Why Birth Control Remains Just Out of Reach for Most Indonesian Women
Conservative social beliefs have created a contraception catch 22 where the women most in-need have the toughest time finding it.
Illustration by Faradella Meilindasari
Stigma surrounding premarital sex in Indonesia is forcing millions of unmarried women to either turn to an unregulated, and at times dangerous, black market to buy birth control or do nothing at all and risk pregnancy. Sex education is limited, abortion is only available in underground back alley clinics, and the laws are written in a way that seems to ignore outright the fact that men and women are having sex before marriage regardless of government regulations on birth control.
How do I know? Let me explain. My partner and I recently had "a problem." We were using protection, but, sometimes, even the best solution available (condoms) fails. When he started to panic (we found out that we had a problem way too late), I remained calm. "Relax," I said, "I've got this." But in retrospect, I might have been a bit too optimistic here.
First, some background: I'm Indonesian, but I lived most of my life abroad, attending high school in Singapore and university in the United States. In both places, social mores surrounding sex and birth control are far more liberal than here in Indonesia. But, at the time, I had no idea.
I grabbed my phone and Googled where to buy morning after pills in Jakarta. In the US, all pharmacies sell this medication over the counter and most are open 24-hours-a-day. In Singapore, a doctor will prescribe them after a simple ten-minute consultation.
So what did I find in Indonesia? Nothing. No one was offering over-the-counter morning after pills (or any birth control aside from condoms, really) and all the articles written about the matter were vague and totally unhelpful.
Meanwhile, the longer you wait from the initial "accident," the less effective the pills are at preventing pregnancy. I'm a young woman in the middle of my university education. I have plans and ambitions and becoming a mother this young is not an option.
So, panicking, I texted a friend who spent her entire life in Jakarta for some advice. "SOS, where can I get Plan B in Jakarta??"
"Legally or illegally?" my friend asked.
"Whatever. ASAP. TIME IS TICKING."
"Well legally, you need a prescription from a certified doctor," she explained. "But some clinics will refuse to prescribe you birth control if you aren't married. A lot of clinics will question your personal life and make things uncomfortable."
Why is this so difficult? It's because of the way the laws are written. The Indonesian Family Planning Board (BKBBN) has ruled that fertile married couples should have access to birth control. But the BKBBN also said that it doesn't recommend birth control for unmarried, sexually active individuals. "We distribute birth control to legal health providers who deal with married couples only," Sugiyatna, a director at BKNN, told Magdalene.
So what are unmarried women supposed to do? The problem starts way back when young girls are first exposed to sex education. Indonesia promotes abstinence-only sex ed in middle school, and that's if the school offers any form of sex ed at all. Most of the time, sex ed classes teach girls how babies are made, and how to be a good mother and wife. The idea that someone might be having sex before marriage—or for reasons other than baby making—isn't mentioned at all.
But abstinence-only sex ed doesn't stop people from having sex. A 2012 survey by the Central Statistics Agency (BPS) found that 21.4 percent of respondents between the ages of 15 and 24 were already having sex. And those are only the people who were brave enough to admit they were breaking the country's conservative views on sex in the first place. Plenty of others were likely out there, but were too embarrassed to admit that they were sexually active.
"Pre-marital sex is an open secret these days," Dr Soraya Alamsjah, general practitioner at Prodia Women's Health Care, told VICE. "A lot of women are doing it. Women come in to me everyday, married and unmarried, with sexual health and birth control concerns."
And sometimes they come in already pregnant. The same survey found that six out of every ten women who admitted to having an unwanted pregnancy terminated the fetus, despite the fact that abortion is illegal in Indonesia. These unregulated abortions are extremely dangerous, and can, at times, cause women to be hospitalized with extreme complications.
"The mortality rate is really high for unsupervised, illegal abortion," Dr Soraya told VICE. "Childbirth for underage teenagers also carries high mortality risks. Whichever way you look at it, it's better to prevent pregnancy when individuals are not ready physically, emotionally, and financially to have families."
But if doctors don't want to prescribe birth control for unmarried women, then how do they do it? Some friends told me they carried a fake marriage certificate to keep nosey doctors at bay. Others said they turned to the black market to find birth control that would otherwise remain out of reach.
It also comes down to a doctor's individual choice, explained Dr Soraya. There aren't any rules set in stone that bar doctors from prescribing birth control to unmarried women. But since the central government doesn't explicitly condone the practice, most government-funded clinics won't write a prescription without first seeing a marriage certificate. Meanwhile other doctors worry that providing young women with birth control is a de-facto endorsement of premarital sex.
Condoms are readily available, and sold over-the-counter at most convenience stores, but these same social concerns that make doctors not want to prescribe birth control in the first place also make young men and women too embarrassed to buy condoms.
"Patients confide in me that they are ashamed to buy condoms," Dr Soraya said. "They would rather use the pull-out method, which is riskier and does not protect them from STIs."
Society at-large still associates premarital sex with immorality, a fact that shuts down conversations about access to birth control," said Asti Widihastuti, an independent consultant for sexual and reproductive health at Angsamerah clinic.
"Even married women do not want to talk about STI concerns, because STIs are associated with immorality, whereas it's usually the husbands who pose the risk," Asti said. "Meanwhile, unmarried women are too ashamed to disclose their sexual history in order to get PAP smear or HPV injection. This is concerning."
So how did it work out for me? I can't get into the details, but after a lot of searching and discussion, I was able to get my hands on a box of Postinor. I'm not pregnant. But I had to deal with slut-shaming pharmacists, slow-ass clinics, and weird WhatsApp conversations. It was hard enough of a process that a lot of women would give up or seek easier, but riskier alternatives.
This story was produced in conjunction with FemFest 2017—an event discussing gender, sexuality, and feminist issues right here in Jakarta, Indonesia. The feminist festival runs from 26-27 August at SMA 1 PSKD in Central Jakarta. See the full address here.