Written by Marindah Putri, Winner of the IPAS Indonesia Foundation’s Reproductive Justice Writing Competition
“When I use contraception, I get sick; I feel dizzy, nauseous, and even vomit,” said Ms. Isma (pseudonym).
Ms. Isma, a mother of two and a homemaker, stated, “…but I force myself because my husband does not allow me to stop using contraception.”
Ms. Isma eventually decided to stop contraceptive injections, after which she gave birth to two more children, bringing her total number of children to four.
“My husband just scolded me, saying, ‘How can a wife not manage to avoid getting pregnant?’” Ms. Isma told me, “…now, I am using contraception again.”
Ms. Isma decided to resume using contraception, but not long after, a few months after the birth of her fourth child, she was diagnosed with breast cancer. After several years of battling cancer, Ms. Isma has now passed away peacefully.
Ms. Isma’s story is one of many instances of reproductive violence experienced by women. Reproductive violence is a form of gender-based violence, where women often face injustice in determining their reproductive health. The deeply entrenched patriarchal culture in society places the burden of controlling pregnancy and childbirth on women. Contraceptive methods are predominantly designed for women, leading to women dominating contraceptive use.
According to data from BKKBN, among all modern contraception users, the number of women undergoing tubectomy is 856,550, while only 36,386 men undergo vasectomy. According to the journal Global Health: Science and Practice, the gap between women and men in the use of permanent contraception is widening.
Globally, vasectomy use has drastically declined, even though, from a medical perspective, vasectomy is far simpler and safer than tubectomy. Societal gender stereotypes dictate that because women are inherently capable of pregnancy and childbirth, they should be more concerned with contraception than men. Masculinity constructs suggest that men control sexual relations and decide the number of children. Men are also reluctant to use contraception due to the masculine values they uphold.
Hierarchical relationship patterns between husbands and wives result in reproductive health decisions and rights not being made fairly and equally. Discussing reproductive justice is not merely a biological issue, but also requires an understanding of power dynamics, destructive traditional gender norms, and patriarchal culture, which lead to the emergence of discriminatory policies and rules that are unjust to women.
Reproductive justice emphasizes the importance of the principle of individual rights to choose whether or not to have children without coercion and structural barriers. Access to information and resources to achieve this freedom of choice must be considered, one of which is access to comprehensive sexual education. Reproductive justice is difficult to achieve without comprehensive sexual education; both are interconnected to ensure every individual understands the rights, access, and information needed to make informed decisions regarding their reproductive and sexual health.
A framework is needed for the socialization and dissemination of comprehensive sexual education programs as a preventive measure against sexual and reproductive violence. Since school, sexual education has focused solely on females, excluding males. Sexual education typically focuses only on bodily organs and reproductive anatomy. Comprehensive sexual education in Indonesia needs to emphasize an understanding of gender ideology, as gender ideology is often not substantively considered in sexual health education.
Several studies have found that comprehensive sexual education programs addressing gender-related topics are more effective and have a positive impact. These programs emphasize the contextualization of individual experiences regarding perceptions of masculinity and femininity, reflection on experiences with gender stereotypes, and the consequences of gender bias resulting from societal norms and values. This understanding also needs to be integrated with human rights approaches, gender equality, and gender role transformation. The gender-transformative approach in comprehensive sexual education aims to explore men’s involvement in changing masculinity constructs at the interpersonal level.
This approach seeks to create more gender-equitable relationships. Women and men need adequate access to information regarding contraception use, and the notion that men do not need to use contraception must be dispelled through positive masculinity education. Men must learn about contraceptive methods, ensure that the contraception used by their wives is safe and does not cause harmful side effects, and also be willing to use contraception or undergo sterilization methods themselves. Men should no longer be fixated on destructive and detrimental traditional norms; they must understand that women have rights over their bodies, and thus decisions regarding having children, the number of children, and birth spacing are made jointly and equitably with women. Women have the right to undergo their reproductive experiences in a state of physical and mental health, with adequate healthcare services, and children born have the right to grow and develop in a healthy and safe environment.
References
Claussen, C. (2018). Men engaging boys in healthy masculinity through school-based sexual health education. Sex Education. https://doi.org/10.1080/14681811.2018.1506914
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Goldfarb, E. S., & Lieberman, L. D. (2021). Three decades of research: The case for comprehensive sex education. Journal of Adolescent Health, 68, 13-27. https://doi.org/10.1016/j.jadohealth.2020.07.036
Gupta, G. R. (2000). Gender, sexuality, and HIV/AIDS: The what, the why, and the how. Durban, South Africa: International Center for Research on Women (ICRW).
Jacobstein, R., et al. (2023). Down but not out: Vasectomy is faring poorly almost everywhere—We can do better to make it a true method option. Global Health: Science and Practice, 11(1), e2200369. https://doi.org/10.9745/GHSP-D-22-00369
Leiva, L., Torres-Cortés, B., Antivilo-Bruna, A., et al. (2024). Gender-transformative school-based sexual health intervention: Study protocol for a randomized controlled trial. Trials, 25, 360. https://doi.org/10.1186/s13063-024-08191-w
PKBI. (n.d.). 7 components of comprehensive sexuality education. Retrieved from https://pkbi.or.id/7-komponen-pendidikan-seksualitas-komprehensif/
Ross, L. J., & Solinger, R. (2017). Reproductive justice: An introduction. Oakland, CA: University of California Press.
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BKKBN Team. (2024). Number of Contraception Users by Modern Contraceptive Method, Family Data Update 2024. Retrieved from https://portalpk.bkkbn.go.id/tabulasi/IKB/Tabel10