MARCH 2025

Country context: Taking stock of family planning and reproductive health

Home to 277.5 million people, Indonesia is an upper-middle-income country and the fourth most populous nation in the world. Widely regarded as having a successful family planning program, the total fertility rate dropped from 5.4 births per woman in 1970 to 2.6 per woman by 1999. This decrease coincided with a surge in the prevalence of modern contraceptives (mCPR) use among married women, rising from 7 percent in 1973 to 54 percent by 1999. At the same time, between the 1970s and late 1990s, Indonesia experienced rapid economic growth, with its GDP increasing on average by 7 percent annually, before the catastrophic 1997 Asian financial crisis. As of 2024, Indonesia is the largest economy in Southeast Asia and the tenth largest economy in the world. And while the Indonesian government has in recent years emphasized policies supporting, and public funding for, universal access to family planning and reproductive health services as a fundamental right, significant gaps in implementation and delivery persist.

Expanding modern contraceptive prevalence

Limited access to, and awareness of, family planning and reproductive health services are key barriers to achieving health and gender equity goals. Indonesia’s progress in mCPR among married women has stagnated at around 59 percent since 2012, while mCPR use among unmarried women is extremely low, at around 1.5 percent. Unmarried women and youth, in particular, have less access to modern contraceptive methods than married couples, as public family planning services primarily focus on married couples while sex before marriage remains socially taboo. As of 2017, the most commonly used method was injectables at 50.6 percent, followed by the pill at 21.1 percent, intrauterine devices (IUDs) at 8.5 percent, and implants at 8.2 percent. Although the share of Indonesian women with unmet need for family planning has marginally improved, from 10.2 percent in 2012 to an estimated 9.6 percent in 2023, at this rate of progress, it will take more than 80 years to halve the current unmet need to less than 5 percent. Furthermore, adolescent pregnancy and child marriage persist as interlinked challenges in the country: one in nine women aged 20 to 24 is married by the age of 18, and two-thirds become pregnant by 18, as of 2018 data. As of 2020, Indonesia had the fourth highest number of child marriages in the world, with 32.1 million women aged 20-24 married or in a union before the age of 18. These challenges additionally contribute to maternal health risks across the country. Despite progress over the past two decades, maternal mortality continues to be a critical public health issue in Indonesia, one with cascading socioeconomic implications, including those related to gender inequality, poverty, and overall quality of life.

Strengthening maternal and newborn care

The maternal mortality ratio declined from 298.6 per 100,000 live births in 2000 to 172.9 in 2020, representing significant progress. However, this rate remains more than double the SDG Target 3.1 of reducing global the maternal mortality ratio to fewer than 70 per 100,000 live births, with significant variations across the country. Indeed, UNFPA Representative in Indonesia, Hassan Mohtashami, in an October 2024 interview with FP Analytics, noted that “The unacceptably high maternal mortality in Indonesia, compared to other ASEAN countries and other G-20 countries, is not the status that Indonesia deserves. I think Indonesia—an upper middle-income country with significant growth and achievements on all fronts in all sectors—should not have this maternal mortality ratio.” He acknowledged that the government is aware that maternal mortality needs to be improved and is seriously engaged in work to that end.

A panoply of socioeconomic and cultural barriers has caused many family planning and reproductive health indicators to stall and fall short of national targets. One major barrier to progress is the decentralization of the public health system, which took place in 2001 after the Asian financial crisis and subsequent political turmoil. The country transferred managerial and operational responsibilities of its health programs to its then 440 regencies (kabupaten) and cities (kota), which expanded to 514 as of 2023. While the goal of decentralization was to increase opportunities for community participation in health care, the sudden devolution meant that the regencies and cities had to rapidly learn new roles and responsibilities, creating a transition period that delayed critical health services. Moreover, maternal and child health were not uniformly prioritized subnationally, which resulted in uneven progress on reproductive health across provinces and districts.

