EUIS SUNARTI

Membangun Ketahanan Keluarga dan SDM Indonesia Berkualitas

Keluarga Berencana dalam Konteks Peningkatan Kualitas Sumberdaya Manusia dan Ketahanan Keluarga - EUIS SUNARTI

Keluarga Berencana dalam Konteks Peningkatan Kualitas Sumberdaya Manusia dan Ketahanan Keluarga

March 7th, 2012

Seminar Program KB dalam Konteks Pembangunan Sumberdaya Manusia (Jakarta 8 September 2008)

 

KELUARGA BERENCANA DALAM KONTEKS PENINGKATAN KUALITAS SUMBERDAYA MANUSIA DAN KETAHANAN KELUARGA

A.   Landasan, Kinerja, dan Tantangan Program KB Indonesia

1.   Landasan dan Urgensi Program KB

 Program Keluarga Berencana (KB) secara mikro berdampak terhadap kualitas individu dan secara mikro berkaitan dengan tujuan pembangunan pada umumnya. Secara mikro, KB berkaitan dengan kesehatan dan kualitas hidup ibu/perempuan, juga kualitas bayi dan anak.  Secara makro, KB dan kesehatan reproduksi berkontribusi baik secara langsung maupun tidak langsung untuk meraih MDG’s (Singh et al. 2003 dalam UNFPA 2006), yaitu : 1) memberantas kemiskinan dan kelaparan, 2) mewujudkan pendidikan dasar untuk semua, 3) mendorong kesetaraan gender dan pemberdayaan perempuan,  4) mengurangi angka kematian anak, 5) meningkatkan kesehatan ibu, 6) menjamin kelestarian lingkungan hidup, dan 7) pembangunan kemitraan global untuk pembangunan

Penggunaan KB berkaitan dengan rendahnya kematian ibu dan kematian anak dan dapat mempengaruhi pertumbuhan ekonomi. Memiliki anak lebih sedikit dan lebih sehat dapat mengurangi beban ekonomi pada keluarga miskin, dan memungkinkan mereka menginvestasikan sumberdayanya dalam pengasuhan, perawatan, dan sekolah anak, sehingga nantinya diharapkan dapat memutus mata rantai kemiskinan  (UNFPA 2005a, WHO 1994 dalam UNFPA 2006). Secara nasional, investasi KB juga membuka “a window of opportuniity” (jendela kesempatan) bagi pertumbuhan ekonomi yang lebih cepat melalui penurunan fertilitas dan perubahan struktur umur populasi dan angka ketergantungan (dependency ratio). Peningkatan rasio jumlah pekerja terhadap jumlah anak yang harus ditanggung menyebabkan peningkatan tabungan dan investasi, serta perbaikan standar kualitas kehidupan dan rendahnya kemiskinan (Bloom et al. 2003, Merrick 2002 dalam UNFPA 2006). “A window of opportunity” dapat menurunkan 14 % tingkat kemiskinan di Negara berkembang antara tahun 2000 dan 2015 (Mason and Lee 2004 dalam UNFPA 2006). Investasi dalam KB juga dapat menurunkan biaya pelayanan social seperti biaya pelayanan kesehatan, pendidikan, pangan, perumahan, dsb. Rendahnya pertumbuhan penduduk juga dapat mengurangi tekanan terhadap eksploitasi sumberdaya alam yang terbatas (Singh et al. 2003 dalam UNFPA 2006).

2.   Kinerja Program KB di Indonesia

Keberhasilan program KB di Indonesia salah satunya ditunjukkan oleh penurunan TFR (Total Fertility Rate) dari 5.6 (awal tahun 2007) menjadi 2.6 (SDKI tahun 2002-2003).  Saat ini diproyeksikan wanita di Indonesia rata-rata melahirkan 2,4 anak, atau lebih dari 50 persen angka kelahiran telah diturunkan. Hasil pendataan keluarga menunjukkan rata-rata jiwa per keluarga adalah 3.82 (tahun 2006) dan 3.79 (tahun 2007).  Menurunnya angka kelahiran tersebut di atas, merupakan sebagian besar akibat dari meningkatnya kesertaan ber-KB dari sekitar hanya 5 persen pada awal tahun 70 menjadi sekitar 62 persen saat ini.

Integrasi program KB dan Kesehaan Reproduksi (KR) di Indonesia mengikuti ICPD (International Conference on Population and Development) di Cairo 1994. Sejak tahun 2004, terjadi perubahan visi program KB nasional dari keluarga kecil bahagia dan sejahtera menjadi keluarga berkualitas pada tahun 2015 (Anonym 2004). Kebijakan pengelolaan/pengendalian pertumbuhan penduduk, penurunan IMR dan MMR, dan peningkatan kualitas program KB tercantum dalam UU No 25 tahun 2000 tentang program pembangunan nasional

Penurunan angka kelahiran menyebabkan pergeseran distribusi penduduk menurut kelompok umur dimana proporsi penduduk muda semakin menurun, proporsi penduduk usia kerja meningkat pesat dan proporsi penduduk lansia naik secara perlahan sehingga rasio ketergantungan menjadi menurun. Kondisi tersebut berpotensi memberikan keuntungan ekonomis atau dikenal dengan bonus demografi.  Idealnya, penurunan proporsi penduduk muda mengurangi biaya untuk pemenuhan kebutuhannya, sehingga sumber daya dapat dialihkan untuk memacu pertumbuhan ekonomi dan peningkatan kesejahteraan masyarakat.

