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Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
Prof biranabortion in indonesia
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Prof biranabortion in indonesia

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  • 1. ABORTION IN INDONESIAABORTION IN INDONESIA Biran Affandi Klinik Raden Saleh Department of Obstetrics and Gynecology Faculty of Medicine , University of Indonesia/ Ci M k G l H i lCipto Mangunkusumo General Hospital Jakarta Affandi B. Abortion in Indonesia . National Conference on Women’s Mental Health , Department of Psychiatry‐Faculty  of Medicine,Airlangga University / Dr. Soetomo General Hospital , Surabaya 26‐27 Nov. 2011 
  • 2. Objectives:Objectives: 1.To overview abortion in1.To overview abortion in  Indonesia 2.To review problems of  unsafe  b dabortion in Indonesia 3 T di ibl l ti3.To discuss possible solutions Affandi B. Abortion in Indonesia . National Conference on Women’s Mental Health , Department of Psychiatry‐Faculty  of Medicine,Airlangga University / Dr. Soetomo General Hospital , Surabaya 26‐27 Nov. 2011
  • 3. G tt h I tit t I B i f S i N 2 2008Guttmacher Institute . In Brief Series No. 2 , 2008
  • 4. ABORTION in INDONESIA (I) MMR : 220 PER 100 000MMR : 220 PER 100 000 (SDKI 2010)(SDKI 2010)MMR : 220 PER 100,000MMR : 220 PER 100,000 (SDKI, 2010)(SDKI, 2010) -- THE HIGHEST IN ASEANTHE HIGHEST IN ASEAN 1010 -- 30 % MATERNAL DEATHS30 % MATERNAL DEATHS -- ABORTION RELATEDABORTION RELATED (WHO,2004)(WHO,2004) NO DATA ON ABORTION DEATHNO DATA ON ABORTION DEATH (MOH 2005)(MOH 2005)(MOH,2005)(MOH,2005)
  • 5. ABORTION in INDONESIA (II)( ) MWRA: 52 MMWRA: 52 M(BKKBN,2010)(BKKBN,2010) CONTRACEPTIVE PREVALENCE: 60% (30 M)CONTRACEPTIVE PREVALENCE: 60% (30 M) CONTRACEPTIVE FAILURE: 4CONTRACEPTIVE FAILURE: 4--5%5% 1.21.2 -- 1.5 M PREGNANCIES1.5 M PREGNANCIES1.21.2 1.5 M PREGNANCIES1.5 M PREGNANCIES 60%60% INDUCED ABORTIONINDUCED ABORTION 0.720.72 –– 0.90 M ABORTION0.90 M ABORTION Affandi B.  Unsafe Abortion : Indonesian Experience . 1st International Congress on Women Health & Unsafe Abortion , Bangkok , Thailand , 20‐23 January 2010
  • 6. ABORTION in INDONESIA (III) UNMET NEEDS : 9 %UNMET NEEDS : 9 %UNMET NEEDS : 9 %UNMET NEEDS : 9 % -- 4.6 M MWRA4.6 M MWRA 60% Pregnant60% Pregnant 2.7 M2.7 M PREGNANCIESPREGNANCIES 30% INDUCED ABORTION30% INDUCED ABORTION30% INDUCED ABORTION30% INDUCED ABORTION 0.81 M ABORTION0.81 M ABORTION
  • 7. ABORTION in INDONESIA (IV) ADOLESCENT GIRLS (10ADOLESCENT GIRLS (10--19 years):19 years): 46 M46 M (BKKBN 2010)(BKKBN 2010)46 M46 M (BKKBN, 2010)(BKKBN, 2010) 1010--50% Sexually Active50% Sexually Active ADOLESCENT PREGNANCIES ?ADOLESCENT PREGNANCIES ? 60% x 10% x 46 M = 2 76 M60% x 10% x 46 M = 2 76 M60% x 10% x 46 M = 2.76 M60% x 10% x 46 M = 2.76 M ABORTION (?)ABORTION (?)( )( ) 60% x 2.76 M = 1.7 M60% x 2.76 M = 1.7 M
  • 8. ABORTION IN INDONESIAABORTION IN INDONESIAABORTION IN INDONESIAABORTION IN INDONESIA SPONTAN : 15 - 20% x 5 Million pregnancies = 750,000 – 1000,000 I d d 0 7 + 0 81 + 1 7 M 3 21 MInduced : 0.7 + 0.81 + 1.7 M = 3.21 M
  • 9. Guttmacher Institute . In Brief Series No. 2 , 2008
  • 10. ABORTION METHODSABORTION METHODSABORTION METHODSABORTION METHODS METHOD CLINICIAN TRADITION/SEF VACUUM ASP 91% - VACUUM ASP. D/C PG/INJECT. 91% 30% 4% - - - MEDICINE HERBS MASSAGE - - - 8% 33% 79% OTHERS - 79% 17% Affandi B.  Unsafe Abortion : Indonesian Experience . 1st International Congress on Women Health & Unsafe Abortion , Bangkok , Thailand , 20‐23 January 2010
