a dynamic structural model of contraceptive use and
TRANSCRIPT
A Dynamic Structural Model of Contraceptive Use and Employment Sector Choice for Women in Indonesia
-Uma Radhakrishnan
Fourth Annual Research Conference on Population, Reproductive Health, and Economic Development
Cape Town, 2010
2
Research Outline
Develop a dynamic structural model to investigate the impact of the Indonesian family planning program on labor force participation and contraception choices of women
Estimate model using simulated maximum likelihood techniques with Indonesia Family Life Survey 1(IFLS 1) data for the period 1979-93
Use exogenous variation in timing of introduction of 3 types of family planning clinics for identification
3
Indonesian Context
Total Fertility Rate in Indonesia, 1965-70 to 2000-02
Notes: This figure is from Mize (2006).
Source: Contraceptive Prevalence Survey (1987) and Indonesian Demographic and Health Survey (1991, 1994, 1997, 2002-2003)
4
Indonesian Context
Contraceptive Prevalence Rate in Indonesia, 1977-2006
Notes: This figure is from Mize (2006).
5
Indonesian ContextLabor Force Participation Rates by Gender in Rural and Urban Areas: Indonesia in 1971, 1980, and 1990
1971 1980 1990
MaleUrbanRuralTotal
61.270.468.7
59.171.268.5
64.074.471.1
FemaleUrbanRuralTotal
22.534.232.1
24.235.232.7
31.642.238.8
Both Sexes 49.9 50.2 54.7
Notes: This table is quoted from Manning (1998).Source: CBS, Population Censuses, 1980 and 1990.
6
Women, Child Care, and Informal Sector
What remains unchanged is that women continue to hold primary child care responsibility
Large fractions of working women are employed in the informal sector characterized by:
Flexible timing
Easy entry and exit
Proximity to residence
Compatibility between work and family responsibilities (especially child care)
7
Research Motivation
Very little investigation of the impact of the family planning program on women’s labor force participation and wages
To understand the compatibility between work and family responsibility, especially child care provision as women make joint contraceptive method and employment sector choices
Structural model allows me to conduct policy experiments
8
Indonesian Family Planning Program
Introduced in late 1960s
Family planning program was introduced as part of five-year development plans
Initial geographic expansion Phase 1- 1970-74 (6 provinces including Java and Bali)
Phase 2- 1975-79 (10 provinces belonging to Outer Islands 1)
Phase 3- 1980-84 (remaining provinces)
10
Indonesian Family Planning Program: Changing Nature
Initially followed a clinic-based approach Community Health Centers (Puskemas) Failed to reach a large group of target women
Community-based approach was first established in mid 1970s
Key idea was to use existing institutions to promote family planning Family Planning Distribution Points (PKKBD) Village Integrated Health Posts (Posyandu)
11
Literature Review
Impact of family planning programs on fertility and socio-economic outcomes
Goldin and Katz (2002); Miller (2005); Joshi and Schultz (2007)
Female labor force participation in developing countriesJaffe and Azumi (1960); Tiefenthaler (1994)
Modeling contraceptive behaviorCarro and Mira (2002)
Joint modeling of employment and fertility decisionsHotz and Miller (1988); Francesconi (2002)
12
Contribution of this Research
Distinguish between formal and informal sectors of employment
Allow joint contraception and employment choices to understand link the between family responsibility and employment
Endogenize wage rates so that sector-specific experience impacts wages, and this in turn affects cost of having a child
Allow uncertainty in fertility control
13
Economic Model
I develop a finite horizon, discrete choice dynamic structural model in which married women in each period choose both method of contraception and sector of employment to maximize their expected discounted life-time utility function
14
Model
Marriage and education are treated as exogenous
Choose a sector of employment,
k=1, formal sector
k=2,informal sector
k=3, not working
Choose a contraceptive method,
m=1, modern method
m=2, traditional method
