Carol Warren

This chapter focuses on the factors influencing Mekong Delta farmers’ satisfaction with health insurance services in the context of agricultural practice. The study identifies three key factors affecting farmers’ satisfaction with health insurance services: participation and payment procedures, hospital service quality, and the support of hospital and social insurance staff. Statistical analysis indicates that these factors significantly impact farmers’ satisfaction levels, with women rating health insurance services higher than men. Moreover, the study underscores the importance of improving access to quality care and enhancing client satisfaction to address the challenges faced by farmers in accessing healthcare services. The research employs a mixed-method approach, including surveys, interviews, and focus group discussions, to gather empirical data from 180 farming households in An Giang, Can Tho, and Soc Trang provinces. The chapter recommends policy reforms to address the socio-economic and environmental changes in the Mekong Delta, advocating for the integration of technological innovations such as telemedicine and artificial intelligence (AI) diagnostic tools to enhance healthcare accessibility. The study’s implications extend to the Vietnam Ministry of Health and Social Security Agency, providing insights to identify areas for improvement in health insurance policies and social security systems. The research contributes to the ongoing discourse on enhancing healthcare services for rural populations, with implications for policymakers, healthcare providers, and social security agencies.

This article addresses the importance of understanding informal and customary arrangements to comprehend social security in the contemporary Indonesian context. Highlighting the work of K. von Benda-Beckmann, the focus is on how people foster circles of solidarity to deal with vulnerability, and needs for food, shelter and care, while creating their social security mixes, in which state provisions and community arrangements are combined. We argue that – since there is no welfare state capable of providing for all aspects of social security – people will depend on informal provisions that belong to the realm of moral economy. Based on both authors’ field research, the article explains how this social security mix functions in practice, with examples from the Indonesian islands of Bali and Sumba. We explore to what extent such a moral economy persists, and how moral economy arrangements for mutual support differ from state welfare, in particular from normative and relational perspectives, and how people shape articulations between the two support systems. We argue, in line with the von Benda-Beckmann approach, that it is crucial to understand social security practices as a mixture resulting from Indonesia’s economic and legal pluralism.

Background: As a Hindu-majority province in Indonesia, Bali presents a unique and distinctive culture. Patrilocal (purusa) marriage and patrilineal inheritance as a continuation of the patriarchal system puts a man in the key role as a family successor. Having a son is a priority for a married couple in Balinese society. As a consequence, Balinese women experience several constraints related to their economic productive, reproductive, and adat (ritual) roles. When a family does not have a male heir, their daughter is pressed to find a spouse willing to accept sentana (matrilocal) marriage. This secondary form of marriage brings another complication for Balinese-Hindu women and does not necessarily relieve their submissive position.

This research analyzes Balinese-Hindu women’s perspectives on their marriage experiences and fertility decisions.
Methods: The data was collected in two areas representing rural (Banjar Tumbakasa in Gianyar) and urban (Banjar Biaung in Denpasar) locations in Bali Province, Indonesia from November 2019 to February 2020. Primary data was based on in-depth interviews of six rural and six urban married Balinese-Hindu women.

Results: This qualitative inquiry into Balinese women's experience of the marriage system and fertility options in urban and rural Bali revealed varying degrees of social expectation to provide male descendants for their families. At the same time, economic burdens still haunt them in this development era, and have conflicting implications for family size. Their stories of purusa (patrilocal) and sentana (matrilocal) marriage were complex, being strongly associated with customary law (adat) in traditional society. Paradoxically, however, it was rural women in the study sample who disproportionately opted for the sentana arrangement and limitation of family size.

Conclusions: This study explores women's fertility aspirations, notably regarding son precedence. It problematizes the sentana marriage alternative as a solution to lighten the expectations and burdens affecting women.

