Aging: A new challenge for Indonesia

Aging: A New Challenge for Indonesia by Graeme Hugo ~

Introduction

In 1987 Indonesia's major weekly news magazine Tempo ran a story which reported on three recent murders. Murder stories are staple items in such magazines, but what was different about these murders was that each involved an adult murdering one of their elderly parents. While such practices are, of course, not at all widespread in Indonesia, the fact that they occurred at all is perhaps one extreme indication of important changes which are occurring in intergenerational relationships within Indonesia which do have considerable significance for the well-being of the nation's older population.

As in many Third World nations there is a widespread belief in Indonesia that the rapid growth of their elderly population does not constitute an issue of concern. The conventional wisdom among the Indonesian elite, especially policy-makers, is that the traditional extended family will take care of their expanding future aged population as it has in the past. While there is very little mention of the elderly in the planning documents which guide Indonesia's development, the conventional wisdom is enshrined in the following quotation drawn from the GBHN (the Broad Outline of State Policy) which serves as the basis for national development planning:

The Indonesian culture and the existing value systems regarding the aged for their protection against the hazards of old age, socially, economically, etc., is inherently based on the extended family system and the community. Therefore, the policy and the approaches of the Indonesian government for the protection of the aged and becoming more responsive to their needs and

*Gmeme J. Hugo BA, MA, PhD FASSA is a Reader in Geography at the Hinders University of South Australia. He has also held visiting positions at a number of universities including the University of Hawaii and Hmanuddin University (Indonesia), as well as with a number of international organ~fions and Australian, Indonesian and South Australian government departments. His doctoral work and much subsequent research has dealt with population issum in Southeast Asia, especially Indonesia, and his publications have included Population Mobility in West Java (Oadjah Mada University Pre~), Internal Migration, Urbanization and Development in Zndonesia (United Nations Economic and Social Commission for Asia and the Pacific). He is joint author of The Demographic Dimension in Indonesian Development (Oxford University Press). He has also worked extensively on AustraliAn population lames and problems and has a book entitled Australia's Changing Population: Trends and Implications (Oxford University Prr in January 1992 he will take up the Chair of Geography at the University of Adelaide.

requirements, i.e., to obtain a fair and equitable share in the national development, is to strengthen the existing value system. Through those systems are the aged integrated into the community in which they belong, rather than being segregated to an alien setting in which they will only feel a sense of isolation and lack of belongingness.x

This paper makes a plea for greater consideration to be given by policy-makers, planners and researchers in Indonesia to aging issues. It demonstrates that Indonesia has one of the most rapidly growing aged populations in the world and discusses some of the distinctive characteristics of that population. The sources of support for the elderly in Indonesia are briefly summarized and- it is argued that the assumption that traditional family systems supporting the elderly will continue to be fully effective in this role is at best a very questionable one.

It is necessary at the out~et, however, to provide a context for the discussion by outlining some of the main features of Indonesia. It is the world's fifth most populous country with 180 million people (1990) and comprises an archipelago of more than 13,000 islands, although 60~ live on the island of Java which accounts for 6.9% of the national land area. This concentration is even more marked for the population aged 65 years with over 68% of them living in "inner Indonesia" in 1985. The enormous geographical diversity within and between the islands is more than matched by Indonesia's social, economic, religious and ethnic complexity with more than 300 distinct ethno-linguistic groups, all of the world's major religions significantly represented and major regional variations in average levels of well being in the population.*

During the 1970s and 1980s Indonesia experienced rapid and sweeping social and economic change. For most of this period economic growth has exceeded 5% per annum, self- sufficiency in the staple food, rice, has been achieved as has universal attendance at elementary school. Whereas less than 50/0 of eligible women were practicing modern contraceptive methods two decades ago in many parts of Indonesia, more than 50% of such women are now doing so. The proliferation of transport and communication systems has greatly reduced the isolation of even the remotest villages, s While Indonesia remains a predominantly rural nation with 74% of the population living in communities so designated, urbanization is occurring at a very rapid pace. The growth of the urban population was 5.4% per annum over the 1980-90 period compared with 0.8% for the rural population. 4 In spite of the enormous changes of the last two decades, Indonesia remains squarely within the echelons

(Continued on page 19)

Ageing International December 1991 3

success. With attention beginning to be paid to the Youth ode's popularity in Japan, a slowly growing number of middle-aged and older Americans are finally beginning to discover that their late countryman's words may indeed have some meaningful significance for them.

