Center for Reproductive Health

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Levels , Trends and Determinants of Informed Choice in Family Planning in Indonesia

Summary
Informed choice is an integral part of family planning service. Informed choice refers to whether women are provided adequate information when choosing a family planning method. This specific information becomes one of indicators in FP2020 global commitment to family planning and is known as Method Information Index (MII). Informed choice implementation will help government guarantee that family planning service are being delivered with good quality and according to right-based principles. Maximizing informed choice is hoped to help reduce discontinuation rates, unmet need, and a skewed national method mix.
Background
Family planning (FP) enables everybody to decide their choice on sexual life and reproduction. FP also represents women and children opportunity to achieve higher education and participate on social life. It makes family planning decision making very important and should be based on accurate information on type and informed choice. Health service providers and government are responsible to provide facilities that will help everybody to decide their reproductive life through FP counseling and education.
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Tingkat, Tren dan Faktor Penentu dari Informed Choice dalam Keluarga Berencana di Indonesia

Informed choice adalah suatu bagian penting dari pelayanan keluarga berencana. Informed choice mengacu pada apakah wanita diberikan informasi yang cukup ketika memilih metode keluarga berencana. Informasi spesifik ini menjadi salah satu indikator global komitmen FP2020 terhadap keluarga berencana dan dikenal sebagai Method Information Index (MII). Implementasi Informed choice akan membantu pemerintah memastikan bahwa pelayanan keluarga berencana disediakan dengan kualitas yang bagus dan dengan prinsip berdasar hak. Memaksimalkan informed choice diharapkan dapat membantu mengurangi tingkat putus pakai, unmet need dan method mix nasional yang tidak seimbang.
Latar Belakang
Keluarga Berencana (KB) memungkinkan semua orang untuk memutuskan pilihan mereka dalam kehidupan seksual dan reproduksi. KB juga mempresentasikan kesempatan wanita dan anak-anak untuk mendapatkan pendidikan tinggi dan berpartisipasi dalam kehidupan sosial. Hal ini membuat keputusan yang berhubungan dengan keluarga berencana menjadi sangat penting dan harus berdasarkan informasi yang akurat dari tipe dan informed choice. Penyedia pelayanan kesehatan dan pemerintah bertanggung jawab untuk menyediakan fasilitas yang akan membantu semua orang dalam memilih kehidupan reproduksi mereka melalui KB.
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Putting the results of the 2015 PMA 2020 survey in Indonesia into context

By: Anggriyani Pinandari , Siswanto Wilopo, Robert Magnani, and Amirah Wahdi
Indonesia participation in global family planning commitments was launched in the London Summit 2012. The main target is providing family planning method for 120 million women of reproductive age in the world and reaching other 17 related indicators by year 2020. To ensure Indonesia’s contribution for the target, government established 8 family planning indicator targets through National Medium-Term Development Plan (RPJMN) 2015-2019. Indonesia also commits to maintain investment for FP programs financing, including reallocating resources to the most densely populated provinces and districts where the TFR is still high and located mostly in rural areas and smaller islands. The country will broaden access and choice by strengthening public and private clinic services and provision of long-acting and secure contraceptive methods, including post-partum FP program.
Indonesia is experiencing a second demographic transition which characterized by increased number of productive and reproductive age. This coming era is marked by the change of sexual and reproductive pattern, such as increasing on premarital sexual intercourse and unwanted pregnancy. This is a challenge for family planning program to guarantee controlled growth of the population and fulfillment of contraception needs. In RPJMN 2015-2019 government is targeting TFR to drop to 2.28 (see Table 1). For which we need to increase the number of contraception users especially for modern method.
Indonesia have annual data collection to tracking the progress of RPJM indicators, but none for FP2020. In 2015, PMA2020 was conducted for the first time to full fill that need and provide trajectory of each indicators toward 2020. This analysis aim to present the current progress and profile of Indonesia family planning indicators by putting the result of first round of PMA2020 2015 and others existing data.
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Meletakkan Hasil dari Survei PMA2020 2015 ke dalam Konteks

