Menopause - Country-specific information of Indonesia

Menopause - Country-specific information of Indonesia

Ali Baziad (1) and Dr Cipto Mangunkusumo (2)
(1) Department of Obstetrics and Gynaecology, University of Indonesia, Jakarta
(2) General Hospital, Jakarta, Indonesia

Statistics

The number of women aged 40-65 according to the population data form the Ministry of Health 1996:

1971: 9,577,726

1980: 12,944,825

1990: 16,128,977

It is projected that by the year 2000 the number of women aged 40-65 will be approximately 21,891,200.

The population composition for the period of 1980 to 2020 shows a marked dif-ference in the number of children under 5 years compared with elderly people. The number of children under 5 years will decrease from 21,190,672 (14.4%) in 1980 to 17,595,966 (6.9%) by 2020. By contrast, the number of elderly people will increase from 7,998,543 (5.5%) in 1980 to 29,021,128 (11.4%) by 2020 (Table II).

Table I: Projection of the increase in the elderly population by 2050 compared with 1990.

Table II: Population development of elderly people and children under 5 (0-4 years) in Indonesia from 1980 to 2020

Indonesia’s success in improving the welfare of its people within almost three decades has resulted in an increased life expectancy. In 1980, female life expectancy was 50.9 years (males 54.0 years); in 1990 these figures were 62.7 and 59.1 years, respectively, and it is estimated that by the year 2000 they will have increased to 70 and 60 years, respectively. As a consequence of the increased number of elderly women, various health problems will be encountered more frequently. In the elderly population, cardiovascular diseases generally came in first place, followed by musculoskeletal disorders. The study undertaken at St. Elizabeth Hospital, Semarang (Central Java) by Budhidarmojo in 1087 elderly subjects suggests that people >60 years suffer mostly cardiovascular, infectious and cerebrovascular diseases. In 1992, a study was performed at two hospitals, i.e. Dr. Kariadi Hospital (Semarang) and Tegalrejo Hospital. Dr. Kariadi Hospital is a government hospital serving as referral hospital, while Tegalrejo Hospital is a private hospital, and patients admitted at this hospital are of the upper socioeconomic strata. The disease most commonly suffered by both males and females at both hospitals was cardiovascular disease.

Table III: Elderly patients treated

Table IV: Diagnoses in elderly patients

The therapeutic modes generally applied at both hospitals are medical, pharmacologic, and operative therapy as well as physiotherapy. The most frequently occurring cause of mortality is cardiac arrest. Table V contains an overview of the characteristics of 118 female patients with acute myocardial infarction treated at the Harapan Kita National Cardiac Center from January 1, 1993 to May 31, 1995.

Table V: Risk factors of coronary heart disease (female patients)

In 1980, the average age of menopausal women in Jakarta was 44-45 years, while in 1990 it was 50 years. The women studied were those of the upper socioeconomic strata. Types and frequency of complaints were: hot flushes 93.4%; sleep disorders 31%; palpitations 62%; bone pain, 57%; libido disorders, dysuria, painful sexual intercourse 58%; night sweats 67%.

In 1985-1986, a study was conducted in Java and West Sumatra (Minangkabau). The respondents in this study totaled 603 postmenopausal women. Of these, 297 were Central-Javanese living in the urban and rural area (Table VI).

Table VI: Education level and age of respondents

The socioeconomic classes of these subjects were divided into upper, middle and lower. The religious affiliation of both Javanese and Minangkabau was stated as Moslem for most of the subjects in this study.

The mean age at menopause was 50.2 years (Table VII) for educated Central-Javanese women. This is approximately the mean age of menopause in the USA and Europe.

Table VII: Mean age at menopause in relation to education

For educated Minangkabau women, the mean age at menopause was 48.7 years. The educated Central-Javanese women were from the upper socioeconomic class. In contrast, the urbanized Minangkabau women lived in a large town, Padang, which is not as developed as the capital of Jakarta.

Climacteric complaints were treated only symptomatically. Only a small number of patients presented for consultation with a physician. Special guidance for meno-pausal women did not exist at both hospitals and health centres, and those admitted for treatment were generally given tranquilizers (40%).

Those not consulting a physician treated themselves by means of traditional medicines such as native herbal tea. The first menopausal clinic in Indonesia was established in Jakarta in 1990. This clinic was part of the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Indonesia. In 1996, the first private menopausal clinic was established in Jakarta as part of the private collaboration between Austria and Indonesia. By 1992, there were only three hospitals providing special services for the elderly, one in Jakarta and two in Semarang.

Although by now menopausal clinics are available, the number of women presenting for treatment is still very limited. Indonesian women, either in rural or in urban areas, consider menopausal complaints as something normal, although they may be quite disturbing. Complaints like bone pain are considered as rheumatics, and they are treated by means of rheumatic medications obtained without prescription. Sleep disorders, depression, tension, and irritability are treated by means of tranquilizers and sleeping pills. In addition, a large number of physicians, either specialists or general practitioners, have not fully understood HRT. For example, of 70 women with com-plaints of dyspareunia, only 29% consulted a physician – and their treatment consisted only of sedation.

Through information in mass media and seminars, physicians come to understand that HRT has more positive than negative aspects. However, HRT use in Indonesia is still very limited. Fear of breast cancer is the leading cause: there are a large number of physicians in Indonesia who still regard HRT as the cause of breast cancer.

As we know, HRT is a long-term process and its efficacy will be evident only after several months. This situation frequently makes the patient impatient and tired of tak-ing the medication. The patient wants to be relieved of her complaints within one or two days.

Many requirements have to be met and an examination must be done prior to HRT administration; besides, the patient has to undergo frequent controls during HRT use. The medication is relatively expensive and generally the patient has to pay by herself. Health insurance is voluntary in nature.

