Talking about sex. Religiously

”Shhh! Don’t say sex education”, Wan Nedra cautions, with a smile. Dr Nedra is vice-dean at the Farsi University in Jakarta and a volunteer leader with the Muslimat Nahadat ul Ulama. The Nahadut ul, like the Muhammediya, is one of the leading religious charitable groups in Indonesia. It funds not just schools and hospitals, but also helps mobilize communities to battle problems like poverty.

What is not so well-known is the role the group plays in promoting family planning in the country. It does this not only by counselling couples but also educates students at the Islamic boarding schools, or pesantrens it runs.

Dr Nedra of Nahdatul Ulama

”We call it reproductive health education,” says Dr Nedra. Depending on their age, children learn about their body parts, contraceptives and sexual rights. The Nahadut ul publishes literature called the “maslahah” which use ayahs or verses from the Quran and examples from the Sunnah (life of the Prophet) to talk about family planning.  The study of fiqh or Islamic jurisprudence, includes biology, and tahaarah (rules of cleanliness) talks about maintaining internal hygiene, relating it to the spread of HIV and sexually transmitted diseases. A far cry from the general practice is most madrassas or for that matter in many religiously oriented institutions.  Some things are a strict no-no however. Abortion is not touched upon. Or vasectomy.

This approach of working within the limits imposed by culture and religion is refreshing. Sex education remains a touchy subject in India and there is huge opposition to the idea of introducing it in schools. The Nahadut ul’s approach is an intelligent one. Something we could learn from. Instead of saying a blanket no to a subject that needs to be looked at, not through the lens of morality, but health.

World’s first male pill

Mention Genderussa, and most people imagine it to be a feminine hygiene product. In fact it is the world’s first non-hormonal, oral male contraceptive drug, currently in the third phase of clinical trials in Indonesia. If all goes well, it will hit the markets here early 2013.

Genderussa capsules

The question everyone is asking however is, will men have it? Indonesian health experts are hoping they will. At nearly 237 million,Indonesia is the fourth most populous country in the world. The government here has taken a huge initiative in curbing population growth, but its progress has been hampered by the lack of male participation, with less than 2% of men chipping in. Genderussa, experts here are hoping will change that age-old mindset. ‘’Family planning is not just for women. It’s a decision made by the couple, ‘’ says Dr Sugiri Syarief of the national Demographic and Family planning agency, BkkbN.

Derived from the native Justicia Genderussa plant which grows in Papua, Indonesia, research into the pill started in 1987, after some experts found that men on these islands traditionally used the genderussa leaves as a contraceptive. Local laws do not allow the men to get married unless they pay a huge dowry. They can, however live in with their partners, as long as they do not have children.

Justicia genderussa

“Our tests showed the leaves had properties that disturb the enzyme system of the sperm,’’ says Prof Bambang Prajogo, Senior Researcher at the Faculty of Pharmacy, Airlagga University in Surabaya which is conducting the trials. Genderussa, however is a toxic plant, and the alkaloids are removed with an acidic solution. Traditionally the people would boil the whole plant to eliminate the toxic compounds. ‘’We have done tests to ensure there is no pesticide residue, ash content, microbes and radioactive impurities in the leaves,’’ claims Prajogo. The findings have been published in an Indonesian journal, but not as yet internationally.

‘’Genderussa guarantees safety, quality and efficacy as per WHO requirements on contraceptive drugs,’’ says Dr Dyan Pramesti, who is leading the clinical trials. There is a common side effect, namely abdominal discomfort. One subject we spoke to however said he would recommend the pill to his friends.

Dr Dyan Premasti

Islam allows  non permanent methods of family planning. So genderussa fits right in. It’s taken like any birth control pill, one dose a day. If it works, and passes safety standards in other countries, it could well revolutionize the way the world looks at family planning. Hormonal contraceptives are endangering the lives of many women. Genderussa, which is non-hormonal, could prevent that. Last, and most important, it’s a fundamental move towards gender equality.

Feeding the Media: The Indonesia Way

One of the hardest things for journalists is to pitch a story that does not fit into the ‘’breaking news’’ slot.  And this is not just the case in India. When it comes to health or any other development-related issue for that matter, fighting for news space is quite hard.

