Indonesia – Ministry of Health’s guidelines on female genital cutting
Following on from our blog back in May on the status of FGC in Indonesia, we look at developments in Indonesia over the last few months.
At the World Health Assembly in May of this year, it came to the attention of the world’s health authorities that Indonesia has reversed its position from its 2006 ban on FGC. Back in November 2010, the Ministry of Health (MOH) in the Republic of Indonesia issued a report stating that FGC is permitted so long as it is carried out by health carers and following specific guidelines.
This is a very worrying piece of guidance in Orchid’s view, and takes Indonesia in the wrong direction for a worldwide end to FGC.
Ministry of Health of Indonesia
A 2003 paper reports that 92% of Indonesian families would choose to continue the practice of FGC on their children and grandchildren. In affect, the 2010 MOH Regulation approves what is already a culturally normalised practice. The problematic issue from a human rights perspective is that this new regulation gives authority to those carrying out FGC and supports a consensus that it is an acceptable practice.
The authorisation of FGC according to Indonesian Ministry of Health is regulated by strict medical guidelines (see Article 4 of document) under which only doctors, midwives, and nurses trained to MOH standards are allowed to carry out the procedure. According to Indonesia’s Minister of Women’s Empowerment, Linda Amalia Sari Gumelar, the high demand for FGC makes it hard to control the practice and therefore medicalisation is necessary in order “to avoid further harm.”
Arguably, it is the practice itself that is most harmful to women, physically, emotionally and psychologically. The MOH guidelines do suggest that the risk of infection and complications will be rarer since FGC will be less likely to take place in unhygienic, back-street operating rooms. However anecdotal evidence shows that the 2006 ban did little to prevent FGC from being practiced in hospitals, such is its hold in the world’s largest Muslim nation. Therefore it is not necessarily conclusive that legalising or de-legalising FGC will have much bearing on how or where it is performed.
Orchid feels that there is something hugely concerning in the mass regulating of such an intrusive procedure. By reducing girls and women to their body parts upon which a medical procedure is performed, the MOH’s guidelines for practising FGC take away any sense of individual experience of the woman or girl who is subject to the procedure. The detached step-by-step wording of the procedure makes for chilling reading. See [i] below for the guidelines in full.
Definitions: Circumcision or Genital Cutting?
Throughout the guidelines, the Indonesian Ministry of Health uses the term ‘female circumcision’ to mean, “the procedure performed to cut the skin covering the outer part of clitoris, without damaging it.” 
Use of the term ‘circumcision’ is now rather outdated in the arena of FGC activism, and may be explained here by the fact that the WHO categorises the most common type of FGC performed in Indonesia as Type 4, meaning a pricking, cauterising or incision of the clitoris.
The use of the term ‘circumcision’ rather equates FGC with male circumcision, which can lead to confusion about the gravity and consequences of the procedure. In the MOH guidelines, the suggested cut is indeed more akin to male circumcision, but however we categorise or label FGC, it remains a practice that denies a woman her right to bodily integrity. Artha Budi Susila Duarsa from Yarsi University in Jakarta makes the case that, “even a small wound on the genitals can lead to sexual, physiological and physical problems.”
Activism against the guidelines
In May of this year, The Legal Aid Institute for Women’s Protection in Indonesia (LBH Apik) sent a petition to President Susilo Bambang Yudhoyono. They protested against the passing of the regulation of FGC on the grounds that it opposes the principles of various laws including the laws on child protection and health.
The national coordinator for LBH Apik, Nursyahbani Katjasungkana said, “In almost all civilized nations, circumcising [female] children is considered as a discrimination and violence towards females and as an injudicious act towards the female physique.” 
Nursyahbani, who is also a lawyer and international rights activist, was brought up in a family where FGC was an unchallenged norm. She had undergone the practice as a baby along with her sister, just as her mother before them. When Nursyahbani had a daughter of her own, she felt immense pressure to have the procedure performed on her baby. She now deeply regrets the decision she made to have her daughter cut and speaks openly with her daughter about the experience.
“The first time I saw clearly how female sexuality was oppressed was in the case of my own daughter. I knew that female circumcision … was a means to control women’s bodies and their sexuality.”
Amnesty International is at the forefront of the movement to condemn the MOH’s regulation. Amnesty views FGC as a clear act of violence upon a woman’s body and criticises any state that does not challenge the practice.
In June, Amnesty released a joint statement with Indonesian civil society organisations stating that by lifting its ban on FGC, Indonesia is “reinforcing the perception that others are entitled to control a woman’s or a girl’s sexuality.”
Orchid Project can only echo the concerns of Amnesty International and the Indonesian activists quoted here. When we were at the World Health Assembly in May there was general outcry from the medics gathered there about the Indonesian MOH guidelines, but this outcry has not yet mobilised to action. It must.
It is clear that FGC is a social norm in Indonesia as much as in parts of West Africa, where social change programmes have enabled communities to abandon the practice. What is different is the lack of awareness that FGC is an issue in Indonesia. These guidelines are tantamount to the Government of Indonesia admitting there is a problem, and we need to work to encourage the government to take positive action to tackle FGC (with community-based programmes, some legislation) as opposed to issuing guidelines which essentially condone the practice.
[i] REGULATION OF THE MINISTER OF HEALTH ON FEMALE CIRCUMCISION
NUMBER 1636/ MENKES/PER/XI/2010
(1) Female circumcision shall be performed according to the following procedures:
(a) the carer shall wash his/her hands with soap and clean flowing water for 10 ten minutes;
(b) The carer shall wear sterile gloves;
(c) The patient shall lie on her back, legs parted carefully;
(d) Fixation shall be done on the knees, exposing the vulva;
(e) The carer shall clean vulva with povidon iodine 10%, using gauze
(f) The carer shall remove smegma existing between frenulum clitoris and glands of clitoris until the area becomes clean
(g) The carer shall then make a small cut on the skin covering the frontal part of clitoris (frenulum clitoris) using the tip of a sterile disposable needle of size 20G-22G from the mucous side toward the skin without harming the clitoris.
(h) The carer shall wash again the operated area with providon iodine 10%;
(i) The carer shall finally take off the gloves; and
(j) Wash his/her hands with soap and clean flowing water