Indonesia telah mengalami bonus demografi yang ditandai dengan menurunnya rasio ketergantungan mulai tahun 1971 hingga mencapai angka terendah pada tahun 2015-2020 yang merupakan jendela kesempatan (the window of opportunity) untuk melakukan investasi bagi pembangunan sumber daya manusia. Bonus demografi sebenarnya sudah mulai kelihatan sejak akhir tahun 2000  dimana beban ketergantungan yang diukur dari ratio penduduk usia anak-anak dan tua per penduduk usia kerja, telah menurun tajam, dari sekitar 85-90 per 100 di tahun 1970 menjadi sekitar 54-55 per 100 di tahun 2000.

Bonus demografi, atau juga the window of opportunity, hanya akan bermanfaat kalau mutu penduduk mendapat pemberdayaan yang memadai dan penyediaan lapangan kerja yang mencukupi. Oleh karenanya bonus demografis yang sudah dialami Indonesia ini belum memberi makna yang berarti karena kualitas penduduk Indonesia sangat rendah. Karena tingkat pendidikan penduduk yang rendah,  tidak bersekolah dan tidak bekerja, dengan jumlahnya yang membengkak sangat besar, sebenarnya bonus demografi yang mulai muncul dewasa ini telah berubah menjadi penyebab beban ketergantungan menganggur yang sangat tinggi. Kondisi tersebut menghilangkan dampak positif bonus demografi sebagai  akibat dari proses transisi demografi yang berkembang dengan baik.

3.   Tantangan Program KB Indonesia

Program KB di Indonesia menghadapi berbagai tantangan, terutama pada era desentralisasi dan otonomi daerah, serta pada kondisi terjadinya degradasi daya dukung sumberdaya alam pemasok kebutuhan pokok manusia. Desentralisasi (pada januari 2001) membawa perubahan mendasar bagi institusi yang mengurusi KB dan kesehatan. Menurut BKKBN (2005) terjadi penurunan perhatian pemerintah daerah terhadap pembangunan kependudukan.

Selain rendahnya kualitas SDM dan besarnya anggka pengangguran, tantangan pembangunan kependudukan di Indonesia berkaitan dengan menurunnya daya dukung alam bagi kehidupan umat manusia. Pembangunan kependudukan menjadi semakin penting mendapat perhatian di masa sekarang dan masa yang akan datang. Penurunan daya dukung hutan dan wilayah resapan air bagi pemenuhan kebutuhan air bersih penduduk serta daya dukung pertanian bagi penyediaan pangan merupakan dua diantara permasalahan daya dukung kehidupan di masa kini dan masa mendatang.

Perluasan akses dan perbaikan kualitas program KB merupakan hal utama dari upaya peningkatan dan pemeliharaan kesehatan individu dan masyarakat dan membantu mereka untuk mengaktualisasikan potensinya. Kemiskinan yang masih tinggi menuntut intervensi pemerintah untuk tetap menjamin dan menyediakan kebutuhan alat kontrasepsi khususnya bagi keluarga miskin dan bagi wilayah-wilayah tertinggal dan daerah terisolasi. Tantangan upaua peningkatan pelayanan  program KB lainnya adalah capacity building dan pelatihan SDM,  peningkatan ketersediaan jasa KB seperti konseling KB, IEC, jasa pelayanan pemasangan kontrasepsi, fasilitas prenatal,  kelahiran yang aman dan post-natal, distribusi dan pemilihan alat KB, dan  Integrasi KB dengan program kesehatan reproduksi

 

B.   Keluarga Berencana Dalam Konteks Sumberdaya Manusia

Berbagai hasil penelitian menunjukkan bahwa akar pembangunan kualitas SDM ditentukan sejak kehidupan janin dalam kandungan. Pertumbuhan dan perkembangan janin berkaitan dengan peningkatan prevalensi beberapa penyakit seperti diabetes, hipertensi, jantung koroner dan stroke pada masa dewasa (UNICEF, 1997). Beberapa penjelasan keterkaitan program KB dalam konteks sumberdaya manusia berkaitan dengan daya hidup serta kualitas ibu  dan anak. Kualitas ibu diantaranya berkaitan dengan kualitas kehamilan, keselamatan kelahiran, dan kualitas ibu pasca kelahiran yang berdampak terhadap kesehatan jangka panjang dan produktivitas kerja. Sementara itu kualitas anak berkaitan dengan daya hidup serta kualitas Janin, bayi saat dilahirkan, dan kualitas anak. Dampak kekurangan gizi saat kehamilan terhadap pembangunan sumberdaya manusia disajikan pada Tabel1.

Tabel 1. Dampak kekurangan Gizi saat kehamilan terhadap Pembangunan Sumber Daya Manusia

Kondisi

Proses

Dampak

Kekurangan zat gizi yodium semasa kehamilan Menghambat perkembangan otak janin Kehilangan IQ 5-10 poin
Kekurangan gizi protein energi disebabkan oleh kekurangan makanan bergizi dan infeksi Pertumbuhan lambat dan perkembangan otak  terganggu Kehilangan IQ 5-10 poin
Anemia kekurangan zat besi pada bayi Gangguan fungsi kognitif dan pengembangan Kehilangan IQ 5-10 Poin
Kecacingan pada  anak Penurunan penyerapan zat gizi dan kekurangan zat besi Ketidakmampuan/ terhambat belajar
Anemia kekurangan zat besi pada orang dewasa Penurunan kemampuan kerja dan daya tahan Penurunan pendapatan dan produktifitas
Kekurangan Vitamin A Penurunan daya tahan tubuh terhadap infeksi Resiko kematian anak tinggi
Kekurangan Zat seng Pertumbuhan lambat dan penurunan resistensi terhadap infeksi Peningkatan frekuensi kesakitan dan peningkatan pengeluaran biaya pengobatan

Sumber : UNICEF, (1997a).

