Advocacy Works: How Efforts Increased Use of Modern Contraception in Indonesia
28 Mar 2018
Targeted, evidence-based advocacy efforts designed to prioritize family planning in six districts in Indonesia increased access to and use of long-acting methods of contraception, new Johns Hopkins Center for Communication Programs research suggests.
Baseline data showed that more than half of Indonesian couples who wanted to stop childbearing were still relying on short-acting methods such as oral contraceptive pills and injectables. This mismatch of method with fertility intentions points to the lack of availability and accessibility of longer acting contraceptive methods to those who want them.
The Improving Contraceptive Method Mix (ICMM) project was led by CCP and funded by USAID and the Australian Department of Foreign Affairs and Trade with support from the Bill & Melinda Gates Institute for Population and Reproductive Health. It was designed to address this concern through targeted district-level advocacy by working with decision makers to revitalize local advocacy and outreach groups and make the case for larger family planning budgets and increased availability and training on the provision of long-acting methods.
The findings suggest that women in the districts where family planning was prioritized were significantly more likely to be using the contraceptive methods they wanted – most notably long-acting contraception.
“This is one of the first studies that has been able to connect the dots between advocacy, the amount of money and other resources that communities allocate for family planning and the increased use of long-acting contraceptive methods,” says CCP’s Director for Communication Science & Research Douglas Storey, PhD, the study’s leader.
Along with Indonesian ICMM colleagues representing government, NGO and program planning perspectives, Storey will present this work on a panel entitled “Evidence-based Advocacy: From Theory to National Scale Up and Sustainability” at the 2018 International Social and Behavior Change Communication Summit in Nusa Dua, Indonesia, on April 16. Starting with the theory of advocacy communication, the panelists will present three approaches to evidence-based advocacy that built upon each other and used a distinct and proven set of tools.
While Indonesia was once hailed as a family planning success story, progress has stalled since the early 2000s when the government decentralized the health infrastructure, leaving decisions about policy and funding to the local level. This, in turn, led to regional variations in the commitment of resources to and the prioritization of family planning. Recently, women in Indonesia have had difficulty learning about and accessing a wide range of contraceptive methods. A lack of method choice often results in discontinuation of contraceptive use and increases the chance of unintended pregnancy.
Evidence-based advocacy — such as that applied through ICMM — can help overcome the effects of decentralization and ensure that family planning programs are strong throughout the country, Storey says.
Working in partnership with local decision makers, ICMM showed that advocacy improves political commitment. In the six districts where ICMM worked, budget allocations at the district level for family planning activities and community outreach increased from an average of Rp 985 million (US$74,000) in 2013 to an average of Rp 1.3 billion (US$ 100,000) in 2016. This advocacy approach was also effective in engaging stakeholders in family planning working groups at the sub-district and village levels and helped implement effective family planning programs in the decentralized context. In ICMM-supported districts, village budget allocations for family planning have increased by more than 300 percent from Rp 2.2 billion (US$165,000) to Rp 6.7 billion (US$ 503,000) since 2015. These are not external funds but reflect local commitment to family planning as a public health need, Storey says.
After the intervention, contraceptive users in ICMM districts also began shifting away from shorter-acting methods towards longer acting methods, as compared to users in six districts where ICMM did not engage in advocacy. After leaders in all six ICMM districts increased family planning funding and implemented supportive policies, the study showed the odds of married women using long-acting methods was higher — ranging from 12 percent higher in East Java to 31 percent higher in West Nusa Tenggara. In control districts, there was no significant change.
“Women in the intervention districts were significantly more likely to use a long-acting contraceptive method after the advocacy intervention than they were before it,” Storey says. “These results show that evidence-based advocacy is effective to reinvigorate family planning programs, expand the method mix, and more fully meet the family planning needs of women in Indonesia.”
Based on the success of ICMM – and other CCP-led advocacy efforts in Indonesia such as Advanced Family Planning and MyChoice – Indonesia’s National Family Planning Coordination Board (BKKBN) has planned and budgeted for a national scale up of evidence-based advocacy across 33 additional provinces. Fabiola Tazir, an advocacy official with BKKBN, is also on the panel and will address this.
There is still time to register for the summit to attend these and other presentations. But don’t delay – registration closes on March 30.