Profbirankb Di Indonesia , Saat Ini

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KB DI INDONESIA , SAAT INIBiran Affandi

Klinik Raden Saleh

Departmen Obstetri dand Ginekologi

Facultas Kedokteran , Universitas Indonesia /

RSUP Cipto Mangunkusumo

JakartaAffandi B. KB di Indonesia , saat ini . Pelatihan Ketrampilan Laparoskopi Oklusi Tuba dg Anestesi Lokal , PKMI , Jakarta , 7-10 Feb.2011


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OBJECTIVES1. To overview Millennium

Development Goals (MDGs)

2. To review Status of Family PlanningProgram in Indonesia

3. To discuss role of Family Planning inachieving MDGs in Indonesia

Affandi B. KB di Indonesia , saat ini . Pelatihan Ketrampilan Laparoskopi Oklusi Tuba dg Anestesi Lokal , PKMI , Jakarta , 7-10 Feb.2011


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Todays Worlds Challenges

5,000

10,000

15,000

20,000

25,000

30,000

35,000

10 wealthiestcountries

10poorestcountries

GNIPerCapita

US$ 670

US$ 34,134 Income Poverty: More than onebillion

people in the world live on less than

$1/day. Another 1.8 billion struggle tosurvive on less than $2/day.

Hunger & Malnutrition:More than800 million people go to bed hungryevery day; 300 million are children.Every year six million children die from

malnutrition before their fifth birthday. Education: A total of 114 million

children dont get even a basiceducation and 584 million women areilliterate.

Health: Around 529,000 women are

dying / year in pregnancy & childbirth.Every year 11 million children die frompreventable diseases. Every dayHIV/AIDS kills 6000 people andanother 8200 are infected with thedeadly virus


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Global Response to These Challenges:(also called thesilent tsunami)

THE MILLENNIUM DECLARATION At the UN Millennium Summit in Sept 2000, 189

member states adopted the Millennium Declaration,

to cooperate on issues including development &poverty reduction; peace, security & disarmament;environmental protection; human rights, democracyand good governance; etc.

The Declaration is translated into the MillenniumDevelopment Goals (MDGs)with specific, concreteand inter-related targets, indicators and a time frameto be achieved by 2015.


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Millennium Development Goals1.Eradicate extreme poverty and hunger

2.Achieve universal primary education3.Promote gender equality & empower women

4.Reduce child mortality

5.Improve maternal health6.Combat HIV/AIDS, malaria & other diseases

7.Ensure environmental sustainability

8.Develop a global partnership for development

MDGs challenges are not new; what is new is that they involve concrete,

time-bound & quantitative targets for action by 2015.


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MOST POPULOUS COUNTRIES , 2009

COUNTRY POPULATION (Million)

1. China 1,346

2. India 1,198

3. U.S.A. 315

4. Indonesia 230

5. Brazil 194

Sources: United Nations (2009), World Population Prospect: The 2008 Revision;

Affandi B. Unsafe Abortion : Indonesian Experience . 1st International Congress on Women Health & Unsafe Abortion , Bangkok , Thailand , 20-23 January 2010


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0.00

25.00

50.00

75.00

100.00

125.00

150.00

175.00

200.00

225.00

1600 1700 1800 1900 2000

205 m

18.314.210.8

40.2

250.00

275.00

300.00

285 million

FAMILY

PLANNING

REDUCED

80 MILLION

POPULATION IN INDONESIA(Million)

FAMILY

PLANNING

REDUCED

100

MILLION

330 million

230 m

2009



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CONTRACEPTIVE PREVALENCE

INDONESIA , 1970-2007

0

10

20

30

40

50

60

70

80

1970 1980 1987 1997 2002 2007

26 %

5 % (?)

48 %

57 %60 % 61.4 %



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Reproductive behavior

Too many, too close, too early, and too

late pregnancies are a major cause of

maternal, infant and childhoodmortality and morbidity

Mexico City Declaration on Population and

Development, August 1984

Fathalla, Rosenfield, Indriso, et al., Reproductive Health Global Issues, 1990


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PERENCANAAN KELUARGA

1. Seorang wanita telah dapat melahirkan, segera

setelah ia mendapat haid yang pertama(menarche)

2. Kesuburan seorang wanita akan terusberlangsung, sampai mati haid (menopause)

3. Kehamilan dan kelahiran yang terbaik, artinyarisiko paling rendah untuk ibu dan anak, adalahantara 20-35 tahun

4. Persalinan pertama dan kedua paling rendah

risikonya5. Jarak antara dua kelahiran sebaiknya 2-4 tahun

Affandi, 1984

Affandi B. Oral Contraceptive Pills & Weight Gain, FKUI/RSCM, April 2008


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POLA PERENCANAAN KELUARGA

2 - 4

20 35

Fase Fase Fase

Menunda

Kehamilan

Menjarangkan

Kehamilan Tidak Hamillagi

Affandi, 1984



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CONTRACEPTIVE METHODS

RATIONAL CHOICE

2 - 4

20 35

Phase

DIFFERING SPACING COMPLETING

-Pill (Yasmin)

- IUD- Conventional

- Inject.

- Implant

- IUD

- Inject.- Pill (Yasmin)

- Implant

- Conventional

- IUD

- Inject.- Pill (Yasmin)

- Implant

- Conventional

- Steril

-Steril

-IUD-Pill (Yasmin)

- Implant

- Inject.

