The ratio of Maternal Mortality Rate (MMR), which is still at 228 deaths per 100,000 live births, still remains a main concern in reproductive health in Indonesia (Indonesia Demographic and Health Survey, 2007). The rate of unfulfilled needs for the Family Planning services is currently at 9%, including 4.7% to limit the number of births and 4.3% to interpregnancy intervals. It is expected that the number of women needing reproductive health and family planning services will increase from 64 million in 2009 to 68 million in 2015. A total of 42% (29 million) from the population of women in need of reproductive health and family planning services will consist of unmarried women which are prohibited by the Health Law to access the family planning service. Approximately 65 million youths aged 10-24, representing 28% of the total population of Indonesia, need special attention concerning reproductive health.

 

The most current survey conducted as part of the research shows that the general knowledge of reproductive health in Indonesia is still low. 45% females and 49% males aged 15-24 believe that there is no risk of pregnancy in a one-time sexual intercourse. The lack of information has caused numerous unplanned pregnancies among adolescents, as shown in the abortion rate which is at 10% for girls under 19 years old and 33% for unmarried women. It is estimated that the number of girls under 19 years old that had an unsafe abortion will be higher, particularly in villages. Moreover, youths themselves are not involved in the process of the making, planning, implementing and evaluating of policies and programs concerning their own reproductive health.

 

Previous experiences of Women Research Institute (WRI) in carrying out the pilot project in Central Lombok and Gunung Kidul demonstrate the prevalence in child marriages and unwanted pregnancies. As an illustration, the proportion of women with history of abortion ranges from 10% (in Central Lombok District) to 17% (in Mataram City).

 

Approximately 10% from abortion cases in West Nusa Tenggara were not performed by medical professionals. While the legality of abortion itself is still debatable, this mirrors the failure of health facilities to accommodate this issue properly. In 2011, the total births in Central Lombok District reached 18,915 births and approximately 10% occurred among adolescents aged 14-19.

 

Meanwhile, 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 2011. 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 – 19.

 

According to its research findings, WRI held a seminar and launched two documentary films based on WRI’s pilot projects in the districts of Gunungkidul and Central Lombok. Through the film screening and discussions, it is expected that ways can be found to synergize adolescent reproductive health and the Maternal Mortality Rate reduction program which are currently held separately. Moreover, the relation between the fulfillment of adolescent reproductive health and the reduction of Maternal Mortality Health should also be analyzed.

 

Seminar Process

 

Opening Speech by Sita Aripurnami, Director of Women Research Institute

The issues of Maternal Mortality Rate (MMR) and adolescent reproductive health are yet to be considered serious issues by several parties. WRI’s experiences in the empowerment of women and youths are presented in this documentary film. The increase in early marriage is a serious matter and is of great importance to be discussed together. WRI expresses its appreciation to Gunungkidul District that welcomed the documentary film produced by WRI and committed, together with decision makers, to enhance the education on adolescent reproductive health in Gunungkidul. Considering that the target year of MDGs will end shortly, it is imperative to discuss ways to achieve the targets of 2015 MDGs.

 

Opening speech by David Hulse, Country Representative of Ford Foundation

Today is a special day, 12-12-12. The high occurrence of early marriage affects poverty. Early marriage and pregnancy will also influence the young maternal deaths in Indonesia; consequently, the age of maternal deaths during pregnancy or birth continuously occurs at a younger age. Ford Fooundation attempts to reduce MMR in Indonesia through education on reproductive health to reduce the rate of early marriages which also lowered early pregnancies. What WRI has done is on the right track to reduce MMR.

 

Key Note Speaker Dr. Nafsiah Mboi, SpA, MPH, Indonesian Minister of Health

I extend my highest appreciation to what our friends from WRI have done. Research on this issue has been carried out since the 1980s through the struggle to advocate the Law on Child Protection, Law No. 23/2003. I have yet to seen breakthroughs and the courage to think out of the box; the situations in the 80s and now are different. Youths should be able to think more innovatively by adhering to the Law on Child Protection and Health Law No. 36 of 2009.

 

Reducing MMR is an issue mandated by President SBY in achieving the 2015 MDGs. If we work hard together, we can achieve it in 2015, although it is indeed difficult to reduce MMR from 222/100,000 live births. It will not be solved only by stating that the cause of MMR is bleeding during young pregnancy, etc. We must seek the causes of the bleeding, both during young and late pregnancy, including pregnancy for women after 40, which proves that the Family Planning program has failed.

 

Before I became a minister, Bu Endang issued a policy on Delivery Warranty (Jampersal), in order to prevent more pregnancy-related deaths due to the high cost. Puskesmas has also been equipped with Basic Neonatal Obstetrics Services (PONED) and Comprehensive Neonatal Obstetrics Services (PONEK); however, this is still hindered by the uneven spread of obstetricians and gynecologists. During my early days as a docter, I was asked to be on duty without giving the options of yes or no in order to serve the people. If we now place docters in remote areas with limited facilities, it will be considered as violating human rights. Most graduates from medicine or nursing desire to be placed in big hospitals with complete equipments. The efforts to reduce MMR should be analyzed even further, as the budget and equipments have been improved yet the rate is still high.

 

The early marriage situation has happened since 30 years ago. The difference is that today we already have the Law on Child Protection, Law No. 23 of 2003. It is a pity that this law is still not widely used to advocate judges that permit the marriages of 16 year old adolescents because such judges actually violate the Law on Child Protection. Children in Indonesia refer to those who are under 18 years old. Every child has the right to obtain child services according to their physical and mental needs, including education which caters to their mental and talents.

