SAFE SEXUAL BEHAVIOR: THE USE OF CONDOM AMONG NEVER

MARRIED MALE ADOLESCENTS IN INDONESIA

Mia Wahdini1, Pimonpan Isarabhakdi2

1,2
Institute for Population and Social Research, Mahidol University Salaya, Nakhon Pathom,
Thailand
Corresponding : 1mia.wahdini@gmail.com, 2pimonpan.isa@mahidol.ac.th

ABSTRACT

The trend of premarital sex among adolescent, especially male in Indonesia has increasing
gradually from 5 in 2002/2003 to 8 percent in 2012. In consequence 9 percent of adolescents
experience unwanted pregnancy and 5 percent of them suffer for sexual transmitted diseases
symptoms (BPS, 2012). The mixed of taboo discussion of condom use, limited access and limited
adequate IEC material for never married adolescent had put Indonesian male youth at high risk of
unsafe practice. However, there are some of male adolescent who use condom as safe sex practice.
Therefore, the study aims to investigate factors affecting condom use at last sexual intercourse
among never married male adolescent in Indonesia.

Using secondary data from 2012 Indonesia Youth Adolescent Reproductive Health Survey, this
study focus on male youth population for less indication of under reporting data. Total of 1,368
never married male adolescent aged 15-24 years old that has been engaged to premarital
relationship are selected for this study. Further, logistic regression analysis for nonlinear probability
model show that the past behavior of condom use is a strong predictor of condom use at last sex.
Male adolescent who use condom at first sexual intercourse are 36 times more likely to use condom
at last sexual intercourse. Also, the region of residence have strong impact on safe sex practice.
Those who live in Kalimantan region, Java & Bali region and Sumatra region are 2 times more
likely to use condom at last sex than those who located in Papua area. As the strong impact of safe
practice at first encounter, it is suggested that futher study should be on consistent use of condom to
prevent sexual transmitted disease and unwanted pregnancy.

Keyword: Condom use, male adolescent, premarital, past behavior, Indonesia

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1. INTRODUCTION

The trend of pre-marital sexual practice among adolescence in Indonesia has been increasing within
a decade, from 5% in 2002/2003 to 6% in 2007 then increase up to 8% in 2012 among male adolescence (1,
2). Compare to another religious Asian countries in year of 2000, the proportion of Indonesian young male
age 15-19 that ever had sexual intercourse are quite low, which are 12 percent and 27 percent for Philipine
and Thailand respectively (3). While Indonesia known as majority of Muslim population, Philipine are
known for Catholic majority, and Thai people largerly embraced Budhist. However, this increasing trend are
indicator that regardless the religiosity status, Indonesian would might experience the same pathway as
another asian contry had experienced in the past.

The emerging of premarital sexual in Indonesia might caused by several causes. First, it is happen as
the longer abstinence period, since there are wider gap between age at first menarche and age at first married.
Among young male, within one decade, puberty sign (wet dream) was coming at younger age, from 15 years
old to become 14 years old (1, 2), while the age of married are getting older. IDHS 2012 reported that the
ideal mean age of married are 23.1 and 25.8 years old for female and male respectively (2). Second, as
changing in life style and social structure, young male are having more encouregment to increase the sex
drive, which are showen in frequently dating activity. 25 percent of adolescence in Indonesia start to have
first date at age 12-14 years old, and almost 50% both female and male having their first date at age 15-17
years old. Moreover, the role of dating had changed to become more and more intimate. 30 percent of young
male reported that had petting the girl friend as part of dating experience (2), and some are continuing the
petting session to sexual intercourse activity. Pornograph also involved in promoting premarital sexual
behaviour among young male. It is reported that 84 percent of 9 year student in Pontianak City, West
Kalimantan, have been exposed by pornograph, most likely happen to male adolescent which some of them
are being in acting out stage already (4, 5). Meanwhile, this behaviour are not followed by adequate
knowledge of reproductive health issue. As the result, this young male are more prone to the negative impact
of unsafety behavior. The harmful effect are the unwanted pregnancy of the partner, the transmission of
sexual diseases, including HIV/AIDS infection and other social and psychological effects.