As a Hindu-majority province in Indonesia, Bali presents a unique and distinctive culture. Patrilocal (purusa) marriage and patrilineal inheritance as a continuation of the patriarchal system puts a male in the key role of family representative and successor. Having a son is a priority for a married couple in Balinese society. As a consequence, Balinese women experience several constraints related to their economic productive, reproductive, and adat (ritual) roles. When a family does not have a male heir, their daughter is pressed to find a spouse willing to accept sentana (daughter succession) marriage. This secondary form of marriage brings another complication for Balinese-Hindu women and does not necessarily relieve their submissive position. This study analyzes Balinese-Hindu women’s perspectives on their marriage experiences and fertility decisions in patrilineal society in changing rural and urban conditions.

The data was collected in two areas representing rural (Gianyar) and urban (Denpasar) locations in Bali Province, Indonesia from November 2019 to February 2020. Primary data was based on in-depth interviews of six rural and six urban married Balinese-Hindu women.

This qualitative inquiry into Balinese women's experience of the marriage system and fertility options in urban and rural Bali revealed varying degrees of social expectation to provide male descendants for their families. At the same time, economic burdens still haunted them in this development era and manifested conflicting implications for family size. Their stories of purusa and sentana marriage were complex because it has strongly associated with customary law (adat) in traditional society. Paradoxically, this study found that it was predominantly rural women who opted for the sentana arrangement and expressed a preference for smaller family sizes.

This study explores women's fertility aspirations, notably regarding son precedence. It problematizes the sentana marriage alternative as a potential solution to alleviate the expectations and burdens placed on women.

Weber’s theory of formal and substantive rationality (WFSR) explains the range of people’s motivations when engaging in different forms of economic activity. Human rationality is driven by formal rationality, which focuses on economic gains, and substantive rationality which considers non-economic factors such as power, trust, and cultural values that could offset the shortcomings of social exchange theory (SET). The study used the exploratory sequential mixed method including semi-structured interviews with key tourism stakeholders and follow-up survey. Most stakeholders from both groups agreed that tourism brings about economic benefits and employment opportunities; however, tourism results in adverse environmental and cultural impacts. Sapa stakeholders generally support tourism development for both economic and non-economic reasons. The findings of this study do support that the SET and Weber’s theory explain the contradictory perspectives of multiple ethnic groups in the community. Specifically, in this study, the perspectives of Kinh respondents regarding impacts of tourism development were found to be quite contradictory compared to those of the ethnic minority groups. Such contradictions could present a challenge to the application of participatory approaches in tourism development and the development of a “shared vision” among tourism stakeholders. Implications for tourism planners and suggestions for future research are also discussed.

As we finalised this volume, the COVID-19 pandemic bore down on Indonesia and disrupted the picture of declining rural poverty discussed in earlier chapters. To reflect on the implications for rural livelihoods and the scenarios we identified, we conducted interviews and reviews of available reports. Here we offer some preliminary thoughts on the impacts of the pandemic and consider how COVID-19 has triggered changes within the scenarios outlined in Chapter 2. We also reflect on the role of social assistance during this crisis.

The scenario approach applied in this volume understands rural transformation as a diachronic process, where contextual and relational mechanisms interact dynamically with political, institutional, economic, social and environmental structures and social relations to produce discernible patterns of agrarian change over time. A path dependency is at work in each scenario: as proximate and relational processes have converged with structures to shape a scenario over historical time, these patterns work causally, setting the conditions for possible outcomes into the future. However, change is not predetermined. When a contingent event occurs, such as a pandemic, it may reinforce pre-existing patterns, reproducing or deepening the effects. Yet, the contingent event may also trigger reactions and changes that can shift livelihood trajectories in new directions. As we will argue below, the pattern of change will depend upon how the contingent trigger (for example, a pandemic) plays into processes and structures characteristic of the specific scenario. In this epilogue, then, we set out to explore how the COVID-19 pandemic works as a contingent trigger exerting pressure on existing patterns of rural change, and intensifying the insecurity of the most vulnerable, producing both winners and losers.

