Wimpie Pangkahila, M.D., and J. Alex Pangkahila, M.D.
Demographics and a Historical Perspective
Located in the archipelago southeast of Asia along the equator, Indonesia comprises some 13,700 islands, including Java, one of the most densely populated areas of the world, with 2,108 persons per square mile. Besides Java, Indonesia includes four other major islands: Sumatra, Kalimantan (most of Borneo), Sulawesi (formerly Celebes), and Irian Jaya (the western half of New Guinea). Bali, known as the paradise island, is also part of Indonesia. The mountains and plateaus on the major islands have a cooler climate than the tropical lowlands.
In 1997, Indonesia had over 200 million people with more than 300 ethnic groups. The age distribution of the population was: under age 15, 39.2 percent, 15 to 59,56.5 percent, and 5.3 percent over age 60, and a population density of 262 per square mile. Life expectancy at birth in 1995 was 59 for males and 63 for females. The 1995 birthrate was twenty-four per 1,000 and the death rate eight per 1,000, for a natural annual increase of 1.6 percent. The infant mortality was sixty-five per 1,000 live births. Indonesia has one hospital bed per 1,643 persons, and one physician per 6,861 persons. The literacy rate is 78 percent, and 97 percent attend primary school.
Indonesia is a developing country with major problems in the social and economic areas. Most people still have a low subsistence standard of living. However, the small middle- and upper-class populations have a very good standard of life. It is estimated that the country will join the developed countries in the near future. The 1995 per capita gross domestic product was $2,900.
B. A Brief Historical Perspective
It is generally believed that the earliest inhabitants of the Indonesian archipelago came from India or Burma (Myanmar). Later immigrants, known as Malays, came from southern China and Indochina. This later group is believed to have populated the archipelago gradually over several thousand years. Hindu and Buddhist civilizations reached Indonesia about 2,000 years ago, taking root mainly on the island of Java. In the fifteenth century, Islam spread along the maritime trade routes and became dominant in the sixteenth century. In the seventeenth century, the Dutch replaced the Portuguese as the dominant European power in the area. The Dutch gained control over Java by the mid-1700s, but the outer islands were not subdued until the early 1900s, when most of the current territory of Indonesia came under Dutch rule.
After the Japanese occupation of 1942-1945, nationalists fought four years until the Dutch granted Indonesia its independence. Indonesia declared itself a republic in 1950. In 1957, Indonesia invaded Dutch controlled West Irian (the western half of New Guinea); in 1969, tribal leaders voted to become part of Indonesia, a move sanctioned by the United Nations. East Timor became the twenty-seventh province of Indonesia after tribal and political leaders declared integration in 1975. Since 1965, after the fall of the Communist Party and the late President Sukarno, the government has been led by President Suharto.
1. Basic Sexological Premises
A. Character of Gender Roles
In the traditional Indonesian society, women clearly occupy a lower social status than men. This is still the dominant value in Indonesian culture. The idea that the females place is in the kitchen is still easy to find, especially in the villages. The husband-wife relationship is a chief-assistant relationship rather than a partnership.
Nevertheless, the role of women is improving in modern Indonesian society. Many women work outside the home, particularly in restaurants, garment, and cigarette factories, even though their wages are lower than those of males. Many female physicians, notaries, and lawyers are found in modern Indonesia. A few women have achieved high political positions as cabinet and parliament members.
B. Sociolegal Status of Males and Females
From the standpoint of national law, males and females enjoy the same rights in schooling and careers. However, in some areas, traditional laws discriminate against females. Only males, for instance, have a right to receive a legacy from their parents. This contributes to a higher status for males. Another consequence of traditional values is that parents insist on having a son, even though the government has proclaimed a limit of only two children per family, regardless of sex. Many pregnant women come to clinics seeking male-sex preselection, even though there is no method that can give a 100-percent guarantee of having a male child.
C. General Concepts of Sexuality and Love
Traditionally, Indonesian women connected sexuality with love, and engaged in sexual activities only with the male they loved, i.e., their husband. Women, it was believed, were not able to have sex with a male unless she loved him. In contrast, the traditional view fully accepted males as having sex with any female they liked. In essence, females were only sexual objects, designed for male pleasure.
This traditional view is changing in modern Indonesia. For many, sex and love are easy to separate and are frequently viewed as two different things. Many females, especially among the young, want to engage in sexual intercourse with anybody they like without the necessity of loving that person. This concept, of course, is not well received by the older generation.
