Unsafe abortion is a significant public health issue in Indonesia. An estimated 3.21 million abortions occur annually in Indonesia, the majority of which are unsafe. Unsafe abortions are performed outside of health care facilities by unskilled providers and in unsanitary conditions, leading to complications and an unknown number of deaths each year. Expanding access to contraception and safe abortion services performed by skilled clinicians is necessary to reduce the health risks of unsafe abortion in Indonesia.
1. ABORTION IN INDONESIAABORTION IN INDONESIA
Biran Affandi
Klinik Raden Saleh
Department 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
2. 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
3. G tt h I tit t I B i f S i N 2 2008Guttmacher Institute . In Brief Series No. 2 , 2008
4. 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
1010 -- 30 % MATERNAL DEATHS30 % MATERNAL DEATHS
-- ABORTION RELATEDABORTION RELATED (WHO,2004)(WHO,2004)
NO DATA ON ABORTION DEATHNO DATA ON ABORTION DEATH
(MOH 2005)(MOH 2005)(MOH,2005)(MOH,2005)
5. 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 PREGNANCIES1.21.2 1.5 M PREGNANCIES1.5 M PREGNANCIES
60%60% INDUCED ABORTIONINDUCED ABORTION
0.720.72 –– 0.90 M ABORTION0.90 M ABORTION
Affandi B. Unsafe Abortion : Indonesian Experience . 1st International Congress on Women Health & Unsafe Abortion , Bangkok , Thailand , 20‐23 January 2010
6. ABORTION in INDONESIA (III)
UNMET NEEDS : 9 %UNMET NEEDS : 9 %UNMET NEEDS : 9 %UNMET NEEDS : 9 %
-- 4.6 M MWRA4.6 M MWRA 60% Pregnant60% Pregnant
2.7 M2.7 M PREGNANCIESPREGNANCIES
30% INDUCED ABORTION30% INDUCED ABORTION30% INDUCED ABORTION30% INDUCED ABORTION
0.81 M ABORTION0.81 M ABORTION
7. 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
8. 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
10. 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
11. ABORTION IN INDONESIAABORTION IN INDONESIA
20082008
ABORTION BY
URBAN RURAL
Rich Poor Rich Poor
Doctor
Mid if
57
16
24
28
26
26
13
18Midwifw
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
12. 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
13. Unsafe abortion leads to an unknown
number of complications and deaths
R 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
15. 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.
17. 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.
18. 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.
19. 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 y
and 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.
20. 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 y
mothers whose health is then seriously at
risk.risk.
21. 3.Make the economic argument for g
access 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.
22. 4. Involve men
To overcome familial,
community and political barriers tocommunity and political barriers to
accessing safe abortion services g
men 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.