Focus Edition 48
Working on the Integration of Reproductive Health (Kespro) and Sexuality
in Pesantren and Madrasah Education
by: AD. Kusumaningtyas     

“We understand, the book Qurrat al-Uyun is also visualized vulgarly, the explanation only by sentences, sometimes santri (the pesantren students) study it by visualizing on their own mind,” said Gus Humam, the son of Kyai Tamam, head of Pondok Pesantren Raudlatul Falah, Rembang, during the forum of sex education for santri above 17 years old. The activity was carried out by Center of Information and Consultation of Reproductive Health for Adolescents (PIK KRR (abbreviation of Pusat Informasi dan Konsultasi Kesehatan Reproduksi Remaja) in Pesantren Raudlatul Falah, with facilitators from Rembang District Health Office. A similar statement was also made by Hanik, one of the participants, “Actually it is not a problem, we the students are not strangers to sex education issue. The Qurrat al-‘Uyun that we learned in pesantren is actually the book of sex education.”  Hanik firmly stated, “But the discussion in the book is not as detailed as in this counseling,” he thought the pictures made the discussion to be so detailed and vulgar.

Students of class X Madrasah Aliyah (Senior High School) Al Ghazaliyah, Jombang had shouted istighfar (the act of seeking forgiveness from Allah. This act is generally done by repeating the Arabic words astaghfirullah, meaning “I seek forgiveness from “Allah”) when Lukmanul Hakim, the teacher of Sexual and Reproductive Health Education (PKRS; Pendidikan Kesehatan Reproduksi dan Seksual) explained the subjects he would teach. Because hearing word ‘sexuality’, the students’ imagined the teacher would teach things that have been considered as taboo. With his creativity, Lukman invited his students to play games to recognize their own bodies. As a result, at the third meeting the students began to dare to name the reproductive organs and asked important things about reproductive health issues, whether masturbation is haram (forbidden or proscribed by Islamic law) or not. At least the discussion on reproductive health and sexuality is not a new subject in the pesantren world or other Islamic educational institutions.

The talks about reproductive health and sexuality are often addressed ambiguously. On one hand, it is seen as taboo, pamali (forbidden to do) , saru (vulgar), it is considered as an indecent subject to be talked openly. On the other hand, it is on demand, sought, and discussed shyly and awkwardly. This ambiguity raises many issues due to some myths and wrong information. As the effects, many social problems arise in the society from this kind of situation.

Problems of Reproductive  Health Education: Whose Responsibility?
The Indonesian Demographic and Health Survey data in 2012 shows that number of girls aged 15-19 who gave birth is quite high, 48 births per 1000 women. This number increased from the results of the Indonesian Demographic and Health Survey in 2007, which was 37 births per 1000 women. (See in the Summary of Reproductive Health Education to Become Part of National Education Curriculum to Prevent Children and Adolescents from Sexual Violence, delivered by SEPERLIMA Network to the First Lady and OASE Working Cabinet at Wisma Negara, Tuesday 3 February 2015).

The percentage of girls and boys who have been dating based on the SDKI (Indonesian abbreviation of Indonesia Demographic and Health Survey) in 2012, KRR (Consultation of Reproductive Health for Adolescents) component is higher than that compared to the Indonesian Youth Reproductive Health Survey 2007. In 2012, 85% male adolescents have been dating, while in 2007 was only 72%. In 2012, 85% female adolescent have also been dating, in 2007 was 77%. Nearly half of young girls and boys aged between15-24 years old who have not been married, begin courting the first time at the age of 15-17 years (47% for girls and 45% for boys). (see in the Summary of Reproductive Health Education to Become Part of National Education Curriculum to Prevent Children and Adolescents from Sexual Violence, delivered by SEPERLIMA Network to the First Lady and OASE Working Cabinet at Wisma Negara, Tuesday 3 February 2015).

When teenagers reach their baligh (puberty), some are boarded into pesantren to continue their study. Most of their time is spent in pesantren. They can not ask parents. Oftentimes a teenage girl who gets her first period does not know how to deal with it, she never gets explanations from her mother. A teenage boy also does not understand about wet dreams, they never have such a dialogue with his father. The parents tend to leave this issue to other parties like schools or pesantren, which they hope can provide the right information on this issue. So, most teenagers actually receive unreliable information about reproductive health and sexuality, so they want to know from their peers who are also feeling uncertain about the correct information.

Parents who are expected to provide some information about reproductive health and sexuality are often stuttered when they face their sons and daughters’ questions: Where’s the baby coming from? How do parents explain it? Is it true that conversation about reproductive health only related to where the birth begins?

