After months of telling its citizens to stay at home, Indonesia is now facing fears of a potential baby boom. With the country under quarantine from COVID-19, many people have stopped going to clinics to get contraceptives out of fear of catching the virus. This projected increase in pregnancies comes after extensive efforts by the country to encourage smaller families, an action taken in order to fight against the concern of child malnutrition. This problem is so severe that government vehicles drove around the cities and pleaded with the public through loudspeakers: “You can have sex. You can get married. But don’t get pregnant. Dads, please control yourself. You can get married. You can have sex as long as you use contraception.”
The National Population and Family Planning Board (BKKBN) is Indonesia’s government-backed family planning program tasked with helping married couples manage the creation of their families. BKKBN is widely successful and employs 24,000 counselors to help execute their mission, much of which includes distributing free contraceptives to the public.
The agency recently determined that there had been a significant decrease in the use of contraception between March and April of 2020 and that about 10 million couples in the country no longer had access to a form of birth control. An increase in pregnancy rates is deeply concerning for the Indonesian government because the country is struggling to manage the current population size given its available space and resources. In order to try and alleviate some of these effects, the government has openly discouraged people from having large families for years and freely provided various forms of birth control. About half of those who use contraceptives receive monthly or trimonthly hormone injections, 20% use birth control pills and many use IUDs. Condoms remain unpopular, though, across the country. It is worth noting that abortion in Indonesia is only permitted if it is “to save the woman’s life.” There are many possible contributors to the drop in contraceptive use during this quarantine period, such as a fear of leaving the house to acquire contraceptives (especially from hospitals), closed contraception clinics and other closed health care providers.
One significant consequence of Indonesia’s population struggles is child malnutrition, a problem that Indonesian President Joko Widodo promised to alleviate within 4 to 5 years. More severe cases of child malnutrition (especially when paired with poor hygiene) can result in child stunting, a condition where the child is more than two standard deviations below the median of child growth standards as determined by the World Health Organization. If children are experiencing stunting then they are more susceptible to pneumonia, diarrhea and a weakened immune system. Given that COVID-19 is known to be more fatal for those with compromised immune systems, this is an especially pertinent concern. Long-term effects include an increased chance of experiencing chronic diseases such as hypertension and a lowered IQ. According to the organization 1,000 Days Fund, a group dedicated to the elimination of stunting, children with stunting can miss about a year of school because of the sickness. While Widodo has found some success in lowering the number of child stunting cases in the past few years, this period of quarantining may prove to be a major setback.
BKKBN announced that Indonesia should expect about 420,000 more babies than the average 4.8 million in the upcoming year. One demography expert at the Indonesian Institute of Sciences, Dr. Augustina Situmorang, believes pregnancy spikes are most likely to occur in low-income families who relied on the previously-accessible birth control provided by BKKBN in addition to young women who lost their jobs, had to return to their hometowns, and then had to get married due to social pressures.
Indonesia’s health care system is already working overtime and has suffered considerably from COVID-19, registering more than 33,000 cases and over 1,900 deaths. Nevertheless, the government is attempting some preventive measures to combat more potential pregnancies. This includes allowing access to multiple months of birth control pills at a time, making door-to-door deliveries of contraceptives along with emergency supplies, and hoping to distribute contraceptives to 1 million people on June 29, dubbed “National Family Day.” Going forward, the Indonesian government will have to move efficiently if it wants to limit the burden felt by the Indonesian health care system with future generations.