2. Religious and Ethnic Factors Affecting Sexuality
A. Source and Character of Religious Values
During the first few centuries of the Christian era, most of the islands came under the influence of Hindu priests and traders, who spread their religion and culture. Moslem invasions began in the thirteenth century and most of the area was Moslem by the fifteenth. Today, 88 percent of Indonesians are Moslem, with Hindu, Buddhist, and both Protestant and Catholic Christian minorities. There is a commendable degree of religious tolerance among the people.
Christian Portuguese traders arrived early in the sixteenth century, but were ousted by the Dutch around 1595. After Napoleon conquered the Netherlands homeland in 1811, the British seized the islands but returned them to the Dutch in 1816. After the Japanese occupation during World War II ended, nationalists declared Indonesian independence from the Dutch. After a years fighting, a treaty was signed, political stability returned, and economic development began.
In the past, conservative religious and cultural values had a strong influence on sexual attitudes and behaviors. For instance, it was taboo for male and female adolescents to walk together in public. A daughter who became pregnant before marriage posed a disaster for her whole family.
However, the influence of religious and traditional cultural values has decreased in recent decades, most noticeably since 1980. This is evident in the fantastic changes in the sexual attitudes and behaviors of the people, especially among the young.
B. Source and Character of Ethnic Values
Each ethnic group has its own culture and sexual values. The Javanese and Balinese, for instance, are more modern than the Dyaks and other tribal cultures of Borneo. In general, however, sex is considered something private and even secret. Sex is appropriate only between husband and wife. Women are like maids, there for their husbands benefit. Wives are subservient to their husbands in everything including sexual contact. Some men who engage regularly in homosexual behavior do so because they believe that they have supernatural powers that will disappear if they have sexual contact with women.
In todays globalization trends, sexual attitudes and behaviors are changing rapidly in all the cultures of Indonesia. Premarital sex, for example, is now common among adolescents. Even premarital pregnancy is easy to find and, for many parents, it is no longer the disaster it was only a generation or two ago.
3. Sexual Knowledge and Education
A. Government Policies and Programs
Sex education is not a priority in the governments program. School curricula do not offer students any education on sexual topics or issues. However, the Department of Education and Culture has recommended a book, About the Sexual Problem in the Family, by Wimpie Pangkahila, as a source of sexual information for high school students. This 1988 book discusses many sexual problems that occur in Indonesian families as a result of misinformation, misunderstanding, and myths, such as the belief in the harmful consequences of self-pleasuring or the impossibility of pregnancy if sexual intercourse occurs only once a month. This 152-page book is available in many bookstores and some libraries.
The Indonesian Health Department and the National Coordinating Board of Family Planning have a program for Reproductive Health Education. This program, designed for young people, provides seminars on topics of reproductive and sexual health.
In recent years, some secondary high schools have introduced a small segment of sex education as part of their extracurricular offerings. Outside experts are invited to talk about sexuality in these seminars.
B. Informal Sources of Sexual Knowledge
Despite the public reticence about sexuality, the Indonesian people are eager for and need more information about the subject. Hence the popularity of public and semiprivate seminars on sexual topics. Many social organizations for young people, and womens organizations, sponsor seminars for their members with outside experts invited to speak about sexuality.
Some magazines, newspapers, and radio broadcasts also have columns or programs in which sexuality and sexual problems are discussed. Readers and listeners write or call in asking about some sexual issue or problem they are facing. Many people, however, still express a negative reaction to these forms of informal sexual education.
4. Autoerotic Behaviors and Patterns
A. Children and Adolescents
Autoeroticism is common among children in the phallic stage of their psychosexual development. Although some parents report that they watch their children pleasuring themselves to orgasm, many parents are afraid when they discover their children self-pleasuring because they believe this to be an abnormal act.
Autoeroticism is also common among adolescents as a way of tension release. One study by Wimpie Pangkahila found that 81 percent of male adolescents and 18 percent of female adolescents aged 15 to 20 years old engaged in self-pleasuring. Most reported using their fingers, sometimes lubricated with a liquid. Some rubbed against a pillow or mattress. Only a few females reported using a vibrator.
Autoeroticism is very common among adults, especially single adults. The pattern is the same as among adolescents. However, many people still believe that autoeroticism is morally wrong and will result in harmful physical and mental consequences, such as sterility, impotence, and a decrease in memory ability.
5. Interpersonal Heterosexual Behaviors
Sexual exploration and sex rehearsal play are common among children as a natural part of their psychosexual development. However, many parents are afraid of such behavior, believing that it results in sexual abnormalities.
Some ethnic groups, especially in the remote areas and among tribal people, have ritual ceremonies for adolescents, especially for the female on the occasion other first menstruation. These ceremonies differ greatly from one ethnic culture to another.
