Indonesia
Reproductive Decision-making and Women's Psychological Well-being
Family planning use is widespread in Indonesia. Fifty-five percent of married women use contraception. Yet, in spite of the fact that the government program has increased access to contraception, women are sometimes denied the opportunity to select the contraceptive methods best suited to their needs or preferences. This lack of choice may reflect women's low status in Indonesia as well as the orientation of the family planning program.
How women feel about themselves (including their self-esteem) and the quality of family relationships are core components of their psychological well-being. By understanding the effects of the government's family planning program on the well-being of women, the decisions women make to exercise their reproductive rights, and the effects those decisions have on women's psychological well-being, Indonesia can enhance the quality of its family planning services.
Research Findings
To determine the effect of Indonesia's family planning program on the psychological well-being of women, researchers surveyed 800 married women, ages 25 to 49, from Lampung and South Sumatra provinces. To help develop the survey questionnaire, researchers conducted 12 focus group discussions with women and men from both provinces. In-depth interviews with 24 women complemented the survey.
- Survey data indicated that users of contraception (modern or traditional methods) felt more satisfaction in their relationships with others than did non-users. Contraceptive users also felt they had more control over their reproductive lives; however, they experienced a higher level of role stress than non-users.
- Users of modern contraceptive methods, compared to users of traditional methods, were more satisfied with their relationships, less overwhelmed by child care and domestic responsibilities, and better able to tend to their economic and social needs.
- Women with two or fewer children said they felt more in control of their reproductive lives than women with three or more children.
- Factors other than family planning use and fertility affected women's psychological well-being. Women living in urban areas reported more satisfaction with family welfare, more time for themselves and others, and greater reproductive control than rural women. However, urban women also felt more personal stress and were less able to attend to economic and social needs. Women who worked for income reported greater ability to attend to economic and social needs and less personal stress than non-working women. On the other hand, working women also said they experienced more shame, less satisfaction with family welfare, and less time for themselves and others.
- In the in-depth interviews, most women expressed positive opinions about family planning. In particular, they pointed out that having fewer children relieved their own work load, as well as the family's financial burdens. A woman from rural Lampung stated, "If we had many children, oh my, oh my. It would be troublesome if we had many children - too many expenditures."
- The majority of women made contraceptive decisions within the framework of the interests of others, particularly their husbands. Their husbands' concerns and interests affected the types of methods they used and their decisions to switch methods or stop using contraception.
- Almost universally, women were responsible for actually using the contraceptive method, and men generally left decisions about what contraceptive method to use to their wives. The wishes of husbands regarding family size tended to prevail.
- Although they spoke of the benefits of family planning, many women experienced side effects that led to discontinuation or method switching. Husbands were not always sympathetic. An urban woman from Lampung experienced many problems with the injection, including bleeding, dizziness, and hair loss. She felt so unattractive that she discontinued. After having three more children, she tried using the pill. But after four years of physical problems, including frequent headaches, irritability, and loss of desire for sex, her husband complained, "Your husband comes, and you are just as cold and passive as a banana tree!"
Recommendations
Indonesia's family planning program should continue to improve efforts to provide women and men with better information on contraceptive options, possible side effects, and how to handle negative experiences. In addition, the family planning program should challenge the myth that family planning and contraceptive use are for women only. Communication, education, and marketing campaigns should depict men as interested and involved in reproductive health issues, including family planning. Men already using family planning could be recruited as family planning promoters, who encourage other men to take responsibility for couples' reproductive health.
Study Details
Researchers responsible for this study were: Dr. Irwanto, Dr. Heru Prasadja and Dr. Nancy Sunarno of the Center for Societal Development Studies, Atma Jaya Catholic University; Ms. E. Kristi Poerwandari of the Women's Studies Graduate Program, University of Indonesia; Dr. Karen Hardee of The Futures Group International; Dr. Elizabeth Eggleston of Family Health International; and Dr. Terence Hull of the Australian National University. Research was supported by the Women's Studies Project at Family Health International, through a Cooperative Agreement funded by the U.S. Agency for International Development with field support from the USAID Mission in Jakarta.
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