Adolescent sexual and reproductive health and rights.

INTRODUCTION

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"The reproductive health needs of adolescents as a group have been largely ignored to date by existing reproductive health services. The response of societies to the reproductive health needs of adolescents should be based on information that helps them attain a level of maturity required to make responsible decisions. In particular, information and services should be made available to adolescents to help them understand their sexuality and protect them from unwanted pregnancies, sexually transmitted diseases and subsequent risk of infertility. This should be combined with the education of young men to respect women's self-determination and to share responsibility with women in matters of sexuality and reproduction." (ICPD Programme of Action, Para. 7.41)

The World Health Organisation (WHO) defines adolescence as the period of progression from the onset of secondary sex characteristics to sexual and reproductive maturity; the development of adult mental processes and adult identity; and transition from socio-economic dependence to relative independence (10-19 years). (1) This is a crucial period both for the individual and for society as a whole. Many adult perceptions and behaviours are actually formed during this period and it is imperative to focus on this group and educate them about their sexual and reproductive health and rights. Adolescence is also variously defined as a period of transition from childhood to adulthood. In Indonesia the period of adolescence spans different years. Many studies on adolescent reproductive health define adolescents as young people aged 15-24 years (2) because many parents believe that children who are still in primary school are too young to be interviewed about issues related to sexuality. The Indonesian Ministry of Health defines adolescents as those aged 1019 years (3) in its programmes, while the National Family Planning Coordination Board's (BKKBN's) programmes define adolescents as those aged 10-24 years. In everyday life, adolescents (remaja) are defined as single and aged around 13-16 years, or those in junior or senior high school. The adolescent population of Indonesia is rather high--40.6% of the total population or 220,485,945 people in 2002. (4)

Advocacy for sexual and reproductive health and rights includes knowledge of reproductive organs and their functions, and the processes and systems related to a guarantee of reproductive safety - physical, mental and social. It also includes the right to freely determine and be responsible for the number, spacing and timing of births, the right to obtain information and tools to control reproduction, the right to have the highest standards for reproductive and sexual health, the right to make decisions free from discrimination, force and violence (Chapter VII, Conference Action Cairo). (5) Globally, the Programme of Action of the International Conference on Population and Development (ICPD), held in Cairo in 1994, placed great emphasis on the problems and needs of adolescents precisely because sexual and reproductive health of adolescents is of growing concern.

The aim of the development of reproductive health services and education for adolescents is to protect them from the risks of early marriage, unwanted pregnancy, abortion, sexually transmitted infections (STIs), HIV/AIDS and sexual violence. Furthermore, the effort to upgrade adolescent reproductive health and sex education will enrich the quality of life and create harmony between people. In the end, it is hoped that the access to adolescent reproductive health education and services will increase their independence in looking after their reproductive functions and processes, and their sexuality, so that their reproductive health rights will be fulfilled and their quality of life is enhanced.

The influence of ICPD on Indonesian adolescent reproductive health policy was demonstrated by the attention given to it by the government. In 1996, the Essential Reproductive Health Services Packet (PKRE) was issued by the Department of Health; one of its key targets was to prepare adolescent reproductive health services. Later in l998, the Indonesian Department of Health issued a management guideline on essential reproductive health services for the central Community Health Centers (puskesmas). The formation of the National Commission on Reproductive Health (2000) was continued, with the aim of upholding the results of the ICPD Plus 5 agreement in Den Haag (1999.) In addition, the Indonesian Department of Health issued a policy to extend information and reproductive health education to adolescents, to be implemented by the BKKBN and the Department of Education. In 2000, the BKKBN created a programme for the establishment of adolescent reproductive health to be integrated into family planning services, such as, the Protecting Adolescent Couples Programme (BKR), Center of Reproductive Health Information for Adolescents (PIKR), and Family AIDS Awareness. Later in 2001, the Department of Education introduced reproductive health education into schools.

However, in Indonesia, the controversy on whether or not sexual and reproductive health education and services should be extended to adolescents persists. This is one of the reasons that the adolescent sexual and reproductive health policy has not been yet implemented in the country. Adolescent sexual and reproductive health and rights education is a contentious issue because society is still divided on whether its introduction will signal social approval for premarital sex and encourage promiscuity. Hence this topic needs to be handled with great sensitivity when dealing with either parents and elders or with adolescents themselves who feel awkward, embarrased and self-conscious when discussing issues of sexuality. At the same time, worldwide trends of extended years of education and delayed age of marriage point to sexual activity outside the institution of marriage. It is therefore necessary to educate young people about the means of protecting themselves from the risks of pregnancy and STIs.

Even though ICPD strongly emphasises the importance of adolescent reproduction, it still has not been given serious enough attention. Socio-culturally, reproductive and sexual health is regarded as a purely biological matter and it is taboo to speak about it publicly. Sex is regarded as occuring only within the institution of marriage and can only be discussed as such. This situation is attenuated by various rules and regulations which limit adolescents in obtaining access to reproductive health services.

Married adolescent women have access to public reproductive health and family planning information and services because access is given only to married couples. Government family planning services also offer information, education and counselling but do not provide contraceptive methods to unmarried people. (6) Indonesia's current population and development strategies are based on Population Law No. 10/1992, which limits family planning access to married couples. As a result, the needs of unmarried women and adolescents cannot be legally met by existing public services.

Abortion is illegal in Indonesia (Law on Health No. 23/1992), except for medical reasons following defined procedures. Nonetheless, induced abortion is widely practiced by both married and unmarried women. A study carried out by the Centre for Health Research at the University of Indonesia in 2000 estimated that there are around 2 million abortion cases per year and roughly 30% of them occur among adolescents. (7)

This research study is an attempt to describe t he implementation of ICPD, with particular regard to the sections on the obligations of governments in opening up access for adolescents to formulate reproductive health rights such as Chapter VII (Section E). The goal is to map the reproductive health situation of adolescents in Indonesia and the government's responsibility in granting access to information and adolescent reproductive health services in accordance with ICPD. For the purposes of this research, adolescent sexual reproductive health and rights is pertinent to general adolescents but does not include adolescents who may be trafficked into the sex trade or are engaged in commercial sex.

Monitoring the implementation of ICPD Programme of Action is one way of peeking into the reality of adolescent reproductive health and the access available to them to realise their needs. This research is important: it is a means of making the government accountable for putting ICPD into effect.

RESEARCH METHODOLOGY

OBJECTIVES

The goals of monitoring ICPD Programme of Action are:

1) To illustrate the knowledge and attitude of adolescents concerning reproductive health, at the same time mapping the gravity of the issue that is faced by adolescents in giving shape to reproductive health rights.

