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Health and human rights advocates in Indonesia are alarmed at the public health and human rights implications of a proposed legislative change to limit the distribution of contraceptive supplies, and control the provision of information about contraception.
Article 481 of the draft revised Criminal Code limits the distribution of contraceptives, and the provision of information regarding contraceptive use, to authorised health professionals. The proposed penalty is a fine of IDR 10 million (USD 750).
Indonesia is the world’s fourth most populous country with 257 million people. It is projected that the population will increase to 322 million by 2050. The contraceptive prevalence rate improved only marginally from 57.4% in 1997 to 61.9% in 2012 and the country has the highest maternal mortality rate in Southeast Asia, of 359 per 100,000 live births. Despite legal prohibition on abortion, unless for medical reasons or victims of sexual crime, it is estimated that 2 million abortions are performed annually, most illegal and in unsafe circumstances. Indonesia has 690,000 people living with HIV, the third highest prevalence in Asia and the Pacific. UNAIDS’ GAP Report estimates that only 8% of people living with HIV/AIDS in Indonesia have access to antiretroviral therapy.
This is not the first time that sexual and reproductive rights have been threatened by legislative changes in Indonesia. In 2015, legislators in a district in Sumatra, the Bengkulu Legislative Council, also drafted a bill to limit the sale of contraceptives to pharmacies, arguing, perversely, this would curb the spread of HIV/AIDS. Their argument is that the availability of condoms and other contraceptives contributes to higher rates of pre-marital and extra-marital sex. Currently, the Constitutional Court is also reviewing the Criminal Code following challenges lead by a conservative group, Family Love Alliance (AILA), seeking to criminalise homosexuality.
Oddly, these legislative changes are proposed at a time when the President and the Ministry of Health have made commitments to improving access to contraception, and to HIV testing and treatment. President Joko Widodo spoke of his government’s work to improve the family planning programme at the 4th International Conference on Family Planning (ICFP) in 2016. Lack of access to contraception has also been identified as a key contributor to the rise in inequality in Indonesia. Sexual health and contraception information is not readily available in the country and not to unmarried adolescents, because of the country’s religious beliefs and cultural attitudes.
Criminalising people for providing information about contraceptive use will have a negative impact on health promotion NGOs and community groups which undertake significant sexual health advocacy and education programmes. The National Family Planning Coordinating Board (BKKBN) itself reported that they currently have only 16,875 officials working across the country and calculate the need for an extra 45,694 within the next five years. Sexual health and family planning promotion is mainly done by voluntary village health workers, religious workers and community leaders. The proposed legislation will make the work of all community-level volunteers illegal, as well as that of sexual and reproductive health and human rights advocates. It will also increase the negative stigma and discrimination already experienced by vulnerable groups and key populations living with, or at risk of, sexually transmitted infections. These legislative changes will further increase maternal mortality and prevalence of STIs and HIV. As Indonesia is aiming to achieve Universal Health Coverage, the massive hidden costs of discriminatory legal frameworks should be avoided.
Indonesia needs human rights-based legal responses that are grounded in evidence-based public health measures; removing discriminatory articles from the draft Criminal Code would be a significant step towards achieving a healthier and more equal society.
Citta Widagdo is a doctoral student at the University of Birmingham School of Law, where she researches the implementation of the human right to health in Indonesia.