References

DeWitt, Karen, "Work of an Obscure Poet Bonds a City and Japan," The New York Times, October 8, 1991.

Mason, Margaret, "Inspired Economics: 'Youth' and the Japanese Businessman," The Washington Post, September 17, 1990.

Miyazawa, Jiro, Kando.no 5hifu Sei~hun, Kokoro no chikasui wo kumiageru (Impressive Poem "Youth"--Pumping up the Ground Water of the Mind). Tokyo, Takei*Suppan, 1988.

Takeda, Toshihiko, Japan Ministry of Health & Welfare, Japan External Trade Organization, New York, correspondence, April 15, 1991.

Continued from page 3

of those countries designated as less developed. Per capita GNP remains low at US$500, as does life expectancy at 57 years .5

The Demography of Aging in Indonesia

In 1990, 6.4 million Indonesians were aged 65 years or more so that Indonesia had the tenth largest elderly population among the world's nations? The aged, however, only make up 3.6070 of the total population and this is one of the reasons why the elderly have not been the subject of much policy or research attention. However, the rapidity of recent growth of the elderly population in Indonesia, depicted in Table 1, must be stressed. The population aged 65 + has grown more than twice as fast over the 1971-85 period as the total population and more rapid growth is in store for the next four decades.

The aged population will almost double between 1980 and 2000 from 4.91 to 9.52 million. Over that period Indonesia will have the fourth fastest-growing aged population in the world. In 1971 only 2.5~ of the population were aged 65 years and over, but this will increase to 5070 by 2000 and 7.4070 in 2020.

The demographic explanation for the increased tempo of aging and growth of the aged population in Indonesia is fairly clear. Declining levels of mortality have been important in two respects. As in many less developed countries (LDCs), a decline in infant and child mortality, together with continued high fertility in the 1950s and 1960s,

created a "bulge" in the Indonesian age structure similar to those characteristic of many more developed countries (MDCs) which experienced a post World War II "baby boom." This bulge will of course, lead to a substantial increase in the number of elderly Indonesians in the early years of the next century. In addition, there has been an overall improvement in mortality in recent years which has seen life expectancy at birth increase from 37.5 in 1955-60 tO 57 in the mid 1980s. 2

The major factor influencing the aging of the Indonesian population, however, is the unexpected and rapid decline in fertility which has seen the total fertility rate decline from 5.61 in 1967-70 to 4.27 in 1980 and 3.26 in 1985. T This unprecedentedly rapid fertility decline will inevitably produce an accelerated process of aging of population, especially beyond the year 2000 when the increase in the share of the aged will increase much faster than was the case in Western countries in the post World War II period. As G.W. Jones stresses in discussing aging in all ASEAN countries, "What is to come is crucial, not what has already happened. ''s

Table 1 shows that the universally recognized pattern of sex ratios decreasing with age also applies in Indonesia although this pattern is not as great as in most MDCs. It is interesting to note that the excess of females among the elderly has increased since 1971 and this trend is likely to continue in the latter part of this century.

In both MDCs and LDCs, one of the major issues or areas of concern as the population ages is the changing balance between various age groups. Table 2 shows that in Indonesia, the "total dependency ratio" has fallen since

Table 1: Indonesia: Growth of the Elderly Population 1971-85

1971 1980 1985 % Change

1971-85

Population Aged 65 + 2,968,377 4,913,015 5,572,948 87.7 Percent Aged 65 + 2.51 3.34 3.40 35.4 Total Population 118,400,000 146,800,000 164,000,000 38.5 Population Aged 75 + 786,858 1,525,373 1,645,818 109.2 Percent Aged 75 + 0.67 1.31 1.00 49.2 Sex Ratio 65 + 94.2 84.8 88.7 - 5.8 Sex Ratio 75 + 93.6 82.3 79.5 - 15.1 Sex Ratio Total Population 97.2 98.8 99.1 - 2.0

Source." Indonesia, Central Bureau of Statistics 1971 and 1980 Censuses and Intercensal Survey of 1985


1971 with the "child dependency ratio" declining even more substantially. On the other hand, the "aged dependency ratio" has increased, although it is still very low by MDC standards. These shifts are of considerable policy significance, although it needs to be pointed out that the resources "freed up" by the decline in the child dependency ratio cannot simply be redirected toward meeting the increased demand created by the increasing aged dependency ratio.