Since 85% of the Indonesians is Moslem, any bleeding occurring during HRT use is considered as a nuisance to prayer activities. As a matter of fact, bleeding of this sort is different from the bleeding caused by menstruation. During menstruation prayer is not justifiable, while bleeding caused by HRT use can be justified while performing prayer.

There are many physicians without an adequate understanding of HRT, and they consider the hormones contained in HRT similar to those in oral contraceptives. If the bleeding occurs during the use of HRT, the patient is usually advised to undergo curettage. This intervention is not very favourable with patients, to the extent that they will not willingly come for further treatment.

Because the number of menopausal women is steadily increasing and most of them are from the lower socioeconomic strata, the Government of Indonesia has initiated a number of activities, such as:

1. Provision of services through health centres and primary health services, such as general practitioners and integrated service stations (posyandu).

2. Establishment of menopausal clinics at each hospital, or units of geriatric service.

3. Establishment of private menopausal clinics in big cities.

4. Midwifery regulations of menopause.

5. Enhancement of the participation of family physicians (general physician plus).

Breast cancer remains an important problem in developing countries such as Indonesia. The data collected from 13 pathology laboratories spread all over Indonesia by the National Center for Pathology show that breast cancer ranks as the second most common cancer among females, with a relative frequency of 18.03% (ASCAR = aged-standardized cancer ratio 17.84%) in 1988 and 18.44% (ASCAR 17.46%) in 1989.

The annual incidence of breast cancer in Japan has been reported to be lower (12.1–16.6 per 100,000 females) than in America (71.7 per 100,000 females). In Indonesia, the incidence rate was 18.6 per 100,000 females.

The majority of women with diagnosed and treated breast cancer in the general hospital show up rather late, and they have a very low probability to be cured. Most of them are diagnosed at a late stage, while those who are diagnosed at an early stage prefer to go to traditional healers. When at last they are referred back to the hospital, they usually are in a late stage of the disease. Most women with breast cancer came from a middle to lower socioeconomic level.

Table VIII: The 10 most prevalent causes of mortality

Breast cancer has mostly been found in the age groups under 35 years and between 40-44 years. The majority (87%) of the cases were in an advanced stage (IIIA, IIIB).

Epidemiological analysis of risk factors for breast cancer in Indonesian females

This study found that the most prominent risk factors were induced by menopause and short-term breastfeeding or lactation, i.e. less than 4 months (RR=5.59 and 5.44, respectively). The risk of breast cancer was three times higher in underweight patients, closely linked genetic traits and fatty diet (RR: 2.2, 2.85 and 2.63, respectively). A relationship between hormonal contraceptives and risk of breast cancer has not been shown in this study. Fatty food was found as one of the important risk factors. As for demographic origin, urban dwellers were at increased risk (RR: 2.22; 95% CI = 1.63-3.02).

Epidemiological risk factors for breast cancer related to menopausal status

To clarify the risk factors for breast cancer in premenopausal and postmenopausal women, a hospital-based case control study was conducted in Indonesia. Three hun-dred women with breast cancer were interviewed and 600 controls were selected, matched for age and socioeconomic class. The following significant findings were revealed: for premenopausal breast cancer, an increased risk was detected in women with breast trauma (adjusted RR: 2.62; 95% CI: 1.09-6.31); OC use 4.96 (1.51-16.4); milk consumption 1.81 (1.01-3.25) vs no milk consumption; fresh fruit 3-4 times/week 2.42 (1.16-5.05), vs less than once/week. A decreased risk was detected in women with daily consumption of cooked vegetables (0.34; 0.15-0.77) vs not-daily consumption. For postmenopausal breast cancer, an increased risk was found in women with age at menarche of ³15 years (2.25; 1.35-3.76); regular menstruation after age 30 (4.61; 2.44-8.67); daily milk consumption (5.84; 2.92-11.66) vs no milk consumption. A decreased risk was found in postmenopausal women who were divorced or widowed (0.33; 0.18-0.59), and in women with many livebirths and many occasions for breastfeeding (0.32; 0.13-0.76).

Table XIII: Mortality pattern of diseases at hospitals in Indonesia (1990-1994)

Maternal mortality was estimated to be 450/100,000 livebirths. The maternal mortal-ity rate in Indonesia is still very high compared with other Southeast Asian countries, and even higher than the average of developing countries. According to the Assistant Minister of Women’s Affairs; reduction of the maternal mortality rate in Indonesia is being jeopardized primarily by cultural tradition, socioeconomic aspects, gender dis-loyalty, inadequate education, services, and health facilities. However, if these pro-blems are put together they can be separated into sociocultural and economic aspects, services, health facilities or clinical management. The survey shows that more than 80% of maternal mortality can be attributed to the classic trias: bleeding (40-60%), birth canal infection (20-30%), and gestosis (20-30%).

Generally, this classic trias can be improved upon by adhering to three admoni-tions: 1) do not be late in deciding to refer to the nearest health facilities; 2) do not be late to reach the health centre or hospital; 3) if the patient has arrived at the hospital, do not be late in supplying appropriate management.

The inadequacy of health service coverage is, among others, caused by geograph-ic conditions, population distribution, inadequate health facilities, and the quantity and quality of health personnel. It turned out that only 30-40% of the first referral facilities, i.e. district hospitals, had obstetricians and gynaecologists, on their staff. Furthermore, even in hospitals where medical specialists are available, it is still uncertain whether they are able to conduct comprehensive obstetric emergency services on a full-time basis. On the other hand, because of geographic obstacles, distances between a health centre and the hospital can hardly be bridged within 2 hours.

