Despite all the evidence that family planning contributes to reduction in maternal mortality and morbidity, as well as neonatal, infant and child mortality, investment in family planning both by countries and donors have decreased in the last two decades. The progress of family planning indicators has stalled in many developing countries, with Indonesia being no exception. The number of women of reproductive age globally who want to avoid pregnancy but who do not use modern contraceptive methods remains high. In 2017, the total number of women who had an unmet need for family planning reached 215 million. Although this is lower compared to 2014 (225 million), the figures are about the same as 2009. In Africa, 47 percent of women who do not want to become pregnant – 58 million in 2017 – either use no contraceptive method or use traditional methods. In Asia, the proportion of unmet need for family planning was 20 percent, equivalent to 132 million women.
In most countries of the developing world, the unmet need for family planning causes unwanted pregnancies and may also increase abortion rates, which is sometimes unsafe and can lead to maternal death. Women with an unmet need for family planning account for 84 percent of unintended pregnancies. Increased contraceptive use may reduce abortion rates. Unfortunately, the unmet need for family planning is also influenced by religious and cultural factors related to general disapproval of pregnancy prevention and use of contraceptives. It is also affected by method-specific barriers to use, such as access, perceived effectiveness and safety, perceived and actual side effects of use, appropriateness, familiarity and convenience.
It is important that the unmet need for family planning is addressed by medical personnel. However, one of the major gaps in accessing family planning services is the lack of skilled providers who can offer a range of services, including long-acting and permanent methods of contraception, counselling about informed choices, the possible side effects and what to do when these arise.
Family planning is key to achieving the SDGs and is a strategic investment in future generations. It is also critical to achieving the demographic dividend in countries with high fertility rates.
Towards a Solution
To cope with the unmet need for family planning, many countries have turned for solutions to Indonesia’s Center of Excellence on Unmet Need for Family Planning. The government of Indonesia has long-standing partnerships in the region and beyond with relevant institutions and with the United Nations Population Fund (UNFPA). Joint activities have focused on development of curriculum and training modules, procurement of training supplies, including anatomical models, and identification of training facilities, trainers and facilitators.
South-South and Triangular Cooperation (SSTC) is among the priority policies of the government of Indonesia. It has been a world leader in this type of collaboration since the 1955 Bandung Conference, considered to be among the earliest South-South Cooperation conferences. This high-level commitment makes such programmes very promising, with a greater chance of sustainability.
Specific family planning collaboration was formalized and established through a Memorandum of Understanding between the Faculty of Medicine, University of Gadjah Mada, the National Population and Family Planning Board (BKKBN) and UNFPA. Established in 2014, it is formally named Indonesia’s Center of Excellence for SSTC on Comprehensive, Rights-based Family Planning and is being managed by the University of Gadjah Mada. The primary goal of the Center of Excellence is to provide quality training on family planning and other essential managerial competencies to health workers. It has active support from this tripartite as well as the Indonesian Ministry of State Secretariat. The Center designs and organizes capacity building programmes for medical personnel in developing countries and helps them prevent adverse maternal health outcomes by reducing the unmet need for family planning.
The curriculum and contents are designed on the principle of performance-based learning, enabling each participant to have a different learning pace. Each participant is nurtured by trainers and facilitators to ensure that the programme meets their specific needs. The focus of the course is on the tasks, knowledge, skills and activities needed to enable the trainee to be a skilled family planning service provider. Appropriate hands-on experience is provided through individual practice using anatomical models for each contraceptive method, which enables the trainees to acquire the needed skills, with immediate and constructive feedback. Only after mastering the content, can trainees proceed with hands-on experience through patients. The practice with patients is done under tight procedures and supervision by the Center of Excellence trainers.
Most of the training materials used have been developed or adapted from training resource packages started by the United States Agency for International Development (USAID), the World Health Organisation (WHO) and UNFPA. Specific materials on the Indonesian family planning programme, behavioural change communication, reproductive health commodity security and monitoring and evaluation were developed by trainers for these specific sessions. In addition to face-to-face sessions, all the teaching and learning materials and evaluation processes are accessible online before, during and after the formal training sessions. This accessibility is helpful to trainees as they are able to review the training materials prior to attendance, and, especially, after they return to their respective countries. Their continuous feedback on the materials also ensures regular updates and communication with the trainers.
The Center of Excellence provides 18-day training programmes to medical personnel from other developing countries, with a maximum of 10 participants for each training cohort. UNFPA provides technical assistance in the preparation and implementation of the training. BKKBN and the Ministry of Secretariat provide scholarships annually to the best candidates from other developing countries to join the training. In-person attendance at this prestigious training institution is among the incentives offered to participants by this programme.
From 2015 to 2019, there have been five batches of training, comprised of 39 medical doctors and ob-gyns from ten countries of Asia and Africa. The Center of Excellence also holds national training for faculties of medicine from other universities in Indonesia. Upon returning to their respective countries, feedback received by the Center indicate that participants have been satisfied with the training are eager to apply their improved knowledge and skills.