Healthcare Workers and Violence against Women in Indonesia
By: Bryant Roosevelt Sabur
Tags: Indonesia, Violence Against Women

Violence against women is one of the oldest issues our society faces. From rape, domestic violence, and many others, they are done to maintain the status quo (AKA patriarchy, where men dominate women). It is present in all levels of our life, from state (criminalizing safe abortion) to the personal (domestic violence). This means that various institutions and organizations have played a role. Healthcare workers are no exception, and two cases highlight this.

Around the end of 2019, a female athlete was sent back home, accused of not being a virgin. Her parents, not accepting of this accusation, had her checked by a doctor. Her hymen was found to be intact, and the conclusion was that she was a virgin. The fact that the accusation would have been grounds enough to send her back is ridiculous itself; your sexual activity does not correlate with your performance capacity. But there is another form of violence present here, virginity testing.

Virginity testing (or two finger test) is done to determine if a female has had sexual intercourse. We have a systematic review (highest level of evidence in medicine) by Olsom and Garcia in 2017 concluding it has no evidence base and harms those examined. WHO along with UN Women has also declared it a human rights violation. Yet it is still defended and even practiced in Indonesia. In a Kumparan article in late 2018, the deputy head of the health division of TNI confirmed its use to inspect potential female officers and wives of officers, also mentioning its use by the police and other companies. Though the police denies this, Human Rights Watch researcher Andreas Harsono notes that until 2018, there are still reports of virginity testing. The fact that a women’s virginity is considered important shows how women’s sexuality is not owned by themselves.

Another case is female genital mutilation (FGM). A January 2020 VICE article revealed that an organization conducts mass khitan for females, which is basically FGM. It has no medical basis and harms the females (sexual function, psychological, and many more, as WHO notes), yet it is still practiced even by the doctor interviewed. Although they try to justify themselves, such as to reveal the clitoris to allow orgasm (even though evidence shows the opposite), and that no cutting is involved (then how do you reveal it?), they admit that it is so that women are not sexual in the future, showing the intention to control women’s sexuality, even with the help of a doctor.

There are various approaches to combat these human rights violations. Opening dialogues with future parents could help inform them. A non-medical explanation, such as the one by Laily Fitri in Twitter explaining the lack of Islamic grounds for FGM, is important. I believe the role of healthcare worker is not just an inflicting one in this issue. In the mentioned Kumparan article, dr. Robbi, an OB-GYN, reiterates the lack of value in virginity testing. The VICE article also interviewed dr. Mahesa, an IDI member, who explained the harms of FGM. Healthcare workers have an obligation to uphold their practice to the highest standards, and should strive to fulfill, not violate, their patient’s human right.

For healthcare workers, there are several things you can do. First, start in your own practice. If a parent comes asks to get their daughter checked for virginity, counsel them. Inform them that no medical examination can determine someone’s virginity, and how harmful it is. If you can, go further. Deconstruct virginity (it being a social construct, only being an indicator/risk factor for certain health conditions and not a women’s quality, etc.). The same can be done for a parent who wishes to have their daughter’s genital be mutilated. Explain the lack of medical benefit, its harms, and if possible, open a dialogue with them, understanding why they wish to do so and responding to their thoughts and concerns.

If you lack time, as is often the case for those in public health facilities with limited time and too many patients, an arguable approach is to do it “safely”. How? Well, in the case of a virginity testing, while being alone with the patient, you can do sexual history taking (without judgment of course). This would also give you a chance for some counselling. If you have to report to someone else, such as the parent, ask the patient first. Upholding their confidentiality and best interests (which they can determine themselves) is of utmost importance. In the case of FGM, a practice that seems to be done on the grounds is to put some Betadine onto cotton and then applying it on the genital with the aid of something long, such as a needle. In both cases, you essentially do not harm the patient (no two finger test or actual needle mutilating the genital). However, the attitude that got them there, and the social system that is patriarchy, would still live on. With limited time, I’d argue this is a better alternative to scolding the parent, possibly pushing them to visit another healthcare worker to have their daughter two finger tested or genital mutilated.

If you can, advocate. Advocate in your family, to your friends, in your social media. Explain how virginity testing and FGM are harmful, have no medical basis, and only serve to keep women oppressed. In Instagram, @vaginismusindonesia and @monsyouth, both healthcare providers, have posts showing the irrelevance of virginity testing. If you are in the position, you could even advocate in your profession’s organization. Release a statement, set standards, and include it in your education about violence against women. The Ministry of Health already has a law in 2014 indicating FGM is not a medical procedure. The original draft of the anti-sexual violence bill (RUU PKS) had 15 forms of sexual violence, one of them being traditional practices in sexual nature that harms women (FGM falls within this category). The profession should hold itself accountable, for their patient’s wellbeing.