m=3 , not using contraception
ot
k
mt
m
15
Classification of Choices
Sector of Employment Formal: self-employed with permanent workers,
government employees, private employees
Informal: self-employed, self-employed with temporary workers, family workers
Contraceptive Methods Modern: implants, IUD, condoms, pills, injections
Traditional: rhythm, withdrawal, traditional herbs
16
Motivation to Control Fertility and Sector of Employment
Motivation to control fertility depends on compatibility between raising children and employment sector
Motivation to control fertility can be inferred by method of contraception used
While making contraceptive decisions, a woman considers the trade-off between costs of having a child and the benefits from having one
17
Utility Function
Expected discounted life-time utility function:
ct - consumption (pecuniary component)
qkmt - nonpecuniary component
- choice-specific time shock
E c qt A
t A
T
t kmt kmt
F
[ ( )]
0
0
kmt
18
Budget Constraint
- sharing rule parameter- wage earnings of the woman in sector k- husband’s wage- unearned income of husband and wife- price of contraception used- average expenditure on a child
wt
k
wt
h
Yt
Pm
Pn
c w w Y P m P Nt t
k
t
h
t m t
m
n t [ ]
19
Wage Equation
- education
t - age
- provincial minimum wage rates
- experience in formal sector
- experience in informal sector
- wage error
- unobserved ability
X t
L
Ot1
1
Ot1
2
t
k
G
w
i
w w G t X O Ot
k
k k k k t
L
k t k t t
k
w
i 0 1 2 3 4 1
1
5 1
2
20
Nonpecuniary Utility
Number of births
Age of youngest child
Duration dependence
Birth spacing
Birth in the previous period
Interactions of choices with exogenous characteristics such as age, religion, location, access to contraceptives
Several other interaction terms
21
Birth Probability Function
- age
- method of contraceptive in period t
- duration for which the method was used
- unobserved fecundity
t
mt
m
Mt
m
f
i
F t m Mm t t
m
t
m
f
i
, ( , , , ) 1
22
Data
Indonesia Family Life Survey 1(IFLS 1), 1993
Covers 13 provinces (321 Enumeration Areas) and 83% of the population
Retrospective panel
Individual and family level data on employment, income, education, migration, contraception use, and fertility
Community level data that can be linked to individual and household level data
24
Variables used in Empirical Analysis
Source: IFLS 1
N=2,067
Age at time of marriage Wages
Urban Unearned Income
Muslim Method of contraception
Age Sector of Employment
Education Duration in formal sector
Birth spacing Duration in informal sector
Number of children Duration not working
Age of youngest child Duration using modern methods
Gives birth Duration using traditional methods
Province Duration not using contraceptives
Enumeration Area
25
Descriptive Statistics
Variable Mean Standard Deviation
Sample of 2067 Women
Age at time of marriage* 19.67 3.97
Urban 0.51 0.50
Muslim 0.86 0.35
Sample of 20,707 woman-year observations
Age* 24.20 5.21
Number of children 2.44 1.27
Age of youngest child* 2.07 2.29
Gives birth 0.22 0.42
Duration in formal sector* 2.62 1.81
Duration in informal sector* 2.93 1.98
Duration not working* 10.79 8.69
Duration using modern methods* 2.37 1.61
Duration using traditional methods* 0.10 0.53
Duration not using contraceptives* 4.47 2.88
Notes: * denotes unit of measurement is Year. Source: IFLS 1
26
Joint Choices and Identification
Model joint contraception and employment decisions
Unobserved heterogeneity may drive both decisions leading to biased estimates
Use exogenous variation in timing of introduction of 3 different types of family planning clinics and exogenous variation in minimum wages rates for identification
27
Estimation Outline
Solve the dynamic programming problem
Use representative people to reduce computational cost (Brien, Lillard, and Stern (2006))
Estimate the birth probability function and wage equation outside the structural model.
After solving the dynamic programming problem and estimating parameters of wage and birth function, using data on observed choices and state variables , estimate parameters of utility function and budget constraint using simulated maximum likelihood techniques.
