2 POPULATION BY AGE FROM SELECTED SOURCES Table 2.2 gives the percent dis- tribution of the sample population by broad age groups in the 1980 Census, the 1985 Intercensal Survey (SUPAS), the 1987 National Indonesia Contra- ceptive Prevalence Survey (NICPS), and the 1991 IDHS. It is clear that there has been a decrease in the percentage of per- sons under 15 years old and an increase in the proportion in other age groups. The dependency ratio, calculated as the ratio of non-productive persons (under 15 and 65 and over) to persons 15-64 based on these figures has been decreas- ing gradually from 79 in 1980 to 67 in 1991. The decline in the dependency ra- tio indicates a lessening of the economic burden on persons in the productive age groups, who support those in the non- productive age groups. Table 2.2 Population by a~e from selected sources Pement dislxibufion of the population by ago group, according to selected sources, Indonesia 1991 1985 1980 Imerceasal 1987 1991 Age group Census survey NICPS IDHS <15 40.9 38.8 36.9 36.2 15-64 55.9 59.8 59.3 59.9 65+ 3.2 4.0 3.8 3.9 Total I00,0 I00.0 I00,0 I00.0 Median age 21.5 Dependency ratio 78.9 73.1 68.6 67.2 11 2.3 HOUSEHOLD COMPOSIT ION Table 2.3 provides information on the size and composition of sampled households, factors which may influence the allocation of financial resources among household members, thus affecting the overall well-being of the members. Large household size may be associ- ated with crowding in the dwelling, which can lead to unfavorable health conditions. Single- parent families, especially if they are headed by females, usually have limited financial re- sources. Household composition can also be analyzed through family type, distinguishing among others, nuclear and extended families. Of all households covered in the IDHS, 13 percent are headed by women. This proportion has remained at a similar level since 1980. The proportion is slightly higher in ur- ban than in rural areas. There are, on average, 4.6 persons in a household; urban households are 0.4 persons larger than rural households. Taking account of adult household members age 15 and over only, the large majority of households are composed of two related adults of the opposite sex or three re- lated adults. Single adult households are com- paratively rare, comprising only 7 percent of all households in both urban and rural areas. In addition, approximately 6 to 7 percent of households include one or more children who are living with neither their natural father nor their natural mother. Table 2.3 Household composition Percent distribution of households by sex of head of household, household size, relationship structure, and presence of foster children, according to urban-rural residence, Indonesia 1991 Residence Characteristic Urban Rural Total Household headship Male 86.4 87.2 87.0 Female 13.6 12.8 13.0 Number of usual members 1 5.3 4.5 4.7 2 9.2 10.7 10.3 3 14.9 18.0 17.1 4 18.4 21.2 20.4 5 17.0 17.5 17.4 6 13.6 12.5 12.8 7 9.0 7.5 7.9 8 5.0 4.0 4.3 9 + 7.6 4.2 5.2 Mean size 4.9 4.5 4.6 Relationship structure One adult 6.5 6.5 6.5 Two related adults: Of opposite sex 36.4 44.3 42.0 Of same sex 2.0 1.9 1.9 Three or more related adults 46.4 45.2 45.5 Other 8.7 2.1 4.1 With foster children 6.4 6.5 6.5 2.4 EDUCATIONAL LEVEL OF HOUSEHOLD POPULAT ION Education has been identified as an important characteristic which affects demographic and health behavior. Many phenomena such as reproductive behavior, use of contraception, health of children, and hygienic practices are related to the education of household members. Table 2.4.1 provides data on the educational attainment of the population obtained from the IDHS household questionnaire. Approximately 85 percent of men and 75 percent of women have had some schooling; 37 percent of men and women have some primary education but have not completed primary school, 20 percent of men and 18 percent of women have completed primary school. The proportion who have at least some secondary education is 28 percent for men and 21 percent for women. 12 Table 2.4.1 Educational level of the household population: age and residence Percent distribution of the de jure male mad female household populations age five and over by highest level of education attended, according to age and urban-rural residence, Indonesia 1991 Level of education Missing/ Median Some Completed Some Don't number Age/residence None primary primary secondary+ know Total Number of years MALE Age 5-9 41.0 58.1 0.1 0.0 0.9 100.0 8163 1.0 10-14 1.2 68.5 13.5 16.8 0.1 100.0 7729 5.2 15-19 1.5 14.3 26.5 57.7 0.0 100.0 6360 8.1 20-24 3.4 15.1 26.0 55.5 0.1 100.0 5043 9.1 25-29 5.4 24.7 27.4 42.5 0.0 100.0 5011 6.7 30-34 7.9 31.2 26.9 33.9 0.2 100.0 4370 6.4 35-39 9.6 33.1 28.0 29.3 0.0 100.0 4082 6.3 40-44 10.4 30.6 28.8 30.0 0.2 100,0 2984 6.3 45-49 14.3 32.1 26.5 27.1 0.1 100.0 2651 6.2 50-54 21.9 33.2 23.0 21.4 0.4 100.0 2422 4.9 55-59 29.5 37.4 18.1 14.9 0.2 100.0 1744 3.3 60-64 35.3 36.3 19.6 8.1 0.7 100,0 1735 2.7 65+ 43.5 31.0 18.0 6.9 0.6 100.0 2358 2.1 Resldance Urban 9.0 28.0 15.9 47.0 0.2 100.0 16989 6.8 Rural 17.4 41.1 21.9 19.3 0.3 100.0 37672 4.8 Total I 14.8 37.0 20.0 27.9 0.3 100.0 54661 5,9 FEMALE Age 5-9 39.1 59.9 0.0 0.0 1.0 I00.0 7654 1.1 10-14 1.9 65.4 15.3 17.4 0.0 I00.0 7534 5.3 15-19 3.0 16.6 32.2 48.1 0.0 100.0 6841 6.9 20-24 6.2 22.5 30.4 40.7 0.I I00.0 5739 6.7 25-29 13,3 33.7 24.0 28.9 0.I I00.0 5533 6.2 30-34 17.4 37.8 24.0 20.7 0.I I00.0 4575 5.3 35-39 19.7 37.9 73.2 19.2 0.0 100.0 3862 5.0 40~4 28.4 36.8 18.3 16.5 0.I I00.0 2711 3.6 45-49 41.0 30.0 16.2 12.6 0.I 100.0 2938 2.4 50-54 57.5 22.9 10.5 8.4 0.7 100.0 2418 0.0 55-59 62.8 22.3 9.4 4.8 0.7 100.0 1839 0.0 60-64 70.0 18.4 6.3 4.5 0.8 100.0 1700 0.0 65+ 79.1 11.8 5.9 2.0 1.2 100.0 2549 0.0 Residence Urban 15.5 29.9 16.5 37.8 0.3 100.0 17560 6.3 Rural 28.7 39.6 18.8 12.6 0.3 100.0 38338 3.5 Total 1 24.6 36.6 18.0 20.5 0.3 100.0 55898 4.3 STotal includes cases with missing values on age. 13 Table 2.4.1 also shows the median number of years of schooling attained by males and females in each five-year age group. The data indicate that public education became important only in the last few decades, in particular, after Indonesia proclaimed its independence in 1945. This is shown by the lower medians for older age groups. Overall, males have a median duration of schooling of 5.9 years, 1.6 years longer than females. While men between the ages of 25 and 49 have attended school for 6.2 to 6.7 years, for women the median is between 2.4 and 6.2 years. The gap in the median number of years of schooling between males and females is more than 1 year for people 15 years and older, but is negligible among those 5-14 years. These figures imply that, in recent years, girls have had as much opportunity as boys to pursue education. There is a notable difference in educational attainment between urban and rural dwellers. The median years of schooling for urban men is 6.8 years, or 2.0 years longer than rural men, while urban women spend 2.8 years longer in school than their rural counterparts. Tables 2.4.2 and 2.4.3 show differentials in educational attainment by region and province for males and females. As expected, Java-Bali's population is better educated than the population in other parts of the country. Educational level also varies between provinces in Java-Bali. The highest median duration of schooling occurs among men in Jakarta (9 years), almost 4 years longer than the median for men in Central and East Java. While women in Jakarta enjoy the longest median duration of schooling (6.8 years), the median for women in Bali is only 3.4 years, sborter than the median for women in Central and East Java (3.7 and 3.6 years, respectively). In Outer Java-B ali I, for both males and females, North Sum atra and North Sulawesi show the highest medians, whereas West Nusa Tenggara and West Kalimantan have the lowest. In Outer Java-Bali II, where men in most provinces have a median duration of schooling ranging from 5.4 years to 6.3 years and women's medians range from 3.8 years to 5.3 years, people in two provinces---East Timor and Irian Jaya--stand out as having much less education than people in other provinces; 3 years or less for men and less than 1 year for women. It should be kept in mind, however, that these provinces became part of the Republic only in 1976 and 1961, respectively. 14 Table 2.4.2 Educational level of the male household population: region and province Percent distribution of the de jure male household populations age five and over by higliest level of education attended, according to region mad province. Indonesia 1991 Region/province None Level of education Missing/ Number Median Some Completed Some Don't of number primary primary secondary+ know Total men of years MALE Java.Ball 14.7 36.6 21,7 DKI Jakarta 5.8 21.1 14.3 West Java 15.9 37.6 24.1 Central Java 14.6 40.0 23.3 Ol Yogyakarta 14.0 28.5 15.3 East Java 15.5 38.1 20.5 Bali 17.1 29.6 19,9 Outer Java-Bali I 14.4 37.8 17.4 DI Aceh 12.1 35.2 19.9 North Sumatra 9.4 35.7 18.1 West Sumatra 10.8 37.9 17.4 South Sumatra 14.7 37.7 19,8 Lemptmg 11.8 43.7 18.8 West Nusa Tenggara 26.8 36.4 13.7 West Kalimaman 20.0 45.2 11.0 South Kalimantan 10.8 35.4 23.6 North Sulawesi 7.9 39.8 14.3 South Sulawesi 21.2 34.4 15.6 Outer Java-Ball I1 16.6 37.2 17.0 Riau 12.6 41.6 16.3 Jambi 13.6 40.2 19.4 Bengkulu 11.4 39.9 16.2 East Nusa Tenggara 19.9 35.5 21.1 East Timor 36.9 31.9 8.2 Central Kalimantan 13.3 41.1 17.8 East Kalimantan 10.2 35.0 15.3 Centlal Sulawesi 10.8 35.3 22.0 Southeast Sulawesi 16.1 36.9 13.6 Maluku 12.8 37.4 16.9 Irian Jaya 42.0 26.3 9.9 Total 14.8 37.0 20.0 26.9 0.1 100.0 33579 6.0 58.6 0.1 100.0 2641 9.2 22.3 0.1 100.0 10559 5.8 22.0 0,0 100.0 8393 5.3 42,2 0.0 100.0 916 6.5 25.7 0.1 100.0 10209 5.3 33.3 0.1 100.0 860 6.2 29.9 0.5 100.0 14814 5.9 32.5 0.2 100.0 963 6.2 36.0 0.8 100.0 3069 6.3 33.7 0.2 100.0 1239 6.1 27.5 0.4 100.0 1948 6.0 24.9 0.8 100.0 1815 5.7 22.8 0.3 100.0 1064 3.9 23.0 0.8 100.0 1032 4.0 29.9 0.3 100.0 847 6.2 37.9 0.1 100.0 725 6.3 28.2 0.6 100.0 2112 5.1 28.5 0.7 100.0 6268 5.6 29.1 0.4 100.0 1156 5.5 26.8 0.0 100.0 626 5.6 32.1 0.4 100.0 374 5.9 23.0 0.6 100.0 948 5.7 22.8 0.2 100.0 241 2.8 25.4 2.3 100.0 463 5.6 39.2 0.3 100.0 578 6.3 30.4 1.4 100.0 519 6.2 32.9 0.5 100.0 363 5.4 31.7 1.1 100.0 573 6.0 20.4 1.3 100.0 427 3.0 27,9 0.3 100.0 54661 5.9 15 Table 2.4.3 Educational level of the female household population: region and province Percent distribution of the de jure female household populations age five and over by highest level of education attended, according to region and province, Indonesia 1991 Region/province None Level of education Missing/ Number Median Some Completed Some Don't of number primary primary secondary+ know Total women of years FEMALE Java-Ball 26.0 35.3 19.4 19.2 DKI Jakarta 10.3 25.3 18.8 45.4 West Java 23.6 38.9 21.3 16.0 Central Java 27.9 36.5 20.3 15.1 DI Yogyakarta 29.5 26.2 13.6 30.7 East Java 29.5 34.7 17.7 17.9 Bali 36.1 27.4 17.2 19.2 Outer Java-Ball I 21.5 38.7 15.7 23.7 DI Aceh 22.2 37.6 16.3 23.5 North Sumatra 15.1 37.8 17.2 29.1 West Sumatra 15.5 39.7 14.7 29.8 South Sumatra 19.5 41.1 17.6 21.6 Lampung 17.8 47.7 15.9 18.2 West Nasa Tenggara 37.3 33.2 12,8 16.5 West Kalimantan 36.5 38.3 8.0 16.2 South Kalimantan 18.6 37.9 20.9 22.3 North Sulawesi 8.5 41.4 16.0 34.0 South Sulawesi 28,9 33,0 14,5 23,0 Outer Java-Ball II 24.0 38.8 16.1 20.3 Riau 21,1 43.0 15.0 20.6 Jambi 23.9 42.7 15.9 17.4 Bengkulu 17.4 42.2 15.6 24.5 East Nusa Tenggara 22.5 37.0 22.8 16.7 East Timor 53.9 24,9 4,6 16.2 Central Kalimaman 20.8 45.2 12.3 19.5 East Kalimantan I8.4 39.2 15.8 26.0 Central Sulawesi 16.6 39.2 22.4 21.1 Southeast Sulawesi 25.2 35.3 14.9 23.8 Maluku 18.3 39.1 17.7 24.2 Irian Jaya 51.9 25.3 6.7 14.8 Total 24.6 36.6 18.0 20.5 0.2 100.0 34757 4.2 0.2 100.0 2757 6.8 0.3 100.0 10532 4.3 0.2 100.0 8867 3.7 0.0 100.0 945 4.8 0.1 100.0 10778 3.6 0.1 100.0 877 3.4 0.5 100.0 15060 4.6 0.4 100.0 973 4.6 0.8 100.0 3144 5.7 0.2 100.0 1297 5.3 0.2 100.0 2021 4.9 0.5 100.0 1724 4.5 0.2 100.0 1144 2.8 1.0 100.0 992 2.3 0.3 100.0 862 5.3 0.2 100.0 710 6.2 0,5 100.0 2194 3.9 0.7 100.0 6082 4.2 0.3 100.0 1114 4.0 0.1 100.0 625 3.8 0.3 100.0 341 4.8 1.1 100.0 955 5.2 0.4 100.0 226 0.0 2.2 100.0 425 4.1 0.6 100.0 532 4.7 0.8 100.0 506 5.3 0.8 100.0 371 4.0 0.7 100.0 581 5.3 1.3 100.0 405 0.0 0.3 100.0 55898 4.3 16 2.5 SCHOOL ENROLLMENT Table 2.5 presents the percentage of the household population 5 to 24 years of age enrolled in school, by age, sex and urban-rural residence. The data show that for people under age 12 years, the percentage enrolled in school is practically identical for girls and boys. While one in four children age 5-6 are in school, by age 7-12, nearly 90 percent of children are attending school. The proportion decreases for the older age groups. There are differences in school enrollment between urban and rural residents at all ages and for both sexes; the rural population has consistently lower school enrollment than the urban population. Table 2.5 School enrollment Percentage of the de jure household population age 5-24 years enrolled in school by age group, sex, and urban- rural residence, Indonesia 1991 Age group Male Female Total Urban Rural Total Urban Rural Total Urban Rural Total 5-6 23.1 14.0 16.7 25.7 14.6 17.8 24.3 14.3 17.2 7-12 92.2 84.2 86.5 93.3 84.3 86.8 92.7 84.3 86.7 13-15 83.8 57.3 65.3 71.6 53.0 58.9 77.6 55.2 62.1 7-15 89.5 76.1 80.0 85.9 74.8 78.0 87.7 75.4 79.0 16-18 59.8 31.4 40.4 50.0 23.6 32.5 54.6 27.4 36.3 19-24 24.2 7.7 13.8 16.3 4.3 8.7 20.0 5.8 11.1 2.6 HOUSING CHARACTERIST ICS Table 2.6 gives the distribution of households by selected housing characteristics. The source of drinking water, type of sanitation facilities, type of flooring and distance to household water are important determinants of the health status of household members, particularly children. The seriousness of major childhood diseases, such as diarrhea, can be reduced by proper hygienic and sanitation practices. Overall, half of the households covered in the IDHS have electricity. There is a notable difference between urban and rural areas; 88 percent of households in urban areas have electricity compared to only one in three in rural areas. Half of the sampled households get their drinking water from a well. Water that is either piped into the residence, into the yard or obtained from a public tap, is used by 15 percent of the households, 39 percent in urban and 5 percent in rural areas. Other sources of drinking water include springs (15 percent) and pumps (11 percent). Of all households covered in the survey, 44 percent have a private toilet, 10 percent use a shared facility, and the remaining 46 percent do not have a toilet. The difference between urban and rural areas is significant; 2 of 3 households in urban areas have a private toilet, while in rural areas the percentage is 37. The majority of people who do not have a toilet facility use a river or creek. 