Reproductive Health Problems at the Adolescent.

Adolescence is a transition period between childhood and adulthood and relatively

have not reached the stage of mental and social maturity so they must face conflicting
emotional and social pressures. There are so many life events that will occur that will not
only determine the life of adulthood but also the quality of life of the next generation so that
this time is placed as a critical period.

In developing countries this transition period is very fast. Even the age at first sex is
always younger than the ideal age for marriage (Kiragu, 1995: 10, quoted from Iskandar,
1997).

The effect of global information (audio-visual media exposure) that is increasingly

accessible actually provokes children and adolescents to adapt unhealthy habits such as
smoking, drinking alcoholic beverages, drug abuse and illegal injections, inter-teen fights or
brawls (Iskandar, 1997) . In the end, cumulatively these habits will accelerate early sexual
active age and lead them to high-risk sexual behavior habits, because most adolescents do not
have accurate knowledge about reproductive health and sexuality and do not have access to
reproductive health information and services, including contraception.

• Reproduction Health

The needs and types of reproductive health risks faced by adolescents have different
characteristics from children or adults. Types of reproductive health risks faced by
adolescents include pregnancy, abortion, sexually transmitted diseases (STDs), sexual
violence, and the problem of limited access to information and health services. This risk is
influenced by various interrelated factors, namely demands for young marriage and sexual
relations, access to education and employment, gender inequality, sexual violence and the
influence of mass media and lifestyle.

Especially for young women, they lack basic information about the skills to negotiate
sexual relations with their partners. They also have less opportunity to obtain formal
education and employment which will ultimately affect their decision-making abilities and
empowerment to delay marriage and pregnancy and prevent unwanted pregnancies (FCI,
2000). Even in rural young women, the first menstruation will usually be immediately
followed by marriage which puts them at risk of pregnancy and early childbirth (Hanum,
1997: 2-3).

Sometimes the trigger of unhealthy behavior or habits in adolescents is precisely the

result of disharmony between father-mother relationships, the attitude of parents who taboo
child / adolescent questions about reproductive functions / processes and causes of sexual
stimulation (libido), as well as the frequency of child abuse (child physical abuse ).

They tend to feel uncomfortable and unable to provide adequate information about the
reproductive organs and the reproduction process. Therefore, fear easily arises among parents
and teachers, that education that touches on the issue of reproductive organ development and
its functions actually encourages adolescents to have premarital sex (Iskandar, 1997).

The condition of the school environment, the influence of peers, the unpreparedness
of teachers to provide reproductive health education, and the conditions of violence around
residential homes also influence (O'Keefe, 1997: 368-376).

Teenagers who do not have permanent residences and do not get parental protection
and affection have more contributing factors, such as: constant anxiety and fear, exposure to
threats from fellow street youths, extortion, abuse and other acts of violence, sexual
harassment and rape (Kipke et al., 1997: 360-367). These adolescents are at risk of exposure
to unhealthy environmental influences, including drug abuse, alcoholic drinks, crime, and
prostitution (Iskandar, 1997).

• Reproductive Health Services for Adolescents

The choices and decisions made by a teenager depend greatly on the quality and
quantity of information they have, and the availability of services and policies that are
specific to them, both formal and informal (Pachauri, 1997).

As an initial step in prevention, increasing adolescent knowledge about reproductive

health must be supported by explicit communication, information and education (IEC)
materials about the causes and consequences of sexual behavior, what should be done and be
supplemented with information on service offerings that are willing to help in case of
pregnancy. unwanted or infected ISR / PMS. Until now, information about reproductive
health was disseminated with vague and unfocused messages, especially if it led to sexual
behavior (Iskandar, 1997).

In terms of health services, maternal and child health services and family planning in
Indonesia are only designed for married women, not teenagers. Even health workers have not
been equipped with the skills to serve the reproductive health needs of adolescents (Iskandar,
1997).