Kualitas kehamilan berkaitan dengan lama hamil dan penambahan berat badan ibu selama hamil, dimana kedua indicator tersebut saling berhubungan (WHO 1995; Jaffin & Hayworth dalam Halpern 1987; Rosso 1990). Sementara itu penambahan berat badan ibu selama hamil berkaitan dengan status gizi ibu sebelum hamil dan jarak antar kehamilan. Hasil penelitian menunjukkan rendahnya jarak hamil berhubungan dengan kejadian premature dan gangguan petumbuhan Janin (IUGR= Intra Uterine Growth Retardation), serta rendahnya penambahan berat badan ibu selama hamil, yang pada akhirnya berhubungan dengan berat bayi lahir dan penurunan kekebalan tubuh dan pertumbuhan bayi. Daya hidup bayi dan ibu ditunjukkan oleh indicator IMR (infant mortality rate) dan MMR (maternal mortality rate). IMR (infant mortality rate) laki dan perempuan menurun dari 40.8 (tahun 2000) menjadi 32.3 (tahun 2005). Hubungan antara angka kematian bayi dengan jarak hamil menunjukkan bahwa semakin rendah jarak hamil semakin tinggi angka kematian bayi, dan hal tersebut konsisten pada semua Negara yang angka kematian bayinya tinggi, sedang, dan rendah (Haaga 1995 dalam Andersen, Pelletier & Alderman 1995). Hasil kajian pada wanita di Negara berkembang menunjukkan bahwa nutritional stress saat hamil berkaitan dengan kerja berat selama hamil dan menyusui yang tidak diikuti dengan peningkatan asupan energy. Ketidakseimbangan ini menyebabkan rendahnya penambahan berat badan selama hamil (leslie 1995). Selain factor biologis dan fisiologis, aspek social seperti stress yang dialami ibu ditengarai mempengaruhi kualitas kehamilan. Hasil penelitian Sunarti (2001) menunjukkan bahwa penambahan berat badan selama hamil (kualitas kehamilan) dipengaruhi oleh komponen ketahanan keluarga.

Jarak kehamilan (birth spacing) berdampak terhadap kesiapan ibu untuk hamil lagi yang ditunjukkan oleh status gizi sebelum hamil. Status gizi ibu sebelum hamil menjadi factor penentu penambahan berat badan selama hamil yang beresiko terjadinya kelahiran BBLR. Selain mempengaruhi penambahan berat badan selama hamil, jarak kelahiran yang pendek dan status gizi ibu yang kurang memadai bisa menyebabkan terjadinya IUGR (Intra Uterine Growth Retardation, kegagalan tumbuh janin saat dalam kandungan)dan kelahiran bayi dengan BBLR. Bayi BBLR karena IUGR memiliki kemampuan “catch-up” yang lebih rendah dibandingkan bayi BBLR karena premature (Bhargava 1995; Fiedelius 1953 dalam UNICEF 1997; Chaodari 1991 dalam UNICEF 1997). Bayi BBLR mudah terkena infeksi, lebih mudah dan lebih lama sakit, dan sakit yang diderita lebih berat, serta mempunyai keterbatasan kemampuan intelektual (Committee on Nutritional Status During Pregnancy 1990). Rendahnya berat badan bayi lahir menyebabkan kondisi yang tidak menguntungkan dalam pertumbuhan, perkembangan, daya hidup, dan perkembangan penyakit saat dewasa. Sementara itu Ibu yang sering hamil, memiliki peluang besar terjadinya maternal depletion zat-zat gizi terutama persediaan mineral tubuh yang dapat menyebabkan penuaan dini, osteoporosis, dan anemia sehingga mempengaruhi kinerja dan produktivitas kerja.

Berbagai kajian literature menunjukkan bahwa program KB (jarak antar kehamilan dan frekuensi hamil) berkaitan dengan daya hidup dan kualitas ibu dan anak, atau berkaitan dengan kualitas sumberdaya manusia. Secara sederhana keterkaitan tersebut disajikan pada Gambar 1.

 

C.   Keluarga Berencana dalam Konteks Ketahanan Keluarga

Perhatian terhadap ketahanan keluarga meningkat seiring pemahaman akan bervariasinya kemampuan keluarga dalam mengelola sumberdaya dan menanggulangi masalah keluarga yang berdampak terhadap keutuhan keluarga.  Terlebih lagi tantangan keluarga di era globalisasi sekarang ini. Menurut Soetrisno (1997),  keluarga Indonesia menghadapi tantangan seiring masuknya nilai-nilai baru atau nilai budaya global yang seringkali bertentangan dengan nilai budaya bangsa. Dalam kondisi ini maka ketahanan dan bahkan kelangsungan hidup budaya nasional sangat tergantung dari ketahanan keluarga sebagai unit terkecil dari suatu bangsa dalam menghadapi arus penetrasi budaya global tersebut. Keluarga Indonesia saat

ini sedang menghadapi konflik antara Das Sein dan Das Sollen dalam memahami nilai budaya nasional yang akan berakibat pada melemahnya ketahanan keluarga sebagai benteng dalam menghadapi nilai budaya global. Mengingat pentingnya fungsi dan peran keluarga baik bagi kehidupan individu dan keluarga itu sendiri maupun terhadap kelangsungan masyarakat, Zeitlin et al (1995) memandang penting upaya penguatan keluarga serta implikasinya dalam kebijakan dan program pemerintah.