17 As far as primary construction materials of the floor are concemed, 3 of 10 households in the sample have dirt flooring, the same propor- tion have concrete or brick floors, and 34 percent have tile or wood flooring. These proportions vary between urban and mral areas; while 79 per- cent of urban households have' tile or con- crete/brick floors, in rural areas the percentage of households with this type of floor is 35; 21 per- cent of the rural households have wood floors and 40 percent have dirt floors. Overall, the source of water for house- hold purposes is on the premises in 51 percent of the households, and 34 percent of the households have a source between 1 and 9 minutes away. Ur- ban households are closer to their source of water than rural households. While 75 percent of the households in urban areas have water on the premises and 12 percent are within 5 minutes of the source, in rural areas the corresponding num- bers are 41 and 20 percent. 2.7 PRESENCE OF DURABLE GOODS IN THE HOUSEHOLD Data in Table 2.7 indicate that the pro- portion of households which have a radio, a tele- vision set and a refrigerator is 55, 28 and 38 per- cent, respectively. Urban households are more likely to have the convenience of these items than rural households. For instance, while 72 percent of urban households have a radio, in rural areas only 48 percent do. The difference in the pos- session of a television set and a refrigerator be- tween urban and rural households is more dra- matic; in urban areas, the proportion of house- holds having a television and a refrigerator is 58 and 79 percent respectively, while the corre- sponding proportions in rural areas are 16 and 21 percent. There is only a small difference in the ownership of a bicycle or boat between urban and rural areas; however, while 23 percent of urban households have a motor vehicle, in rural areas the percentage is only 9. Table 2.6 Housing characteristics Percent distribution of households by housing characteristics, according to urban-rural residence, Indonesia 1991 Residence Housing characteristic Urban Rural Total Electricity Yes 87.6 32.8 48.9 No 12.3 67.1 51.0 Source of drinking water Piped into residence 21.0 1.4 7.1 Piped into yard/plot 3.6 0.7 1.6 Public tap 14.3 2.4 5.9 Pump 16.8 8.5 10.9 Well 38.6 54.4 49.8 Spring 2.8 20.2 15.1 River 1.1 8.3 6.2 Rainwater 1.2 2.6 2.2 Other 0.5 1.4 I.I Missing / Don't know 0.2 0.1 0.2 Total 100.0 100.0 100.0 Sanitation facility Private, septic tank 38.7 5.8 15.4 Private, no septic tank 23.2 31.2 28.9 Shared public 14.3 7.6 9.5 Pit 0.1 0.6 0.5 Bush/Forest/Yard 2.0 7.5 5.9 River/Creek/Stream 17.3 33.1 28.5 Other 4.4 14.0 11.2 Missing/Don't know 0.2 0.I 0.I Total 100.0 I00,0 I00,0 Flooring Tile 36.9 8.5 16.9 Concrete/brick 42.1 26.8 31.3 Wood 9.0 20.9 17.4 Bamboo 0.6 4.0 3.0 Dirt/earth 11.3 39.5 31.2 Other 0.0 0.2 0.2 Missing / Don't know 0.2 0.1 0.1 Total 100.0 100.0 100.0 Distance to household water On premises 75.1 40.9 50.9 1-4 minutes 11.8 20.4 17.9 5-9 minutes 8.2 19.2 15,9 10+ minutes 3.8 19.1 14.6 Missing / Don't know 1.1 0.4 0.6 Total 100.0 100.0 100.0 Mean 1.2 4.9 3.8 Total 7879 18979 26858 18 Table 2.7 Household durable goods Percentage of households possessing specific durable consumer goods, by urban-roral residence, Indonesia 1991 Residence Durable goods Urban Rural Total Radio 71.6 47.6 54.7 Television 57.5 16.0 28.2 Refrigerator 78.8 21.1 38.0 Bicycle or boat 38.7 40.8 40.2 Motor vehicle 23.0 8.5 12.8 Number of households 7879 18979 26858 2.8 BACKGROUND CHARACTERISTICS OF RESPONDENTS Table 2.8.1 presents the distribution of re- spondents to the individual questionnaire by various background characteristics, including age, marital status, urban-rural residence, and religion. The dis- tribution of ever-married women by age group in the 1991 IDHS is very similar to that for the 1987 NICPS and the 1990 Census. Of the ever-married women in the sample, 92 percent are currently married, 4 percent are di- vorced, and 4 percent are widowed. The proportions have changed little since 1987 (CBS, NFPCB, and IRD, 1989). Nineteen percent of ever-married women interviewed in the survey have never attended school, 35 percent have some primary education but did not finish primary school, 26 percent completed primary school, and 20 percent have at least some secondary school; this last category includes women who have education beyond secondary school. Although decreasing, the majority (71 per- cent) of respondents live in rural areas. This pro- portion was 83 in 1971, 78 in 1980, 74 in 1985, and 72 in 1987. Of all women interviewed in the survey, 92 percent are Muslim, 6 percent are Protestant or Catholic, 2 percent are Hindu and 1 percent are Buddhist. Table 2,8.1 Background characteristics of respondents Percent dis~'ibutiun of ev~-marded women by selected background characteristics, Indonesia 1991 Number of ever-married women Background Weighted Un- characteristic percent Weighted weighted Age 15-19 5.4 1243 999 20-24 15.5 3557 3361 25-29 20.9 4788 4876 30-34 18.5 4244 4399 35-39 16.1 3687 3859 40-44 11.3 2583 2638 45-49 12.3 2807 2777 Residence Urban 29.2 6691 7051 Rural 70.8 16218 15858 Education No education 19.1 4385 4479 Some primary 34.8 7974 7524 Completed prima~ 26.1 5969 5461 Some secondary + 20.0 4581 5445 Marital status Married 92.1 21109 21187 Widowed 4.1 944 855 Divorced 3.7 856 867 Religion Muslim 88.8 20344 18347 Protcstant/Chdstiaza 5.7 1314 1960 Catholic 2.6 602 1155 Hindu 1.7 386 1084 Buddhist 0.9 204 269 Other 0.3 58 90 Total 100.0 22909 22909 19 The weighted and unweighted numbers of women in the sample by region and province are presented in Table 2.8.2. The IDHS is a weighted sample of ever-married women. Outer Java-Bali I and Outer Java-Bali II were oversampled in order to provide a sufficient number of cases on which to base estimates. The weighted percentage of women living in Java-Bali is 64 percent, 25 percent live in the Outer Java-Bali I region, and 11 percent live in Outer Java-Bali II. 2.9 RESPONDENT'S LEVEL OF EDUCATION Table 2.9.1 is an overview of the relation- ship between women's level of education and the background characteristics of age and residence. Re- spondents are distinguished by their marital status; the first panel presents information on ever-married women, while the lower panel refers to currently married women. Examination of this table shows that there are only slight differences between the two groups of women in terms of their distribution by education. The distribution by age is as expected; the percentage of women who have not gone to school and, to a lesser extent, womer t who have some pri- mary education increases with age, while the per- centage who have completed primary orhigher edu- cation shows the opposite pattern. Twenty-five per- cent of women age 20-29 have at least some sec- ondary school. Women in urban areas are more likely to have higher education than their rural counterparts. While only 10 percent of women in urban areas Table 2.8.2 Background characteristics of respondents: region and province Percent dis~xibutiun of ever-married women by region and province, Indonesia 1991 Number of ever-married women Weighted Un- Region/province percent Weighted weighted Java-Ball 63.9 14637 8296 DKI Jakarta 4.7 1086 1813 West Java 20.5 4701 1585 Central Java 16.2 3708 1370 DI Yogyakarta 1.4 328 1066 East Java 19.6 4500 1469 Bali 1.4 314 993 Outer Java.Ball I 24.9 5709 9760 DI Aeeh 1.5 349 710 North Sumatra 4.9 1112 1194 West Sumatra 2.1 475 1000 South Sumatra 3.7 848 1184 Lampung 3.0 698 1017 West Nusa Tenggara 1.8 412 986 West Kalirnantan 1.7 399 874 South Kalimaatan 1.6 377 935 North Sulawesi 1.1 254 668 South Sulawesi 3.4 786 1192 Outer Java-Ball 11 11.2 2563 4853 Riau 2.0 459 491 Jambl 1.2 282 474 Bengkulu 0.6 139 386 East Nusa Tenggara 1.7 400 472 East Timo¢ 0.4 96 467 Central Kalimantan 0.8 184 434 East Kalimantan 1.0 237 416 CenWal Sulawesi 0.9 204 434 Southeast Sulawesl 0.6 131 343 Maluku 1.0 222 477 Irlan Jaya 0.9 209 459 Total 100.0 22909 22909 have never gone to school, the percentage in rural areas is more than double at 23 percent. The urban-rural difference is most pronounced at the secondary or higher level; urban women are four times more likely than rural women to attain this level of education. Tables 2.9.2 and 2.9.3 show the distribution of women by education according to region and province. Among ever-married women, the percentage who have no education is 20 percent in Java-Bali, 17 percent in Outer Java-B ali I and 22 percent in Outer Java-B ali II, while the percentage of women who have some secondary or higher education is 19 percent in Java-Bali, 23 percent in Outer Java-Bali I and 21 percent in Outer Java-Bali II. 20 Table 2.9.1 Level of education: age and residence Percent disla'ibution of ever-married and of currently married women by highest level of education attended, according to age and urban-rural residence, Indonesia 1991 Characteristic Level of education Number Some Completed Some of None primary primary secondary+ Total women EVER-MARRIED WOMEN Age 15-19 5.3 28,1 48,9 17.7 100.0 1243 20-24 7.6 29.2 37.0 26.2 100.0 3557 25-29 14.3 35.8 25.5 24,5 100.0 4788 30-34 17.7 39.1 24.2 18.9 100.0 4244 35-39 19.4 38.3 23.3 19.0 100.0 3687 40-44 28.8 37.1 18.4 15.7 100.0 2583 45-49 41.1 30.0 16.5 12.4 100.0 2807 Residence Urbm 9.5 25.3 23.9 41.3 100.0 6691 Rural 23.1 38.7 26.9 11.2 100.0 16218 Total 19.1 34.8 26.1 20.0 100.0 22909 CURRENTLY MARRIED WOMEN Age 15-19 5.2 27.7 48.7 18.4 100.0 1152 20-24 7.5 28.5 37.5 26.6 100.0 3388 25-29 14.0 35.6 25.3 25.0 100.0 4570 30-34 17,7 38.7 24.6 19.0 100.0 4000 35-39 18.5 38.5 23.7 19.2 100.0 3386 40.44 28.0 36.7 18.8 16.5 100.0 2298 45-49 39.8 30.2 16.8 13,2 100.0 2314 Residence Urban 8.6 24.8 23.8 42.7 100.0 6120 Rural 22.2 38.6 27.6 11.6 I00.0 14989 Total 18.3 34.6 26.5 20.6 100.0 21109 21 Table 2.9.2 Level of education among ever-married women: region and province Percent distribution of ever-married women by highest level of education attended, according to region and province, Indonesia 1991 Level of education Number Some Completed Some of Region/province None primary primary secondary+ Total women Java-Ball 19.5 34.5 27.3 18.7 100.0 14637 DKI Jakarta 6.8 20.0 24.4 48.8 100.0 1086 West Java 18.0 36.9 30.7 14.4 100.0 4701 Cen~al Java 22.9 36.6 26.9 13.6 100.0 3708 DI Yogyakarta 18.0 27.1 21.9 32.9 100.0 328 East Java 20.6 34.7 25.3 19.3 100.ll 4500 Bah 31.3 27.7 25.6 15.4 100.0 314 Outer Java-Ball 1 17.1 36.2 23.9 22.8 100.0 5709 DI Aceh 16.3 34.0 25.4 24.3 100.0 349 North Sumatra 6.8 35.4 29.4 28.4 100.0 1112 West Sumatra 6.1 38.9 23.1 31.9 100.0 475 South Suma~a 15.8 36.3 28.0 19.9 100.0 848 Lampung 12.7 49.1 23.5 14.7 100.0 698 West Nusa Tenggara 41.1 28.7 16.3 14.0 100.0 412 West Kahmantart 41.9 33.8 9.4 15.0 100.0 399 South Kahmant an 12.9 36.9 27.1 23.1 100.0 377 North Sulawasi 3.0 33.7 22.1 41.2 100.0 254 South Sulawasi 25.3 30.6 22.7 21.4 100.0 786 Outer Java-Ball II 21.8 33.6 23.5 21.0 100.0 2563 Riau 12.8 41.1 24.3 21.9 100.0 459 Jambi 20.5 37.8 22.4 19.3 100.0 282 Bengkulu 11.4 36.1 24.9 27.5 100.0 139 East Nusa Tenggara 24.1 29.9 30.0 15.9 100.0 400 East Timor 63.9 12.6 6.5 17.0 100.0 96 Central Kahmantan 19.1 45.7 15.7 19.4 100.0 184 East Kahmantan 13.7 37.8 21.0 27.4 100.0 237 Central Sulawesi 10.2 30.0 35.4 24.4 100.0 204 Southeast Sulawesi 18.3 30.5 26.4 24.8 100.0 131 Maluku 14.1 32.6 27.9 25.4 100.0 222 Idan Jaya 59.9 18.0 9.3 12.8 100.0 209 Total 19.1 34.8 26.1 20.0 100.0 22909 22 Table 2.9.3 Level of education among currently married women: region and province Percent distribution of currently married women by highest level of education attended, according to region and province, Indonesia 1991 Region/province None Level of education Number Some Completed Some of primary primary secondary+ Total women Java-Ball 18.5 34.2 27.9 19.4 100.0 13419 DKIJakarm 5.7 18.3 24.0 52.0 100.0 973 WestJava 17.7 37.0 30.8 14.6 100.0 4386 Central Java 21.2 36.9 27.6 14.3 100.0 3331 DIYogyakarta 16.7 27.4 22.2 33.8 100.0 307 EastJava 19.5 33.8 26.4 20.2 100.0 4119 Bali 30.7 27.6 26.0 15.7 100.0 30 2 Outer Java-Ball I 16.3 36.1 24.3 23.3 100.0 5309 DI Aceh 15.4 33.8 25.5 25.3 100.0 327 North Sumatra 6.3 35.3 29.5 28.9 100.0 1049 West Sumatra 6.0 38.2 23.7 32.1 100.0 436 South Sumatra 15.0 36.5 28.3 20.1 100.0 792 Lampung 12.2 48.5 24.3 15.0 100.0 664 West Nusa Tenggata 40.3 27.8 17.0 14.9 100.0 369 West Kalimantan 41.0 33.9 9.9 15.3 100.0 373 South Kalimantan 11.2 37.3 27.5 24.0 100.0 339 North Sulawasi 3.0 34.0 22.1 40.9 100.0 240 South Sulawesl 24.2 30.7 22.9 22.2 100.0 719 Outer Java-Ball II 21.3 33.5 23.9 21.4 100.0 2382 Riau 12.4 40.9 24.8 21.8 100.0 426 Jambi 19.8 37.4 22.7 20.1 100.0 265 Bengkulu 10.7 36.6 24.3 28.4 100.0 132 East Nusa Tenggara 24.6 29.6 30.6 15.2 100.0 367 East Timor 61.3 13.3 6.7 18.6 100.0 87 Central Kalimantan 18.9 44.2 16.7 20.2 100.0 170 East Kalimant an 13.2 37.9 20.6 28.3 100.0 216 Central Sulawesi 9.9 30.1 35.4 24.6 100.0 195 Southeast Sulawesi 17.1 31.2 26.7 25.0 100.0 122 Maluku 14.0 31.9 28.3 25.9 100.0 210 Irian Jaya 59.5 18.3 9.4 12.8 100.0 191 Totd 18.3 34.6 26.5 20.6 100.0 21109 The difference in women's educational attainment across provinces is pronounced. While 3 percent of ever-married women in North Sulawesi did not go to school, in East Timor and Irian Jaya the proportion is 64 and 60 percent, respectively. In Jakarta, half of the women have some secondary or higher education, while this proportion is only 14 percent in West Java, a neighboring province. The larger percentage of women having higher education in certain provinces may be due in part to the greater availability of higher education facilities. 