Oleh: Anggriyani Pinandari , Siswanto Wilopo, Robert Magnani, Amirah Wahdi, Karina Puspitasari
Partisipasi Indonesia dalam komitmen keluarga berencana global diluncurkan pada the London Summit 2012. Dengan target utama menyediakan metode keluarga berencana untuk 120 juta wanita usia subur di dunia dan mencapai 17 indikator terkait pada tahun 2020. Untuk memastikan kontribusi Indonesia terhadap target tersebut, pemerintah membuat 8 target indikator keluarga berencana melalui Rencana Pembangunan Jangka Menengah Nasional (RPJMN) 2015-2019. Indonesia juga berkomitmen untuk menjaga investasi untuk program pembiayaan KB, termasuk merealokasikan sumber daya ke area yang paling padat penduduk dan pulai kecil. Negara akan memperluas akses dan pilihan dengan memperkuat pelayanan klinik umum dan swasta dan menyediakan metode jangka panjang dan aman, termasuk program KB post-partum.
Indonesia sedang mengalami transisi demografi kedua yang dikarakterisasi dengan meningkatnya jumlag usia produktif dan subur. Era ini ditandai dengan perubahan pola seksual dan reproduksi, seperti meningkatnya hubungan seksual sebelum menikah dan kehamilan tidak diinginkan. Hal ini menjadi tantangan untuk program keluarga berencana dalam menjamin kontrol terhadap pertumbuhan populasi dan pemenuhan kebutuhan kontrasepsi. Dalam RPJMN 2015-2019 pemerintah mentargetkan TFR menurun ke angka 2.28 (lihat tabel 1). Dimana kita perlu meningkatkan jumlah pengguna kontrasepsi terutama untuk metode modern.
Indonesia mempunyai pengumpulan data setiap tahun untuk mencatat kemajuan dari indikator RPJM, tetapi tidak untuk FP2020. Di tahun 2015, PMA2020 pertama dilakukan untuk mengisi kebutuhan tersebut dan memberikan lintasan dari tiap indikator menuju 2020. Analisis ini ditujukan untuk menunjukkan perkembangan saat ini dan profil indikator keluarga berencana Indonesia dengan meletakkan hasil dari round 1 PMA2020 tahun 2015 dan data yang tersedia lainnya.
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Extreme Contraceptive Method Mix in Indonesian Provinces: Contributing Factors and Consequences

By: Center for Reproductive Health and Center for Health Policy and Management
Summary
Contraceptive Method Mix usually interpreted as a measure of the extent to which women and couples have access to a wide range of contraceptive methods. Extreme skewness of methods mixes are often taken as an indication that women/couples in a given country or sub-national area are not being provided access to a wide range of contraceptive options for one reason or another. Four (4) provinces had skewed method mixes dominated by a single method (i.e., 60% or more) – Aceh, South Sumatra, West Kalimantan and NTB. It was caused by two potential factors: (1) informed choice (or lack thereof) among family planning clients and (2) service disruptions caused by stock-outs of contraceptive commodities .
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Ketimpangan distribusi method mix di Provinsi-provinsi Indonesia: Faktor kontribusi dan konsekuensinya

Oleh: Pusat Kesehatan Reproduksi dan Pusat Kebijakan dan Manajemen Kesehatan FK UGM

Ringkasan

Metode kontrasepsi campuran biasanya diinterpretasikan sebagai suatu ukuran dari cakupan dimana wanita dan pasangan mempunyai akses terhadap berbagai macam metode kontrasepsi. Kemiringan ekstrim dari metode campuran biasa dianggap sebagai suatu indikasi bahwa wanita/pasangan pada suatu negara tertentu atau area sub-nasional tidak disediakan akses terhadap berbagai jenis pilihan kontrasepsi dikarenakan suatu alasan tertentu. Empat provinsi mempunyai metode campuran yang miring didominasi oleh satu metode (contohnya., 60% atau lebih) – Aceh, Sumatra Selatan, Kalimantan Barat, dan NTB. Hal ini disebabkan oleh dua faktor potensial : (1) informed choice (atau kurangnya informed choice) diantara klien keluarga berencana dan (2) pelayanan yang terganggu disebabkan oleh kehabisan alat kontrasepsi.
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Understanding “All Women” Family Planning Program Indicators in the Context of Trends in Marriage: Indonesian Case Study