BKKBN, kualitas SDM, Ketahanan Keluarga Bapenas

Gambar 1. Keterkaitan Frekuensi Kelahiran Dan Jarak Hamil Sebagai Faktor Risiko Kehamilan Dengan Kualitas SDM Anak Dan Ibu

Keluarga merupakan institusi pertama dan utama pembangunan sumber daya manusia karena. Keluarga sebagai institusi pertama pembangunan SDM karena di keluargalah seorang individu tumbuh berkembang, dimana tingkat pertumbuhan dan perkembangan tersebut menentukan kualitas individu yang kelak akan menjadi pemimpin masyarakat bahkan pemimpin negara. Sedangkan keluarga sebagai institusi utama pembangunan SDM karena di keluargalah aktivitas utama kehidupan seorang individu berlangsung sehingga keberfungsian, ketahanan, kesejahteraan keluarga akan menentukan kualita individu. Selain itu keluarga merupakan unit sosial terkecil, pembangun institusi masyarakat. Keluarga berkaitan dengan masalah sosial, sehingga banyak para pembaharu sosial yang memandang bahwa keluarga sebagai dasar kesehatan masyarakat (Sunarti, 2001). Keluarga yang mampu menjalankan nilai-nilai dasar dan mampu membangun lingkungan keluarga berkualitas dipandang mampu melahirkan individu generasi penerus berkualitas sehingga diharapkan akan menjadi pemimpin bangsa yang berkualitas.

Keluarga memiliki berbagai fungsi penting yang menentukan kualitas kehidupan baik kehidupan individu, keluarga, bahkan kehidupan sosial (kemasyarakatan). Fungsi keluarga dapat dibagi menjadi fungsi ekspresif dan instrumental. Fungsi ekspresif keluarga berkaitan dengan pemenuhan kebutuhan emosi & perkembangan, termasuk moral, loyalitas, dan sosialisasi anak. Sementara itu fungsi instrumental berkaitan dengan manajemen sumberdaya untuk mencapai berbagai tujuan keluarga. Sementara itu BKKBN (Dawam,1996) membagi fungsi keluarga ke dalam 8 kelompok yaitu fungsi : 1) keagamaan, 2) sosial budaya, 3) cinta kasih, 4) melindungi, 5) ekonomi, 6) reproduksi, 7) sosialisasi dan  pendidikan, dan 8) Pembinaan lingkungan

Peran keluarga dalam pembangunan SDM berkualitas berkaitan dengan nilai-nilai yang dianut keluarga, kualitas lingkungan keluarga diantaranya kualitas hubungan atau  interaksi yang terjalin diantara anggota keluarga.  Keluarga yang menganut dan dapat menjalankan nilai-nilai dasar seperti cinta kasih, rasa hormat, komitment, tanggungjawab, dan kebersamaan keluarga, maka diharapkan dapat membangun lingkungan berkualitas yang ditunjukkan oleh adanya hubungan sosial yang harmonis di keluarga. Beberapa indikator dari adanya hubungan sosial yang harmonis di keluarga adalah ditunjukkan dengan adanya lingkungan yang stabil dan dapat diprediksi, ikatan emosional yang kuat antar anggota keluarga, orangtua yang penuh cinta kasih, dan adanya konsensus diantara anggota keluarga (Sunarti, 2008).

Keluarga memiliki tugas perkembangan sepanjang kehidupannya yang menjaga keberlangsungan dan keberlanjutan kehidupan ummat manusia. Tugas tersebut adalah : 1) Pemeliharaan kebutuhan fisik, 2) Alokasi sumber daya, 3) Pembagian tugas, 4) Sosialisasi anggota keluarga, 5) Reproduksi, penambahan dan pelepasan anggota keluarga, 6) Pemeliharaan tata tertib, 7) Penempatan anggota di masyarakat luas, dan 8) Pemeliharaan moral dan motivasi (Duvall, 1970).

Perhatian terhadap pentingnya ketahanan keluarga termaktub dalam Undang Undang No 10 Tahun 1992 tentang pembangunan kependudukan dan keluarga sejahtera mendefinisikan ketahanan keluarga sebagai “kondisi dinamik suatu keluarga yang memiliki keuletan dan ketangguhan serta mengandung serta mengandung kemampuan fisik-materiil dan psikis-mental spiritual guna hidup mandiri dan mengambangkan diri dan keluarganya untuk hidup harmonis dalam meningkatkan kesejahetraan lahir dan kebahagian batin.”  Dengan menggunakan pendekatan system (input, proses-output) keluarga, Sunarti (2001) memaknai ketahanan keluarga sebagai kemampuan keluarga untuk mengelola sumberdaya keluarga, mengelola dan menanggulangi masalah yang dihadapi, untuk mencapai tujuan yaitu kesejahteraan keluarga. Selanjutnya hasil analisis faktor laten ketahanan keluarga ditemukan tiga komponen ketahanan keluarga yaitu ketahanan fisik, ketahanan social, dan ketahanan psikologis. Ruang lingkup ketahahan keluarga dari sudut pandang komponen system dan komponen laten ketahanan keluarga disajikan pada Gambar 2.

BKKBN, kualitas SDM, Ketahanan Keluarga

Gambar 2. Ruang Lingkup Ketahanan Keluarga Dari Pendekatan Sistem dan Pendekatan Faktor Laten

Output dari ketahanan keluarga adalah kesejahteraan keluarga yaitu terpenuhinya kebutuhan keluarga sebagai system dan kebutuhan setiap anggotanya sebagai individu.  Kebutuhan individu dan keluarga hendaknya dipertimbangkan dalam konteks masyarakat dan ekosistem, dan menjadi landasan motivasi perilaku individu dan keluarga. Dari pandangan keluarga sebagai ekosistem, terdapat beberapa asumsi dimana organisme (keluarga) hendaknya memiliki mekanisme timbal balik (feed-back) dalam rangka beradaptasi dengan baik terhadap perubahan lingkungan. Mekanisme tersebut berkaitan dengan beberapa hal yaitu; bagaimana keluarga memperoleh informasi mengenai perubahan lingkungan, seberapa banyak kontrol keluarga terhadap keragaman lingkungan, mekanisme adaptif apa saja yang dimiliki keluarga, dan apakah keluarga mengalami stress ketika keluarga harus beradaptasi terhadap perubahan drastis yang didorong oleh pihak luar (Melson, 1980). Kemampuan keluarga dalam beradaptasi merupakan teori Parson, yaitu bagaimana keluarga memperoleh sumberdaya dari luar untuk didistribusikan agar terpenuhinya kebutuhan pokok merupakan fungsi yang menentukan keberlangsunagn keluarga (Hamilton 1983)

