"acceptors") to use contraceptives. But this emphasis on numbers
meant that the acceptors did not always receive sensitive or
appropriate services.
The
Indonesian government, recognizing the need to improve the quality
of services, asked the Foundation for help. Foundation staff knew
that feminist, consumer, and professional groups shared a concern
for improving the quality of care in family-planning services. Yet
there was little agreement as to what "quality care" meant. Some
measured quality by the technical efficiency of the methods
provided or by computerized information systems; others looked to
proper clinical procedures or respectful provider-client
interaction.
The
Foundation is now working to help build a consensus on quality care
in order to improve the country's family-planning system. One
grant, to the Population Council, supports a working group of
researchers, feminists, and officials from BKKBN and the Department
of Health who are developing a pragmatic definition of quality of
care.
Another
grant, to the University of Indonesia's Demographic Institute, is
funding a survey of 7,000 households to determine the extent to
which better services yield higher rates of contraceptive use. The
Foundation also supports multidisciplinary research on related
issues at Gadjah Mada University's Population Studies Center. In
addition, Foundation-supported researchers at the University of
Indonesia's Institute of Applied Psychology are exploring how power
relations between men and women can affect sexual behavior and
women's risk of acquiring sexually transmitted diseases and
HIV.
These and
other grants in Indonesia are part of the Foundation's effort to
focus analysis on women's concerns and experiences and to draw
attention to the variety of influences on reproductive health and
population.
Brazil
Brazil,
unlike Indonesia, has no government family-planning program.
Nevertheless, socioeconomic development has greatly improved
women's access to basic education and employment opportunities and
contributed to a sharp decline in birth rates. Since 1970,
population growth has slowed from 3 percent to 1.9 percent
annually.
But this
reduction in population growth has come at a high cost to women.
Research has shown that although oral contraceptives are widely
available without prescription in Brazil, lack of public education
on their appropriate use has resulted in many women taking "the
pill" despite having medical reasons not to. Moreover, women who
suffer ill effects from oral contraceptives or cannot afford them
have no other contraceptive option but sterilization or abortion.
Both are illegal but widely