In 24-25 November 2023, Jakarta Feminist conducted an online Women’s Tribunal as an opening of 16 Days Anti Violence Against Women and as an pre-event of Feminist Festival 2023: Women’s Liberation Stage. This tribunal covered 6 cluster of issues:

1. Sexual and Reproductive Health
2. Mental Health
3. Climate Crisis Impact on Women’s Health
4. Gender-Based and Sexual Violence
5. Access to Health Services for Women, Marginalized Groups, and Vulnerable Populations
6. Women Workers’ Safety and Health Rights

This initiative aims to document human rights violations, encompassing discrimination, oppression, and gender-based violence across various health clusters, by gathering testimonials from victims and survivors and present robust demands and recommendations to the government, policymakers, law enforcement, and relevant stakeholders, urging them to take responsibility and ensure the fulfillment of survivors’ and victims’ rights in alignment with international human rights standards.

In the cluster of Women’s Mental Health, the team are:

1. Ayu Oktariani – Ikatan Perempuan Positif Indonesia (IPPI)
2. Sari Aznur – The Positive Indonesia Network and Womxn’s Voice
3. dr. Sandra Suryadana – Doctors Without Stigma Community

We listened to 3 testimonials, told us women’s experience in drug abuse cases and we read 1 testimonial about the challenges in advocating women’s as violence victims.

Testimonials

Testimony by Nanda:

Nanda is a 20-year-old woman, a widow with one child. She was in a relationship with a man without any intention of marriage, but her boyfriend insisted on getting married. Due to this reason, the boyfriend gathered marriage funds by engaging in drug trafficking. In this situation, Nanda was also caught when her boyfriend was arrested by Densus 88. Nanda was arrested for being perceived as aware of her boyfriend’s activities as a drug dealer but not reporting it. In prison, Nanda witnessed a lot of violence, leading her to experience trauma. Nanda was also manipulated by her boyfriend, who used marriage as a reason to become a drug dealer. The lawyer representing her boyfriend also manipulated the situation by stating that “if a woman confesses, her punishment will be lighter because of her motherhood status,” which had no relevance at all. Nanda was then sentenced to 16 years in prison and was released after serving 9 years. The issues faced by Nanda significantly impacted her mental health.

Testimony by Fani:

Fani started using drugs since adolescence. She also frequently experienced physical violence from her family, who considered her behavior as teenage delinquency. Fani was regarded as a problematic child and was sent to a boarding school instead of attending public school. After completing her education at the boarding school, she was not allowed to leave the house or meet her childhood friends. Fani was then forced into marriage without being able to choose. After six months of marriage, Fani returned to drug use and eventually divorced after four years of marriage. In 2005, Fani was arrested for drug possession and served an 18-month sentence. During her time in prison, Fani had to spend a significant amount of money, experienced violence, and faced inhumane treatment. Fani also did not have the opportunity for rehabilitation. She had to endure the post-drug use effects without any support. After being released from prison, Fani lost custody of her child and was forcibly separated from her child by her husband’s family.

Testimony by Rosi:

Rosi is a drug user who also lives with HIV. She has been using drugs since adolescence and has undergone rehabilitation several times. She has also been arrested but did not go to prison because she could take the peaceful route offered by the arresting police. In 2016, she resumed drug use, which led to the end of her marriage. Rosi also lost her job and assets. Living in dire conditions without employment, a year later, she became pregnant with her boyfriend, who unfortunately passed away. At that point, Rosi decided to engage in drug trafficking to support herself. In 2020, Rosi was arrested along with her child, who ended up spending time in prison as well. She faced a lot of violence in front of her child during her time in prison, including limited care she could provide for her child. Rosi had to demand help for her child by confronting people in prison. She often received offers to become a police informant to expose other drug cases, with the reciprocal benefit of easier legal processes and additional money. However, Rosi declined. She was released during the COVID-19 pandemic due to concerns that her HIV status made her more vulnerable to COVID-19.

