Focus of Edition 36
Rediscuss Family Planning
‘A lot of kids a lot of luck’, ana dina ana upa (there is day, there is rice), each child born to bring their own fortune, a very popular phrase used in our society. About three to five decades ago, the average number of children of every family are more than three. A female can give birth between five to fifteen children.
However, the situation does not only happen once. It is still happening now. One former member of House of Representative (Hj.Yoyoh Yusroh, deceased) has 13 children. Even she (Bu Yoyoh her nickname) has given her opinion that family planning proposed by government is a form of human rights violations.
Mrs. Eros, a woman living as a cake seller from Purwakarta and wife of Mr.Asep, a public three-cycle rider, has given birth 25 times. Mrs. Eros never tried family planning program. She joined this program, had tried some contraceptive methods, but always failed. In fact every year, she could give birth two times.
Both phenomenon is a reflection of how Family Planning program (KB) is understood by many people and its implementation in daily life. Family Planning program had a boom during New Order, although it was responded in two different sides : praised and hated. However, when government changed to so-called the reform era, the issue of family planning are rarely heard again. Therefore, it is important for us to see again what and how is the Family Planning program so far and its connectivity with reproductive health issues.
Reflection from the History of Family Planning: Idea of Birth Restrictions
“Two children are enough!” The slogan had grown large enough in the New Order era. We could find it easily behind the coin denominations of Rp 5, – published by Bank Indonesia in 1974, or in the village arches and others. Family Planning programs were very popular in the New Order. In 1987, the Government of Indonesia had received an award from UN for its success in the field of population and family planning. That time President Soeharto was invited to New York, USA to receive the award.
Yet efforts to obtain the awards were also determined by coercion of forced sterilization or through use of Depo Provera injections secretly committed in Timor. Depo-Provera is a type of medicine given by injection that serves as a contraceptive for a period of 3 months and re-administered injections every 3 months. In addition, the approach to family planning was conducted targeting women as ‘the owner of the womb’ to become family planning acceptors. However, regardless how women were engaged to be acceptors, in truth through control over their reproductive organs and roles, the country managed to overcome problems of the population explosion.
The Family Planning itself in terms of limiting number of births has been known for a long time. It is closely related to very important aspects of population: 1) number of population size, 2) amount of population growth, 3) number of national mortality, 4) number of national natality , and 5) number of population migration. The person who first put forward theory of Thomas Robert Malthus’s population is living in year 1776 to 1834. In first edition of Essay on Population in 1798 Malthus expressed two main opinions: a) Food is essential for human life, and b) human’s desiree can not be arrested.
Malthus said the population growth is much faster than food. As a result, there will be a big gap between number of population and necessities of life. Malthus put forward the argument; the population tends to increase geometrically (geometric progression), while the needs of real life can be improved arithmetically. One day there will be a population explosion caused by an imbalance between numbers of population and limited amount of available food due to the land narrowing.
According to Malthus there is no deterrent factors can reduce tossing and lameness of comparison between human population and preventive checks such as number of births hamper efforts by moral restraint: 1) delay time of marriage; 2) control of sexual desire; and 3) abstinence from having sex. The positive checks are factors to increased mortality such as: 1) natural disaster; 2) outbreaks of disease; 3) crime; 4) war.
Indeed, efforts to reduce number of people have been made by humans since long-long ago. First, in many ways to resist birth of unwanted children, such as killing a newborn baby (which occurred in various countries in the past, such as ancient Greek, Arab ignorance, ancient China and ancient Egypt), or have an abortion (abortion) which is unsafe when it is done for example using herbs or massage by the shaman, when the mother’s life also threatened. It is also done through pregnancy prevention or regulation by using contraceptives or without the use of contraception such as periodic abstinence or interrupted coitus (‘azal).
Later, the attempt to ‘set-born’ was also introduced by Marie Stopes (1880-1958), a midwife who lived in neighborhood of workers in UK. Adjusting or limiting births is also a means to limit size of family according to her ability and own conscience. Marie introduced the use of contraceptive and simple methods , such as condoms or periodic abstinence.
Besides Marie, also known Margaret Sanger (1879-1966) a nurse in gynecology at New York Hospital. One of her patients named Saddie Sachs died after a forced abortion because she did not know how to manage pregnancy. From her experiences as a nurse, Margaret Sanger knew how mothers really need information about contraception because of limited economy, health and social development. With all risks, she plunged into Birth Control movement of America in 1912. She did not have knowledge about contraceptive methods, so she went to Europe to learn about contraception in 1913. Upon her return, she published journal “The Woman Rebel”. Her writings on family planning, first published in “The Woman Rebel” in 1914, she used term Birth Control and publications that were sent by post (Comstock Union) which was banned. But after struggling to find people who dared to publish, a book containing her methods of contraception “Family Limitation” (restricted family) was published in 1914.
From various accounts above, the issue of Family Planning was initially triggered by Robert Maltus to control population growth in the world through birth control. At first, the concept of birth control is really birth control. Along with “human rights” discourses in “reproductive rights”; this concept eventually evolved into Family Planning.
