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by. Rita Serena Kolibonso
Women‘ s Situation During the Reproductive and Productive Life Cycle
According to the Indonesian Demographic Health Survey 1997, one of 11 women wants to limit or delay future pregnancies without using contraceptive. While the Center for Health Research University of Indonesia in 2001 estimated that the total number of abortion cases in Indonesia is about 2 million cases per year. More than 70% of abortion is requested and performed by women who are married or live in stable unions and already have several children (Dewi, 1997; Population Council, 1998).
Abortion in Indonesia
Unsafe Abortion Situation
In 1950 the number or Maternal Mortality Rate (MMR) was very high. The Indonesian Family Planning Association (IFPA) estimated there were 800/100.000 cases but the government was against family planning (FP), there was no sensitivity toward women’s situation. The IFPA provided innovative information-education programs using volunteers.
In 1970, the National Family Planning program was more targeted and demographic oriented but there was lack of quality and of women empowerment. In 1980, the excesses of national program were the high contraceptive failure, high high drop out rates and unwanted pregnancies cases.
Maternal Mortality Rate (MMR) and Abortion Estimation
According to the Indonesian Demographic Health Survey (IDHS) 1997, the MMR in Indonesia was 390/100.000 cases. Formal estimation of abortion cases according to Household Health Survey (HHS) in 1995 was 11,1% while quoted from the Ministry of Health Director General’s statement was higher estimate of 50%.
Abortion in Indonesia from Time to Time
Abortion in Indonesia is, actually, not a new phenomenon as indicated by the pictorial relief at the Borobudur Temple which was built around the time of the eight century. Any religions consider abortion as sinful deed.
Cultural and Social Norms
Many cultures in Indonesia ‘reject’ modern abortion care but traditional herbs, massage and other ways are commonly used as a way to induce menstruation. Virginity is still considered as way to measure women’s moral values and unwanted pregnancies as irresponsible behaviour that unmarried young woman with an unwanted pregnancy should be expelled from school and work.
Abortion and Law in Indonesia
Abortion Law from Time to Time
On January 1, 1918, the Penal Code of Indonesia was enacted by the Dutch colonial government to stamp out the dangerous abortion procedures performed by traditional healers. It was stated in ch.14 clause 299 that abortion was a crime against morality and in ch.19 clauses 346-349 it was stated that abortion was a crime against life that anyone who advertised, encouraged, performed or experienced an abortion was liable to prosecution.
In 1991 a Bill on Health was submitted to the parliament but there were pro and contra about it. The archbishop of Jakarta sent out a pastoral letter to all churches in Jakarta which said “Catholics involved in an abortion would automatically be excommunicated”. And the chairperson of the influential Indonesian Council of Muslim Religious Leaders asserted that “Abortion at whatever stage of pregnancy is unacceptable”. In September 1992, the President of Indonesia officially enacted the new health law which does not resolve the problem but adds to controversy rather than clarifying the issues. It could be seen through the ambiguity in the wording, the inconsistencies of the clauses within the article itself and it could not be implanted since there was no Operational Regulation to implement the law. As a result the number of accidents and unwanted pregnancies and ‘injuries’ caused by “forced massaging” kept increasing.
Health Law No. 23/1992, Article 15
1. In an emergency case, in order to save the life of a pregnant woman or that of her fetus, a certain medical procedure could be performed.
a. Based on medical indications that warrant the procedures.
b. Done by a health personnel who is qualified and has the authority to do it, and done in a professionally responsible way, and they (the medical indications) should be confirmed by a team of experts.
c. With the consent of the concerned pregnant woman or her husband or her family.
d. Performed in an assigned health facility.
2. The mentioned medical procedures should only be performed under the following conditions:
3. For further detail regulation on this matter, an operational regulation (Indonesian: Peraturan-Peraturan) shall be issued by the government.
The imperfect Health Laws no. 23/1992, rigid cultural and social norms are preventing women’s access to:
a. Full and accurate information and education regarding critical RH and sexuality issues.
b. Proper and client’s sensitive counseling.
c. Provision of caring and non-judgmental services.
d. Rights-based safe abortion services using appropriate and advanced RH technology.
They also do not deter women to seek abortion services even provided by unskilled providers with unsafe techniques, without empathy, and in the absent of counseling.
And the final consequences are the persistence of high MMR in last two decades and the persistence of irresponsible providers who perform unethical and unsafe abortion (violating women’s human right).
The Non-Government Organization (NGO)
NGO‘s Mission
· Support efforts to ensure legal protection for women’s sexual and reproductive rights.
· Urge policy/strategy development and implementation to ensure access to quality and affordable reproductive health care without any discrimination.
· Promote information dissemination that raise public awareness/understanding on reproductive rights and equal status of women and men.
NGO‘s Strategies
1. Build Community Support.
a. Conduct polling on safe abortion with a result of 78% of a sample of 159 people agreed to lower the death risk of unsafe abortion (2000) and 85% of a sample of 600 people agreed that the decision of having abortion should be made through a counseling process (2000).
b. Work with the media to disseminate gender-sensitive information and for safetiness of a standard (medical) abortion procedure.
c. Organized meetings and seminars on the incidents and consequences of unsafe abortion, the right to utilize RH technology for a safer abortion care, and the legal circumstances for which induced abortion is permitted.
2. Making alliances with different organization/institution such as medical professionals (Persatuan Obstetri Ginekologi Indonesia/POGI, Ikatan Dokter Indonesia/IDI, Ikatan Bidan Indonesia/IBI), law professionals, government organizations, parliament members, women’s groups/NGOs faith-based organizations, and the media.
3. Research-based data collection (safe abortion services based on counseling in 9 cities).
a. Clinic/Hospital-Based research.
Objective: legal and regulatory reform on safe abortion services based onfacts findings: women’s need and feelings about access to safe abortion services and women’s decision-making through counseling to prevent repeated abortion.
b. Research areas are 9 cities which are Medan, Batam, Bandung, DKI Jakarta, Surabaya, Bali, Lombok, Yogyakarta and Manado in 9 provinces, implemented by local counterparts on voluntary basis.
c. Sample: a minimum total of 1000 respondents.
d. Duration: January-December 2002
e. Criteria of women’s in need :
(1) women with less than 12 weeks ‘suspect’ pregnancy period.
(2) women visit the appointed health facilities/clinic.
(3) women reveal physical as well as psycho-social indications.
(4) pre and post counseling are appropriately given and received.
(5) women give consent to registered/trained/qualified doctors who are engaged in the study.
f. Variables (data) collected.
(1) demographic: age, education, occupation, religious, marital status.
(2) psycho-social status: psychological and social reasons for abortion and family socio-economic status.
(3) physical status: medical history, pregnancy and birth history (including previous abortion history).
g. Success Measures (quality improvement).
(1) counseling: complete or incomplete (pre and post abortion procedure).
(2) medical services.
• comprehensive= both doctor and counselor fill in the medical record completely and client’s satisfaction is scored positive.
• complete= medical record is complete but client’s satisfaction is scored negative.
• incomplete= if doctor or counselor does not fill in list of indications completely.
(3) facilities.
• equipments and protocols are used properly.
• informed consent and request forms are signed by clients on voluntary condition.
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