Referral procedures themselves have not been optimized, and some cases of maternal mortality are due to late arrival at the referral centre. Many deliveries take place at home and are being assisted by traditional birth attendants or midwifes. These women are at the frontline of obstetric services. Most cases of hospital maternal and perinatal mortality occur in women having been referred from home. Many women prefer delivery at home because they feel closer to their family and neighbours. In addition, room is always available, and cross-infections may be prevented at home. However, the most important factor for home delivery is that it is less expensive. Nevertheless, there are also some disadvantages, such as assistance by traditional birth attendants or midwifes, usually consisting of just one person. In addition, sanitation, facilities, equipment and clean water are inadequate, and if a referral is wanted, transportation and assistance will be necessary during travel. The WHO has esti-mated that 500,000 pregnant women throughout the world become victims of repro-duction each year (Source: Abdullah Cholil, MPH, Assistant Minister 1 for Women’s Affairs and Jusuf Hanafiah, Obstetrics and Gynaecology, Faculty of Medicine, North Sumatra University, 1997: March 19, page 15).

Based on a report from various regions over a period of 10 years (1987-1997), a very high incidence of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) was found in three provinces out of 20, i.e. Jakarta, Riau, and Irian Jaya. The number of HIV/AIDS cases currently reaches more than 169,000. Distribution according to age shows that most patients belong to the reproductive age group (15-49 years), encompassing 80% of all cases.

The magnitude of the number of HIV/AIDS patients in the reproductive age group is attributed to the increased industrialization in Indonesia which has resulted in the development of a great number of industrial centers. Industrial centers pull migrant groups from rural areas to cities as labour force. In the cities the migrants were like-ly to find a life with less restrictions, such that the desire to maintain the old social norms disappeared. An overwhelming exposure to tempting mass media of various kinds as well as loose social norms have created an environment vulnerable to the risks of sexual transmitted diseases.

Health level

1. Mortality rate

1.1. Infant hospital mortality rate

Table 2.I shows that from 1990 to 1994 infant mortality rate at the hospitals decreased from 64.9 per 1 000 livebirths in 1990 to 49.1 per 1,000 livebirths in 1994. Compared with other studies performed in the community, such as the 1986 Household and Health Survey which found an IMR of 87 per 1,000 livebirths, infant mortality at hospitals is far lower. The infant mortality rate at general hospitals of class A, B, an D is 39-61 per 1 000 livebirths, while general hospitals of class C have a higher rate of infant mortality. This is because the general hospital of class C serve as referral hospitals in their area,and as such patients admitted usually are in a critical condition. Compared with IMR in all hospitals (49.1), general hospitals of the Regional Government, Department of Health, have a higher mortality rate, i.e. 64.4. However, this finding does not suggest that these hospitals are poorer in their services; the general hospitals of class A, B, C & D serve all levels of the community, and usually the patients referred to these hospitals are in a critical condition.

Table 2.I: Infant mortality rate (IMR) at Indonesian hospitals (1990-1994)

50.5% of infant mortalities (340 of 673 mortalities) at the general hospitals of class A, B, C & D are caused by diseases originating in the perinatal period. At a national level, 483 of 913 infant mortalities (52.9%) are caused by diseases originat-ing in the perinatal period. 43.7% of diseases originating in the perinatal period are caused by premature and immature birth, and 3.9% by tetanus neonatorum. This find-ing suggests that 47.6% of perinatal mortalities are largely determined by maternal conditions before delivery. Premature and immature births are a disorder attributed to a short period of pregnancy and unspecified low birthweight.

Table 2.II: Infant mortality rate at general hospitals of class A,B,C,&D (1994)

1.2 Hospital maternal mortality rate in Indonesia

Table 2.III shows that from 1990 to 1994, maternal mortality at the hospitals experi-enced a decrease, compared with maternal mortality rate at a national level, as sug-gested by the 1986 Household and Health Survey i.e. 4.5 mortalities per 1000 live-births. There are a number of determining factors, including an effectieve referral sys-tem, and whether patients referred to the hospital by a lower unit have been managed properly. Other factors affecting maternal mortality are, among others, the education-al level of the mother, occupation, birth assistance, equipment/blood transfusion facilities and transportation. Table 2.IV: Maternal mortality rate at general hospitals of class A, B, C, & D (1994)

Table 2.III: Maternal mortality rate in Indonesia

Table 2.IV: Maternal mortality rate at general hospitals of class A, B, C, & D (1994)

Maternal mortality rate at general hospitals of class A, B, C & D managed by the Regional Government (Pemda) was 5.6 per 1000 livebirths. This figure is much higher than the maternal mortality rate at national level in 1994, i.e. only 3.5 per 1000 live-births (see Table 2.IV).

As for class of hospitals, it turns out that general hospitals of class C have a high-er mortality rate, i.e. 6.2 per 1000 livebirths. This is because hospitals of this type provide services and management for referrals which have not been dealt with properly.

Viewed from the cause of disease, it is evident that obstetric cases are largely found in complications of pregnancy, delivery, and postpartum, i.e. 48.7% (9071 out of 18,643 cases), and that mortalities mostly occur in the same group, i.e. 47.3% (35 of 74 mortalities) (see Table 2.V).

Table 2.V: Distribution of obstetric patients according to cause of disease

Hypertensive complications of pregnancy, delivery, and postpartal state are the most frequent cause of death with a CFR (case fatality rate) of 2.8%.

Of 18,589 cases classified for education, most cases (27.8%) had a primary school level. Looking at the number of mortalities, 36 of 74 (48.6%) occurred in the group with primary school education.

It is evident that mortality is overrepresented in the group with educational level of primary school downwards (cases 24.2 + 3.6 + 8.7% = 36.5%; mortality 45.9 + 2.7 + 9.5% = 58.1%).

Table 2.VI: Distribution of obstetric patients according to education (1994)

Mortality at ages 20-24 is higher than that at ages 30-34; CFR, however, is the same (0.4), while the highest CFR is found at ages under 20 years. This finding shows that delivery is less safe under 20 years of age. Women with parity 4-5 seem to run the highest risk of mortality.

