The medical and social aspects of abortion in Indonesia
By Mangku Sitepoe
JAKARTA (JP): The recent discovery in Jakarta of 11 fetuses dumped as mere garbage has grabbed media headlines.
These dead babies were not given a proper burial. In Britain, when a person's dog dies it is buried properly since it was a living creature. Also in Indonesia, when a pet dies it is buried -- not simply dumped.
The fact that these 11 babies were thrown into a garbage disposal site only serves to indicate that the values of life have eroded and that there are some individuals who consider these lifeless fetuses mere things to be thrown away.
These fetuses began to grow and develop in the wombs of their mothers, but since their presence was unwanted they ended up lifeless in a garbage disposal site as a result of an abortion or a menstrual regulation.
In medical terminology, the termination of a pregnancy by ending the life of a fetus is called abortus or an abortion. What is called a proper abortion varies from one country to another.
In Indonesia, an abortion might be allowed if it is carried out before the fetus weighs 500 grams or when the pregnancy is less than 20 weeks. In the Netherlands, an abortion may be conducted before the pregnancy reaches 16 weeks or before the placenta formation is completed. In Britain it is allowed before the fetus is 28 weeks old.
There are two types of abortion: abortus spontaneous (a spontaneous abortion), which occurs from natural causes, and abortus provocatus, which is a deliberate abortion.
The latter type is again divided into two subtypes: abortus medisinalis, an abortion in the context of professional medical action, and abortus kriminalis, an abortion conducted in violation of the prevailing laws.
As abortion means not only the termination of pregnancy but also the termination of life, abortus provocatus can also be categorized as the murder of a fetus, or foeticide.
If during an abortion the fetus concerned is still alive outside the womb before its life is finally terminated, this is called infanticide.
This explains why a Dec. 3 report in Kompas saying that the case involving the 11 lifeless fetuses is infanticide may not be correct.
To determine whether a case of abortus provocatus is infanticide or foeticide, a floating test of the lungs must be conducted. This test has not been conducted in the case of the 11 dead fetuses.
Who can perform an abortion?
Doctors, paramedics, traditional midwives and the conceiving mothers themselves are all able to bring about an abortion through different methods, including using certain medicines, conducting an operation or through a massage.
Before taking up their profession, doctors are required to recite the doctor's oath which reads, among other things: "I will respect human life from its conception".
Fertilization takes place when a sperm cell meets an ovum. Biologically speaking, these two sex cells are classified as the cells of living creatures.
Viewed from the oath said by a doctor, abortus provocatus is categorized as foeticide. Therefore, abortion is now allowed.
As for abortus medisinalis, this is a medical act which also terminates the life of a fetus. This type of abortion is conducted only by a doctor or it would be termed abortus kriminalis. In countries where abortion is prohibited, all kinds of deliberate abortion are categorized as against the law.
Of the world's five most densely populated countries, Indonesia, unlike China, India, Russia and the United States, still prohibits abortion.
In Indonesia's legal code, two laws are related to abortion: the Criminal Code and Law No. 23/1992 on the principles of health affairs.
Article 346 of the Criminal Code prohibits abortion. It stipulates that a woman who deliberately aborts or terminates her pregnancy, or has another person to 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 an act of terminating life (killing the fetus), resulting from an act of fertilization, is prohibited.
This means that all cases of abortus provocatus, whether medisinalis or kriminalis, are categorized as acts in violation of the law.
A doctor's oath is in tune with the criminal code -- it is against any termination of life.
Admittedly, since abortus medisinalis is prohibited, many women go to traditional midwives or irresponsible persons to have an abortion. The result is that many pregnant women are victimized.
What about abortion related to pregnancy resulting from a rape case, a failure in family planning or a threat to the life of the mother?
According to Indonesian law, abortion in the above cases would also be deemed in violation of the law. It seems, therefore, that a humanitarian act might contradict the law.
It appears that Law No. 23/1992 on the principles of health affairs goes toward permitting abortion practices by qualified medical personnel. Article 15 of the law reads: "In an emergency, as an effort to save the life of a conceiving woman and/or the fetus, a particular medical act may be performed".
By virtue of this article, practices of abortus medisinalis may be performed. A panel of experts must decide whether an abortion may be performed in cases of pregnancy resulting from a rape. This would also be the case if a mother contracts a disease which may endanger her and the fetus' lives during labor or may harm the baby being conceived.
In short, this article allows an abortion to be carried out in an attempt to save the mother and her baby.
The legalization of abortion may lead to an increasing number of abortion cases, whether for medical or other (social and economic) reasons.
Should restriction not be imposed, the number of irresponsible and unqualified people performing abortions would likewise increase. Cases of foeticide and infanticide would rapidly rise in number, as has reportedly been the case in China and India.
"Being female becomes a risk to life", said Shree Venkatram in the Dec. 1995 issue of the magazine Development and Cooperation when commenting on the impact of abortion legalization in India.
In the case of Indonesia, there are unwanted pregnancies which lead to abortus kriminalis. In some states in India, there are many cases of infanticide when births are undesired. A baby is sometimes killed the moment it is born and known to be female, since male babies are more desirable.
A survey on births of female babies has been conducted in the state of Bihar. The survey reveals that most mothers think that it is better to kill their female babies as early as possible after they are born rather than letting them live and suffer all their lives later on.
Indian mothers prefer giving birth to male babies because sons can protect them in their old age. Sons also control, for the most part, the inheritance left by their fathers.
In India, 70 percent of women marry before they are 17 years old. These women become pregnant at a tender age and often resort to abortion. Abortion is often seen as an option if it is known that the fetus is female. It is estimated that 600,000 to 800,000 cases of abortion occur in India every year.
In India, abortion is permitted if the pregnancy has not passed 20 weeks. In the Haryana and Punjab states, pregnant mothers flock to obstetricians that possess ultrasonographer equipment to find out the sex of the fetus they are conceiving. Amniocentesis, a test of the embryo liquid to find out the sex of the fetus, is also a popular test among pregnant women.
With the help of an ultrasonographer, the sex of the fetus in the womb is detectable when a pregnancy reaches four weeks old. This means that a conceiving woman still has four weeks before deciding on a foeticide.
As a result of foeticide, in 55 districts in the states of Haryana, Uttar Pradesh, Rajasthan, Madya Pradesh and Bihar the ratio between boys and girls is 100:80.
The initial practice of embryo transfer in veterinary medicine was marked in 1963. Two decades later, the first test tube baby saw the light of day.
The embryo-transfer technique is similar to the abortion technique: the outcome of fertilization in the uterus of the mother animal is taken out. In the case of a cow, an irrigation is made into the uterus of the mother cow. In an embryo transfer, the main objective is to obtain a living embryo -- which is basically an abortion without life termination.
The embryo obtained from the donor mother animal is then conserved before it is later "implanted" into another female animal which serves as the recipient mother.
In the case of humans, both the donor mother, whose embryo is taken out, and the recipient woman who wishes to have a child (also known as a "surrogate mother") must be well prepared. If the transfer runs smoothly, the result is called an "early adoption".
Reproduction science has made such strides that the world was astounded when it was announced that the cloning of a sheep, a lamb called Dolly, was now a fact of life.
Cloning is something similar to abortion. However, the cloning of a human being is rejected by all parties.
The writer is both a physician and veterinary doctor.