Testimony by Samahita:

Samahita faces convoluted administration and complaint methods that lack a victim-centered perspective. Victims of physical and sexual violence often find themselves burdened by costs that should not be their responsibility. Ironically, numerous media outlets seek to exploit these cases for virality. Throughout the process, victims endure repeated trauma, and ultimately, they are the ones who face social sanctions from society.

The Interconnection of Women’s Physical and Mental Health

Until now, there are still many people who do not comprehend the unity between physical health and mental health – that there is no health without mental health. Complete health is not solely defined by physical well-being; mental well-being is equally integral. There exists an inseparable and close relationship between physical and mental health, where physical health issues can impact mental health and vice versa.

Regrettably, society often views mental health as a mystical and spiritual matter rather than a health concern. The misconception persists that women facing mental health issues are deemed unclear in thought or ungrateful, requiring spiritual or religious intervention. The reality is that women, dealing with physical conditions within the dynamics of a patriarchal environment, are vulnerable to mental health issues. Unaddressed mental health problems in women can significantly affect their overall well-being, impacting physical health and daily functionality. Both aspects are crucial for women to meet the various demands they face daily.

It is crucial to understand that mental issues often surface without awareness, potentially starting in adolescence, where they may be dismissed as teenage conflicts rather than important matters requiring prompt resolution and the uncovering of root causes. These unresolved issues can sometimes become triggers for substance abuse, exacerbating mental health problems further. This emphasizes the interconnectedness of mental health and substance use, with mental health serving as either a cause or consequence of substance use. Even when undergoing mental health treatment, the medications used fall into the category of substances, potentially leading individuals to develop new addictions. Mental health issues need attention and integration into existing programs to address these complex challenges comprehensively.

Women’s Mental Health and Violence

Similar to the interconnection between physical and mental health, there is a close relationship between women’s mental health and violence. Violence can adversely affect women’s mental health, and conversely, women’s mental health issues can lead to experiences of violence.

Women, facing various demands and daily challenges, are prone to mental health problems. However, societal misconceptions and biases, including those held by healthcare professionals, tend to blame women with mental health issues, distancing them from their rightful access to mental health care and often leading to violence against women.

Several factors make women more vulnerable, including discrimination, injustice, and widespread acceptance of violence against women, especially from a young age or adolescence. This impacts women’s mental health as they feel there is no safe haven, leading to a lack of early counseling and therapy efforts, resulting in more complex issues, including substance abuse.

The high tendency for women using substances, experiencing violence, not to report their cases to the legal system or anyone is due to fear that substance use will overshadow the violence issue. This makes women who use substances a hidden and hard-to-reach population that often experiences layered violence.

The background of violence also serves as a trigger for substance use, often influenced by their partners. Exploitation and abuse against women using substances occur from close acquaintances to law enforcement, creating a complex web of challenges for these women.

Women’s Mental Health with Economic Situations

Due to the often-overwhelming responsibilities of caregiving within families, women inevitably incur associated costs. Ideally, women should be supported in achieving optimal physical and mental health to fulfill these tasks. Unfortunately, women are frequently perceived as commodities constantly demanded and burdened without the provision of means to meet these demands.

Women with excessive workloads struggle to maintain optimal health, impacting their income. The lack of income can result in women being unable to access healthcare services. It is not uncommon for women to jeopardize their own health to earn a living for themselves and their families, especially their children. Challenges faced by women in accessing healthcare include uncertainty about where to access services, the need for treatment costs, distance to healthcare facilities, discomfort in seeking services alone, and the potential absence of specialized healthcare services for female substance users.

Additionally, biological factors, social factors (such as patriarchal culture), and economic factors, where women are economically dependent on men or their partners, contribute to women’s involvement in the illegal drug trade. Women are often victims of human trafficking within the drug trade circle, driven by economic needs. The allure of a better life and improved living standards for themselves and their families becomes the goal for women involved in the drug trade.