23 2.10 EXPOSURE TO MASS MEDIA The availability of newspapers, television and radio, is shown in Table 2.10.1. Twenty-seven percent of ever-married women read the newspaper at least once a week, 61 percent watch television once a week and 63 percent listen to the radio. While television viewing, radio listening and newspaper reading do not vary much across age, the oldest women are slightly less likely to do these activities than younger women. As expected, there is a positive association between exposure to mass media and level of education. Likewise, urban residence is associated with exposure to mass media. Urban women and women who have higher education are more likely read the newspaper, watch television, and listen to the radio than women in other subgroups. Table 2.10.1 Exposure to mass media: age~ residence T and education Percentage of ever-married women who usually read a newspaper once a week, watch television once a week, or listen to radio once a week, by age, urban-rural residence, and education, Indonesia 1991 Characteristic Read Watch Listen to Number newspaper television radio of weekly weekly weekly women Age 15-19 27.1 59.0 69.2 1243 20-24 29.2 62.4 67.2 3557 25-29 30.3 63.9 64.8 4788 30-34 28.4 62.9 63.0 4244 35-39 28.8 61.8 61.8 3687 40-44 22.4 58.0 57.8 2583 45-49 17.8 52.2 55.9 2807 Residence Urban 51.2 86.2 74.7 6691 Rural 16.9 50.3 57.8 16218 Education No education 0.4 37.4 44.0 4385 Some primary 13.2 55.3 59.5 7974 Completed Frimea'y 31.3 66.6 69.9 5969 Some secondary + 70.5 85.2 76.8 4581 Total 26.9 60.8 62.7 22909 24 Table 2.10.2 shows the distribution of ever-married women by exposure to mass media, according to region and province. In general, women in Java-Bali are more likely to have access to mass media than women in other areas. Within Java-Bali, large differences emerge. Women in Jakarta are much more likely to read a newspaper and watch television than women elsewhere in the country. The low percentage of newspaper readers in Bali may be associated with the large percentage of women who have no education. Table 2.10.2 Exposure to mass media: region and province Percemage of ever-married women who usually read a newspaper once a week, watch television once a week, or listen to radio once a week, by region and province, Indonesia 1991 Reginn~mvince Read Watch Listen to Number newspaper television radio of weekly weekly weekly women Java-Ball 28.1 67.0 67.9 14637 DKI Jakarta 62.2 93.9 74.4 1086 West Java 31.6 71.9 81.8 4701 Central Java 20.4 62.8 63.4 3708 DI Yogyakarta 39.5 76.7 65.7 328 East Java 22.8 58.8 56.4 4500 Bali 11.8 60.7 61.2 314 Outer Java-Ball I 24.7 51.1 55.8 5709 DI Aceh 22.7 52.4 54.5 349 North Sumatra 22.5 54.4 49.9 l 112 West Sumatra 25.0 54.9 47.4 475 South Sumatra 20.4 46.2 48.1 848 Lampung 19.7 46.7 62.5 698 West Nusa Tenggara 18.6 41.0 47.6 412 West Kalimentan 28.8 71.7 60.5 399 South Kalimantan 24.9 51.7 67.1 377 North Sulawesi 41.8 47.0 41.7 254 South Sulawesi 33.1 48.3 73.1 786 Outer Java-Ball I I 25.4 46.7 48.4 2563 Riau 30.9 66.6 63.2 459 Jambi 22.7 62.7 55.6 282 Bengkulu 33.8 62.8 57.7 138 East Nusa Tenggara 13.5 11.7 17.0 400 East Timor 16.7 13.6 26.3 96 Central Kalimamma 12.5 34.0 72.6 184 East Kalimant en 44.2 78.3 69.1 237 Central Sulawesi 28.1 50.9 44.5 204 Southeast Sulawesi 14.8 33.3 43.3 131 Malu.ku 38.2 57.0 56.1 221 Irian Jaya 19.1 21.8 23.6 208 Total 26.9 60.8 62.7 22909 25 CHAPTER 3 FERTILITY In the Indonesia Demographic and Health Survey (IDHS), information on fertility was gathered by two procedures. First, a series of questions on the number of live births was asked. Experience has indicated that certain types of events are under-reported. To minimize bias, the children were distinguished by sex, whether they lived at home or away, and whether they were living or dead. Distinction by sex improves reporting, and allows estimation of sex-specific mortality rates. Second, a full birth history approach was utilized, in which for each live birth the following information was collected: sex, age, whether the birth was single or multiple, whether the child was living in the household or away, and survival status of the child. For dead children, the age at death was recorded. Information on whether currently married women were pregnant was also asked. The 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. The more complicated birth history procedure is used less frequently, although it offers a richer set of data for analysis. The fertility measures presented here are calculated directly from the birth history. In applying a direct fertility estimation procedure, two issues are worth noting. First, interviews were conducted only with surviving women; there is no information on the fertility of women who did not survive. The fertility rates would be biased if the mortality of women in the childbearing ages was high and if there was a significant difference in fertility between surviving and non-surviving women. In Indonesia, neither of these appears to be the case. The second issue has to do with the limitation of the survey to ever-married women. Since most births in Indonesia occur within marriage, the number of births to single women is negligible. Although information on fertility was only asked of ever-married women, estimates can be made for all women regardless of marital status using information in the household schedule, and by assuming that women who were reported as never married had no children. In the collection of information through a birth history, it is important to obtain accurate data on age and the timing of births. Errors in reporting the number of children affect estimates of fertility levels, whereas errors in the timing of births distort trends. If these errors vary by socio-economic characteristics of the women, the differentials in fertility will also be affected. 3.1 FERT IL ITY LEVELS AND TRENDS The measure of current fertility presented in this report is the total fertility rate (TFR). The "It~R is calculated by summing the age-specific fertility rates and can be interpreted as the average number of births a hypothetical group of women would have at the end of their reproductive lives if they were subject to the currently prevailing age-specific rates from age 15 to 49. Table 3.1 and Figure 3.1 present the age-specific fertility rates from the 1991 IDHS along with results from selected sources. It is important to note that the rates from different data sources are not strictly comparable, because of differences in data collection procedures, geographic coverage, estimation techniques, and time reference. Nonetheless, they serve the purpose of reflecting recent fertility trends in Indonesia. According to the data in Table 3.1, the overall fertility decline in the past 20 years is 46 percent, from 5.6 children per woman in the late 1960s to 3.0 children per woman around 1990. Thus, during this period, fertility in Indonesia has progressed about 75 percent of the way to replacement level fertility, i.e., 2.2 children per woman. 27 Mother's age Note: Estimates for 1971 to 1985 are computed using the own children method while 1987 NICPS and 1991 IDHS rates are calculated directly from birth history data. TFR: Total fertility rate expressed per woman. GFR: General fertility rate (births divided by number of women 15-44), expressed per 1,000 women CBR: Crude birth rate expressed per 1,000 population 1Excludes 7 provinces in Outer Java-Bali U 21-36 months prior to survey 1971 1976 1980 1985 1987 1990 Census SUPAS Census SUPAS NICPS 1 Census 1967-1970 1971-1975 1976-1979 1980-1985 1984-1987 1986-1989 1991 IDHS (1988-199I) 2 Urban Rural Total 15-19 155 127 116 95 78 71 39 82 67 20-24 286 265 248 220 188 178 135 176 162 25-29 273 256 232 206 172 172 147 162 157 30-34 211 199 177 154 126 128 114 118 117 35-39 124 118 104 89 75 73 66 75 73 40-44 55 57 46 37 29 31 16 26 23 45-49 17 18 13 10 10 9 3 8 7 TFR 15-49 5.61 5.20 4.68 4.06 3.39 3.31 2.60 3.24 3.02 TFR 15-44 5.52 5.11 4.62 4.01 3.34 3.27 2.59 3.19 2.99 GFR 94 116 108 CBR 24.0 25.6 25.1 Figure 3,1 Age-Specific Fertility Rates Indonesia 1967-1991 Births per 1000 Women 3OO 250 200 150' 10(~ 5O 0 Table 3.1 Fertility rates from various sources Age-specific and cumulative fertility rates from selected sources. Indonesia 1971-1991 i i i i i 15-19 20-24 25-29 30-34 35-39 40-44 Age I 1967 70 J~1971 75 ~1976 79 --1981 84 ~1983 87 .1988 91 i 45-49 28 The pace of decline in fertilty has varied across time. It was relatively slow prior to the mid-1970s, accelerated in the subsequent decade, and seems to have slowed down slightly in recent years. As illustrated in Figure 3.1, age-specific fertility rates for the youngest group of women have declined by more than half during this period, from 155 births per 1,000 women to 67 births per 1,000 women. In addition, the shape of the age-specific fertility curve has flattened considerably, denoting substantial decline in fertility rates of women age 20 to 29 although more than 50 percent of births occur to women in these ages. Table 3.1 also shows age-specific fertility rates for urban and rural areas for the three years preceding the IDHS, as well as the general fertility rate and the crude birth rate. The general fertility rate (GFR) is the number of live births per 1,000 women age 15-44 years. The crude birth rate (CBR) is the number of births per 1,000 population. It is calculated by summing the product of the age-specific fertility rates and the proportion of women in the specific age group out of the total number of persons who usually live in the selected households. The GFR is 108 and the CBR is 25.1. There is a substantial gap in fertility between urban and rural residents. Urban women have, on average, half a child less than rural women. The largest urban-rural difference in age-specific fertility occurs among younger women age 15-24. Fertility trends can also be investigated using retrospective data from a single survey. Table 3.2 is generated from the birth history collected in the IDHS. The age-specific rates in the tables are progressively truncated with the elapsed time before the survey. The bottom diagonal of estimates is also partially truncated. Due to the truncation, changes over the past 20 years are observed from the age-specific rates for women up to age 29 years. Caution should be exercised when interpreting data in these tables because of possible recall lapses resulting in omission or incorrect dating of events, especially by older women and for distant time periods. Table 3.2 Age-specific fertility rates Age-specific fertility rates (per thousand women) for four-year periods preceding the survey, by mother's age, Indonesia 1991 Number of years preceding the survey Mother's age 0-3 4-7 8-11 12-15 16-19 15-19 70 98 129 136 141 20-24 166 197 241 243 256 25-29 158 181 224 230 251 30-34 116 137 175 194 (234) 35-39 70 85 114 (143) 40-44 21 37 (71) 45-49 (9) (10) Nora: Rates in parentheses are partially traneated. Overall, fertility decline in the past 20 years has been substantial, and there are indications of a recent acceleration in the rate of decline among women 15-24 accompanied by a slowing of the decline among women 25-44. A similar pattern can be seen in Table 3.3, which shows fertility and marital duration. For the same marriage duration, at all times, recent fertility is lower than in the distant past. 29 Table 3.3 Fertility by marital duration Fertility rates for four-year periods preceding the survey, by number of ye~s ~;mce f'tr st marde, ge, Indonesia 1991 Number of yem's preceding the survey Years since first marriage 0-3 4-7 8-I1 12-15 16-19 0-4 286 297 332 317 304 5-9 174 207 257 264 281 10-14 129 158 203 216 241 15-19 95 117 152 180 213 20-24 51 66 97 145 a 25-29 18 33 a a Note: Fertility rates are per 1,000 ever-married women. aLess then 125 person-years of exposure Table 3.4 and Figure 3.2 focus on the six provinces in Java-Bali where comparable data are available from the Population Censuses of 1971 and 1980, the 1976 Indonesia Fertility Survey (IFS), the 1985 Intercensal Population Survey, and the 1987 National Indonesia Contraceptive Prevalence Survey (NICPS). In demographic studies of Indonesia, it is important to set this region apart from the rest of the country because of its distinct socioeconomic and political context. The distinction is particularly relevant in fertility analysis, since organized family planning programs in this region were initiated earlier than elsewhere in the country. Table 3.4 shows that, among the provinces in Java-Bali, West Java has consistently had the highest fertility rates, while Yogyakarta has the lowest fertility, particularly since the late 1970s. Until the mid 1970s, the fertility rate in Bali was second highest after West Java. However, a rapid decline in the early 1980s brought the rate in Bali to a level lower than all other provinces in the region except Yogyakarta. The low fertility levels in Yogyakarta and Bali are accompanied by higher percentages of women who are using family planning methods (see Chapter 5). Table 3.4 Total fertility rates for provinces in Java-Bali Total fertility rates for provinces in Java-Bali from selected sources, Indonesia 1971-1991 Province 1971 1976 1980 1985 1987 1991 Census SUPAS Cereus SUPAS NICPS IDHS 1967-1970 1971-1975 1976-1979 1980-1985 1984-1987 1988-19911 Jakarta 5.18 4.78 3.99 3.25 2.8 2.14 West Java 6.34 5.64 5,07 4.31 3.6 3.37 Central Java 5.33 4.92 4.37 3.82 3.2 2.85 Yogyakarta 4.76 4.47 3.42 2.93 2.3 2.04 East Java 4.72 4.32 3.56 3.20 2.7 2.13 Bali 5.96 5.24 3.97 3.09 2.6 2.22 Note: Estimates for 1971 to 1985 are computed using the own children method while 1987 NICPS and 1991 IDHS rates are calculated directly from birth history data. tl-36 months prior to the survey. 30 No. of Children Figure 3,2 Total Fertility Rates by Province Java-Bali 1967-1991 Jakarta West Central Yogyakarta East Java Java Java BaN 3.2 FERT IL ITY DIFFERENTIALS Table 3.5 shows differentials in fertility by background characteristics. The first column of the table shows total fertility rates (TFR) for the three years preceding the survey (mid-1988 to mid-1991), while the second column presents the mean number of children ever born (CEB) to the oldest women (40-49 years of age). The average number of children ever born is an indicator of cumulative fertility; it reflects the fertility performance of older women who are nearing the end of their reproductive period, and thus represents completed fertility. If fertility has remained stable over time, the two fertility measures, TFR and CEB, would either be equal or similiar. Regionally, Java-Bali continues to have the lowest fertility in the country. However, since Outer Java-Bali II is experiencing a rapid decline, the difference in fertility between this region and the rest of the country is narrowing. Fertility in Java-Bali is 23 percent lower than in Outer Java-Bali I, and 28 percent lower than in Outer Java-Bali II. Among the six provinces in Java-Bali, four have reached a fertility level close to 2 children per woman (Yogyakarta 2.04, East Java 2.13, Jakarta 2.14, and Bali 2.22). Fertility hi West Java continues to be the highest in the region (3.37), with a difference of more than one child between this province and the four provinces with the lowest fertility. In general, there is an inverse relationship between education and fertility, that is, fertility decreases as education increases. However, similiar to findings from previous data (e.g., 1987 NICPS), women who have no education have the same or lower fertility than women who have some primary education. At the same time, women who have no education are experiencing a faster decline in fertility than women who have gone to school. 31 Table 3.5 also indicates that completed fertility (CEB) among women age 40-49 is much higher than the TFR for the three years preceding the survey, suggesting a substantial reduction in fertility. The 1987 NICPS showed a similar pattern. 