On 21st July 2014, Indonesia government release a new regulation on abortion, PP No. 61/2014 which resonance with the previous higher constitution, UU 36/2009 tentang Kesehatan. In Indonesia, some regulation is a restatement of other higher regulation like PP repeats the stances in UU. Thus in term of content, the new PP on abortion contains no new policy. Abortion in Indonesia remains to be prohibited for most causes unless to safe mother’s life or preventing mental illness in rape victims.
Restricted law on abortion in Indonesia leads institutional safe abortion to be impenetrable to access. It leaves women in crossroad of choosing options available to terminate their pregnancy. If the safe one is restricted, the only choice remain is unsafe abortion. 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. Among WHO Asia’ regions, South-Eastern Asia, in which Indonesia included, has the highest rate at 26 per 1000 women aged 15-44 who undergo unsafe abortion.
In Indonesia about 11-14% of maternal mortality (392 in 100,000 live births) is caused by unsafe abortion. It means there is 43-55 women death in 100,000 live births while there are about 4.5 million birth per year in Indonesia. Other studies estimate there are about 37 abortion in 1,000 women aged 15-49 years. Though the real number may exceed this estimation as most of unsafe abortion consider outlaw and become unrecorded, abortion causes (at least) thousands of mother dead each year.
According to WHO, one of the major causes of abortion is unmet need of contraception. There are about over 40% of pregnancies worldwide are unplanned, resulting from non use of contraception and ineffective use of contraception. In Indonesia, about 760,000 or about 17% of all live births is unwanted or unplanned. There are very limited studies provide information on what happen to these kids after they are born, whether they rise well by their parents with adequate nutrition and stimulation, whether they receive enough care and love during childhood or whether they simply neglected.
There was a Prague study regarding this inquiry which followed the development and mental well being over 35 years of 220 children born in 1961-1963 whose mother had been twice rejected to abort the same pregnancy. In 1960s, women who wanted to terminate their pregnancy in Czech should first be agreed by some special commission. In the age of 9 years, children from unwanted pregnancies were paired with other 220 children born from accepted pregnancies. The follow up was conducted among the children at age 9, 14-16, 21-23, 28-31 and 32-35.
At first, children born out of unwanted pregnancies had similar birth weights and lengths, same chance of having congenital abnormalities and similar score on signs of minimal brain dysfunction compared to the accepted pregnancy children. However, as they became older the unaccepted pregnancy children develop more psychosocial problem. They had dropped out of school more and had obtained lower scores in school. The boys of unwanted pregnancy were significantly less sociable and well adjusted than the controls, when they got older they were less satisfied with their jobs, relationship and overall mental well being compared to the control. The gap was more significant between unwanted pregnancy women and control women in term of unemployment, unmarried status and parenting difficulties that required authority attention.
The study also includes siblings of unwanted men and women to minimize the confounding factor and it was found that the siblings did not show these psychosocial problems. The study concluded that retaining unwanted pregnancy entails an increased risk for negative psychosocial development and mental well being in adulthood. The result of this study, in part, turned the Czech government to to abolish
abortion commissions in 1986.
Looking at the magnitude of problem caused by unsafe abortion, it is necessary for regulators to start considering the importance of increase accessibility to legal abortion. This can be done by broadening the inclusion of allowed abortion in constitution. By loosening abortion law, unsafe abortion rate can be minimized and therefore reduce the number of maternal death and future mental health problem.
Despite the benefit, legalising abortion in Indonesia remains to be a major challenge. Most religion see abortion as a sinful conduct, an attempt of murder. Norm and religion remains the same from time to time, but people interact and change. In older time, religious group denied any use of contaception for birth plan but look how we are all benefited from it today. More economic growth, better human development index, and so on. Thus, sociocultural value should never prevent us from accesing better care of medicine