- Conventional

Phase Phase



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Impact of contraception on the individual

Limiting family size, beneficial to poorer familieswith limited resources

Spacing of pregnancies to accommodate changing

economic needs

Deferment/delay of starting family, in womenseeking career development

Freedom from fear of unplanned pregnancies


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Impact of contraception on the population

Management of rapid population growth, in regionswith inadequate resources

Reducing maternal mortality as well as perinatal/infantmorbidity and mortality

Conserving worlds scarce resources

Improving general standard of living


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Benefits of family planning Self-determination/Quality of Life

Maternal Health Child Health and Development

Womens Empowerment

Economic Well-beingFamily

Economic DevelopmentMacro (e.g. demographic

dividend)

Population pressure (Resources/Demands)

Environmental

National Security/Political Stability

Reduced Abortion Shelton J. ESD , 2007


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Family planning are hypothesized

to affect women's lives1. Personal autonomy/self-esteem -- the right to make and

stand by one's own decisions; value or regard an individualplaces on herself

2. Health -- both physical and psychological well-being

3. Educational attainment -- the ability to obtain an educationand the level of educational attainment

4. Employment and economic resources -- the nature ofemployment; acquisition and allocation of resources

5. Family relationships -- degree of equality with spouse androle within kinship structure

6. Public standing -- ability to participate in public activities and

esteem accorded individual women by community.

FHI , 2010


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Cates .Contraception 2010 ; 81 : 460-1


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PROGRESS INDONESIA (1/8)1. Menanggulangi Kemiskinan & Kelaparan menjadi -nya (2015)

Tantangan:

-Rendahnya mutu kehidupan (IPM)

-Kesenjangan tinggi (antar daerah &

desa-kota)

-Kemiskinan yg dialami perempuan


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PROGRESS INDONESIA (2/8)2. Mencapai Pendidikan Dasar untuk Semua menyelesaikan SD semua

Tantangan:

-Rendahnya tingkat pendidikan penduduk

-Dinamika perubahan struktur penduduk-Kesenjangan tingkat penididikan

-Fasilitas pendidikan yg belum merata

-Kualitas pendidikan yg rendah

-Manajemen pendidikan yg blm efektif &

efisien


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PROGRESS INDONESIA (3/8)3. Mendorong Kesetaraan Gender & Pemberdayaan Perempuan

Tantangan:

-Kualitas hidup perempuan

-Peranan perempuan dlm pembangunan

-Regulasi yg bias/diskriminasi gender

-Kesempatan kerja perempuan

-Partisipasi perempuan

-Pengarusutamaan gender dlm

pembangunan


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PROGRESS INDONESIA (4/8)4. Menurunkan Angka Kematian Anak menjadi 1/3-nya (2015)

Tantangan:

-Sebab kematian pada anak (ISPA, komplikasi perinatal, &

diare)

-Kesehatan neonatal & maternal

-Perlindungan & Pelayanan Kesehatan

-Penerapan desentralisasi kesehatan


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PROGRESS INDONESIA (5/8)5. Meningkatkan Kesehatan Ibu menurunkan angka kematian -nya

Tantangan:

-Struktur pendudukproporsi wanita subur tinggi meningkatkan kebutuhan lynn

kesehatan

-Penerapan desentralisasi kesehatan

-Keterbatasan biaya & tenaga


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Prevalensi HIV/AIDS pd usia 15-29 diperkirakan

di bawah 0,1%, namun yg beresiko tinggi

melebihi 5%. Juni 2005: dilaporkan 3.358 penderita AIDS. Yg

sebenarnya, diperkirakan sekitar 103.971

Penggunaan kondom oleh PSK mencapai 59,7%

(naik 41%)

Kondom sbg alat KB pd 2003: 0.9% (naik dari

0.7%)

Prevalensi malaria 2001: 850/100.000 & angkakematian spesifik 11/100.000 untuk laki-laki &

8/100.000 wanita

Tahun 2004: 34,4% penduduk usia > 15 tahun

merokok (meningkat dari 31, 5% pd 2001)

PROGRESS INDONESIA (6/8)6. Memerangi HIV/AIDS, Malaria, & Penyakit Lainnya

Tantangan:

-Ancaman epidemi HIV/AIDS

-Hubungan dg kemiskinan

-Kurangnya SDM

-Beban kesehatan & ekonomi


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PROGRESS INDONESIA (7/8)7. Memastikan Kelestarian Lingkungan Hidup

Tantangan:

-Pemulihan krisis ekonomi

-Desentralisasi

-Tata kepemerintahan yang baik

-Globalisasi


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Hutang luar negeri Indonesia (Maret 2005): US$67,12 Milyar

Perdagangan: belum ada perkembangan berarti

bagi negara sedang berkembang Kemitraan: Indonesia mengusulkan debt swap for

MDGs

Kerjasama regional: Deklarasi Jakarta; Non

Alignment Movement Center for South-South

Technical Cooperation (NAM CSST); & Bali Strategic

Plan, United Nations Environment Program (UNEP)

PROGRESS INDONESIA (8/8)8. Membangun Kemitraan Global untuk Pembangunan


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The British government has

pledged to place anunprecedented focus on

family planning, including

abortion, in its efforts to forwardthe UNs Millennium

Development Goals (MDGs)LifeSiteNews.com , 2010


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F il l i 't l


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Family planning won't solve

all our problems It is, however, a highly effective cross-cutting

development imperative that can contribute to

achieving the Millennium Development Goals.

Achieving universal access to family planning is

within our grasp, but we need to increase

investment in contraceptive technology research,

development of more evidenced-based policies,

engagement from the public and private sectors,

and overall commitment worldwide Cates , 2009

Documents

Profbirankb Di Indonesia , Saat Ini