The Interconnection of Women’s Health with Existing Policies and Laws

It is evident that current substance abuse policies contradict health perspectives on substance use. These policies not only criminalize drug use but also exhibit a strong masculine bias. Moreover, even harm reduction programs, which should ideally adopt a health perspective on substance use and HIV risks, maintain a patriarchal undertone. Women who use drugs face more complex social issues, including the loss of custody rights, limited access to reproductive and sexual health services, increased vulnerability to mental health problems, and the loss of social support from their families.

Concerning harm reduction policies and the criminalization of drug use, there is no specific guidance for women-friendly drug rehabilitation programs. As women are invariably linked to children, when a woman using drugs wants to quit, the lack of rehabilitation facilities accommodating her needs as a mother becomes a significant barrier. The well-being of children is not prioritized in harm reduction program designs, making women more susceptible to continuing drug use, leading to further involvement in the illicit drug trade.

This situation ultimately puts women in a position where they may face imprisonment. The conditions and situations outside of prison are already unfriendly to women’s needs, raising concerns about the fate of female inmates trying to access reproductive and sexual health services. The limited availability of service access within correctional facilities or prisons introduces new health problems for women. Many female inmates experience severe mental health issues, childbirth, child-rearing, and changes in sexual orientation without accurate information on sexuality. Even the provision of minimal services is lacking. The treatment of female inmates is inhumane, with disproportionately high prison sentences imposed on drug users, which, in reality, harm no one else but themselves. The focus should be on addressing their mental health and understanding the reasons behind their drug use. Deliberate actions are considered evil when they harm others or the environment, categorized as crimes. However, when an individual harms only themselves, can such actions be classified as drug crimes?

The Relevance in Drug Abuse Cases and HIV

These four points of interconnection become evident in cases of drug abuse as conveyed by various testimonies. Drug addiction, essentially a matter of physical and mental health, is often misconstrued as teenage misconduct that requires intensive spiritual guidance or treated as a criminal act necessitating legal measures. These misguided solutions have distanced women with drug addiction from accessing the healthcare services to which they are entitled. Instead of addressing the addiction issue, they add to the physical and mental burden on women. Women with drug addiction face physical, psychological, social, and economic violence in the attempt to “redirect them onto the right path.” The societal stigma associated with drug addiction further marginalizes these women, potentially making their recovery more challenging.

Women with drug addiction also bear unique risks and burdens compared to men due to the possibility of pregnancy and childbirth. The risk of unplanned/unwanted pregnancies and contracting HIV adds complexity to their efforts to access healthcare. High levels of stigma and multiple forms of discrimination against women with this condition, including from healthcare professionals and public health authorities, may lead to unsafe abortions and HIV transmission to their children due to inadequate healthcare services.

Criminalized women with drug addiction face multifaceted issues. The delicacy and emotional vulnerability of women are exploited for the benefit of others, resulting in unjust punishments. They are denied the means and access to child care, often separated from and stripped of their custody rights, adversely affecting not only the mental health of the women but also that of their children. In many cases, women find themselves engaging in risky occupations, such as drug trafficking, to meet their children’s needs.

Many studies have indicated a correlation between HIV infection and mental health (MH), including how psychological issues such as stress, anxiety, fear of death, and guilt act as inhibiting factors in prevention and treatment efforts (routine testing, treatment engagement, retention, and adherence) [Mangurian et al., 2017; Senn & Carey, 2009, Mehrotra et al., 2016; Bukhori et al., 2022]. The prevalence of mental disorders, including depression, anxiety, and substance use disorders, is higher among people living with HIV compared to the general population, particularly in low- and middle-income countries (ranging from 10% to 50%) (Oladeji, 2020).