Premarital Sexual Activities and Relationships
Premarital sexual activities are considered taboo. In general, older persons and parents oppose all sexual activities engaged in before marriage. However, during the past decade, there has been a change in sexual attitudes and behaviors among adolescents. Some studies in a few Indonesian cities reveal a growing trend among adolescents to engage in premarital sexual activities such as necking, petting, and even intercourse.
Knowing that parents and the older generation oppose premarital sexual activities, young people hide their activities from them. On the other hand, parents frequently give their children more opportunities to be alone with their boy- or girlfriends. And many adolescents take advantage of these opportunities for sexual activities.
Premarital Courtship, Dating, and Relationships
Dating and premarital sexual relations among adults are very common in modern Indonesian society. The culture requires a particular kind of courtship when a couple wants to marry. In this courtship, the parents and family of the male approach the parents of the female to make the arrangements. In some ethnic groups, a courtship document is signed when presents, such as cows, buffalos, gold, and jewelry, are given. For many people in these groups, this custom is very expensive, because they have to collect enough money to buy the presents for courtship.
Sexual Behavior and Relationships of Single Adults
Self-pleasuring is a common sexual behavior among single adults, even though it is not allowed by religious and moral values. Sexual relationships among male and female single adults are also taboo. However, some data show that many couples engage in sexual relations before they marry. A study by Wimpie Pangkahila suggested a rate of 53 percent for urban couples. Another study of rural, pregnant women found a premarital intercourse incidence of 27 percent.
Many single adult males have sexual contact with prostitutes. Prostitution exists in many places in Indonesia, whether it is legal or illegal. The range of services comes in various classes from low-cheap to high-expensive.
Marriage and the Family
Indonesia has had a marital code to regulate marriages since 1974. The law requires that a marriage be performed in a religious ceremony and then be registered in the civil act office for Christians, Buddhists, and Hindus. The marriages of Moslems are registered in the Moslem Religion Affairs Office.
Extramarital intercourse is common, especially among males. Many married men seek prostitutes or have sexual relations with single or married women. Extramarital intercourse is also found among married women, but in a lower incidence than among husbands. Although married women do have sexual relations with single and married men, most people consider this very bad and unacceptable behavior. In a typical, double moral standard, extramarital sex by males is considered something usual, even though it is forbidden by religion, morality, and law.
Sexuality and the Physically Disabled and Aged
Most Indonesians believe that sex is only for the physically normal and young people. Most feel uncomfortable when a disabled or aged person still thinks about or expresses an interest in sexual activities. However, marriages do occur between disabled persons, or between a disabled and an able-bodied person. Some disabled and many aged people do come to sexual clinics with their sexual problems for counseling and treatment.
Incidence of Oral and Anal Sex
Generally Indonesians do not accept fellatio, cunnilingus, and anal sex as foreplay or sexual outlets. Most people consider these behaviors as abnormal or sinful. On the other hand, many people do engage in fellatio and cunnilingus.
Many men seek out prostitutes only for fellatio, because they enjoy that outlet, but their wives refuse to engage in it. Some women do like to have cunnilingus, but refuse to perform fellatio for their husbands. Still, many couples enjoy both fellatio and cunnilingus as a part of their sexual activities.
Fellatio and cunnilingus are becoming popular among young people as a sexual alternative to vaginal intercourse. Cunnilingus is preferred especially by and for females, because it does not tear the hymen, which many still believe is a mark of virginity. Very few couples engage in anal sex.
6. Homoerotic, Homosexual, and Ambisexual Behaviors
A. Children and Adolescents
Homoerotic or homosexual activities are not common among Indonesian children, although some sexual exploration involving exhibiting the genitals is known to occur.
Some adolescents engage in homosexual activities as a sexual outlet, while others engage in this activity for material gain as homosexual male prostitutes. In one Java society of traditional artists, known as Reog Ponorogo, some adolescents engage in homosexual activities to serve adult males who are believed to have supernatural powers (See Section 1B above).
In general, Indonesians consider homosexuality and bisexuality as abnormal acts forbidden by morality and religions. Despite this taboo, thousands of adults engage in homosexual and bisexual relationships. A Functional Group for Gays and Lesbians exists with branches in some large cities. Most gays and lesbians, however, hide their orientation and activities because they know that most people oppose homosexual behavior.
Since homosexual marriage is illegal, homosexual persons are limited to living-together arrangements and cohabitation. Sexual outlets among homosexual, lesbian, and bisexual-oriented adults include oral sex, anal sex, and mutual self-pleasuring. Some lesbians use vibrators.