In the field, the concept itself is divided into two categories:
a. Birth control
This method is implemented with emphasis on number of children or space births according to marital circumstances. In Arabic this method is identical to tahdiid al-nasl (limiting the offspring).
b. Planning parenthood
Implementation of this method focuses on parent’s responsibility to establish a safe home life, and peaceful, although not by way of limiting family members. In Arabic this method is translated as tandzim al- nasl (setting the offspring).
Understanding the Implementation of Family Planning Program in Indonesia and Its Development
The final goal of family planning is none other than a movement to create a happy and prosperous family. This goal need to be achieved through socialization and institutionalization of norms of a small happy and prosperous family (NKKBS). Detailed formulation of a happy and prosperous family has been well stated in Law no. 10/1992 “the prosperous family is established pursuant to a valid marriage, able to meet spiritual and material needs to live a decent life devoted to God Almighty, with harmonious relationship, compatible and balance among members and families with society and environment “(BKON, 1994:7).
Therefore, the implementation of family planning program in Indonesia began with the involvement of various religious figures. Because the Indonesian major population is Muslim, automated process also involves a Muslim individual or religious leader. In fact, pioneers of family planning movement are Muslim people. In early I970’s Dr. KH. Idham Chalid, a Nahdlatul Ulama or NU figure who was Minister of Social Welfare, and KH. SM. Nazaruddin Latif, a major supporter of Family Planning (BKKBN, 1993:45-46).
Although it involved a number of Islamic leaders, the religious constraints still existed. Please note that essential involvement of these figures above did not aim to reduce socio-religious resistance. The involvement of Mrs. Syamsuridjal, Mrs. Moch. Roem and Dr. Idham Chalid was more on structural-functional level. They were thinkers, activists and supporters of family planning movement.
Given “family” is the key to succeed family planning in Indonesia, several large organizations have variety of associated programs. NU has a program “Keluarga Maslahah” (Prosperous Family) run by autonomous bodies such as LKKNU, Fatayat Welfare Foundation (YKF), and Muhammadiyah have “Keluarga Sakinah” (Peaceful Family) implemented by Aisyiah. Family planning concept here is actually more on “planning parenthood” rather than “birth control” alone.
Family planning should not just stop at introducing issue of contraceptive devices and pursuing target number of acceptors. More important is the emphasis on fulfilling male and female reproductive rights ; both husband and wife. Given the understanding above, the important thing is to plan a family together.
To manage family planning programs, in 1968 the government established National Family Planning Agency (LKBN). This institution did not last long, until the government establish National Family Planning Coordinating Board (BKKBN) in 1970, as a non departmental government institution in charge of coordinating national family planning program. Since then, family planning in Indonesia began as a program designed by the government. This is where the government began to devote its attention to the population problem.
Initially, main purpose of the family planning program is to reduce the rate of population growth; so does this program seem ‘target oriented’, regardless information on importance of family planning and benefits to have small families. Some achievements can be seen from the number of acceptors (in 1997) 23 million people; 98% are women. The total fertility rate declined quite dramatically from more than 5 before 1970 to less than 3 in 1990’s.
Various studies have shown that women’s bodies are often become the targeted contraceptives, less
frequently heard of their rights as acceptors. For example, during family planning, acceptors as consumers obtained less detailed information about advantages and disadvantages of contraceptive tools such as spiral, copper-T, injectables, norplant, implants, condoms, tablets (pills) and so forth. They also did not get a more complete clarity about characteristics of intra uterine device, the risks and side effects. Not to mention when dealing with family planning field workers (field officers) to perform certain practices to obtain exclusive consumer choice. For example: a) having certain contraceptive use, b) directing women to obtain certain contraceptives without an initial examination sufficient to determine whether they are suitable contraceptive, or they just follow the program at that time.
The consumer as acceptors of family planning should get services and explanation of their rights, such as:
1) The right to security and safety
2) The right to obtain information
3) The right to be heard
4) The right to vote
5) Right to redress
6) The right to privacy
It seems that various phenomena is a frequent practice, it should become our common concern. Therefore, the International Conference on Population and Development (ICPD) or the International Conference on Population and Development in Cairo in 1994 has changed its paradigm in managing population and development issues, from controlling population growth and fertility decline approach to focus on reproductive health and rights approach. Reproductive health issues as agreed in ICPD is defined as “a thorough state of physical, mental and social, not merely an absence of disease or weakened state.” This definition also mentions ‘health’ as not just physical but also involves mental and social health.
The reproductive health concerns various development of organs, start from womb until it die. The health condition of a mother during pregnancy influences a baby who will be born, including reproductive organs’ health of the baby. This paradigm shift is also changing the approach in terms of Family Planning, from looking at women as “production machine” of children; to approach seeing women as human figures who should be equally respected and their inherent rights must be fulfilled; including in reproductive and sexual rights.
Islam and Family Planning: Diversity of Perspectives
There are various arguments about family planning in Islam. Opinion approving the implementation relied on a verse in Al Qur’an; “And let the fear of God if those who leave behind their children who are weak, that they worry about their welfare. Therefore let them have fear of Allah, and let them speak right words.“(Surah An-Nisa (4); 9).