 

For women that marry early, their access to education, jobs, and productivity will be closed. Article 10 of the Law on Child Protection states that every child has the right to voice their opinions and be heard, receive and find information according to their age and intelligence to increase their capacity. This means that the government is obliged to provide information on reproductive health to children and youths according to their level of intelligence and development.

 

Articles 71-77 Law No. 36 of 2009 on Health discuss the reproductive health that can be used to advocate. Everyone has the right to perform safe and healthy sexual activities with their legal partner. Therefore, I ask all of you to help the Ministry of Health to issue Government Regulations to fulfill reproductive health needs for children and youths. Sex education is given, according to the Law on Child Protection, before children or youths start performing active sexual relationships with a method appropriate for the development and age of children or youths.

 

In align with the 12 years of the compulsory education program, education should be given at the primary and secondary (junior high and high school) levels. The benefits of the research should be felt by teachers and parents, as it is usually parents who force children for early marriage. Many e-learning methods have been implemented, which can be used to accelerate sex education. Social media can also be used to disseminate to children and youths regarding the penal for perpetrators of sexual relationships and their right to refuse if enforced to marry early.

 

A good relationship between children and parents can reduce the rate of early marriages. We can explain that early marriages should be avoided in order for children to be able to develop physically, mentally, and socially.

 

The efforts to prevent risky sexual behavior are carried out from upstream to downstream. At the upstream level, we have provided education and yet this does not gurantee it will be successful. Thus at the downstream level, I tried to prevent it by giving condoms. I am certain that my intentions and the religious leaders’ intentions are the same; empowering children with religious basics and power so that they can say no to risky sexual behavior. The group that cannot be disregarded is the judges, who should be more ‘friendly’ to children and youths. Once more let’s unite, yes we can. We can enhance adolescent health and reduce MMR.

 

Film Screening

 

In this session, two WRI documentaries entitled ‘Reproductive Rights for Youths, Gunung Kidul’ and ‘Save Women from Maternal Mortality, Lombok’. This was followed with a panel discussion and Q&A session.

 

Heru Prasetyo, Deputy I of Monitoring and Controlling of Initiatives on Climate Change and Sustainable Development, President’s Delivery Unit for Development Monitoring and Oversight (UKP4)

Gender and Youths in Post-2015 Agenda

The declaration signed by 192 countries in 2000 stated that the series of security and human rights including the relation with development, environment, etc. This resulted in eight targets of MDGs. It can concluded that MDGs is an imperfect yet impactful part on the world’s countries and population, such as by enhancing education, health, etc.

 

Within MDGs there is an issue of injustice that should’ve been overcome, as the development that we are doing results in very rich and very poor groups. The efforts that should be carried out is how to realize justice by closing the disparity to avoid conflicts.

 

Technology may be considered to be misleading, but we can also take advantage from technology. UKP4 uses cellphones to receive pictures for reports to UKP4 in the event of violation of the implementation of program or agreed policies. In the future, we hope that the relationship between public and the government can be more collaborative, no longer merely control and coordination. We have to put our efforts in this as the challenges will grow bigger if we work separately on our own.

 

In 15 years, the leaders will be those are now still youths. Therefore, it is imperative to train youths and put a greater effort in providing maximum facilities and services for their education – for a better future world.

 

Ir. Dewi Yuni, Assistant Deputy for Gender in Health, KPPPA

Post-2015 Agenda for Women and Children

Until today, Indonesia has still been unable to reach its target to reduce MMR as mandated in MDGs. The 2007 data from Indonesia Demographic and Health Survey shows that the MMR in Indonesia is still at 228 per 100,000 live births, making it one of the highest in South East Asia. Women’s awareness to check up during pregnancy is still low; and even when the awareness is there, a number of obstacles hinder these women to access such health facilities.

 

The median age of first marriage has shifted from 18.1 (1984) to 19.8 (2007) for women. Early marriage can happen to both boys and girls, but the most common victim are girl child, as after getting married they will lose the access to education, jobs, and other social aspects. There are still many cases of marriage among girls aged 10-14 which cause risky early pregnancy, leading to the increase in MMR.

 

The government has issued a number of policies to reduce early marriages and MMR, such as the Law on Child Protection, poverty alleviation program, MDGs which also support those objectives, the Jampersal policy, etc. The government is committed to involve youths in sustainable development to reduce early marriages.

 

Immawan Wahyudi, Vice Regent of Gunungkidul

School-Aged Children and Youth Health Development Policy

I fully support what WRI has carried out, particularly with the film producing. What is happening in society is something that should be exposed instead of concealed so that all parties will be aware of the reality and improve such condition together, such as in the geographic and demographic landscape of Gunungkidul, where a number of 42 villages in 10 subdistricts still considered as underdeveloped villages (29.17%). The citizens of Gunungkidul have a very strong social relationship, as well as very high spirit of entrepreneurship and work ethics. The health issue of children and youths is very complex and carious for every age group (education level).

Intersectoral cooperation such as youths and sports, health, and regional government is carried out to enhance the health status of children and youths. Related programs include School Health Unit, Little Doctors and Peer Counsellors, Adolescent Health Care Services at Puskesmas (Public Health Centers). There are currently 10 health centers in Gunungkidul, five are in good condition while the rest are still under development, as well as an Establishment Forum for Teen Counseling Information Center in Gunungkidul.

 

Early marriage (and pregnancy) happening to children results in a vicious circle of poor health. Various issues that adolescents face in Gunungkidul District are: adolescent issues are still not a priority; the lack of synergy between institutions within the district; the limited budget support; the small number of schools that maximize adolescent health programs; the lack of conformity between the service hours of health centers and teen-counseling; and the lack of health budget in schools – thus, consultation and check-up fees will have to be covered by adolescents themselves.