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THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 99
Table 3.3.3: Age at first sex by gender and district, Indonesia 2009
Source: University of Indonesia, Situation analysis of adolescents 2009
In order to assess further risks to reproductive health, particularly in terms of risk of exposure to STIs, respondents were then asked how many sexual partners they had had and whether they
had experienced any of a described set of STI symptoms or had these diagnosed. The results varied by district and province with males, particularly in the age group of 16-18 years being more
likely to have had multiple sexual partners, particularly in eastern Indonesia in NTT and Papua. Males were more likely too to report experiencing symptoms of STIs across all districts, which
is concerning given that according to the results of the 2007 IYARHS survey mentioned above, young males have the least knowledge of STI symptoms and safe sex practices.
Respondents were also asked if pregnancy
169
or births had resulted from sexual intercourse. In general for all age cohorts 10-12, 13-15 and 16-18 years between 5-10 per cent of respondents
reported pregnancy resulting from sexual intercourse whether directly girls, or indirectly the partners of boys, with the exception of Central Java where rates were under 3 per cent overall.
The highest rates were found in Aceh and Papua provinces. What is also interesting is that in many districts, pregnancies were more likely to be reported in children aged 10-12 years or those
aged 16-18 years than they were in children aged 13-15 years. While the higher rates of pregnancy amongst 16- to 18-year-olds may be explained by greater frequency of sex, the higher rates of
pregnancy amongst 10- to 12-year-olds is more likely related to lower knowledge of reproductive health and lack of access to contraception. This is evident in the University of Indonesia 2009
survey results, which show that across the age cohorts, as age increased so too did knowledge of reproductive health. Knowledge of reproductive health was highest in Central Java, particularly
in Solo district, where rates of pregnancies and STIs were the lowest, rates of multiple sex partners were amongst the lowest, and rates of use of contraception was amongst the highest.
However, if we compare the two districts in the study in Papua, where rates of pregnancies were amongst the highest across the districts for the 10- to 12-year-old cohort in Jayapura
district, the use of contraception was higher in the Jayawijaya district where pregnancies were lower overall compared to Jayapura. In Aceh, the likelihood of using contraception decreased
marginally with each age cohort in both districts with younger groups being slightly more likely
169 Adolescent pregnancy refers to both male adolescents whose girlfriends fell pregnant and female adolescents who fell pregnant as a result of hisher engagement in sexual intercourse
170 University of Indonesia 2010 Situation analysis of adolescents 2009
to use contraception than older groups, particularly amongst adolescent girls. Furthermore, it was in Aceh, particularly in Aceh Timur district, where there were higher rates of pregnancy in
girls compared to all other districts, and one of the lowest mean ages of first sex, and rates of pregnancy were at similar levels to Jayapura, which had higher rates of pregnancy compared to
most districts. In most other districts, as age increased amongst adolescents, so too did the use of contraception with the exception of Jayawijaya mentioned above where the use of contraception
amongst 10- to 12-year-olds was amongst the highest rates for all districts and all age cohorts.
The results of the University of Indonesia 2009 survey indicate that there are links between knowledge of sexual health, the use of contraception, mean age of first sex, and incidence of
pregnancy and STIs, although the linkages and trends are complicated, depending on context and a number of different factors. There is one clear message, however, that adolescents as
young as nine have had sex in Indonesia, and that where there is little knowledge of reproductive health, low use of contraception and a low first age of sex, then the risks of pregnancy and
STIs are higher. However, the results of each twin pair of districts show that the results are all relative to practices overall in the provinces. In places where contraception was most likely to be
used Solo, Sikka and Jayawijaya districts there were also slightly lower rates of pregnancies compared to their counterparts in the twinned pairs of districts, but not always compared to other
districts in other provinces. Furthermore, these findings were not uniform across all age cohorts in Solo, Sikka and Jayawijaya, and these areas did not necessarily have better knowledge of
reproductive health than their counterpart districts in the twinned pairs. These findings on the use of contraception also did not necessarily correspond with rates of STIs, indicating that there is a
disconnect between safe sex practices and the use of contraception.
