State Family Planning Policies in the Islamic and Arab Demographic Giants: Does Indonesia Offer a Path for Egypt to Achieve below-Replacement-Level Fertility to the Benefit or Detriment of Women?

Friday, July 18, 2014: 11:30 AM
Room: Booth 54
Oral Presentation
Andrzej KULCZYCKI , University of Alabama

Indonesia is the world's most populous Muslim-majority nation and Egypt has its largest Arab population. Both countries have similar overall and any modern-method contraceptive prevalence rates (61% and 58%) and levels of unmet need (12-13%). Fertility decline recently stalled in both countries, but at a lower level in Indonesia than in Egypt (2.6 and 3.0 births/woman, respectively).  In the mid-1960s, both countries established clinic-oriented national family planning programs with strong bureaucratic and financial support. However, state policies led to skewed method choice with each country relying heavily on a single reversible method that accounts for over 50% of contraceptive use, reducing choices for women.  Also, each program each has recently hit trouble.  Indonesian politicians have shifted their attention and resources away from family planning.  Injectables are increasingly offered by local midwives with strong incentives and by more private providers. Indonesia now has the world's highest injectable use rate (32%), but reliance on long-acting contraception is weak.  The Egyptian program has poorer informed choice, higher discontinuation rates, and heavier reliance on public sector sources now undermined by ongoing political turmoil.  The IUD remains the most widely used method (36%), but 7% of women now use injectables, more than in other Arab states and possibly soon usurping pills as the second most common method.  We use survey data, documentary evidence, and key informant interviews to examine these developments further.  With certain caveats, the Indonesian experience offers lessons for instituting more solidly founded contraceptive and population policies and for accelerating the path toward replacement-level fertility in Egypt, notwithstanding its major societal turmoil. Increasing injectable use can help meet demands on the fragile state health system, make use of Egypt's underdeveloped community-based channels, and may serve as a catalyst for other Arab states to help them reach more sustainable population and development trajectories.