Indonesia

OVERVIEW

In Indonesia, contraception (birth control) is available, including birth control pills, injectables and IUDs. While you technically need a prescription for emergency contraception (the morning after pill), this is not widely enforced in many parts of the country. You can get an STD/STI test at many clinics and facilities, and especially in Jakarta, there are many resources that assist in the treatment, counseling and support of people who are HIV+. There is an HPV vaccination pilot program in Indonesia but there is currently no PrEP program in place, as of January 2017. While there is maternity leave of 3 months, there is barely any paternity leave in place. Abortion is generally illegal in Indonesia, although it is commonly performed in an underground and clandestine capacity, often in unsafe and not recommended conditions.

Contraception

Laws & Social Stigmas

In Indonesia, you can buy contraceptives without a prescription at most pharmacies (known as "apotiks"). You may be able to find a wider selection of medications, as well as more professional services, at hospital pharmacies. But even in hospital pharmacies, you will not find all brands, and Nuvaring seems unavailable in Indonesia. It is estimated that 62.9% of Indonesian women (ages 15-49) who are married or in unions use some form of contraceptive with injectables and oral contraceptives as the most common choices.

What to Get & Where to Get It

• You can find many birth control pills in Indonesian pharmacies (or "apotek" in Indonesian). Some brands you can expect to see are Levonorgestrel Pill, Microgynon, Microgynon-30 and Nordette. To conduct a search on drug availability, check out the MIMS website.
• You can find condoms ("kondoms" in Indonesian) in many supermarkets and grocery stores. However, some Indonesians feel shy about buying condoms in public, so there are also online companies where you can buy condoms from the privacy of your own home. For example, here are some online vendors based out of Indonesia. There is also a company called Asmaraku, which sells condoms and other intimate products online for Indonesians. You can find brands like Vivo, Simplex and Dasoni sold on Asmaraku, ranging in price from about RP 35,000 to 5,000 per box. The website supposedly also sells vibrating condoms. For a survey of some of the condom choices in Indonesia, here's an amusing article.
• It appears that the contraceptive ring, like Nuvaring, is not available in Indonesia (though we'll need to research this more but to be certain).
• For local recommendations on places to get contraception, please visit the city pages, such as the Jakarta or Ubud pages.
• You can also consult the Indonesian Planned Parenthood Association (IPPA) for family planning services and advice. Address: Kebayoran Baru, 12120. Tel: (021) 720 7372 / (021) 739 4123 / (021) 724 5905.

Emergency Contraception

Important Notes: Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC as soon as possible after unprotected sex. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click here and here.

Laws & Social Stigmas

Emergency contraception is technically available by prescription only. In some parts of the country, like Jakarta and Ubud, pharmacists often sell emergency contraception without a prescription. However, in some other parts of the country, like Lombok, people have reported difficulty accessing emergency contraception (even with a prescription). In the private sector, the lowest cadre of health workers who are allowed to sell or dispense EC are midwives. It is estimated that 11% of Indonesian women of reproductive age have knowledge of EC and that 0.3% have ever used it.

Based on one study, it appeared that Indonesian health care professionals support keeping it prescription-only: "Although most participants were familiar with EC, only 22% received a very good knowledge score (4 or 5/5 answers correct), while 52% received a poor score (0–2/5 correct). Most participants did not support the OTC availability of EC (70%). Logistic regression identified that participants who prescribed EC had an Odds of 3.8 (95% CI 1.90, 7.73) of approving OTC EC, after adjustment for age and speciality."

What to Get & Where to Get It

• Check out this list of 24 hour Jakarta pharmacies.
• You can obtain dedicated emergency contraception in Indonesia at pharmacies. You may be able purchase ellaOne, which is considered the most effective EC on the market (as of January 2017). To take ellaOne properly, you take 1 pill within 120 hours after unprotected sex. The other dedicated EC brands that you can find is Postinor 2. For Postinor-2, you should take 2 pills within 120 hours after unprotected sex.
• You can have an IUD inserted to prevent pregnancy. Please refer to the "Contraception" section for details.
• If you can't access dedicated emergency contraception, you can use regular oral contraceptives (birth control pills) as emergency contraception. For combined pills (progestin-estrogen), you'll need to remember that, in 28-day packs, only the first 21 pills can be used. You can take Levonorgestrel Pill, Microgynon, Microgynon-30 or Nordette. For all of these brands, you should take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later.

Sexually Transmitted Infections (STIs/STDs)

Important Note: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment that may prevent HIV infection, and it may be available in your city. Take PEP as soon as possible.

Laws & Social Stigmas

In Indonesia, there are no travel or residency restrictions related to HIV status. You will not be asked for a medical certificate in order to enter the country. According to Indonesian law, if you want to obtain an Indonesian work visa (KITAS) from the Education Department (DIKNAS), you may need to take an HIV test. However, locals report that this is not typical and that they've never been asked for an HIV test.