3.3.2.3 Other adolescent practices: Smoking, drinking and drug-taking In terms of other health issues, as age increases, in all districts, so too does the likelihood of
smoking, where the rate of having smoked in the 30 days prior to the survey amongst 16- to 18-year-olds ranged from approximately 25-35 per cent across district
170
. Smoking is more likely amongst boys than girls, and rates were higher in Central Java province and Sikka district
NTT, with little difference between rural and urban areas. Furthermore, young adolescents do smoke: between 10-15 per cent of 10- to 12-year-olds reported having smoked in the last 30 days.
The likelihood of smoking is reportedly driven by the influence of friends, and curiosity, again particularly amongst boys. On average, for those young males who smoke, they begin at 14
across the districts, with greater variation for girls, ranging from 13-14 years. Age 13-14 years is also when adolescents begin to experiment with alcohol, and there was larger variation for drug
usage, ranging from average first use at age 10 in Kupang district in NTT, up to 17 years in Banda Aceh. Although, the ages for first use of drugs were lower in most districts than the ages of first
consuming alcohol 12-13 years.
Adolescent drinking is also prevalent, with between 10-20 per cent of adolescents across the districts having drunk alcohol in their lifetime, with higher rates in NTT around 20 per cent, and
similar levels in other districts. However, in Aceh there are lower rates of having been drunk the lowest rates overall were for Aceh Timur and similarly high rates in Central Java and Papua, and
marginally higher rates again in NTT. This was again most likely amongst boys. The comparison of regional results were the reverse for drug-taking during the adolescents’ lifetimes ranging
from 1-3 per cent of adolescents having used drugs. Rates were higher in Aceh and Papua than
Province Aceh
Central Java East Nusa Tenggara NTT
Papua Age at first sex years
Mean 16.8
17.9 13.7
16.0 14.5
14.4 15.6
16.2 16.3
17.3 15.0
16.8 15.5
15.0 13.7
14.8 Youngest
15 17
10 15
13 10
10 14
11 17
12 15
13 15
9 11
Oldest 17
18 16
17 16
17 18
18 18
18 17
18 17
15 18
18 District and gender
Banda Aceh Male
Female Aceh Timur
Male Female
Solo Male
Female Brebes
Male Female
Kupang Male
Female Sikka
Male Female
Jayapura Male
Female Jayawijaya
Male Female
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THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 101
most other districts in other provinces, indicating that there may be a link between the availability or prohibition on drugs and alcohol, cultural practice, and what adolescents will experiment with.
Most are influenced by friends or experiment with drugs or alcohol to release stress particularly in Jayawijaya, Aceh Timur and Sikka, the rural areas where rates were highest for drug use.
The influence of family was particularly important in NTT where alcohol consumption was most prevalent.
3.3.3 PROGRESS, STRATEGIES AND CHALLENGES
Indications are that transmission of HIV is likely to increase, as the number of HIV-positive women continues to increase. The trend of Indonesia’s HIV epidemic up to 2025 shows a signiicant
increase of new HIV cases among clients of sex workers and their partners as a relection of the trend towards a feminized HIV epidemic, as mentioned above.
171
One of the implications for interventions required to respond to this feminization is the need to set up comprehensive
integrated PMTCT services within maternal, neonatal and child health MNCH programmes, in particular in selected areas where the HIV epidemic has become generalized in the population,
and accessible to members of the high-risk populations experiencing a concentrated HIV epidemic. This will help to ensure universal access for women and children for prevention, care,
support, treatment and protection as part of the continuum of care.
Major limitations hampering a successful PMTCT response, identified in a rapid assessment conducted by the Ministry of Health, are as follows
172
: • Lack of integration of PMTCT into the maternal and child health programmes, and
consequently, limited availability of PMTCT services - VCT is only available in hospital settings and referral mechanisms within hospital departments and from community health centres are
not operating optimally to maximise the use of this service.
• Inadequate quality of existing PMTCT services, especially in terms of routine provider-initiated testing and counselling PITC.
• Lack of continuum of care and treatment for motherinfant pairs, including a comprehensive ‘PMTCT Plus’ package.