About 5 percent Indonesian adolescent who practiced premarital sexual were reported suffer from
sexual transmitted diseases (STDs) in the last 12 months prior of IYARH 2012 survey. In 2013, during 2010
– 2013 there are 93,170 HIV cases reported. Number of cases among young people age 15-24 years are
about 18.6% (1,412 cases) and the biggest proportion are among 20-29 years old age group which is 15,213
cases (58%). Report also shows that 83 percent the causal of transmission are because unsafe sexual
behavior, among hetero and homosexual practice (6). In addition, there are about 9 percent of adolescent
who commit in premarital sexual had experience the unwanted pregnancy. About 60 percent of those
pregnancies had termination, yet only 12 percent were done by assisting of doctor or midwife. The basic
reason of unwanted pregnancy was because most of the adolescent are lack of health reproductive

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knowledge. As for example, there are about 30 percent promiscuous adolescent experience more than one
time unwanted pregnancy (2).

These negative effects actually could prevented by safe practice. Using condom are the most safety
method for never married adolescent that engaged in premarital sexual. As one of family planning method,
condom has known able to avoid the unwanted pregnancy and prevent sexual transmitted diseases, if used
correctly. Unfortunately, the premarital practice among adolescent in Indonesia are not following by safety
practice. Condom use among premarital youth is remain the accustomed thing. The unfamiliarity of condom
use among adolescent are because several factors. First, the un-appropriate knowledge of contraceptive
method (5, 7, 8). Second, strong limitation of material that discussed the benefit of condom, due to eastern
value of Indonesia. Most of reproductive health material for adolescent pertain the condom as one of
contraceptive method for married couple only. No opportunity to introduce the condom physically, let alone
to practice how to use condom correctly. Third, limited facilities or communities that provide comprehensive
counselling of contraceptive use, especially condom for never married adolescent. The promiscuity young
male in Bogor City, West Java Province, confess that they haven’t known any place that provide any kind of
reproductive health information (9). Fourth, limited access to possessed condom for never married
adolescent. Beside in public health center or hospital, condom mostly available in pharmaceutical or
convenient store. And, condom are considered to be prescribed for married only. It is very rare for the
counselling place to provide condom for never married adolescent, even less the technology such as condom
ATM not yet available in Indonesia. Strong stigma had obstruct the adolescent to purchase condom in public
place, especially the school aged of adolescent.

However, among the offensive situation that Indonesian adolescence must face, there still are those
who practice safe behavior. The trend of using condom at first premarital sexual slightly increase, from 6
percent in 2002 to 24 percent in 2012 (1, 2). Similarly, condom use at last sexual intercourse is slightly
increasing corresponding with the trend of practice premarital sexual, which from 13 percent in 2002 to 27
percent in 2012 (1). However, the figures remain low comparing with another Asian countries, such as
Thailand which at least 30% of never married adolescent age 18-21 years old were always using condom at
their last sexual intercourse (10). Special attention are given to young male practice since this group are
more permisif about sexual practice, that they have less dificulty to disclosure the sexual status rather than
female adolescent. Therefore, this paper would focusing on young male practice instead of capturing
adolescent practice in general. This study need to explore the factors affected male adolescent using condom,
especially at their last premarital sexual intercourse. The term of sexual intercourse refers to penetration of
penis per-vaginal, which oral sex is not regarded as sexual intercourse.

MATERIAL AND METHOD

This study was based on secondary data set from Adolescent Reproductive Health survey as the component
of Indonesian Demographic and Health Survey (IDHS). The design of study was cross sectional. Data

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collection was conducted from May to July in 2012. Sampling method in IDHS using three-stage of stratified
sampling. First stage was to select primary sampling unit (PSU) which formed during the 2010 population
census. Second stage was to choose the census block (CB) from selected PSU with probability proportional
size (PPS) of the number household in the PSU. Total 1,840 CBs selected, which consist 874 CBs in urban
area and 966 CBs in rural area. The third stage is to choose 25 household from each selected CBs using
systematic sampling. In the chosen household all male who met the criteria aged 15-24 years old and never
married were eligible to participate in the survey. The data was collected by trained enumerator using
structured questioner for never married man. Further, only those who never married yet has engaged in
premarital relationship are taken as the respondent in this study. After omitting the exclusion criteria, there
are total 1,368 never married men aged 15-24 years old as the sample of the study.

