Tag Archives: Sexual education

Under the Knife: Female Genitalia Mutilation Causes Long Term Psychological Effects on Indonesian Women

First published in Indonesia Expat, 1 August 2017

Female genitalia mutilation is common practice in Indonesia. Although it is largely associated with Islamic teachings, many claim there is no connection to the religion. I speak to women who have experience first-hand and discover that there are more than negative physical effects caused by this incredible act of violation of human rights.

Nini works as a house helper in Jakarta. Recently a grandmother to baby twin girls, she had planned to accompany her son and daughter-in-law to the twins’ first official doctor’s appointment a few days after their births in South Jakarta. The routine visit was to include a check-up, vaccinations and the female circumcision.

Female genitalia mutilation, known in Bahasa Indonesia as ‘sunat perempuan’ is a common practice in Indonesia – and not just in rural areas. Parents and guardians like Nini have been told that the practice of either partially cutting or removing the clitoris entirely at a young age, without the child’s consent, is part of religious tradition that must be honoured. According to a 2016 report by UNICEF, 49 percent of Indonesian girls aged below 14 had undergone female genital mutilation by 2015.

In the country with the highest population of Muslims in the world, many people in Indonesia believe the practice is part of their religious passage. Historical records show that the practice began in the country with the arrival of Islam in the 13th century. It is carried out in different regions of the archipelago where Islam is predominant.

“I only know about sunat perempuan from the Betawi people I know, who say that it’s a religious passage in Islam,” says Nini, a Muslim who is originally from Cirebon and has not been circumcised. “Maybe it’s according to different regions’ traditions and beliefs.”

In 2013 the Indonesian Ulema Council ruled in favour of this violation against human rights, claiming it is part of Islamic teachings. Many Muslims, however, would disagree that it is taught in their religion.

Wulan Danoekoesoemo is the Co-Founder of Lentera Indonesia, an NGO aimed at providing support and counsel for victims of sexual abuse. Wulan is also a practicing Muslim and believes there is no passage in the Koran that teaches female circumcision.

“Female genitalia mutilation is not part of Islamic teachings,” she tells Indonesia Expat. “It has no medical/health benefit and was passed on through the generations as part of culture and tradition.”

Wulan herself is a victim of this violation against human rights. When she was only a few days old, her mother – believing she was acting in her daughter’s best interests at the time – took her to a clinic to have the procedure done on her. Although Wulan does not have any significant physical effects, she experiences psychological side effects until this day on a daily basis.

“Every time I get water on that region, I feel an incredibly overwhelming feeling of sadness and depression that I can’t explain,” she confesses.

“I feel worthless. It’s as though that part of me still recalls the extraordinary violation that took place all those years ago, and conveys it through my emotions.”

Wulan also teaches psychology at Binus University, and believes the psychological ramifications of female genitalia mutilation are significant to a woman’s development.

“When you’ve been violated from such a young age, it stays with you and defines the person who you are,” she says honestly. “Contrary to male circumcision in Indonesia, where the child or young man ultimately gets to make the decision as to whether or not he wants to ‘have the snip,’ girls are not asked – it just happens to them.”

The World Health Organisation states that the procedure has no health benefits whatsoever, contrary to popular local belief, unlike male circumcision, where health benefits include a reduced risk of some sexually transmitted diseases, protection against penile cancer and a reduced risk of cervical cancer in female sex partners.

The same practice on females can lead to harm. According to the World Health Organisation the procedure “can cause severe bleeding and problems urinating and later cysts, infections, as well as complications in childbirth and increased risk of newborn deaths.”

As Wulan experienced, psychological problems, including low self-esteem, depression and anxiety are long-term consequences associated with the practice.

Female genital mutilation is classified into four major types. Type one is the partial or total removal of the clitoris, type two is the partial or full removal of the clitoris and the labia minora, and type three is the narrowing of the vaginal opening through the creation of a covering seal. Type four includes all other harmful procedures carried out on the female genitalia for nonmedical purposes; pricking, piercing, scraping and cauterizing.

In Indonesia, types one and four is prevalent. In 2006 the government tried to ban the practice, a move that proved unsuccessful and was lifted. In 2010, the Health Ministry issued a decree outlining the ‘proper’ procedure for the circumcision, and has since tried to accommodate cultural and religious considerations, focusing efforts on eradicating type one genital mutilation and promoting a ‘safer’ type four, which involves pricking the clitoris, not removing it. Activists claim this contradicts the 2006 ruling prohibiting clinics from performing any mutilation and causes confusion among the public.