Official projections show these patterns continuing for the next two decades with the aged dependency burden in 2005 being almost double that in 1971 while that of the young is almost half that of 1971. Moreover, it is likely that these tendencies will continue during the early part of the twenty-first century. Chen and Jones project the total dependency ratio to fall to 45 in the year 2020 and thereafter increase due to the rapid increase in the aged dependency ratio. By the year 2050, it will have returned to 1980 levels. 9 The important crossover year for when the aged dependency ratio is projected to exceed the child dependency ratio is 2045.

In MDCs, one of the major problems associated with the sex imbalance at older ages has been the "increased poverty of older women and greater risks of ill health and institutionalization of women."1~ To this could be added the problems of loneliness of single older women which, although well documented in MDCs, are scarcely referred to in the LDC literature. Yet in village-based field work in West Java, I found that one of the most signficant social problems in those rural communities was the loneliness, poverty and deprivation of older widows and never-married women who lived on their own and often had to rely upon the charity of the community to survive, n

Support Systems for the Elderly in Indonesia

There is no consensus in the literature about the implications of the economic development and social change associated with modernization for the well-being of the elderly) 2 The well-being of the aged population is influenced by a complex set of interacting factors--their income, living conditions and arrangements, social contacts and, above all, their physical and mental health. There is insufficient data currently available to determine definitively whether or not the well-being of the elderly has deteriorated over recent years. Indeed, there is a lack of information concerning their present situation vis-a-vis other age groups--let alone how this has changed over time. There are certainly scattered indications of worsening of the situation of the elderly, but how representative such reports are cannot be established.

Most older residents of countries like Indonesia contrive to work far beyond the retirement ages adopted in more developed countries. The ASEAN Aging Survey for example found that 61070 of elderly Indonesian males and 34070 of women were in the workforce) Nevertheless, as is the case elsewhere, with the onset of old age the capacity of Indonesians to earn their own living declines and they are forced to reduce their workload or move out of the workforce. A survey in Java found that 35.707o of elderly people in urban areas not working left the workforce for health reasons; this applied to 50.707o of their rural counterparts: s

Table 2: Indonesia: Actual and Projected Dependency Ratios 1971-85

Number of Dependents Per 100 Persons Aged 15-64

1971 1980 1985 1995 2005

Total Dependency Ratio (less than 15 and more than 64 years)

Child Dependency Ratio (less than 15 years)

Aged Dependency Ratio (More than 64 years)

86.82 79.07 74.68 61.33 52.57

82.13 73.25 68.73 54.25 44.53

4.69 5.82 5.93 7.08 8.04

Source: Indonesian Censuses of 1971 and 1980 and Intercensal Survey of 1985 r Biro Pusat Statistik 1987

20 Ageing International December 1991

In situations where the elderly cannot earn a living through work, their level of well-being is going to depend upon the extent to which they have been able to accumulate wealth and assets during their more active working years, their children and other younger family members are willing and able to give them support, government provides support and other elements in the community give support (e.g., friends, voluntary organizations, etc.).

All of these can and do vary as a society undergoes economic and social development and urbanization. However, establishing what is happening in these four areas among Indonesia's elderly is very difficult with the data currently available. A brief summary of current knowledge is given below.