Educational institutions like madrasah and pesantren, are often considered to be ignorant toward this issue. However, true conversations about reproductive health and sexuality can not be avoided. Pesantren has a formal school or madrasah ibtidaiyah (elementary school), madrasah tsanawiyah (junior high school), madrasah aliyah (senior high school) where the source of available information about reproductive health comes only from the biology and fiqh teachers. While in the traditional pesantren, it is only obtained from Kyai (male pesantren leader) or teachers of fiqh lesson. In the Biology lessons, there are contents around reproductive organs and functions, and in fiqh there are discussions of thaharah (cleanliness) which talk about things that cause mandatory bathes for Muslims such as menstruation, junub (sexual intercourse between husband and wife), and wiladah (bleeding after giving birth).

Reproductive Health and Sexuality in the Pesantren Tradition
In some pesanten, some of Yellow Books (Kitab Kuning) that studied by students have the content of reproductive health and sexuality. For example, in pesantren Assalam Selopurao, Jambewangi Blitar, some yellow books studied by santri are Risalatul Mahidh in Javanese Krama (high language), Uqudul Lujayn in Arabic, Qurratul Uyun in Arabic. Halim Soebahar and Hamdanah Ustman have conducted research that discussed books that have content about reproductive health and sexuality which are studied in various pesantren in Madura; 1) ‘Uqudul Lujayn by Syekh Nawawi Al-Bantani 2) Adabul Mar’ah 3) As Silah fi Bayanin Nikah, both works are written by KH Moh. Cholil Bangkalan.

Yet from the study, those yellow books have more patrilineal normative female obligations, almost no aspect of health knowledge with all its consequences. In fact, when further identified, in addition to the classical books with popular titles as mentioned above, there are other various books such as: Risalatul Mar’ah, Kitabun Nikah, Al Usfuriyah, Fathul Izhar, Ma Baina al-Nisa wa al-Rijal, Fiqhun Nisa ‘ , Qiyamul Lail, Fathul Syaiban, Al-Bahts fi Binai Usrotil Hasanah. These books teach including adab/ethic of sexual manners, marriage issues, discussions about menstruation, istihadhah (irregular bleeding besides menstruation) and nifas (post natal bleeding), women’s studies, fiqh of women, akhlak (moral) education, and discussions on how to build a good family. The existence of these books shows the richness of the classical Islamic tradition of pesantren which discuss about reproductive health and sexuality.

However on the other hand, health issues (including reproductive health) in pesantren have long been inspected. Nurcholis Majid (1997) has recorded many things concerning pesantren, among others: from environmental side of the building layout is usually located around the mosque with irregular layout, narrow chaotic dorm rooms, dirty and inadequate  available bathrooms compared to the numbers of santri. The general cleanliness is very apprehensive. Santri’s simple life tend to be less hygienic, often associated with skin diseases, from internal behavior in the environment tend to be liberal and arbitrary, but when dealing with outsiders tend to be timid. Because of unhealthy environment and inadequate facilities, in some pesantren there is liwath/ homosexual practice which is almost taken for granted.

The above situation was still encountered by the Research Team of Gender and Sexuality Center from University of Indonesia, while conducting research among santri in the area surrounded some big pesantren like Darul ‘Ulum Rejoso, Tebuireng, Denanyar and Bahrul Ulum Tambakberas in East Java. Besides conducting a survey on the understanding of reproductive health and sexual behavior of santri, this team was also deepening in Focus Group Discussion (FGD) of several groups of male students. Among issues revealed in the discussions, there were some santri from various pesantren who claimed to had been touched in their genitals part by their own friends while sleeping in the dormitory. They refer the incident as nyuluh, meaning the male genitals are rubbed on thighs of their fellow, usually done when they want to sleep in a room contains several santri. Nyuluh are usually done by seniors to juniors or to new santri.

Another problem often arises in pesantren is issue of reproductive health related with the reproductive organ cleanliness, such as itching around the genitals experienced by male students and whitish problems that are often experienced by female students. Generally male students admitted often do not change underwear for two days, known in term “side A side B” means pants are worn both sides in turn. Meanwhile, female students generally only change their pads once a day if they have menstruation that causes them to have itchy or whitish problems.