Ketahanan keluarga berkaitan dengan mekanisme akomodatif dan adaptif keluarga terhadap perubahan lingkungan yang sangat beragam, seperti dicontohkan reaksi keluarga terhadap berbagai program pemerintah. Dampak negatif yang sangat nyata dari kebijakan dan program pemerintah terhadap ketahanan keluarga adalah bila menyebabkan peningkatan anggota keluarga atau kepala keluarga yang kehilangan pekerjaan. Penelitian secata jelas menunjukkan keterkaitan kehilangan pekerjaan  dan pengangguran (walaupun sementara) dengan tingkat stress (Moen, P. dalam McDonald & Nye, 1979), dan dampak kesulitan ekonomi keluarga (karena kehilangan pekerjaan) terhadap keberfungsian keluarga. Hasil kajian mengenai dampak program kesejahteraan (welfare program) terhadap stabilitas perkawinan dan perkawinan kembali (remarriage) di Amerika Serikat menunjukkan bahwa keluarga berpendapatan rendah (kulit putih) penerima program bantuan kesejahteraan memiliki frekuensi gangguan perkawinan lebih tinggi dibandingkan dengan keluarga bukan penerima program.

Hasil penelitian ketahanan keluarga di Indonesia menunjukkan pentingnya penguatan keluarga Indonesia terutama keluarga miskin dan yang berada pada kondisi crisis. Ketahanan keluarga berkaitan dengan keberfungsian keluarga dalam pembangunan kualitas sumberdaya anak seperti hasil penelitian Sunarti (2008) yang menunjukkan bahwa ketahanan keluarga mempengaruhi pengasuhan anak dan akibatnya mempengaruhi pertumbuhan dan perkembangan anak.  Penelitian mengenai ketahanan keluarga petani miskin (Sunarti dkk 2007) menunjukkan bahwa kemampuan adaptasi keluarga menentukan keberanian keluarga untuk menetapkan tujuan yang ingin dicapai, keberfungsian integrasi dan latency keluarga. Akses dan pemanfaatan informasi  mempengaruhi kesejahteraan subjektif. Petani yang memiliki akses dan memanfaatkan informasi yang diterimanya memiliki peluang yang lebih besar untuk lebih sejahtera (subjektif) dibandingkan hal sebaliknya. Untuk meningkatkan kesejahteraannya, pada umumnya petani miskin dan buruh tani beserta para istrinya menerapkan pola nafkah ganda.

Penguatan ketahanan keluarga semakin penting dewasa ini dimana keluarga menghadapi berbagai perubahan, tantangan, dan crisis. Pada kondisi tersebut keluarga membutuhkan dukungan social dari lingkungan di sekitarnya (Sunarti 2007). Hasil penelitian ketahanan keluarga Jawa yang telah lama tinggal di Aceh kemudian diusir terkait  kerusuhan GAM, menunjukkan bahwa dukungan social yang diterima keluarga sangat membantu keluarga untuk tetap bertahan dan menjalankan fungsi keluarga yang minimal (Sunarti dkk 2005)

 

D.   Program Ketahanan Keluarga  : Beyond Family Planning

PP no 21 Tahun 1994 tentang pembangunan keluarga sejahtera memberikan landasan konsep keluarga sejahtera, keluarga berkualitas, dan kualitas keluarga. Keluarga sejahtera adalah keluarga yang dibentuk berdasarkan atas perkawinan yang sah, mampu memenuhi kebutuhan hidup spiritual, dan materiil yang layak, bertaqwa kepada Tuhan Yang Maha Esa, memiliki hubungan yang serasi, selaras, dan seimbang antar anggota dan antara keluarga dengan masyarakat dan lingkungan. Sedangkan keluarga berkualitas adalah keluarga-keluarga yang sejahtera, sehat, maju, mandiri, mempunyai anak yang ideal, berwawasan ke depan dan bertanggung jawab. Sementara itu kualitas keluarga adalah kondisi keluarga yang mencakup aspek pendidikan, kesehatan, ekonomi, social budaya, kemandirian keluarga, dan mental spiritual serta nilai-nilai agama yang merupakan dasar untuk mencapai keluarga sejahtera.

Arah pembangunan keluarga sejahtera dalam kurun waktu 2004-2009 tertera dalam Peraturan Presiden RI Nomor 7 Tahun 2005 tentang RJMN 2004-2009.  Dalam PP tersebut dinyatakan bahwa pembangunan kependudukan dan keluarga kecil berkualitas merupakan langkah penting dalam mencapai pembangunan berkelanjutan, yang dilakukan melalui pengendalian kuantitas penduduk dan peningkatan kualitas insani dan sumber daya manusia.  Hasil pendataan keluarga tahun 2007 menunjukkan terdapat  57.491.268 keluarga. Sedangkan hasil pendataan tahapan keluarga sejahtera dengan menggunakan 21 indikator disajikan pada Tabel 2. Data keluarga sejahtera menunjukkan masih tingginya keluarga yang tergolong KPS dan  KS-I tahun 2007 (46.7%). sedangkan jumlah KPS dan KS-I yang tergolong miskin pada tahun 2007 sebesar 35.7%.