Accumulation of Assets There are strong indications that the current generation of elderly persons in Indonesia has not been able to share in the economic benefits of Indonesia's development over the last two decades as have later generations. This is partly associated with the fact that the elderly of Indonesia have very low levels of formal education, having passed through their childhood and young adult years during the colonial occupation when educational opportunities for indigenous people were very limited. The ASEAN Aging Survey found that only 7070 of males aged 60 years and over and 2~ of females had any secondary or post-secondary education; only 44070 of males and 14% of females were literate. ~ The levels of education and literacy decrease consistently with increased age and are substantially lower in rural than in urban areas. Hence Sigit found in his Java survey that 42% of urban elderly persons (21.3070 of males and 62.1070 of females) were illiterate as were 55.1070 of their rural counterparts (38.2070 of males and 69.9070 of females). 13 Consequently, during the period of rapid economic expansion older workers found it especially difficult to compete in the formal sector of the labor market because they were generally less well educated than the younger generations who reached school age during the post-war expansion of education. This has resulted in much higher proportions proceeding to high school and tertiary education than had been the case with the cohorts moving into these ages in the 1920s, 1930s and 1940s.

The economic situation of the elderly is very difficult to establish in any context and almost impossible in a "data- poor" situation such as in Indonesia. Nevertheless, there are some indications that the elderly are less well off economically than the younger adult population due to inability to earn. In Indonesia it is off• estimated that around 30070 of the 60+ populationmor 2.65 million persons--are living in the "poorest of the poor conditions. ''~ This proportion is substantially higher than for the population as a whole. 2 Moreover, in a survey in Java it was found that 35.1070 of the urban elderly and 44.5~ of their rural counterparts found their receipts from all sources inadequate. ~3

An elderly street vendor in Jakarta

Photo: UN Photo/Andrea Brizzi

Family Support High workforce participation notwithstanding, there is still considerable reliance on the family for economic and social support among Indonesia's elderly population. The ASEAN Aging Survey, for example, found 22070 of males and 47070 of females indicating their major source of support to be children or grandchildren, while 50070 and 7007o respectively relied upon them for at least some income.

There is some concern that the social, economic and demographic changes which are currently occurring in LDCs such as Indonesia are undermining the basis of this family support. One of the most striking transformations in Indonesia in recent years has been the fertility decline referred to earlier. Demographers suggest that this has been associated with significant changes in family structure and intergenerational relationships within families. Caidweil argues that a major cause of the initiation of fertility decline is the import of European concepts of family relationships and obligations, with mass education and the mass media being major vehicles of that importation. 1( Caldwell says that from a demographic viewpoint the most important "social exports" from Europe have been the predominance of the nuclear family with the strong husband-wife ties and concentration of concern and expenditure on one's children


rather than one's parents. It is generally accepted that such changes in family structure have occurred in Indonesia and this has been a fundamental factor in the fertility decline. While the crucial change is in the shift from an emotionally extended to an emotionally nuclear family, it is interesting to note that the population of Indonesians living in residentially extended families (Le. , extended families living under one roof) has declined from 13.4% at the 1971 census to 11.8)/0 at the 1985 intercensal survey.

Two aspects of traditional families favored the aged being given strong support--first, the intrinsic normative structure which placed major significance upon caring for one's parents and, second, having a large number of progeny meant that the burden of care of the elderly was shared among a large number of children and grandchildren.

The first of these is clearly under threat, but the implications of the second also need to be recognized. With the decline in fertility and increased longevity the ratio of kin caters to old people is being reduced. This may well be a factor in reducing the strength and effectiveness of informal support systems for the aged.

A recent survey in Java sheds some light on the extent to which older people have access to family-based support systems. TM "In urban areas 10.1% of older persons had no living children and 27.9o7o had only 1 or 2. The equivalent population in rural areas were 8.7% and 28.6~ These proportions were especially high for women (14.207o and 35.207o in urban areas and 11.207o and 34.20/o in rural areas.) Sibling support is also limited with 50.1% of older urbanites having no brothers still alive and 41.4% having no living sisters. In rural areas the equivalent figures are 46.4~ and 42.5% respectively. Even in cases where the urban elderly have living children, only 34.2070 receive visits more than weekly and 40.4% receive visits infrequently, hardly ever or never. In rural areas the equivalent percentages were 54.6% and 26%." Hence it is clear that it is possible to exaggerate the extent to which family support is accessible or even available to elderly people in Indonesia.