Take maternal mortality or poor health infrastructure in villages for instance. Huge concerns in India. Reports on these tend to get buried unless there is a shocking peg, like a pregnant woman dying on the streets because no hospital would admit her. And if this was to clash with, say the Indian cricket team’s return after some huge win, well forget about it.

How does one get around this? Here in Indonesia, the BkkbN, the government’s National Population and Family Planning Board, that has played a seminal role in curbing the country’s population growth, has a partnership with the local media. This, they say, has helped in two ways. One, the media has helped spread information about its various services to the provinces. Two, it gets feedback on what’s going wrong.  I can see a few eyebrows being raised here.  The media after all is meant to take on the government, question it, although one could perhaps do with more of that, at least in India.

Across many provinces, the BkkbN has set up the Family Planning Journalists Association, made up of local reporters who are given training in population and FP issues. Orientations help familiarize them with the various contraceptive methods and services provided by the state. The groups change every 4 years, and what’s important to note is that they are not on the BkkbN’s payroll.

‘’The media have played a big role in the FP program’s success,’’ says Siti Fatonah, Head, BkkbN West Java. West Java is one of the biggest provinces, its population contributing to 20% of Indonesia’s total. ‘’Putting the right kind of image forward was difficult for us. The media has helped. We get to know about field workers demanding payment for free services,” adds Fatonah.

But how free and frank is this partnership really, one can’t help but wonder.

‘’They do not interfere. They never stop us from writing negative stories. We often report on things that are going wrong,’’ says Sulhan Syafe, who heads the West Java FPJA.   What attracted him towards taking up the position?  ‘’After Suharto stepped down and democracy came to Indonesia, the media could write what it wanted.  But no one cared about FP related issues. I do this because I know journalists lack information and perspective about our FP program.  I have seen how farmers with 6-7 children struggle to feed their families and this issue is critical for Indonesia,’’ says Syalfe.

The government support, however, does not ensure that FP issues always get played up.  ‘’I have to fight, beg and plead with my editor to carry stories.  They are always willing to give space to politics and to stories about Lady Gaga’s concert being called off,’’ says Elly Burhaini Faizal, Correspondent with The Jakarta Post.

BkkbN credits its FP program’s success, to a large extent, to its partnership with the media. Something it needs to build on given the tremendous challenges that still lie ahead. Indonesia is the fourth most populous country in the world, and there is poor health infrastructure in the remote provinces.  One suggestion is that the government should perhaps widen its media partnership to include senior editors!

Lessons from Indonesia

It has the world’s largest Muslim population, yet Indonesia is widely regarded as the poster child of successful family planning.  A remarkable achievement, given that as recent as in the early 70’s, the average family size here was 5.6 births per woman. Today that stands at 2.3 and all this in a span of just over four decades. Indonesia’s approach has lessons for many, including India which at 2.73 births per woman is far from the Millennium Development Goal of 2.1.

The government here has done this through partnership with various stakeholders – community leaders, media, private health sector and more importantly religious leaders. Getting leaders from groups like the Muhammediya has been critical to the program’s success.  One of Indonesia’s oldest Faith Based Organizations, the Muhammadiya  was formed in November 1912 in Yogyakarta. It has leaders in all thirty three provinces in the country and supports key government initiatives in health and education.

“But doesn’t Islam discourage family planning”, I ask Dr Atikah M Zaki, Health and Social Coordinator of the Aisyiyah, the women’s wing of the Muhammediya group. “Islam is not against temporary methods,” Dr Zaki points out. “We encourage pills, IUD, injections and spacing. It is permanent methods like abortions and sterilizations that are not allowed.”

The group even counsels couples who are divided over FP. “When the wife wants to delay babies and the husband is opposed to it, our local leaders intervene and convince him,” says Dr Fifi Maghfirah.  In fact the Muhammediya was the first Islamic organization in the world to promote FP.  “In most Muslim countries there is no difference of opinion on temporary methods of contraception,” says Farahanaz Zahidi Moazzam, a freelance journalist and activist from Pakistan. “But the difference between Indonesia and other Muslim countries is that it is discussed openly here.  What is remarkable is that the organization is using religion to promote FP,” Moazzam adds.

It is a tactic that could work in India where family planning remains a sensitive topic. Bringing community leaders on board could help overcome reservations that decades of the government’s  ‘’Hum Do Hamare Do’’ (We are two, and we have two) campaigns have not.