In the context of gender-based violence and the availability of healthcare services experienced by women living with HIV-AIDS (WLHA), the impacts extend beyond mental health, and more critically, there is indirect femicide. Taking examples from IPPI documentation findings:

• In cases of WLHA, many male partners experience fragile masculinity, leading to denial of the HIV situation in their families. They decide not to undergo HIV testing when their wives/partners are diagnosed early on. It is not just a refusal to undergo health examinations, but there are efforts to prohibit partners from seeking healthcare services and undergoing treatment.
• In healthcare services and the HIV response system, we observed mandatory examination programs for all pregnant women that lack preparedness and counseling during the examination process. Examinations are conducted individually by women without the presence of their partners. As a result, pregnant women may return home with a diagnosis that they received alone, posing potential risks of violence. Both of these situations, if left unaddressed and not promptly treated, will contribute indirectly to the mortality rate of women. This can occur either due to the lack of HIV treatment and care or death resulting from worsening pregnancy conditions due to HIV in both the woman and her child. In conclusion, these situations serve as indirect pathways to femicide occurrences.

What is regrettable is that these misconceptions extend beyond the personal or family level to the community and national levels. Women with addiction and other mental health issues experience layered structural pressures. Although the Mental Health Law is now incorporated into the Omnibus Health Law, a true integration of mental health understanding into existing laws is still lacking.

Recommendation

In alignment with the caregiving burdens often placed on women, the health of a child is undeniably linked to the health of its mother. A physically and mentally unhealthy mother will inevitably impact the care provided to her child. Therefore, women’s health should not be overlooked or considered an excessive or unnecessary cost, as it directly affects the well-being of future generations.

Here are our recommendations:

Services:

1. Enhance the availability of women-friendly mental health services, including trained professionals and cost-effective services, across diverse backgrounds of women. Implement gender-based violence protection services that are responsive to drug users, focusing on the needs of women and children.
2. Integrate mental health screenings (both initial and routine) and mental health care into ongoing HIV care, adopting the continuum of mental health care principle: identification and prevention, treatment and therapy, and recovery.
3. Raise awareness among mental health professionals regarding HIV, substance abuse, family planning (KESPRO), sexual orientation, gender identity, expression, and sex characteristics (SOGIESC), and gender-based violence issues to improve understanding and service delivery.
4. Ensure the availability of healthcare services tailored to the needs of women and children, including mental health, both during legal processes and within correctional institutions.
5. Guarantee the fulfillment of Sexual and Reproductive Health Rights for women serving sentences in correctional facilities.

Education:

1. Conduct structured training programs to provide psychosocial support with an appropriate referral system.
2. Increase awareness of mental health issues among all groups of women, imparting self-care skills, preventing mental health problems, and providing individualized treatment.
3. Integrate education on substance abuse (NAPZA), family planning (Kespro), Gender Diversity, violence, mental health, and related topics into the National Education curriculum.

Peer Support:

1. Encourage collective support from individuals, communities, and society for all women from various backgrounds with mental health needs.
2. Develop psychosocial peer support programs for adolescents, aiding them in establishing effective support systems to address conflicts such as identity crises, self-confidence, self-acceptance, bullying, and sexual issues.

Policy and Law Enforcement:

1. Decriminalize drug use by revising narcotics laws to eliminate emphasis on imprisoning drug users.
2. Conduct additional analysis in resolving legal cases, considering social, economic, and cultural aspects.
3. Establish responsibilities, clarify the rights of female drug users, and ensure the fulfillment of these rights throughout legal processes.
4. Conduct periodic consultations with law enforcement agencies (APH) to ensure the fulfillment of gender-sensitive rights and needs, and develop case support schemes during legal processes.
5. Establish a victim-centered complaint mechanism and SOP to facilitate reporting and responsive case handling according to women’s needs.
6. 6. Enhance the capacity of law enforcement personnel in handling gender-based violence cases, including expanding awareness of gender-based violence, to address cases without causing ongoing trauma to victims.

Media:

1. In reporting gender-based violence cases, the media needs to tighten the implementation of journalistic ethical codes that safeguard, protect, and ensure the security and privacy of victims.
2. Media sensitivity to reported gender-based violence issues is essential to enable the media’s active role in advocating for justice for the victims.