Further, even where older persons are living in a traditional family situation, the extent of support provided is unclear. J. Evans concluded from a detailed micro-level research study in Solo, Central Java that the popular Javanese perception of veneration of the elderly and complete support provided for them within the bosom of the family and the local community is, to some extent, a myth. 15

As is the case in most LDCs, few Indonesians live alone. The ASEAN Survey found that 8% lived alone and 15% lived only with their spouse (in Australia the comparative proportions axe 23% and 23.2~ respectively.) 9 However, there are substantial differences between the data for males and females largely due to the fact that most Indonesian women outsurvive their husbands due to their greater longevity and the fact that they tend to be younger than their husbands. Hence 8 out of every 10 Indonesian aged men live with their spouses compared with fewer than 3 out of 10 aged women. Most remaining aged men live with other

Elderly persons residing in a home for the aged in Jakarta reading the Koran UN Photo/Andrea Brizzi

family members, while of the other women, 57~ live with other family members and 13.5~ live alone.

Government Support As in most LDCs, pension schemes for the elderly are only available to persons who have worked in the formal sector for a particular period and are based upon the level of contributions made while employed. The bulk of pension recipients are urban dwellers since social security coverage is not usually extended to agricultural workers and where available, they are predominantly provided to males. TM

Nevertheless, pensions are rarely sufficient to meet the needs or the full living costs of elderly persons, s

In the 1985 ASEAN survey 1307o of elderly male respondents indicated that their main source of income was a pension and 16% received some income from this source? The equivalent proportions for elderly women were 4o70 and 5% respectively. TM Jones reports that some 11.5~ of Indonesia's current work force (involving some 6 million persons) are presently covered by pension or old-age assurance provisions, s These are almost exclusively civil servants, army personnel and city-based employees of large private sector organizations, especially industrial concerns.

There is very little formal aged service infrastructure available in Indonesia. For example, there are very few specialized institutions for the aged and the level of institutionalization of the aged is very low. Adi reports that the city of Jakarta (1985 population 7.9 million) has only nine institutions for the aged, with a total resident population of 420. x They are operated by non-governmental organizations. Indonesia's Fourth Five-Year plan which covered the period 1984-1989 stated that there was a need to make provision through institutional and home-based services for the approximately 630,000 very poor elderly persons who were lacking family support. Yet, some 85O70 of elderly people interviewed in a 1985 survey in Java disagreed with the concept of institutionalization for old people. TM


It is clear that, there is a lack of non-institutionalized services for the aged in Indonesia. In traditional Javanese communities there were strong traditions of gotong royong (community self-help) which ensured community cooperation across a wide range of areas, including the care and maintenance of older people without family to take care of them. However, the extent to which this has been continued into the present is not known and needs further research. In the light of rapid economic and social change, it seems highly unlikely that one can continue to rely in the future on the existing tradition to take care of older persons without family unless some additional form of support is provided.

Chen and Jones identify a number of areas of service provision which need to be given urgent attention in ASEAN nations and they certainly are of considerable relevance in Indonesia. 9 These include: 1) thorough assessment and provision for the most vulnerable elderly, namely those without families or living alone; 2) more services to assist the homebound elderly such as day care centers, respite centers, home nursing services, "meals on wheels," befrienders, etc.; 3) an assessment of the needs of the rural elderly since the few services which exist are mainly in urban areas; and 4) attention given to ways of assisting and encouraging families who care for their elderly members within the traditional system.

In Indonesia there is a need to provide the elderly (especially the handicapped) with greater opportunities for community-based social activities. In this context the conclusions of a WHO-sponsored survey in the Philippines and Malaysia are also relevant to Indonesia. The study specifically stresses the "need to explore the appropriateness and effectiveness of day center programs, particularly in urban settings in countries where the growing numbers of the aging in the population and limitations on extended family activities mean that opportunities for social interaction among the elderly are necessarily restricted.. , it is important that urban planning policies, public housing and community development activities take proper account of the special needs of the growing minority of the elderly. Housing policies in the past, for instance, have too often not responded to the needs of the extended family and have resulted in diminished opportunities for family interaction and support. ''17

Other Support Systems One of the striking findings of the ASEAN survey of the elderly in Java was that 24% of the aged respondents participate in educational programs for the elderly. 9 When compared with MDCs, these indicate very high rates of participation in such community organizations. These figures, however, may exaggerate participation levels because the question may have been interpreted as participation in the regular village meetings which most rural residents in Java attend.