• Inconsistent reporting. • Stigma associated with HIV infection.
Research, data and policy towards and about AIDS and HIV in Indonesia have tended to be tightly focused on high-risk groups rather than on the general population. This is not an unwarranted
approach considering the nature of the epidemic in the country, but there are limits and some dangers associated with this narrow focus. The latest report from the Indonesian National AIDS
Commission KPA acknowledges this and has taken steps to encourage and broaden data collection and policy.
173
This is particularly important and critical with regards to women and children. Although 25 per cent of the accumulated AIDS cases in Indonesia are female, data
and research on HIV and AIDS and how they relate to women and children in Indonesia remain scant.
174
One urgent measure advocated by the KPA is to include intimate partners of most at- risk population members into the ‘high-risk group’ from which they are currently excluded.
175 171 KPA 2010 National HIV and AIDS strategy and action plan 2010-2014
172 Ministry of Health 2007 PMTCT Rapid Assessment, Mimeo supported by UNICEF: Jakarta 173 KPA 2010 National HIV and AIDS strategy and action plan 2010-2014
174 KPA 2009 UNGASS report, p25 175 Ibid., p26
The new national strategic plan also added ‘most-at-risk’ adolescents as one of their priority groups.
176
The KPA has introduced a new HIV and AIDS Strategy and Action Plan 2010-2014. There is continuity in programming, but also acknowledgement that the trend of the epidemic is changing.
Accordingly, the new targets are as follow:
1. 80 per cent of key populations are to be reached by comprehensive and effective prevention programmes.
2. Behavioural change to prevent transmission of HIV infection will to be achieved including a consistent and correct condom use in 60 per cent of high-risk sexual transactions, and b
increase in use of sterile injection equipment to 60 per cent of injecting drug users. 3. Comprehensive services will be available including assurance that all eligible PLHIV receive
ARV treatment in a setting where they receive professional and humane treatment, support and care, provided without discrimination, and including provision of effective referrals as
well as adequate guidance and case monitoring, as needed.
4. All HIV-positive pregnant women and their children will receive ARV prophylaxis as appropriate.
5. Every person infected andor affected by HIV, especially orphans and needy widows, will have access to and utilise social and economic support, as needed.
6. Enabling environments are established that empower civil society to have a meaningful role in the response to HIV and AIDS, and where stigma and discrimination towards PLHIV
and people affected by HIV and AIDS are eradicated. Progress in this area will need to be measured by observing the degree to which the situation of positive people and other key
populations has improved.
7. Increases in government commitment to the national response and in budget allocations at all levels, thus assuring an adequate, self-reliant, and sustainable Indonesian response to HIV
and AIDS.
Despite the progress made through the previous national action plans, the KPA’s 2010-2014 Action Plan has identified specific areas which need additional attention including
177
: 1. Weak leadership in several government departments and regions, which has led to
inadequate support policies as well as severely limited programme implementation. 2. Improvement is needed in management, including, budget design more sharply focused to
facilitate achievement of targets, as well as more transparent budget management. 3. Strengthening of logistics management, particularly for ARV and methadone, to ensure
sufficient stock is reliably available at treatment service sites when needed. 4. Improvement of coordination and partnership at provincial and district levels to overcome
difficulties experienced by some local AIDS Commissions KPA-D in their efforts to coordinate with government departments, implementing agencies, local NGOs and other stakeholders in
the response to HIV and AIDS.
5. Increased involvement of key populations, particularly for prevention programmes. 6. Improvement of monitoring and evaluation, particularly at the local level province and
district, with regard to the work of government departments.
176 KPA 2010 National HIV and AIDS strategy and action plan 2010-2014 177 Ibid., p35
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The data gaps and indications of poor knowledge of adolescents on HIV and AIDS and STIs, and weak outreach services providing HIV testing and protection for young people aged 15-25
years, as mentioned above, also highlight that there is a need to pay more attention to most-at- risk adolescents, as at present there is an absence of policy and programming tools specifically
designed for this group.