3.3 CHILDREN EVER BORN AND LIVING In the survey questionnaire, the total number of children ever bom was ascertained by a sequence of questions designed to maximize recall. Lifetime fertility reflects the accumulation of births over the past 30 years and therefore, its relevance to the current situation is limited. However, the data are useful in providing back- ground information for understanding current fertility. Table 3.6 presents the distribution of all women and of currently married women by the number of chil- dren ever bern. Since respondents in the IDHS are ever- married women, information on the reproductive history of never-married women is not available. However, since virtually all births in Indonesia occur within marriage, it is safe to assume that never-married women have had no births; this is the assumption made in Table 3.6. The dif- ference between the fertility of all women and currently married women is brought about primarily by the propor- tion of women who remain unmarried, which is more pronounced in the younger ages. The average number of children increases with age, reflecting the family building process. Among all women, one in three does not have any children, 14 percent each have one or two children, 12 percent have three children, and the remaining 27 per- cent have four or more children. The corresponding pro- portions for currently married women are as follows: 8 percent did not have a child, 19 percent and 20 percent have one and two children respectively, 16 percent have three children, and one in three have four or more chil- dren. Five percent of women age 45-49 are childless. The last column of Table 3.6 shows the average number of children still living. Overall, women have an average of 2.3 children, 2 of whom were still living at the Table 3.5 Fertility by background charactefistlcs Total fertility rate for the three years preceding the survey and mean number of children ever born to women age 40-49, by selected background characteristics, Indonesia 1991 Mean number of chil&en Total ever born Background fertility to women characterislic rate 1 age 40-49 Residence Urban 2.60 4.71 Rural 3.24 4.97 Region/Province Java-Bali 2.68 4.69 DKI Jakarta 2.14 4.43 West Java 3.37 5.37 Central Java 2.85 4.69 DI Yogyakarta 2.04 4.11 East Java 2.13 4.24 Bali 2.22 3.98 Outer Java-Ball I 3.50 5.34 DI Aceh 3.76 5.75 North Sumatra 4.17 5.89 West Sumatra 3.60 5.98 South Sumatra 3.43 5.26 Lampung 3.20 5.41 West Nusa Tenggara 3.82 5.69 West Kalimantan 3.94 5.72 South Kalimant an 2.70 4.74 North 8ulawesi 2.25 4.27 South Sulawesi 3.01 4.58 Outer Java-Bali II 3.75 5.10 Education No education 3.28 4.76 Some primary 3.51 5.12 Completed primary 3.07 5.33 Some secondary + 2.58 4.18 Total 3.02 4.90 1Women age 15-49 years time of interview. For currently married women, the respective averages are 3.1 and 2.7 children. These figures are lower than those found in the 1987 NICPS, reflecting a decline in fertility in the past four years. For all women and for currently married women, the difference between the number of children ever born and still living is notable only after age 30. 32 Table 3.6 Children ever born and living Percent distribution of all women and of currently married women by number of children ever born (CEB) and mean number ever born and living, according to five-year age groups. Indonesia 1991 Number of childr~ ever born (CEB) Number Mean no. Mean no. Age of of of living group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children ALL WOMEN 15-19 90.9 7,6 1.3 0.1 0.1 0.0 0.0 0.0 0.0 0.0 0.0 100.0 6280 0.11 0.09 20-24 45.8 31.6 17.0 4.3 1.0 0.2 0.1 0.0 0.0 0.0 0.0 100.0 5523 0.84 0.75 25-29 16.9 22.4 28.2 18.6 9.6 3.3 0.6 0.3 0.0 0.0 0.0 100.0 5408 1.96 1.74 30-34 8.9 8.9 21.2 22.8 17.5 11.1 5.6 2.6 0,S 0.4 0.1 100.0 4456 3,08 2.71 35-39 5.2 6.4 13.7 18,2 20.0 14.8 9.9 6.2 2.8 1.5 1.4 100.0 3772 3.95 3.47 40-44 6.6 5.4 9.7 13.5 14.7 13.7 12.7 9,7 5.9 4.2 3.8 100.0 2646 4.64 3.91 45-49 4.9 7.7 7.1 10.7 13.1 11.7 12.1 10.7 9,2 6.0 6.9 100.0 2847 5,14 4.30 Total 32.5 14.3 14.4 11.7 9.3 6.3 4.3 3.0 1.8 1.2 1.2 100.0 30933 2.31 2.00 CURRENTLy MARRIED WOMEN 15-19 52.9 39.8 6.6 0.2 0.4 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1152 0.55 0.48 20-2A 15.3 48,9 27.0 6.9 1.5 0.4 0.1 0.0 0.0 0,0 0.0 100.0 3388 1.32 1,19 25-29 5,5 24.5 32,5 21.5 11.1 3.9 0,7 0,4 0.1 0.0 0.0 100.0 4570 2.25 2.01 30-34 3.2 8.6 22.6 24.4 18.8 12.1 6.0 2.8 0.9 0,4 0.1 100.0 40C0 3.31 2.92 35-39 2.4 5.6 14.0 18.9 20.6 15.2 10,5 6.6 3.1 1.6 1.5 100,0 3386 4,12 3,63 40-44 3.8 5,0 9.4 13.3 14.8 14.4 13.6 10.7 6.2 4.7 4.2 100.0 2298 4.88 4.13 45-49 3.1 7.1 6,6 10.5 12,8 12.0 12.3 11.8 9.4 6.6 7.8 100.0 2314 5.37 4.53 Total 8.3 19.2 20.0 16.0 12.5 8.5 5.8 4.1 2.4 1.6 1.6 100.0 21109 3.14 2.73 3.4 BIRTH INTERVALS The timing of births has implications for both fertility and mortality. Some evidence suggests that woman who have births in rapid succession f'mish their childbearing years with more children than those who space births farther apart. Changes in birth spacing patterns affect period fertility measures. Further, short birth intervals (less than two years) are associated with an elevated risk of mortality for children. Shorter intervals are generally associated with higher morbidity and mortality for the next child (see Chapter 9). Table 3.7 shows the percent distribution of births in the five years prior to the survey according to the length of the interval since the previous birth. Figures at the bottom of the table indicate that women in Indonesia favor relatively long birth intervals; the median length of birth interval is 38 months; 36 percent of the births occurred four years or longer after a previous birth, 44 percent had a two- to four-year interval, and only one in five had an interval of less than two years. 33 Table 3,7 Birth intervals Percent distribution of births in the five years preceding the stt~ey by number of months since previous birth, according to demographic and socioeconomic characteristics, Indonesia 1991 Number of months since previous birth Characteristic 7-17 18-23 24-35 36-17 48+ Median no. of months Number since previous of Total birth births Age 15-19 19.9 21.4 52.5 2.9 3.3 100.0 25.7 95 20-24 15.0 18.7 34.9 14.1 17.3 100.0 29.4 1425 25-29 7.9 11.8 30.1 17.3 32.9 100.0 37.1 3337 30-34 5.9 11.7 27.1 15.5 39.8 100.0 40.6 2860 35-39 5.4 8.7 23.7 16.6 45.6 100.0 44.9 1799 40-44 2.6 10.2 23.4 16.1 47.7 100.0 46.0 649 45-49 5.7 2.0 18.7 12.4 61.2 100.0 50.1 209 Birth order 2-3 8.8 12.1 27.3 15.2 36.6 100.0 38.2 5587 4-6 5.9 10.8 28.8 16.6 37.9 100.0 39.5 3658 7+ 7.4 14.7 32.8 17.3 27.7 100.0 34.6 1129 Sex of prior birth Male 7.6 11.4 29.4 16.1 35.5 100.0 37.9 5367 Female 7.6 12.6 27.3 15.9 36.7 100.0 38.5 5007 Survival of prior birth Living 6.1 11.0 28.4 16.7 37.9 100.0 39.6 9137 Dead 18.6 19.2 28.6 10.8 22.8 100.0 27.8 1237 Residence Urban 9.3 11.6 25.7 15.4 37.9 100.0 38.9 2933 Rural 6.9 12.1 29.5 16.2 35.3 100.0 37.9 7441 Region/Province Java-Ball 5.3 9.4 25.0 16.4 43.9 100.0 44.0 5527 DKI Jakarta 9.3 11.0 24.2 16.7 38.8 100.0 40.2 369 West Java 5.5 10.6 25.2 12.2 46.5 100.0 44.4 2211 Cenlxal Java 4.6 10.5 24.9 19.8 40.3 100.0 42.6 1463 D1 Yogyakarta 4.8 7.9 20.7 14.9 51.7 100.0 48.9 97 East Java 4.7 5.4 25.1 19.6 45.1 100.0 45.7 1280 Bali 7.1 11.8 28.6 16.5 36.0 100.0 38.4 108 Outer Java-Ball I 10.0 15.4 32.2 15.4 27.0 100.0 33.5 3359 Outer Java-Ball H 10.7 13.8 32.5 15.6 27.4 100.0 33.8 1488 Education No education 6.7 13.0 27.5 16.6 36.3 100.0 38.6 1841 Some primary 6.7 11.0 30.0 14.8 37.5 100.0 38.5 4174 Completed primary 7.7 11.8 28.1 17.0 35.4 100.0 38.1 2594 Some secondary + 10.6 13.4 25.9 16.5 33.6 100.0 37.1 1765 Work status since marriage Worked since marriage 6.7 12.1 27.6 16.7 36.9 100.0 39.2 5401 Did not work 8.6 11.8 29.3 15.1 35.2 100.0 37.2 4967 Current work status Currently working 6.7 12.3 27.9 16.6 36.5 100.0 39.0 4066 Not currently working 8.2 11.7 28.7 15.5 35.9 100.0 37.7 6274 Total t 7.6 12.0 28.4 16.0 36.1 100.0 38.2 10374 Note: First-order births are excluded. The imerval for multiple births is the number of months since the preceding ~Tregnancy that ended in a live birth. oral includes cases with missing information on work status since marriage and current work status. 34 While the proportion in each birth interval category varies little according to children's sex, urban- rural residence, mother's education or mother's work experience, there are significant differences by mother's age, region/province of residence, and to some extent, birth order. Younger women have shorter birth intervals than older women; women age 15-19 have birth intervals half as long as women in the 45-49 year age group. On average, women in Java and Bali have intervals 10 months longer than women in other parts of Indonesia. The median birth interval in Java-B all is 43 months, while in the other regions, it is 33 months. Among provinces in Java, women in Yogyakarta have the longest inter-birth intervals; fertility is also lower in Yogyakarta than in any other province in Java. 3.5 AGE AT FIRST BIRTH The onset of childbearing is an important fertility indicator. A rise in the age at first birth is usually a result of increasing age at first marriage, although the opposite may not be true. In many countries, postponing the first birth, combined with spacing the second birth, has contributed greatly to reducing fertility. Table 3.8 shows the distribution of women by current age and age at first birth. The prevalence of very early childbearing has declined over time. While 9 percent of women age 40-49 had their first birth before age 15, only 3 percent of those age 20-24 did so. About half of women age 30-49 had their first birth before age 20; the corresponding percentage for women age 20-24 is 36, a 28 percent decline. The last column in Table 3.8 presents the median age at first birth according to women's current age. Except for the oldest age group, there is evidence that age at first birth has been increasing among Indonesian women; it is 19.8 for women 40-44, and 20.4 for women 25-29. Table 3.8 Age at first birth Percent distribution of women by age at first birth, according to current age, Indonesia 1991 Current age Women Median with Age at first birth Number age at no of first births <15 15-17 18-19 20-21 22-24 25+ Total women birth 15-19 90.9 1.2 4.9 3.1 NA NA NA 100.0 6280 a 20-24 45.8 3.4 15.1 17.8 13.0 4.8 NA 100.0 5523 a 25-29 16.9 5.3 20.7 20.2 16.3 14.5 6.0 100.0 5408 20.4 30-34 9.0 6.8 23.8 19.5 15.8 15.4 9.7 100.0 4456 20.0 35-39 5.2 6.3 23.0 21.4 14.7 16.3 13.0 100.0 3772 19.9 40~14 6.6 8.7 24.5 18.2 15.5 14.8 11.8 100.0 2646 19.8 45-49 4.9 9.0 23.2 17.3 15.4 14.8 15.4 100.0 2847 20.1 NA = Not applicable aLess than 50 percent of the women in age group x to x+4 have had a birth by age x 35 Table 3.9 presents data on differentials in age at first birth according to selected background characteristics of the woman. Overall, among women age 25-49, the median age at first birth is 20 years. There is wide variation between subgroups of women; urban women have their first child when they are 1.5 years older than their rural counterparts, and women in Java-Bali start motherhood one year earlier than women in other regions. Women who have secondary or higher education start childbearing wben they are 3.6 years older than women who have not completed primary education but among those with no education or some primary education only, age at first birth is almost identical. Table 3.9 Median age at First birth Median age at first birth among women 25-49, by current age and selected background characteristJ.cs, Indonesia 1991 Current age Women Background age characteristic 25-29 30-34 35-39 40-44 45-49 25-49 Residence Urban 22.1 21.1 21.1 20.7 20.3 21.2 Rural 19.8 19.6 19.5 19.5 19.9 19.6 Region/Province Java-Ball 20.1 19.5 19.6 19.4 19.6 19.7 DKI Jakarta 24.0 22.1 21.6 21.8 20.8 22.2 West Java 18.9 18.3 18.2 18.7 18.1 18.5 Central Java 20.5 20.1 19.9 20.1 20.0 20.2 DI Yogyakarta 22.5 22.6 22.0 21.3 20.6 21.9 East Java 19.9 19.1 19.6 18.8 19.4 19.5 Bali 22.1 21.0 21.5 22.1 21.6 21.6 Outer Java-BaH I 21.0 20.6 20.5 20.4 20.7 20.7 Outer Java-BaH H 21.0 20.9 20.9 20.8 21.4 21.0 Education No education 18.8 18.6 19.5 19.4 20.1 19.3 Some primary 19.3 19.4 19.1 19.2 19.2 19.3 Completed primary 19.8 19.4 19.5 19.6 19.8 19.6 Some secondary + 23.8 23.3 22.8 22.2 22.3 23.2 Total 20.4 20.0 19.9 19.8 20.1 20.1 3.6 TEENAGE FERTILITY This section presents information on fertility amongwomen age 15-19 (seeTable3.10). (Teenagers who have never married are assumed to have had no pregnancies and no births.) The topic of teenage fertility is important because teenage mothers and their children are at increased risk of social and health problems. For example, children bom to young mothers am more prone to illness and to higher mortality during childhood than other children. Also, young women may have to curtail their education in order to have children. Although fertility among young women has declined substantially, childbearing still starts relatively early in Indonesia; more than 12 percent of women 15-19 years have become mothers (9 percent) or are currently pregnant with their first child (3 percent). There are large differentials between subgroups of women. As expected, the proportion of women who have started childbearing increases with age; while less 36 than 0.5 percent of 15-year olds have become mothers or are pregnant with their first child, by age 19 the proportion has reached 8 percent. Teenagers in rural areas, in Java-Bali, and teenagers who have less than primary education have children earlier than those living in urban areas, in Outer Java-Bali, and those who have primary or higher education. Rural women in their teens are three times more likely than urban women to have given birth or be pregnant with their first child. Among the provinces in Java-Bali, West Java and East Java are quite different from the rest of the region. In these provinces, 1 in 5 and 1 in 6 teenagers respectively have already started childbearing compared to about I in 10 in the other provinces. Women's education is closely related to the initiation of childbearing; while 20 percent of teenagers who have less than primary education have had children or are expecting their first child, the corresponding percentage among those with some secondary schooling is 5 percent. Table 3.10 Teenage fertility Percentage of women 15-19 who are mothers or pregnant with their first child, by selected background characteristics, Indonesia 1991 Percentage who are: Percentage who have Pregnant begun Number Background with fast child- of characteristic Mothers child bearing teenagers Age 15 0.2 0.2 0.3 5976 16 0.5 0.3 0.8 5342 17 1.7 1.1 2.8 4960 18 4.6 1.3 5.8 4297 19 6.5 1.7 8.2 3865 Residence Urban 4.2 1.5 5.8 2121 Rural 11.5 4.0 15.5 4164 Region/Province Java-Ball 13.1 4.8 17.9 2937 DKI Jakarta 3.8 1.8 5.7 423 West Java 15.2 4.3 19.5 1189 Central Java 6.7 2.1 8.9 927 DI Yogyakarta 4.1 0.3 4.4 97 East Java 10.3 5.2 15.4 1148 Bali 5.0 2.4 7.4 95 Outer Java-BaU I 6.7 2.0 8.7 1750 Outer Java.Ball II 9.3 3.3 12.6 710 Education No education 19.5 2.4 22.0 