That verse explains the economic weakness, lack of stability in physical health and intelligence due to children’s malnutrition is responsibility of both parents. This is where the role of Family Planning is needed.
Implementation of Family Planning was seriously debated among ulama (scholars), some allow it, and some ban it. Among scholars’ who allow are Imam Ghazali, Shaykh al-Hariri (grand mufti of Egypt), Sheikh Mahmud Syaltut, and Sayyid Sabiq. Imam Ghazali does not prohibit Family Planning considering difficulties experienced by a mother during birth with a need of frequent health care, to avoid life difficulties and to maintain the mother’s beauty.
Shaykh al-Hariri provide provisions for individuals in family planning: a) for child spacing, b) to prevent disease when she conceived, to avoid harm when she conceived and has misscarriage, c) to maintain the mother’s health, because every pregnancy is also a suffering, and d) to prevent the child from physical disability if the husband or wife carried out sexual transmitted diseases.
Shaykh Mahmud Syaltut distinguished the concept of family limitation (tahdiid al-nasl) or limiting the offspring (tandzhim al-nasl) or setting or planning the offspring. Tandzim al-Nasl likened to space births because of special circumstances, whether both have anything to do with families, community and country.
Sayyid Sabiq in “Fiqh As-Sunnah” also allows one to carry out Family Planning with reason the father was a faqir (needy) unable to provide education to their children, and the mother is dha’if (weak) to have children.
“And do not kill your children for fear of poverty. We provide for them and for you. Indeed, their killing is ever a great sin.” (Surah al-Isra (17): 31). The opinion states that family planning through birth control is not justified in Islam, because it violates human nature, just because afraid of poverty, forgetting Allah the Almighty who always provides.
In the context of Indonesia, there are various perspectives among Muslims. The two largest organizations in Indonesia, Nahdlatul Ulama (NU) and Muhammadiyah have a firm view in supporting the program. The endorsement was delivered in the Legal Affairs Committee Decision of Muhammadiyah in 1968 and Syuriah NU in 1969 which allowed Family Planning for the purpose of maternal and child health, with consent of husband and wife, so the children will not burden other people.
In the leadership of Chairman of Indonesian Ulema Council (MUI), KH Syukri Ghozali, and the Chairman of Fatwa Commission, Prof. KH Ibrahim Hosen, at the MUI National Congress of Ulama on12-15 October 1983, on Population, Health and Development, decided to support the development of Population and Family Planning program. The population problems in Indonesia, making MUI argues: “uncontrolled population growth cause various problems in society, such as economic and social conflicts”. MUI also noted, “The mortality rate is still high, especially among children under five years (infant mortality) , and high natality rates are still needing improvement of health and care services ” (MUI, 1984).
An Effort to Social Well-Being
The basic concept of Islam in Family Planning can be seen from the basic concept of human rights in Islam. The fulfillment of basic human rights are in line with al- Ushuliyyat Khamsah which was introduced by Imam al-Ghazali (d. 1111 AD) in his popular book, “al-Mustasyfa”; Islam protects five basic things (al- kulliyyat khams) they are a) Hifdz al-nafs (soul protection, right to life), b) Hifdz al-Din (the protection of religion, freedom of religion), c) Hifdz al-nasl (protection of offspring, the right to continue the generations), d) Hifdz al-‘aqli (protection of brain, the right to think), and e) Hifdz al-Maal (protection of property or property rights). The concept of Family Planning is seen from the effort is manifestating the right to continue generation (Hifdz al-nasl).
Because Family Planning is a ‘right’; it should be implemented without coercion and must be accompanied by a sufficient information to couples who will undergo the program. Supposedly, KB is also a ‘voluntary choice’ not human rights violations as mentioned by Hj. Yoyoh Yusroh at the beginning of this paper. Any information and explanation on working procedures, impact and various risks should be clarified early. Both to the woman if she gives consent that use of contraception have risk to herself and body; and to the man, if he chooses condoms or vasectomy so in the future hinder his chances to have children.
In the future, it is expected that no more women suffered in the reproductive health issues, such as unwanted pregnancy from the prohibition to join Family Planning program by their husbands, to continuous childbirth due to threat of “the angels’s curse”. Wife is a partner for her husband, she also has the right to enjoy sexual relationship without coercion. Allah Almighty said in QS. Al Baqarah verse 187: ”They are an apparel for you and you are an apparel for them, completing each other”. The condition that each party is able to enjoy sex, both should be equally well and healthy physically, mentally and socially.
In closing, the concept “Family Planning” is more meaningful than birth control or birth restriction. It is more important to prepare young premarried couples to build their marital and family relation equally and fairly. Through emphasis that “Sakinah Family” can only be achieved voluntarily by participation of all parties, both men and women as spouses, parents, and children, in preventing early marriage and pregnancy, in planning when and how many children to have, and in planning the role of parenting and education for their children.  AD.Kusumaningtyas