28
Birth Probability Function-Probit Model
Variables Estimates
Age of Woman -0.0109*(0.0021)
Lagged Modern Method -0.5655*(0.0574)
Lagged Traditional Method -0.3438*(0.1262)
Duration of Modern method * LaggedModern Method
-0.0885*(0.0182)
Duration of Traditional Method *Lagged Traditional Method
-0.087(0.0468)
Constant -0.3439(0.0508)
29
Main Results from Structural Estimation 1:Contraception
Covariates Modern Method Traditional Method
Age of Woman Positive Positive
Muslim Positive Negative
More than primary Education Positive Negative
Posyandu Positive Negative
Puskemas Positive Negative
PKKBD Positive Positive
Age of Youngest Child Negative Negative
Birth in Previous Period Negative Negative
Number of Births Positive Positive
Duration Positive Positive
Urban Negative Positive
30
Main Results from Structural Estimation 2: Employment
Covariates Formal Sector Informal Sector
Age of Woman Positive Positive
Muslim Negative Positive
Number of births Negative Positive
Birth in Previous Period Negative Positive
Age of Youngest Child Positive Positive
Duration Positive Negative
Urban Positive Negative
31
Main Results from Structural Estimation 3:Choice-Independent
Covariates(Not choice Dependent)
Change
Utility from birth when age>35 Negative
Utility from birth spacing Positive
Utility from birth Positive
Utility from number of births Positive
32
Policy Simulations
Decrease cost of using contraceptives. Improvement in quality of family planning
services such as reduced wait times Reduction in price of contraceptives Reduction in distance to clinics
Increase utility experienced by working mothers Reduction in cost of child care Flexible timings in formal sector employment Better working condition in informal sector
33
Punch Line !
Estimates indicate that : Informal sector jobs offer greater compatibility between work
and child care. Women with more kids and young kids derive more utility
from working in the informal sector. Access to modern methods of contraception (presence of clinics)
reduces cost of using modern methods. Choice of contraception method and employment sector vary
by exogenous characteristics such as religion, urban or rural residence, Muslim, presence of clinics and age of woman.
Number of kids , birth spacing, and age of youngest child play an important role in impacting choices made by married women.
34
Conclusion
Investigate the expansion of Indonesian family planning program on employment and contraceptive choices of married women, while recognizing the interdependency of these choices.
Access to contraceptives increases the likelihood of participating in the formal sector, conditional on adequate job creation rates in formal sector.
Although outcomes are observed at the individual level, it has implications for the economy as a whole: participation of women in labor force increases per capita income and this translates into economic growth.
37
Migration
Non-random selection in migration
Migration to obtain contraception will bias estimates
Modeling migration will not reduce bias unless it is exogenous
Assume that women lives in EA in all sample years as found in 1993, IFLS 1.
38
Nonpecuniary utility function
q o X m X o m
o O m M t n b n N o
o n N o r o N b n b n o
b n N n r
kmt km t
k
t km t
m
t t
k k
t
m m
t
k
t
k
t
m
t
m
t t t t t
k
t
k
t t t
k
t t
k
t t t t t t
k
t t t t t o
i
1 1 2 2 3 4
5 1 6 1 7 8
9 10 11 12 13 14
15 16 17
1 35
' '
( )
m
i
39
Exogenous Variation in Minimum Wage Rates
Exogenous variation in minimum wage rates in the different provinces over time is used to identify parameters related to employment choices.
Minimum wage rate is set by Ministry of Manpower based on recommendation of governors in different provinces.
Internal and external pressures unrelated to local economic conditions in setting of minimum wage rates
Reasonable to assume variation in minimum wage rates does not impact contraceptive choices.
40
Real Minimum Wages in IFLS 1 provinces
Real Regional Minimum Wage in Indonesia, 1985-1994
(Rupiah/month)
-
500
1,000
1,500
2,000
2,500
3,000
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
Year
Min
imu
m W
ag
es
North Sumatra
West Sumatra
South Sumatra
Lampung
Jakarta
West Java
Central Java
Yogyakarta
East Java
Bali
South Sulawesi
South Kalimantan
West Nusa Tenggara
Notes: Real Wages are in 2000 Indonesian Rupiah.Source: Minimum Wage data was obtained from Arup Suryahadi and David Newhouse.
41
Solving the Dynamic Programming Problem
Solution involves obtaining value function for each person for each point in the state space for a given set of parameters.
Backward recursion.
For t<T*, value function at each point in the state space is the sum of current utility plus the discounted value of the expected best choice next period.
Backward recursion continues until t=0.
Large state space makes it computationally expensive to evaluate the value function at every point.
42
Reducing Computational Cost
Impose upper bounds on several state variables (age of youngest child, birth spacing, and number of births).
Interpolation
Model unobserved heterogeneity using Heckman and Singer (1984) approach
43
Representative People
Individuals differ by the following exogenous characteristics: religion location presence of 3 types of clinic 4 types of people with respect to unobserved
heterogeneity
This results in 2*2*23*4=128 representative people
Use interpolation method in Brien, Lillard, and Stern(2006)
44
Birth Probability Function
Estimate this is as a Probit, where the dependent variable is 1 if a birth occurs and 0 otherwise.