Preventing and managing reproductive cancers and diseases

In addition to maternal mortality, breast and cervical cancers are significant challenges in Indonesia, representing the two leading causes of cancer-related deaths among women. As of 2022, mortality rates were 14.4 and 13.2 per 100,000 people, for breast and cervical cancer, respectively. Early detection rates for these cancers remain low, with only 6.8 percent of the target population in 2021 undergoing breast and cervical cancer screening. While Indonesia recently launched its National Cervical Cancer Elimination Plan 2023–2030, it requires substantial investments to meet three ambitious targets: 90 percent HPV vaccination coverage for both girls and boys, 75 percent screening coverage with HPV-DNA for women aged 30–69, and a 90 percent treatment rate for pre-cancer and invasive cancer. Meanwhile, the national prevalence of HIV was 0.3 percent in 2022, although rates varied among key population groups and reached as high as 25 percent for male sex workers. The uptake of antiretroviral treatment remains low, with just one-third of those diagnosed receiving treatment as of 2022. To understand the range of family planning and reproductive health challenges in Indonesia, it is important to examine the structural, cultural, environmental, and other barriers that undermine care and impede the realization of targets.

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Policies and programs: Assessing multistakeholder efforts

In 2022, Indonesia, with the support of UNFPA, Yayasan Cipta (an Indonesian NGO focused on family planning, sanitation, and nutrition), and Global Affairs Canada, joined 36 governments in pledging commitments under Family Planning 2030 (FP2030) to advance rights-based family planning and reproductive health services. In addition to expanding mCPR, its ten FP2030 commitments include implementing risk-mitigation measures amid health crises like COVID-19, enhancing monitoring and evaluation, and integrating family planning with other health programs, such as community nutrition. Indonesia has also committed to strengthening its role in South-South Cooperation on family planning and reproductive health. To that end, Indonesia has provided training and advocacy support to more than 20 countries across the global south, engaging Muslim leaders and communities in particular.

These global commitments align with the national development priorities as espoused in Indonesia’s 2020–2024 National Medium-Term Development Goals (RPJMN). The RPJMN serves as the foundation for all government ministries and agencies for formulating their respective strategic plans. The most relevant strategic plan for family planning is the 2020-2024 Strategic Plan of the National Population and Family Planning Board (BKKBN), Indonesia’s lead agency for family development, population, and family planning programs. The government has also recently launched its National Cancer Plan 2024–2034, outlining six strategies to prevent and control cancers, including breast and cervical cancer. The plan aims, among other goals, to improve health care infrastructure and human resources, develop an integrated cancer registry, and harness cross-sectoral partnerships. As of December 2024, the government is finalizing its 2025–2029 RPJMN, which will further map out the country’s strategy towards meeting its 2030 family planning and reproductive health goals.

Anticipating and targeting demographic change

One significant gap in Indonesia’s policies is that access to national family planning services, particularly contraceptive services, is limited to married couples. Other groups, such as unmarried women and youth, are excluded, which helps to explain why the modern contraceptive rate is low among unmarried women, at around 1.5 percent. Moreover, public health indicators on family planning often focus on married women or couples, overlooking a life-course approach that would monitor reproductive health needs across different age groups and life stages. Attention to younger populations is particularly important given Indonesia’s youth bulge: 25 percent of its population is aged 0–14 years old. Indonesia is currently in a demographic transition, with 68 percent of its population at economically productive ages (15–64 years old), but overall annual population growth has slowed. Investing in the reproductive health needs of the young and working-age population will enable them to make informed decisions about their health, education, and work, facilitating Indonesia’s human and economic development in the future.

Funding and coordinating family planning and reproductive health

As part of its efforts to improve access to family planning services, in 2016 Indonesia included modern contraception services and family planning counselling in its national health insurance system. Without insurance, contraceptive costs can be significant, especially for the poor, ranging from 40,000 rupiah (USD 2.8) per injectable contraceptive shot, 400 thousand rupiah (USD 28.6) per intrauterine device (IUD), to 6 to 7 million rupiah (USD 428.6) for tubal ligation and vasectomy, but these services are provided free of charge to national insurance members. A 2023 study, using results from the 2021 Indonesian family planning census, showed that having national insurance was associated with higher uptake of modern contraceptive methods by low-income families. However, low-income families were not yet widely covered by the health insurance: about 30 percent still had no insurance at the time of the survey. Thus, expanding the national insurance to universal coverage represents a critical step toward improving family planning.

