Despite being separated by vast geographical distances, the districts of Brebes, Lombok Timur, and Serang share a common challenge: the stigma surrounding gender-based violence (GBV), which discourages many survivors from speaking out and seeking help.
Dr. Gerald Mandra Dwiputra, from the District Hospital in Serang, shared a troubling case with UNFPA, the United Nations sexual and reproductive health agency. “I had a patient who kept returning over the past two years, each time with more severe injuries,” Dr. Dwiputra recalled. Eventually, the patient opened up, asking for a medical report to warn her abuser. However, she refrained from reporting the incident to the authorities, citing fears about her children, financial dependence, and the risk of escalating violence.
In the region, health workers such as doctors and midwives are increasingly seeing survivors of violence in emergency rooms. Unfortunately, many victims are reluctant to share details, leaving healthcare providers limited in their ability to help beyond treating physical injuries.
According to statistics, one in four women and girls aged 15 to 64 in Indonesia have experienced physical or sexual violence during their lifetime. However, many fear speaking out about their abuse, as they worry about facing discrimination, the disruption of their families, or the loss of financial support—threats often used by abusers to silence their victims.
Fighting Stigma and Challenging Deep-Rooted Practices
In some parts of Lombok Timur, practices like ‘bride kidnapping’ continue to occur, where girls are taken by men wishing to marry them. Traditionally, it is considered shameful for a girl to return after being “kidnapped” without marrying, often leading to forced child marriages.
While Indonesia has made progress in reducing child marriage rates, nearly 6% of women aged 20 to 24 were married before turning 18. Child marriage not only violates a girl’s autonomy but also increases her risk of dropping out of school and experiencing adolescent pregnancy, which carries serious health risks.
At the Soedjono District Hospital in Lombok Timur, midwife Hustiniyanti has observed a shift in parental attitudes. “In the past, parents would marry off the girls quickly to their kidnappers to avoid bringing shame to the family,” she said. “Now, some parents are taking their daughters to the hospital for medical check-ups instead.”
However, delays in seeking medical help often result in the loss of vital evidence of sexual violence, complicating the treatment of sexually transmitted infections and other health concerns.
Raising Awareness and Changing Perceptions
Hustiniyanti explained that many survivors did not initially recognize that they had been victims of violence. In a legal system that relies on reports to hold perpetrators accountable, this lack of awareness and education perpetuates silence, leaving survivors without the support they need.
Dr. Fitria Tata Alvina from Sebes District Hospital also noted the confusion many health workers felt when dealing with cases of sexual violence. “We would conduct exams, but when the survivor asked for a forensic report, I found it difficult because there are specific procedures for such cases,” she said.
Dr. Yossie Guventri Suprana from the Brebes Hospital shared similar concerns. “I was hesitant and even afraid of making mistakes when examining survivors,” she admitted. Until recently, she would refer survivors to the nearest clinic for further assistance.
In 2024, UNFPA partnered with Indonesia’s Ministry of Health to launch a training program aimed at equipping healthcare providers with the skills and knowledge to handle cases of gender-based violence effectively. Midwife Hustiniyanti, who attended this training as part of the Women at the Centre project supported by Takeda Pharmaceutical Company Ltd., said the difference was clear. “When survivors feel comfortable, they can better express their needs,” she explained.
For midwife Ewin Nafwiya, the training transformed her approach to working with adolescent patients. “They start opening up during one-on-one counselling sessions, which allows me to follow up on their cases,” she said.
Improving Support and Strengthening Referral Systems
Dr. Suprana now ensures that survivors do not have to recount their traumatic experiences multiple times. “I used to ask for more details after nurses or midwives had asked some initial questions,” she explained. “Now, I realize that asking survivors to repeatedly talk about their trauma can have additional negative impacts on their mental well-being.”
A new non-governmental integrated service center has also been set up in Brebes, where survivors can receive support, counselling, and protection. “Now, I know that after performing a medical examination and with the survivor’s consent, I can refer them to this center for further support,” said Dr. Alvina.
These efforts are part of a larger commitment to transforming the healthcare response to gender-based violence in Indonesia, offering survivors not only medical care but also the critical support they need to rebuild their lives.
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