Based on needs assessment report by Rahima on Sexual Health and Reproductive Youth in 2012 in Banyuwangi, it  showed that 80.7% students either in pesantren or in Islamic schools outside pesantren (madrasah aliyah) ever dating experience. Results of the study also showed of all students who dated, had done some various sexual activities. Sometimes, the courtship relationships had gender insinuation (power relations on basis of sex) which emerged cases of violence and sexual behavior that were vulnerable to reproductive health disorders. The research and facts should have opened eyes and awakened various parties to the importance of providing comprehensive education on reproductive health and sexuality, including integrate it into the learning process in pesantren, schools and madrasah.

The Integrative Efforts of Reproductive Health Issues through Educational Institutions
The idea of ​​integrating reproductive health issues through educational institutions has actually been a matter of time for the government attention. In 2000 the Department of Religious Affairs in cooperation with the World Bank published a booklet entitled Adolescent Reproductive Health. The book was published by Department (now Ministry) of Religious Affairs of the Secretariat General of Safe Motherhood Project in (Central) Jakarta in 1999/ 2000. The book was part of Adolescent Reproductive Health (ARH) Program as a written guideline for adolescent reproductive health issues in the Department of Religious Affairs. The target groups of the program were the students of:  a) madrasah tsanawiyah (junior high school) and madrasah aliyah (senior high school), b) pesantren, c) youth mosque, and d) bride candidates. The content presented in this program were about Consultation of Reproductive Health for Adolescents covering matters related to human status and reproduction, adolescent growth, male and female reproductive organs, pregnancy, risky sexual behavior with consequences, pre-marriage preparation, and guidance and counseling. It was also described in the booklet that methods used in the guidance and counseling, could be lectures, discussions, dialogues, simulations, role plays and so on. The materials could be delivered in a special and separate ways, and also be integrated into a current and standardized curriculum. In the implementation, this program could be held with support and role of many parties such as family, Kyai, Nyai, teachers, preachers, and peers.

In public schools, one of the most effective efforts is the information extension through educational institutions closest to the students, schools, especially in the Biology learning. The efforts undertaken include integrating reproductive health education in Biology subject in high schools, especially through the implementation of the 2013 national curriculum. Biology learning in schools, discusses human reproductive system, has a big contribution to overcome reproductive health problems in teens. Biology in Senior High School examines connections between reproductive system and reproductive health, and through implementation of the 2013 national curriculum, reproductive health education supported by the learning of physical, sport and health education. Thus, it is expected that adolescents in high schools can be protected from reproductive health problems.

The sources of information in reproductive health are available in pesantren, basically there is nothing very specific discussing reproductive health issues. In Biology lessons sometimes found content about reproductive organs, and conversations about reproductive organs are also discussed in the subject of fiqh. However, nowadays pesantren have started to have Pesantren Health Posts (Poskestren) as one of the community health efforts in pesantren with the principle of, by, and for pesantren people who prioritize promotive (improvement) and preventive services without ignoring curative (treatment) aspects and rehabilitation by health recovery with the help of local health centers. Based on the analysis of research conducted by Kharisma Wijayanti as quoted from her report when she highlighted the activities of Poskestren developed in Pemalang Regency and Lampung Province, there have been developed models of education or counseling of adolescent reproductive health among santri and through the pattern of peer coaching. The models are more polite in considering condition and mental development of adolescents.

The initiative to integrate reproductive health through process of education in madrasah and pesantren is also done by PKBI (Indonesian Family Planning Association) Lampung by providing Adolescent Reproductive Health Training for Madrasah Aliyah and pesantren teachers. According to Herdimansyah, the director, PKBI Lampung has taken an intense approach to 25 schools in Lampung through the programs of  Dunia Remajaku Seru (DaKu) means My Exciting Teenage World, and Dance For Life. Not only public, but also other religious schools, such as Madrasah Aliyah and pesantren became the target of our program,” he continued.

Similar initiatives are also undertaken by Rahima, by conducting reproductive health education in madrasah and pesantren based schools in Jombang, Lamongan, Kediri, and Banyuwangi, East Java. Efforts to socialize reproductive health in schools are also undertaken for Islamic religious teachers and students by socializing the methods of student debates in the school learning; where themes related to reproductive health issues were also raised as motions in the debates.

Reproductive Health Education in the State Policy
In Article 137 of Law no. 36 in 2009 on Health stated that; 1) The Government is obliged to ensure that adolescents can get education, information, and services about adolescent health, so they are able to live healthy and responsible. 2) Provisions concerning the obligation of the Government in ensuring that youth obtain education, information and services on health as referred to in paragraph (1) shall be conducted in accordance with moral considerations of religious values and in accordance with the provisions of laws and regulations.