2) To describe the policies which have been enacted by the Government (Central/Regional) in opening up access and sexual and reproductive health services for adolescents in accordance with ICPD agreement.

3) To put together a position paper that will become advocacy material in encouraging adolescent reproductive health policy.

The government must pay attention to those policies which have already been set forth in the ICPD, Chapter VII (Section E), namely the effort to protect and promote adolescent rights to obtain the highest health standards available, obtain health services which are speciic and proper for adolescents, affordable, and known to be effective for the sexual and reproductive needs of adolescents, including reproductive health education and information, counseling and strategies for the promotion of health. These services must protect adolescents by guaranteeing privacy, self-determination, and respect for their cultural and religious values in the light of international agreements.

In this way, monitoring indicators will focus on three important aspects of adolescent reproductive health, namely: access to information and education, access to services and participation in the process of planning reproductive health services policy. The research includes:

a. The situation of adolescent reproductive health in Indonesia

* Level of knowledge and attitude on reproductive and sexual health

* Obstracles and challenges faced by adolescents in gaining access to information and services related to reproductive health advocacy rights

* Adolescent participation in the policy planning process on reproductive health

b. Government policies on adolescent reproductive health

* National Policy

* Regional Policy (Provincial and Regency levels)

c. International policy related to adolescent rights in meeting their reproductive health demands

* Donor Agency Policy (World Bank, UNFPA, etc) on the fulilment of adolescent rights on reproductive health

d. Aspects related to the implementation of government policy (Central/Regional) that concern access to reproductive health for adolescents

* The form of the programme to be run

* Programme approach methodologies

* Budgetting for adolescent sexual and reproductive health and rights

* Facilities and human resources 

* Cooperation/partnering on reproductive and sexual health

* Programme accountability

e. Obstacles and challenges in operating adolescent reproductive health services

* Socio-cultural challenges

* Legal and regulatory obstacles

EXPECTED OUTPUTS

These are the expected outputs of the monitoring research:

1) The collection of data will become the basis of formulating adolescent reproductive health rights policy advocacy for the Indonesian government, donor agencies and the international community.

2) The identification of supporting factors and obstacles in the implementation ICPD in Indonesia.

3) The monitoring will also provide specific data/ information related to the implementation of ICPD that is connected to adolescent rights to reproductive and sexual health access within the context of regional autonomy. This issue is very important, especially in relation to the political change in Indonesia in 2002, which resulted in the enactment of Amendment No. 22, 2002 on regional government and Amendment No. 25, 2002 on Regional Finance. These amendments will have implications on the ICPD Programme of Action that was signed by the Indonesian government in l999.

4) The findings of this monitoring will also become the groundwork for advocacy strategies to urge the Indonesian government to work on ICPD commitments (see table 2).

KEY INFORMANTS

The compilation of field based research data was conducted using technical questionaires and focus group discussions involving 338 respondents from multi-stakeholders such as: regional civil servants, members of the legislature (DPRD - Dewan Perwakilan Rakyat Daerah), NGOs, youth organisations, women's organisations, teachers, community and religious leaders, health providers, mass media, parents, adolescents (both in school and out of school). The above subjects come from three provinces, i.e. Jambi, West Sumatra, Lampung. The distribution per province is shown in Table 3.

METHOD Of DATA COLLECTION AND ANALYSIS

The methodology used was desk and field research, utilising questionnaires and focus group discussions. The desk research data was collected through a study of the literature as well as various documents produced by the Indonesian Government, related to national and regional policies that support the implementation of ICPD. These documents are in the form of books, regulations, and operational and technical guidelines.

Some of the documents and policies to be the focus of discussion/analysis are: Cairo ICPD 1994 document, Recommendation Results from ICPD+5, Beijing, Platform For Action (PFA), CEDAW, Indonesian Constitutional Amendment 1945, Indonesian Regulation No. 10/1992 and No 23/1992, Indonesian Government Decree No. 433/ MENICES/SK/V/1998 concerning Essential Reproductive Health Services and Comprehensive Reproductive Health Services, National Development Programme 2002 and 2003, Regional Development Programme 2002 and 2003, Advocacy Guidebook on Family Planning and Reproductive Health produced by the National Family Planning Coordination Board (2002), draft of the Reproductive Health law, draft of the Population law and various research indings that are strongly related to reproductive health issues.

Data was procured (via questionnaires and focus group discussions) from government civil servants, legislative members, official sector employees, religious figures, community leaders, parents, adolescents, the media and health providers. 338 people were the respondents from three provinces in Sumatera (Jambi, Lampung and West Sumatera).

On the whole, this monitoring presents field data relating to the situation of adolescent reproductive health post ICPD and the policies undertaken by the government in opening information access and reproductive health services for adolescents.

OBSTACLES

We came up against the following obstacles during the monitoring:

a. Attitude of tight-lipped regional civil servants hindered our attempts to gain access to information, particularly which related to regional policy.

b. The busy schedule kept by key informants (regional civil servants) made it difficult to interview all of them.

c. The scope of the monitoring area was geographically large that it made it difficult for the interviewers to communicate with each other on the problems encountered in the field.

d. The difficulty in accessing funds also influenced the interviewers' performance in certain areas.

e. Most informants did not understand the terminology used and needed clarification and, consequently, time.

FINDINGS FROM THE DESK RESEARCH

ADOLESCENT REPRODUCTIVE HEALTH IN INDONESIA

Although signiicant progress has been made in health and family planning programmes in Indonesia, adolescent reproductive health still needs improvement. Unplanned and unintended births are still high among adolescents--4.1% of women at childbirth are aged less than 18 years. (8) Around 58% of abortions are among adolescents 15-24 years. (9) 10% of women were married, aged less than 16 years. (10) Early pregnancies carry many risks. Adolescent girls are not physiologically ready for childbirth. These risks are compounded by anaemia and under-nourishment: 36% of female adolescents aged 15-24 years are malnourished (11) and 52% of adolescents are anaemic according to the 1995 Indonesian Demographic Health Survey. With the current trend to postpone marriage many more are likely to engage in premarital sex. This puts young people at greater risk of unintended pregnancies, abortions or births among unmarried adolescents. Unsafe abortion is regarded as one of the major contributors for maternal death for women aged 15-19 years. Simultaneously, young people are also at risk for contracting STIs which may impair their reproductive health in the long run if they lack the ways and means to protect themselves. Table 4 shows how more and more young people are completing their education and hence, delaying marriage.

Interestingly enough, Table 5 applies general Total Fertility Rate (TFR) statistics to the population of adolescents to create a possible scenario of what may be happening with adolescents. This creates the case for adolescent sexual and reproductive health and rights education and awareness.

