Since 2000, Indonesia has made several advances in identifying the needs of reproductive health for teenagers and defining the choices of policies. The government has realized the needs for better sexual and reproductive health education in schools, in particular considering the epidemic growth of sexual transmitted diseases (STIs) and HIV/AIDS in this country. However, due to the political sensitivity regarding the Adolescent Reproductive Health, policy dialogues have not been transformed into concrete programs to cater to the needs of teenagers’ reproduction. Urgent policy issues include the need to review the Health Law (Law No. 36 of 2009) and revise it to ensure that reproductive health education is inserted into the school curriculum and that the restrictions on birth control for single youths must be lifted. Reproductive health services for single youths must be provided and offered in a friendly and confidential environment so that those in need may access the service without being exposed to stigmas.

The Health Law regulates various health issues, such as health principles and goals, the rights and obligations of each individual to access healthcare, the government’s responsibilities to provide healthcare, the government’s responsibilities to provide resources so that the health sector can provide the most possible healthcare for the people, and so on. However, the law is contradictory in itself. On the one hand, if the life of a pregnant woman is threatened, abortion under particular medical procedures is needed. On the other hand, such medical procedures are considered to violate the legal norms. Therefore, when female teenagers are faced with pre-marital pregnancy, they often opt for unsafe abortion, staking their lives in the hands of unprofessional assistants and traditional birth attendants. In addition, the Marriage Law No. 1 of 1974, which sets the minimum legal age for marriage at 16 for females and 19 for males, should also be re-reviewed.

Despite more than one in five Indonesians being 15-24 years old, Indonesia’s policy and program agenda currently overlook teenagers. As a result, Indonesian teenagers and youths are still unprepared to face challenges of reproductive health and responsibilities that they will encounter when they enter their reproductive years.

WRI’s Previous Achievements

WRI has demonstrated its achievements in its pilot projects in Gunung Kidul District and Central Lombok District, which were sponsored by Ford Foundation. WRI held a pilot project in Gunung Kidul and Central Lombok on sex education and reproductive health for policy makers, female villagers and teenage girls since November 2010. Gunung Kidul was chosen due to the high number of unwanted pregnancies among females aged 11-19, which led them to unsafe abortion procedures. According to the data from Adiwarga Clinic, in 2010, there were 366 cases of unsafe abortions in Gunung Kidul. Central Lombok was chosen because in 2011, according to the Central Lombok Health Office, the number of births among females aged 14-19 was 1,891. Several important findings which need to be highlighted and considered as WRI’s achievements are as follows:

 

1. WRI has developed a database on women’s participation in both pilot districts on the needs for sexual health and reproduction, particularly the needs for maternal healthcare; state of sexual and reproductive health and facilities for women and girls, including data of maternal health and budget allocation, profiles of poor women, girls and their families, and a list of poor and marginalized women and girls in the pilot project’s areas.

2. After being facilitated for a year, in early 2012, the Community Forum was established in two villages in Gunung Kidul, namely Karangawen Village and Kanigoro Village. WRI gave trainings on reproductive rights and budget analysis for members of the Community Forum, which consisted of decision makers at the village level, rural midwives, rural nurses, women and girls, as well as men that benefit from the health service. The Community Forum has succeeded to involve teenagers in the planning of programs to serve their reproductive health needs.

3. The Community Forum activity has led to the establishment of the Core Group in Gunung Kidul, which is ready to initiate the establishment of the Youth Forum at the District Level. WRI plans to facilitate the Youth Forum to educate public policy makers at the district level on adolescent reproductive needs. In the future, best practices at the two villages will be replicated in other villages in Gunung Kidul, facilitated by the Youth Forum.

4. Since 2011, two Community Forums have been established in two villages, namely Menemeng Village and Montongsapah Village. Similar to its activity in Gunung Kidul, WRI also provided trainings in reproductive rights and budget analysis to members of the Community Forum. The Community Forum has been a vehicle for women and teenagers to inform the District Health Office regarding issues in reproductive health services.

5. Due to the political and cultural obstacles faced by women and teenagers in regards to their participation in planning and budgeting, it is not surprising that the dissemination of policy making, planning, and budgeting has not been able to promote significant policy changes and budget reallocation to fulfill the reproductive health of teenagers and women. The Community Forum and Youth Forum are expected to need one or two years to secure funding from the regional budgets at the district and village levels to fund their programs on reproductive health service for women and teenagers as planned.

6. WRI’s work in the two pilot projects in Central Lombok and Gunung Kidul have been documented by WRI in the form of documentary films which can be used as an effective tool to educate members of society about Sexual and Reproductive Health and Rights for adolescents and as an advocacy tool  for policy makers.

7. WRI’s previous programs showed that in all four cities, despite the relatively low participation rate of women and adolescents in the process of development planning compared to men, there was an increasing trend of women’s participation, particularly adolescents, in policy making, planning, and budgeting. Moreover, their intellectual contribution and presence have also been acknowledged by the government, both at the village and district levels. The next step is to continue facilitating the Community Forum and Youth Forum and, for the case of Gunung Kidul, conducting budget advocacy at the village and district levels.

