The Role of Women in Family Planning in Indonesia

I. Introduction
Population growth has long been a problem in Indonesia, and particularly as it effects population in the island of Java. To solve this problem the Dutch colonial in 1905 had started to transfer Javanese population to the island of Sumatera. To alleviate this problem, family planning has been introduced into Indonesia.
In Indonesia, the traditional ways to control and to space birth has been employed by herbs and massage. While the use of modern contraceptions recognized by society since National Program on Family Planning, existed in 1970 .
To disseminate the idea of family planning is not an easy task. Even in the developed countries there have been polemical discussions between the supporters of family planning, the funding agencies and religious groups. One of their concerns is budgeting, that public money should not be used for such matters as opposed the religious belief i.e.: abortion. For this reason, the success of family planning in Indonesia, where the most acceptors are women as well as Muslims, be an interesting phenomenon to observe.
The role of religions especially Islam in Indonesian history has been recognized long time before independence. Javanese kings used to entitle themselves khalifatullah sayidin Panotogomo. It is always a mosque in front of the palace in cities in Java. Since the arrival of Islam in the 13th century, the foundation of Islamic kingdom until physical revolution to the Dutch colonialism and achieving Independence are evidents of Muslim involvement in developing the country. For Indonesian society, until now, religious point of view became an important consideration in decision making process. It has been explicitly sated in the First Five year Planning which says that: ”The application of Family Program is volunteer and should be in harmony with Pancasila moral and related religious teaching”
Islam and Family Planning.
The Islamic perspective on family planning is not limited to the idea of birth control or the limitation of births. It cannot be separated from the desire to promote a family which is sakina and prosperous, as well as descendants who are physically and mentally strong, healthy, well educated and secure. Therefore, family planning according to Islam should support and stimulate family welfare.
Family planning is not only a clinical issue; it is related to and affected by the perception, attitudes and behaviour of society. Hence it demands an approach which incorporates community and national welfare. The Qur’a>n and the Sunna define the responsibilities of parents and the community for the welfare of their offspring and future generations.
The principle idea of family welfare in Islam is closely related to the efforts at providing a better life for the children who will form the next generation. The Qur’a>n warns that every family should promote the welfare of its descendants to prevent them from passing on any weaknesses which may cause difficulties in the future (Qur’a>n 4:9).
Islamic teachings encourage Muslims to get married and have children; those children become the responsibility of their parents. Islam is concerned with the preservation of both the mother’s and the child’s health during pregnancy, birth and nursing. It does not, however, restrict the number of children for a couple as long as the parents are capable of raising them successfully. The practice of family planning is not necessarily illegal in Islam, as long as both spouses have good intentions (niyya) in their use of birth control and as long as the method they use is acceptable to Islamic law
In Indonesia, birth control is usually practiced to create an interval between children or to prevent pregnancy after the birth of the last child. The spacing of children and the systematic prevention of pregnancy applied once the desired number of children has been achieved, are meant to provide happiness for the family.
The purpose of national family planning in Indonesia is to decrease the birth rate. In terms of Islamic law, however, there are some considerations which have made it possible for contraception to be accepted by Indonesian Muslims, including the Muhammdiyyah and the Nahdlatul Ulama, the two largest Muslims organization in Indonesia. In Islam, the attitude towards contraception should be based on fatwas and the guidance of Muslim jurists basing themselves on the schools of legal interpretation to which they belong rather than according to the discretion of the individual. These Muslim jurists are the ‘ulama, learned specialists in the religious and traditions of Islam .
Islam permits contraception in the case of need (ha>ja) but does not prohibit the practice in the absence of need. Quoting from the al-Iqna’ of Bujayrimi Musallam says that if contraception is practiced with a valid excuse (‘udhr), such as the need for raising (tarbiyya) another child, it is not blameworthy (lam yukrah). The prevention of pregnancy through coitus interuptus was excercised during the prophet Muhammad’s lifetime. Although he was aware of the practice, he did not prohibit it. Contraception is acceptable, provided that it is practiced for health reasons and improvement of the quality of life. The prophet said:”Jahd al-bala’ kathra al-’yal ma’a qilla al-shay’” (the most disastrous life for (a family) is to have a large family, but without sufficient economic support) reported on the authority of al-H}a>kim. Therefore the importance of promoting family planning is in order that it enhances the quality of life within the boundaries of Islamic teachings.
Among the natural methods of contraception practiced by Muslim is breast feeding the children for two years. This is encouraged by the Qur’an 2:233: “The Mothers shall give suck to their offspring for two whole years...” This method is also practised in Indonesia and is highly recommended by doctors. According to Modern theories of biology, when a woman breast feeds her baby her secretion of prolactine hormone increases while her body stops producing progesteron and estradiol hormones. These two hormones function to make pregnancy possible; therefore there is a possibility to prevent pregnancy throughout the period of breastfeeding.
There are certain circumstances when the birth of a child is not welcome:
1. If bearing a child will endanger the life of the mother or if there is a danger envisaged to the life of the mother at the time of delivery. The above points are justified in the following verse of the Qur’an: “ Do not throw yourself into destruction with your own hands.” (2: 195)
2. If there is any fear that special financial, and educational responsibilities required by children would prevent a prospective parent from fulfilling his/her religious duties.
3. If the birth of a child would force someone to accept unlawful food. The Qur’an says: “Allah wants to ease your problems; He does not want to be harsh towards you “ (2: 185), “nor does He want to force any hardship upon you.” (5:6)”.
4. If there is a likelihood that the health of the child would be jeopardized. A father or mother suffering from a contagious disease which can be transmitted to the children would be justified in the practice of birth control. This does not apply to hereditary disease like diabetes however.
5. If there is a danger thet the parents would not be in a position to give propwer training (tarbiyya) to the children as required by Islam.

