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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

‘I wanted to enjoy our marriage first… but I got pregnant right away’: a qualitative study of family planning understandings and decisions of women in urban Yogyakarta, Indonesia

Authors: Belinda Rina Marie Spagnoletti, Linda Rae Bennett, Michelle Kermode, Siswanto Agus Wilopo

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

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Abstract

Background

Despite several decades of investment into family planning and maternal health systems strengthening, Indonesia’s maternal mortality ratio remains among the highest in Southeast Asia. Among postpartum women unmet need for family planning is greater than at any other time, thus there is great potential to improve the reproductive health outcomes of Indonesian women through enhanced postpartum family planning access. This article explores the socially embedded nature of family planning choices in the Indonesian context, drawing on the experiences of a sample of urban dwelling and predominantly middle class women.

Methods

This was an ethnographic study which explored the reproductive experiences of women residing in Yogyakarta City, and Sleman and Bantul regencies. Fieldwork was undertaken over 18 months from September 2014 to March 2016. This article draws on 31 in-depth interviews (IDIs) conducted with 20 women aged 21 to 38 years who had given birth less than two years prior.

Results

Though there was great variance across women’s reproductive trajectories, the majority had limited understandings of family planning, especially in relation to contraception. Societal norms pertaining to women’s fertility and reproduction underpinned women’s desires to become pregnant soon after marriage. Normative ideals concerning family size and the composition of families underpinned women’s desires for a maximum of two to three children, with at least one child of each sex. Negotiations concerning timing of pregnancies and family size occurred within spousal relationships. The majority of women were using some form of fertility control to prevent or space pregnancies, with method choice decisions often informed by family members, friends and family planning providers. Quality of care among family planning providers was often lacking, perpetuating misinformation, and women’s choices were not always respected.

Conclusions

Our analysis reveals the socially embedded nature of women’s postpartum family planning understandings and choices, and the ways in which social and relational factors sometimes constrain and at other times support women’s reproductive agency. We identify key areas for health sector reform to enhance women’s understandings of postpartum family planning and improve family planning quality of care.
Footnotes
1
In the 2012 Indonesian Demographic and Health Survey unmarried women were for the first time included in the calculation of MMR; which raised the MMR from 220 to 359 [3]. Unmarried women in Indonesia remain unable to legally access family planning services and may only have access to safe and legal abortion services in case of rape.
 
2
Interviews with several participants were interspersed with some English and Javanese at the participants’ discretion.
 
3
As mentioned above, one participant referred by snowballing chose not to disclose her contact details to BRS and the interview was set up via her neighbour (also a participant).
 
4
It was determined that literacy would not be a concern for the participants sampled in this study due to their high levels of education.
 
5
Yet it must be noted that despite the GoI’s purported commitment to CSE, the implementation, content and quality of sexual and reproductive health education remains uneven and when it does occur, it is usually focused on the biological aspects of reproduction and promoting sexual abstinence [71‐73]. A further setback to CSE occurred in late 2015 after the rejection of a request for judicial review of national education law to embed reproductive health education in the national curriculum by the constitutional court on the basis that the activist group who instigated the request has no legal standing [74]. Until a resolution has been achieved in relation to the timing of CSE, reproductive health education in Indonesia will likely remain deficient.
 
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Metadata
Title
‘I wanted to enjoy our marriage first… but I got pregnant right away’: a qualitative study of family planning understandings and decisions of women in urban Yogyakarta, Indonesia
Authors
Belinda Rina Marie Spagnoletti
Linda Rae Bennett
Michelle Kermode
Siswanto Agus Wilopo
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-1991-y

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