The number of comprehensive reproductive health facilities for teenagers is very

limited. Even if there is, its use is relatively limited to adolescents with unplanned pregnancy
or childbirth problems. Concerns about guarantees of confidentiality or ability to pay, and the
reality or perceptions of adolescents towards the displeasure exhibited by health workers,
further limit access to services even if they exist. In addition, there are also legal barriers
related to providing services and information to youth groups (Outlook, 2000).

Because of their conditions, adolescents are service target groups that prioritize
privacy and confidentiality (Senderowitz, 1997a: 10). This has become difficult, given the
basic health care system in Indonesia has not yet placed these two things as priorities in
efforts to improve the quality of client-oriented services.

A recent survey of 8084 young men and young women aged 15-24 in 20 districts in
four provinces (West Java, Central Java, East Java and Lampung) found that 46.2% of
teenagers still thought that women would not get pregnant with just once had sex. This
misperception is largely believed by adolescent boys (49.7%) compared to adolescent girls
(42.3%) (LDFEUI & NFPCB, 1999a: 92).

The same survey also found that only 19.2% of adolescents were aware of an
increased risk for contracting an STD if they had more than one sexual partner. 51% thought
that they would be at risk of contracting HIV only if they had sex with commercial sex
workers (CSWs) (LDFEUI & NFPCB, 1999b: 14).

• Reproductive Health Information Sources

Teenagers often feel uncomfortable or taboo to discuss issues of sexuality and

reproductive health. However, because of their curiosity they will try to get this information.
Often teenagers feel that their parents refuse to talk about sex issues so they then look for
alternative sources of information such as friends or the mass media.

Most parents are not motivated to provide information about sex and reproductive
health to adolescents because they are afraid it will actually increase the occurrence of
premarital sex. In fact, children who get sex education from parents or schools tend to behave
better sex than children who get it from others (Hurlock, 1972 quoted from Iskandar, 1997).

The reluctance of parents to provide information on reproductive health and sexuality

is also caused by low self-esteem due to their low knowledge about reproductive health (sex
education). Pre-test results of basic materials on Healthy and Child Reproductive (RSAR) in
East Jakarta (urban) and Lembang (rural) show that when parents feel they have in-depth
knowledge about reproductive health, they are more confident and do not feel awkward to
talk about the topic related to sex problems (Iskandar, 1997: 3). The main obstacle is
precisely how to overcome the view that everything that smells of sex is taboo to be
discussed by unmarried people (Iskandar, 1997: 1).

• Adolescent Attitudes towards Reproductive Health

Teenage survey respondents in four provinces conducted in 1998 showed a slightly

different attitude in viewing sex outside marriage. There are 2.2% of respondents agree if
men have sex before marriage. This figure dropped to 1% when asked their attitude towards
women who have sex before marriage. If sex is carried out by two people who love each
other, then the agreed respondent becomes 8.6%. If they plan to get married, respondents who
agree again increase to 12.5% (LDFEUI & NFPCB, 1999a: 96-97).

A study conducted by LDFEUI in 13 provinces in Indonesia (Hatmadji and Rochani,

1993) found that most respondents agreed that knowledge about contraception must be
possessed before marriage.
• Teenager Sexual Behavior

A survey of adolescents in four provinces again reported that 2.9% of adolescents had
been sexually active. The percentage of adolescents who have practiced premarital sex
consists of 3.4% of young men and 2.3% of young women (LDFEUI & NFPCB, 1999: 101).

A survey of high school students in Manado, reported a higher percentage, namely

20% in young men and 6% in young women (Utomo, et al., 1998).

A study in Bali found that 4.4% of urban teenage girls were sexually active. Studies in
West Java found differences between urban and rural adolescent girls who had been sexually
active, respectively 1.3% and 1.4% (Kristanti & Ministry of Health, 1996: Table 8b).

A qualitative study in urban Banjarmasin and rural Mandiair reported that the 8-10
year interval was the average distance between the age of first having sex and the age at
marriage in young men, whereas in young women the interval was 4-6 years (Saifuddin et al.
1997: 78).