Table 6 shows the unmet need for contraception among adolescents which also helps substantiate the scenario depicted in Table 5.

The Center for Health Research University of Indonesia (CHR-UI) and the Ministry of Health (MOH) have conducted regular behavioural surveillance surveys (1996-2000) in 4 major provincial cities of Jakarta, Surabaya, Manado and Bitung. Among the salient findings were that:

a) age at first sex can begin as low as 14 years, or during junior high school,

b) average age of first sexual experience was 19 years,

c) among the males, many had their first sexual experience with a sex worker,

d) many of the sex workers had their first commercial sex experience before the age of 18,

e) about half of the sex workers were commercially active in their 20s. (12)

The regular behavioural surveillance surveys also indicate that among the young female sex workers who ever experienced STIs, there was a range of 2-14% who reported ever experiencing syphilis, and up to 30% reported ever experiencing gonorrhea. The most recent CHR -UI study in 2003 (supported by UNICEF) was a survey among adolescents (in junior high school or SMP) in Papua. It found that many SMP students were already sexually active. Around half of all students reported having a boyfriend or a girl friend. Dating behaviour commonly entails conversations, holding hands, and hugs. A third of students reported kissing on cheeks and or lips. 17% reported caressing the genital area, and 8% went as far as petting without penetration. In terms of early sexual contact, more than a third - 38% - of all SMP students reported having friends who have had sex. Around 11% reported masturbating, and around 12 % reported having sex. First sexual contact among students can be early as 8 years old. Among those who reported having sex, more than half reported first sex at the ages 13-15 years. First sex is often with their special friend and takes place outside their homes. The reported ages of first sex partners are similar to the respondents (13-15 years old). (13)

The findings of the survey conducted by the Demographic Bureau of the Economics Faculty at the University of Indonesia (LDFEUI) and the National Family Planning Coordination Board in 1999, which surveyed 8,084 adolescents aged 15-24 in 20 regencies in four provinces (West, East and Central Java and Lampung, Sumatera), found that 46.2% of the adolescents felt that a girl could not get pregnant if she only had sexual intercourse once. Male adolescents held this misconception more than females (49.6% compared to females at 42.3%). (14)

It was also found that only 19.2% of adolescents were aware of the increase in risk for STIs if they had more than one partner. 51% thought that they could get HIV/AIDS only with a prostitute. (15) 2.2% of the respondents were in agreement that it was acceptable for boys to have sex before marriage. This figure goes down to 1% if applied to girls. If sexual intercourse takes place between two people who love each other, then the percentage of respondents who say that it is alright rises to 8.6%. If they plan to marry, then the figure goes up to 12.5%. (16)

The above survey is also telling of the sexual behavior of adolescents. An average of 2.9% of adolescents are already having sex: 3.4% of boys and 2.3 % of girls. Another survey conducted by Utomo et al. on high school students in Menado (Sulawesi) shows a higher percentage, e.g. 20% of boys and 6% of girls have had sex. (17)

The Indonesian Family Planning Programme conducted research on adolescent sexual behavior in 18 provinces in 2001 with similar results. Out of 15,350 respondents consisting of 8,255 girls and 7,095 boys, data was obtained that 3.2% of the adolescent girls had been sexually active since they were 16 and 5.7% of the boys since they were 17.18 A study in Bali found that 4.4% of urban girls are already sexually active. In West Java, the findings show that there is a difference between urban (1.3%) and rural (1.4%) females who are continually sexually active.

The sexual attitude and behavior of Indonesian adolescents give a high-risk impact toward the rise in unwanted pregnancy, abortion, sexual violence and the increase in sexually transmitted diseases (STI, HIV/AIDS). Research conducted by the Indonesian Family Planning Association (PKBI) in 2001, found that the percentage of female adolescents that had an unwanted pregnancy and visited their Youth Center asking for assistance was 30.5%. Whereas according to estimates of the Women's Health Foundation (Yayasan Kesehatan Perempuan/YKP) and PKBI there are between 1-2 million abortions a year, and that 20% of those are by adolescents with unintended pregnancies. There is no available data on adolescents with STIs at this time.

Aside from the rise in unintended adolescent pregnancies and abortions, there is also a rise in sexual violence (especially rape) and STIs amongst adolescents. Based on what is reported in the mass media and to the police, sexual violence (especially rape) against adolescent girls and underaged children is increasing. The perpetrators, aside from adults, are adolescent boys aged 12-24 (56.7%). This may also be due to the inability of young men to engage and pursue healthy sexual relationships and have to resort to 'coercion' (and violence) in order to achieve their aims. At the same time, equally disturbing, is data from the Indonesian Department of Health until December 2003, from 4,091 reported cases of HIV/AIDS, the prevalency rate for adolescents (from 5-29 years old) suffering from HIV/AIDS was 678 or 16.57%. These figures indicate clearly that young men and young women who have no access to information and services for sexual and reproductive health are disadvantaged. Adolescents are also exposed to other risk-related behaviours. This includes substance use (smoking, alcohol and drugs) and exposure to STIs and HIV/AIDS. The above figures are just the tip of the iceberg, because sexual issues are sensitive and not all cases are reported.

This situation has arisen primarily because of the low level of knowledge adolescents have about their sexual and reproductive health. This is due to the fact that adolescents often do not feel comfortable talking about their sexuality, their bodies, their desires and their biological urges. However due to the fact that they are naturally curious and are willing to take risks, they will try and obtain this information and experience. The survey and research results conducted in various areas in Indonesia show that about 86% of information on adolescent sexual and reproductive health is obtained from friends, mass media, pornographic books and the internet. Only 13.5% got their information from teachers, parents or adolescent service centers, such as the Youth Center of the PKBI. Based on a survey of sexual behavior, adolescents have risky sexual behaviours because of the wrong type of information procured from the mass media, friends, pornographic books and VCDs, and the internet and because they lack access to sound education and information.

Adolescents get information on sexual behaviour from their friends and the mass media because their parents are not motivated to give them information on sex and reproductive health. Parents are often afraid that this will, in fact, encourage sex outside of marriage. This is a misconception because a number of research findings denote that children who learn about sex from their parents or teachers have the tendency to exhibit better sexual behavior from those adolescents who get information elsewhere. (19) Parents are reluctant to talk to their children about sexuality and reproductive health due to their lack of confidence as well as their lack of knowledge on sexuality. The taboo nature of the subject also serves to silence parents.

