Sexual Health problems might remind some of us of hanging outside clinics waiting for an opportune moment to slip through the door unnoticed, of feeling in a sense unclean.

Sexual Health Education Bali, Indonesia

It is a common assumption when dealing with Sexually Transmitted Diseases (STDs), especially in a country like Indonesia, that one would come up against a 'culture of silence'.

Thankfully, the findings of Jane Pattern, Inne Susanti, Yayasan Sehati and Inne Kartini in their study into 'Reproductive Health in Bali, Indonesia' were that rural women showed strong health seeking behavior and a desire for more information on Reproductive Tract Infections (RTI), STDs and AIDS.

Furthermore, there was a high prevalence of contraceptive use indicating a point of contact with the health care system.

These factors are possibly a direct result of the success of BKKBN - basically Family Planning; and the trust invested in them (note the study indicated a 94.5% user satisfaction).

The study naturally accepts its limitations but expresses some concern.

Understandably, the Government is concerned with soaring population growth and as a result the family planning program focuses too heavily on achieving target numbers of 'acceptors'.

Secondly, the nurses-midwives and Family Planning field workers are the most accessible in the community but a staggering 45.8% had received no information with regards to STDs and AIDS, while the others had received their information from the media or directly from the doctor

My understanding of the study indicates far from a negative appraisal and more of a conclusion to make improvements on services using the existing staff and infrastructure.

The study uncovered a correlation between high incidence of RTI amongst wives of migrant workers, draw your own conclusions. There was also a correlation between women over 30 or those who had left school extremely early and those women who lacked information on RTI, STDs and AIDS.

The indication being to clear up the many misconceptions, use the data to improve health education lectures and have more attentive staff.

Indeed the study concludes that the accessibility, affordability and frequent contact with family planning services in rural Bali is a missed opportunity for additional reproductive health care.

Will it continue to be a missed opportunity?

This becomes a minefield of speculation. The influence of the present economic situation is abound with rumors of dangerous cost cutting in the use of hypodermic needles, lack of money for basic health care, rising costs of drugs and contraceptives, etc.

Some might argue that the insistence of the IMF to move to 'free market forces' would obligate those self-acclaimed conjurors of economic magic to take responsibility in areas such as this through aid, or some type of health support program before the situation gets completely out of control. Whatever I'd hate to see the work of the people involved in this study come to nothing.