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everal government officials, demographers and public health analysts have recently reminded us that the threat of a population boom in Indonesia is real.

In point of fact, population growth in the country during the period from 2000 to 2010 was 1.49 percent per year, compared to 1.45 percent during the period of 1990
to 2000.

The rate translates into at least 3.5 million births per year, which will significantly augment Indonesia’s current population size of 237.6 million people.

In just five more years, Indonesia’s population could swell to more than 250 million people. Furthermore, the United Nations has predicted the country’s population will reach 263 million by 2025.

We should look at the above figures as an early warning, indicating the possibility of a multi-dimensional crisis in the next 15 to 30 years. For sure, the rise of annual population growth rate will over-stretch and overload Indonesia’s limited resources as well as trigger various social, economic, security, ecological and public health problems in the coming years.

The fact that population growth tends to concentrate among people in the lower socio-economic background exacerbates the above data. Poverty, lower access to contraceptive methods compared to people from higher socio-economic backgrounds and lower levels of awareness of the importance of family planning and small family ethos are some factors that facilitate the rapid population growth among low-income people.

Lower adherence to family planning, therefore, may aggravate low-income people’s health and wellbeing, worsening the cycle of poverty.

It is worth mentioning that in the past, Indonesia had a relatively successful family planning program. Since its initiation in 1970, the National Demographic and Family Planning Agency (BKKBN) had organized numerous efforts to make contraceptive methods better available and accessible to Indonesian families, and to promote the norms that support smaller families.

These programs contributed to the rapid increase in the contraceptive prevalence rate from 26 percent in 1971 to 60 percent in 2002, and decreased the total fertility rate from 5.6 to 2.6 during the same period. However, the 1997 economic crisis that hit Indonesia caused a severe financial crisis in the country and triggered a significant decrease of financial allocation to support family planning programs.

Furthermore, the decentralization policy after the fall of Soeharto’s authoritarian regime that change responsibility from national to local governments in organizing family planning had contributed to a deterioration of the programs.

In fact, most heads of districts and cities in Indonesia do not perceive family planning as their priority and therefore do not provide sufficient political and financial commitment to support it.

There are several reasons why population growth is highly likely to concentrate among a low-income population.

First, according to the supply-side point of view, the lower contraceptive prevalence among people from lower economic backgrounds should be attributed to the fact that low income couples experience more constraints obtaining contraceptives because of financial difficulty or geographic isolation.

Second, from the demand-side perspective, attitudinal and cultural factors, including attaching high value to large families or viewing children as valuable assets as old age security may push poor couples to try to have large families and prevent them from accessing and using contraceptives.

Numerous studies found that the desire for more children, resistance to family planning and small family ethos or fears on negative health effects of contraceptive methods are among many other reasons for not using contraceptives.

Additionally, poor families are also highly likely to be less educated and less exposed to media that may promote family planning and the norm of having a small family.

It is therefore important to educate and increase the access of people from lower socio-economic background to contraceptive methods such as offering contraceptives at subsidized prices or free of charge. It is also important to reduce cultural and attitudinal barriers to family planning among people from lower socio-economic backgrounds.

Comprehensive health promotion programs, increasing the level of awareness of the importance of family planning and providing incentives for poor families to utilize contraceptive methods are needed.

Advocacy to provincial, city and district governments to provide more political and financial commitments to support family planning, particularly among the low-income population, is also crucial.

In addition, comprehensive interventions to reduce poverty and socio-economic marginalization are urgently needed since these contributed in creating and maintaining cultural barriers to family planning and hindering access to contraceptive methods.

The writer is a lecturer and researcher at the Faculty of Public Health, Hasanuddin University, Makassar.