This denial of adolescent sexuality is shared by religious and community figures and the government. Religious and community figures feel that sex and reproductive health education is a "Western product" and is not appropriate for Indonesians both young and old. Sexual and reproductive health education for adolescents is often conceived as a push for adolescents to have free sex and promote sex outside of marriage. This attitude of religious and community leaders prohibits adolescent sexual and reproductive health education because the government itself is torn between the 'health' and 'moral' aspects of the issue. This is why the Indonesian government has not made serious effort to eradicate the socio-cultural and legal obstacles so that adolescents could be provided with their reproductive health rights and services.

GOVERNMENT POLICIES ON EMPOWERING ADOLESCENT REPRODUCTIVE HEALTH

There is no government policy specifically connected with adolescent reproductive health services after the Regulation No. 10, 1992 on Population and Family Welfare, and Regulation No. 23, 1992 on Health that were issued by the Indonesian government before ICPD. The government has not yet been able to resolutely manage adolescent reproductive health services. In many of its sections it even hampers adolescents obtaining access to reproductive health services.

The government policy issued by the Indonesian Department of Health in 1996 on the Essential Reproductive Health Services (PKRE) packet implicitly talks about adolescent reproductive health services as a part of the PKRE, but this has yet to be carried out. Although in 1998, the Indonesian Department of Health followed up by issuing a Guide to the Management of Essential Reproductive Health Services in centres of basic health services, for various reasons adolescent reproductive health services have not yet been implemented.

In 2000, following up on the findings of ICPD+5 in Den Haag, the government, through the Indonesian Department of Health, formed a National Commission on Reproductive Health that involved various government departments, the private sector and NGOs. However, this commission was not able to create effective change.

The National Family Planning Coordination Board (BKKBN) carried out other policies pertaining to reproductive health services which in turn were implemented by the Indonesian government as a follow up from ICPD. In 2000, the BKKBN tried to integrate Family Planning services into reproductive health services. Adolescent reproductive health issues were also an important part of this policy. However, in the implementation, adolescent reproductive health issues were not dealt with properly.

For the time being, government policy on specifically protecting adolescents from STI and HIV/AIDS infections has not been carried out. Presidential Decree No. 36/1994 on the Regional Commission for the Control of AIDS and the Letter of Decree of the Coordinating Minister for Social Welfare/Head of the Commission for the Control of AIDS No. 9/KEP/MENKOKESRA/VI/1994 on National Strategy for the Control of AIDS in Indonesia along with the Letter of Decree No 5/KEP/MENKO/KESRA/II/1995 on the National HIV/AIDS Intervention Program, 4th Five-Year Plan, have not yet propelled the actions that must be taken to protect adolescents from HIV/AIDS.

NATIONAL AND PROVINCIAL DECENTRALISATION AND FINANCING REFORMS

Seemingly, current articles indicate that reproductive health services in Indonesia may well be heading towards privatisation. This policy provides a larger opportunity for the private sector and the community to manage health services on their own, while the role of the government would be minimised. This also means that the obligation of the government to its people is also minimised. This is contrary to both the Declaration of Human Rights that "each country must guarantee the rights of its citizenry to obtain basic health services" and the Indonesian Vision for Health 2015 which states that "Health is a Human Right. "

The government policy to reduce subsidising health services (medications, management of hospital and local health clinics) has made it difficult for people, especially the poor, to obtain access to decent health services. Even though the government later created a policy programme called the 'Guarantee of Community Health Services' (JPKM--Jaring Pengaman Kesehatan Masyarakat) and a policy on using gains from crude oil price differentials to assist poor families' access health services through a special Health Card for the poor, there are three problems. One, poor families still find it difficult to access health services; two, these services don't cover reproductive health services yet; and three, reproductive health services for adolescents are not even on the radar.

Decentralisation and regional autonomy came into effect via Regulation No. 22/1999 concerning Regional Governance, and Regulation 25/1999 on Regional Balance Finance. This gave power to the regional governments to develop their own health services. This move was expected to make it easier for people to access affordable and decent health services. However, this expectation has not been fulfilled satisfactorily because the average budget allocation for health services is only 2.5-4% of the APBD (Regional Budget), much less than the 15% recommended by WHO.

Although the move to privatise health services was motivated by both efficiency and accessibility factors, currently nothing has moved in that direction. The removal of health service subsidies at hospital and health clinics, the introduction of medication and service charges for hospitals and government health clinics to contribute to the income of the regional government (PAD), makes the operational costs of the hospitals and clinics restrictive. In the end, health service providers are forced to pass these costs on to the people. Although people are forced to pay more, this is not reflected in a higher quality of services.

This is exacerbated when adolescent reproductive health services are not integrated into the regional health services policy at all. In Jambi, West Sumatera or Lampung, there is no specific regional policy on adolescents and their access to reproductive health services. This holds true for other areas in Indonesia. The frequent reason is that "the entire budget for the development in health has already been allocated in a health services packet. "

The lack of a specific regional policy for adolescent access to reproductive health services makes it difficult for them to obtain services when they have reproductive health problems. At the same time, adolescents may also be worried about the costs of these services - since their financial capacity may be insufficient or non-existent. The result is that adolescents are forced to find help in unsafe venues, such as medications in the market, going to "massage doctors" for abortions, self-medication based on information obtained from friends or media or to ignore while it gets worse.

Resorting to such methods may be life-threatening: for example, unwed adolescents who have illegal abortions or take dangerous medications. The same is true of the increase in STDS (STIs, HIV/AIDS) in adolescent circles; all these are related to the fact that there is no access to reproductive health services for adolescents.

POLICIES OF DONOR AGENCIES

The scope of raising the status of adolescent reproductive health by donor agencies is still quite limited. Piloting and implementing adolescent reproductive health programmes in particular areas and regions, as done by the UNFPA, makes these programmes out of reach for a fair number of adolescents.

A similar policy also is practised at the World Bank as demonstrated by the 'Action to Stop AIDS' programme, funded by the World Bank, UNDP and UNAIDS, operated only in a few regions in Indonesia.

Currently, a number of non-government donor agencies such as the Ford Foundation, JICA and AUS AID have prioritised specific regions to fund, but many regions that fall outside do not gain access for adolescent reproductive health empowerment programmes.

FINDINGS FROM THE FIELD RESEARCH

SUMMARY

Based on the Population Census of 2000, adolescents from ages 10-24 comprise 5,277,621 or 39% of the urban population in the three research areas (Jambi, Lampung and West Sumatra provinces). Table 7 shows the number of adolescents in the three areas. 46.7% are still in Junior High School, 32.2% in high school and 21.1% are no longer in school.

The average age at which adolescents first get information on reproductive health is around 13-14 years old and while in junior high school. That information is usually about the function and use of reproductive and sexual organs from their biology teachers. Information on sexual relations is usually obtained from their peers, the mass media and pornographic VCDs. They do not get information on reproductive health issues, STIs/HIV/AIDS, abortion or gender equality.

