A knocking at the door at midnight woke me up. I cautiously opened the door to see a haggardlooking couple with their 13-year-old daughter. They had walked five days through the wilderness of western Papua seeking help for the girl.
She was two months pregnant, having been raped by her grandfather. They pleaded with my husband, an obstetrician working at the government hospital, to perform an abortion. Abortion is illegal in Indonesia and my husband faced criminal consequences had he performed the surgery. Deeply saddened, he refused them. The mother and the daughter cried and begged for help. They left us looking hurt, angry and defeated. A week later, my husband came home and explained how he had to perform an emergency hysterectomy on that young girl. She had been taken to an illicit abortionist with no formal medical training. The girl was in a terrible condition and indeed the next day she died of sepsis as a result of her injuries at the hands of the criminal abortionist. The law that tied my husband’s hands with this girl killed her. The law makes no exception – perform an ‘elective’ abortion and face prison time. My research documents the prevalent nature of this problem among Indonesia’s legitimate health services providers.
Kartini is an icon of the women’s rights movement in Indonesia. She died in 1904 in childbirth at the age of 25, martyred in a cause she wrote eloquently of. More than a century later, Indonesia today still suffers one of the highest maternal mortality ratios (MMR) in the sub-region (310–370/100,000). As poor as this is, it reflects only those deaths officially linked to pregnancy. Like the young girl in Papua, death is typically not linked to her pregnancy, but simply attributed to sepsis. This spares the family social stigma and possibly criminal prosecution. Laws against abortion kill Indonesian women. What health policy and politics failure allows this? The answer to this question may fairly be described as the cause of these deaths. If one understands the cause, one is equipped to intervene and save human life.
Although practised widely, the issue of abortion brings forth more controversy than perhaps any other single health issue. Abortion is still a subject that provokes fervour and debate because it raises fundamental questions about human values. Nonetheless, radical reforms leading to general decriminalisation of abortion practices have occurred over the past 50 years, especially in the developed world. Do these successes show the way for reform in Indonesia? Perhaps not, first because Indonesia’s situation is unique in the context of developing nations reforming abortion laws, and second because the abortion issue in Indonesia has been framed in the context of the ideological poles of Western democratic liberalism and fundamentalist Islamic values.
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This article comes from the IDS Bulletin 39.3 (2008) Policy Analysis of Abortion in Indonesia: The Dynamic of State Power, Human Need and Women’s Right