Number of abortions performed last year 'astonishing'

JAKARTA (JP): Abortion is strictly prohibited under both the Criminal Code and the Health Law. But despite the legislation, women continue to seek abortions.

The latest study by the Indonesian Society of Obstetrics and Gynecology (POGI), the World Health Organization and the Ministry of Health revealed there were an estimated 2.3 million abortions performed each year in Indonesia.

The study -- which was conducted from January to December last year and involved 579 respondents in North Sumatra, Jakarta, Yogyakarta and North Sulawesi -- estimated that out of the 2.3 million abortions, 600,000 were unwanted pregnancies due to contraceptive failure, 700,000 of the abortions were sought due to poor economic conditions and one million were spontaneous abortions (miscarriages).

"The number is astonishing since abortion is illegal here. But it does not mean we can just close our eyes that the problem of unwanted pregnancy exists," POGI president Biran Affandi told The Jakarta Post.

Of the 579 respondents surveyed, 93.3 percent accepted their pregnancies, while the remaining 6.7 percent considered their pregnancies unwanted.

The study revealed there were various reasons for seeking abortions to end unwanted pregnancies. Already having "enough" children topped the list, with 47.1 percent of respondents giving this answer. The desire to continue school was the second most common reason at 17.2 percent. It was followed by medical reasons (15.7 percent), work (6.8 percent), being on medication prior to the pregnancy (2.9 percent) and others (10 percent).

Some women facing unwanted pregnancies risk their lives trying to perform an abortion by themselves, either by taking certain herbs or drugs, having themselves massaged and consuming certain fruits which supposedly kill the fetus.

Biran said the findings of the study, which were unveiled to the public during the 19th GOI/NGOs/donor agencies coordination meeting on Thursday, reflected the general picture of abortion in the country.

"In the study, we're trying to explore the underlying factors and reasons of providers and women who perform induced abortion," he told the meeting's participants.

Other objectives of the study were to identify the socio- reproductive and demographic characteristics of women performing induced abortions, to examine various social and health implications of induced abortions and to assess the opinions and perceptions of various people.

Unsafe abortions

Unsafe abortions might result in serious infection, and is among various factors contributing to the maternal mortality rate.

Indonesia's maternal mortality rate of 375 per 100,000 births is the highest among member countries of the Association of Southeast Asian Nations (ASEAN).

According to WHO representative to Indonesia Georg Petersen, the lifetime risk of maternal death is 40 times higher in developing countries.

"Looking at the reproductive health indicators in Indonesia, it is rated worse than other ASEAN countries. Although deaths among infants and children have significantly come down over the past 10 years, the maternal death rate shows slow progress in spite of the tremendous efforts made by the government of Indonesia to reduce maternal deaths. Obviously, this has been a great concern," Georg said.

He said there was no single explanation for the high rate of maternal deaths and there were numerous factors involved, including women's lack of ability to control sexual relations and contraceptive use, sexual coercion, incest or rape, contraceptive failure, inadequate access to family planning information and services and a lack of understanding of reproductive health.

WHO has said that globally, 75 million unwanted pregnancies occur each year, and approximately 45 million unwanted pregnancies are terminated. Twenty million of these abortions -- 55,000 each day -- are unsafe, resulting in the death of more than 200 women each day in developing countries.

Despite the lack of data on the extent of morbidity and mortality due to unsafe abortions in Indonesia, WHO estimates 13 percent to 15 percent of maternal mortalities are due to septic abortions.

"This (percentage) could be higher in reality. In some parts of the world, as many as one-third or more of all maternal deaths are associated with unsafe abortions. The fact that so many women risk death, injury, social or criminal consequences to terminate a pregnancy clearly shows how desperately these women wish to delay or avoid having children. The challenge is how to overcome the worst problem and what changes are needed to overcome these obstacles," Georg said.

Family planning

The high number of abortions resulting from contraceptive failure also attracted serious attention at the meeting, titled Magnitude of Abortion-Related Problems and Their Impact on Maternal Mortality and Morbidity.

According to the Ministry of Health's director general of community health, Azrul Azwar, contraceptive failure is always possible because no contraceptive devices are 100 percent safe.

"Family Planning now has around 23 million members and with only 1 percent (contraceptive) failure, we'll have many unwanted pregnancies. If we can't prevent it from happening, what are we going to do about it? We cannot simply ignore it. That's why PKBI (the Indonesian Planned Parenthood Association) provides services for those who face contraceptive failure, so they can get good health services," Azrul told the Post.

PKBI now has around 80 clinics across the country, with the oldest one, which was established in 1981, located in Semarang, Central Java.

The association's chairman in Central Java, Untung Praptohardjo, said at the meeting that out of 1,444 married couples and family planning members who sought abortion consultancy at the clinic, 1,142 of them had abortions.

"The remaining (302) had second thoughts about having the procedure," he said.

Out of the 1,142 women who had an abortion, 369 of the women, or 32.3 percent, were between 36 and 40 years of age, and 41.8 percent of the women, or 477, already had two children.

Prior to the abortions, 341 couples, or 29.9 percent, used pills as their contraceptive method, 221, or 19.4 percent, used condoms, and 189, or 16.5 percent, used injection. After the abortions, most of the couples were told to continue using contraceptives, and 555 of the couples, or 48.6 percent, opted to use implants.

"But it won't be easy to perform abortions since the couples have to meet many requirements," Untung said.

Among the requirements are possession of identification cards, official marriage certificates, family planning member card and signed consent form. The couples also have to pass through the administrative process and undergo medical examinations and counseling.

These strict procedures are required because abortions are strictly prohibited.

Article 346 of the Criminal Code states that a woman who deliberately aborts or terminates her pregnancy, or has another person do so, shall be subject to a maximum of four years in prison. Articles 347, 348 and 349 of the Criminal Code link abortion and the medical profession. All of these articles stipulate that the act of terminating a life (aborting a fetus) is prohibited.

Meanwhile, Article 15 of Health Law No. 23/1992 stipulates that a "certain medical act" can be performed under emergency circumstance in an effort to save the life of a pregnant woman and/or her fetus. This "medical act" must be approved by a team of health experts, performed by authorized professional personnel and conducted in medical facilities with the approval of the mother or her family. (ste)