195 Some primary 17.5 4.3 21.8 1022 Completed primary 10.7 4.8 15.4 2335 Some secondary+ 3.7 1.4 5.2 2777 Total 9.1 3.2 12.2 6280 37 Table 3.11 presents the distribution of teenage women by current age and number of children. (Teenagers who never married are assumed to have had no births and no pregnancies.) Of the 9 percent who are teenage mothers, 7.6 percent have one child, and 1.4 percent have two or more children. Overall, the contribution of women age 15-19 to total fertility in Indonesia is small, and as noted earlier, decreasing. Table 3.11 Children born to teenagers Percent distribution of women 15-19 by number of children ever born (CEB), according to age, Indonesia 1991 Age 0 1 2+ Number of Mean children ever born number Number of of Total CEB teenagers 15 99.3 0.6 0.0 100.0 0.01 1327 16 97.7 2.3 0.0 100.0 0.02 1242 17 93.3 5.5 1.2 100.0 0.08 1265 18 84.6 12.9 2.5 100.0 0.18 1274 19 78.6 17.8 3.6 100.0 0.25 1172 Total 90.9 7.6 1.4 100.0 0.11 6280 38 CHAPTER 4 KNOWLEDGE AND EVER USE OF FAMILY PLANNING 4.1 KNOWLEDGE OF FAMILY PLANNING METHODS AND SOURCES Knowledge of family planning methods and of places to obtain them is crucial in the decision of whether to use a method and which method to use. Knowing about methods but not about sources is an obstacle to the adoption of contraception. In the IDHS, data on knowl- edge of family planning methods were obtained by first asking the respondent 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 meth- od 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, intravag, condom, Norplant, female sterilization, male sterilization, abor- tion, periodic abstinence, and with- drawal). In addition, other methods mentioned spontaneously by the re- spondent such as herbs (jamu), ab- dominal massage (pijat), and pro- longed abstinence were recorded. For each method recognized, the respond- ent was asked if she had ever used the method. Finally, for all modem meth- Table 4.1 Knowledge of contraceptive methods and source for methods Percentage of ever-married women and of currently married women who know specific contraceptive methods and who know a source (for information or services), by specific methods, Indonesia 1991 Know method Know a source Ever- Currently Ever- Currently Contraceptive married married married married method women women women women Any method 93.9 94.6 91.9 92.9 Any modern method 93.6 94,4 91.9 92.9 Pill 90.4 91.2 87.5 88.6 IUD 82.0 83.2 77.6 78.9 Injection 86.5 87.6 83.8 85.1 Intravag 6.1 6.2 5.0 5.1 Condom 62.8 63.9 53.8 54.9 Nurpla_nt 66.0 67.5 60.1 61.4 Female sterilization 54.1 55.2 49.5 50.6 Male sterilization 29.2 29.9 26.8 27.6 Abortion 25.6 26.2 18.6 19.1 Any traditional method 28.0 28.7 19.1 19.7 Periodic abstinence 20.9 21.6 19.1 19,7 Withdrawal 14.0 14.5 NA NA Herbs 5.1 5.2 NA NA Massage 2.1 2.1 NA NA Other 0.6 0.7 NA NA Number of women 22909 21109 22909 21109 NA = Not applicable ods recognized, the respondent was asked where a person could obtain the method if she wanted to use it. If the respondent recognized periodic abstinence, she was asked where a person could go to obtain advice about the method if she wanted to use it. Knowledge of family planning methods and sources is practically universal among ever-married women (94 percen0 as well as among currently married women (95 percent), and virtuaily all of these women recognize at least one modem method (see Table 4.1). These percentages are the same as those derived from the 1987 NICPS. 39 Knowledge of family planning varies by method. The most widely known methods are the pill, injection and the IUD--known by 91, 88 and 83 percent, respectively. The least known modem method is intravag, a non-prcgram method which has only recently become available commercially.~ Male sterilization is also less weU known than other methods. Abortion as a family planning method is known by one of four women. This percentage is high, given that abortion is not a program method. Knowledge of most methods has remained stable or increased slightly since 1987 (see Figure 4.1). However, there has been a large increase in knowledge of Norplant. In 1987, only 30 percent of married women had heard of this method while in 1991, this figure is 68 percent. Table 4.1 also shows that almost all ever-married and currently married women know at least one source for family planning. The percentage of married women who know a source for the pill, injection, and the IUD is 89, 85 and 79 percent, respectively. The gap between knowledge of methods and knowledge of sources is relatively small for most methods, ranging from 2 percent for pill and injection to 9 percent for the condom. Figure 4,1 Percentage of Currently Married Women Who Know Specific Contraceptive Methods Indonesia, 1987 and 1991 Percent 100 91 91 88 82 83 84 80 65 64 68 60 53 55 40 3 27 30 20 0 Pill IUD Condom Injection Norplanr Male Female Ster Ster. A larger percentage of women in urban areas know about family planning methods than women in rural areas (see Table 4.2.1), although the difference is small (98 versus 93 percent). Looking at the pattern according to age, the highest level of knowledge of both methods and sources occurs in age group 20-24. Imravag is a spermicide-impregnated tissue which is inserted prior to intercourse. 40 Table 4.2.1 Knowledge of modemcontraceptlve methods and source for methods: age~ residence T and education Percentage of currently married women who know at least one modem contraceptive method and who know a source (for information or services), by age, urban-rural residence, and education, Indonesia 1991 Characteristic Kllow a Know Know source for Number any a modem modem of method method I method women Age 15-19 89.5 88.9 87.1 1152 20-24 97.1 97.0 96.3 3388 25.29 96.1 95.9 95.0 4570 30-34 96.5 96.3 95.2 4000 35-39 96.2 96.0 94.6 3386 40-44 93.0 92.7 90.1 2298 45-49 86.7 86.3 82.9 2314 Residence Urban 97.9 97.8 96.6 6120 Rural 93.3 93.0 91.4 14989 Education No education 84.7 84.1 81.0 3854 Some primary 94.9 94.7 92.9 7305 Completed primary 97.2 97.1 96.5 5598 Some secondary + 99.6 99.6 98.9 4352 Total 94.6 94.4 92.9 21109 tlncludes pill, IUD, injection, intravag, condom, female sterilization, male sterilization and Nurplant Respondent's level of education has a strong association with knowledge of family planning methods. About 84 percent of women with no education have heard of a modem method. The proportion rises to 95 percent among women with some primary school, and to almost 100 percent of women with secondary or higher education. The pattern with respect to knowledge of family planning sources is similiar. Regional differences in knowledge of methods and sources are small (see Table 4.2.2). Ninety-six percent of married women in Java-Bali have heard of at least one modem method of family planning, compared to 93 percent of women in Outer-Java Bali I and 90 percent of women in Outer Java-Bali II. This pattern is consistent with the pattem of development of the family planning program; the areas where the program has been functioning longest are those with the highest level of knowledge. The percentage of women who know a modem method ranges from 93 to 99 percent in the provinces of Java-Bali, from 84 to 99 percent in Outer Java-Bali I, and from 65 to 99 percent in Outer Java-Bali II, 41 Table 4.2.2 Knowledge of modem contraceptive methods and source for methods: region and province Percentage of currently married women who know at least one modem contraceptive method and who know a source (for information or services), by region and province, Indonesia 1991 Region/province K~ow 8. Know Know source for Number any a modem modem of method method I method women Java-Ball 95.7 95.6 94.3 13419 DKI Jakarta 99.8 99.8 99.0 973 West Java 93.0 92.8 91.8 4386 Central Java 98.4 98.4 96.2 3331 DI Yogyakarta 99.2 99.1 98.5 307 East Java 95.0 94.9 93.7 4119 Bali 97.0 97.0 96.5 302 Outer Java-BaH I 93.6 93.2 91.5 5309 DI Aceh 89.7 87.9 86.5 327 North Sumatra 92.5 92.4 90.8 1049 West Sumatra 95.2 95.0 93.3 436 South Sumatra 95.1 94.9 94.2 792 Lampung 98.8 98.8 97.4 664 West Nusa Tenggara 96.1 95.8 94.1 369 West Kalimantan 84.7 84.0 82.1 373 South Kallmantan 96.9 96.4 94.7 339 North Sulawesi 98.9 98.6 98.4 240 South Sulawesi 89.6 89.2 84.7 719 Outer Java-BaH H 91.0 90.3 88.4 2382 Riau 93.5 93.3 90.9 426 Jambi 95.8 95.8 95.3 265 Bengkulu 96.7 96.7 96.4 132 East Nusa Tenggara 85.1 84.4 83.7 367 East Timor 69.5 65.3 65.0 87 Cen~al Kallmant an 94.5 93.3 91.0 170 East Kalimantan 98.9 98.7 96.5 216 Central Sulawesi 97.1 96.6 93.5 195 Southeast Sulawesi 93.8 93.4 92.2 122 Maluku 93.3 92.2 87.9 210 Irian Jaya 73.4 72.2 69.1 191 Total 94.6 94.4 92.9 21109 1Includes pill, IUD, injection, intravag, condom, female sterilization, male sterilization and Norplant 42 Respondents in the IDHS who said that they had heard of a particular method were also asked where they thought a person could go if they wanted to use the method. The responses to this question are summarized in Table 4.3. For all modem methods except intravag, the most frequently named source is the health center (Puskesmas). A sizeable proportion of women also mention health posts (Posyandu) as a source for these methods. In the case of female and male sterilization, a government hospital is named as a source by more than 60 percent of women. Approximately 15 percent of respondents named pharmacies or drugstores as places to obtain condoms and a relatively large proportion (14 percent) said that they did not know where condoms could be obtained. Table 4.3 Potential source of supply for contraceptive methods Percent distribution of ever-married women knowing a method by supply source they would use if they wanted the method, according to specific methods, Indonesia 1991 Female Male stezili- sterili- Periodic Sourceofsupply Pill IUD Injection lntravag Condom Norplant zation zation abstinence Government source 84.7 79.7 78.0 41.9 62.8 78.0 77.5 75.7 24.7 Governrnent hospital 3.8 9.1 5.2 12.4 4.2 15.1 62.6 61.5 4.2 Hcnith center (Puskesmas) 41.6 58.6 58.9 23.9 41.2 51.5 13.3 11.9 11.0 Health post (Posyandu) 21.7 8.2 10.8 3.7 11.7 6,8 0.7 0.9 5.2 FP post/VCDC/Paguyu, 15.8 1.9 2.3 1.2 4.5 1.4 0.3 0.5 1.S Fieldworker-PLKB 1.7 0.2 0.4 0.4 0.9 0.3 0.1 0.1 1.7 FP mobile-TKBK/TMK 0.1 0.7 0.2 0.1 0.2 0.6 0.1 0.0 0.1 FP safari 0.1 1.0 0.2 0.2 0.1 2.3 0.4 0.8 0.6 Private source 10.9 14.7 18.2 39.6 22.1 12.6 13.7 15.8 18.9 Private hospital 1.5 2.5 2.1 6.4 1.2 2.6 7.2 7.7 1.7 Private clinic 1.1 1.3 1.3 1.1 0.8 1.2 0.8 1.1 1.0 Private doctor 2.7 5.0 5.9 9.4 1.8 5.1 4.5 6.0 8.8 Private midwife 4.4 5.9 9.0 3.8 3.0 3.6 1.3 1.0 7.4 Pharmacy/Drugstore 1.2 0.0 0.0 18.9 15.3 0.1 0.0 0.0 0.1 Other soucee 1.2 0.3 0.6 1.1 0.8 0.4 0.2 0.3 47.8 Traditltional healer (Dukun) 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.4 Friends/Relatives 0.5 0.0 0.1 0.5 0.3 0.1 0.0 0.1 38.9 Other 0.7 0.3 0.5 0.5 0.5 0.3 0.1 0.2 8.5 Don't know 2.8 4.8 2,7 16.4 13.5 8.4 8.1 7.7 7.1 Missing 0.4 0.6 0.4 1.1 0.8 0.7 0.5 0.5 1.5 Total 100,0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 20712 18797 19820 1390 14390 15130 12402 6684 4792 4.2 KNOWLEDGE OF BLUE CIRCLE One of the highest priority programs of the family planning movement is the provision of family planning services through the private sector. The program is directed toward encouraging self-sufficiency of acceptors by having them pay for services. The program was initiated in a campaign in 1987 in large cities, such as Jakarta, Surabaya, and Bandung, and has gradually expanded to almost all of the municipalities throughout Indonesia. The private sector program logo, "Blue Circle" is present on the packaging of 43 contraceptives (e.g., condoms, pills) which are sold to users. For information, education, and communication purposes, the Blue Circle logo is also put on signs outside of the offices of private doctors and midwives, and is widely displayed in other strategic locations such as billboards. In order to evaluate the progress of the Blue Circle campaign, respondents in the IDHS were asked whether they had ever heard of Blue Circle, and if so, did they know what it was. Table 4.4.1 shows that 34 percent of ever-married women had heard of Blue Circle. Of these, only one-third knew that it was a private family planning service and 19 percent mentioned that it concerned family planning but did not specifically mention that it was a private service. Forty seven percent of those who had heard of Blue Circle said that they did not know what it was. Table 4.4.1 Knowledge of Blue Circle: ag% residence~ and education Percentage of ever-married women who have heard of Blue Circle and of those who have heard of Blue Circle, the percentage who think Blue Circle is a private family planning service, by age, urban-rural residence, and education, Indonesia 1991 Among those who heard of Blue Circle, percentage who think it is: Private Other Heard of family family Don't Blue planning planning Don't know ff Characterlstie Circle service service Other know heard of Number Age 15-19 33.2 17.7 23.3 1.3 57.7 22.7 1243 20-24 39.9 29.8 17.5 2.0 50.7 19.6 3557 25-29 39.2 33.8 18.1 0.9 47.2 19.3 4788 30-34 36.4 35.3 18.9 1.2 44.6 18.3 4244 35-39 32.9 35.5 18.0 0.9 45.6 21.4 3687 40-44 27.0 38.1 19.6 1.3 40.9 24.7 2583 45-49 20.4 37.7 17.5 1.0 43.7 27.7 2807 Residence Urban 60.4 37.2 21.7 1.1 40.0 11.8 6691 Rural 22.8 29.4 15.0 1.4 54.2 25.3 16218 Education No education 9.1 13.0 9.0 0.9 77.1 33.8 4385 Some primary 21.7 19.3 19.4 1.7 59.5 25.0 7974 Completed primary 38.1 26.7 20.4 1.3 51.5 18.8 5969 Some secondary + 72.7 47.9 17.9 0.9 33.3 6.3 4581 Total 33.8 33.5 18.5 1.2 46.8 21,3 22909 Young women are more familiar with Blue Circle than older women. However, even in the age group 15 to 24 years more than half of those who said that they had heard of Blue Circle did not know what it was. The Blue Circle campaign has concentrated it efforts in urban areas and has only recently begun to expand to rural areas. It is not surprising, then, that 60 percent of ever-married urban women had heard of Blue Circle, compared to only 23 percent of rural women. 