How health workers in Indonesia are transforming care for survivors of gender-based violence

JAVA/LOMBOK ISLANDS, Indonesia – The districts of Brebes, Lombok Timur and Serang may be geographically distant, but they share a common struggle: The silence surrounding gender-based violence, as stigma and discrimination deter many from reporting their abusers.

“I have a patient who kept coming back over the past two years,” Dr. Gerald Mandra Dwiputra of the District Hospital in Serang recalled to UNFPA, the United Nations sexual and reproductive health agency. “Each time, she arrived with worse injuries.”

At a later visit the patient finally opened up, requesting a medical report so she could warn her abuser that she had told someone. But she stopped short of filing a complaint with the police. “There are various reasons for this,” explained Dr. Dwiputra. “Concerns about their children, financial dependence, or fear that reporting will provoke even more violence.”

From doctors to midwives, health workers in the region are increasingly noticing survivors of violence visiting the emergency room. Yet as their patients rarely felt able to talk about what was happening, they were left with few possibilities to help beyond treating the physical injuries.

One quarter of women and girls aged 15 to 64 in Indonesia report having experienced physical or sexual violence at some point in their lives. Yet many are afraid that if they talk about the abuse, they and their families will face discrimination, their children’s lives may be disrupted, or they could lose financial support – a threat abusers often use to silence their targets.

Two women in head coverings sit across from one another in a medical office with a computer in the background and files open in front of them — In Indonesia, initial medical response for survivors of violence is typically provided at a hospital or a community health centre. © UNFPA Indonesia/Asri Wijayanti

Fighting stigma and encouraging belief in survivors

In some areas of Lombok Timur, communities still practice ‘bride kidnapping’, whereby a woman or a girl is captured and taken away by a man who wants to marry her. Many consider it shameful for a girl to return from a ‘kidnapping’ unwed, so it often results in forced child marriages.

Although child marriage rates in Indonesia have halved in the last ten years, almost 6 per cent of women aged 20 to 24 are still wed before turning 18. As well as being a violation of bodily autonomy, child marriage leaves girls more likely to be forced out of school and at higher risk of adolescent pregnancy, with the potentially life-threatening health dangers this brings.

Yet at the Soedjono District Hospital in Lombok Timur, midwife Hustiniyanti said girls are increasingly arriving at the emergency room after their families have intervened. “Before, parents would quickly wed the girls to their kidnappers to avoid bringing shame to the family,” she explained. “But now, some insist on getting their daughters back and taking them to hospital for a check-up.”

Unfortunately, delays in seeking medical attention often lead to the loss of crucial evidence of sexual violence, and can complicate treatment of sexually transmitted infections.

A woman in a yellow head covering sits behind a desk, with an open file in front of her — Midwife Ewin Nafwiya said the training helped her communicate with both her adolescent clients and her own children. © UNFPA Indonesia / Lucky Putra

“The most disheartening part is that many didn’t even realize that what they’d experienced was violence,” explained the midwife. While the legal system depends on reports to hold perpetrators accountable, limited education and a lack of awareness often perpetuate the silence, leaving survivors without the support they need.

Changing methods and minds through training

Confusion and hesitation about how to seek help are not exclusive to survivors. “Sometimes, we didn’t know what to do or where to go,” added Dr. Fitria Tata Alvina from the Sebes District Hospital. “We would perform an examination, but when the [survivor] asked for a forensic report, I found it confusing because there are specific procedures for that.”

Dr. Yossie Guventri Suprana, who works in the emergency room at the Brebes hospital, agreed. “I was hesitant, and even afraid of making mistakes when examining survivors.” Until earlier last year, she typically referred them to the nearest clinic.

A woman in a green and white patterned outfit and white head covering smiles on a balcony — “Sometimes, we didn’t know what to do or where to go,” said Dr. Fitria Tata Alvina, who works at the District Hospital in Brebes. © UNFPA Indonesia/Itsnain Ginanjar Bagus Setiadi

In 2024, UNFPA launched a training programme with the Ministry of Health to equip health workers with the knowledge and skills to manage cases of violence effectively. Ms. Hustiniyanti attended as part of a Women at the Centre project, supported by the Takeda Pharmaceutical Company Ltd. “It’s so different when survivors feel comfortable,” she said. “They can articulate what happened and express what they need more clearly.”

For Ms. Nafwiya, the training has been transformative with her adolescent patients. “They usually start opening up during one-on-one counselling sessions, and from there I can follow up on their cases,” she said.

And Dr. Suprana is careful not to ask survivors to recount their trauma multiple times. “I had never thought about it before,” she explained to UNFPA. “After nurses or midwives had asked some initial questions, I used to ask patients for more details. But now I realize that repeatedly discussing the violence may have further impacts on them.”

A non-governmental integrated service centre in Brebes has also been established, so survivors can seek support, counselling and protection. “Now I know that after the medical examination and upon the survivors’ consent, I can refer them to this centre,” said Dr. Alvina.