Indonesia is the world’s fourth most populous country, with 264 million people belonging to hundreds of ethnic groups. Its 17,000 islands span a length equivalent to the continental United States. From district to district, there is health-care inequity. And abortion care is “the most neglected service for reproductive health,” says Ipas Indonesia Country Director Marcia Soumokil.
Indonesia also has one of the highest maternal death rates in Southeast Asia. The solution, Dr. Soumokil says, is to make sure that everyone has “the ability to regulate their pregnancy.”
Ensuring that ‘whatever a woman’s situation—she has access to care’
Abortion is “the issue that nobody wants to talk openly about. Even when we know that clandestine services are there, even when we know women are in huge need—we don’t want to talk about it,” says Soumokil.
This reluctance is evident in the situation with Indonesia’s restrictive abortion law, which was passed in 2009, but hasn’t yet been implemented. While the law permits abortion to save a woman’s life, for rape survivors and in cases of fetal impairment, there are no government-supported services for abortion. This means that some OB-GYNs will provide care, and some won’t. Plus, social conservatism and religious fundamentalism contribute to stigma and make it difficult to implement a safe abortion program.
To help implement the law, Ipas Indonesia has been working closely with the family health department in the Ministry of Health (MOH) to support collaboration with other MOH divisions and with the OB-GYN and midwife associations. They are also working with the MOH to develop operational policy, standards and guidelines, clinical protocols and provider trainings for postabortion care—and will eventually do the same for comprehensive abortion care policy.
Ipas Indonesia also facilitated—through technical and legal assistance—the inclusion of treatment for complications of unsafe abortion (commonly referred to as postabortion care) in the country’s official midwifery roles, which passed in February 2019. According to the most recent population survey, in 2015, most women seeking reproductive health care go to midwives. Yet general practitioners and OB-GYNs have traditionally treated women with complications of unsafe abortion.
Midwives will now be able to provide more postabortion care services. Ipas Indonesia will be working with the MOH to support the roll-out of the policy. “The most important thing is making sure women have more available and accessible services,” Soumokil says. “If they prefer to access a service from a midwife, we need to support that.”
Soumokil wants people to understand that “women have different needs and are in different situations. There are many situations in which women can face unwanted pregnancy. We must make sure that—whatever a woman’s situation—she has access to care.”
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