Tabel 2. Sebaran Keluarga Menurut Tahapan Keluarga Sejahtera Hasil Pendataan Keluarga Tahun 2006 dan 2007

No Tahap KS

Tahun 2006

Tahun 2007

Jumlah

%

Jumlah

%

1 KPS

13.326.683

23.9 13.479.039 23.4
2 KS I

13.413.562

24.0 13.387.570 23.3
3 KS II

14.941.051

26.8 15.582.818 27.1
4 KS III

11.773.037

21.1 12.514.508 21.8
5 KS III PLus

2.350.938

4.2 2.527.333 4.4
Jumlah KK

55.803.271

100

57.491.268

100

Terdapat dua sasaran pokok pembangunan kependudukan dan keluarga kecil berkualitas sampai tahun 2009.  Pembangunan kesejahteraan keluarga dilakukan diantaranya melalui program ketahanan dan pemberdayaan keluarga serta program penguatan kelembagaan keluarga kecil berkualitas. Permasalahan yang terkait dengan kualitas dan atau kesejahteraan keluarga adalah masih lemahnya ketahanan keluarga, terutama ekonomi keluarga yang mempengaruhi daya beli termasuk kemampuan membeli alat dan obat kontrasepsi. Keluarga  miskin pada umumnya mempunyai anggota keluarga cukup banyak. Kemiskinan menjadikan mereka relative tidak memiliki akses dan bersifat pasif dalam berpartisipasi untuk meningkatkan kualitas diri dan keluarganya, yang akan  semakin memperburuk keadaan social ekonomi keluarga miskin tersebut.

Program Ketahanan dan pemberdayaan keluarga bertujuan untuk meningkatkan kesejahteraan dan membina ketahanan keluarga dengan memperhatikan kelompok usia penduduk berdasarkan siklus hidup, yaitu melalui janin dalam kandungan sampai dengan lanjut usia, dalam rangka membangun keluarga kecil yang berkualitas. Namun demikian, tingkat partisipasi masyarakat dalam pembinaan ketahanan keluarga, terutama pembinaan tumbuh-kembang anak masih lemah. RPJM 2004-2009 bidang keluarga sejahtera disajikan pada Tabel 3.

Tabel 3. RPJM 2004-2009 Bidang Keluarga Sejahtera

A Kebijakan Pembangunan Keluarga Sejahtera
  1. Meningkatkan pemberdayaan dan ketahanan keluarga dalam kemampuan pengasuhan dan penumbuhkembangan anak
  2. Peningkatan pendapatan keluarga khususnya bagi KPS dan KS I
  3. Peningkatan kualitas lingkungan keluarga
  4. Memperkuat kelembagaan dan jejaring pelayanan KB bekerjasama dengan masyarakat luas, dalam upaya pengendalian jumlah dan laju pertumbuhan penduduk dan pembudayaan keluarga kecil berkualitas
B Tujuan program di bidang keluarga sejahtera
  1. Peningkatan kesejahteraan dan ketahanan keluarga dengan memperhatikan kelompok usia penduduk berdasarkan siklus hidup, yaitu mulai dari janin dalam kandungan sampai dengan lanjut usia, dalam rangka membangun keluarga kecil berkualitas
  2. Pembinaan kemandirian dan peningkatan cakupan dan mutu pelayanan KB dan KR, serta ketahanan dan pemberdayaan keluarga, terutama yang diselenggarakan oleh institusi masyarakat di daerah perkotaan dan perdesaan dalam rangka melembagakan keluarga kecil berkualitas
C Indikator Sasaran RPJMN 2004 – 2009 Bidang Keluarga Sejahtera
  1. Meningkatnya partisipasi keluarga dalam pembinaan tumbuh kembang anak
  2. Meningkatnya jumlah Keluarga Pra Sejahtera (KPS) dan Keluarga Sejahtera I (KS I) yang aktif dalam usaha ekonomi produktif
  3. Meningkatnya jumlah institusi masyarakat dalam penyelenggaraan pelayanan Program Keluarga Berencana Nasional
D Program dan Kegiatan Pokok Pembangunan Keluarga Sejahtera
  1. Program ketahanan dan pemberdayaan keluarga melalui 1) advokasi, KIE dan konseling tentang pola asuh dan tumbuh kembang anak, kebutuhan dasar keluarga, akses terhadap sumber daya ekonomi, peningkatan kualitas lingkungan keluarga, 2) ketrampilan kewirausahaan kelompok UPPKS, 3)Cakupan dan kualitas UPPKS,  BKB, BKR, BKL
  2. Program penguatan pelembagaan keluarga kecil berkualitas (data, informasi, tenaga lapang, supervise)
E Grand strategi Program KB
  1. Menggerakkan dan memberdayakan seluruh masyarakat dalam Program KB
  2. Menata kembali pengelolaan Program KB di seluruh unit kerja
  3. Memperkuat SDM operasional Program KB
  4. Meningkatkan ketahanan dan kesejahteraan keluarga melalui pelayanan KB, , dengan sasaran :
    1. Seluruh keluarga balita menjadi anggota aktif Bina Keluarga Balita (BKB)
    2. Setiap KPS dan KS I anggota UPPKS memiliki usaha ekonomi produktif
    3. Setiap kecamatan memiliki kelompok percontohan Bina Keluarga Remaja (BKR)
    4. Setiap kabupaten/kota memiliki kelompok percontohan Bina Lingkungan Keluarga (BLK)
    5. Meningkatkan pembiayaan Program KB

Rencana kegiatan pemerintah (RKP) dan indicator kinerja bidang keluarga sejahtera tahun 2006 sampai 2009 disajikan pada Tabel 4.