    

Problem Identification

Several main concerns of the reproductive health in Indonesia include the high maternal mortality ratio, which stands at 228 deaths per 100,000 live births (2007 Survey on Indonesian Health and Demography)¹. The rate of unfulfilled needs for the family planning service is at 9%, including 4.7% for control of the number of family members and 4.3% for interpregnancy intervals. It is estimated that the amount of women in need of family planning and reproductive health services will increase from 64 million in 2009 to 68 million in 2015, where 42% (29 million) consists of unmarried women, who are prohibited by the Health Law to access the government’s birth control or family planning services². There are a number of 65 million youths aged 10 – 24, representing 28 percent of the population, who need special attention regarding reproductive health and healthcare.

 The most current survey and research underscore that the general knowledge about family planning is still low. Forty-five percent females and forty-eight percent males aged 15-24 believe that there is no risk of pregnancy in a quick one-time sexual intercourse³. The lack of information has caused numerous unwanted pregnancies among adolescents, as shown in the abortion rate during birth, which is at 10% for girls under 19 years old and 33% for unmarried women⁴. The number of women under 19 years old that got unsafe abortion is estimated to be higher and more common in villages⁵. Moreover, youths and adolescents themselves are not involved in the process of the making, planning, implementing and evaluating of policies and programs concerning their own reproductive health.

WRI’s previous experiences in carrying out the pilot project in Central Lombok and Gunung Kidul demonstrate the prevalence in child marriages and unwanted pregnancies. As an illustration, in Gunung Kidul alone the number of child marriages registered at the district’s Office of Religious Affairs increased from 80 in 2010 to 145 in 20116. Young couples are aged 16 – 21. According to the data collected by the Indonesian Association of Family Planning (PKBI) in Gunung Kidul, the amount of unwanted pregnancies in Gunung Kidul reached 366 cases in 2010, and approximately 31.96% of it involved adolescents aged 11 – 197.

Adolescents are rarely involved in the process of policy making; and yet, they are the future generation with potential to enhance their sexual and reproductive health as well as the condition of their rights. Therefore, it is essential to educate teenagers, regional officers and the Regional House of Representatives with advocacy tools that use gender perspective in order to promote gender-responsive policies and budget allocations at the regional level.

As the pilot projects in Gunung Kidul and Central Lombok districts were more related to rural adolescents, WRI intends to suggest a program to replicate best practices from the empowerment of rural adolescents through sexual and reproductive rights as well as propose a budget for advocacy training and facilitation for the establishment of the People’s Forum and Youth Forum to Jakarta and Bandung (West Java) for the period of 1 June 2013 – 31 May 2015.

It is essential to involve youths and adolescents, both in rural areas and cities, in local decision-making and budgeting in issues concerning sexual and reproductive health and rights to enable them participate better in every level of planning at the local level, in order to deliver their reproductive needs and interests with confidence to regional officers and the Regional House of Representatives. WRI will involve them in workshops and trainings on implementing gender budgeting with other stakeholders, such as regional officers and the Regional House of Representatives. Therefore, it is expected that the involvement of these young women and adolescents will open an access for them to deliver their aspirations and interests to decision makers at the local level.

 

Related article:

Seminar of Sex Education and Sexual and Reproductive Health and Rights (SRHR) for Youths in Bandung, November 14, 2013

Seminar of Sex Education and Sexual and Reproductive Health and Rights (SRHR) for Youths in Jakarta, December 18, 2013

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1 The UN estimated that the maternal mortality rate in 2008 in Indonesia was 240 deaths per 100,000 live births. Cited from WHO (2010), Trends in Maternal Mortality: 1990 to 2008, Estimates Developed by WHO, UNICEF, UNFPA, and The World Bank.
2 Terrance Hull and Henry Mosley, Revitalization of Family Planning in Indonesia. GOI and UNFPA, Jakarta, February, 2009. http://www.itp-bkkbn.org/pulin/004_population_data_information.html
3 BPS-Statistics Indonesia and Macro International (2008), and, the Indonesia Young Adult Reproductive Health Survey (2007).
4 The Age Specific Fertility Rate (ASFR) for females ages 15-19 is 35 births per 1,000 females ages 15-19, while for women ages 20-24 the rate is 106 births per 1,000 women ages 20-24 (Hull and Hartanto, 2009, Fertility Estimates of Indonesia for Provinces: Adjusting Under-recording of Women in 2002-3, and the 2007 IDHS, BPS and UNFPA, Indonesia.
5 Sedgh G and Ball H, Abortion in Indonesia, In Brief, New York: Guttmacher Institute, 2008, No. 2.
6 Data from the Office of Religious Affairs at Gunung Kidul District, 2012.
7 Data from Adhiwarga Clinic, Kehamilan Tidak Dikehendaki di Daerah Istimewa Yogyakarta, 2010