Furthermore, it is important to ensure that social welfare systems are HIV-sensitive and that more data is collected on the situation of children and young people living with HIV and AIDS as well
as on PMTCT, all of which is crucial for proper planning. Current indications discussed above show there is a need to revise PMTCT policy to reach more pregnant women and newborns and
ensure there is greater uptake of ART. An important challenge for the national response is how to increase domestic support for Indonesia’s response to the epidemic. Strong political will is
required to reduce dependency on overseas inancial assistance to combat HIV and AIDS.
On the whole, there appear to be signiicant gaps in the knowledge and information about HIV and AIDS and other STIs and reproductive health more generally including contraception
amongst Indonesian youth. One possible response is to enhance the coverage of these topics within the school system. Some steps in that direction are being taken, targeting three key
dimensions: knowledge about safe sex, fostering attitudes more tolerant of others’ rights and safe behaviour. However, the integration of reproductive health into the national school curriculum is
currently incipient.
178
3.4 EDUCATION
3.4.1 EXPANDING ACCESS TO EDUCATION
It is commonly accepted that higher education levels not only increase the likelihood of employment and provide better life skills, but are also related to other aspects of child welfare
such as health including HIV and AIDS prevention, nutrition, hygiene, and child protection. With this understanding and a stronger focus on the promotion and fulfilment of children’s rights,
working towards universal basic education six years of primary education and three years of junior secondary education has been a major goal of the Government of Indonesia GoI.
The expansion of access to basic education over the past two decades has been impressive. The National Medium-Term Development Plan RPJMN 2010-2014 uses three pillars of
education policy: 1 the equality and expansion of education access; 2 the enhancement of quality, relevance and the competitiveness of education outputs; and 3 the strengthening of
accountability, and the image of public education. There have been significant improvements in certain indicators in recent years but less improvement on other indicators, particularly in terms
of disparities in rural areas, and among the poorer quintiles of the population. As mentioned in the discussions in the previous subsections of Section 3, education levels impact on health
practices. For example, higher levels of education among mothers increase the likelihood of pre- lacteal feeding, hygienic cooking practices, hand washing, and increase the likelihood of seeking
skilled birth attendants to provide assistance for a safe delivery. Furthermore, knowledge of reproductive health from school can lead to safer sex practices and potentially reduce the risk of
HIV and STI infections.
178 KPA 2009 UNGASS report, p37
Gradually, education on various issues related to child special protection are being introduced into the education system and through ministerial regulations. The Indonesian Law on Child
Protection ILCP legislates “…against violence and abuse from teachers, school managers, and schoolmates both in schools and other educational institutions” ILCP, Article 54. For example,
Ministerial Regulation No. 22010 on the National Action Plan for Prevention and Response to Violence Against Children speciies the responsibilities of the Ministry of National Education and
the Ministry of Religious Affairs to socialise the prevention of violence against children, through such means as campaigns, workshops for all education stakeholders, and training for teachers.
As part of the GoI’s goal to increase children’s access to education, since 1994 it has worked steadfastly to introduce compulsory nine years education wajib belajar, which itself was an
increase from the six years compulsory education first introduced in 1984. As noted by Sharon Bessell 2007,
“The expansion of universal education remains a policy priority. Scholarship programs and efforts to enhance community involvement in, and commitment to, education are
examples of the ongoing policy focus on education. However, the low quality of education and issues around punishment and violence in schools has yet to be adequately addressed.
To date the important linkages between these issues and low retention rates have not been recognized.”
179
Schools are also responsible for developing ‘healthy’ schools. According to Ministerial Regulation No. 572009, selected schools are provided with a block grant to develop ‘healthy’ school
models and to provide facilities for physical education and health care e.g., first aid facilities for children, among others. It is evident that child protection and child health issues must, by law,
be addressed and be mainstreamed in educational practice. The challenge for the government’s development partners is to support current government policies which includes addressing these
issues alongside key strategic development goals outlined in the Ministry of National Education’s Strategic Plan 2010-2014, which primarily focuses on issues related to increasing access to quality
education and improving the governance of the education sector through initiatives such as School Based Management, the roll-out of Minimum Service Standards, Teacher Certification,
and strengthening Quality Assurance Mechanisms, to list but a few. Considering the synergies between education and other sectors related to child welfare, improving inter-department
cooperation is important. The following discussion focuses on some of the trends in education in Indonesia and the challenges for the future. It is by no means an exhaustive sectoral review, but
instead aims to highlight both achievements and areas for improvement.