In 2011, there are 10,765 senior high schools in Indonesia, while for state Madrasah Aliyah are 758, and 5,657 for private-run Madrasah Aliyah. There are many more religious schools exist in Indonesia. The existence of these faith-based schools cannot be ignored, these faith-based schools have become a kind of support and alternative school besides the existing public schools. These faith-based schools are under auspices of Ministry of Religious Affairs, where Ministry of Religious Affairs not only nurtures pesantren with all its interests, but also general and religious based education at the same time.  Even so, adolescents attending faith-based schools are also not immune from reproductive health problems. Because after all, teenagers everywhere have the same phase to grow their reproductions, and always want to try new things they find out.

However, until now there has been no policy from the Ministry of Religion which specifically trying to include reproductive health materials targeting schools / madrasah and pesantren under its umbrella. So far, the policy related to the existing reproductive health is limited to collective instructions with the Director General of Islamic Society Guidance in the Ministry of Religious Affairs and the Directorate General of Eradication of Communicable Diseases, and Disease Prevention and Control of Ministry of Health concerning the Immunization of TT (No. 02 of 1989), the Regulation of the Director General of Islamic Society Guidance on Suscatin/the Pre Marriage Course (DJ.II / 491 of 2009), and publishing book Adolescent Reproductive Health by the Department of Religious Affairs of Secretariat General of Safe Motherhood Project of (Central) Jakarta in 1999/2000.

The rise of violence cases and sexual offenses affecting children and adolescents, from sexual harassment, sodomy to rapes in recent years, have made people aware the importance of sexual and reproductive health education in schools. This seems to get a response from the former President SBY (Susilo Bambang Yudhoyono) who at end of his tenure issued the Presidential Instruction no. 5 year 2014 on National Anti Sexual Crime of Children Movement, on 11 June 2014 ago. Not only that, on  21 July 2014 President SBY has also signed the Government Regulation no. 61 of 2014 on Reproductive Health, to supplement Law no. 36 of 2009 on Health. With both of these rules, the real effort to include reproductive health in school learning in fact has been justified.

In August 2014 last year, the Women’s Health Foundation (abbreviated in Indonesia as YKP) held hearings with the Minister of Religious Affairs, Lukman Hakim Saifuddin, to strive for schools or madrasah under auspices of Ministry of Religious Affairs, to support moral education, and special education, curricula on reproductive health. If necessary also encourage it by issuing a Regulation of the Minister of Religious Affairs that regulates the reproductive health curriculum in madrasah. Responding to the proposal, the Minister of Religious Affairs Lukman Hakim Saifuddin, asserted he would give an attention to the curriculum in madrasah or pesantren related to reproductive health education.

YKP along with a task force called SEPERLIMA, Rahima, PKBI, Pamflet, Center for Gender and Sexuality Studies University of Indonesia and HiVOS fight for Sexual and Reproductive Health Education to be put into learning in public schools (which are under Ministry of Education and Culture), including in madrasah, pesantren, and Islamic schools under the Ministry of Religious Affairs of Republic of Indonesia. Currently, SEPERLIMA is also preparing a Judicial Review (JR) on Law no. 20 of 2003 on National Education System (Sisdiknas) so reproductive health can officially enter as part of the core subjects in school.

Among the observed and relieved changes by Lukman Hakim, Sexual and Reproductive Health Education teacher at madrasah aliyah Al Ghazaliah, the students begin to have the right room to inquire and discuss issues of reproductive health and sexuality. The teens are no longer looking for content through internet that has unreliable information. They begin to find the right reference to ask about their curiosity and incomplete information they get in the community. By getting the right information, it will make them critical and unwilling to access sites that provide pornographic content. We don’t need to worry too much and assume that reproductive health education will encourage free sex behavior. We should reflect from Netherlands with Lang Lieve de Liefda which teaches Three Rs (Rights, Responsibility, Respect), the philosophy of social values ​​in adolescent reproductive health education. With reproductive health education they can suppress teenage pregnancy rates, because teenagers in Netherlands actually realize that early sex is very harmful for them.

The results of local research on number of students in Sleman, Yogyakarta, can prevent prejudice and much worries. One of the 3 points of the study concludes there is a significant negative relationship between the level of reproductive health knowledge with attitudes toward free sexual behavior in students of SMK (Senior Vocational School) Bina Harapan Sinduharjo SlemanYogyakarta, value 0,000. This means the higher level of knowledge about reproductive health will protect the teens from the attitude toward free sexual behavior.   So, are you still doubting about the importance of reproductive health education for teenagers? [] AD Kusumaningtyas     

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