Wulan’s circumcision falls into type four. She believes the public needs to be educated about the practice to help them understand.

“People need to know and understand consent and how the female genitalia mutilation does not give the opportunity to women to agree or disagree to the practice. People may mean no harm to their daughters when they exercised this, but they also need to be aware of the physical and psychological impact that may result from this experience.”

Wulan believes the government needs to start being more firm when it comes to protecting personal choices.

“Despite tradition, it is still a matter of taking away an individual’s right to allow or not allow actions to be done to their bodies.”

She urges the government to start socializing accurate information about female genitalia mutilation: “working with local influencers and primary health care providers to reconstruct people’s understanding on female genitalia mutilation issues taking various approaches as well. It will take a lot of time but it needs to start somewhere.”

After receiving the facts about the dangers of female genitalia mutilation, Nini decided not to take her twin granddaughters to have the procedure done. These two little girls were the lucky ones.

Let’s Talk About Sex: Are Indonesia’s Youth Ill-Prepared?

Indonesia, the country with the largest Muslim population in the world, is not an advocate for teaching formal sexual education in schools. Instead, sex education is integrated into biology, social studies and religious classes in an implicit manner, including teachings on abstinence. There is an ongoing debate about the correct way to combat the spread of HIV and sexually transmitted diseases (STDs), as well as preventing unplanned pregnancies, with disagreements generally taking place between the government and non-governmental organizations, religious leaders and sexual health experts. The question is, what effects are the decisions of today’s adults going to have on the children of tomorrow if they are not equipped with the proper information they need about sex?

According to a survey in 2011 by the Ministry of Health, only 20 percent of Indonesians aged 15 to 24 had comprehensive knowledge of HIV. This, coupled with information from UNAIDS that Indonesia is one of Asia’s fastest-growing HIV and AIDS epidemics, shows the urgent need to ramp up education about sex in the country. Indonesia’s first case of the HIV virus was reported in 1987 and in 2012, 610,000 were estimated to be living with the virus according to UNAIDS HIV.

In Surabaya, instead of pushing a sex education agenda, recent news saw Mayor of Surabaya, Tri Rismaharini—through the Department of Trade and industry—forbidding the sale of contraceptives in minimarts and supermarkets to unmarried individuals and under-21s. The move was made in an effort to “protect children as the future generations, as well as minimize the negative effects of the misuse of contraceptives,” said head of the Department of Trade and Industry of Surabaya, Widodo Suryantoro, to Kompas.

Dewi Candraningrum is Chief Editor of Jurnal Perempuan, a publication aiming to educate and train readers of gender equality, opposing any forms of violence against women. Candraningrum believes that banning the sale of condoms to unmarried individuals in Surabaya is a bad sign. “This could lead to many unsafe abortions and unwanted pregnancies, which at the end endangers the lives of women,” she said. “Regulations are not clear in Indonesia. Sometimes they promote [the use of condoms], sometimes not; everything is so arbitrary if related to sexuality,” she continued.

In January, East Java’s city of Jember announced a plan to carry out virginity testing to high school girls, not allowing them to graduate if they failed the test. The plan sparked widespread condemnation, especially among human rights and women’s rights groups, including Jurnal Perempuan. Indonesian officials have recently apologised over said proposal, after top Islamic clerical body, the Ulema Council, announced the tests were not compatible with Islam. The city council of Jember apologized for any offence caused to women and Indonesian students.

How can such proposals to combat the spread of disease and unplanned pregnancies be put forward in the first place, and could they be linked with the general lack of sexual health education in the country? Vidia Darmawi is an independent consultant for the evaluation and review of HIV programmes, having worked with Family Health International and AusAID on HIV projects in 2002-2010. She thinks “it is not because of low-educated local authorities; it’s just that we don’t have an enabling environment or support from the government.”

Sex education in Indonesia is considered a taboo and Candraningrum says that teaching it “is considered harming the life of girls.” The government and education institutions view sex education as promoting ‘free sex’, a term coined by conservatives in an effort to ban sexual education, which Candraningrum believes should be changed to ‘safe and responsible sex’.

 In 2012, former Education Minister Muhammad Nuh said he objected to sex education being taught in Indonesia’s secondary schools, stating that children don’t need formal education about sex because they will learn it “naturally”.

In the same year, the newly appointed Health Minister Nafsiah Mboi declared that the Education and Cultural Ministry should address the spread of HIV/AIDS by providing proper education for schoolchildren. Nafsiah, a Catholic, added that she would promote condom-use to youngsters, which resulted in backlash rallies by Muslim groups considering the move an act of promoting indecency among the country’s youth. Consequently, several weeks later, Nafsiah withdrew her plan of kondomisasi (distributing free condoms), reported to have said: “With confidence, I do not agree with the distribution of condoms to our young people, absolutely not.”

