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30 Oct 2018

Global Issues in Adolescent Health

Sartiah Yusran, 2017
The University of Melbourne


This qualitative study was conducted to describe young people, parents,’ teachers’ and the broader community’s attitude and belief on premarital relationship including premarital sex for teenagers. The second objective is to explore the views on and concepts of sexuality and reproductive health education among young people, parents,’ teachers’ and policy makers and the broader community.  The third aim of this research was to identify the needs of adolescents for sexuality and reproductive health education, including the gap between young people’s needs and existing sexuality and reproductive health education policies and programs.  This study also describes parents’ wishes and teachers’ expectation on the educational concept of sexuality and reproductive health issues. The last aim was to explore the appropriate program policies for a school-based sexuality and reproductive health education program in Makassar, South Sulawesi, Indonesia. 

The research was conducted in 6 Senior High Schools; and involved 56 male and 56 female secondary schools students, 11 male and 18 female secondary students’ parents, and 16 male and 15 female teachers. The study sample also included 9 male and 6 female key informants from different background and from Jakarta, Jogyakarta, Surabaya, Denpasar and also from Makassar.

The methods used included interviews, focus group discussions and key informant interviews. Key informants were interviewed at different occasions and the interviewed focused on the development of policies and programs for school-based sexuality and reproductive health education.  The interviews conducted with parents focused on their opinions related to adolescent premarital sexual relationships and friendships, and their expectations of school-based programs for their secondary school children. Student interviews focused on their needs for a school-based sexuality and reproductive health program, and the teachers were interviewed on their opinion about the sexuality and reproductive health as a single subject or within an integrated curriculum.  Focus group discussions provide data related to the group opinion of teachers, parents and students themselves to cross check with individual opinions obtained from interviews. 

Analysis of the results of interviews and focus group discussions show that premarital relationships are common among secondary school adolescents in Makassar. They were struggling with their exploration of sexuality, due to outside pressure and having to deal with contradictory expectations from their peers, parents and society.  This process is fraught and filled with misunderstandings about what the process actually involves. As a result they seem to be quite unsure of what they actually want to do as opposed to what they feel they have to do to be a part of the society, in ways acceptable to both family and friends. This confusing situation is compounded by the reality that they are also very poorly informed about sexuality and reproductive health.  Therefore, they expect that parents and school should work together providing the right information related to sexuality and reproductive health information.

The result of parents’ interview and focus group discussion indicated their concern about sexual relationships of their children due to religious and cultural taboos, family stigma derived from the loss of the reputation of the family, and their exclusion from social events. Religious restrictions and cultural taboos were the main reasons for parents’ resistance toward children’s premarital relationships and their reluctance to communicate with their children about sex. Therefore, most parents agreed that school was the best place for their children to receive sexuality and reproductive health information. They expected the school to provide information related to the family, future adult relationships, the negative consequences of pacaran (having a boy/girlfriend), and to guide young people to be responsible for their sexual behaviour in accordance with religious restrictions. Not unexpectedly, the school-based program should be placed within a social and moral framework.

Teachers agreed to include sexuality and reproductive health in the school curriculum, although they recognized several challenges in implementing the program. Not all teachers felt confident teaching the subject, and there were still conflicting opinions concerning the possibility of integrating it into the existing curriculum: in biology, religion, counselling and health, and physical education or sports lessons, while the remainder argued against its integration into the existing curriculum. Most of this latter group claimed that only biology teachers were likely to be ready to teach the subject. Most teachers agreed that adolescent sexuality and reproductive health education should be introduced into the secondary school curriculum by developing a core or a comprehensive curriculum.  However, the challenges should be taken into consideration: who will be the teachers, what the contents will be, what approach would be appropriate, and other elements of the teaching process including teaching allocation.

Key informants of this study agreed to develop school-based policy in order to accommodate further efforts to implement the school-based program as a national program, although they recognized that much work is needed. Advocacy needed to begin from the province down to the district level, and to include institutions, school bodies, community and religious leaders. Due to the political and ideological climate, further commitment and collaboration among various stakeholders needs to be strengthened to develop broad community awareness of school-based adolescent reproductive health education (ARHE), especially in school settings. Usaha Kesehatan Sekolah and Komite Sekolah are potential channels for the development of policy and program implementation.  

Secondary school adolescents received information on sexuality and reproductive health information from school too little and too late, and this area has been neglected in school-based curriculum. If the goal of a ‘adolescent reproductive health’ program is to help adolescents to take care of their reproductive health, to reduce their risk taking behaviour toward unwanted pregnancy, unsafe abortion, STIs and HIV/AIDS infection, and the long term effect is to enjoy a healthy and satisfying adolescence and to become healthy, productive adults, then in the future, this program must start with the development of school-based policies and  the implementation of the program into the formal curriculum.

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