Prof biranabortion in indonesia

ABORTION IN INDONESIAABORTION IN INDONESIA

Biran Affandi

Klinik Raden SalehDepartment of Obstetrics and Gynecology

Faculty of Medicine , University of Indonesia/Ci M k G l H i lCipto Mangunkusumo General Hospital

Jakarta

Affandi B. Abortion in Indonesia . National Conference on Women’s Mental Health , Department of Psychiatry‐Faculty  of Medicine,Airlangga University / Dr. Soetomo General Hospital , Surabaya 26‐27 Nov. 2011 

Objectives:Objectives:1.To overview abortion in1.To overview abortion in Indonesia

2.To review problems of  unsafe b dabortion in Indonesia

3 T di ibl l ti3.To discuss possible solutions

Affandi B. Abortion in Indonesia . National Conference on Women’s Mental Health , Department of Psychiatry‐Faculty  of Medicine,Airlangga University / Dr. Soetomo General Hospital , Surabaya 26‐27 Nov. 2011

G tt h I tit t I B i f S i N 2 2008Guttmacher Institute . In Brief Series No. 2 , 2008

ABORTION in INDONESIA (I)

MMR : 220 PER 100 000MMR : 220 PER 100 000 (SDKI 2010)(SDKI 2010)MMR : 220 PER 100,000MMR : 220 PER 100,000 (SDKI, 2010)(SDKI, 2010)-- THE HIGHEST IN ASEANTHE HIGHEST IN ASEAN

10 10 -- 30 % MATERNAL DEATHS30 % MATERNAL DEATHS-- ABORTION RELATED ABORTION RELATED (WHO,2004)(WHO,2004)

NO DATA ON ABORTION DEATHNO DATA ON ABORTION DEATH(MOH 2005)(MOH 2005)(MOH,2005)(MOH,2005)

ABORTION in INDONESIA (II)( )MWRA: 52 MMWRA: 52 M(BKKBN,2010)(BKKBN,2010)

CONTRACEPTIVE PREVALENCE: 60% (30 M)CONTRACEPTIVE PREVALENCE: 60% (30 M)CONTRACEPTIVE FAILURE: 4CONTRACEPTIVE FAILURE: 4--5%5%

1.21.2 -- 1.5 M PREGNANCIES1.5 M PREGNANCIES1.2 1.2 1.5 M PREGNANCIES1.5 M PREGNANCIES60% 60% INDUCED ABORTIONINDUCED ABORTION

0.72 0.72 –– 0.90 M ABORTION 0.90 M ABORTION

Affandi B.  Unsafe Abortion : Indonesian Experience . 1st International Congress on Women Health & Unsafe Abortion , Bangkok , Thailand , 20‐23 January 2010

ABORTION in INDONESIA (III)

UNMET NEEDS : 9 %UNMET NEEDS : 9 %UNMET NEEDS : 9 %UNMET NEEDS : 9 %-- 4.6 M MWRA 4.6 M MWRA 60% Pregnant60% Pregnant

2.7 M2.7 M PREGNANCIESPREGNANCIES30% INDUCED ABORTION30% INDUCED ABORTION30% INDUCED ABORTION30% INDUCED ABORTION

0.81 M ABORTION 0.81 M ABORTION

ABORTION in INDONESIA (IV)ADOLESCENT GIRLS (10ADOLESCENT GIRLS (10--19 years):19 years):

46 M46 M (BKKBN 2010)(BKKBN 2010)46 M46 M (BKKBN, 2010)(BKKBN, 2010)1010--50% Sexually Active50% Sexually Active

ADOLESCENT PREGNANCIES ?ADOLESCENT PREGNANCIES ?60% x 10% x 46 M = 2 76 M60% x 10% x 46 M = 2 76 M60% x 10% x 46 M = 2.76 M60% x 10% x 46 M = 2.76 M

ABORTION (?)ABORTION (?)( )( )60% x 2.76 M = 1.7 M60% x 2.76 M = 1.7 M

ABORTION IN INDONESIAABORTION IN INDONESIAABORTION IN INDONESIAABORTION IN INDONESIA

SPONTAN : 15 - 20% x 5 Million pregnancies= 750,000 – 1000,000

I d d 0 7 + 0 81 + 1 7 M 3 21 MInduced : 0.7 + 0.81 + 1.7 M = 3.21 M

Guttmacher Institute . In Brief Series No. 2 , 2008

ABORTION METHODSABORTION METHODSABORTION METHODSABORTION METHODS

METHOD CLINICIAN TRADITION/SEF VACUUM ASP 91% - VACUUM ASP. D/C PG/INJECT.

