POLICY LANDSCAPE

1 The World Bank Data https://data.worldbank.org/indicator/SP.POP.TOTL?locations=ID

2 Trends in maternal mortality 2000 to 2017 : Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division http://documents.worldbank.org/curated/en/793971568908763231/pdf/Trends-in- maternal-mortality-2000-to-2017-Estimates-by- WHO- UNICEF-UNFPA-

World-Bank-Group-and-the-United-Nations-Population-Division.pdf

3 Maternal Mortality in 1990-2015. Indonesia. WHO, UNICEF, UNFPA, World Bank etc.

https://www.who.int/gho/maternal_health/countries/idn.pdf

4 Indonesia Demographic and Health survey 2017 https://dhsprogram.com/pubs/pdf/FR342/FR342.pdf 5 Abortion in Indonesia. Guttmacher Institute. In Brief. 2008 Series, no. 2.

https://www.guttmacher.org/sites/default/files/report_pdf/ib_abortion_indonesia_0.pdf 6 Indonesian Health Law2009 Draft (English version)

https://www.sabin.org/sites/sabin.org/files/indonesia_health_law_2009.pdf

7 Indonesian Penal Code https://abortion-policies.srhr.org/documents/countries/05-Indonesia-Penal-Code.pdf 8 Global Abortion Policies Database https://abortion-policies.srhr.org/

REFERENCES

ABORTION

POLICY LANDSCAPE

Indonesia

BACKGROUND

Indonesia is the world’s largest archipelago with more than 17,000 islands. As per 2018 census, the total population of Indonesia is about 267.66 million of which 49.7% are female.1

Key reproductive health indicators have displayed steady improvement – MMR has reduced from 305 in 2015 to 177 in 2017.

Contraceptive prevalence rate increased from 50% in 1991 to 61% in 2012 for all methods – it is 57.9%

for modern methods4.

ABORTION LAWS AND POLICIES

Article 75 of the Health Law6 allows abortion for limited conditions. It mandates counselling prior to and following the procedure.

Article 76 lays down further criteria for provision of abortion – with consent of the woman and her husband (except rape victim); by health personnel who have expertise and authority and are certi fied by the minister; at a health service facility, which satisfies the requirements stipulated by the Minister.

ABORTION-RELATED INDICATORS

According to the 2008 Guttmacher In Brief Report, there were about 2 million induced abortions reported in the year 2000, which translates to 37 abortions per year per 1000 women in the reproductive age group. This report was published before changes in the Health Law in 20095.

Maternal mortality ratio (2015)

177/100 000 live births2

20.8 years3 22.4 years3 2.433

64%3 11%3

Median age at first marriage

Median age at birth of first child

Total fertility rate

Contraceptive prevalence rate (all methods)

Unmet need for family planning

Notably, Article 77 of the same law states that the government will be obliged to protect and

prevent a woman from abortions that are of poor quality, unsafe, irresponsible and against religious norms and statutory regulations.

The Government Regulation on Reproductive Health, No. 61/2014, and Ministerial Regulations on Guidance for Training and Health Provision of safe abortion for rape victims and for health-related conditions, No. 3/2016 lay down pre-procedural requirements for services, including:

•

A feasibility/ethical team needs to be established at facility level to determine whether a woman is eligible for an abortion as per existing regulation. The team should consist of two health professionals, of which one should be a medical doctor who has the competence and authority to make such decision (translated to some as ob gyn).

•

A medical doctor is responsible to evacuate the POC (product of conception) and this doctor should be different from the one in the feasibility/ethical team, except in cases of remote areas with limited numbers of doctors.

•

A range of facilities can provide abortion services – from primary health clinic to hospital – but needs to be appointed by the Ministry of Health

POLICY PROGRESS AND GAPS

1

The law recognizes the need to provide safe high-quality services.

2

No standards and guidelines for provision of services, even though procedural pre-conditions have been regulated in a ministerial regulation.

3

Neither misoprostol nor mifepristone are part of EML Indonesia. Also, the use of misoprostol for post-partum haemorrhage, incomplete abortion, and induced abortion is off label, as it was registered merely for gastric ulcer.

4

The operational guidelines stipulate several pre-conditions for services.

The Indonesian Penal Code7, lays down punishments for women who seek abortion (Article 346);

for any person, including physicians, midwives and pharmacists who assist women in causing abortion with or without her consent (Article 347-349); and any person who provides information on abortion (Article 299).

Now, on process the revision of Indonesian Penal Code : doctors who abortion because of medical indication or rape victims in accordance with regulation, not convicted (Article 471)

Figure 1: Conditions8 and gestation limit for which abortion is permitted in Indonesia

Save

woman’s life

Physical health

Mental health

Rape/

Incest

Fetal

impairment

Economic/

social reasons

request On

Conditions

permitted till 6 weeks

Conditions not permitted Conditions p

ermitted (n o lim

it)

Condition not permitted