Regarding HPV, according to the HPV Information Centre, "Current estimates indicate that every year 20928 women are diagnosed with cervical cancer and 9498 die from the disease. Cervical cancer ranks as the 2nd most frequent cancer among women in Indonesia and the 2nd most frequent cancer among women between 15 and 44 years of age. About 4.0% of women in the general population are estimated to harbour cervical HPV-16/18 infection at a given time, and 87.2% of invasive cervical cancers are attributed to HPVs 16 or 18."

Testing Facilities

• For local recommendations on places to get STI tests, please visit the city pages, such as the Jakarta or Ubud pages.

Support

• Jakarta AIDS Information System
• POKDISIJS AIDS - Dr. Djoebairi Zoerban: Provides HIV treatment. Department of internal medicine, Medical faculty of the Indonesian State University, Cipto Mangoenkoesoemo Hospital, JI. Salemba Raya no. 6, Jakarta, Indonesia
• Yayasan Pelita Ilmu (Pelita Ilmu Foundation): NGO therapy center, supported by the Ford Foundation. Provides HIV treatment. JI. Kebon Baru IV No. 16 (District Tebet), Jakarta, Indonesia, Phone/Fax: 021 8379 5480
• Jl. Kebon Baru Utara no. 15: Provides HIV treatment. Asem Barig Raya, also in Tebet, Jakarta, Phone: 021 831 9673, Contact person: Dr. Wahjuningsih or Mr. Asep
• Yayasan Mitra Indonesia: Jl. Kebon Kacang IX/78, Jakarta
• Yayasan Pelita Umu in cooperation with RSCM (Cipto Hospital): JI. Tebet Timur Dalam VIII Q No.6, Tebet, Jakarta Selatan, Phone: 831 1577
• Rumah Sakit Cipto Mangunkusumo - RSCM (Cipto Hospital): Pok Dik Sus AIDS, FK Ul - RSCM, JI. Diponegoro No.71, Jakarta Pusat, Phone: 390 5250
• Yayasan Citra Husada Indonesia: JI. Blimbing, Gang Y No.4, Denpasar, Bali
• Yayasan Spiritia: National peer support organisation for people living with and affected by HIV. Jl. Johar Baru Utara V No. 17, Johar Baru, Jakarta 10560, Indonesia m Phone: +62 (21) 422-5163/8, Fax: +62 (21) 4287 1866, E-mail: info@spiritia.or.id
• Yayasan AIDS Indonesia: Helps with Information and prevention. Address: Hotel Menara Peninsula, Lantai 3 (3rd floor), JI. Jend. S. Parman 78, Slipi, Jakarta Barat, Phone: 549 5313, 530 3951, 534 9813

Medications & Vaccines

What to Get & Where to Get It

• If you have a yeast infection, you can ask for Fluconazole at the pharmacy.
• If you have a urinary tract infection (UTI), you can tell the pharmacist that you have "infeksi saluran kemih."
• You can access the HPV vaccine in Indonesia. The country also has a national HPV vaccine pilot program.
• There is currently no Pre-exposure prophylaxis (PrEP) program in Indonesia.

Menstruation

What to Get & Where to Get It

In Indonesia, pads and pantyliners are the most common menstrual product, and they can be found in grocery stores, convenience stores, pharmacies, etc. While you can find tampons in Indonesian cities, especially at international and high-end pharmacies and grocery stores, they are much less common than pads. You can look for tampons at pharmacies like Guardian and Century. Some tampon brands you can expect to see are Playtex, Laurier and Charm. You can also try to check in Japanese supermarkets for tampons. In smaller towns, you'll have great difficulty finding in tampons. As for menstrual cups, you may be able to find them from small-scale businesses, especially those that cater to an international crowd. You can also purchase them online. For example, you can order the Mooncup from the UK, which can be delivered to Indonesia - click here for details. You can also order the Lunette menstrual cup online LiveLoveLuna. There appears to be no local sellers of DivaCup or LadyCup in Indonesia, so those brands should also be purchased online.

You can find tampons available in Bali but not in many of the popular scuba diving destinations such as Komodo. If you plan to scuba dive or participate in other water activities, it's recommended to buy a menstrual cup in advance.

Costs

Tampon prices:

• "I think is between 75 k till 90... I saw it at one of Matahari mall supermarket at Blok M. I think is Bali village supermarket." (February 2017)
• "I generally pay Rp30.000 to Rp50.000 for eight tampons in Palembang, about $3 to $5." Pads are cheap -- "a couple of dollars for a dozen or more."

Gynecological Exams

What to Get & Where to Get It

• For local recommendations on places to get contraception, please visit the city pages, such as the Jakarta or Ubud pages.

Pregnancy

Laws & Social Stigmas

According to Indonesian law, women must receive 3 months of maternity leave with 100% of their wages covered. They must take at least half of their maternity time after the birth. If a pregnant woman can receive the proper paperwork from her doctor, she can also be allowed to not work between 11 PM to 7 AM. While some sources say that men have absolutely no paternity coverage, other sources ay that men can receive 2 days of leave when their wives give birth.