44 Education is closely associated with knowledge of Blue Circle. Only 9 percent of women with no education have heard of Blue Circle. This proportion rises to 22 percent among women with some primary, 38 percent among those who completed primary, and 73 percent among women with secondary of higher education. Among the provinces, the highest proportion of ever-married women who have heard Blue Circle occurs in Jakarta (73 percent), followed by Yogyakarta (see Table 4.4.2 and Figure 4.2). This finding is not surprising since the Blue Circle campaign started in large cities like Jakarta. By region, knowledge of Blue Circle is highest in Java-Bali at 37 percent, 30 percent in Outer Java-Bali 1 and 25 percent in Outer Java-Bali II. The lowest level of knowledge occurs in East Nusa Tenggara in Outer Java-Bali II where only 9 percent have heard of Blue Circle, although almost two-thirds of those who have heard of Blue Circle know that it is a private family planning service. In several other provinces where overall knowledge of Blue Circle is low, the percentage of those who know Blue Circle who correctly identify it is high, such as East Nusa Tenggara and North Sulawesi. Table 4.4.2 Knowledge of Blue Circle: region and province Percemage of ever-married women who have heard of Blue Circle and of those who have heard of Blue Circle, the percentage who think Blue Circle is a private family planning service, by region and province, Indonesia 1991 Among those who heard of Blue Circle, percentage who think it is: Private Other Heard of family family Don't Blue planning planning Don't know if Region/province Circle service service Other know heard of Number Java-Ball 36.6 29.2 23.6 1.1 46.1 24.3 14637 DKI Jakarta 73.4 32.3 30.8 1.0 35.9 8.5 1086 West Java 35.4 22.9 23.4 1.6 52.2 20.2 4701 Central Java 34.7 33.4 13.3 0.8 52.4 15.0 3708 DI Yogyakarta 64.9 48.3 22.2 0.4 29.0 4.7 328 East lava 29.1 25.3 31.0 1.0 42.7 41.7 4500 Bali 28.9 70.6 4.8 0.3 24.2 18.8 314 Outer Java.Ball I 30.4 41.3 6.5 1.9 50.2 13.3 5709 DI Aceh 20.2 27.5 8.2 0.6 63.6 3.9 349 North Sumatra 31.1 37.1 21.7 7.4 33.8 5.3 1112 West Surnatla 28.7 46.7 10.5 2.4 40.4 7.8 475 South Sumatra 35.6 42.6 0.0 0.0 57.4 15.1 848 Lampung 38.5 36.2 0.5 0.5 62.8 21.4 698 West Nusa Tenggara 18.1 38.3 16.5 0.6 44.6 21.5 412 West Kalimantan 28.0 36.1 0.0 0.0 63.9 10.4 399 South Kalimantan 41.8 43.0 2.8 1.3 53.0 22.5 377 North Sulawesi 31.8 65.8 0.0 0.5 33.7 5.8 254 South Sulawesi 23.9 48.2 0.3 0.0 51.5 18.1 786 Outer Java-Ball i l 25.0 47.7 8.4 0.6 43.3 22.4 2563 Riau 23.0 40.7 34.7 1.7 22.8 6.9 459 Jambi 28.2 44.6 0.0 0.0 55.4 35.3 282 Bengkulu 30.9 44.9 3.3 0.0 51.8 14.3 139 East Nusa Tenggara 8.6 60.3 18.1 0.0 21.7 43.5 400 East Timor 12.1 29.8 55.9 3.6 10.7 31.8 96 Central Kaliroantaa 33.3 27.8 0.0 0.7 71.5 16.6 184 East Kalimantan 51.4 45.3 0.0 0.0 54.7 1.2 237 Central Sulawesi 26.2 21.6 5.2 0.0 73.2 16.9 204 Southeast Salawesi 18.1 85.2 0.0 0.0 14.8 44.1 131 Maluku 34.1 72.1 0.0 1.2 26.7 11.4 222 Irian Jaya 15.1 81.8 0.0 0.0 18.2 31.8 209 Total 33.8 33.5 18.5 1.2 46.8 21.3 22909 45 Figure 4.2 Percentage of Ever-Married Women Who Have Heard of Blue Circle Program and Who Know It Is Private Family Planning Program ©© ~v~ ~'~ - - v - - ~ . Java-Bali Jakarta West Java Central Java Yogyakart~ East Jav~ Bal Outer J-B Outer J-B I 0 20 40 60 80 Percent IDH8 1991 4.3 DISSEMINATION OF FAMILY PLANNING INFORMATION The objectives of the Information, Education, and Communication (IEC) component of Indonesia's family planning program are to disseminate knowledge about family planning in particular and to institutionalize the "small, happy, and prosperous family" norm in general. IEC activities are conducted through the mass media and through family planning groups and workers. The use of the mass media including newspaper, radio and television, is integral to the IEC program at both the central and provincial levels. Family planning television programs are shown on both central and regional stations run by the government. Family planning information is carded on the radio by government and private stations throughout the country. IEC activities are also carried out through community groups which are formed at the village or neighborhood level. Generally, IEC activities at periodic community group meetings are handled by a family planning field worker or by the group leader. 4.3.1 Knowledge of the Best Methods for Delaying and Limiting Births One very important indicator of the success of the IEC program is the extent to which accurate information is conveyed to women about the objective of using modem contraceptive methods. Table 4.5 indicates that 70 percent of women believe that either the pill, IUD or injection is best for delaying births. Although the family planning program recommends that women use the IUD only when they have all the children they want, about 21 percent of women say this method is best for delaying the next birth. The percentage of women who think that female sterilization is best for stopping childbearing is 20 percent while very few named male sterilization or Norplant as the best. 46 About one in five women said they did not know the best contraceptive for delaying a birth and about one in four said that they did not know the best method for stopping childbearing. From these data, it appears that there is a need for greater knowledge about the methods appropriate for different childbearing desires. It should be noted that the figures in Table 4.5 are almost,identical to the figures derived from the 1987 NICPS. Thus, there has been little improvement in this aspect of contra- ceptive knowledge since 1987. 4.3.2 Provision of Information by Family Planning Field Workers Family planning field workers and cadres at the grassroots level play a very important role in the IEC component of the family planning program. They arc not only agents of dissemination of family planning innova- tions, but are also the "motor" of the family planning movement. Various activities are carried out by the cadres at regular monthly meetings, such as recording current users, IEC activities, referrals to the proper fami- ly planning services, self-rcliant family planning move- ment (KB Mandirz) activities, and other activities inte- grated with family planning, such as income generation and family welfare education. Table 4.5 Perceived best method to delay or limit births Percent distribution of ever-married women by the method they think best to use to delay or limit births, Indonesia 1991 JBest Best for for Method delaying limiting Pill 28.3 15.1 1UD 20.7 15.5 Injection 22.1 15.5 Condom 1.0 0.3 Norplam 3.9 4.6 Female sterilization 0.7 19.8 Male sterilization 0.1 1.0 Periodic abstinence 0.9 0.4 Withdrawal 0.4 0.2 Herbs 0.8 0.7 Massage 0.3 0.3 Other 0.4 0.3 Don't know 20.4 26.2 Total 100.0 100.0 Number 22909 22909 Table 4.6.1 shows the percentage of currently married women who had been visited by a family planning field worker in the 6 months prior to the survey. Overall, one in three women was visited. The percentage visited reaches 30-32 percent of women age 20-29 but is lower among teenagers and women age 40 or over. Rural women arc more likely to be visited by a family planning field worker than urban women. Visits by a field worker arc positively related to the respondent's level of education. Women who have attended school arc much more likely to be visited by a field worker than those with no education. Compared to women in the other two regions, women in Outer Java-Bali II are most likely to be visited by a family planning field worker (see Table 4.6.2), but there are significant differentials between provinces within each region. In Java-Bali, DKI Jakarta has the lowest percentage (11 percent) while Central Java and East Java have the highest percentage of women who were visited by a family planning field worker (34 and 35 percent, respectively). In Outer Java-Bali I, the lowest percentage occurs in North Sumatra (11 percent) and the highest in North Sulawesi (41 percent). In Outer Java-Bali If, the percentages are lowest in Central and Southeast Sulawesi (13 and 14 percent) and highest in East Nusa Tenggara (60 percent). Women who arc using contraception are more likely to have had a visit from a family planning field worker than nonusers, 35 percent compared to 24 percent. This finding suggests that family planning field workers should be encouraged to increase their efforts to visit nonusers. The same pattern was found in the 1987 NICPS results. 47 Table 4.6.1 Visits by faimly planning field workers: age t residenc% and education Percentage of currently married women who have been visited by a family planning field worker in the 6 months prior to the survey, by age, urban-rural residence, education, and current conla'aceptive use status, Indonesia 1991 Not Using using Background contra- conta'a- characteristic ception ception Total Number Age 15-19 35.6 17.4 22.9 1152 20-24 36.9 24.9 31.0 3388 25-29 37~ 27,l 32,9 4570 30-34 33.3 27.0 30.6 4000 35-39 37.1 25.8 32.3 3386 40-44 29.8 19.8 24.6 2298 45-49 29.2 18.1 21.2 2314 Residence Urban 28.5 20.9 25.1 6120 Rm~ 38.3 24.5 31.0 14989 Education No education 29.4 17.6 21.9 3854 Some primary 35.0 23.3 28.9 7305 Completed primary 38.5 28.0 33.7 5598 Some secondary + 34.4 26.1 31.0 4352 Tom1 35.1 23.6 29.3 21109 48 Table 4.6.2 Visits by family planning field workers: region and province Percentage of currently married women who have been visited by a family planning field worker in the 6 months prior to the survey, by region, province, and current contraceptive use status, Indonesia 1991 Not Using using contra- con~a- Region/provinco ceptinn coption Total Number Java-Ball 34.4 24.0 29.6 13419 DKI Jakarta 12.7 8.5 10.9 973 West Java 38.8 30.3 34.6 4386 Central Java 26.6 17.3 21.9 3331 DI Yogyakarta 36.7 26.6 33.8 307 East Java 42.3 26.7 35.3 4119 Bali 19.8 10.1 17.0 302 Outer Java-Ball I 32.8 20.9 26.1 5309 13I Aceh 29.2 20.3 22.8 327 North Sumatra 14.1 8,8 10.8 1049 West Sumatra 31.1 18.2 23.4 436 South Sumatra 36.8 23.5 29.8 792 Lampung 36.1 28.4 32,5 664 West Nusa Tenggara 46.0 32.7 37.9 369 West Kalimantan 25.3 13.2 18.6 373 South Kalimantan 33.0 18.0 25.8 339 North Sulawesi 44.6 31.6 40.5 240 South Sulawesi 42.8 29.7 34,6 719 Outer Java-Ball H 45.0 27.8 35.2 2382 Riau 25.3 19,7 21.9 426 Jambi 59.5 35.8 47.2 265 Bengkulu 51.5 17,7 37.4 132 East Nusa Tenggara 77.8 48.2 59.8 367 East Timor 47.7 29.0 33.7 87 Central Kallmantan 54.3 20.9 35.8 170 East Kalimantan 35.5 17.6 28.0 216 Central Sulawesi 14.8 11.2 13.0 195 Southeast Sulawesi 21.6 8.1 13.7 122 Maluku 53.9 40.0 46.0 210 lrian Jaya 46.4 28.0 31.8 191 Total 35.1 23.6 29.3 21109 49 4.3.3 Appropriate Sources of Family Planning Information Mass media programs used to disseminate information about family planning in Indonesia through radio and television include spot shows, dramas, reports, discussions, and regular series. Another important means of disseminating family planning information 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 a family planning worker's job is institutionalization, or working through community organizations such as mother's clubs, religious groups, women's organizations (PKK), and the organization for wives of civil servants (Dharma Wanita). Income generating activities and rewards to long-term users are among the strategies used to introduce family planning and maintain motivation. In an effort to discover which actual or potential sources of family planning inform ation are considered appropriate by women in Indonesia, the IDHS included a set of questions on this subject (see Table 4.7.1). Table 4.7.1 Appropriate sources for family planning information: age~ residence~ and educt ion Percentage of ever-man-led women who believe specific sources are appropriate for obtaining family planning information, by age, urban-rural residence, and education, Indonesia 1991 Family planning Women's Number Private Private field Village Religious org. Pharma- Tele- of Characteristic doctor midwife worker official leader 0PKK) eist Teacher vision Radio women Age 15-19 72.6 80.0 78.4 53.4 39.2 60.0 42.l 37.2 64.0 65.3 1243 20-24 80.6 87.1 85.1 61.5 47.3 70.9 47.9 43.3 71.9 73.6 3557 25-29 79.7 86.0 84.1 62.0 49.2 69.6 47.3 45.5 72.7 73.3 4788 30-34 81,4 86,8 84,4 63,7 51,6 71.7 49,0 49,2 72,1 73.4 4244 35-39 80.5 85.9 82.9 67-5 51.1 70.2 47.5 48.6 70.3 70.3 3687 40-44 76.8 81.7 79.5 62.3 49.4 66.2 44.3 47.3 66.9 68.0 2583 45-49 70.5 76.7 72.2 55.6 45.2 59.1 41.3 42.6 61.0 61.4 2807 Residence Urban 85.6 90.1 87.2 58.7 52.3 75.4 51.0 47.3 83.0 81.2 6691 Rural 75.5 82.0 79.7 62.1 47.1 65.1 44.5 45.1 64.0 65.9 16218 Education No education 63.2 69.8 64.5 54.5 40.6 51.1 34.6 38,4 49,7 51.7 4385 Some primary 78.0 84.6 81.9 64.8 49.8 67.7 47.1 48.0 67.2 68.7 7974 Completed primary 83.3 88.7 87.1 63.9 49.8 73.6 50.8 46.7 74.2 75.5 5969 Some secondary+ 87.5 92.2 91.6 57.3 52.8 77.9 50.6 47.7 86.5 84.6 4581 Total 78.4 84.3 81.9 61.1 48.6 68.1 46.4 45.7 69.5 70.4 22909 At least three of four ever-married women considered private doctors, midwives, and family planning field workers appropriate sources of family planning information and 68 to 70 percent said women's organizations (PKK), television, and radio are appropriate family planning information sources. Teachers, religious leaders, and pharmacists are thought to be appropriate sources by less than half of women. 50 There is little difference by urban-rural residence in the percentage of ever-married women who believe specific sources are appropriate for family planning information. Eighty-six percent of ever-married women in urban areas believe that private doctors are appropriate for family planning information, compared to 76 percent of ever-married women in rural areas. Furthermore, 90 percent of ever-married women in urban areas and 82 percent in rural areas think that private midwives are appropriate sources for family planning information. This finding supports the strategic role of midwives in the delivery of family planning services as well as in the improvement of maternal and child health. The types of providers of family planning information who are considered acceptable vary by women's education. For example, 65 percent of ever-married women with no education think that family planning field workers are appropriate for family planning information, compared to 92 percent of those with some secondary or more education. Differentials by province in the proportion of women who believe that a specific source of family planning information is appropriate are shown in Table 4.7.2. In most provinces, the largest proportion of women consider midwives acceptable, followed by family planning field workers, and private doctors. In East Timor, however, the largest proportion of women believe that religious leaders are an appropriate source of family planning information. Table 4.7.2 Appropriate sources for family planning information: region and province Percentage of ever married women who believe specific sources are appropriate for obtaining family planning information, region and province. Indonesia 1991 Family planning Women's Number Private Private field Village Religious urg, Pharma- Tele- of Region/province doctor midwife worker official leader (PKK) cist Teach¢~ vision Radio women lava-Ball 77.6 84.3 83.9 69.9 56.9 75.1 54.8 53.6 74.8 76.0 14637 DKI Jaka.qa 92.3 97.1 97.0 70.4 69.3 91.9 66.2 60.5 95.5 96.9 1086 West Java 68.1 79.1 77.9 60.3 46.0 67.9 40.2 43,4 66.1 70,5 4701 Central Java 82.8 86.0 89.6 85.3 72,2 87.3 72,6 71.2 83.7 83.9 3708 DI Yogyakatm 89.8 94.3 97.0 80,6 68,5 93.2 59.2 65.1 89.9 89.9 328 East Java 78.1 84.2 81.6 67.3 54.3 68.7 54.1 49.0 71.2 70.4 4500 Bali 88.3 90.4 79.3 57.0 22.5 53,7 27.3 26.6 61,8 57.2 314 Outer Java-Ball II 82.8 86.8 78.6 47.8 35.1 56.5 34.1 