In relation to access to education specifically, many of the government’s objectives have yet to be fully realized. For example, between 1994 and 2007, children’s universal education had still
not been achieved with the net enrolment ratio NER for junior secondary school at 65.2 per cent in 2004
180
, and approximately 76 per cent transitioned from primary to junior secondary school in 2009.
181
On a somewhat positive note, while still below 100 per cent, this marked
179 Bessel, S. 2007, ‘Children, welfare and protection’, in McLeod, R. H. and MacIntyre, A. Eds., Indonesian democracy and the promise of good governance, Institute of Southeast Asian Studies: Singapore p152. It is worth noting that UNICEF has for at least the past
decade recognized the linkages between punishment, violence and low retention rates. UNICEF’s education programme, has among other things promoted School Based Management and Active, Joyful, Effective Learning environments, which have directly addressed
issues of violence in schools. This is clearly implied by the goal of creating ‘joyful’ learning environment in schools and a common slogan used in schools of ‘Guru ramah, murid bahagia dan percaya diri’ Friendly teacher, happy and self-confident student. In
other words, students will not be happy if punished physically or bullied, which often results in higher rates of early school leaving, particularly in contexts where access, quality and relevance of education is low and rates of poverty are high.
180 Bessel, S. 2007 ‘Children, welfare and protection’, p150 181 Based on data from: Departemen Pendidikan Nasional Ministry of National Education, Statistics of National Education, available
at: http:www.depdiknas.go.id Last accessed 10 October 2010. Based on National Socio-Economic Survey 2009 data, the net attendance rate at junior secondary school was 67 per cent.
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THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 105
increase between 2007 and 2009 when compared to earlier time frames can be partly attributed to the government’s introduction of the School Operational Assistance BOS programme in
2005 discussed in Section 2, one objective of which was to target assistance to disadvantaged children. This progress also suggests that Indonesia is set to achieve its MDG goal of achieving
universal primary education by 2015.
Other important initiatives launched by the GoI include teacher certification programmes for developing key competencies and minimum qualifications, student scholarship programmes
targeting disadvantaged andor gifted children to ensure they are able to access education services, and developing standards for the quality of education services.
182
However, as with efforts to achieve universal primary education, these initiatives as yet have not been fully
achieved. This is demonstrated by early school leaving rates, high rates of class repetition, relatively low transition rates to junior secondary school, and even lower rates for transition from
junior secondary school to senior secondary school, as well as participation in early childhood education, which are discussed below. Additionally, it is widely accepted that much work is still
required to improve the overall quality of education for children in line with Education For All EFA goals and, importantly, to reduce issues of violence in schools, which is also discussed
further below.
The GoI prides itself on having more ambitious targets for universal basic education than those set out globally in MDG No. 2 which calls for universal primary education. According to recent
evaluations, Indonesia is on target to achieve MDG No. 2 on universal primary school education by 2015, as well as MDG No. 3 on gender equality for girls’ enrolment in schools. In this section
on access to education, first the general trends in terms of participation at kindergarten, primary and junior secondary level schools are summarised. National aggregate data is provided and,
wherever possible, disaggregated data is presented to demonstrate inequalities and disparities based on ruralurban residence, province, and gender, as well as composite indices of disparity.
3.4.2 EARLY CHILDHOOD EDUCATION ECE
The importance and multiple benefits of early childhood education ECE are increasingly being recognized and promoted, not least because good quality early education contributes positively
to a child’s overall growth and development and increases their school preparedness.
183
The mid- decade assessment of EFA in Indonesia has also indicated that ECE has positive impacts on levels
of academic achievement.
