Conflicts inside and out on the legality of abortion

JAKARTA (JP): The recent international conference on population judged that the most feasible way to escape prolonged conflict over the abortion issue is by surrendering the necessary implementation directives to individual countries.

That way, relieved delegates could go home and deal with the problem of abortion in their own way. In reality, however, things may not be as simple as that, as Indonesia has found out for itself.

The Cairo Declaration, adopted at the closing of the International Conference on Population and Development on Sept. 13, states that "Women who have unwanted pregnancies should have ready access to reliable information and compassionate counseling."

It also declares that "any measures or changes related to abortion within the health system can only be determined at the national or local level according to the national legislative process."

"In circumstances in which abortion is not against the law, such abortion should be safe," it continues. "In all cases women should have access to quality services for the management of complications arising from abortion."

Furthermore, it suggests that "post-abortion counseling, education and family planning services should be offered promptly which will also help to avoid repeat abortions."

Finally, it urges that all governments and relevant inter- governmental and non-governmental organizations "to deal with the health impact of unsafe abortion... as a major public health concern and to reduce the recourse to abortion through expanded and improved family planning services."

Though it may sound like the best option, this compromise is not necessarily easy to follow through as many countries, like the Philippines, must contend with conflicting opinions and other internal problems.

Health law

Indonesia is another case in point. Various legal and medical complexities stand in the way of implementing its abortion regulations.

Soon after the Health Law was ratified in 1992, medical and legal experts, as well as woman's right activists, attacked the law for being flimsy and vague on the subject of abortion.

Officials promised that the vagueness would be quickly eliminated with the issuance of more detailed implementation directives, especially Clause 15.

The clause rules that "termination of pregnancy is prohibited for whatever reasons" while "certain medical actions" are possible when the life of the mother and unborn baby are in danger.

Two years have passed but no directives have been issued. In fact, legal and medical experts as well as religious leaders are still engaged in a sharp debate as to how the directives should be formulated.

According to Dr. Suheni Soedjatmiko from the Ministry of Health, members of the team entrusted to prepare the directives are still having difficulties reconciling their views.

"I believe, it is impossible to predict how or when this problem will be solved," she told The Jakarta Post.

Kartono Mohamad, chairman of the Indonesian Planned Parenthood Association, asserts that it is not likely that the directives can be formulated at all.

"There cannot be any implementation of directives regarding abortion because they will definitely go against the Law," said the leader of the non-governmental organization established long before the national family planning program began in the 1970s.

As for the debates, Kartono said he had yet to see an end to them. He charged that the government was too concerned with the reactions of religious groups, mainly Islamic, instead of the welfare of those concerned.

This period of indecision means that effective control of medical procedures is impossible, Suheni indicated.

Rape

Activists, like Sita Aripurnami from the Kalyanamitra foundation, have discovered that their longstanding grievances have not been dealt with.

Two years ago Sita lashed out at the laws and stated that the extremely narrow abortion regulations pose a great opportunity for abuse.

She said pregnant teenagers or rape victims whose "mental or physical well-being are threatened by pregnancy," might resort to illegal, often unsafe, abortion because their rights were not recognized.

Rita S. Kalibonso of the Jakarta Legal Aid Office expressed the same concern for hundreds of raped young women who might find themselves pregnant and unable to seek appropriate medical help.

Another noted lawyer, Nursyahbani Katjasungkana, pointed out, however, that the implementation of directives was not the key issue because the government has adopted a 1960s jurisprudence ruling that abortion is permitted for pregnant mothers whose lives are threatened.

Sita, nonetheless, still has a long list of complaints. She argues that the Health Law is "biased towards large cities," as abortion is only permitted after "the consideration of experts."

Technically, this is a major problem in areas with only one obstetrician, like in Kupang, East Indonesia, she said.

"Who would think of consulting "experts" besides informed, elderly women or their midwives and doctors," she asked.

"I'm for access to safe abortion," said Sita, who terminated her second pregnancy when she realized she had contracted herpes. "But I'm not sure about the legal aspects. It could be even more difficult for women who really need it," she concluded.

Advancement

How the Health Law could possibly keep up with rapid medical advancements is another area of contention.

Obstetricians and gynecologists, for instance, say that the law might not be able to preclude violations committed with sophisticated medical techniques. Such a development could be beyond the government's control.

The termination of pregnancies without surgery is one of the advanced methods. By using a hormonal preparation, in the form of either an injection or vaginal suppository, women can abort their fetuses in one or two days.

Perhaps it is just as well that the Cairo Declaration has stated that "prevention of unwanted pregnancies must always be given the highest priority and all attempts should be made to eliminate the need for abortion." (swe/anr)