Table 2.VII: Age distribution of obstetric patients (1994)

Table 2.VIII: Distribution of obstetric patients according to parity (1994)

1.3. Crude mortality rate (CMR)

Table 2.IX shows that hospital CMR does not change significantly from year to year. In contrast with hospital CMR, the nationwide crude mortality rate tends to decrease from year to year, as shown by the census of 1980 (CMR 12.6) and by the Population Survey between Censuses (Supas) of 1985 (CMR 9.1).

Table 2.IX: Hospital crude mortality rate (1990-1994)

Rusli Amran and the Rewriting of Minangkabau History

Rusli Amran and the Rewriting of Minangkabau History

by Jeffrey Hadler

Rather than review Rusli Amran’s five books on West Sumatran history, this essay will serve as a brief introduction to Minangkabauist historical debates among so-called amateur historians in Indonesia. (All titles are given in English translation. See Reference list for Indonesian citations.) Most Indonesianists are familiar with the writings of Taufik Abdullah, Deliar Noer, Alfian, Harsja Bachtiar, and other foreign-trained Indonesian scholars of Indonesian history. But there is another group of informal historians whose books were written in an entirely Indonesian context and for an Indonesian audience. These historians deserve our attention.

By the middle of 1961 Minangkabau patriotism was ruined. The PRRI “Revolutionary Government” secessionists, whose three year struggle against the national state had been a protest against the central government’s perceived Javanism and communism, were beaten. Minangkabau people left West Sumatra for Jakarta and Medan, never to return. This was a time of rantau cino, permanent “Chinese” out-migration, when Minangkabau gave their children Javanese names and grumbled that at home in Sumatra “the winners (yang Minang) have all left, what remains are the water buffalo (Ka[r]bau).” Jakarta’s　Padang restaurants boomed and migrants from Sumatra, ethnicity withheld, fitted themselves into lives far from ancestral highlands and unhappy memories.

1963 brought another slap to the exhausted Minangkabauists. In his wonderfully bizarre “Tuanku Rao: Hambali Islamic Terror in the Batak Lands (1816-1833),” the Mandailing writer Mangaradja Onggang Parlindungan scoffed,

“Brothers from Minang sangat parah handicapped, karena kepertjajaan mereka akan mythos2 tanpa angka2 tahunan. Mythos Iskandar Zulkarnain Dynasty, Mythos Menang Kerbau, Mythos Bundo Kanduang, Tambo Minangkabau, dlsb., semuanya 100% ditelan oleh Brothers from Minang. Tanpa mereka sanggup selecting-out 2% facta2 sejarah dan kicking-out 98% mythologic ornamentations dari mythos2 itu. Tanpa mereka sedikit pun usaha, mentjarikan angka2 tahunan untuk menghentikan big confusions” (679).

[The Brothers from Minang are severely handicapped due to their belief in ahistorical myths. The myth of Alexander the Great’s dynasty, the myth of the Victorious Buffalo, the myth of the Ur-Mother, the Legend of Minangkabau and the like have been swallowed whole by the Brothers from Minang. They have been incapable of selecting-out the 2% historical facts and kicking-out the 98% mythologic ornamentations within those myths. They have not made the slightest effort to seek out accurate dates and put an end to the big confusions.]

It took the fall of Sukarno and the destruction of the Indonesian Communist Party for the brothers from Minangkabau to answer Parlindungan’s challenge. The first “History of Minangkabau” was published in 1970 and included a self-congratulatory foreword by Parlindungan himself. With accurate dates and a substantial bibliography, the authors synthesized the ethno-mythical history of Minangkabau and the political history of West Sumatra. The great Islamic populist intellectual, Hamka, directly challenged Parlindungan in his 1974 book “‘Tuanku Rao’ Between Fact and Fantasy.” But the most concerted effort to rewrite the history of Minangkabau was undertaken by Rusli Amran, a retired officer of the Indonesian Foreign Service.

Rusli Amran was born in Padang in 1922 and educated in the Dutch, Japanese, and national school systems. During the Revolution he helped found the newspaper Berita Indonesia and in the early 1950s joined the state bureaucracy, first the Ministry of Defense, then Economy, and finally Foreign Affairs. He represented the Republic of Indonesia in Moscow and Paris through the decade when Minangkabau was most alienated from the nationalist project. When Amran retired in 1972 he devoted himself to a massive historical project: the writing of West Sumatran history in a form both comprehensive and accessible to Indonesian students.

Rusli Amran loved the archive. He spent much of the 1970s and 1980s mining the resources in the Netherlands and Jakarta, paying particular attention to research and reports available in nineteenth century Dutch colonial journals. His first of five books, “West Sumatra up to the Plakat Panjang,” is a massive history that includes archaeological sources from the thirteenth century, but is most concerned with the interactions of British, Dutch, and Minangkabau up through the Padri Wars and the “long declaration” (Plakat Panjang) that marked the beginning of intensive Dutch administration in West Sumatra. Amran’s research is rigorous but his style is informal. He is careful to translate all quotations and sources into Indonesian, and titles a chapter on initial European penetration “Masuklah Si Bule,” Enter Whitey. This first book is his most ambitious – almost 700 pages long, with a thorough bibliography and legible facsimile reproductions of archival documents and original source materials. His second book, “West Sumatra Plakat Panjang,” is a continuation of the first and along with translations of Dutch sources contains appendices of data culled from Dutch journals. Both these books make linguistically and logistically difficult Dutch sources easily accessible to Indonesian students of West Sumatran history.

