Contraceptive use among the poor in Indonesia.

Context: Indonesia has experienced a dramatic increase in contraceptive use and an equally dramatic fertility decline over the last 30 years. Yet recent reductions in family planning funding, program decentralization and the diminishing role of the public sector as a service provider may lead to lower use among poor women.

Methods: The data for analysis were drawn from the 2002-2003 Indonesia Demographic and Health Survey. Bivariate techniques were used to compare overall contraceptive use, reliance on specific methods, source of supplies and reasons for nonuse of contraceptives between poor and better-off women. Multivariate regression assessed the association between use of a modern method and selected social, demographic and attitudinal characteristics.

Results: Better-off women wanted significantly fewer children than did moderately or extremely poor women (2.8 vs. 3.0-3.4), were more likely to approve of family planning (93% vs. 87-91%) and were more likely to believe their spouses approved (91% vs. 80-87%). Better-off women and moderately poor women had higher odds of using modern contraceptives than did extremely poor women (odds ratios, 1.6 and 1.4, respectively). Compared with women who gave a non-numeric response, those who wanted two or fewer children had higher odds of using a modern method (2.0). The odds were also higher among women who lived in a district in which the mean ideal number of children was below the national median (1.5).

Conclusion: Governmental efforts to increase contraceptive use among poor women need to focus on changing attitudes toward smaller family sizes and family planning.