Use parameters from Probit regression to obtain probability of birth in the structural model after conditioning on method used, duration of use, age of the women, and unobserved fecundity level.
45
Wage Equation
Estimate outside structural model to reduce computational costs.
Two-stage method in Heckman(1979) is used to correct for selection bias, as wages are observed only for working women.
46
Likelihood Contribution
Pr( , , ( ))exp[ ( |( ( ), , ) / ]
exp[ ( |( ( ), , ) / ]( ) ( )
{ , }
{ , }
i
kmt t i
lzt t il z
k m
d
t tt S tV d S t
V d S tdF dG
kmt
1 2
Pr( , , ( ), )exp[ ( |( ( ), , ) / ]
exp[ ( |( ( ), , ) / ]( ) ( )
{ , }
{ , }
i t
kmt t i
lzt t il z
k m
d
t t tt S t wV d S t
V d S tg w w dF
kmt
2 2 2 1
Likelihood contribution of a woman who is not working in period t is:
Likelihood contribution of a woman working in the informal sector in period t is:
47
Why Structural Model?
Enables policy simulation
According to Professor Stern:
“Adds discipline to modeling and estimation, and makes it easier to talk about the model and the economics in it”
48
Geographic Expansion of Indonesian Family Planning Program
Phase 1 provinces - West Java, Jakarta, Central Java, East Java, Yogyakarta, and Bali
Phase 2 provinces - Aceh, North Sumatra, West Sumatra, South Sumatra, Lampung, North Sulawesi, South Sulawesi, South Kalimantan, West Kalimanatan, and West Nusa Tenggara
Phase 3 provinces-Riau, Jambi, Bengkulu, East Nusa Tenggara, Central Kalimantan, East Kalimantan, Central Sulawesi, South East Sulawesi, Maluku, Irian Jaya, and East Timor.
49
Descriptive Statistics: Education
Education Percentage
Primary 0.572
Junior Secondary 0.167
Senior Secondary 0.208
College 0.050
Source: IFLS 1
50
Estimates of Contraceptive Failure Rates in the United States
Method Failure Rate in 12 Months(Typical Use)
Implant 2.8
Injectable 3.2
IUD 3.7
Pill 6.9
Diaphram 8.1
Male Condom 8.7
Withdrawal 18.8
Periodic Abstinence 19.8
Other 32.0
Notes: Failure rate is the percentage of women who accidentally become pregnant as estimated in Tussell and Vaughn (1999) using 1995 National Survey of Family Growth in the United States.Source: Quoted from Tussell and Vaughn (1999).
51
Distribution of sample Women by Province, 1993
Province Number of women Percentage
North Sumatra 197 9.53
West Sumatra 99 4.79
South Sumatra 116 5.61
Lampung 87 4.21
DKI Jakarta 213 10.30
West Java 331 16.01
Central Java 200 9.68
DI Yogyakarta 101 4.89
East Java 288 13.93
Bali 128 6.19
West Nusa Tennegara 121 5.85
South Kalimantan 96 4.64
South Sulawesi 90 4.35
Total 2067 100
Source: IFLS 1
52
Descriptive Statistics
Variable Mean Standard Deviation
Sample of 2067 Women
Age at time of marriage* 19.67 3.97
Urban 0.51 0.50
Muslim 0.86 0.35
Sample of 20,707 woman-year observations
Age* 24.20 5.21
Number of children 2.44 1.27
Age of youngest child* 2.07 2.29
Gives birth 0.22 0.42
Duration in formal sector* 2.62 1.81
Duration in informal sector* 2.93 1.98
Duration not working* 10.79 8.69
Duration using modern methods* 2.37 1.61
Duration using traditional methods* 0.10 0.53
Duration not using contraceptives* 4.47 2.88
Notes: * denotes unit of measurement is Year. Source: IFLS 1
53
Number of Family Planning Clinics Introduced between 1980-93
010
2030
40
Num
ber
of P
osya
ndu
1980 1985 1990 1995Year
Number of Posyandus' introduced between 1980-93
05
1015
20
Num
ber
of P
uske
mas
1980 1985 1990 1995Year
Number of Puskemas introduced between 1980-93
010
2030
Nu
mbe
r of
PK
KB
D
1980 1985 1990 1995 2000Year
Number of PKKBDs introduced between 1980-93
Notes: Posyandu is Village Integrated Health Posts. Puskemas is Community Health Center. PKKBD is Family Planning Distribution Points.