This chapter examines the impact of environmental decline on local livelihoods in a west Balinese coastal community, as a case study of the precarity arising from resource degradation affecting many rural communities in Indonesia and beyond (Rigg et al. 2016). Alongside vulnerability to life cycle crises of illness, death and disability, precarity for the population of Perangkat (pseudonym), a fishing community in the district of Jembrana, west Bali, arises from a number of serious anthropogenically induced environmental challenges, leaving villagers with limited prospects of a “sustainable” future to support livelihoods in their home community. More broadly, this case study is a harbinger of longerterm vulnerabilities, exploring the under-recognised looming threats to food security and economic development posed by natural resource degradation. The new precarities are starkly evident in the fisheries sector, but represent a wider issue driven by unsustainable production practices in agriculture and other sectors of intensified natural resource extraction. The paradox in these cases is that the same market expansion and capitalist accumulation processes that underpin “development” trajectories are ultimately undermining them. The fishing village of Perangkat was officially classified as a desa tertinggal (left-behind village) during the Suharto Era. The progression out of poverty over the 1990s and early 2000s and the subsequent unravelling of the local economy as a consequence of the collapse of the Bali Strait fishery since 2010 do not fit neatly into conventional agrarian transition models or stages of poverty scenarios. The primary focus of this chapter is on the impact of resource decline and the complexity of interpreting questions of poverty, food security and social protection in settings where an ambiguous sense of “precarity” poses so many shades of grey in the measurement and assessment of community and household livelihood trajectories, presenting a scenario of reversal precipitated by resource degradation.

Small-scale fisheries (SSF) provide crucial contributions to livelihoods, food and nutrition security, and the well-being of coastal communities worldwide. In Indonesia, 2.5 million households are involved in SSF production, yet these households are characterised by high poverty rates and vulnerability due to declining ecosystem health and climatic change. In this study we applied the Sustainable Livelihoods Framework to analyse the characteristics and immediate and longer-term outcomes of 20 SSF livelihood-focused intervention programs implemented in coastal communities across the Indonesian Archipelago over the last two decades. Projects covered a wide range of spatial scales, funding providers and key participants. Factors supporting positive program outcomes included application of inclusive and holistic approaches to sustainable livelihoods, implemented and supported over appropriate time frames; use of participatory capacity development methodologies and locally-situated project facilitators; and collaborative engagement with local government, non-government organisations and private-sector actors. However, it was impossible to identify evidenced successes from a longer-term sustainability perspective. Short project timeframes, absence of baseline or monitoring data, pressure for satisfactory reports to donors, and limited post-project evaluation, together with invisibility of women’s work and non-commercial exchanges, affected the adequacy of assessments. Given the lack of post-project assessment among projects studied, a thorough review of longer-term project impacts is recommended, guided by the Sustainable Livelihoods Framework, to evaluate sustained improvements in livelihoods outcomes and environmental sustainability. This would support best-practice design and implementation of SSF livelihood-focused interventions, disseminated beyond academia, to influence policy and development to achieve socio-economic equity and environmental goals.

This study investigates the social and environmental impacts of the rise and decline of the fishing industry in an Indonesian coastal community as a case study of the conflicted role of governance in marine resource management. It analyses the relationship between two distinct but intersecting fisheries in west Bali: the traditional small-scale artisanal fishery targeting diverse near shore species for the local market, and the large-scale commercial purse seine fleet that exploits the once rich Bali Strait sardine fishery. The recent collapse of the sardine fishery has had a marked impact on the livelihoods of fishers in both the artisanal and commercial sectors. A significant issue for the future of fisheries dependent communities is the need to raise the priority of equity and sustainability in resource governance. The failure of regulatory regimes to control overfishing is found to be a key factor in the unravelling of the local economy and presents an instructive case for analysing the wider implications of a fundamental conflict in the political economy of the global system between unevenly matched market-driven resource use and sustainable development practices. Methodologically, the research combines qualitative and quantitative approaches to compensate for the dearth of data available for the artisanal and commercial fishery sectors respectively. Catch statistics on the rise and decline of the commercial sardine fishery are linked to qualitative information from a longitudinal study on the livelihood impacts of resource decline in a community engaged in both fisheries. In connecting interview data on village level livelihood issues with commercial fishery data, the study highlights the imperative of good governance across scales for policy makers and development practitioners concerned with equity and sustainability of fisheries as a critically important component of global food security.