Conclusion

It is clear that in Indonesia, as is the case in most LDCs, there is an almost total reliance upon the family and, to a lesser extent, on the local community to care for the elderly. As Chen and Jones point out, Indonesian policy-makers " . . . whether of necessity or from philosophical conviction, seek to maintain the existing systems of family care and concern for the elderly. The family is seen as ultimately responsible for its e lderly dependen t s , and institutionalization to be used only as a last resort. The aim is to obtain as much community participation as possible. This philosophy is reflected in the kinds of income maintenance, health care, recreational programs and publicly-funded institutional care available to the elderly. Governments provide limited special services for particular groups of the aged, and rely on private and charitable groups to assist in providing for the needy. Social security programs are typically limited to employed individuals with complementary special welfare programs for the impoverished and the impaired. ''9

Nevertheless, it is clear that there are changes occurring in intergenerational relationships in Indonesia and that Heisel's conclusion made more generally for LDCs is highly relevant to Indonesia: " . . . values of the traditional family system are still very important and the aged command respect and attention from the young members of the family, who have the responsibility for caring for their elders. However, recent economic and social changes, particularly migration, have produced a decline in the traditional system of assigning responsibility in the family and in its capacity to cope with some of the fundamental needs of its aged members. ''le

In Indonesia the rapid growth of the general population is placing great strain on the provision of all types of public services and utilities. In such a situation it is difficult to persuade city, regional and national governments to move into what are largely new areas of spending in providing specialized services for the aged. The need for such services, especially those which mesh with, and support and encourage family-based systems, is, however, considerable.

References

1Adi, R. "The Aged in the Homes for the Aged in Jakarta: Status and Perceptions." Jakarta, Pnsat Penettian: Universitas Katolik Indonesia Atma Jaya, 1982. ~Hugo, G.J., Hull, T.H., Hull, V.J. and Jones, G.W. The Demographic Dimension in Indonesian Development, Kuala Lampur: Oxford University Press, 1987. SHugo, G.J. "Population Movement, Economic Development and Social Change in Indonesia since 1971." Tijdschrift v o o r

Econoraische en Sociale Geografi, 79,4, 1988. 4Hugo, G.J., (forthcoming). "Ageing in Indonesia: A Neglected Area of Policy Concern," in D.R. Philips (ed.), Ageing in East and Southest Asia, London, Edward Arnold.

(Continued on page 34)


live in this type of housing benefit greatly. Clearly then, the major obstacles in the implementation of viable granny flat programs are management issues which are mostly in government hands. It would be interesting to learn why the Canadian government has been so supportive of the

program in contrast to the governments of the other countries discussed. For not until there is a real commitment on the part of government agencies to this housing option for older persons can some of the major obstacles be overcome.


5 World Bank Report: The Challenge of Development, Washington, DC: Oxford University Press, 1991. eMamas, S.G.M. "Penduduk Indonesia dan Berberapa Proyekinya Di Masa Mendating Dalam Kaitannya Dengan Proses Transisi Demografi" (Indonesia's Population and Several Future Projections in Relation to the Demographic Transition Process). Paper presented to meeting on the Contemporary and Future Situation of Indonesia's Population and the Implications for Future Sectoral Development organized by Ministry of Population and Environment, Jakarta, 25-26 March 1991. 7Hull, T.H. and Dasvarma, G.L. "The 1985 Intercensal Survey of Indonesia: Evidence of Continuing Fertility Decline," International Population Dynamics Program Research Note No. 77, 9th July. Canberra: Department of Demography, Australian National University, 1987. s Jones, G.W. "Consequences of Rapid Fertility Decline for Old Age Security." Paper presented at Seminar on Fertility Transition in Asia: Diversity and Change, Bangkok, 28-31 March, 1988. 9Chen, A.J. and Jones, G.W. Ageing in ASEAN and its Socio Economic Consequences, Singapore: Institute of Southeast Asian Studies, 1988. l~ J.S. and Hoover, S.L. International Trends and Perspectives: Aging, Washington, DC: U.S. Department of


lSAssociated Press. "Doctor in Suicides Assails U.S. Ethics," The New York Times, November 3, 1991.