Source: IFLS 1
54
Identification of the Wage Structure
Identification of the wage structure comes from covariation of wages and observables across the two sectors for similar occupations.
55
Identification of State Dependence
State dependence is separately identified from unobserved heterogeneity by variation in choices made by individuals with similar observable characteristics who have experienced a certain state relative to individuals who have not experienced that state.
56
Exogenous Variation in Timing of Introduction of Posyandu
02
46
Ave
rage
Fer
tility
1940 1950 1960 1970 1980Year of Birth
Before After
Average Fertility by Birth Cohort and Timing of Introduction of Posyandu
Notes: Posyandu is Village Integrated Health Posts. “After” is for EAs where Posyandu was introduced after 1980 and “Before” is for EAs where Posyandu was introduced before 1980.
Source: IFLS 1
57
Exogenous Variation in Timing of Introduction of PKKBD
12
34
56
Aver
age
Ferti
lity
1940 1950 1960 1970 1980Year of Birth
Before After
Average Fertility by Birth Cohort and Timing of Introduction of PKKBD
Notes: PKKBD is Family Planning Distribution Points. “After” is for EAs where PKKBD was introduced after 1980 and “Before” is for EAs where PKKBD was introduced before 1980.
Source: IFLS 1
58
Exogenous Variation in Timing of Introduction of Puskemas
12
34
56
Ave
rage
Fer
tility
1940 1950 1960 1970 1980Year of BIrth
Before After
Average Fertility by Birth Cohort and Timing of Introduction of Puskemas
Notes: Puskemas is Community Health Center. “After” is for EAs where Puskemas was introducedafter 1980 and “Before” is for EAs where Puskemas was introduced before 1980.
Source: IFLS 1
59
Issues with Using Access to Family Planning Program as Instruments for Identification
Outcomes of interest may be biased by non-random nature of program expansion.
Correlation between timing of introduction and unobserved taste for fertility will lead to biased estimates
60
Identification (Utility Parameters)
Parameters of utility function are identified by
Data on choices and individual characteristics
Variation in timing of introduction of different types of fertility clinics within each enumeration area and variation across enumeration areas over time in access to contraceptives
Exogenous variation in local labor market conditions (real minimum wage rates) across provinces and over time
61
Identification (Wage equation)
Coefficients of the wage equation are identified by covariation of observable characteristics and wages across individuals within a sector
Variance of the wage error is identified by differences in wages across individuals in a sector in a given period conditional on observables
62
Identification of Unobserved Heterogeneity
Variance of the unobserved preference heterogeneity is identified by persistence in choices made by individuals over time relative to individuals with same observables.
Variance of unobserved ability is identified by persistent differences over time across individuals in wages conditional on observables.
Variance of unobserved natural fecundity level is identified by variation in fertility across women conditional on observables and choices made.
63
More about the Model
Choose 1 of 9 alternatives; denote dkmt=1, if sector k and method m are chosen in period t
Decision making horizon is from A0 to T*, but women live until TF, TF>T*
64
Likelihood Equation
Solution to individual’s optimization problem provides the choice probabilities in the likelihood equation
Sample likelihood equation is the product across individuals, time, and choices of the contributing probability corresponding to each alternative
L t S t dHiti
i(.) Pr( , , ( )) ( )
65
Women as Decision Makers
The utility maximization problem can be considered as
A two-stage benevolent dictator problem.