184
In Indonesia, ECE is dispensed by a variety of institutions including kindergartens, faith-based organisations, playgroups, day-care centres, holistic integrated early
childhood development ECD services, ECE posts pos PAUD, pendidikan anak usia dini, and faith-based ECD centres. The GoI considers early childhood education within the wider framework
of early childhood services that also comprises child and maternal health services i.e., Integrated Service Posts and Mother’s programmes - see Section 3.1.
At the beginning of the 2000s, Indonesia was ranked low among other low-income countries with an ECE participation rate in kindergarten just over 21 per cent.
185
While the GoI now has a target of providing 75 per cent of Indonesian children aged 0-6 years with ECE services, even with the
inclusion of frequently undercounted religion-based ECE centres and schools, the overall rate of children aged 0-6 years accessing ECE was still just under 47 per cent according to EFA estimates
in 2007; still some way off its target.
186
Moreover, the rate of children aged 3-6 years accessing ECE services was only approximately 34 per cent in 2009, according to BPS - Statistics Indonesia
enrolment igures Figure 3.4.1. The RPJMN 2010-2014 acknowledges that in general in 2010 the overall provision of early childhood education services is still poor.
The data presented in Figure 3.4.1 demonstrates ECE service gross attendance rate
187
for children aged 3-6 years taken from the National Socio-Economic Survey 2009, showing a slowly increasing
trend in attendance.
Figure 3.4.1: Early childhood education, 3-6 years old attendance rate over time, Indonesia 2001-2009
Source: National Socio-Economic Survey 2001-2009, processed by BPS - Statistics Indonesia. Note: The National Socio-Economic Survey report provides data on pre-school attendance ages 3-6 years
Data published in the mid-decade report of EFA also point towards significant urbanrural disparities for the enrolment of children aged 3-6 years old, standing at 25.4 per cent and 15.4
per cent, for urban and rural areas respectively.
188
Furthermore, data from a study of ECE financing demonstrates that around 30 per cent of children of Indonesia are excluded from a set
of services that are critically important for early childhood development, which is strongly related to poverty.
189
It must be noted that one reason for low ECD participation rates is that that support for early childhood education in Indonesia is relatively new and the Directorate of Early Childhood
Education was created as recently as 2001.
190
A 2005 report by UNESCO underlined that there was an almost complete absence of government investment in early childhood education and
that kindergarten education was supported almost entirely by private sources, with parents
182 GoI 2010 RPJMN 2010-2014; Minister of National Education Ministerial Regulation No. 632009 on Education Quality Assurance; 183 See Bachrudin, M. 2007 Early childhood care and education in Indonesia: Current practice and future policy directions, UNESCO:
Jakarta, p38. For details of impact on children and for an exploration of the broader beneits of early education to development processes and society, see: Samuelsson, I. and Yoshie, K. Eds. 2008 The contribution of early childhood education to a sustainable
society , UNESCO: Paris, available at: unesdoc.unesco.orgimages0015001593159355e.pdf Last accessed 1 September 2010
184 Education For All Secretariat, Ministry of National Education 2007 Education for all EFA: Mid-decade assessment Indonesia, EFA Secretariat: Jakarta
185 UNESCO 2005 Education for all: The quality imperative, Education For All EFA, Global Monitoring Report: Paris, p5, available at: www.unesco.orgeducationgmr_downloadchapter1.pdf Last accessed 10 October 2010
186 Education For All Secretariat 2007 EFA: Mid-decade assessment Indonesia, p13 187 The term ‘gross attendance rate’ is used here rather than ‘enrolment’ as this is based on survey data
188 Education For All Secretariat 2007 EFA: Mid-decade assessment Indonesia 189 UNICEF 2009 Holistic and ECD for all in Indonesia: Supporting communities to close the gap, UNICEF: Jakarta
190 UNESCO 2005 Education for all: The quality imperative, p5
5-6 years old
Year
3-6 years old 2001
14.46 25.04
23.11 22.56
22.8 24.85
26.64 25.32
28.87 34.39
41.78 49.41
37.57 37.77
34.85 33.21
32.39 32.37
35.02
13.38 12.78
12.96 14.58
15.23 14.68
16.09 20.19
10 20
30 40
50 60
2002 2003
2004 2005
2006 2007
2008 2009
Per cent
3-4 years old