By: Siswanto Wilopo, Robert Mangani
Background
In order to emphasize the principle that all women and their partners are entitled to access to family planning and other reproductive health services, many of the FP2020 “core” indicators are being measured for all women of reproductive age (WRA) as opposed to only among married women (MWRA) as has been traditionally done. Notable among indicators affected by this refinement are the Modern Contraceptive Prevalence Rate (mCPR) and the Number of Additional Users of Modern Contraception, two of the “headline” FP2020 core indicators.
While being based upon sound human rights principles, interpreting trends in key indicators measured for all WRA can be confounded by changes in the proportion of women of reproductive age that are married (and presumably exposed to risk of pregnancy). In cases where marriage patterns in a given country are changing rapidly, it can become challenging to determine what share of observed changes in mCPR is due to changes in contraceptive
behaviors, which is the intent of the indicator, versus changes in population composition with regard to proportions WRA that are married.
Such a scenario arose recently in Indonesia when the results of the 2015 PMA2020 survey revealed a modest increase in mCPR after many years of stagnation, but at the same time a marked increase in the proportion of women of reproductive age that were married. The relevant data are shown on the table 1. As may be observed, the mCPR increased by 1.6 percentage points from 2012 to 2015 among MWRA women and 3.1 percentage points among WRA. However, the 2015 PMA2020 revealed an increase in the proportion of women of reproductive age that were married from 73% to 76%.
When this increase is taken into account, the change in mCPR among WRA that is due to changes in contraceptive behaviors falls to 1.2% (with remainder being due to the increase in the proportion of women of reproductive age that were married).
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Memahami “Semua Wanita” Indikator Program Keluaraga Berencana dalam Kontek Tren Perkawinan: Studi di Indonesia

Oleh: Siswanto Wilopo, Robert Mangani
Latar Belakang
Untuk dapat menekankan pada prinsip bahwa semua wanita dan pasangan mereka berhak atas akses kepada pelayanan keluarga berencana dan kesehatan reproduksi lainnya, banyak dari indikator “inti” FP2020 diukur untuk semua wanita usia reproduksi (WRA) dan bukan hanya wanita sudah menikah umur subur yang sebelumnya dilakukan (MWRA). Perlu dicatat beberapa indikator yang dipengaruhi oleh perubahan ini yaitu Modern Contraceptive Prevelance Rate (mCPR) dan jumlah tambahan pengguna kontrasepsi modern, dua dari “ judul utama” dari indikator inti FP2020.
Walau berdasarkan pada prinsip hak asasi manusia, interpretasi tren pada indikator kunci yang diukur untuk semua WUS dapat terpengaruh oleh perubahan pada proporsi wanita usia subur yang telah menikah (dan dianggap terekspos pada resiko kehamilan). Pada kasus dimana pola pernikahan pada suatu negara tertentu berubah secara cepat, dapat menjadi tantangan untuk menentukan seberapa bagian dari perubahan yang diamati dalam mCPR disebabkan oleh perubahan pada perilaku kontrasepsi, yang mana merupakan tujuan dari indikator, dan bukan perubahan di komposisi populasi membandingkan proporsi WUS yang telah menikah.
Skenario tersebut dapat muncul akhir-akhir ini di Indonesia ketika hasil dari survei PMA2020 tahun 2015 menunjukkan sedikit kenaikan di mCPR setelah lama stagnan, namun pada waktu yang sama ditandai mengalami kenaikan pada proporsi dari wanita usia subur yang telah menikah. Data yang relevan ditunjukkan pada tabel 1. Dapat dilihat, mCPR , meningkat 1.6 poin persentase dari 2012 ke 2015 diantara wanita yang telah menikah usia subur dan 3.1 poin persentase diantara wanita usia subur. Namun, pada PMA2020 tahun 2015 menunjukkan peningkatan pada proporsi wanita usia subur yang sudah menikah dari 73% ke 76%. Ketika kenaikan ini dipertimbangkan, perubahan pada mCPR diantara WUS yang disebabkan perubahan pada perilaku kontrasepsi turun ke 1.2% (dengan pertimbangan bahwa kenaikan disebabkan kenaikan pada proporsi wanita usia subur yang telah menikah).
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Annotated Bibliography: Selected Researches on Family Planning in Indonesia 2005-2015

Annotated Bibliography
Selected Researches on Family Planning in Indonesia 2005-2015