Indonesian Muslims Point of view.
The Muhammadiyyah
The Ulama from the legal Affairs Committee of Muhamadiyyah, when giving their opinion, start from they understand regarding family planning , that is, as an effort to balace fecundity with ability; and not due to the fear of having children. The core of Muhamadiyyah opinion regarding the Family Planning Program is that: It is regarded as a wayout in pressing circumstances. A circumstance that is considered pressing or urgent is related to three things: First, when there is concern regarding the life or health of the mother when she is pregnant, or when she delivers a baby, based on a doctor’s opinion or prior experience. In that case, Muhamadiyah states that religion allows someone avoid pregnancy, based on al-Qur’a>n: “And make not your own hands contribute to (your) destruction.” (Al-Baqarah, 195); “Nor kill (or destroy) Yourselves.” (Al-Nisa>’, 29).
Second, When there are too many children to take care of, someone’s religion could be threatened if he or she were driven to violate religious norms to fulfill the demands of the family, such as stealing, robbing, etc. They refer to Al-Baqarah 185, and Al-Ma>’idah, 6). Birth control that is based on solely on the anxiety that the children will not make their way in life cannot be accepted, since in Hud 6 Allah has guaranted the fortune of children.
The third urgent circumstance, according to Muhamadiyah is the anxiety about the life, health and education between one birth and another. The reason for this comes from the H}adith : “Do not endanger yourselves or others (including your children).” (narrated by Ah}mad and Ibn Ma>jah). Meanwhile, the management of the time between births is commensurate with the encouragement given by al-Qur’a>n in Al-Baqarah, 233, Luqma>n, 14 and Al-Ah}qa>f, 15. From the three verses above, the Legal Affairs Committee of Muhamadiyyah draws the following conclusions:
1. Even though these verses are of varying themes, there has arisen a logical understanding, that when when the duration is less than thirty months between pregnancies or nursing, it is only fair that the husband, for love’s sake, does not increase the burden on his wife by forcing her to conceive and deliver another baby. This could mean long-lasting sacrifice for his wife.
2. Even though a Muslim should be able to accept everything that happens to him or her according to his or her trust in God, it is imperative that everyone try to alleviate pain and sorrow and try to fulfill life’s demands, in addition to his or her faith in God’s mercy.
3. Based on the understanding that what is reflected in the above verses is the will of God, we can still hope for His mercy when we have reasonably long intervals between birth, in order to alleviate the burden of a woman in the midst of her service to Him.
4. Meanwhile, in addition to determination and prayers for a good fate given by Allah, we also need the advice of people who are expert in health matters.
The Legal Affairs Committee of Muhammadiyah also pays special attention to the technical issues of family planning. Based on the teaching of the hadith about anything harmful to ourselves or to others, family planning should practiced approately, should be approved by both husband and wife, and should not be physically or phychologically detrimental to the person practicing it.
Muhamadiyyah is of the opinion that the use of any contraceptive method should consider the factors mentioned above. Coitus interruptus can be practiced as long as it is approved by the wife. Also, the installation of any intravaginal contraceptive device should be done by a female doctor or nurse except in urgent circumstances, male doctor can perform it.
Muhamadiyah views that the effort to avoid pregnancy by destroying or altering the body’s organs is a violation of the teachings of Islam. Therefore, the vasectomy and tubectomy methods are not approved. Abortion is not accepted either for it is thought to be in the category of murder. Even though a foetus does not have a soul, according to them abortion is prohibited in Islam. Al-Ghazali’s view concerning this that a life begins with a contact between the sperm and the ovum which waits in the womb. Therefore, abortion, even in the early stage, is still considered crime.
Exceptions to this rule can be accepted only in very urgent situations, such as when the life of the mother is threatened if the foetus continues growing. The mother should not be sacrificed only for her child-to-be, since she is the source of the foetus and her life is already in existence. This is based on the ritual law that when someone has to choose between two bad choices, he or she has to choose the one that is of less negative impact.
It can be concluded then, that Muhamadiyah starts with encouragement to have descendants who are strong both physically and spiritually, so that they will not be a burden for others. In the family planning theory, they emphasize that one must not jeopardize life, either physically or spiritually, and one must not alter or destroy human organs, especially the woman’s genitals. Concerning certain methods, such as abortion, the practice can be accepted only in urgent circumstances.
The type of program which is done by the Muhamadiyah is becoming one of the models that show how religious group participate in family program without leaving religious principles. There were such programs funded by Path finder Fund, UNFPA, Family Planning International Assistance, Asia Foundation etc. This even gives experience and wide horizon for both sides that might be followed by other organizations as well as the agencies.
The Nahdlatul Ulama
The Islamic law which is developed and applied by the Nahdlatul Ulama (NU) characterizes Indonesia. Nurcholish says that Islam in Indonesia should be understood within the context of Indonesian cultural influences. Among the principles of the NU is that of adapting to new situations. The aim of this principle is to create programs and activities which can solve actual problems, not only for the members of the NU but also for the Indonesian nation or even human beings as a whole. This is reflected in their motto: “al-Muh}a>faza ‘ala> al-qadi>m al-s}a>lih} wa al-akhdh bi al-jadi>d al-as}lah}: preserving the old that which remains good and adopting the new that is better.”
In 1968-1969 the Nahdlatul Ulama began to address the importance of family planning for the umma. On September 25, 1969 in Jakarta, The Central Board of the NU produced a document on family planning, which set forth the following guidelines:
1. Family planning should be undertaken as a mean of spacing pregnancies for the sake of family welfare, not preventing pregnancy out of a desire to limit the (members) of the family.
2. Family planning should be based on the importance of the welfare of mother and child, not from the fear of poverty or starvation.
3. Family planning must not include abortion.
4. It is forbidden to destroy and / or remove either the husband’s or his wife’s reproductive organs.
5. Family planning must be an individual matter (voluntary) and not a mass movement with enforced rules.
6. Family planning must take place with the agreement of both husband and wife.
7. Methods of family planning should only include those permissible under religious law and ethics.
8. Couples should be careful not to misuse family planning to commit sin (ma‘s}iyya) or abuse.

