Reassessing the level and implications of male involvement in family planning in Indonesia.

BACKGROUND: Although there is global recognition of the importance of involving men in family planning and reproductive health matters, this issue has received insufficient attention in many countries. The present study sought to characterize married Indonesian males as to their level of involvement in family planning, identify the correlates thereof and assess the implications of male involvement for unmet need for family planning. METHODS: A mixed methods research design was used. The main source of quantitative data was 2017 Indonesian Demographic Health Survey (IDHS) data from 8,380 married couples. The underlying "dimensions" of male involvement were identified via factor analysis. The correlates of male involvement were assessed via comparisons across the four dimensions of male involvement identified in the factor analysis. Outcomes were assessed by comparing women's and couple's unmet need for family planning for the four underlying dimensions of male involvement. Qualitative data were collected via focus group discussions with four groups of key informants. RESULTS: Indonesian male involvement as family planning clients remains limited, with only 8% of men using a contraceptive method at the time of the 2017 IDHS. However, factor analyses revealed three other independent "dimensions" of male involvement, two of which (along with male contraceptive use) were associated with significantly lower odds of female unmet need for family planning. Male involvement as clients and passive male approval of family planning, which in Indonesia empowers females take action to avoid unwanted pregnancies, were associated with 23% and 35% reductions in female unmet need, respectively. The analyses suggest that age, education, geographic residence, knowledge of contraceptive methods, and media exposure distinguish men with higher levels of involvement. Socially mandated gender roles concerning family planning and perceived limited programmatic attention to males highlight the quantitative findings. CONCLUSIONS: Indonesian males are involved in family planning in several ways, although women continue to bear most of the responsibility for realizing couple reproductive aspirations. Gender transformative programming that addresses broader gender issues and targets priority sub-groups of men as well as health service providers, community and religious leaders would seem to be the way forward.

Despite global recognition of the importance of involving men in family planning and women's health matters, this matter has received insufficient the attention in many countries. The present study sought to characterize married Indonesian males as to their level of involvement in family planning, identify correlates of male involvement, and assess the implications of varying levels of male participation for family planning outcomes.The study used a mixed methods research design. The main source of quantitative data was a 2017 Indonesian Demographic Health Survey (IDHS) data set of 8,380 married couples. Factor analyses were undertaken to identify the underlying dimensions of male involvement. The correlates of male involvement were assessed via comparisons across the four underlying dimensions of male involvement group identified in the factor analysis. Outcomes were assessed by comparing women's and couple's unmet need for family planning for the four underlying dimensions of male involvement. Qualitative data were collected via focus group discussions with four groups of key informants.The study found that male involvement as family planning clients remains limited, with only 8% of men using contraceptive methods themselves. However, Indonesian men are involved in other ways such via approval of family planning and active communications that contribute to lower female unmet need for family planning. The analyses suggest that age, education, geographic residence, knowledge of contraceptive methods, and media exposure distinguish men with higher versus lower levels of involvement. The most important contribution of males to realizing couple-level desires to limit or space births is via the approval of family planning, which empowers females take action to avoid unwanted pregnancies. Socially mandated gender roles concerning family planning and perceived limited programmatic attention to males are highlighted in the quantitative findings.In the way of an overall conclusion, Indonesian males are involved in family planning in several ways, although women continue to bear most of the responsibility for realizing couple reproductive aspirations. Gender transformative programming that addresses broader gender issues and targets priority sub-groups of men as well as health service providers, community and religious leaders would seem to be the way forward.

The impact of family planning on maternal mortality in Indonesia: what future contribution can be expected?

BACKGROUND: Although efforts to reduce high maternal mortality in countries such as Indonesia tend to focus on addressing health risks among pregnant women, family planning has been shown globally to reduce maternal mortality by reducing both total and higher-risk pregnancies. This article assesses past contributions of family planning to the reduction of maternal mortality in Indonesia and the potential future contribution toward achieving the 2030 SDG maternal mortality goal. METHODS: The study takes advantage of data from long series of population censuses and large-scale surveys that are available in few other low- and middle-income countries. We use the decomposition method suggested by (Matern Child Health J, 16:456-463, 2012) and regression-based policy simulations to estimate the number of maternal deaths averted during 1970-2017 due to contraceptive use and project potential future contributions to the year 2030. RESULTS: It is estimated that between 523,885 and 663,146 maternal deaths were averted from 1970 to 2017 due to contraceptive use, a 37.5-43.1% reduction. If the contraceptive prevalence rate (CPR) were to rise from 63% in 2017 to 70% in 2030 and unmet need for family planning were to fall to from 10 to 7%, an additional 34,621-37,186 maternal deaths would be averted, an 18.9-20.0% reduction. A 2030 CPR of 75% and unmet need for family planning of 5% would result in 51,971-54,536 maternal deaths being averted, a 28.4-29.4% reduction. However, the CPR growth rate would have to nearly double the 2000-2017 rate to reach 70% CPR by 2030 and more than triple to reach 75%. Achieving the most ambitious target would still leave the maternal mortality ratio at 125 in 2030 without corresponding improvements in maternal health services. CONCLUSIONS: Although substantial reductions in maternal mortality between 1970 and 2017 can be attributed to contraceptive use and further contributions to the year 2030 are probable, smaller contributions are likely due to the already relatively high CPR and the challenges that must be overcome to move the CPR significantly higher. The ability of Indonesia to reach the 2030 SDG maternal mortality target of 70 maternal deaths per 100,000 live births will depend primarily upon health system effectiveness in addressing health risks to women once they are pregnant.