If you are in Jakarta, the best prenatal care be found in private hospitals. However, Indonesian women, especially in rural areas, have a variety of ways of accessing prenatal care. To read a more comprehensive run-down of services, check out this article from AngloInfo.

What to Get & Where to Get It

• The best prenatal health care in Indonesia can be found in Jakarta. Many Indonesian women still have home births with midwives (especially in rural areas), but many others use hospitals. The best hospitals in Jakarta are private hospitals and international clinics. Unfortunately, these private facilities are more expensive, so they are not accessible to many women and families. According to AngloInfo, "When choosing a hospital in an urban area, it is suggested to clarify whether emergency facilities such as neo-natal intensive care are available, if the father is allowed to be present at the birth, and which procedures the hospital uses for births."

Abortion

Laws & Social Stigmas

In Indonesia, abortion law is very strict and modeled after the Dutch Criminal Code. According to Indonesian law, abortion is prohibited except for very specific circumstances, which include: if there is a medical emergency determined at early stages of the pregnancy, if the pregnancy endangers the life of the mother or the fetus, if the fetus is at risk of a genetic disease or if the pregnancy is a result of rape. In all other circumstances, abortion is illegal.

Despite the strict abortion laws, Indonesia has a high abortion rate. While there is no official data, it's estimated that 2 million induced abortions occur in Indonesia each year and that the deaths caused by unsafe abortions account for 14-16% of all maternal deaths in Southeast Asia. Furthermore, estimates indicate that Indonesia experiences 20% more abortions per year than in Southeast Asia as a whole. Sadly, three out of one thousand women are hospitalized in Indonesia every year from botched abortions.

There are many methods of abortion in Indonesia. First, there is also a loophole in Indonesian law that can sort-of (in a grey area way) permit abortion: Menstrual Regulation. This law allows that women can receive vacuum aspiration as a procedure to "regulate" their menstruation if they have missed their period. Studies show that the majority of women who receive MR procedures in Indonesia are married and educated.

Due to lack of economic resources, accessibility and education, many Indonesian women resort to traditional and folk methods to induce abortion. Perhaps one of the most common traditional methods is massage, also known as "pijat" in Indonesia. This is the traditional method performed by a "Dukun Bayi," meaning it's not performed by a trained health care professional and is therefore not recommended. Nevertheless, it remains one of the most popular methods for poor and rural women due to lack of options. Some other women ingest an herbal drink called "Jamu," which originates from Java. The most effective Jamu for menstrual regulation and abortion is considered to be "Jamu telat bulan" (or Jamu Peluntur), which is made of boiled roots and leaves. It is common for women to find that they're still pregnant after attempting to drink Jamu many times, so they then seek out other abortion options.

Among modern methods, you can find dilatation and curettage (D&C), which is taught in many Indonesian medical schools and also known by Indonesian midwives (but is often practiced illegally in unsafe environments). Some women also get saline injections in the second trimester, but it's not often not effective in fully inducing abortion. There is also a black market for the abortion pill, but there are many unsafe pills and you should be very careful.

According to a 2015 report, the most common methods of abortion in Indonesia were vacuum aspiration or D&C (38%), oral medication or massage (25%), injected abortifacient (13%), foreign objects inserted into the vagina or uterus (8%), magic (8%), herbal methods or other methods inserted into the vagina/uterus (5%), and acupuncture (4%). Many of these methods are unsafe and one should exercise extreme caution when considering the best method. Please contact a health provider (we have recommendations below in the "What To Get & Where To Get It") section before seeking out an abortion option.

What to Get & Where to Get It

• If you need to get an abortion but don't know where to turn in Indonesia, you should consider contacting Indonesia Samsara. They can let you know the available resources and your options. Phone: 0813 2717 1188 (Telkomsel), 0857 2900 1188 (IM3), 0878 3977 0033 (XL) and 0896 7467 7433 (Three). Email: samsara.indonesia@gmail.com. Facebook: https://www.facebook.com/samsar4/
• You can potentially get the "abortion pill" by mail. Check out this link for details.
• If you are considering leaving the country to obtain a legal abortion, you can obtain a legal abortions in Vietnam, Cambodia, India, Australia and China. You can also get an abortion in Japan, where there are some restrictions but most women find a way to get it under the law.

Costs

If you are pregnant and considering getting an abortion outside Indonesia, you will need to consider the following costs: transportation to the country where you will be obtaining an abortion, hotel or accommodation costs in that country, cost of the abortion in the country and the total amount of days you may need to be in the country both before and after the abortion.

Advocacy & Counseling

• Talitha Kum: This is a Catholic religious sisterhood of women who help victims of human trafficking. "We, members of Talitha Kum Southeast Asia, as consecrated persons and lay partners, are committed to eradicating human trafficking, modern-day slavery, forced labour and debt bondage, especially among children and women, in the Southeast/East Asia region." Email: apwrath@apwrath.org