The status of adolescent reproductive health in the research areas is based on data obtained from the following sources:

(1) The statistics are still high for adolescents who marry at a young age--the average is 16 years for girls and 17 years for boys. This is shown in Table 8. In Jambi, Lampung or West Sumatera, adolescents marry early (based on the findings of focus group discussions conducted with a number of respondents, including adolescents, parents and community leaders), because of pressure by their parents for them not to "date" for any lengthy period of time, because the parents are afraid it will bring disgrace to the family. Other reasons were due to pregnancy (in Jambi 22.3%, Lampung 26.1% and West Sumatera 20.3%).

(2) The rise in adolescents who have pre-marital sex leads to an increase in unwanted pregnancies, STIs and HIV/AIDS.

(3) The increase in sexual violence cases (rape) of adolescent girls.

Data/information gathering through field based research was conducted in three provinces, Jambi, West Sumatera and Lampung. In each province a city and a regency were picked as research areas: in Jambi, it was Jambi city and the regency of Muara Jambi; in West Sumatera, it was Padang city and the regency of Agam; and in Lampung, it was Bandar Lampung city and the regency of Lampung Tengah. Data was collected over three months (August--October 2003) and involved a research team in each province (with an average of three team members) and from a total of 338 respondents.

The respondents were divided into the following categories as shown in Table 9.

SECONDARY AND PRIMARY DATA

The adolescent informants in the monitoring activity were aged between 10-24 years and the breakdown for each age group is:

The informants were divided based on gender also:

The informants were divided according to their level of education.

The present occupation of these adolescents was:

ADOLESCENT REPRODUCTIVE HEALTH IN THE RESEARCH AREAS

The state of adolescent reproductive health in the three research provinces is not that different from other areas in Indonesia. Out of 171 adolescent respondents, 76.6% in Jambi, 88% in Lampung and 87.4% in West Sumatera stated that they had never received information on sexual and reproductive health from their parents, teachers or even the government.

The data on who adolescents would turn to for information if they had a reproductive health problem: in Jambi, 66.7% in would ask their friends about it, 22.6% would go to the media and 10.7% would try and ask their parents, teachers or adolescent service centers, such as a youth center. Adolescents in Lampung would ask their friends (64.5%), go to the media (28.7%) or ask their teacher (6%). In West Sumatera, 75.3% would ask their friends, 20.5% would go to the media and 4.2% would ask their teachers at school.

Adolescents mainly choose a peer or the media as the best place to obtain information about reproductive health because they felt that their friends and the media would keep it confidential and would better understand their needs, while parents, teachers or doctors often would either moralise or blame them.

Of the 171 adolescent respondents, both amongst school-goers and drop-outs, the following data was obtained: in Jambi 76.6% responded that they had never received any information on reproductive health either from school or community, 9% responded that they had received information from activities conducted by SIKOK (Youth Center) Indonesian Family Board in Jambi, 8.4% had received information from their biology teachers at school and 6% via the radio, TV and newspapers. In West Sumatera, 87.4% stated they had never received information, 7.6% received information from their biology teachers, 3% from the Cemara Family Planning Board Youth Center of West Sumatera, and 2% from the radio, TV and newspapers. In Lampung, 88% had not received anything, 4% received information from the Skala Family Planning Board in Lampung, 5.5% from their biology teachers and 2.5% from the radio and newspapers. One adolescent summed it up well when she said: "We know that getting information from the internet and pornographic books confuses us but where are we to get information from? Our parents or teachers do not offer us even an iota of information on reproductive and sexual health although this information is very necessary and much needed." (Iriani Dewi).

Another reiterated indignantly: "Youngpeople rarely receive guidance from parents, elders, teachers or the government. It is mainly because of this that we seek information on reproductive and sexual health from our friends and the media to understand what is happening to us when our physical and sexual instincts awaken. The result is that many follow the advice of our peers or the media to try new things to explore our sexuality. If we make a mistake and get pregnant, we are blamed by our parents and the leaders in society. But this isn't fair because they don't guide us or educate us on reproductive and sexual health, but we get blamed for making mistakes out of ignorance!" (Hazrah).

Furthermore, if they had a reproductive health problem, they all answered that they would ask a friend (Jambi 85%, West Sumatera 87.5% and Lampung 84.6%). The remainder said they would look for the information from the radio, newspaper or their local Family Planning Board Youth Center.

The government, through the BKKBN and the Department of Health has a programme to disseminate information on reproductive health to adolescents. However, as many as 89% in Jambi, 87% in West Sumatera and 91% in Lampung responded that they knew nothing about this. The remainder knew about it because they had been invited to represent their school by attending a Reproductive Health, HIV/AIDS and Narcotics lecture that was held by the National Family Planning Coordination Board (BKBN), Health Department and police. Some of the feedback include:

1. "BKKBN once held a talk on narcotics and HIV/AIDS in our school, but the talk was so boring, we ended up not paying any attention." (Irianto).

2. "Talks on the dangers of HIV/AIDS and narcotics were done in our school once by the Department of Health and the police, however the information given was more to frighten us, rather than providing choices as the way out for teenagers. " (Fitriani).

The rights of adolescents to obtain reproductive health education have also been ignored. In all three provinces, 88% responded that they had never received reproductive health education, either in school or from their family/ community. Fortunately there is still the 12% who had been through a reproductive health education programme at their local Family Planning Board Youth Center.

78% of the Jambi youth, 81.5% of the youth in West Sumatera and 84.3% of the youth in Lampung stated that ideally their parents, the government or their school teachers would be the best sources of information. The others named an expert on reproductive of health or someone who understands adolecents.

LACK Of POLICY ON SERVICES For ADOLESCENTS

At the provincial, regency or municipal level there is not yet an adolescent reproductive health services policy. Of all the state hospitals (at the provincial or regency level), private hospitals and the basic health services providers (Puskesmas community health clinics) in all three research areas, there was not one that specifically made available adolescent reproductive health services.

If an adolescent has a reproductive health problem he or she has to go to a hospital or clinic where he or she will be treated as a regular patient. The main reason given by the Health Providers is that there are no special guidelines by the Department or Bureau of Health to have special reproductive health services for adolescents. There are no facilities or financial or human resources.

From the field monitoring findings, only those NGOs in the field of reproductive health give information and services to adolescents. In Jambi, the places which give out information, education and services on adolescent reproductive health were SIKOK (Youth Center for Information and Consultation) and PKBI; in West Sumatera, the Cemara PKBI and in Lampung, the SKALA PKBI and Damar Foundation.