Several countries in Asia have documented large reductions in common STDs through successful condom programmes. In a World Health Organisation (WHO) report, Thailand measured a 95% drop in common curable STDs during the 1990s, following introduction of the 100% condom-use programme, implemented by STD clinic staff working with sex trade establishments – in Indonesia we see 40-50 percent condom-use at best. Cambodia measured large decreases in STDs over five years following a similar intervention.

An anti condom programme poster by Umat Islam Indonesia Menolak Kampanye Kondomisasi (Muslims against a condom distribution programme)
An anti condom programme poster by Umat Islam Indonesia Menolak Kampanye Kondomisasi (Muslims against a condom distribution programme)

Namibia, a country that once had one of the highest rates of HIV, took aggressive action to reduce the spread of the virus. In a five-year plan (2010/11-2015/16), in conjunction with the US government, life skills-based HIV prevention is being taught at secondary schools, more than 25 million condoms are distributed every year to the public sector, and over 60% of men and women aged 15-24 have advanced knowledge of HIV, compared to Indonesia’s 20%, mentioned earlier. Sex before the age of 15 has also dropped in Namibia, as has the percentage of people reporting multiple partners. Could Indonesia take a leaf out of Namibia’s book?

In 2013, Terence H. Hull—Emeritus Professor at the Australian National University—along with Iwu Dwisetyani Utomo, Peter McDonald, Anna Reimondos and Ariane Utomo produced a report titled Sex Education: Do primary students understand how pregnancy can occur? A comparison of students in Jakarta, West Java, West Nusa Tenggara and South Sulawesi, Indonesia, to understand Indonesian students’ understanding of conception. The study covered students from a wide variety of backgrounds in four different regions of Indonesia with contrasting economic, geographic and sociocultural and population characteristics. 1,762 grade 6 students (11 to 12-year-olds) provided answers to the following list of behaviours and processes, indicating whether they believed each behaviour or process could lead to pregnancy:

1) When a man and a woman kiss

2) When a man and a woman hug

3) When a man and a woman have sex

4) When the sperm comes into contact with the egg.

Just over half of the students showed an advanced understanding of conception, correctly identifying that hugging and kissing do not lead to pregnancy and that sexual intercourse and the sperm coming into contact with the egg does. An additional 16% of the students had a purely biological understanding of pregnancy, and the remaining third were categorized as ‘other’, indicating a poor understanding of conception. Students in general schools and those in top-rated schools were more likely to have an advanced understanding of the causes of pregnancy than students in Islamic religious schools and schools with average performance. Location also had a significant effect on the understanding of conception, with West Nusa Tenggara and South Sulawesi showing particularly lower odds in comparison with Jakarta.

Studies in the West have proven that children have the intellectual capacity to understand the process of sex and reproduction by the end of primary school, and children as young as six are able to understand the fundamentals of how conception occurs.

Hull and co. observed “the obstacle to providing children with comprehensive sex education thus has less to do with the children’s ability to understand than it does with the strong apprehension of parents, teachers and policy-makers, to discuss sex with children…”

What happens when children are not provided with accurate information at an early enough age? They are most likely to turn to other sources, for instance their friends, the media and the ever-available Internet. Due to the quality of information available from these sources, adolescents are increasingly at risk of practicing unsafe sex.

Much effort is needed to overcome challenges provided by Indonesia’s current decentralized school system. Due to decentralisation, even current topics such as HIV and AIDS, which are included in the minimum standards for the national curriculum, do not always reach the district or school levels and are not always adhered to by textbook publishers, as reported by UNESCO (2010). Teachers are often found to shy away from talking candidly about sex to pupils, due to the sensitive nature of the topic, and teacher training must be implemented. Darmawi would like to see the education ministry “equip selected teachers with good materials and skills on how to convey [the message]” adding that “parents should also be involved in pre and post [class] discussions on sex education.”

Darmawi says, “In general, we’re really making progress in Indonesia compared to 10 years ago. HIV services can be accessed widely, information on safe sex can be more easily found in hotels (in red light areas), shops and posyandu (children and pregnant women clinic).” Hull and co.’s report concludes, “In the interim… for individual schools or districts, the local content curriculum provides some opportunities for including reproductive health material.” When asked whether any progress has been made since his report in 2013, Hull responded: “No improvement is likely.”

First published in Indonesia Expat (March 11, 2014)