According to Bearak (2020), the incidence of unintended pregnancies from 2015 to 2019 reached 121 million per year. This figure shows that 64 unsaved pregnancies are occurring in every 1.000 women aged 15-49 years. In general, when compared to the data of the previous period, the pregnancy rate has not decreased since 1990-1994. With this data, it can be shown that there are 73.3 million abortions annually, which is equivalent to 39 abortions per 1.000 women aged 15-49 years (Bearak: 2020). From this figure, it can also be calculated that three out of ten pregnancies end in abortion (WHO:2021)
Research published in 2014 which examined the maternal mortality rate (MMR) from 2003 to 2012 found that 7.9% of maternal mortality is due to unsafe abortions with an estimated value range from 4.7% – 13.2% Maternal Mortality Ratio (MMR) or equivalent to 193.000 pregnancies (Say: 2014). However, data on the causes of MMR due to unsafe abortion do not describe the actual condition because the problem is not reported due to the law that still prohibits abortion. When abortion is done in accordance with the law, cultural and religious perceptions still hold back the reporting. The leading causes of death from unsafe abortions are bleeding, infection, sepsis, genital trauma, and bowel necrosis (B. Haddad:2019).
There are not many studies that have successfully reported the need for safe abortion in Indonesia, this is due to the positive law that still completely prohibits activities related to abortion. Currently, abortion can only be done with only limited exceptions. There are only two studies that try to show the estimated abortion rate of 1000 women per year in Indonesia. In 2000, based on research conducted in six regions in Indonesia, the estimated abortion was 37 abortions for every 1000 women aged 15-49 years (Guttmacher Institute: 2008), Women who had abortions were on average aged 20-29 years (46%) and married (66%) (Guttmacher Institute: 2008). A recent study in Indonesia found in 2018 the abortion rate on the island of Java was 42.5 abortions per 1000 women aged 15-49 years (Giorgio, M. M, et.al, 2020). This level is higher than the global abortion rate of 39/1000 women (WHO: 2020).
Within the current legal framework in Indonesia, Law No. 36 of 2009 on Health has stated that abortion is allowed for victims of rape and abortion based on medical indications. The derivative rules for the implementation of safe abortion have also been formed, namely Governmental Regulation No. 61 of 2014 on Reproductive Health, Ministry of Health Regulation No. 03 of 2016 on Training and Implementation of Abortion Services, and Guidelines for the Implementation of Abortion Services of the Ministry of Health of the Republic of Indonesia. ICJR published a research report in 2020 on the Implementation of a Safe, Quality, and Responsible Abortion Policy following the Health Law in Indonesia, including an analysis related to the legal framework and stakeholder interests regarding the implementation of safe abortion. From the study, it was found that until now the Minister of Health has not appointed any healthcare facility that can provide safe abortion services, even though the provisions of this rule have been in effect since 2016.
The absence of these services has an impact on rape victims, as happened in Jombang last July 2021, the minor (12 years old) was raped by a 56-year-old man and had an unintended pregnancy, and her abortion request was rejected by the investigators because “there was no experience” on dealing with abortion needs. This is obviously because there is no designated health care facility for safe abortion.
Other than the absence of assigned healthcare facilities, it was found that one of the obstacles faced regarding the difficulty of providing safe abortion services for rape victims is because the limited legal provisions that still provide a 40 days’ gestational limit to be performed for rape victims.
In its development, on 09 March 2022, WHO published new guidance on Abortion Care to guide countries to formulate safe abortion policies. The guidance explains that the state should abolish a legal provision restricting abortion with a gestation limit. WHO states that the gestation limit is not science-based and currently safe abortions with technological developments can be performed up to 28 weeks’ gestation.
In the development of the discussion on the draft Bill in November 2019, it was explained that there were efforts to update the law related to the abortion criminalization in the draft Bill by introducing that abortion for rape victims can be performed up to 120 days’ gestation.
Then in the developments of the latest draft Bill by the Government version of 4 July 2022, there are several changes within the formulation of Article 467 paragraph (2):
(2) The provisions referred to in paragraph (1) shall not apply if women are victims of rape or other criminal acts of sexual violence that cause pregnancy whose gestational age does not exceed 12 (twelve) weeks or has indications of a medical emergency.
There was a reduction in gestational age from 120 days (16 weeks) to 12 weeks. This provision still needs to be pushed to follow the latest WHO guidelines in 2022.
On this basis, in commemoration of International Safe Abortion Day, the ICJR calls for:
- Ministry of Health to immediately assign healthcare facilities to provide safe abortion as mandated in the law
- For legal reform, the Government and the House of Representatives to strengthen the regulation of abortion for victims of sexual violence for up to the gestational age of 28 weeks or returned the formulation to 16 weeks’ gestational age to provide an opportunity to build a health system for safe abortion.
28 September 2022
ICJR