Government institutions, such as the Bureau of Health and the National Family Planning Coordination Board (BKKBN), which are the leading sectors for providing adolescent reproductive health services, have yet to fulfill their functions and tasks. Their reason is that since there are no continual special fund allocations, the facilities are limited and there is a lack of human resources to provide continuous service. One adolescent questioned: 'We heard that the Department of Health provides reproductive health servicesfor young people as do the BKKBN, but where have those services gone when we needed them most?' (Yuli Handayani).

ADOLESCENT PARTICIPATION AND INVOLVEMENT

In the family, adolescent participation in decision-making is quite limited, the parents are the dominant decision makers on adolescent issues such as school and marriage. At school, participation of the students is limited to composing the class rules; the school regulations rarely involve the adolescents, unless the students are involved as student representatives in OSIS (Indonesian Intra-Student Organisation) and in the socialisation of the relevant school regulations. Hence, parents and teachers continue to a large extent to be perceived as authority figures who do not involve students meaningfully in the decisions that affect their lives. One informant so rightly put it: "There should be youth involvement in planning for programmes for young people, instead most programmes done by the Department of Health and BKKBN are irrelevant to our needs, and leads to waste of money." (Renaldi-Formaja).

PARENTAL RESPONSE TO ADOLESCENT RIGHTS TO REPRODUCTIVE HEALTH

From the interview it was learned that parents imparted reproductive health information to those children who had just entered puberty (at and after they had wet dreams and their first menstrual period), through messages and advice such as being careful when dealing with the opposite sex and keeping themselves clean. More often than not, it is the girls at the onset of menstruation who get any kind of information, and most often the information is couched in advice about 'good' behaviour and being careful when socialising with the opposite sex. Boys rarely obtain any information on their sexual and reproductive health.

Parents experience socio-cultural obstacles in dispensing information to their children because communications can be difficult between parents and children. Parents find it uncomfortable to give this kind of information and when they do, it is in the form of advice and messages that are given when the child hits puberty. Also, many parents rely on their oldest children to give information on reproductive health to their younger siblings. Usually the children are asked if they have any problems about reproductive health, and if they do, then the parents will treat the child with medications from a pharmacy or with traditional medications. Only if the situation is really bad will they be taken to the hospital for reproductive health services.

Although adolescents obtain basic information on reproductive health from their peers, many of them feel that it should be their parents who are the first source of information.

ROLE OF SCHOOLS

There is still no state or private educational institution at the junior or senior sigh level that has incorporated material on sexual and reproductive health and gender equality into their curriculum. Out of 12 schools surveyed (6 each of junior/ senior high) not one had allocated time in the classroom for sexual and reproductive health and gender studies. Besides the fact that the subject is not in the curriculum and the current study load is too heavy, the lack of special teachers to teach these subjects is also a contributing factor.

RESPONSE OF HEALTH PROVIDERS ON ADOLESCENT ADVOCACY RIGHTS FOR REPRODUCTIVE HEALTH

Health providers are doctors and midwives, who in general do not understand reproductive health issues. Their information was obtained when they were in college, and they feel they need further training to provide reproductive health information to adolescents.

Many health providers gave ideal answers. On the subject of decentralisation, it appears that the health field that regulates training, is still held responsible by the provinces. The training is only technical in nature and does not include issues specific to adolescent sexual and reproductive health.

Services provided are limited to basic medical services, check ups and treatment. Information services on general health are conducted in schools, working together with schools close by the relevant community health centres through school health activities.

RESPONSE OF THE MASS MEDIA ON ADOLESCENT ADVOCACY RIGHTS FOR REPRODUCTIVE RIGHTS 

Most of the mass media (print and electronic) do not concern themselves very much with adolescent sexual and reproductive rights. In actual fact, the media often exploits adolescent reproductive rights for commercial purposes.

Even so, some media, consistently give space for adolescents to consult on reproductive health matters for example, Kompas and Media Indonesia. In the regions there are a number of newspapers and private radio stations, which consistently provide an adolescent consultation rubric working with the PKBI Youth Centers. In Jambi, for example, the Jambi Post daily newspaper and Eria Buana and Nada Berlian radio stations routinely open a consultation and sex education forum. In West Sumatera, the Singgalang daily paper and in Lampung, the Lampung Post daily fulfill this purpose.

RESPONSE OF THE REGIONAL GOVERNMENT ON ADOLESCENT REPRODUCTIVE HEALTH ADVOCACY RIGHTS

The provincial, regency and municipal governments, which were part of the sample monitoring, do not have any adolescent reproductive health policies. Ironically, the relevant executives and officials (Health Board, BKKBN, National Education Board) and the legislative circles knew nothing about the contents of ICPD documents. Even though the BKKBN officials knew about the existence of ICPD, they have not fully understood the contents and the scope of the document and programme of action. They are focused on family planning. The BKKBN has a programme, Mentoring Adolescent Couples (BKR), but it does not live up to expectations for various reasons: untrained workers, inexperience with adolescents, lack of technical guidance and insufficient funds.

The main reason given by the regional government (at the Provincial and Regency/Municipal levels) as to why there was no policy specific to adolescent sexual and reproductive health, was that the people were not ready to accept sex and reproductive health education in the schools for their adolescent children, as that would encourage children into free sexual relations. The other reason was that sexual and reproductive health education is the responsibility of the parents. The lack of policy on Reproductive Health services at the provincial, district or municipal causes a lack of specific adolescent services at hospitals or community health centers. Adolescents are not aware about their rights to services relating to reproductive health; they only know about their right to education.

PROTECTION

Adolescents' understanding of violence is that violence is a physical act: physical contact through hitting, grabbing and fighting. Verbal sexual abuse is not considered a form of violence. Adolescents do not know where they can obtain protection if they have a sexual or reproductive health problem, particularly if they are the object of sexual harassment or violence. What they do know is that the police will handle these issues in accordance with the law, although this service is not satisfactory to the adolescents and the community especially when the cases must go to court.

CONCERNS AND RECOMMENDATIONS FORTHE FUTURE

Reproductive health problems are nearly the same everywhere in Indonesia; the differences if any, are slight. The main difference is in the dichotomy between urban and rural adolescents: in urban areas may have greater access to more accurate information on reproductive health. From the research, it is clear that access to reproductive health information is severely lacking. Ignorance can be fatal. Parents are, by and large, unable to communicate effectively the necessary information (of course this may also be due to the fact that parents themselves may not be equipped with accurate information). The government's efforts in providing information are not optimal, and in general, the mass media is also not actively informing adolescents. There is a dire need to recognise that equipping a large percentage of the population with information and education will enable them to be sexually responsible adults.

