Why Indonesia should legalize abortion
Shela Putri Sundawa
The Jakarta Post
The government has issued a new regulation on abortion, Regulation No. 61/2014, based on the 2009 Health Law. In terms of content, the new regulation on abortion contains no new policy. Abortion in Indonesia remains prohibited in most cases, unless the mother's life is in danger or in the case of rape.
Restrictions on abortion in Indonesia mean that institutional safe abortions are impossible to access. If the safe way is restricted, the only choice is unsafe abortions.
The World Health Organization (WHO) defines unsafe abortion as a procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both. Southeast Asia has the highest rate of women aged 15-44 who undergo unsafe abortions, at 26 per 1,000 women.
In Indonesia, about 11 to 14 percent of maternal mortality (392 in 100,000 live births) is caused by unsafe abortions. It means there are 43 to 55 women who die due to unsafe abortions per 100,000 live births, while there are about 4.5 million births per year in Indonesia. Other studies estimate 37 abortions in 1,000 women aged 15-49 years. The real number may be higher, as most unsafe abortions are illegal and unrecorded.
According to the WHO, a major cause of abortion is an unmet need of contraception. More than 40 percent of unplanned pregnancies worldwide results from not using contraception and the ineffective use of contraception. In Indonesia, about 760,000 or around 17 percent of all live births are unwanted or unplanned.
There are very limited studies providing information on what happens to these children after they are born; whether they are raised well by their parents with adequate nutrition and stimulation, whether they receive enough care and love during childhood or whether they are simply neglected.
One study from Prague followed the development and mental well-being over 35 years of 220 children born between 1961 and 1963, whose mothers had requested abortions twice, and were twice rejected. In the 1960s, women who wanted to terminate their pregnancy in the former Czechoslovakia needed to secure the permission of a special commission. The subjects from the unwanted pregnancies were studied from the age of 9, and compared to other 220 children born of wanted pregnancies.
The follow-up was conducted among the children at ages 9, 14-16, 21-23, 28-31 and 32-35. At first, children born from unwanted pregnancies had similar birth weights and lengths, the same chance of having congenital abnormalities and similar scores on signs of minimal brain dysfunction compared to the children of wanted pregnancies.
However, as they became older, the study showed that the children of unwanted pregnancies developed more psychosocial problems. They had a higher school dropout rate and, if they stayed in school, obtained lower grades. The male children from unwanted pregnancies were significantly less sociable and more maladjusted compared to other males and when they grew older, they were less satisfied with their jobs and relationships, while their overall mental well-being fared less compared to the boys and men of wanted pregnancies.
The gap was even more significant among females of unwanted pregnancies in terms of unemployment, single status and parenting difficulties. The study, which included some siblings, found that siblings did not exhibit these psychosocial problems. The study concluded that retaining unwanted pregnancies entailed an increased risk of negative psychosocial development and mental well-being in adulthood. The results of this study led in part to the Czech government abolishing abortion commissions in 1986.
The magnitude of the problem of unwanted pregnancies makes it imperative that regulators start to consider the importance of increasing accessibility to legal abortions.
This could be done by broadening the inclusion of allowed abortions in the law. In that way, we could minimize the unsafe abortion rate and so reduce maternal deaths and future mental health problems.
Despite these benefits, legalizing abortion in Indonesia remains a major challenge. Most religions see abortion as a sin, nothing short of attempted murder. Norms and religious strictures may sometimes be the same, but people interact and change.
In the past, religious groups prohibited the use of contraceptives, but look at how we all benefit from them today. Greater economic growth, better levels of human development and so on.
Thus, sociocultural values should never prevent us from trying to access better health care.
The writer is a medical doctor from the University of Indonesia (UI), a health advocate and an independent researcher. She was the Global Cancer Ambassador for Indonesia from the American Cancer Society and a country representative for the UN General Assembly on non-communicable diseases in 2011.
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