34,0 61.6 61.5 5709 DI Aceh 85.5 87.6 84.7 37.6 28.6 55.8 41.2 27.5 60.8 57.4 349 North Sumatra 88.0 89.6 74.2 45,6 34.5 50.9 38.5 32,1 56.6 56.3 1112 West Sumatra 85,5 91.6 84,6 46,9 31.2 66.7 30.9 37.6 71.4 73.3 475 South Sumatra 79.7 88.3 78.2 38.2 29.0 58.1 38,2 29.0 63,4 61.8 848 Lampung 90.4 97.1 94.5 66.7 48.9 76.4 52,9 63.3 92.1 92.9 698 West Nusa Tenggara 70.6 73.9 69.6 62,1 44.2 55.9 29.2 31.7 49.5 46.9 412 West Kalimantan 73.4 79.3 75.7 58.0 53.2 63.9 43.9 52.3 76.4 75.0 399 South Kalimantan 83.9 90.2 82.8 57.8 53.1 59.3 22.0 24.2 66.7 77.8 377 North Sdawesl 73.5 72.0 76.0 55,9 35.1 74.6 31.7 36.1 54.6 54.3 254 South Sulawesi 83.0 82.8 69.9 29.2 13.3 28.7 9,7 13.0 32.4 30.9 786 Outer Java.Ball 11 73.6 78.9 77,5 40,5 31.4 54.1 25.9 27.2 57.3 58,0 2563 Riau 87.7 90.3 75,0 46,5 36.3 62,3 40.3 36.2 68,8 70.0 459 Jambi 97.6 99.1 96.2 73,3 61.3 81.2 62.1 57.3 87,0 86.5 282 Bengkulu 82.9 89.4 86,5 37,1 23,0 56,7 32.6 36.8 79.5 79.0 139 East Nusa Teaggara 58,6 73.6 69,2 23.8 7.0 29.5 8.0 10.0 15.0 21.3 400 East Timor 52.7 40,3 33.8 32.3 55.3 37.1 7,9 8,2 25.0 33,4 96 Central Kallmantan 65.0 76,2 77.6 35.5 44.0 46.7 12,0 13.9 60.7 59.9 184 East Kalimantan 89,7 95.2 95.0 54.2 63.4 73.7 43.5 49,3 91.7 91.7 237 Central Sulawesi 58,2 60.3 85,5 51.7 24.0 69.1 17.9 28.8 65.3 58.0 204 Southeast Sulawesi 78.5 79.3 79.9 31.5 26.6 58.7 21.7 25.3 68.2 79,7 131 Maluku 82.6 89.8 86.5 20.4 13.6 54.0 8.1 5.1 51.5 44.5 222 Inan Jaya 33.5 38.3 48.7 26,0 3.8 19.1 5.3 11.8 22,9 22,1 209 Total 78.4 84.3 81.9 61.1 48.6 68.1 46.4 45,7 69.5 70.4 22909 51 4.4 EVER USE OF FAMILY PLANNING METHODS For each method recognized, the respondent was asked if she had ever used that method. About 66 percent of ever-married women have used a method of contraception sometime, and 64 percent have used a modem method (see Table 4.8). The most common method women have ever used is the pill (37 percent) followed by the IUD and injection (22 and 27, respectively). Much smaller proportions of women report having used the condom (5 percent), Norplant (3 percent) and female sterilization (3 percent). Seven percent o fever-married women have used a traditional method sometime: periodic abstinence (3 percent), withdrawal (3 percent), herbs (2 percent), and 1 percent have used massage. Table 4.8 Ever use of contraception Percentage of ever-mamexl women and of currently rrumfed by specific method and age, Indonesia 1991 women who have ever used any contraceptive method, Method 15-19 20-24 25-29 30-34 35-39 40-44 45~-9 Total EVER-MARRIED WOMEN Any method 37.6 65.4 73.7 76.3 73.4 63.7 45.6 66.3 Any modern method 36.8 63.7 71.7 74.5 71.1 61.0 42.1 64.2 Pill 22.0 32.0 39.6 44.0 43.9 36.2 26.5 37.0 IUD 4.1 15.3 23.4 27.2 28.0 25.0 15.3 21.7 Injection 15.5 34.6 34.4 31.9 27.1 16.4 8.6 26.6 Condom 0.1 2.2 4.8 6.4 6.7 6.7 3.9 4.8 Noqolant 1.6 3.9 3.8 4.3 4.3 2.4 0.8 3.4 Female s~rilizalion 0.0 0.2 0.9 3.1 4.0 5.9 4.3 2.6 Male sterilization 0.3 0.1 0.4 0.8 1.2 0.6 0.6 0.6 Abortion 0.0 0.2 0.1 0.6 0.7 0.4 0.4 0.4 Any traditional method 1.6 4.2 7.5 8.1 9.7 9.8 7.6 7.4 Periodic abstinence 0.4 1.4 3.1 3.4 5.4 4.1 2.9 3.2 Withdrawal 0.7 2.1 3.6 3.3 3.6 3.7 1.7 2.9 Herbs 0.4 0.7 1.2 1.9 2.0 3.4 2.4 1.7 Massage 0.1 0.3 0.6 0.5 0.5 0.6 l. l 0.6 Other 0.0 0.1 0.3 0.3 0.3 0.6 0.4 0.3 Number of women 1243 3557 4788 4244 3687 2583 2807 22909 CURREN17.Y MARRIED WOMEN Any method 39.1 66.9 75.7 Any modern method 38.2 65.1 73.6 Pill 22.3 32.8 40.6 IUD 4.4 15.7 24.1 lnieetiort 16.1 35.4 35.3 Condom 0.1 2.2 4.9 Norplant 1.7 4.1 3.9 Female sterilization 0.0 0.2 0.8 Male sterilization 0.3 0.1 0.4 Abortion 0.0 0.2 0.1 Any traditional method 1.7 4.2 7.7 Periodic abstinence 0.4 1.4 3.2 Withdrawal 0.7 2. I 3.7 Herbs 0.5 0.7 1.2 Massage 0.l 0.4 0.6 Other 0.0 0.2 0.3 Number of women 1152 3388 4570 77,.4 76.4 67.8 50.3 69.3 76.6 74.1 65.2 46.8 67.1 45.4 45.9 38.4 29.7 38.7 28.2 29.3 26.9 17.0 22.8 32.9 28.5 18.2 9.~. 2g.1 6.5 7.0 7.3 4.2 5.0 4.5 4.6 2.7 1.0 3.6 3.2 4.1 6.2 4.8 2.7 0.9 1.3 0.7 0.7 0.6 0.5 0.8 0.4 0.5 0.4 8.3 10.2 10.3 8.0 7.6 3.4 5.7 4.2 3.2 3.3 3.4 3.8 3.9 1.7 3.1 1.9 2.1 3.7 2.4 1,8 0.5 0.5 0.6 1.1 0.6 0.3 0.3 0.7 0.5 0.3 4000 3386 2298 2314 21109 52 CHAPTER 5 CURRENT USE OF FAMILY PLANNING Information on the current level of contraceptive use, or contraceptive prevalence, is important for measuring the success of the National Family Planning Movement. Contraceptive prevalence is def'med as the proportion of currently married women age 15-49 who were using some method of family planning at the time of the survey. This chapter presents data concerning levels, trends, and differentials in current use, sources of family planning methods, age at time of first contraceptive use, accessibility, reasons for using a particular method, and some indicators of the quality of use of the pill, injection and condom. 5.1 CURRENT USE OF FAMILY PLANNING Fifty percent of currently married women are using contraception, 47 percent modem methods and 3 percent traditional methods (see Table 5.1). As with ever use, the pill (15 percent), IUD (13 percent), and injection (12 percent) are the most commonly used methods, together accounting for over 80 percent of current contraceptive use. Other modem methods with significant proportions of users are Norplant and female sterilization, each used by 3 percent of married women. Table 5.1 Current use of contraception Percent distribution of currently married women by contraceptive method currently used, according to age, Indonesia 1991 Method 15-19 20-24 25-29 30-34 35-39 40~4 45-49 Total Any method 30.0 51.0 53.6 56.8 57.5 48.3 27.4 49.7 Any modern method 29.1 49.4 51.2 54.1 53.7 44.8 25.0 47.1 Pill 11.8 15.1 17.6 18.1 16.0 11.6 6.0 14.8 IUD 3.5 10.9 12.8 15.0 17.0 17.8 10.2 13.3 Injection 11.7 19.3 15.6 11.9 9.9 5.2 1.8 11.7 Condom 0.1 0.2 0.7 1.2 1.2 1.2 0.5 0.8 Norplant 1.7 3.7 3.2 3.8 4.2 2.2 0.9 3.1 Female sterilization 0.0 0.2 0.8 3.2 4.1 6.2 4.8 2.7 Male sterilization 0.3 0.1 0.3 0.8 1.2 0.6 0.6 0.6 Any traditional method 0.9 1.6 2.4 2.7 3.8 3.5 2.5 2.6 Periodic abstinence 0.1 0.5 1.1 1.2 2.1 1.1 1.0 1.1 Withdrawal 0.4 0.5 0.9 0.7 0.8 0.9 0.4 0.7 Herbs 0.4 0.3 0.3 0.7 0.7 1.2 0.5 0.6 Massage 0.1 0.2 0.1 0.1 0.2 0.2 0.5 0.2 Other 0.0 0.1 0.1 0.1 0.1 0.1 0.1 0.1 Not currently using 70.0 49.0 46.4 43.2 42.5 51.7 72.6 50.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1152 3388 4570 4000 3386 2298 2314 21109 Modem methods predominate in all subgroups but there are clear differences in the overall level of use between 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 35-39 (58 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 mml women (see Table 5.2.1 and Figure 5.1). Over half (56 percent) of currently married urban women are using a method, compared to 47 percent 53 Table5.2.1 Current use of contraception: background characteristics Percent distribution of currently married women by contraceptive method currently used, according to selected background characteristics, Indonesia 1991 Education Residence No Some Corn- Some No. of living children cduca- pri- plctcd second- Method Urban Rural tion maD' primary aD'+ 0 l 2 3 4+ Total Any method 55.7 47.2 36.5 47.2 54.4 59.4 7.7 48.3 59.5 58.8 51.6 49.7 Any modern method 51.1 45.4 35.6 45.2 52.2 53.8 7.2 46.2 56.5 55.9 48.4 47.1 Pill 13.8 15.2 12.5 I6.5 1%0 11.2 4.7 15.7 19,0 17.0 13.1 14.8 IUD 14.2 13.0 10.1 11.3 13.6 19.3 0.7 10.9 17.2 17.2 14.1 13.3 Injection 14.4 10.6 7.3 10.7 14.4 13.9 1.8 16.2 13.6 12.2 10.0 11.7 Condom 1.8 0.4 0.2 0.4 0.6 2.2 0.0 0.5 1.1 1.0 0.9 0.8 Nozplant 1.2 3.9 3.1 3.8 3.3 1.8 0.0 2.5 3.9 4.0 3.4 3.1 Female sterilization 5.2 1.7 1.6 2.1 2.5 5.0 0.0 0.2 1.2 3.8 5.9 2.7 Male stcriliza~on 0.4 0.7 0.8 0.4 0.8 0.3 0.0 0.3 0.4 0.7 1.1 0.6 Any traditional method 4.6 1.8 1.0 2.1 2.1 5.6 0.5 2.1 3.0 2.9 3.2 2.6 Periodic abstinence 2.4 0.6 0.2 0.5 0.8 3.4 0.1 0.9 1.5 1.3 1.1 1.1 Withdrawal 1.0 0,5 0.2 0.7 0.7 1.2 0.1 0.6 0.7 0.8 0.8 0.7 Herbs 0.9 0.4 0.4 0.6 0.5 0.7 0.2 0.3 0.5 0.5 0.9 0.6 Massage 0.2 0.2 0.2 0.3 0.1 0,1 0.0 0.2 0.1 0.2 0.3 0.2 Other 0.1 0.1 0.1 0.1 0,0 0,2 0.0 0.1 0.2 0.1 0.1 0.1 Not currently using 44.3 52.8 63.5 52.8 45,6 40.6 92.3 51.7 40.5 41.2 48.4 50.3 Total 100.0 100.0 100.0 100.0 100,0 100.0 100.0 100.0 100.0 100.0 100,0 100.0 Number 6120 14989 3854 7305 5598 4352 2013 4541 4706 3567 6283 21109 Figure 5,1 Percentage of Currently Married Women Using a Contraceptive Method Urban Rural NO Education Some Primary Completed Prrmary Some Secondary + Java-Bah Outer J-B I Outer J-B II 56 47 37 47 54 5o . . 53 44 43 10 20 30 40 50 60 70 Percent IDHS 1991 54 of rural women. The mix of methods also differs, with urban women relying more heavily on the use of condoms, injection, female sterilization and periodic abstinence, and rural women relying more heavily on the pill, IUD and Norplant. Contraceptive use increases with the respondent's level of education. Thirty-seven percent of currently married women with no education are using a method, compared to 59 percent of those with secondary or higher education. While pill use varies erratically by education level, use of almost all other methods except Norplant, is higher for better educated women. Traditional methods also account for a higher proportion of use among better educated women than among less educated women. Contraceptive use increases rapidly with the number of living children a woman has; it reaches a peak among women with 2 or 3 children, after which it declines among women with 4 or more children. Eight percent of childless women are using a method of family planning, mostly the pill, presumably to delay their first birth. As the number of children increases, reliance on the pill diminishes relative to the IUD and injection. Use of Norplant and female sterilization is highest among women with 3 or more children. Tables 5.2.2-5.2.4 show the proportion of married women currently using contraception by province in each of the three regions. Contraceptive use is highest in Java-Bali (53 percen0, followed by Outer Java- Bali I (44 percent) and Outer Java-Bali II (43 percent), reflecting the order in which the family planning program was initiated. Women in Java-Bali tend to rely more heavily on the IUD, while the pill and Norplant account for a greater proportion of use in the Outer Islands. Table 5.2.2 Current use of contraception: Java-Bali Percent distribution of currently married women by contraceptive method currently used, according to province, Java-Bali. Indonesia 1991 Java-Bali DKI West Central DI East Method Jakarta Java Java Yogyakarta Java Bali Total Any method 56.0 51.0 49.7 . 71.3 55.4 71.9 53.4 Any modern method 51,8 49.7 48.1 57.0 53.0 70.2 51.I PiU 11.9 17.7 10.4 8.2 16.0 4.3 14.5 IUD 17,5 7.5 15.6 27.8 22.3 44.8 16.1 Injection 12.7 19.0 13.2 9.6 6.9 9.9 13.0 Condom 2.4 0.3 1.2 5.3 0.4 0.9 0.8 Norplam 1.4 3.0 3,7 1.3 3.5 0.7 3.1 Female sterilization 5.5 1.2 2.5 4.5 3.9 8.6 2.9 Male sterilization 0.4 1.1 1.2 0.3 0.1 1.0 0.7 Any traditional method 4,2 1.3 1.7 14.3 2.4 1.7 2.3 Periodic abstinence 2.3 0.6 0.9 4.1 1.1 1.5 1.0 Withdrawal 0.9 0.1 0.4 7.2 0.6 0.0 0.5 Herbs 0,9 0.5 0.1 0.0 0.5 0.1 0.4 Massage 0.0 0.1 0.2 0.2 0.1 0.1 0.1 Other 0.1 0.0 0.l 2.8 0.1 0.0 0.1 Not currently nslng 44.0 49.0 50.3 28.7 44.6 28.1 46.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 973 4386 3331 307 4119 302 13419 55 Table 5.2.3 Current use of contraception: Outer Java-Ball I Percent distribution of currently married women by contraceptive method currently used, according to province, Outer Java-Bali l, Indonesia 1991 Outer Java-Bali 1 West West South North South DI North West South Nusa Kali- Kali- Stria- Sula- Method Aceh Sumatra Stmaatra Sumatra Lamptmg Teaaggara manure martian wesi wesi Tclal Any method 28.9 37.2 40.3 47.1 53.8 39.0 44.4 51.9 68.5 37.1 43.5 Anymode~ method 24.9 34.0 37.8 44.6 50.8 38.2 42.9 47.2 62.8 32.9 40.3 Pill 12.6 11.1 8.2 16.8 20.8 13.4 20.4 31.6 16.8 16.4 16.1 IUD 1.9 7.7 11.2 8.5 15.3 11.6 4.9 3.9 24.4 3.9 8.8 l~ecfion 8.6 7.4 10.6 10.6 11.3 7.6 13.4 5.8 13.5 7.7 9.4 Condom 0.4 1.4 0.4 0.9 0.2 0.1 1.0 0.4 0.3 0.4 0.7 No~lant 0.5 1.3 5.9 4.3 1.3 4.8 2.0 2.6 4.6 2.2 2.7 ~males~dllza~on 0.9 5.2 1.5 3.4 1.2 0.6 0.8 2.7 3.2 2.2 2.6 MMesmfiliz~on 0.0 0.0 0.0 0.0 0.5 0.1 0.4 0.1 0.0 0.0 0.1 AuytradltlonM method 4.0 3.1 2.5 2.5 3.0 0.8 1.4 4.7 5.7 4.2 3.1 ~do~c~sf inen~ 1.6 1.6 0.7 0.6 1.1 0.2 1.0 0.6 4.6 0.9 1.1 With~awM 1.0 0.7 1.5 1.0 1.3 0.0 0.2 0.0 0.3 2.7 1.0 Herbs 0.7 0.8 0.1 0.4 0.2 0.6 0.1 4.2 0.6 0.2 0.7 Mass~e 0.5 0.1 0.1 0.5 0.3 0.0 0.1 0.0 0.2 0.4 0.2 Oth~ 0.2 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 Not currently using 71.1 62.8 59.7 52.9 46.2 61.0 55.6 48.1 31.5 62.9 56.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 327 1049 436 792 664 369 373 339 240 719 5309 There are major differentials in the use of contraception within regions. In Java-Bali, contraceptive use is highest in Bali and Yogyakarta and lowest in Central Java and West Java. More than 70 percent of currently married women in Bali are using contraceptive methods, 98 percent of which are modem methods. In Outer Java-Bali I, contraceptive use is highest in North Sulawesi (69 percent) and lowest in DI Aceh (29 percent). The highest level of contraceptive use in Outer Java-Bali II occurs in Bengkuhi and East Kalimantan (58 percent) and the lowest in East Timor and Irian Jaya (25 and 21 percent, respectively). The mix of methods varies considerably by province. Interestingly, in Java-Bali, the provinces with the highest overall prevalence rate have the smallest proportion of pill users. For example, in Bali and Yogyakarta, pill use accounts for only 6 and 12 percent of contraceptive use respectively, while in Central Java, 22 percent of users depend on the pill. In Bali, 45 percent of currently married women--or 62 percent of users---are using the IUD. Injection and female sterilization am the second most widely used contraceptive methods in Bali. Yogyakarta shows a pattem similar to that in Bali, with the IUD predominating among users. After the IUD, traditional methods (primarily withdrawal) are used most commordy by married women in Yogyakarta. 56 Table 5.2.4 Current use of contraception: Outer Java-Bali lI Percent distribution of currently married women by contraceptive method currently used, according m province, Outer Java- Bali-I/, Indonesia 1991 Method Riau Jambi Outer Java-Bali II East Central East Central South- Beng- Nusa East Kali- Kali- Sula- east Irlan kulu Tenggara Timor mantan mantan wesi Sulawesi Maluku Jaya Total Any method 39.8 47.9 58.3 39.2 25.1 44.6 57.9 50.4 41.9 43.2 20.6 42.8 Any modern method 35.2 46.3 55.9 35.0 20.4 42.9 54.6 47.5 37.9 36.5 18.9 39.3 Pill 11.6 22.3 20.7 3.9 1.4 23.2 22.4 21.3 16.3 9.5 6.4 14.0 IUD 5.6 5.8 13.1 10.3 4.5 6.7 13.9 8.7 4.7 10.5 5.2 8.2 Injection 11.9 9.8 12.5 8.8 10.5 8.8 11.6 11.1 8.5 11.4 5.0 10.1 Condom 2.4 0.4 0.5 0.2 0.2 0.3 2.1 0.0 0.0 0.2 0.0 0.8 Norplant 2.2 6.2 7.6 5.9 3.6 3.5 1.3 4.3 6.2 3.6 0.9 4.0 Female sterilization 1.5 1.8 0.8 2.3 0.2 0.5 3.1 2.1 1.9 1.3 1.4 1.7 Male sterilization 0.0 0.0 0,5 3.5 0.0 0.0 0.3 0.0 0.3 0.0 0.0 0.6 Any traditional method 4.6 1.6 2.4 4.2 4.7 1.7 3.4 2.8 4.0 6.6 1.6 3.5 Periodic abstinence 0.6 0.7 1.4 3.4 1.4 0.0 1.0 1.2 1.9 2.6 0.5 1.4 Withdrawal 1.8 0.0 0.3 0.0 0.5 0.0 0.3 0.5 1.9 0.9 0.0 0.6 Herbs 0.4 0.7 0.3 0.9 2.1 1.7 2.1 1.2 0.0 2.9 0.5 1.1 Massage 1.5 0.2 0.5 0.0 0.7 0.0 0.0 0.0 0.0 0.2 0.0 0.4 Other 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.0 0.7 O. 1 Not currently using 60.2 52.1 41.7 60.8 74.9 55.4 42.1 49.6 58.1 56.8 79.4 57.