The Nossal Institute for Global Health, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 333 Exhibition Street, Melbourne, VIC, 3000, Australia.
Center for Reproductive Health, Faculty of Medicine, Gadjah Mada University, Jalan Farmako Sekip Utara, Yogyakarta, 55281, Indonesia.
BMC Pregnancy Childbirth. 2018 Aug 30;18(1):353. doi: 10.1186/s12884-018-1991-y.
Despite several decades of investment into family planning and maternal health systems strengthening, Indonesia's maternal mortality ratio remains among the highest in Southeast Asia. Among postpartum women unmet need for family planning is greater than at any other time, thus there is great potential to improve the reproductive health outcomes of Indonesian women through enhanced postpartum family planning access. This article explores the socially embedded nature of family planning choices in the Indonesian context, drawing on the experiences of a sample of urban dwelling and predominantly middle class women.
This was an ethnographic study which explored the reproductive experiences of women residing in Yogyakarta City, and Sleman and Bantul regencies. Fieldwork was undertaken over 18 months from September 2014 to March 2016. This article draws on 31 in-depth interviews (IDIs) conducted with 20 women aged 21 to 38 years who had given birth less than two years prior.
Though there was great variance across women's reproductive trajectories, the majority had limited understandings of family planning, especially in relation to contraception. Societal norms pertaining to women's fertility and reproduction underpinned women's desires to become pregnant soon after marriage. Normative ideals concerning family size and the composition of families underpinned women's desires for a maximum of two to three children, with at least one child of each sex. Negotiations concerning timing of pregnancies and family size occurred within spousal relationships. The majority of women were using some form of fertility control to prevent or space pregnancies, with method choice decisions often informed by family members, friends and family planning providers. Quality of care among family planning providers was often lacking, perpetuating misinformation, and women's choices were not always respected.
Our analysis reveals the socially embedded nature of women's postpartum family planning understandings and choices, and the ways in which social and relational factors sometimes constrain and at other times support women's reproductive agency. We identify key areas for health sector reform to enhance women's understandings of postpartum family planning and improve family planning quality of care.
尽管几十年来一直在投资计划生育和加强孕产妇保健系统，但印度尼西亚的孕产妇死亡率仍位居东南亚之首。在产后妇女中，计划生育的未满足需求大于任何其他时候，因此，通过增加产后计划生育的可及性，改善印度尼西亚妇女的生殖健康结局具有巨大潜力。本文探讨了计划生育选择在印度尼西亚背景下的社会嵌入性质，借鉴了一些居住在雅加达市以及日惹和班图尔县的城市中产阶级妇女的经验。
这是一项民族志研究，探讨了居住在日惹市、日惹县和班图尔县的妇女的生殖经历。实地工作从 2014 年 9 月至 2016 年 3 月进行了 18 个月。本文借鉴了 2014 年 9 月至 2016 年 3 月期间对 20 名年龄在 21 至 38 岁之间、产后不到两年的妇女进行的 31 次深入访谈（IDIs）。
尽管妇女的生殖轨迹存在很大差异，但大多数妇女对计划生育，尤其是避孕措施的了解有限。与女性生育和生殖有关的社会规范支持了她们在婚后尽快怀孕的愿望。关于家庭规模和家庭构成的规范理想支持了妇女最多生育两到三个孩子的愿望，每个性别至少有一个孩子。关于怀孕时间和家庭规模的协商在夫妻关系中进行。大多数妇女正在使用某种形式的生育控制措施来防止或间隔怀孕，方法选择决策通常由家庭成员、朋友和计划生育提供者提供信息。计划生育提供者的护理质量往往很差，导致信息错误，妇女的选择并不总是得到尊重。
我们的分析揭示了妇女产后计划生育理解和选择的社会嵌入性质，以及社会和关系因素有时限制和支持妇女生殖自主权的方式。我们确定了卫生部门改革的关键领域，以提高妇女对产后计划生育的理解，并改善计划生育护理质量。