14Kevorkian, Jack. Prescription: Medicide: The Goodness of Planned Death. Amherst, NY: Prometheus Books, 1991.

lSGibbs, Nancy. "Dr. Death Strikes Again," Time, November 4, 1991. 16Knox, Richard A. "Igniting a Deadly Debate: Suicide Doctor Seen as Threat," The Boston Globe, October 27, 1991.

17Quill, Timothy E. "Sounding Board: Death and Dignity: A Case of Individualized Decision Making," The New England Journal of Medicine, Vol. 324, No. 10, March 7, 1991.

lSEditorial opinion. "Dealing Death or Mercy?," The New York Times, March 17, 1991.

19Altman, Lawrence K. "A How-to Book on Suicide Surges to Top of Best-Seller List in Week," The New York Times, August 9, 1991.

~gHumphry, Derek. Final Exit: The practicalities of self-deliverance and assisted suicide for the dying. Eugene, Oregon: The Hemlock Society, 1991.

~lUnited Press International. "Hemlock Society co-founder found dead of apparent suicide," October 9, 1991.

Commerce, Bureau of the Census (International Research Document No. 12), 1984. nHugo, G.J. "Population Mobility in West Java, Indonesia." Yogyakarta: Gadjah Mada University, 1978. t:Hugo, G.J. "The Changing Urban Situation in Southeast Asia and Australia: Some Implications for the Elderly." Paper prepared for International Conference on Aging Populations in the Context of Urbanization, Sendal, Japan, 12-16 September, 1988. lSSigit, H. "A Socio-Economic Profile of Elderly in Indonesia," Phase III ASEAN Population Program Country Report, Socio- Economic Consequences of the Ageing of the Population Jakarta: Central Bureau of Statistiks, 1988. 14Caldwell, J.C. "Toward a Restatement of Demographic Transition Theory." Population and Development Review 2(3-4): 321-366. lSEvans, J. "The Economic Status of Older Men and Women in the Javanese Household and the Influence of this upon their Nutritional Level." Journal of Cross Cultural Gerontology Vol. 5,3, 1990. lSHeisel, M.A. "Population Policies and Aging in Developing Countries." Paper presented to 13th International Congress of Gerontology, New York, July 12-17, 1985. l~Andrews, G.R., Esterman, A.J. and Rungie, C.M. Aging in the Western Pacific. Manila: World Health Organization Regional Office for the Western Pacific, 1986.

2~Associated Press. "'Smothering Alleged in Suicide Note," The Washington Post, October 28, 1991.

2SWalsh, Edward. "Recasting 'Right to Die': Public Hospital Seeks to End Life Support," The Washington Post, May 29, 1991.

:4Belkin, Lisa. "As Family Protests, Hospital Seeks An End to Woman's Life Support," The New York Times, January 10, 1991.

:~Cranford, Ronald E. "Helga Wanglie's Ventilator," Hastings Center Report, Vol. 21, No. 4, July-August 1991. :eAssociated Press. "Judge Rejects Request by Doctors To Remove a Patient's Respirator," The New York Times, July 2, 1991.

~Associated Press. "Minnesota Woman Dies After Right-to-Life Ruling," The Washington Post, July 6, 1991.

~SCassel, Christine K., and Neugarten, Bernice L. "The Goals of Medicine in an Aging Society." In Binstock, Robert H. and Post, Stephen G., Too Old for Health Care? Controversies in Medicine, Law, Economics and Ethics. Baltimore: The Johns Hopkins University Press, 1991.

~Schwartz, Harry. "An opposing view: Stop wasting money on hopeless cases," USA Today, May 30, 1991.

S~ observations by author and conversations with participants at conference on Medical Decision-Making and the "Right-to-Die" After Cruzan, Washington, DC., September 1990.

SlSteinfels, Peter. "At Crossroads, U.S. Ponders Ethics of Helping Others Die," The New York Times, October 28, 1991.


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Aging: A new challenge for Indonesia