Commentary on menstruai regulation as a health service: challenges in Indonesia

Abstract

In the 1800s Indonesia enacted laws forbidding the performance of abortions. These laws are still in force. Furthermore the Criminal Law of Netherlands Indies of 1918 makes induced abortion a criminal act. In 1973 the teaching hospital of the University of Indonesia began a menstrual regulation project. Qualified physicians can perform menstrual regulation. Despite changes in legal attitudes peoples attitudes do not change as fast. Many do not want to receive this new health service. Information from the 1970s on the frequency of abortions in hospitals and maternity clinics/hospitals in metropolitan Jakarta is cited. One of the larger studies is of 18 hospitals (85.7% of all hospitals in metropolitan Jakarta) and 22 maternity clinics or maternity hospitals in metropolitan Jakarta during 1972-75. Abortions rose while births remained constant. Estimations indicate that perhaps 25-60% of such abortions are induced. Research at the Dr. Cipto Mangunkusumo Hospital Jakarta using randomized response found premeditated abortion among 32.7% of the women admitted for all abortion types. A study of 1187 pregnant women who come to the Center for Maternal and Child Welfare in Surabaya found that the number of unwanted pregnancies rose with the number of living children. Several factors contribute to the high numbers of illegal abortion in Indonesia. These include the fact that abortion is not acceptable to many for religious or cultural reasons. Also many girls marry at too young an age or become sexually active before marriage. Health providers discourage women who seek help for unwanted pregnancies. Society regards abortion as taboo. Professional health services within easy financial reach should be provided. It should have clear legal standing. The procedure should be performed at an early gestational age. (Within 14 days after a missed period or at most within the 1st trimester.) Women must have information about this.