By Siswanto Agus Wilopo
Indonesia is well known for the success story in promoting and implementing family planning program nationally since 1970s. Prior to the introduction of the family planning programme in the 1970s, the total fertility rate (TFR) is 5.6. Over the subsequent period, the adoption of contraception along with changes in people’s perceptions regarding the ideal number of children and ideal age for marriage caused a dramatic decline in fertility levels.
During this period, the TFR declined from 5.6 in 1968 down to 2.6 births per woman in 2012, or a drop of around 50%, while the contraceptive prevalence increased from miniscule to 61.9 percent. As the family planning programme expands various studies, best practices and literatures are developed by various institutions including government institutions, research institutions, academicians, development partners and individual researchers.
The main objective of compilation and development of this annotated bibliography of
family planning is to document the recent studies and best practices in Indonesia during the period of ten years, from 2005 to 2015. The majority of the studies and best practices are those accepted for oral or poster presentations at the International Conference on Family Planning, Nusa Dua, Bali, 25-28 January 2016. All of these studies and best practices are compiled into one cohesive annotated bibliography. It is expected that this document serve as a reference for researchers and programme managers from various sectors within the Government of Indonesia, as well as international community.
This Selected Researches on Family Planning in Indonesia 2005-2015: an Annotated Bibliography is produced by the National Population and Family Planning Board (BKKBN) of Indonesia in collaboration with National Sub-Commitee of Scientific of the International Conference on Family Planning 2016, UNFPA and USAID. The papers contain useful information that will enrich the understanding of the family planning trends and issues in Indonesia. However, I would like to note that the opinions, findings and recommendations contained within the studies are solely the views of each individual researcher/writer, and may not necessarily reflect the views or policies of BKKBN, UNFPA and USAID.
I extend the appreciation and unbounded thanks to UNFPA Indonesia and USAID for their support. Similarly to the team of writers and all parties for their assistance in preparing this publication. May this publication motivate our courage and efforts to develop the better program in the future for Indonesia, as well as colleagues from various countries and development partners to get more useful information.
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SURVEILLANCE TO ESTIMATE DISEASE BURDEN, COST OF CHILD CARE UTILIZATION, COST-BENEFIT AND COST-EFFECTIVENESS EVALUATIONS OF IMMUNIZATION PROGRAMS FOR ROTAVIRUS DIARRHEA IN INDONESIA: EXPANDED SURVEILLANCE

By Siswanto Agus Wilopo, Paul Kilgore, Soewarta Kosen, Yati Soenarto, Muchamad Syururi, Aminah, Cahyono, Maria Ulfa and Abu Tholib
Rotavirus (RV) is one of the most common causes of acute dehydrating diarrhea in young children in developed and developing countries1 2. In 2006, RV was estimated to cause 610,000 deaths annually in children younger than 5 years of age. For this age group, RV is also responsible for 2.4 million hospitalizations, 24 million clinic visits, and 114 million episodes of gastroenteritis requiring home care3. By age 5, nearly every child will have an episode of RV gastroenteritis, 1 in 5 will visit a clinic for treatment, 1 in 65 will be hospitalized, and about 1 in 293 will die. RV mortality occurs primarily in the poorest countries where 82 percent of RV deaths occur.
In Indonesia, diarrheal diseases continue to be a significant of public health problem for three reasons. First, the prevalence of diarrhea morbidity did not change significantly in recent decades. Second, it continues to be a third-order cause of death among children <5 years old , and third, RV diarrhea is a significant cause of pediatric hospitalizations 7-12. This hospitalization causes an economic burden, which results a significant impact to the poor families in Indonesia. However, precise estimates of RV-related morbidity are difficult to obtain from routine hospital data because stool samples from children with diarrhea are not routinely tested. Only limited data are available for laboratory-confirmed cases of RV associated
gastroenteritis. It is because a specific diagnosis of RV infection is rarely done at a
hospital on cost grounds and because diagnosis does not alter treatment or outcome. No national reporting system is established, underlining the need for RV surveillance in Indonesia.
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SURVEILLANCE TO ESTIMATE DISEASE BURDEN, COST OF CHILD CARE UTILIZATION, COST-BENEFIT AND COST-EFFECTIVENESS EVALUATIONS OF IMMUNIZATION PROGRAMS FOR ROTAVIRUS DIARRHEA IN INDONESIA: EXPANDED SURVEILLANCE Read More »