91% 30% 4%

- - - MEDICINE

HERBS MASSAGE

- - -

8%

33% 79% OTHERS

- 79%

17%

Affandi B.  Unsafe Abortion : Indonesian Experience . 1st International Congress on Women Health & Unsafe Abortion , Bangkok , Thailand , 20‐23 January 2010

ABORTION IN INDONESIAABORTION IN INDONESIA20082008

ABORTION BY URBAN RURAL

Rich Poor Rich Poor

Doctor Mid if

57 16

24 28

26 26

13 18 Midwifw

Traditional Self

16 19 18

28 25 24

26 31 17

18 47 22

Affandi B.  Unsafe Abortion : Indonesian Experience . 1st International Congress on Women Health & Unsafe Abortion , Bangkok , Thailand , 20‐23 January 2010

UNSAFE ABORTIONSUNSAFE ABORTIONSUNSAFE ABORTIONSUNSAFE ABORTIONS

- OUTSIDE HEALTH CARE SYSTEM- UNSKILLED PROVIDERS

UNSANITARY CONDITIONS- UNSANITARY CONDITIONS- 95% DEVELOPING COUNTRIES

→ 0.5 M DEATH

Affandi B.  Unsafe Abortion : Indonesian Experience . 1st International Congress on Women Health & Unsafe Abortion , Bangkok , Thailand , 20‐23 January 2010

Unsafe abortion leads to an unknown number of complications and deathsR i f b i i d• Recent estimates of abortion associated mortality in Indonesia are unavailable. 

• WHO estimates that unsafe abortion is responsible for 14% of maternal deaths inresponsible for 14% of maternal deaths in Southeast Asia, and 16% of maternal deaths in regions of Southeast Asia that have highlyin regions of Southeast Asia that have highly restrictive abortion laws (including d )Indonesia) Guttmacher Institute . In Brief Series No. 2 , 2008

Unsafe abortion: the preventable pandemic(1)• Every year, about 19–20 million abortions are done by individuals without the requisite skills, or in environments below minimum medical standards, or both. 

• Nearly all unsafe abortions (97%) are in developing countries. An estimated 68 000 women die as a result, and millions more have complications, many permanent. Important causes of death include haemorrhage, infection, and poisoning. 

Grimes et al Unsafe abortion: the preventable pandemic The Lancet Sexual and Reproductive Health Series October 2006.Grimes et al. Unsafe abortion: the preventable pandemic. The Lancet Sexual and Reproductive Health Series, October 2006.

Unsafe abortion: the preventable pandemic(2)

• Legalisation of abortion on request is a necessary but insufficient step toward improving women’sbut insufficient step toward improving women s health; in some countries, such as India, where abortion has been legal for decades access toabortion has been legal for decades, access to competent care remains restricted because of other barriersother barriers. 

• Access to safe abortion improves women’s health, d i d d i i d iand vice versa, as documented in Romania during 

the regime of President Nicolae Ceausescu. Grimes et al. Unsafe abortion: the preventable pandemic. The Lancet Sexual and Reproductive Health Series, October 2006.

Unsafe abortion: the preventable pandemic(3)

• The availability of modern contraception can reduce but never eliminate the need for abortion. 

• Direct costs of treating abortion• Direct costs of treating abortion complications burden impoverished health care systems, and indirect costs also drain struggling economies.

Grimes et al. Unsafe abortion: the preventable pandemic. The Lancet Sexual and Reproductive Health Series, October 2006

Unsafe abortion: the preventable pandemic(4)Unsafe abortion: the preventable pandemic(4)

• The development of manual vacuum aspiration to empty the uterus, and the use of misoprostol have improved theuse of misoprostol, have improved the care of women. 

• Access to safe, legal abortion is a fundamental right of womenfundamental right of women, irrespective of where they live. 

Grimes et al Unsafe abortion: the preventable pandemic The Lancet Sexual and Reproductive Health Series October 2006Grimes et al. Unsafe abortion: the preventable pandemic. The Lancet Sexual and Reproductive Health Series, October 2006.

The underlying causes ofThe underlying causes of morbidity and mortality frommorbidity and mortality from unsafe abortion today are not blood loss and infection but, rather, apathy and disdain t dtoward women

Grimes et al. Unsafe abortion: the preventable pandemic. The Lancet Sexual and Reproductive Health Series, October 2006.

Areas for action 1. Provide comprehensive sexual and 

reproductive health servicesreproductive health services 

Once legal or available, abortion and menstrual regulation services need to be provided as part of a quality assured sexual p p q yand reproductive health package. Safe abortion services are an essential part of theabortion services are an essential part of the service package needed to reach targets for universal access to reproductive healthuniversal access to reproductive health. 

Realising Rights  (2009) . Factsheet #2 Combating  unsafe abortion is key to improving maternal health.

2. Make the links between unsafe abortion and maternal health There is a tendency to separate the issueThere is a tendency to separate the issue 

of unsafe abortion from maternal health li d d b t d t liti lpolicy and debate due to political 

sensitivities. The de‐linking of the two issues ignores the evidence that many women undergoing unsafe abortion are already g g ymothers whose health is then seriously at risk.risk. 

3.Make the economic argument for gaccess to safe abortion services Th t f t ti li tiThe costs of treating complications from unsafe abortion are a burden on already fragile health systems in developing countries Contraceptivedeveloping countries. Contraceptive services and safe abortion services are very cost effective. 

4.      Involve menTo overcome familial, 

community and political barriers tocommunity and political barriers to accessing safe abortion services gmen need to be engaged as h i f ’ l dchampions for women’s sexual and reproductive rights. p g

Realising Rights  (2009) . Factsheet #2 Combating  unsafe abortion is key to improving maternal health.