The Role of Women in Family Planning in Indonesia.
In Indonesia, especially the participation of women cannot be isolated from the agreement of the ulama to the subject matter. In this case the role of Muslim organization as Muhamadiyah and Nahdlatul Ulama is very significant, for they have autonomous bodies which all the members are women such as Aisyiah, Nasyiatul Aisyiyah, Muslimat and Fatayat Nahdlatul Ulama. Through these autonomous bodies, they implement family planning programs whether by themselves as well as cooperated with government programs, because the latter for sure they cannot reach everyone, therefore, Muhamadiyah concentrates their programs in urban areas while Nahdlatul Ulama more in the grass root level.
Some of the Population Activities in Support of Family Planning Movement
1. Integrated health-family planning program.
In every activity, family planning movement encourages other development sectors, or various institutions to participate in the family planning activities. To support family planning movement, Ministry of Health Develops National Health system that places community and family as major subject in overcoming health problems. To this reason, it is expected that community has a concern on health or family planning matters related to religion, ethics, and culture to create both public health and health for all.
2. Post for Integrated Health and Family Planning Services (Posyandu), as an effort for maternal and child health.
Family planning development is as an integrated post of maternal and child health, and integrally conducted by other development sectors. One of efforts for improving maternal and child health is conducted through Posyandu activities. Including IEC activities on nutrition, family planning, health, immunization, and family planning services. Posyandu activities have established throughout Indonesia until neighborhood association level, managed by cadres of PKK (Women Movement).
3. International Training Program.
The success of Indonesia in managing family planning program has been recognized by other countries and donor agencies. Because of this success, many countries have sent participants to learn the management of family planning in Indonesia. To anticipate the demand, BKKBN established International Training Program in the mid of eighties, and this institution is now an important asset of the Prosperous Family Development and National Family Planning Movement that is useful to disseminate the ideas of Indonesian Family planning and prosperous family program to other countries. For example, training program in Family Planning IEC (information, Education, and Communication) in July-August 1994 had attended by participants of the several countries.
4. Immunization Program to Reduce Infant Mortality.
According to WHO, child mortality in developing countries is about five millions for year. It is caused by diseases that can be prevented by vaccine, and 500.000 children experienced handicaped because of polio. To prevent this matter, the government mobilize immunization program until village level, by the year 1992, about 73.99% of the number of children under five (Balita) have got immunization, and it is expected that it will increase in the next years. In Table A-6 shows that estimated infant mortality rate (IMR) in 1967 was 145 per 1000 live birth. This rate reduced to 63 in 1990, and it was 52 in 1995.
5. Towards a Self-reliance of the Family Planning.
To maintain the family Planning users. Contraceptive services through both village family planning management Assistance (PPKBD) and Sub-Village Clinics have been successful, but in terms of self-reliant family planning services, BKKBN provides services through village unit cooperatives (KUD). In this cooperation family planning services are paid to KUD. Increasing community participation in national family planning has changed the program managed by government to community movement. The impact of this family planning movement is reflected to fertility reduction year by year. Table A-7 shows that from 1971-1994 had experienced the reduction of total fertility rate (TFR) as much as 50%, namely from 5.6 in 1971to 2.8 in 1994. The reduction of fertility rate was mostly caused by high commitment in development, institutions at village levels supporting family planning, high family planning awareness and practice, and higher age at marriage as well as birth interval. The objective of population development that is necessarily developed in support for the increasing number of labor force (15-60 years), namely 2.5 millions every year. It includes women labor force, and they necessarily get the availability of employment. As shown in Table A-8, one third the labor force (38.86%) is women. By providing an employment for women, it is expected that family social-economic status will improve, and it will improve, and it will improve family welfare. The member of family planning in Indonesia (acceptors) is counted by couple, as a matter of fact that most of the effective contraceptive users are emphasized more on women. We may observe from various tools practiced by them. During 1993-1994 the only means practiced by men is condom (1.79%), while pills (32,25%), injections (29,71%), IUDs (23,90%), implant (7,18%), and sterilization (5,64%) are used by women. (see chart B-3). The other role played by women is concerning the participation of field-workers both Family Planning Field Workers (PLKBs) and Family Planning Field Workers Supervisors (PPLKBs), Community institutions such as Village Family Planning Management Assistants (PPKBDs) and their sub divisions (Sub-PPKBDs), about 90% of them are women, why? Because the issues of family planning is relatively sensitive in the community, thus people especially in the village are more comfortable to consult such matters with them. The weighing group for children is conducted a weighing activity for children under five (Pokbang), children development program (BKB) and income generating program for family (UPPKS) are also provided by women. (see chart B-8)