Amran’s third book in the series, “West Sumatra: The Anti-Tax Rebellion of 1908,” closes his history of the coffee cultivation system and nineteenth century colonial exploitation with a study of reactions to the imposition of a money tax. His fourth book is a break with the narrative – a quirky tribute to his hometown of Padang that mixes archival and anecdotal sources to focus on personal histories and studies of the Eurasian community and the role of the Javanese. He also includes an impressive collection of reproduced photographs. This work in many ways anticipates much of the current scholarship on race and social change in the colonial period. Amran’s insistence on using the name “West Sumatra” rather than the ethnically-defined “Minangkabau” in all of his writings reinforces his important interpretation of West Sumatra as a multi-ethnic society and its history as one of interactions among Europeans, Chinese, Javanese, Batak, and Minangkabau. Amran’s final book, published after his death in 1996, is a collection of essays entitled “Old Tales from the Pages of History.” These essays are wonderful explorations into some of the stranger figures and moments in West Sumatran history and make for light and stimulating reading.

As important as Rusli Amran’s writings is another extraordinary act of generosity. While undertaking archival research, he photocopied every available journal article and manuscript relating to West Sumatra. This is an enormous collection of documents. Amran then made multiple copies of this collection and deposited them in three locations in West Sumatra: the library of the Literature and Humanities Division of Andalas University in Limau Manis; the reading room of the West Sumatran Arts Council in the Abdullah Kamil Building in Padang; and the Center for Documentation and “Inventorization” of Minangkabau Culture in Padang Panjang. Through Amran’s efforts students of West Sumatran history have access to books that provide lucid and unpretentious introductions to the colonial period. And they also have access to the primary sources without having to travel to the Netherlands or even Jakarta. Finally, Rusli Amran’s widow has established the Yayasan Rusli Amran in Jakarta to house a study and documentation center and to support research into West Sumatran history. While largely unknown internationally, Rusli Amran has done much to foster the study of Minangkabau history in Indonesia. His books are well worth reading.

The author is assistant professor in the Department of South and Southeast Asian Studies, University of California, Berkeley.

References

Parlindungan, Mangaradja Onggang. 1963. Pongkinangolngolan Sinambela gelar Tuanku Rao: Terror Agama Islam Mazhab Hambali di Tanah Batak 1816-1833. Jakarta: Penerbit Tandjung Pengharapan.

Mansoer, M.D. et al. 1970. Sejarah Minangkabau. Jakarta: Bhratara.

Hamka. 1974. Antara Fakta dan Khayal “Tuanku Rao.” Jakarta: Bulan Bintang.

Amran, Rusli. 1997. Cerita-Cerita Lama Dalam Lembaran Sejarah. Jakarta: Balai Pustaka.

Amran, Rusli. 1988. Sumatra Barat Pemberontakan Pajak 1908: Bag. Ke-1, Perang Kemang. Jakarta: Gita Karya.

Amran, Rusli. 1988. Padang Riwayatmu Dulu. Revised edition. Jakarta: C.V. Yasaguna.

Amran, Rusli. 1985. Sumatra Barat Plakat Panjang. Jakarta: Sinar Harapan.

Amran, Rusli. 1981. Sumatra Barat Hingga Plakat Panjang. Jakarta: Sinar Harapan.

Traditional Dance of Minangkabau

The Piring Dance is very popular among the West Sumatran people. It involves great skill and exotic and dynamic movements while the dancers hold plates or saucers in their palms! It is also known as the Candle Dance. Randai Traditional Drama and Theatre of Kota Nan Ampat is a Minangkabau Traditional art centre and the drama there has an educational message. The Rantak dance is created by Gusmiati Said and is dominated by Pencak Silat, the traditional martial art of West Sumatra, with movements such as taping, hand movements, waving and jumping. The composition takes great consideration of space, time and energy (power) thus resulting in an entity presented as an art of expression. Tiupan Saluang is a traditional art expressing the feeling followed by the blowing flute, while the Tabuik Festival of Pariaman regency is a traditional cultural ceremony held on 1st - 12th Muharram. Tabuik comes from Bengkulu to respect Huse in (The grandson of Prophet Muhammad) who died in the war against King Yazid. Tari Payung or the umbrella dance is anothervery well known dance among the young people from the land of Minangkabau. Danced to the tune of "Babendi-bendi" (a song about a horse drawn carriage which is original to that area), this dance portrays the happy bantering between newly married couples on their honeymoon. The umbrella becomes a symbol that the husband should always protect his wife from the rain and heat of life. --------- For more information on workshops & training sessions for "Traditional Dances of Sumatra, Indonesia" --- EMAIL

MINANGKABAU - VOA

MINANGKABAU

The Minangkabau are a society in West Sumatra, Indonesia, which is based on matriarchal influence and Islamic belief. In a Minangkabau village, the practices and rituals are based on "adat." Adat emphasizes the maternal in daily life where women control economic and social issues.

Historically, the Minangkabau have dealt with their share of conflict. In the 14th century, a Javanese prince invaded the area and tried to institute a male-dominated regime. The Minangkabau "successfully withstood and struggled against it." In the 19th century, there was strife between adat officials and Islamic fundamentalists, but again, they found a way to accommodate both adat and Islam.

The Minangkabau system of matrilineality is more like a "partnership," according to cultural historian Riane Eisler. Ms. Eisler said Peggy Reeves Sanday's book on her experiences, Women at the Center: Life in a Modern Matriarchy, dispels the notion that society has always been and always will be male-dominated.

"The Muslim religion and culture were superimposed on their system," Ms. Eisler said, "and they now consider themselves Muslim. But if you really look at the description that Peggy has of how they look at nature, how they look at gender, how they look at some, you know, pretty basic things, what you find is much more of the remnants of their earlier belief system."

Islam and matrilineal adat are accepted as equally sacred, but there is an emphasis on female jurisdiction that Islam does not have. For example, many of the ceremonies, particularly weddings, call on the women to run the show. Women go to pick up the groom and return him to the bride's house - the opposite of the Muslim tradition. Property rights are in the hands of women, and they inherit land and can instigate divorce and child custody.

