Contraceptive Practice in Indonesia: Did the Village Midwife Program Make a Difference? Public Deposited

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Last Modified
  • March 20, 2019
Creator
  • Weaver, Emily H.
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • Forty years after Indonesia's Family Planning Program was created, the country continues to struggle to meet the reproductive health needs of some of its hardest-to-reach populations. Over the last decade, contraceptive prevalence has stagnated and unmet need for contraceptives has risen. One Government initiative that provides reproductive health services is the Village Midwife Program, which was designed to address gaps in access to reproductive healthcare for rural women and has been in place since1989. The midwives are poised to expand safe motherhood promotion among the poor and hard-to-reach populations, improve accessibility and utilization of family planning services, and enhance the mix of contraceptives available to target populations (World Bank, 1991). Although provision of family planning services is one of the midwives' core responsibilities, no research has explored the dynamic between the Village Midwife Program and contraceptive practice. Using data from the Indonesia Family Life Survey from 1993 to 2007, this dissertation evaluates the linkages between village midwife availability, contraceptive prevalence and method choice using a fixed effects logit methodology to control for selective placement of midwives. Also evaluated is the midwives' effect on the Government's targeted priority populations. The study's findings indicate that although village midwives did not affect contraceptive prevalence, for women using modern contraceptives, the village midwives influenced women's method choice. Specifically, the midwives increased the probability of injectable contraceptive use by 10.5% in 2007 while decreasing the probability of oral contraceptive use by 5.5% in 2000 and 5.2% in 2007 and of contraceptive implants by 4.8% in 2007. Although the Government hoped that village midwives would channel women into longer-lasting methods such as intrauterine devices and implants, the women's switching behavior indicates that the program succeeded in providing additional outlets for a preferred method type. Given the halt in contraceptive prevalence rate and rising unmet need in Indonesia, the Government should consider new approaches to promote longer-lasting methods focusing on demand-side issues such as information, education and communication campaigns and targeted approaches for women with unmet need.
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  • In Copyright
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  • "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Health Policy and Management of the Gillings School of Global Public Health."
Advisor
  • Fried, Bruce
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  • Chapel Hill, NC
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  • Open access
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