Education is a long life process, and it has to be provide to young generation earlier. They are expected at least to get a nine-year education.
Estimation of life expectation
Health policy and efforts to improve family welfare will support to increase life expectation for Indonesian population. The increase of family welfare can make family members to get a better health care.
Efforts for the improvement of health and family welfare have already been successful. It is reflected to the increase of life expectation rate for Indonesian people year by year.

Estimation of infant mortility rate (imr).....
Total fertility rate (tfr) .....
Labor force ....

On the chart one we are going to see the Indonesian population trend from 1971 until 1995, and that is 195.283.200. The information on population trend is very important especially relating to the increase of young population number, the number of school age children as well as young labor force which they will cause the increase of education, health, employment needs etc.
I need the following data:
1. page 1 Indonesian map
2. page 5 Tabel 3 Projection of Indonesian population according to sex and age.
3.page 7 Tabel 5 about IMR
4. page 165 the map of Bali
5. page 139 the map of DIY
6. page 3 on Indonesian Population Trend 1971-1995
7. page 11 on the estimation of life expectancy in Indonesia
8. page 13 on Estimation of infant mortality rate in Indonesia
9. page 15 on Total fertility rate
10. page 17 on Number of labor force
11. Info tentang MKE (metode kontrasepsi efektif): IUD, MO sterilization, implant
12. Info tentang NON-MKE

Population activities in support of Family Planning Movement
- Integrated Health-Family Planning Program
- Post for integrated health and family planning services (Posyandu), as an effort for maternal and child health.
- International Training Program
- Immunization program to reduce infant mortality
-Toward a self-reliance of the Family Planning

Bibliography
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A Paper presented in The Congress of the Social Sciences and Humanities,
Canadian Asian Studies Association, University of Ottawa,
Ottawa, June 3, 1998