Source: VOA, 30 May 2002

May 2002

From University of Pennsylvania

Indonesia's matriarchal Minangkabau offer an alternative social system

For the last century, historians, anthropologists and other scholars have searched both human history and the continents to find a matriarchy--a society where the power was in the hands of women, not men. Most have concluded that a genuine matriarchy does not exist, perhaps may never have existed.

Anthropologist Peggy Reeves Sanday disagrees. After years of research among the Minangkabau people of West Sumatra, Indonesia, she has accepted that group's own self-labeling, as a "matriarchate," or matriarchy. The problem, she asserts, lies in Western cultural notions of what a matriarchy "should" look like--patriarchy's female-twin.

"Too many anthropologists have been looking for a society where women rule the affairs of everyday life, including government," she said. "That template--and a singular, Western perspective on power--doesn't fit very well when you're looking at non-Western cultures like the Minangkabau. In West Sumatra, males and females relate more like partners for the common good than like competitors ruled by egocentric self-interest. Social prestige accrues to those who promote good relations by following the dictates of custom and religion."

Dr. Sanday decided to propose a new definition of matriarchy after living for an extended period with the Minangkabau. The R. Jean Brownlee Endowed Term Professor of Anthropology at the University of Pennsylvania, and Consulting Curator at the University of Pennsylvania Museum of Archaeology and Anthropology (UPM), she has spent most of the last 21 summers and some sabbaticals living in a Minangkabau village, conducting research supported in part by the Museum. In 1997, she curated a UPM photography exhibition, "Eggi's Village: Life Among the Minangkabau of Indonesia." She's followed that public exploration with a provocative new book, Women at the Center: Life in a Modern Matriarchy (Cornell University Press, May 2002).

Who are the matriarchal Minangkabau and why should we care? Dr. Sanday comes to her research as an expert on gender issues, violence and sexual politics in American society. (She's the author of A Woman Scorned: Acquaintance Rape on Trial [Doubleday, 1996], and Fraternity Gang Rape: Sex, Brotherhood and Privilege on Campus [New York University Press, 1990].) For her, it's a question to be passionate about, because the answer helps to broaden our understanding of the range of social possibility.

Today, four million Minangkabau, one of the largest ethnic groups in Indonesia, live in the highlands of the province of West Sumatra. Their society, Dr. Sanday discovered, is founded on the coexistence of matrilineal custom and a nature-based philosophy called adat. More recently, Islam was incorporated into the foundation. Despite the recent outbreak of violence associated with Islamist ideologies in many parts of the world, Dr. Sanday describes a peaceable, almost violence-free Minangkabau society.

Adat, the Nature Based Philosophy

The key to Minangkabau matriarchy, according to Dr. Sanday, is found in the ever-present adat idea expressed in the proverb "growth in nature must be a teacher."

"One must nurture growth in humans, animals, and plants so that society will be strong," people told her.

The emphasis on nurturing growth, she asserts, yields a unique emphasis on the maternal in daily life. "While we in the West glorify male dominance and competition, the Minangkabau glorify their mythical Queen Mother and cooperation," said Dr. Sanday. In village social relations women are likened to "the center where the fish net meets." Senior women are associated with the central pillar of the traditional house, which is the oldest pillar because it is the first erected. The oldest village in a group of villages is referred to as the "mother village." When they stage ceremonies in their full ceremonial regalia, women are addressed by the same term reserved for the mythical Queen. Such practices suggest that matriarchy in this society is about making the maternal the center, origin, and foundation, not just of life but of the social order as well.

The power of Minangkabau women extends to the economic and social realms. Women control land inheritance and husbands move into the households of their wives. Unlike many other societies in which anthropologists say women are exchanged between families at marriage, in this society men are exchanged. During the wedding ceremony the wife collects her husband from his household and, with her female relatives, brings him back to her household to live. In the event of a divorce the husband collects his clothes and leaves. Yet, despite the special position women are accorded in the society, the Minangkabau matriarchy is not the equivalent of female rule.

"Neither male nor female rule is possible because of the Minangkabau belief that decision-making should be by consensus," Dr. Sanday said. "In answer to my persistent questions about 'who rules,' I was often told that I was asking the wrong question. Neither sex rules, it was explained to me, because males and females complement one another. As with everything else, the Minangkabau have a proverb to describe the partnership relationship between the sexes: 'Like the skin and nail of the fingertip.'"

Islam and the Minangkabau

Today, according to Dr. Sanday, while the Minangkabau matriarchy is based largely on adat, Islam also plays a role--but not in the way one might expect. Islam arrived in West Sumatra sometime in the 16th century, long after adat customs and philosophy had been established. At first there was an uneasy relationship between adat and Islam and, in the l9th century, a war between adherents of adat customs and fundamentalist beliefs imported from Mecca. The conflict was resolved by both sides making accommodations. Today, matrilineal adat and Islam are accepted as equally sacred and inviolate, handed down from the godhead. "At a time when consumerism is more prevalent in Indonesia than ever before, these sacred principles of Minangkabau culture and society act to support one another," she noted.

Resurgent Islamic fundamentalism, nationalism, and expanding capitalism--all are realities that Dr. Sanday acknowledges can erode the Minangkabau's nature-based matriarchal culture and the adat that infuses meaning into their lives. She remains optimistic that their culture has the innate flexibility to adapt to a changing world. "Had the Minangkabau chosen to fight rather than to accommodate the numerous influences that impinged on their world over the centuries, had they chosen to assert cultural purity, no doubt their 'adat' would have long ago succumbed. The moral of the Minangkabau story is that accommodating differences can preserve a world" (from Women in the Center).

Women in the Center (288 pages, 31 halftones, $29.95) is available through the University of Pennsylvania Museum Shop. For more information and to order call toll free 1-877-359-4695.

