Ignoring teen sexuality only increases health risks

Firman Lubis

I remember my first blue movie. A friend from university had managed to smuggle it back to Indonesia from overseas. A group of us gathered in a classroom with the door locked, terrified of being caught but amazed at what we were watching. Until that point such films had been urban legend. Strict censorship and no formal sex education meant that for many, this foreign erotica was our first introduction to sexual acts beyond hand holding.

That impromptu screening was many years ago. Unfortunately not much has changed since then. Many young Indonesians continue to obtain their sex education from pornographic films and magazines.

Social taboo means that teen sexuality cannot be talked about in open forums. Teens whisper about love, sex, petting and flirting, but only in school corridors and behind closed doors. Myths about sex abound. And the lack of comprehensive sex education means that young Indonesians are naively putting themselves at risk of disease and unwanted pregnancy. Why have these taboos persisted?

Cultural conservatism

Indonesia agreed to improve adolescent reproductive health at the International Conference on Population and Development (ICPD) in 1994. Despite this agreement, in 1996 Indonesia passed two new laws that confirmed the nation’s conservative stance on teen sexual health. The New Order government and Islamic groups had reached an agreement on family planning. Islamic groups would support the propagation of contraception so long as it was only made available to married couples.

The 1996 Family Health Law and Population and Development Law therefore explicitly deny any possibility for unmarried sexually active adolescents to obtain proper services to prevent or treat reproductive health problems.

Regulations compound the stigma, both institutional and social, against sexually active teens. Since its inception, the family planning program has resisted calls to provide clinical services for sexually active adolescents. Conservative groups argue that exposure to discussion of sex and contraceptives will encourage adolescents to experiment sexually. It seems libidos are only acceptable within the institution of marriage. Any expression of sexuality outside that domain is forbidden.

Young Indonesians explain that while they know condoms are important they find contraceptive services difficult to access. Similarly, when an adolescent contracts a sexually transmitted infection (STI) they face the awkward task of seeking help from healthcare providers. Social discomfort leads many young people to try to treat the infection themselves. It is not uncommon for substances like lemon juice to be used to prevent both pregnancy and sexually transmitted infections.

It comes as no surprise that abortion remains illegal. Very few safe abortion services are available. Many women are forced to seek out traditional providers who use methods such as abortive herbal concoctions, massage, and unsafe abortion techniques. Such termination practices make a significant contribution to maternal mortality among young mothers in Indonesia.

Heads in the sand

All these factors contribute to the current situation where, more than a decade after the ICPD, the incidences of unwanted pregnancies, unsafe abortion and STIs among Indonesia’s youth have increased.

Lack of knowledge plays a part in increased sexual health problems. Most parents feel uncomfortable talking about sex with their children. Adolescents often say that it is much easier to talk to their friends than their parents. With alarming frequency pornography is cited as a source of information.

Sex education must include open discussion and link into high quality clinical services to ensure adolescents are able to make well-informed choices. At present, only youth-focused NGOs and some private schools have implemented comprehensive sex education. Meanwhile parents and the community encourage youths to wait until marriage before they engage in sexual activity.

Young people should also be informed of the risks and know how to protect themselves from STIs and unwanted pregnancies. Providing young people with restricted information on the basis that sex outside of marriage is immoral and they should remain abstinent until marriage is both unrealistic and potentially harmful.

Regulation of adolescent sexuality in Indonesia remains strongly based on moral and religious beliefs rather than any pragmatism that addresses current health needs. If Indonesia fails to implement all changes agreed to at the ICPD, rather than just those that are socially palatable, there will continue to be increasing reproductive health problems among adolescents.

Firman Lubis (flubis@rad.net.id) is senior lecturer at the University of Indonesia’s Medical Faculty.