Family planning, environment, and autonomy: A mixed methods evaluation of an integrated PHE intervention in rural Indonesia

Abstract

The political and stakeholder will towards conservation is as high as it has ever been, and such conservation is now increasingly promoted as a holistic process directly connected to human rights and well-being. Thus, maintaining well-being and rights of local populations through integrated conservation and development approaches has started to become a key element of tackling environmental change. One such approach is the Population Health and Environment (PHE) approach which centres on the provision of health and family planning services to remote communities as a cornerstone of achieving sustainability. At its core, the PHE approach suggests that in conditions of multiple environmental pressures reliable access to family planning services creates a sense of empowerment, which spills over onto a greater sense of ownership and motivation to conserve their environment. The aim of this thesis was to link the fields of development, environmental conservation, reproductive rights, and human psychology and examine whether in a remote ecologically precarious location one’s perceived ability and options to reliably plan the preferred number and spacing of births would then have a spillover effect on perceived autonomy and motivation in general including towards environmental management. Such autonomy and motivation were proposed to be measured through Self-Determination Theory’s concepts of autonomy and self-determined motivation. Working with a local NGO, this project used a sequential exploratory design to evaluate a PHE intervention in a rural village in Indonesia, with focus groups (N = 4) informing the development, implementation, and analysis of a pre- (N = 300) and post-intervention (N = 226) questionnaire. The results presented here suggest that family planning was used by members of a resource poor community to support environmental sustainability and income and food security. Yet, the findings highlighted the existing poor access to health and family planning services in remote locations. At the same time, there was evidence of attitudinal ambivalence: participants wanted to plan family size to secure a better future for their children but were emotionally and culturally connected to the idea of a big supportive family. An association was found between feeling in control of one’s family size and feeling motivated towards the environmental conservation through motivation towards family planning. While the targeted part of a PHE intervention (Health Ambassadors) did not effect changes in participants’ autonomy and motivation on its own, an overall positive change was recorded possibly due to the sum of activities happening in the case-study site between the two questionnaire data collections.