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  • Title: Induced abortion in Indonesia.
    Author: Hull TH, Sarwono SW, Widyantoro N.
    Journal: Stud Fam Plann; 1993; 24(4):241-51. PubMed ID: 8212094.
    Abstract:
    Induced abortion is one of the most difficult sociomedical problems facing the Indonesian government. While well-known in traditional society, the practice was discouraged by all Indonesian religious groups, and forbidden by the Dutch colonial authorities. Although abortion was technically illegal under the criminal code, a judicial interpretation in the early 1970s permitted medical professionals to offer the procedure so long as they were discreet and careful. The numbers of medical abortions carried out in Indonesia rose dramatically, and there was evidence of matching declines in the incidence of morbidity and mortality caused by dangerous illegal procedures. Medical and community groups campaigned for a more liberal abortion law to protect legal practitioners and stamp out illegal traditional practices. Their efforts appeared to bear fruit in the draft Health Law, but when the law was passed by the legislature in late 1992, the issue was again clouded by contradictions and inconsistencies. This review of induced abortion services provides insights into the historical development of services and the ambivalent position of the law towards abortion in Indonesia. There is and had been a demand for abortion services. Abortion is performed with the approval of government, and religious (Muslim), and community leaders. A strong regulatory code is set by professional associations. The Health Law passed in late 1992 was intended to protect legal practitioners but instead created ambiguities by forbidding abortion when in violation of legal, religious, and ethical norms and 2) permitting the medical procedure by trained physicians for the purpose of saving the life of a pregnant woman or the fetus. The law does not clarify the mechanism for resolving situations when norms are inconsistent or in conflict. Pregnancy services are offered by traditional practitioners (illegal provider), midwives and nurse-midwives (illegal provider), general practitioners and physician specialist (usually illegal providers), and obstetricians and gynecologists. Demand for abortion services has grown due to the pressure to delay marriage, the restriction to 2 children, the desire for small families, and the increase in unwanted pregnancy among the unmarried. Traditional methods of abortion include "pijat" or kneading and punching of the abdomen by traditional birth attendants or healers, "jamu" or herbal remedies which are ingested, and "jamu sticks" which are inserted into the vagina and cervix. Physicians use dilation and curettage, menstrual regulation, vacuum curettage (the mostly widely used method), saline injections, and prostaglandin suppositories. Ru486 is under consideration only and has not yet been accepted or used. There were an estimated 750,000 to 1 million abortions performed per year or a ratio of 16.7-22.2 abortions/100 live births in 1989. The consequences of induced abortion determined by practitioners in Indonesia are physical effects (bleeding, infection, cervical damage, and mortality) and psychological effects. There are undesirable effects from illegal abortion, and, without clear reform. the issue will become political and the demand for abortion will increase. The medical professional associations, voluntary family planning groups, and women's groups are pressing for reform, but the government is fearful and not responding.
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