There are five variables which are the age group to measure social economic and demographic factors, which
are region of resident, residential type of area, education level and number of household member. Since
Indonesia are extend outward as archipelago nation, there are regional factors related to local custom, values
and tradition of each region. The regional of resident are categorized into 7 regions, which are Sumatra,
Kalimantan, Sulawesi, Papua, Maluku, Java & Bali and Nusatenggara regions. Having total of 34 provinces,
instead of consist exact same number of provinces, each region are more likely to represent social
demographic picture of society accross the provinces in the main island and small islands arround. The
categorized of the region also coming from formal ISO 3166-2 Newsletter II-1 (corrected 2010-02-19) (11).

Knowledge variables were measured by asking three questions, include “wheter know that condom could
prevent unwanted pregnancy/condom could prevent sexual transmitted disease/know condom as one of
contraceptive method” every question has 1 point, those who had correct answer for 3 point are categorized
as good knowledge of condom, score less than 3 are categorized as poor knowledge. The past practices
factors are measured by two variables, which are wheter the young male using condom as well as the age at
first sexual intercourse. Software Stata S.E. program Ver. 12 were used to do data analysing. Descriptive
statisctic were used to describe the frequencies and percentage distribution of respondent characteristic. Chi
square and correlation test were used for bivariate analysis. Logistic regression are used to determine the
odds and relationship of each independent variables (social, economic and demographic factors, knowledge
factors and past practices factors) with dependent variable (the condom use at last sexual intercourse among
never married young male).

ETHICAL APPROVAL

The data set of 2012 IDHS was downloaded from the MEASURE DHS website. The research
proposal was sent to the IPSR-Institutional Review Board to be reviewed. The application was
approved with Certificate of Ethical Approval No. IRB-0001007.

RESULT

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Cases with missing data are dropped out, and run analysis with cases remained. Therefore, the total sample
size decreased from 1,368 to become 1,340 respondents. Table 1 indicates that the mean age of young male
practices premarital relationship are 20.5 years old, in which 64 percent of the population are belong in late
adolescent age group (20-24 years old). The highest population of premarital male adolescent are located in
Sulawesi region (24 percent) then followed by Java & Bali region (20.9 percent). Sulawesi region are consist
of all provinces in Sulawesi Island, as well as Java and Bali region which consist of all provinces in Java and
Bali islands. Majority of premarital young male are living in urban area (56.3 percent), had secondary level
as the highest education level (46.6 percent), and lived in the household that consist 5-8 people (53.5
percent). Size of the young premarital male household range from minimun 1 people to maximum 21 people,
with average number 5 to 6 people lived at a household. No futher information whether the household do
polygamous marital or not. About 77 percent of respondent admit to not used condom at fisrt sexual
intercourse, while 74 percent admit same practice at last intercourse. However, 79 percent respondent had
good knowledge of condom use and majority of them (47.2 percent) know that pregnancy is possible to
happen after only one sexual intercourse. Averagely, the young male having first premarital intercourse when
they were 17 years old, majority at 16-19 years old age group (67 percent). Nevertheless, the youngest cases
of male adolescent had first sexual intercourse are 10 years old.

Table 1. Descriptive characteristic of male adolescent engaged in premarital sexual intercourse

Frequency Percentage
Characteristics Category
(n) (%)
Use condom at last sex
intercourse Not use 997 74.40
Use 343 25.60

Age 15-19 years old (young adolescent) 477 35.60

20-24 years old (late adolescent) 863 64.40
Mean: 20.46, SD: 2.39, Min: 15, Max: 24

Region Papua 118 8.81

Maluku 204 15.22
Sulawesi 322 24.03
Kalimantan 116 8.66
Nusatenggara 103 7.69
Jawa & Bali 280 20.90
Sumatera 197 14.70

Residential type of area Rural 585 43.66

Urban 755 56.34

Education level Lower than secondary 437 32.61

Secondary level 624 46.57
Higher than secondary 279 20.82

Household size 9 people or more 168 12.54

5-8 people 717 53.51
1-4 people 455 33.96
(continued Table 1)
Frequency Percentage
Characteristics Category
(n) (%)

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 Mean: 5.70, SD: 2.62, Min: 1, Max: 21