Tabel 4. Rencana Kegiaan Pemerintah (RKP) dan Indikator Kinerja Bidang Keluarga Sejahtera tahun 2006 – 2009

Catatan :

  • Hasil rekapitulasi dari berbagai laporan BKKBN
  • Indikator kinerja Bidang KS tahun 2005 bersifat kualitatif

E. ISSUE DAN REKOMENDASI

Program KB dalam konteks pembangunan SDM dan Ketahanan keluarga perlu terus ditingkatkan dan diperbaiki pelaksanaan programnya mengingat tantangan pembangunan kependudukan semakin besar di masa sekarang dan masa yang akan datang.  Selain itu juga diperlukan upaya sungguh-sungguh untuk meminimalisasi hilangnya manfaat ekonomi dari bonus denografi yang telah dialami bangsa Indonesia.

Keterkaitan program KB dengan perkembangan sosial ekonomi nasional merupakan akumulasi kinerja pelaksanaan program dari seluruh wilayah Indonesia yang memiliki tingkat kemajuan berbeda.  Masih terdapat wilayah dengan pertumbuhan penduduk yang tinggi (contohnya Provinsi Riau). Sampai saat ini belum tersusun suatu kebijakan dan strategi pengendalian kuantitas, peningkatan kualitas, dan pengarahan mobilitas penduduk yang sesuai dengan pertumbuhan ekonomi wilayah.  Terdapat peningkatan peserta KB aktif (dari % Pasangan usia subur) dari tahun 2006 (69.53%) ke tahun 2007 (70.16%). Namun demikian masih cukup tinggi prosentase unmet-need (kelompok yang ingin anak ditunda dan tidak ingin anak lagi) yaitu 17.65 % (terhadap 40.120.916 PUS) pada tahun 2006 dan 17.57% (terhadap 41.257.075 PUS) pada tahun 2007. Beberapa catatan hasil evaluasi program KB menunjukkan pentingnya penyediaan tenaga trampil dan terlatih yang dapat berkomunikasi dan mengerti kebutuhan klien serta jaminan penyediaan dan pemenuhan kebutuhan alat kontrasepsi terutama bagi masyarakat miskin.

Keterkaitan program KB dan pembangunan SDM berada pada keluarga, karena pengambilan keputusan, pengetahuan anggota keluarga yang melandasi keputusan, serta perilaku lainnya yang berkaitan dengan indicator-indikator kualitas SDM ada pada kehidupan keseharian di keluarga. Pengetahuan tentang KB dalam kaitannya dengan kualitas SDM dan kesejahteraan keluarga, keputusan berpartisipasi ber-KB, serta pengaturan sumberdaya untuk ber-KB terkait merupakan gambaran ketahanan keluarga.

Pada tataran konsep, ketahanan keluarga memiliki dimensi yang lebih luas dari kesejahteraan keluarga karena kesejahteraan merupakan output dari ketahanan keluarga. Namun dalam tataran program, RPJM 2004-2009 bidang keluarga sejahtera yang dilaksanakan BKKBN difokuskan kepada program ketahanan keluarga kepada keberfungsian ekonomi dan fungsi sosialisasi keluarga yang memiliki anak balita, remaja, dan lansia. Hal ini menghantar pada pembahasan apakah memang tepat menempatkan program ketahanan dan keluarga sejahtera sebagai beyond family planning ? atau apakah diperlukan repositioning program ketahanan dan pemberdayaan keluarga  walaupun masih ditempatkan sebagai pendukung program KB/KR (Beyond Family Planning) ?

Indikator kinerja pembangunan KS dalam RKP 2004-2009 yang ditetapkan terlihat tidak konsisten, dan Indicator yang digunakan lebih menekankan pada proses dan bersifat sementara. Kalau indikator output pertumbuhan, gizi, dan kesehatan merupakan ranah Departemen Kesehatan, indicator pendidikan merupakan ranah Departemen Pendidikan, lantas bagaimana dengan indicator perkembangan anak ? dan apakah indicator keluarga sejahtera merupakan ranah BKKBN yang menempatkan program ketahanan dan pemberdayaan keluarga sebagai beyond family planning ?  hendaknya perlu ditetapkan bahwa indicator keluarga sejahtera merupakan indicator pembangunan yang dilaksanakan lintas departemen, dan bukan sebagai indicator kinerja program KPK semata.

Kesejahteraan keluarga merupakan output dari ketahanan keluarga. Data tahapan KS dipandang masih tetap dibutuhkan, karena memiliki fungsi dan peran yang melengkapi dengan data pembangunan lainnya. Data tahapan KS dapat memotret  kualitas kehidupan keluarga dan menyediakan informasi bagi penentuan kebijakan dan program pembangunan lainnya. Data tahapan KS juga dapat ditempatkan sebagai salah satu indicator pembangunan yang menuntut koordinasi pelaksanaan pembangunan lintas departemen. Hasil pendataan menunjukkan bahwa dari tahun 2006 ke tahun 2007 hanya sedikit sekali penurunan keluarga KPS dan KS-1, dan penurunan KPS dan KS-I gakin. Hal tersebut menghantar pada pertanyaan besar terkait efektifitas program pemerintah yang dilakukan selama ini, baik yang secara tidak langsung apalagi secara langsung ditujukan untuk perbaikan ekonomi keluarga, peningkatan kesejahteraan keluarga, dan pengentasan kemiskinan. Sistem dan mekanisme pendampingan yang tidak tuntas dipandang sebagai salah satu kurang efektifnya upaya pemberdayaan ekonomi keluarga. Demikian pula dipandang penting untuk perluasan target sasaran pemberdayaan ekonomi keluarga.

Penurunan kinerja dan pelaksanaan program KB dan KS di daerah terkait perubahan struktur dan mekanisme kerja program KB dan KS setelah otonomi daerah, menyebabkan kesan seakan-akan BKKBN hanya sebagai pencatat indicator, dan bukan sebagai penjamin dan pengawal pencapaian indicator KB-KS.