7. Gender Conflicted Persons
There are no precise statistics on the incidence of gender conflicted persons. It is estimated that there are thousands of male transsexuals. Waria, an abbreviation of Wanita (female), and Pria (male), are popular terms for gender conflicted persons in Indonesia. In Surabaya, capital city of East Java, Perkumpulan Waria Kotamadya Surabaya or the Association of Waria in Surabaya provides members with support, education, and career training as beauticians, artists, or dancers. These skills hopefully allow Waria to support themselves and avoid a life of prostitution. Support groups also provide information about AIDS prevention. Many transsexuals work as prostitutes.
Only a few male transsexuals, usually well-known artists, can afford to have surgery to change their sexual anatomy. The average cost for such surgery is the equivalent of 330 to 400 percent of a middle-class workers monthly income, about $1,500 to $2,000 in American money.
8. Significant Unconventional Sexual Behaviors
A. Coercive Sex
Sexual Abuse, Incest, and Pedophilia
There is no research on child sexual abuse, incest, or pedophilia. What is known about these issues comes from reports in the newspapers detailing some incidents of coercive sex involving children. Legal penalties exist for persons convicted of child sexual abuse, incest, and pedophilia. The social response to these acts is very negative, and the perpetrators are viewed as criminals.
Even though there is no significant data about sexual harassment, it is believed that it happens very often. Many women who work in factories or offices, or walk along the street suffer from a variety of sexual harassments, although few women realize they are victims of sexual harassment that is contrary to the law. The penalty for sexual harassment may range from three to six months in prison.
Fortunately, in recent years, some women leaders have been trying to educate women that sexual harassment is illegal, and that women have the right to prosecute those who engage in it.
As with other forms of sexual coercion, there is no significant data on the incidence of rape in Indonesia. Rape incidents perpetrated by an acquaintance, boyfriend, or stranger, and rapes that end in murder are reported in the newspapers. Marital rape is not reported in the news media, although some wives in counseling or therapy do report being raped by their husbands when they refuse to have sexual intercourse.
Prostitution is widespread and occurs in many locations from small to large cities. In some jurisdictions and cities, where prostitution is illegal, the law may prosecute either the prostitutes or those who manage the business of prostitution. Childhood prostitution is supported by wealthy sex tourists from the Middle East, Europe, Japan, and other countries, but it is not the extensive problem it is in neighboring nations, like Thailand, Cambodia, Myanmar, and Vietnam (Kristof 1996).
C. Pornography and Erotica
In keeping with conservative tradition, pornography is illegal throughout Indonesia. However, it is not difficult to find blue or hard-core video material. Some people sell pornographic books, magazines, and pictures, despite their being illegal.
9. Contraception, Abortion, and Population Planning
Indonesia has a national program promoting contraception to help married couples plan their families. This program addresses only married people, and not adolescents or unmarried adults. Information on contraception is provided through womens social organizations, newspapers, radio, and television broadcasts.
In the early 1980s, the government provided free contraceptives at public health centers. In 1988, with an improving economic situation and people recognizing the need for family planning, the government gradually began reducing its support, encouraging people who could afford them to obtain contraceptives from physicians in private practice or midwives with reasonable fees. The poor can still obtain free contraceptive services at public health centers where the only charge is for an inexpensive admission ticket.
The most popular contraceptive is the oral hormonal pill. Women have to be examined by a physician before they can obtain a prescription for it, but renewal of such prescriptions is not limited. Intrauterine contraceptive devices are also popular, followed by hormonal implants.
Despite this limitation of contraceptive information to married women, some adolescents and unmarried adults also use contraceptives. They are available in pharmacies (apothacaries or chemists), and include the condom and vaginal film (tissue). Often the hormonal pill can be obtained without a physicians prescription.
In general, the people do not agree that unmarried people should have access to and use contraceptives. Thus, there is no formal education in the schools about contraceptives for adolescents. Sexually active adolescents and single adults have only informal sources of information about contraceptives: newspapers, television, radio programs, and seminars sponsored by interested social groups.
B. Teenage Unmarried Pregnancies
Unmarried pregnancies are not uncommon, but data is nonexistent. What little information is available simply documents the number of unmarried pregnancies in different years. One urban clinic, for instance, reported 473 unmarried pregnant women seeking aid in 1985-86, a second clinic served 418 pregnant unmarried women in 1983-86, and a third clinic reported 693 unmarried pregnancies in 1984-90. These reports provide only raw data with no perspective, and the frequency and incidence of unmarried pregnancies are much higher than the few studies indicate. Likewise, there are no data that would allow one to compare the incidence of unmarried pregnancies in the cities and rural areas. However, the incidence of abortions performed by traditional healers suggests that unmarried pregnancies are not uncommon in the rural areas.