Use condom at first sex

intercourse Not using condom 1,032 77.01

Using condom 308 22.99

Age of first intercourse 10-15 years olf 193 14.40
16-19 years old 898 67.01
20-24 years old 249 18.58
Mean: 17.54, SD: 2.07, Min: 10, Max: 24

Knowledge of condom use Poor 284 21.19

Good 1,056 78.81

Knowledge of pregnant after Don’t know 139 10.37

one intercourse No 568 42.39
Yes 633 47.24
Total 1,340 100

When concentrating on the region of resident, never married adolescent who located in Kalimantan region,
Java & Bali region and Sumatera region had odd of using condom at last sex intercourse 169 percent, 137
percent and 141 percent respectively larger than those who located in Papua region. When all variabels being
equal, education level had statistically significant with condom practice where those who graduated from
secondary level are having odd to safe practice 55 percent larger than those who had lower education level.
Moreover, first sexual experience factors are giving the biggest impact on condom practice. Never married
adolescent who using condom at first sexual intercourse are 35.6 times more likely to practice consistent
behavior at last sexual intercourse than those who not use. The social, economic and demographic factors,
knowledge factors and past practice factors altogether able to explain the practice of condom use at last
sexual intercourse among never married adolescent in Indonesia up to 39 percent, out of 50 percent
maximum possibility of R2 value.

Table 2. Result of logistic regression analysis focussing on factors affecting using condom at last sexual
intercourse among male adolescent in Indonesia

Variables b OR SE
Age group
15-19 years old (ref.)
20-24 years old 0.33 1.39 0.29
Regional
Papua (Ref.)
Maluku 0.05 1.06 0.44
Sulawesi 0.35 1.42 0.53
Kalimantan 0.99 2.69* 1.16
Nusatenggara 0.22 1.24 0.58
Jawa&Bali 0.86 2.37* 0.89
Sumatera 0.88 2.41* 0.94
Continue table 2
Variables b OR SE
Education level
Lower than secondary (ref.)

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 Secondary 0.44 1.55* 0.32
Higher than secondary 0.48 1.62 0.42

Household size
9-31 people (ref.)
5-8 people -0.13 0.87 0.24
1-4 people -0.47 0.63 0.18
Residential type of area
Rural (ref.)
Urban 0.01 1.01 0.19
Knowledge of condom use
Poor (ref.)
Good 0.18 1.20 0.28
Knowledge of pregnant after one intercourse
Don't know (ref.)
No -0.20 0.82 0.26
Yes, able 0.33 1.39 0.43
Using condom at first sex
Not use (ref.)
Use condom 3.57 35.61*** 6.69
Age at first intercourse
10-15 years old (ref.)
16-19 years old -0.16 0.85 0.23
20-24 years old -0.36 0.70 0.23
Constanta -3.14 0.04*** 0.02
N = 1,340, df = 18, Log likelihood = 464.4611, R2 = 39.06%, Sig. = 0.00
Note: *p value < 0.05, **p value < 0.01, ***p value < 0.001

However, it is found that age at first intercourse, household size and having no knowledge of the
reproductive health issue are negatively associated with condom practice at last sexual intercourse,
eventhough not statistically significant (p value=0.552 & 0.278).

DISCUSSION
Region of resident and safe sexual practice among young male
Kalimantan region, Sumatera region and Java & Bali region had highest probability of safe practice
among never married adolescent compare to Papua region. Based on 2010 Riskesdas (basic health research)
MDGs reported, a similar result found in previous research (8, 12), which reported that province of Irian
Barat, province of Papua and province of Maluku Utara are the three provinces with highest proportion of
unsafe sexual practice. Meanwhile, Provinces of Aceh, Sumatera Barat, and Sumatera Utara are the top three
highest of safe sexual practices which located in Sumatera region.

Papua region are belong to 22 percent of all Indonesia teritory, yet in 2011 it only has 338 high
school facilities at whole region. Compared to Java and Bali region which only belong to 7 percent of
Indonesian teritory, total of high school facilities registered are 9,320. Sumatera region and Kalimantan
region are also belong for quite large area of Indonesia, which are 25 percent and 28.5 percent respectively.
Yet, number of education facilities are larger than Papua which are 4,837 and 1,297 respectively. Gap of
education facility at secondary level in each region might explain the different of condom behavior among

7
young male in these region (13). The reflection of access of information could also seek from proportion of
internet access among 5 years old population, where in Papua the rate is only 8 percent but 20.5 percent, 16
percent and 14.2 percent for Java & Bali, Kalimantan and Sumatera region respectively (13).