Most Indonesian women obtain their contraceptive products from the private sector. Private medical providers have become the leading source of modern contraceptive methods, serving 48 percent of women, compared to 34 percent served by the public sector and 18 percent by other sources, such as pharmacies, based on the 2017 Demographic Health Survey. Driven by government policies designed to expand the role of the private sector in family planning and reproductive health to help manage public health spending, private health care providers have become the leading supplier of injectables and IUDs to Indonesian women, accounting for 67 percent and 52 percent of the supply, respectively. In contrast, public providers supplied 75 percent of implants and conducted 55 percent of sterilizations, while drug stores supplied the majority (52 percent) of contraceptive pills. However, the government remained a major financer of family planning services as of 2021, shouldering 64 percent (approximately USD 247 million) of Indonesia’s family planning program expenses. These funds were allocated to the BKKBN (35.8 percent), Ministry of Finance (26.2 percent), and Ministry of Health (2 percent). Patients’ out-of-pocket spending accounted for 34.6 percent of family planning and reproductive health costs, while the national insurance administration (0.37 percent), NGOs (0.10 percent), and UNFPA (0.02 percent) rounded out the remaining expenditure.

Moreover, multilateral institutions and philanthropic foundations play critical roles by providing both funding and technical assistance. In addition to UNFPA’s technical and financial support, and USAID’s foundational role in the formation of BKKBN and the early national family planning program, non-governmental and philanthropic organizations, such as the Bill and Melinda Gates Foundation, fund and implement family planning initiatives in Indonesia. One example is MyChoice (active from 2014 to 2021), implemented by the Johns Hopkins Center for Communications Programs, which partnered with local Muslim organizations to conduct information-dissemination campaigns. The program used multiple platforms, including television, community outreach, and a mobile app to provide information about contraceptive methods. Through community outreach, the program engaged with 500,000 women, while its mass media campaigns reached 10.5 million, or 70 percent of women of childbearing age, in major cities as of 2021. The program did not specify any targeted outreach metrics for men, suggesting an opportunity to expand gender-responsive approaches to family planning.

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Looking ahead: Pursuing untapped opportunities and key priorities

Indonesia’s national family planning program, reinforced by steady economic development, has demonstrated lasting impacts on the well-being of families, particularly women and children. A 2021 study showed that contraceptive use reduced maternal deaths by up to 43.1 percent, or 663,000 deaths, from 1970 to 2017. Today, lives remain at stake. Reaching a 75 percent contraceptive prevalence rate by 2030 could translate to an almost 30 percent decline in maternal deaths by 2030. To achieve this target, family planning programs need to undergo an accelerated implementation process, one that reaches the country’s remote regions and is inclusive, rights-based, and tailored to the needs of different population groups.

Ensuring access to family planning and reproductive care

Key to responsive, resilient health systems at the local level is the presence of community health workers who provide quality public health services and are well-versed in family planning. Health workers are recognized as essential sources of information on family planning methods at the community level. In rural areas where health care facilities are limited, midwives deliver crucial maternal and child health care. Indonesia has, as Hassan Mohtashami shared, “one of the largest number of midwives in the world, over 400,000 midwives, with over eight hundred midwifery training programs. But what we noticed is that the quality of the education and the practice of midwifery needs significant improvement.” Community health and midwifery training can serve as a key area of focus in the future, including through government and NGOs initiatives, multilateral engagement, and public-private partnerships.

Indonesia has “the largest number of midwives in the world, over 400,000 midwives, over a thousand midwifery programs. But what we noticed is the quality of the education and practice of midwifery needs significant improvement.”

— Hassan Mohtashami, UNFPA Representative in Indonesia

Digital health interventions present an opportunity to transform family planning and reproductive health services, especially for youth and underserved populations. The government, private sector, and multilateral institutions can work together to explore and leverage digital tools to achieve government and FP2030 commitments. Equally important is the strengthening of data collection and monitoring systems, particularly in remote areas across Indonesia, the world’s largest archipelago. As Claire Charamnac, Social Development Specialist at the Asian Development Bank, emphasized in an October 2024 interview with FP Analytics, data capacity is a persistent challenge across low- and middle-income countries in Asia, where women’s health burdens are often systematically underestimated due to gaps in sex-disaggregated data collection and analysis, from health risk factors to preventive service utilization.

Indonesia’s 50-year experience in family planning and reproductive health programs, including both challenges and achievements, positions it as a leader among South-South Cooperation countries. The government, in partnership with multilaterals and development agencies, can assist countries in the early stages of their family planning and reproductive health services while facilitating cross-country knowledge exchange. This kind of collaborative leadership can help advance rights-based family planning and reproductive health, and hence maternal and child health, in low- and middle-income countries.