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 426 265 132 367 87 170 216 195 122 210 191 2382 5.2 TRENDS IN CONTRACEPTIVE The dramatic changes that have taken place in the level and pattern of contraceptive use in Indonesia over the past 15 years are demonstrated in Tables 5.3-5.5. Table 5.3 focuses on the provinces that comprise the Java- Bali region, for which it is possible to construct comparable estimates of contraceptive preva- lence over a 15-year period. Overall, prevalence has more than doubled in Java-Bali since 1976. Between 1987 and 1991, the percentage of mar- ried women using family planning in Java-Bali increased slightly from 51 to 53 percent. The largest increases (5 percentage points) in Java- Bali between 1987 and 1991 occurred in West Java and East Java. USE Table5.3 Trends in contraceptive use by province: Java-Bali Percentage of ctu-rently married women who are currently using any family planning method by province, Java-Bali, Indonesia 1991 1976 1987 1991 Ratio Province (IFS) (NICPS) (IDHS) 1991/1987 Jakarta 28 54 56 1,04 West Java 16 46 51 1.17 Central Java 28 54 50 0.93 Yogyakarta 40 68 71 1.04 East Java 32 50 55 1.10 Bali 38 69 72 1.04 Total 26 51 53 1.04 57 The small increase in overall prevalence in Java-Bali between 1987 and 1991 is due mainly to an increase in the use of Norplant (from 0.4 percent to 3.1 percent) and injection (from 11 percent to 13 percent) combined with small decreases in the use of the pill, condom, and female sterilization (see Table 5.4 and Figure 5.2). While the 1991 IDHS covered all prov- inces in Indonesia, the 1987 NICPS excluded seven provinces. Thus, the overall prevalence figures for the two surveys are not strictly com- parable. Table 5.5 shows the percentage of mar- ried women using contraception in the 20 prov- inces common to both surveys. The overall prev- alence in the 20 provinces was 48 percent in 1987 and 50 percent in 1991. Table 5.4 Trends in contraceptive use by specific methods: Java-Bali Percentage of currently married women in Java-Bali who are currently using any family plarafing method by specific methods, Indonesia 1991 1976 1987 1991 Method (IFS) (NICPS) (IDHS) Any method 26.3 50.9 53.4 Pill 14.9 16.0 14.5 IUD 5.6 15.5 16.1 Injection 0.2 10.7 13.0 Diaphragm/jelly/foam 0.1 0.0 Condom 1.8 1.8 0.8 Female Sterilization 0.3 3.5 2.9 Male Sterilization 0.0 0.2 0.7 Norplant - 0.4 3.1 Periodic abstLnence 0.8 1.1 1.0 Withdrawal 0.3 0.7 0.5 Other 2.3 2.3 0.6 Number of women 7974 7265 13419 20 15 10 5 o Percent Figure 5,2 Percentage of Currently Married Women Using Specific Contraceptive Methods Java-Bali, 1987 and 1991 16 16 16 15 13 11 3 4 3 Pit! IUD Condom Injection Norptant Female Ster 58 5.3 CONTRACEPTIVE USE AMONG WOMEN OVER 30 AND AMONG THOSE WITH THREE OR MORE CHILDREN One of the five principles of the family planning move- ment is that women over 30 and those with 3 or more children should be using the most effective means of fertility control available. Table 5.6 presents information with which to evaluate the success of the program in meeting this goal. In Table 5.6, long-term methods include female and male sterilization, IUD and Norplant. The table shows that, among women in their early thir- ties, about 24 percent had never used a modem method of con- traception, and 23 percent had used a modem method in the past but were not using at the time of the survey; 54 percent were users at the time of the survey. Thirty-four percent of married women in this age group had 3 or more children and were using a method; of these women, 67 percent were using temporary methods and 33 percent were using long-term methods. Among women age 35-39, 54 percent were using a fami- ly planning method. Among users with 1-2 children, about half Table 5.5 Trends in contraceptive use by specific methods: 20 provinces Percentage of currently married women who ate currently using any family planning method by specific methods, 20 provinces of Indonesia, Indonesia 1991 1987 1991 Method (NICPS) (IDHS) Any method 47.7 50.3 Pill 16.1 15.0 IUD 13.2 13.7 Injection 9.4 11.9 Condom 1.6 0.8 Female sterilization 3.1 2.8 Male sterilization 0.2 0.5 Norplmat 0.4 3.1 Periodic abstinence 1.2 1.1 Withdrawal 1.3 0.7 Other 1.2 0.8 Number of women 10907 19603 Note: Excluded provinces are: Jambi, East Nusa Tenggara, East Timor, Central Kali- mantan, East Kalimantan, Maluku, Irian Jaya were using temporary methods and half were using long-term methods. However, among users with 3 ormore children, 40 percent were using long-term methods and 60 percent were using temporary methods. Thus, although a large proportion of women over age 30 were using a method of contraception, most were using temporary methods, especially those users with 3 or more children. Table 5.6 Contraceptive use status and number of children Percent distribution of currently married women by contraceptive use status and number of living children, aceordJ.ng to age, Indonesia 1991 No. of living children 0 1-2 3+ Never Past used a user of Using Using Using Using Using modem modem any ten~. long-term temp. long-term method t method method I Tota l Number Age method method method method 15-19 61.8 9.1 7.8 16.0 5.2 0.0 0.0 100.0 1152 20-24 34.9 15.7 1.2 32.0 13.5 1.7 0.9 100.0 3388 25-29 26.4 22.5 0.1 23.8 11.4 11.0 4.9 100.0 4570 3034 23,5 22.5 0.2 11.4 8.0 22.9 11.5 100.0 4000 35-39 26,0 20.3 0.0 6.1 5.4 25.2 17.0 100.0 3386 40-44 34.8 20.3 0.0 3.3 3.1 20.9 17.6 100.0 2298 45-49 53.2 21.8 0.0 1.2 0.7 12.0 11.0 100.0 2314 Total 32.9 20.0 0.7 14.8 7.7 14.6 9.2 100.0 21109 lLong-term methods include female and male sterilization, IUD and Norplant 59 5.4 REASONS FOR CHOICE OF CONTRACEPTIVE METHOD The reasons women give for choosing their current contraceptive method are important for the family planning movement, particularly in view of the current emphasis on program self-sustalnability. As shown in Table 5.7, the desire for a more effective method, side effects of other methods, and convenience are the most common reasons given for having chosen a specific method. Table 5.7 Reasons for using current method of contraception Percent distribution of contraceptive users by reason for deciding to use current contraceptive method, according to specific method, Indonesia 1991 Female Male Reason for using Con- Nor- steri- steri- Absti- With- eurrent method pill IUD Injection dora plant lization lization hence drawal Herbs Massage Total 1 Recommendation FP worker 9.7 11.5 5.0 7.2 16.3 5.6 15.5 0.0 0.0 0.0 0.0 8.8 Recommendation friend, relative 3.3 4.3 4.1 0.9 4.5 2.1 10.1 3.3 3.7 9.4 10.3 3.9 Sideeffeetsofothetraethods 21.4 16.3 20.1 36.4 14.2 13.1 4.4 47.6 33.3 36.6 41.1 19.9 Convenience 11.9 15.6 21,3 3.7 15.1 3.2 2.3 11.3 7.9 11.6 12.8 14.5 Access, availability 14.3 1.3 3.4 4.4 0.8 0.0 0.0 0.5 0.2 12.4 0.0 5.7 Cost 6.5 0.7 1.9 0.0 2.0 0.0 0.0 0.2 0.0 0.0 0.0 2.7 Wmated permanent method 1.5 5.6 2.5 1.3 8.3 37.7 32.5 2.0 0.7 0.3 1.6 5.6 Husband preferred 3.2 1.9 3.4 23.1 2.8 3.4 18.5 10.6 24.6 7.1 4.8 3.9 Wanted m~ effective method 20,3 31.6 31.7 11,6 29.4 28.4 16.3 11.5 14.9 7.6 9.0 26.3 Medical advice 1.1 2.0 0.9 0,2 0.4 3.1 0.0 0.4 0.0 0.0 0.0 1.3 Advice of gov, official 0.4 4.7 0.0 0.0 0.6 0.8 0.0 0.0 0.0 0.0 0.0 1.5 Afraid of other methods 2.2 1.1 1.8 4.4 1.4 0.0 0.0 5.1 4.5 5.9 8.0 1.8 Other 2.8 2.0 2.0 6.9 3.1 1.8 0.0 6,8 8.5 7.3 3.4 2.6 Don't know 1.2 1.3 1.6 0.0 1.1 0.1 0.0 0,2 0.0 1.2 9.0 1.2 Missing 0.1 0.1 0.2 0.0 0.0 0.6 0.4 0.6 1.7 0.7 0.0 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 3129 2815 2476 167 658 600 121 233 143 117 39 10521 ITotal includes some users of other methods not shown sepetrately The reasons given for the decision to use a specific method vary according to the method used. Approximately 30 percent of the IUD, injection and Norplant users stated that they chose the method because they wanted a more effective method while between 15 and 20 percent said that they chose the method because it was convenient or to avoid the side effects of other methods. A substantial proportion of pin users (14 percent) said that they chose the method because of its accessibility or availability; few users of other modem methods reported this as their reason for choosing the method. Most sterilized women said that they chose this method because they wanted a permanent or more effective method. The most common reason given for using any of the traditional methods is to avoid the side effects of other methods. 5.5 QUALITY OF USE OF PILL, INJECTION AND CONDOM The pill is the most popular method of contraception used in Indonesia. In order to study the "quality" of pill use, the IDHS included a series of questions for women who said they were using the pill. Each respondent was first asked if she had a package of pills in the house. If not, the respondent was asked why she did not have a package and was requested to identify the brand of pills she was using from a brand chart carried by the interviewer. If the respondent said she did have a package of pills in the house, the interviewer asked to see it, then recorded the brand and noted on the questionnaire whether pills were missing in order. If 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. 60 About 93 percent of pill users were able to show the interviewer a packet of pills (see Table 5.8). Most women who could not show a packet gave the reason that they had run out of supplies (data not shown). Of those who showed the packet, 93 percent had pills missing in order. A matter of concern is that only 85 percent of pill users reported taking a pill less than two days before the survey. Most women who had not taken a pill during that period said that they were having their menstrual period or they had run out of pills. A few women (7 percent) said they were not taking the pill because their husband was away. Although many of the women who missed taking a pill are still protected from pregnancy, the data suggest that the effective level of pill use is somewhat lower than the reported number of pill users. Table 5.8 Pill use compliance Percentage of currently married women who are using the pill and the percentage of 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, Indonesia 1991 Percentage of pill users who: Took Took Percent Can pills pill Background using show in <2 days characteristic pil l package order ago Number Age 15-19 11.8 99.7 94.2 92.0 136 20-24 15.1 95.4 92.3 87.1 512 25-29 17.6 92.1 94.7 86.7 806 30-34 18.1 93.6 93.4 84.1 725 35-39 16.0 91.0 91.4 81.7 543 40-44 11.6 89.3 87.5 85.1 267 45-49 6.0 84.7 97.9 74.0 140 Resldance Urban 13.8 92.2 92.9 80.7 848 Rural 15.2 92.7 93.0 86.4 2282 Education No education 12.5 89.8 91.9 84.1 483 Some primary 16.5 93.2 92.2 85.2 1207 Completed primary 17.0 92.1 94.3 85.4 952 Some secondary + 11.2 94.5 93.3 83.6 488 Total 14.8 92.5 93.0 84.8 3129 The data show that there are small differences in the quality ofpiU use by background characteristics of the respondent. There is a negative association between age and the proportion of pill users who took a pill less than two days before the survey. Only three of four pill users age 4549 took a pill in the two days prior to the survey. As mentioned above, all pill users were asked about the brand of pill they used. The most popular brands are Marvelon 28 and BKKBN Microgynon, followed by Stophamil and Microgynon 30ED (see Table 5.9). The other brands which have a sizeable number of users are Nordette 28, Blue Circle Microgynon and Noriday and Ovostat 28. 61 Table 5.9 Use of pill and condom brands Percent distribution of currently married pill users and of condom usess by breast of pill/condom u~d, Indonesia 1991 Brand Total Number Pill Marvelon 28 21.4 670 Blue Circle Microgy. 5.5 171 Mierogynon 30 ED 14.1 440 Nordette 28 7.1 221 Ovostat 28 3,1 96 Restovar 28 micro 2.1 66 Exluton 1,1 36 BKKBN Microgynon 21,1 661 Stophamil 16.9 530 Noriday 4.0 126 Brand uncoded 0,6 19 Other 1,6 50 Don't know 1,4 44 Total 100,0 3129 Condom Young young 002 5,4 9 Young young Super 1,6 3 Young young Hi-way 2,5 4 Young young 0.03 2,2 4 Romantic 003 1.3 2 Kondom untuk prog KB 30,1 50 KB Dun Lima 15.1 25 Jellia Ultra 2,3 4 Jellia Sexy 4,3 7 Dua Lima 14,4 24 lCmgtex Longtlme 1.g 3 Kingtex Ring 4,9 8 Brand uncoded 4.5 7 Other 3.3 6 Don't know 6.2 10 Total 100.0 167 The IDHS also investigated condom and injection use compliance. Interviewers asked all injection users when they received their last injection and all condom users to show a package of condoms. Only 88 percent of injection users received an injection less than three months before the survey (see Table 5.10); this means that 12 percent of injection users may actually be at risk of pregnancy. As in the case of pill users. older users appear to use the method less effectively than younger users. Differences by other background variable, such as residence and education are very small. The proportion of condom users who could show the interviewer a packet is moderately high (74 percent) but lower than the figure for the 1987 NICPS (90 percent). The condom is not widely used in Indonesia, with less than one percent of currently married women relying on it. The most popular brands are KB and Dualima. 62 Table 5.10 Use of iniection and the condom Percentage of currently married women who are using injection and the percentage using the condom, the percentage of injection users who have received an injection in the last three months, and the percentage of condom users who can show a packet, by b~kground characteristics, Indonesia 1991 Injection users Condom users Percent Injection Percent Can Background using <3 using show characteristic injection months Number condom package Number Age 15-19 11.7 86.8 135 0.1 * 1 20-24 19.3 89.8 653 0.2 * 5 25-29 15.6 89.5 715 0.7 (76.5) 33 30-34 11.9 87.7 477 1.2 78.0 49 35-39 9.9 84.8 335 1.2 (74.2) 39 40-44 5.2 82.6 120 1.2 (65.2) 27 45-49 1.8 68.0 42 0.5 * 12 Residence Urban 14.4 86.4 882 1.8 72.4 111 Rural 10.6 88.5 1594 0.4 78.4 56 Education No education 7.3 84.3 280 0.2 * 6 Some primary 10.7 87.2 783 0.4 (67.0) 28 Completed primary 14.4 89,7 807 0.6 (77.8) 36 Some secondary + 13.9 87.4 606 2.2 76.5 97 Region Java-Bali 13.0 89.6 1739 0.8 71.2 113 Outer Java-Bali I 9.4 84.2 497 0.7 74.4 35 Outer Java-Bali H 10.1 81.3 240 0.8 (92.6) 18 Total 11.7 87.7 2476 0.8 74.4 167 * Less than 25 unweighted cases ( ) Based on 25

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