Right Method. Right Time. My Choice. Reinvigorating Family Planning in Indonesia
The Right Method. Right Time. My Choice. Reinvigorating the Family Planning Program in 11 Selected Districts in Indonesia (My Choice) is a three-year health communication project in Indonesia, funded by the Bill and Melinda Gates Foundation with the aim of promoting family planning uptake and appropriate method choice matching users’ fertility goals and life stage. The program will take place in four provinces, namely, 1) the Special Administrative District of the City of Jakarta; 2) North Sumatra; 3) Central Java; and 4) South Sulawesi, covering urban and rural locations, as well as Javanese and nonKJavanese cultural and political regions. My Choice program will implement supply side and demand generation communication programs designed to promote underutilized Long Acting Reversible Contraceptives (LARCs) for women whose life stage calls for greater control over longKterm spacing and limiting of births. In addition, the program will communicate to healthcare workers the benefits of LARCs and the realignment of incentive structures under the new Universal Health Coverage scheme (UHC) to support more widespread availability of LARCs. My Choice is a proof of concept project. The My Choice consortium (JHUCCP, JHPIEGO, the Futures Institute and DKT International) will work closely with the national family planning agency, BKKBN, and the Ministry of Health to demonstrate and evaluate innovative communication interventions for healthcare workers and the community that, if proven effective, BKKBN can scale up nationwide.
I greatly appreciate the opportunity I was given to work in Indonesia and learn firsthand about the country, culture, and acceptability of a digital health intervention for family planning. My experience working in the field was invaluable to my growth as a global public health professional, and specifically for the advancement of my dissertation fieldwork. I spent approximately seven months in Indonesia, based in Jakarta but traveling to several cities and islands as part of data collection and information sharing. During that time I found several experiences particularly valuable.
Early on in my time in Indonesia, I traveled to the city of Yogyakarta to take language classes in Bahasa Indonesia. I took one week of intensive language classes and came away with the ability to speak enough of the language to confidently navigate daily life, as well as specific vocabulary related to contraception and mobile phones that helped to prepare me for observing interviews on these topics. As I joined interviews, my language skills further developed. By mid-way through the interviews I was able to follow along and understand the gist of interviewees’ responses, so that I could actively contribute to interviews by offering follow-up probes to better elucidate the experiences of women using the new SKATA mobile application.
Being on the ground in Indonesia I learned firsthand about the mobile communication infrastructure, mobile providers and data packages and how these factors play a critical role in sustained use of a mobile health intervention. In interviews I was able to witness slow download speeds that frustrated potential users of our mobile application; these experiences were unanticipated even to the local Jakarta-based mobile application developers we worked with. Topography and communication infrastructure vary dramatically from urban to rural areas and in the island of Java compared to farther islands from the political center of the country. In addition, mobile data packages become less of a necessity and more of a luxury that people purchase when they have enough money. Being able to see the reality of how people use and experience a mobile app in their home setting was eye opening to me, and to our project team. Through this experience we realized the importance of providing some offline components to the SKATA app, particularly static contraceptive information, to ensure that our intervention is as accessible as possible.
I led a data collection effort while in Indonesia, and I quickly realized that without the support of my colleagues I would have not been able to complete this task. Office staff familiar with local transportation and accommodation helped to arrange our travel logistics. My local interviewer was dedicated to collecting high quality data. My colleagues on the project team joined me for some of the interviews, so that they could also relay our findings to the mobile app developers, provincial coordinators promoting SKATA, and could help to identify ways in which the SKATA app should be revised going forward. There were a total of nine staff others who supported my research efforts, and without them our work could have never run so smoothly. Bringing back ‘oleh-oleh’ or local snacks from your travels is tradition in the Indonesian workplace. Every trip, I made sure to allocate a bit of time to oleh-oleh shopping, and as my research came to a close I gave my travel support staff individual gifts to express my thanks. I also wrote sincere thank you notes and took time to have individual wrap-up conversations with my colleagues to express my gratitude and let them know that I am dedicated to supporting their work from Baltimore.
Conducting fieldwork is challenging, but also rewarding. I always needed to keep in mind the goals of my research, while remaining flexible as schedules were altered and plans were revised. Throughout the experience of conducting research abroad I learned about how cultural norms shape the responses I got to my interview questions, and I enjoyed the warm Javanese welcome for which Indonesia is famous. I am very grateful I got the chance to work in Indonesia, with local staff, for an extended period of time.