Adolescent advocacy rights to access information, education and sexual and reproductive health services still face many obstacles, from a socio-cultural, legal or even a regional policy standpoint. Even though on a national level, from desk research results, a number of policies have been made to give reproductive health information to adolescents, nothing serious has been done by the leading sector agencies in implementing them. Almost all the stakeholder respondents in the monitoring have not understood the importance of reproductive health information and services for adolescents. Because the information they received was incomplete and not comprehensive, sexual and reproductive health education was thought to bring about negative impacts on adolescent sexual behavior.

The main reason given by relevant civil servants (Health Bureau, Family Planning Board, Education Board) for the non-implementation of ICPD in their district was that they did not have the proper technical guidelines, socio-cultural obstacles, limited facilities, nor any workers (human resources) or sources of funding.

Out of 171 adolescent respondents interviewed in the three provinces, as many as 85% stated they had never received information on sexual and reproductive health, 15% stated they had through brochures, newspapers, TV and biology class in school, but that it was incomplete. Cause for concern is that 35 parents and 10 legislators never received information about sexual and reproductive health in accordance with what had been agreed upon in ICPD.

Out of 15 people interviewed, from the Health Board and the Department of Religion, 80.5% had not received information about sexual and reproductive health, 19.5% had heard through coordination meetings but the full significance was not clear. The government circles (which should be the leading sector in promoting sexual and reproductive health--Health Board and BKKBN) also do not have enough sufficient information on ICPD. From 33 interviewees (3 Health Department workers and 3 BKKBN workers at the provincial level; 6 Health Department workers and 6 IFPCB workers at the regency/municipal level; and 15 the Health Providers--6 doctors and 9 midwives), not all of them knew about ICPD . On the average only the definition behind reproductive health in accordance with what was in ICPD Programme of Action was known but not the document in its entirety.

Out of 6 Puskesmas Health Clinics monitored, not one has sexual and reproductive health services for adolescents. The government policy on the Essential Reproductive Health Services packet that was set out in 1996, has not been implemented. The reas on (4 Puskesmases did not even know about the PKRE packet) was limitations of facilities and funds.

There needs to be protection and an allocated budget for adolescent reproductive health services. Of 3 provinces and 9 regencies/municipalities that were the samples in the monitoring there was not one Regional Regulation that protects adolescents from exploitation and sexual violence, child and women trafficking. The main reason was that none of this existed in their specific areas, and if it did exist, the numbers were small. There was not a single sample which had allocated funds to increase the status of adolescent reproductive health. The reasoning was that the budget (for adolescents) was already included in the status of community health, which averages about 2.5-4 % of the regional budget.

This study shows that adolescent reproductive health in Indonesia post ICPD has yet to experience any meaningful progress. Indonesian adolescents are s till experiencing difficulties in obtaining access to information and services relevant to their reproductive health rights. The Indonesian government (both central and regional) has not taken seriously the need to eradicate the social, cultural and legal obstacles that up to now have hindered adolescents from getting access to reproductive health information and services. From the results of the monitoring, many government policies have been made about the distribution of information on adolescent reproductive health services, but these policies have not yet optimally been enforced. Because of this, the recommendations given, based on the results of monitoring, are that the Indonesian government must take responsibility for the outputs of ICPD Programme of Action to their people, specifically adolescents. Sustained advocacy is needed so that the policy makers at the provincial and regency levels will seriously promote and open up access for adolescents in increasing the status of sexual and reproductive health.

ENDNOTES

(1) WHO,1975 cited in Population reports, 1995.

(2) Yayasan Kusuma Buana (YKB) and Kantor Mentri Negara Kependudukan, BKKBN/KLH. 1993. Hasil Need Assessment Reproduksi Sehat Remaja di12 Kota di Indonesia. Jakarta and Utomo, Iwu Dwisetyani. 1997. Sexual attitudes and behaviour of middle-class young people in Jakarta. PhD thesis, The Australian National University, Canberra.

(3) Irdjiati, Ieke. 1997. Kebijaksanaan pemerintah di Bidang Kesehatan reproduksi remaja di Indonesia. Majalah Ilmiah Facultas Kedokteran Universitas Trisakti: 18-22

(4) BPS, 2002

(5) ICPD Cairo, 1994, Chapter VII (e)

(6) Available at the UNESCO website http:// www.unescobkk.org

(7) Demographic, Social and Economic Characteristics of Adolescents (Indonesia) available at http://www.unescobkk.org

(8) Indonesian Demographic Health Survey 2002/03

(9) IPPA survey 1994

(10) Susenas 1998

(11) 1995 SKIA

(12) CHR-UI, 2000

(13) Indonesia Reproductive Health Profile 2003, Ministry of Health, Republic of Indonesia, World Health organisation. Jakarta. 2003.

(14) LDFEUI dan NFPCB. Baseline Survey of Young Adult Reproductive Welfare in Indonesia 1998/1999 Book I. Jakarta: LDFEUI dan NFPCB, Juli 1999a. pg. 92.

(15) LDFEUI dan NFPCB. Baseline Survey of Young Adult Reproductive Welfare in Indonesia 1998/1999. Executive Summary and Recommendation Program. Jakarta: LDFEUI dan NFPCB, Juli 1999b pg. 14

(16) LDFEUI dan NFPCB. Baseline Survey of Young Adult Reproductive Welfare in Indonesia 1998/1999 Book I. Jakarta: LDFEUI dan NFPCB, Juli 1999a. pg. 96-97

(17) Utomo, B., Haryanto B. Dharmaputra, D. Hartono, R. Makalew, dan J. Moran Mills. 1998. "Baseline STD/HIV/Risk Behavioral Surveillance 1996: Result from the Cities of North Jakarta, Surabaya, and Manado". Jakarta: Center for Health Research University of Indonesia, the Ministry of Health RI, dan HAPP/Family Health International.

(18) PKBI, 2002.

(19) Hurlock, 1972, quoted from Iskandar, 1997.

Table 1: Adolescent Population of Indonesia

Adolescent
Population
(ages 15-24) (000's)    2000      2005      2010      2015      2020

Males                  21,415    21,741    21,659    21,486    21,036
Females                20,853    21,170    21,044    20,855    20,416

Source: World Population Prospects, The 2000 Revision.