 

F. Daftar Acuan

Anonim. 1992. Undang Undang Negara Republik Indonesia No 10 Tahun 1992 tentang Perkembangan Penduduk dan pembangunan Keluarga Sejahtera

Anonim. 2004. Indonesia Country Report. National Progress in Implementing the ICPD Programme of Action 1994-2004.

BKKBN. 2008. Kajian Awal RPJM 2010-2014 Bidang Keluarga Sejahtera. Makalah Seminar. Tidak dipublikasikan.

Committee on Nutritional Status During Pregnancy and Lactation. Food and Nutrition Board Institute of Medicine National Academy Sciences. 1990. Nutrition During pregnancy.  National Academy Press. Washington, D.C.

Dawam M. 1996. Pemantapan Fungsi keluarga Menuju Terbentuknya Keluarga Sejahtera. Kajian Aplikasi dan criteria Implementasi Delapan Fungsi Keluarga. Badan Koordinasi keluarga Berencana Nasional. Puslitbang Keluarga Sejahtera, Jakarta.

Duvall, EM. 1970. Family Development. 4th Edition. JB. Lippincort Company, New York

Haaga, J.G., 1995. Family Planning as Promoter of Child Survival and Growth. Dalam Andersen, P.P., David Pelletier, & Harold Alderman. Ed.  Child Growth and Nutrition in Developing Countries. Priorities for Action. Cornell University Press. Ithaca and London

Halpern, Seymour L. 1987. Quick Reference to Clinical Nutrition. A Guide for Physicians. J.B. Lincott Company Philadelphia. London

Hamilton, P. 1983. Key Sociologists Talcott Parsons. Ellis Horwood Limited. New York.

Krysan, M., Kristine A. Moore, & Zill, N., 1990. Identifying Successful Families: An Overview of Construct and Selected Measures

Leslie, Joanne. 1995. Improving the Nutrition of Women in the Third World. Dalam Andersen, P.P., David Pelletier, & Harold Alderman. Ed.  Child Growth and Nutrition in Developing Countries. Priorities for Action. Cornell University Press. Ithaca and London

Melson, G.F. 1980. Family and Environment. Burgess Publishing Company. Mineapolis, Minnesota.

Moen, P. 1979. Family Impact of the 1975 Recession: Duration of Unemployment. Dalam McDonald, Gerald. & F. Ivan Nye. (ed). 1979. Family Policy. National Council on Family Relations. Minneapolis, Minnesota

Mongid. 1996. Gerakan pembangunan Keluarga Sejahtera. Kantor Menteri Negara kependudukan / Badan koordinasi Keluarga Berencana Nasional. Jakarta

Pedersen, S and T.A Revenson. 2005. Parental illness, family functioning and adolescent well-being: a family ecology framework to guide research. University of Montreal, Canada.

Rosso, P.  1990. Nutrition and Metabolism in Pregnancy, Mother, and Fetus. Oxpord University Press. New York

Sunarti, E. 2001. Studi Ketahanan Keluarga dan Ukurannya: Telaah Kasus Pengaruhnya Terhadap Kualitas Kehamilan. Disertasi pada Program Studi Gizi Masyarakat dan Sumberdaya Keluarga. Program Pasca Sarjana IPB. Bogor

Sunarti, E., Ifada, Q., Desmarita, I., dan Hasanah, S. 2005. Ketahanan Keluarga Pengungsi Aceh. Laporan Penelitian Due-Like IPB

Sunarti, E. Amalina R.P., Munawar, C., Nuryani, N., Suryana. 2007. Ketahanan keluarga Petani Miskin. Laporan Penelitian pada Departemen GMSK IPB

Sunarti, E. 2007. Theoritical and Methodological Issues in Family Resilience. Makalah disampaikan pada Senior Official Forum on Families dalam rangka persiapan East Asian Ministerial Forum on Families. Diselenggalakan oleh Departemen Sosial bekerjasama dengan BKKBN, Departemen Luar Negeri, dan Kementerian Negara Pemberdayaan Perempuan, Bali September 2007.

Sunarti, E. 2008. A Study of Plantation Women Workers : Socio Economic Status, Family Strength, Food Security, and Children Growth and Development. Laporan Penelitian disampaikan kepada Neys Van-Hoogstraten Foundation

Soetrisno, L. 1997. Kemiskinan, Perempuan, dan Pemberdayaan.penerbit Kanisius, Yogyakarta.

UNFPA & PATH 2006. Meeting the Need. Strengthening Family Planning Programs.

UNICEF. 1997. Malnutrition in South Asia; A Regional Profie. Stuart Gillespie. Editor. Rosa Publication No.5. UNICEF Regional Office for South Asia. Kathmandu, Nepal.

UNICEF. 1997a. Memaksimalkan Potensi SDM Indonesia. Sebuah Pendekatan Bertumpu pada Resiko di Keluarga, Kebutuhan dan Hak-haknya dalam rangka Menentukan Prioritas dan Strategi REPELITA VII. Jakarta

USAID. 2005. Strengthening Family Planning Policies and Programms in Developing Countries : An Advocacy Toolkit

WHO Expert Committee on Physical Status. 1995. Physical Status: The Use and Interpretation of Anthropometry. WHO Technical Report Series. Geneva

Zeitlin, M.F., Megawangi, R., Kramer, E.M., Coletta, N.D., Babatunde, E.D., & D. Garman. 1995. Strengthening The Family. Implications for International Development. The United Nations University. Tokyo


[1] Dilaksanakan oleh Deputi Bidang SDM dan Kebudayaan, Badan Perencanaan Pembangunan Nasional dalam rangka penyusunan Rancangan Awal RPJMN periode 2010-2014 Pembangunan Keluarga Berencana.

 

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