The Indonesian national family planning program: progress and remaining challenges in implementing a rights-based approach

• Date: 20 November 2023
• Pages: 1-16
• DOI: https://doi.org/10.1108/IJHRH-06-2023-0049
• Published date: 20 November 2023
• Subject Matter: Health & social care,Vulnerable groups,Inequalities & diverse/minority groups,Sociology,Race & ethnic studies,Minorities,Multiculturalism,Racial identity,Work,economy & organizations
• Author: Budi Utomo,Sukma Rahayu,Elvira Liyanto,Nohan Arum Romadlona,Dewi Nuryana,Riznawaty Imma Aryanty,Melania Hidayat,Anggraini Sariastuti,Maria Gayatri,Robert Magnani

The Indonesian national family planning

program: progress and remaining

challenges in implementing a

rights-based approach

Budi Utomo, Sukma Rahayu, Elvira Liyanto, Nohan Arum Romadlona, Dewi Nuryana,

Riznawaty Imma Aryanty, Melania Hidayat, Anggraini Sariastuti, Maria Gayatri and

Robert Magnani

Abstract

Purpose –Indonesia subscribes to rights-based princip les of family planning. However, a chasm

between principles and practice has long been noted on a global b asis, and progress has not been

well-documented. This paper aims to assess the extent to which the Indonesian national family

planning program has evolved in a manner that is cons istent with rights-based principles.

Design/methodology/approach –The primarysource of data was five Indonesian DemographicHealth

Surveys undertaken from1997 to 2017. The analyses were organized around three major categories of

family planning-relatedhuman rights. Trend analysis and logistic regression wereused in analyzing the

data.

Findings –Indonesian women have considerable autonomy in family planning decision, reporting

that family planning decisions were mainly made by themselves or jointly with thei r spouse.

Although contraceptive method awareness and demand for family planning are high, Indonesia

fares poorly with regard to informed choice in contraceptive method selection. Access to family

planning services is comparatively high as judged by contraceptive prevalence, family planning

demand satisfaction and unmet need for family planning. However, significant geographic a nd

socioeconomic inequity were observed on many indicators, with eastern Indonesian provinces

consistently lagging behind.

Research limitations/implications –This paper focuses on married couple, as Indonesia has a

restrictivepolicy to limiting access and information of familyplanning for other groups, unmarried youth in

particular.

Originality/value –This paper makes an important contribution to document how effectively the

prohumanrights policy orientation towardfamily planning has been translatedinto services.

Keywords Indonesia, Rights-based family planning

Paper type Research paper

List of abbreviations

CPR = Contraceptive prevalence rate;

DHS = Demographic Health Survey;

FP = Family planning;

GI = Gini Index;

ICPD = International Conference on Population and Development;

IDHS = Indonesia Demographic Health Survey;

IQR = Interquartile range;

(Informationabout the

authorscan be found at the

end of this article.)

Received 19 June 2023

Revised 29 August 2023

Accepted 15 September 2023

©Budi Utomo, Sukma Rahayu,

Elvira Liyanto, Nohan Arum

Romadlona, Dewi Nuryana,

Imma Batubara, Melania

Hidayat, Anggraini Sariastuti,

Maria Gayatri and Robert

Magnani. Published by

Emerald Publishing Limited.

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Attribution (CC BY 4.0) licence.

Anyone may reproduce,

distribute, translate and create

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DOI 10.1108/IJHRH-06-2023-0049 VOL. 18 NO. 1 2025,pp. 1-16, Emerald Publishing Limited, ISSN 2056-4902 jINTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE jPAGE 1

JKN = Jaminan Keseh atan National;

mCPR = Modern contraceptive prevalence rate;

MII = Method Information Index;

NFP = National family planning program;

TFR = Total fertility rate;

UHC = Universal health coverage; and

VRBFP = Voluntary rights-based family planning.

Introduction

Motivated in part by landmark international conferences such as the 1994 International

Conference on Population and Development (UNFPA, 1994) and the 2012 London Summit

on Family Planning (Hardee et al., 2014a), a sizeable literature has been accumulated over

the years on the basic principles of rights-based family planning and the activities/

processes needed to achieve rights-based programming (Center for Reproductive Rights,

2009;Cottingham et al.,2012;Erdman and Cook, 2008;Hardee et al., 2014a;IPPF, 1996;

Kerber et al., 2007;Kumar et al., 2013,2014;Kumar, 2015;World Health Organization,

2014;Zaidi et al.,2013). Rights-based approach to family planning conceptualized as “one

in which all phases of a program (needs assessment, planning, implementation, monitoring,

evaluation, and management) are viewed through the lens of individuals’ human rights and

how rights are, or are not, upheld in communities and in FP programs” (Hardee et al.,

2014b;Kumar et al., 2014). Erdman and Cook group these reproductive rights into three

major categories:

1. those related to reproductive self-determination;

2. those related to access to sexual and reproductive health services, commodities,

information and education; and

3. those related to equality and nondiscrimination (Erdman and Cook, 2008).

Hardee proposes a useful conceptual framework for voluntary, human rights-based family

planning developed by combining the three elements/categories from the Erdman and

Cook conceptualization with four “interrelated and essential” elements of the right to the

highest attainable standard of health from Article 12 of the International Covenant on Civil

and Political Rights and the International Covenant on Economic, Social, and Cultural

Rights, General Comment No. 14 (sometimes referred to as “AAAQ”), namely, availability,

accessibility, acceptability and quality (CESCR, 2000). The framework is structured around

ten human rights-related principles and standards that pertain to contraceptive information

and services which are availability, accessibility, acceptability, quality, nondiscrimination

and equality, informed decision-making, privacy and confidentiality, participation,

accountability and agency/autonomy/empowerment (FP2030, UNFPA and What Works

Association, 2021).

Most countries around the globe have endorsed the concept of rights-based family

planning. However, the extent to which government endorsement has been translated

into concrete and effective policy and programmatic action varies across diverse country

settings. Indeed, the UN High Commission for Human Rights made note of this “chasm

between theory and practice” many years ago (Office of the United Nations High

Commissioner for Human Rights, 2006). There were several publications in progress

toward countries’ advancing rights-based family planning, but on specific context in

South East Asia has not well-documented (FP 2020 and UNFPA, 2018;Hardee and

Jordan, 2021).

The research reported in this article sought to assess the extent to which the Indonesian

national family planning program (NFP) has evolved in a manner that qualifies as being

genuinely human rights based. The Indonesian NFP was highly successful in lowering the

total fertility rate (TFR) from 3.0 in 1991 to 2.6 in 2002. During this period, the contraceptive

PAGE 2 jINTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE jVOL. 18 NO. 1 2025