Table 2: Framework and monitoring indicators

                                          RELEVANCE TO ON CURRENT
                                          ADOLESCENT REPRODUCTIVE
   CAIRO ICPD +5 RECOMMENDATION              HEALTH CONDITIONS

Countries with international         Many adolescents experience
community support must protect and   unwanted pregnancy, STI/HIV/AIDS
develop the rights of adolescents    infections and early marriage,
concernng sexual and reproductive    because they haven't received
health education and treatment       sexual and reproductive health
                                     education

Eradicating legal and                What difficulties are still being
socio-cultural obstacles which       faced by adolescents in obtaining
obstruct adolescents from            reproductive health information
obtaining sexual and reproductive    and services?
health education

Involving adolescents in the         What percentage of adolescents are
planning, implementation,            involved in the putting together
monitoring and evaluation that has   of policies related to sexual and
to do with the policies on access    reproductive health
of reproductive health services?

   CAIRO ICPD +5 RECOMMENDATION              NEEDS AND REALITY

Countries with international         Have adolescents been able to
community support must protect and   easily obtain reproductive health
develop the rights of adolescents    information and services provided
concernng sexual and reproductive    by the government? Where can
health education and treatment       adolescents get information on
                                     sexual and reproductive health?
                                     How many adolescents have
                                     gotten information on sexual and
                                     reproductive health services?

Eradicating legal and                What impact is being experienced
socio-cultural obstacles which       by adolescents as a result of the
obstruct adolescents from            difficulty in obtaining
obtaining sexual and reproductive    reproductive health information
health education                     and services? How are adolescents
                                     finding the way out from the
                                     socio-cultural and legal obstacles
                                     in obtaining reproductive health
                                     information and services?

Involving adolescents in the         Is there a space for adolescents
planning, implementation,            to become involved in the planning
monitoring and evaluation that has   of the reproductive health needs
to do with the policies on access    on all levels
of reproductive health services?

                                             GOVERNMENT POLICY
                                            FOR ASRH (LOCAL AND
   CAIRO ICPD +5 RECOMMENDATION                  NATIONAL)

Countries with international         What policies have been made
community support must protect and   by the government (Central/
develop the rights of adolescents    Regional) relating to the delivery
concernng sexual and reproductive    of information and services on
health education and treatment       adolescent reproductive health?

Eradicating legal and                What concrete steps have
socio-cultural obstacles which       been taken by the government
obstruct adolescents from            (Central/Regional) in eradicating
obtaining sexual and reproductive    legal and socio-cultural obstacles
health education                     relating to adolescent rights
                                     to obtain reproductive health
                                     information and services?

Involving adolescents in the         Are there any regulations
planning, implementation,            (national and local) as well as
monitoring and evaluation that has   NGOs which can give adolescents
to do with the policies on access    the opportunity to participate in
of reproductive health services?     policy planning that has to do
                                     with reproductive health needs?

Table 3: Reproductive health: Monitoring Distribution of Respondents

Background                                          Jambi     W.Sumatra

Heads of Bureaus at Provincial level                  4           2
Heads of Bureaus at Regency/ Municipality level       8           6
Legislative                                           3           2
Community Health Clinic doctors                       5           2
Midwives/Family Planning                             10           4
NGO/Youth Organisations                               6           4
Secondary School teachers                            15          10
Parents                                              23          13
Junior High Students                                 15          23
Senior High Students                                 15          20
Adolescent drop outs                                 30          13
Mass media                                            4           2
Total                                                138         101

Background                                         Lampung

Heads of Bureaus at Provincial level                  2
Heads of Bureaus at Regency/ Municipality level       6
Legislative                                           2
Community Health Clinic doctors                       2
Midwives/Family Planning                              3
NGO/Youth Organisations                               4
Secondary School teachers                            14
Parents                                              10
Junior High Students                                 20
Senior High Students                                 20
Adolescent drop outs                                 15
Mass media                                            1
Total                                                99

Table 4: Comparison of rising education levels among
adolescents (15-24 years)

                                   1991      1991      1997      1997
Level of Education (%)             Males    Females    Males    Females

No Education                        2.4       4.5       1.7       2.2
Primary Incomplete                 14.7      19.4      11.9      12.5
Primary Complete/Some Secondary    26.3      31.3      26.4      30.9
Secondary Complete and Higher      56.6      44.6      60.0      54.4

Source: IDHS

Table 5: Comparison of Estimated Pregnancy Outcomes for
adolescents (15-24 years old) 2000-2020 (1)

Pregnancy Outcomes
(000's)                2000       2005       2010

Total Pregnancies     3,353      3,428      3,424
Births                2,120      2,171      2,170
Abortions              730        743        740
Miscarriages           503        514        514

Pregnancy Outcomes
(000's)                2015       2020

Total Pregnancies     3,401      3,500
Births                2,155      2,208
Abortions              736        767
Miscarriages           510        525

Source: Adolescent Reproductive Health Indonesia,
USAAID, 1997.

Table 6: Unmet need for contraception for adolescents
(15-24 years old)

Unmet Need (%)                   1991    1994    1997

Total Unmet Need (ages 15--19)   15.6    13.7     9.1
Total Unmet Need (ages 20--24)   13.6    10.9     8.6

Source: IDHS

Table 7: Composition of Adolescents aged 10-24 compared to the
total Population: Jambi, Lampung and Sumatera Barat

Province         Total Population   Total Adolescents

Jambi               2,466,606            843,505
Lampung             6,741,439           1,825,315
Sumatera Barat      4,248,931           2,608,801
Total               13,456,976          5,277,621

Table 8: Average age of marriage in the research areas

Location          Girls         Boys

Jambi               16           17
Lampung            16.5          18
West Sumatera       17           19

Table 9: Respondents by category

                                                        Health
Location    Adolescent      Parent        Teacher      Provider

--Jambi         60            23            15            15
--Padang        56            13            10             6
--Lampung       55            10            14             5
Total           171           46            39            26

                                                         Mass
Location        GO            NGO       Legislative      Media

--Jambi         12             6             3             4
--Padang         8             4             2             2
--Lampung        8             4             2             1
Total           28            14             7             7

Table 10: Adolescent respondents according to age group

Age     Total adolescent informants

10-12                3
13-15               26
16-18               78
19-24               64
Total               171

Table 11: Adolescent respondents according to gender

Gender    Total informants

Females          76
Males            95
Total           171

Table 12: Adolescent respondents according to levels of education

Level of Education                      Total Adolescent Informants

Graduate of Primary School                           26
Graduate of Junior High School                       24
Graduate of Senior High School                       51
Graduate of Junior College/BA                        --
Total                                               171

Table 13: Adolescent respondents according to
current occupation

Activity           Total Adolescent Informants

In school                      113
Not in school                   58
Working                         56
Not working                    115

Table 14: who would adolescents choose to turn to for information
on reproductive health in jambi, Lampung and west Sumatera?

                Jambi            Lampung        West Sumatera

Friends         66.7%             64.5%             75.3%
Media           22.6%             28.7%             20.5%
Teachers        10.7%              6%               4.2%