Women in Minangkabau

Women in Minangkabau

On 11 June 1996 Joke van Reenen defended her PhD Thesis entitled: Central Pillars of the House: sisters, wives, and mothers in a rural community in Minangkabau, West Sumatra. Her position as AIO, Doctoral Assistant (PhD student) at the Research School CNWS: School of Asian, African and Amerindian Studies at Leiden University, had come to an end in December 1995. Discussing the position of assistant and the subject of her passion: Minangkabau, we present a portrait of Joke van Reenen.

By Dick van der Meij

The first question that springs to mind is rather predictably: Why Minangkabau?

In 1984 an anthropologist and a sociologist specialized in non-Western societies were invited to Padang to help developing a Department of Anthropology at Andalas University in this West Sumatran city. This request for funding was submitted to the Dutch Minister for Development Cooperation and to the - then called - Netherlands University Foundation for International Cooperation (Nuffic). So I went to Padang. I spent 5 years in West Sumatra setting up the Anthropology Department and training university staff. While I was there of course I had the opportunity to look around and conduct some research of my own. After my appointment had ended I had the opportunity to do yet another six months of research, so I had a fairly good idea of what I wanted to do and Minangkabau presented itself as the ideal and natural choice.

The second question: Why women?

Gender relations and women's views on gender have always had my special interest. I had conducted earlier research on female perspectives in Tunesia, and it seemed to me to be a natural progression to continue investigating female views in the Minangkabau matrilineal setting. As a matter of fact, I do feel that to try to understand a culture, or even part of it - how can one even begin to try to understand a whole culture? - it would be best to study both male and female roles and perspectives. However, since the roles and perspectives of males had already been studied, I decided to make a complementary study of the female views.

One of the most striking phenomena in Minangkabau is merantau, going out of Minangkabau and seek experience elsewhere. How does this affect the lives of the women who stay behind?

It very much depends on the individual. Many women have no problem at all seeing their husband leave for abroad. Some even encourage their men to leave and find a way to earn money. You see, the problem is that agriculture is no longer sufficient to make a living. There is very little cash around to pay for school fees, uniforms, transportation, and what have you, so the men are forced to leave for longer or shorter periods to earn money. It is really as simple as that.
Some women are really very low after their husbands have left, and some also spoke of the sexual problems this causes, but on average, they can cope fairly well. I have not come across any instances where the women have actually forced their husbands to leave to get rid of them, but this may occur. Nowadays many women follow their husband out of the Minangkabau area, joining them for instance in Jakarta or other places in Java to be with them. Women themselves go out to merantau, for instance for study or in order o find a job. It is no longer an exclusive male prerogative. Another new phenomena is the permanent merantau situation where a single man or a couple decide to stay away from the Minangkabau area, permanently settling elsewhere.

I have the feeling that matrilineal systems like that of the Minangkabau are very rare in the world, is this indeed so?

Actually not really. There are quite a lot of societies which might be labelled matrilineal. However, societies which combine matriliny with matrilocal residence are rare. Intriguingly, there are certain features of Minangkabau matriliny which may be called unique. In Sumatra we have evidence that other societies used to be matrilineal too. For instance, in Aceh where the kinship ties are now organized bilaterally but the settlements are matrilocal, in some aspects the situation resembles that in Minangkabau. Similar systems also existed in South Sumatra, for instance Enggano springs to mind.
At present the matrilineal organization is being evaluated by the Minangkabau people themselves and the views they express are far from unanimous. Many Minangkabau are critical of certain aspects of their own culture, yet few would actually advocate the abolition of the matrilineal kinship system.

What are your feelings about the phenomenon 'Doctoral Assistant'?

Well, before I begin on that, let me tell you that I have been very lucky throughout. I had already done a fair amount of research when I started as assistant and, of course, I knew the field very well. Another great help was that I already had my assistants in the field. So my experiences are not really comparable to those of the average AIO who starts with his/her research in a field he/she does not know. Also, because of my prior research I have used much more than the 4 years allotted to an AIO. By the way, I really needed that time!
While gratefully acknowledging these advantages, I have some criticisms. Even though I feel that 4 years is not unreasonable, I have the impression that both AIOs and their supervisors are still uncomfortable with that time limitation. Sometimes the scope of the research is too ambitious in relation to the time available, thus causing a lot of time to be lost by using it for problems which would have been avoided.
In fact, on the bottom line what I mean to say is that what happens now is that people are required to write a traditional book in a modern setting. Those two are incompatible.
A question of equal importance is: What are we to do with all those young people who have just defended their thesis? Especially, is you remember that the traditional network is still very much in effect, it seems to be fairly pointless to produce a bred of young doctors who will have a terribly hard time to find a suitable job. Many young people who are now doing research have so little experience in anything but research that they find themselves caught short in the skills needed to find a job outside academia. Sadly, in academia, jobs are very rare at the moment. So, I have my reservations about the effect of the new system, but perhaps everything will turn out fine in future.

What are your plans for the future? Going back to Minangkabau and doing more research?

O, yes indeed. I would love to go back to Minangkabau. Of course, I would like to present my book to the people there. They have every right to know what I have made of their information.
On the other hand, I would also like to go back to the Ministry of Development Cooperation. I feel it would be a good thing to work on defining new projects and making contacts with new counterparts. It need not necessarily be in the field of Indonesia, or Southeast Asia. Other places in the world are equally interesting and I am open to whatever job presents itself.

MATRIARCHAL, ISLAMIC AND PEACE-BUILDERS:

MATRIARCHAL, ISLAMIC AND PEACE-BUILDERS:
THE MINANGKABAU OF INDONESIA OFFER AN ALTERNATIVE SOCIAL SYSTEM

Pictured here is a wedding march to collect the husband. Photo: Peggy Reeves Sanday, 1996.