Chiappori’s collective approach
66
Descriptive Statistics: Education
Education Percentage
Primary 0.572
Junior Secondary 0.167
Senior Secondary 0.208
College 0.050
Source: IFLS 1
67
State Space and Value Function
S t o m D r N b tt t t t t t t t( ) ( , , , , , , , , )
1 1 1 1 1
V V S t V S tt t i t i max[ ( ( ), ),........., ( ( ), )], , , ,1 1 3 3
V S t U S t EV S t S t dk m t i kmt i t i kmt, , ( ( ), ) ( ( ), ) ( ( ), | ( ), ) 1 1 1
V U S tk m T
t T
t T
T
kmt i
F
, ,
' *
''*
*
' ( ( ' ), )
State space at time t is:
Value function at time t given state S(t) and unobserved heterogeneity is:
where
For A0 <= t < T*
For T* <= t’ < TF
68
Nonstructural Estimation:Marginal Effects at Means for Select Independent Variables from Contraceptive Choice Multinomial Probit
Variable Pr(Method = Modern) =0.2730dP/dx
Pr(Method = Traditional) =
0.0059dP/dx
Pr(Method = Not Using
Contraceptives)= 0.7210dP/dx
Gave Birth Last Period -0.0918*(0.0103)
-0.0036*(0.0011)
0.0954*(0.0104)
Number of Children 0.1137*(0.0056)
0.0012(0.0007)
-0.1150*(0.0057)
Age of Youngest Child -0.0384*(0.0029)
-0.0008*(0.0004)
0.0393*(0.0029)
Age -0.0003(0.0012)
-0.0000(0.0001)
0.0003(0.0012)
Posyandu 0.0532*(0.0129)
0.0023(0.0016)
-0.0556*(0.0129)
Puskemas 0.0109(0.0131)
0.0005(0.0016)
-0.0115(0.0132)
PKKBD 0.0159*(0.0015)
0.0005(0.0015)
-0.0165(0.0115)
Choice Last Year -0.2144*(0.0099)
-0.0129*(0.0021)
0.2273*(0.0099)
Notes: N=20,707. Method 1 denotes Modern Method, Method 2 denotes Traditional Method, and Method 3 denotes Not Using Contraceptives. Standard Errors are in parenthesis. *implies statistical significance at 5%.Source: IFLS 1
69
Selection in Wage Equation
Estimated outside structural model
Wages are observed for women in sectors they actually work
To correct for selection bias, I model selection process as multinomial logit
Use Fournier and Girgand’s (2004) user written SELMLOG program
70
Nonstructural Estimation:Marginal Effects at Means for Select Independent Variables from Employment Sector Multinomial Probit
Variable Pr(Sector = Formal) =0.1858dP/dx
Pr(Sector = Informal) =0.1460dP/dx
Pr(Sector = Not Working) =0.6681dP/dx
Muslim -0.0225*(0.0117)
-0.0455*(0.0115)
0.0681*(0.0144)
Urban 0.0346*(0.0080)
-0.1672*(0.0078)
0.1325*(0.0101)
Gave Birth Last Period -0.0464*(0.0081)
-0.0126(0.0099)
0.0590*(0.0116)
Number of Children -0.0422*(0.0037)
0.0055(0.0033)
0.0366*(0.0045)
Age of Youngest Child -0.0005(0.0018)
0.0088*(0.0016)
-0.0083*(0.0023)
Age 0.0176*(0.0009)
0.0024*(0.0008)
-0.0201*(0.0011)
Choice Last Year -0.1641)*(0.0107)
-0.1294*(0.0100)
0.2935*(0.0114)
Notes: N= 20,707. Sector 1 denotes Formal Sector, Sector 2 denotes Informal Sector, and Sector 3 denotes Not Working. Standard Errors are in parenthesis. *implies statistical significance at 5%.Source: IFLS 1
71
Imputation
Why Missing data is a problem?
-Missing data maybe correlated with person-specific characteristics
-May lead to biased estimates
Use Sequential Regression Multivariate Imputation (SRMI) algorithm.
Imputations are performed outside structural model
72
Descriptive StatisticsDistribution of Woman-Year Observations by Choices Made
Choice Percentage
Modern Method and Formal Sector 9.17
Modern Method and Informal Sector 7.44
Modern Method and Not Working 23.82
Traditional Method and Formal Sector 0.96
Traditional Method and Informal Sector 0.55
Traditional Method and Not Working 1.80
No Contraceptives and Formal Sector 10.14
No Contraceptives and Informal Sector 10.78
No Contraceptives and Not Working 35.33
Total 100
Source: IFLS 1
73
Sources of Exogenous Variation
Community level data in IFLS 1 includes timing of introduction of 3 types of fertility clinics (access to contraceptives) in each enumeration area
Community Health Centers or Puskemas
(33% introduced after 1980)
Family Planning Distribution Points or PKKBD
(58% introduced after 1980)
Village Integrated Health Posts or Posyandus
(77% introduced after 1980)