Abortion: A legal issue we cannot ignore

By Rebeka Harsono

YOGYAKARTA (JP): The report that two private clinics in Jakarta have carried out more than 100 abortions has created a public outcry.

Police are collecting more information from employees of the clinics which carried out the abortions and are looking for the women who received the procedure.

Abortions can be classified as having a medical or nonmedical motive. An abortion on medical grounds would probably not incur punishment because it is legal according to the 1992 Health Law No. 23.

However, if an abortion is carried out for nonmedical reasons, the procedure is illegal and considered amoral. In many of these instances, women who have become pregnant out of wedlock seek abortions to avoid social stigmatization. In other cases, married women terminate their pregnancy if the child is simply unwanted.

Abortions sought for both medical and nonmedical reasons have often ended in death for the mother. LIPI reported in 1994 that during the period from 1980 to 1988, abortions contributed to the high mortality rate of mothers. Out of every 100,000 pregnancies, 450 women died from childbearing or abortion procedures.

This is cause for great concern because the number is close to half of the deaths among mothers nationwide.

The recent controversial abortion cases may create the momentum needed to legalize abortions for nonmedical reasons.

The motives behind abortions cannot always be considered amoral. But whether for amoral reasons or not, abortions take place illegally in Indonesia and the health risks for the women are high.

Research by Made Heny Urmila Dewi on 75 health officers in Bali revealed that 78 percent of the respondents recommended the legalization of abortion in certain cases to ensure the availability of safe medical services and to provide legal protection to medical officers.

These medical officers' opinions should be seriously considered because they believed that abortion was wrong but have reconsidered its legality. They found it alarming that many women, faced with the fact that professional medical clinics could not legally perform the procedure, took the risk of having an unprofessional practitioner carry out their abortion.

With a majority being Hindu, 59 percent of the respondents claimed they believed abortion for nonmedical reasons was a sin. The remaining 41 percent thought abortion was justified in special socio-economic circumstances such as in cases of poor married couples with too many children, unfaithfulness and family planning.

But, of the 44 persons who disagreed to such abortions, 72 percent did not think they would refuse to recommend an abortion and only 28 percent would advise to maintain the pregnancy.

The group's doctors had an even more flexible attitude: 58 percent said they would be willing to carry out an abortion for nonmedical reasons. Of the paramedics and midwives, only 29 percent said they would perform abortions. But they said abortions should be carried out only if the pregnancy was not more than four weeks old and they could perform a menstrual regulation, an abortion using a sucking method. If the pregnancy was more than four weeks old, they would refer the patient to a more sophisticated hospital in the Balinese capital of Denpasar.

Other medical officials tended to assume an ambiguous attitude. They would advise a pregnant woman give birth to the baby and get married if the pregnancy occurred outside of wedlock. But in cases where the woman demanded an abortion, the medical officers indicated they would perform the abortion or provide a referral.

Paramedics and midwives emphasized that abortions should be viewed in a case by case basis. Economic reasons due to a family's financial income or cases in which the man did not wish to take responsibility for the child were seen as difficult circumstances for a pregnant woman to face.

Many doctors admitted that they disagreed in principle to abortions but their opinions changed after many women experiencing crises came to them to ask for help. For example, one doctor could not turn away a woman who had tried to abort her pregnancy by using a cassava stalk resulting in heavy bleeding and a life-threatening situation.

F.A. Moeloek, a reputed gynecologist, said that the demand for abortions for social, economic and psychological reasons was increasing. This was due to better educational opportunities for women -- bringing about changes in their roles in society -- and the less restrictive socialization among young persons. These have been factors influencing women to want less children.

Failures in birth control and rape cases are also instances in which legal abortions can be carried out according to family planning counselors. The national family planning coordinating board (BKKBN) goes as far as paying for abortion costs for families who fail in birth control.

Traditional midwives and family planning counselors think that the fear of social humiliation and ostracism often pushes the parents of a daughter who is pregnant out of wedlock to pay any sum for an abortion.

Even families who strongly hold to religious values may resort to abortion if faced with the disaster of a daughter's pregnancy outside of wedlock.

It is clear that abortion is a reality in our society and it cannot be denied that it takes place as a result of poverty, disdain for women, saving a family's reputation and family planning.

Therefore it would not be wise if we stuck inflexibly by moral reasons to keep abortion illegal while many women in crisis continue to die. Abortions are the cause for nearly half of mothers' deaths nationwide. Death caused by unsafe medical services need not happen if abortions for nonmedical reasons were legalized.

The September 1992 health law is ambiguous concerning the legality of abortions in certain cases. According to a report by LIPI, the term "abortion" is never used in the law. It is instead referred to as "a certain medical act". This shows how sensitive the abortion issue is in discussions within the House of Representatives.

Article 15 of Law No. 23/1992 stipulates that in an emergency, a "certain medical act" could be performed during efforts to save the life of a pregnant woman and/or her fetus. However, this "medical act" must be justified medically by a team of health experts, be performed by authorized professional personnel, and have the mother's or family's approval.

The law does not explicitly mention abortion as a legal method, so it does not differ much from the previous Law No. 9/1960.

The phrase "a certain medical act" indicates the possibility of a method other than abortion. Although the health minister refers to Law No. 23/1992 as the legal basis for medically needed abortions, the medical community is worried over the law's ambiguity.

Medical officers who have been performing the menstrual regulation method since the 1980s for medically called-for abortions are still demanding a unambiguous law that can protect them.

This is urgent. Otherwise, there will be an increasing number of clinics that take advantage of women facing crises by demanding exorbitant fees.

It cannot be denied that such a law would become the last stronghold to stem moral degradation -- hence the importance of the law. Custom and social values need to be emphasized, but people faced with desperate circumstances tend to commit the act all the same.

The function of the law would not seek to control Indonesians' sexual behavior. Legally married couples have the right to decide on the number of their children. But when a man does not want to take responsibility for his actions, a girl or a woman, whether she likes it or not, often feels forced to seek an abortion.

Deviant behavior and immoral acts happen all the time, whether there is an abortion law or not. Therefore, the legalization of abortion is not the only factor that can increase the number of abortions or inversely prevent them. The facts show the contrary.

The number of abortions are influenced by many factors. Are we really doing all we can to prevent these causes? For example, is our society seriously trying to curb the circulation of pornographic films, and the showing of big screen and television films which make irresponsible sex look socially acceptable?

Modern society has turned women into sex objects. We must change how our society views sex through more responsible social models and methods of sex education.

We need to hold a dialog on sexuality between men and women in an effort to change the perception that women are subordinate.

An agreement to legalize abortion would not be simple. It is not easy to come to a universal conclusion on the concept of a baby's life -- especially on the priority for the safety of the mother or the child, or even the acceptable methods to be used.

However, the essence and the objective of such a law are the same -- it would be a reply to the community's problems. The law should not make normative stipulations only. The morality of the law would reside in the extent to which it is in accordance with the realities of the community's problems.

A problem needs to be prevented but a problem also needs to be settled. That would be the function of the law.

The writer is a graduate of Gadjah Mada University's School of Political Science, Yogyakarta. She is an observer of women's issues.