For the last century, historians, anthropologists and other scholars have searched both human history and the continents to find a matriarchy—a society where the power was in the hands of women, not men. Most have concluded that a genuine matriarchy does not exist, perhaps may never have existed. Anthropologist Peggy Reeves Sanday disagrees. After years of research among the Minangkabau people of West Sumatra, Indonesia, she has accepted that group's own self-labeling, as a "matriarchate," or matriarchy. The problem, she asserts, lies in Western cultural notions of what a matriarchy "should" look like—patriarchy's female-twin. "Too many anthropologists have been looking for a society where women rule the affairs of everyday life, including government," she said. "That template—and a singular, Western perspective on power—doesn't fit very well when you're looking at non-Western cultures like the Minangkabau. In West Sumatra, males and females relate more like partners for the common good than like competitors ruled by egocentric self-interest. Social prestige accrues to those who promote good relations by following the dictates of custom and religion." Dr. Sanday decided to propose a new definition of matriarchy after living for an extended period with the Minangkabau. The R. Jean Brownlee Endowed Term Professor of Anthropology at the University of Pennsylvania, and Consulting Curator at the University of Pennsylvania Museum of Archaeology and Anthropology (UPM), she has spent most of the last 21 summers and some sabbaticals living in a Minangkabau village, conducting research supported in part by the Museum. In 1997, she curated a UPM photography exhibition, "Eggi's Village: Life Among the Minangkabau of Indonesia." She's followed that public exploration with a provocative new book, Women at the Center: Life in a Modern Matriarchy (Cornell University Press, May 2002). Who are the matriarchal Minangkabau and why should we care? Dr. Sanday comes to her research as an expert on gender issues, violence and sexual politics in American society. (She's the author of A Woman Scorned: Acquaintance Rape on Trial [Doubleday, 1996], and Fraternity Gang Rape: Sex, Brotherhood and Privilege on Campus [New York University Press, 1990]. For her, it's a question to be passionate about, because the answer helps to broaden our understanding of the range of social possibility. Today, four million Minangkabau, one of the largest ethnic groups in Indonesia, live in the highlands of the province of West Sumatra. Their society, Dr. Sanday discovered, is founded on the coexistence of matrilineal custom and a nature-based philosophy called adat. More recently, Islam was incorporated into the foundation. Despite the recent outbreak of violence associated with Islamist ideologies in many parts of the world, Dr. Sanday describes a peaceable, almost violence-free Minangkabau society.

		ADAT, THE NATURE BASED PHILOSOPHY
		Most of the family groups have a traditional matrilineal long house. As dictated by custom the entrance of the house faces Mt. Merapi. Photo credit: Peggy Reeves Sanday, 1985.

The key to Minangkabau matriarchy, according to Dr. Sanday, is found in the ever-present adat idea expressed in the proverb "growth in nature must be a teacher." "One must nurture growth in humans, animals, and plants so that society will be strong," people told her. The emphasis on nurturing growth, she asserts, yields a unique emphasis on the maternal in daily life. "While we in the West glorify male dominance and competition, the Minangkabau glorify their mythical Queen Mother and cooperation," said Dr. Sanday. In village social relations women are likened to "the center where the fish net meets." Senior women are associated with the central pillar of the traditional house, which is the oldest pillar because it is the first erected. The oldest village in a group of villages is referred to as the "mother village." When they stage ceremonies in their full ceremonial regalia, women are addressed by the same term reserved for the mythical Queen. Such practices suggest that matriarchy in this society is about making the maternal the center, origin, and foundation, not just of life but of the social order as well. The power of Minangkabau women extends to the economic and social realms. Women control land inheritance and husbands move into the households of their wives. Unlike many other societies in which anthropologists say women are exchanged between families at marriage, in this society men are exchanged. During the wedding ceremony the wife collects her husband from his household and, with her female relatives, brings him back to her household to live. In the event of a divorce the husband collects his clothes and leaves. Yet, despite the special position women are accorded in the society, the Minangkabau matriarchy is not the equivalent of female rule. "Neither male nor female rule is possible because of the Minangkabau belief that decision-making should be by consensus," Dr. Sanday said. "In answer to my persistent questions about 'who rules,' I was often told that I was asking the wrong question. Neither sex rules, it was explained to me, because males and females complement one another. As with everything else, the Minangkabau have a proverb to describe the partnership relationship between the sexes: 'Like the skin and nail of the fingertip.'"

ISLAM AND THE MINANGKABAU
Family photo at a house-building ceremony. Photo credit: Peggy Reeves Sanday, 1985.

Today, according to Dr. Sanday, while the Minangkabau matriarchy is based largely on adat, Islam also plays a role—but not in the way one might expect. Islam arrived in West Sumatra sometime in the 16th century, long after adat customs and philosophy had been established. At first there was an uneasy relationship between adat and Islam and, in the l9th century, a war broke out between adherents of adat customs and fundamentalist beliefs imported from Mecca. The conflict was resolved by both sides making accommodations. Today, matrilineal adat and Islam are accepted as equally sacred and inviolate, handed down from the godhead. "At a time when consumerism is more prevalent in Indonesia than ever before, these sacred principles of Minangkabau culture and society act to support one another," she noted.

Resurgent Islamic fundamentalism, nationalism, and expanding capitalism—all are realities that Dr. Sanday acknowledges can erode the Minangkabau's nature-based matriarchal culture and the adat that infuses meaning into their lives. She remains optimistic that their culture has the innate flexibility to adapt to a changing world. "Had the Minangkabau chosen to fight rather than to accommodate the numerous influences that impinged on their world over the centuries, had they chosen to assert cultural purity, no doubt their 'adat' would have long ago succumbed. The moral of the Minangkabau story is that accommodating differences can preserve a world" (from Women in the Center).