Abortion is illegal throughout Indonesia, except for some medical cases to save a mothers life. However, some abortions are performed in clinics in certain cities. It is impossible to obtain any realistic number of abortions performed in Indonesia, simply because it is illegal. In Jakarta, with a population in 1988 of an estimated 8.8 million, one clinic reported 500 abortions per month, while a Bali clinic reported 7 to 10 abortions per day. Abortions are also performed by native healers who use traditional, often unsafe methods that sometimes result in complications.
D. Population Control Efforts
The success of Indonesias national program of family planning was recognized in 1989 when the United Nations Organization gave its Population Award to the President of Indonesia. Efforts are being made to achieve zero population growth in the near future. These efforts are particularly important considering that the island of Java is one of the most densely populated areas of the world with 2,100 persons per square mile, over 100 million people on an island of 51,023 square miles. By comparison, the states of New York, North Carolina, and Mississippi are each roughly the same size as Java, but have only 18, 6.6, and 2.5 million people respectively.
10. Sexually Transmitted Diseases
Sexually transmitted disease are often found among adolescents and young adults, indicating that the taboos against premarital sex are not observed. The incidence is highest in ages 20 to 24, lower in ages 25 to 29, and in 15- to 19-year-olds. As would be expected given the social customs, the incidence among males is higher than it is among females. The most commonly reported STDs are nonspecific urethritis and gonorrhea. Syphilis is no longer common, although it appears to be increasing in recent years.
Treatment for STDs is available at all health clinics throughout the country. Some years ago, the government sponsored a program to prevent the spread of STDs by providing prostitutes with penicillin injections. Other prevention efforts focus on providing information in group-sponsored seminars and the mass media, newspapers, radio, and television.
At the end of January 1997, Indonesia reported 509 cases of HIV infection, and AIDS cases have been reported. Most of the cases were heterosexual persons ranging from adolescence to old age. The real number of HIV-positive and AIDS cases is believed to be much higher than this report.
Prevention efforts have focused on high-risk groups, particularly prostitutes, both female and male, and people who work in the tourism industry. Most of the HIV and AIDS cases in Indonesia have resulted from sexual contact. Prostitutes are one source of infection, but it is estimated that many HIV-positive tourists have come to popular tourist centers like Bali, and some have introduced the virus through sexual contact with local people. Prevention efforts involve providing information on how to reduce the spread of AIDS and blood tests for HIV infection. Campaigns to popularize the use of condoms are conducted in some areas where prostitution is common. Unfortunately, these education efforts do not deter people from unprotected sexual contact with prostitutes. Consequently, cases of HIV and AIDS will likely explode in Indonesia in the near future.
12. Sexual Dysfunctions, Counseling, and Therapies
The diagnostic paradigm used by Indonesian sexologists is basically that of William Masters and Virginia Johnson, with presenting cases of inhibited male arousal (impotence), early (premature) ejaculation, inhibited (retarded) ejaculation, male and female dyspareunia, inhibited female orgasm, and vaginal spasms. A common psychological sequela for males with a sexual dysfunction is a feeling of inferiority with regard to the partner. This feeling is often what brings the male into seek treatment. Many women, on the other hand, tend to hide their sexual problems and feel shy about seeking treatment. Many married women never have orgasm and never tell their husbands. At the same time, many husbands are unaware or do not even suspect that their wives never have orgasm.
Diagnosis and treatment for sexual dysfunctions are available in only a few clinics.
13. Research and Advanced Education
The Andrology Program at Airlannga University has a postgraduate program (segment) in sexology. The Andrology postgraduate program requires a two-and-a-half-year study in spermatology, experimental reproductive biology, reproductive endocrinology, infertility management, and sexology. Instruction in the sexology specialization includes sexual dysfunction, sexual deviation, and premarital and marital counseling. Some Indonesian sexologists have finished their education and training in the United States, Belgium, and other countries. A few studies of sexuality are currently in process, including management of impotence using intracavernosal injection, and a comparison of sexual perception and behavior in young and old subjects.
At Udayana University Medical School there are two organizations studying sexology as a part of their programs. The mailing addresses for these organizations are:
The Study Group on Human Reproduction. Udayana University Medical School. Attention: Wimpie Pangkahila, M.D., Jl. Panglima Sudirman, Denpasar, Bali, Indonesia
The Indonesian Society of Andrology, c/o Laboratory of Pathology, Udayana University Medical School, Jl. Panglima Sudirman, Denpasar, Bali, Indonesia
Sexual Abuse, Sexual Exploitation, and the Commercial Sexual Exploitation of Children
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