There is no data about condom access in each region for never married male adolescent, but assumed
if main source of reproductive health information are school based, it can conclude that the adolescent in
Indonesia having different opportunity to gain the appropriate information based on their region of resident.
And, as the knowledge increase, the young male adolescent are trying more to purchase, possess and used
the condom as part of safe sex behavior (14), and vice versa.

Education level impact on safe sexual practice

Higher education level, at least secondary level, was found as the protective factors for never
married young male to do safe sexual practices, this result corespond with WHO report in 2004 (15) .
Education is refer to formal education level, which in this study conclude that those whom at least graduated
from secondary level are more likely to use condom at last sexual intercourse. Being in formal education
system, young male are having more chance to discussed about sexual reproductive health (SRH) matter
with teacher, which also known as the protective factors related to condom use (15). As the raising of age,
the higher the education, the oppportunity of attain specific sex education at school also increase. Though the
text book at school mostly did not mention about condom use, the knowledge of safe sexual practice of
condom use are quite high among 12th grade student compare to 6th grade student (16). The quality of
education could be significant different accross the region. For example, it is known that students in West
Nusatenggara as representative of Nusatenggara region are having low knowledge of reproductive heatlh
compare to those located in West Java and Jakarta. Similar result found from students located in South
Sulawesi that had lower reproductive health knowledge compare students from Jawa and Bali region (16).

Higher education also could be not significant as protective factors might because the late adolescent
are chosing alternative method of avoid unwanted pregnancy. The main reason of using condom among
young male are more likely to prevent pregnancy rather than prevent sexual transmitted infection (7, 9).
Therefore, the increase the age the higher the education and especially the more experience of sexual
intercourse a young male could have, the alternative method of pregnancy prevention beside of condom are
choosen. For example, withdrawal method are chosen by 63 percent of late adolescent (aged 20-24 years old)
than 36 percent of young adolescent group at both first and last sexual intercourse (2).

However, since majority age of first intercourse among young male are 16-19 years old as same age
for high secondary school student, this could be the most appropriate time to educate them of reproductive
health issues, including condom use.

Consistency of using condom (predicted by past practices) among male adolescent

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The practice of condom use at first sexual intercourse are the most stronger factors in predicting safe sexual
behaviour among young male at last sexual intercourse. To use condom at first intercourse, a young male at
least should have characteristic as follows: have knowledge of condom use, higher education level, have
access of condom purchasing, positive attitude of condom use and self efficacy of using condom (16).
Statistically, for young male in Indonesia, using condom at last sexual intercourse are strongly related with
practice of using condom at first sexual intercourse, level of education and region of resident. As region also
affecting the access of education and indirectly effected access of reproduction health knowledge, it is might
also affected the practice of condom use at first sexual intercourse.

CONCLUSION AND RECOMMENDATIONS

As education hold very important roles in safe sexual practice among never married young male, it is
necessary to encourage the education attainment among young adolescent especially the male. To
disseminate repropductive health information, policy maker can consider to conduct an appropriate sex
education directly to adolescent, especially the young male. The material of sex education should cover all
the taboo issues and given at appropriate time. In this paper, age of 10 year secondary student to fisrt year
college student are the most appropriate time to educate about sexual related issues.

However, the youngest age of sexual intercourse are 10 years old and found out that 15 percent of young
male having first sexual experience between age 10-15 years old. Indicator that there are group of young
male in Indonesia who had start their sexual debut at very early age, approximately before graduated from
junior high school or even primary level of school. As access of this age group are mostly from school,
appropriate and more variety of reproductive health material collaborate with related subject at school are
needed to overcome this situation (17).

ACKNOWLEDGMENT
The author would like to express the gratitudes for NFPP (national family planning and population board)
Republic of Indonesia for financial support during my study period. As well as Institute of Population and
Social Research (IPSR) University of Mahidol Salaya for beneficial research skilled I ganed during the
study. And, high appreciation to Measure DHS who provide the dataset for this study. Hopefully this study
could give positive contribution for Indonesian adolescent welfare in the future.

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