  • 11. ABORTION IN INDONESIAABORTION IN INDONESIA 20082008 ABORTION BY URBAN RURAL Rich Poor Rich Poor Doctor Mid if 57 16 24 28 26 26 13 18Midwifw Traditional Self 16 19 18 28 25 24 26 31 17 18 47 22 Affandi B.  Unsafe Abortion : Indonesian Experience . 1st International Congress on Women Health & Unsafe Abortion , Bangkok , Thailand , 20‐23 January 2010
  • 12. UNSAFE ABORTIONSUNSAFE ABORTIONSUNSAFE ABORTIONSUNSAFE ABORTIONS - OUTSIDE HEALTH CARE SYSTEM - UNSKILLED PROVIDERS UNSANITARY CONDITIONS- UNSANITARY CONDITIONS - 95% DEVELOPING COUNTRIES → 0.5 M DEATH Affandi B.  Unsafe Abortion : Indonesian Experience . 1st International Congress on Women Health & Unsafe Abortion , Bangkok , Thailand , 20‐23 January 2010
  • 13. Unsafe abortion leads to an unknown  number of complications and deaths R i f b i i d• Recent estimates of abortion associated  mortality in Indonesia are unavailable.  • WHO estimates that unsafe abortion is  responsible for 14% of maternal deaths inresponsible for 14% of maternal deaths in  Southeast Asia, and 16% of maternal deaths  in regions of Southeast Asia that have highlyin regions of Southeast Asia that have highly  restrictive abortion laws (including  d )Indonesia) Guttmacher Institute . In Brief Series No. 2 , 2008
  • 14. Unsafe abortion: the preventable pandemic(1) • Every year, about 19–20 million abortions are done  by individuals without the requisite skills, or in  environments below minimum medical standards,  or both.  • Nearly all unsafe abortions (97%) are in developing  countries. An estimated 68 000 women die as a  result, and millions more have complications, many  permanent. Important causes of death include  haemorrhage, infection, and poisoning.  Grimes et al Unsafe abortion: the preventable pandemic The Lancet Sexual and Reproductive Health Series October 2006.Grimes et al. Unsafe abortion: the preventable pandemic. The Lancet Sexual and Reproductive Health Series, October 2006.
  • 15. Unsafe abortion: the preventable pandemic(2) • Legalisation of abortion on request is a necessary  but insufficient step toward improving women’sbut insufficient step toward improving women s  health; in some countries, such as India, where  abortion has been legal for decades access toabortion has been legal for decades, access to  competent care remains restricted because of  other barriersother barriers.  • Access to safe abortion improves women’s health,  d i d d i i d iand vice versa, as documented in Romania during  the regime of President Nicolae Ceausescu.  Grimes et al. Unsafe abortion: the preventable pandemic. The Lancet Sexual and Reproductive Health Series, October 2006.
  • 16. Unsafe abortion: the preventable pandemic(3) • The availability of modern contraception can  reduce but never eliminate the need for  abortion.  • Direct costs of treating abortion• Direct costs of treating abortion  complications burden impoverished health  care systems, and indirect costs also drain  struggling economies. Grimes et al. Unsafe abortion: the preventable pandemic. The Lancet Sexual and Reproductive Health Series, October 2006
  • 17. Unsafe abortion: the preventable pandemic(4)Unsafe abortion: the preventable pandemic(4) • The development of manual vacuum  aspiration to empty the uterus, and the  use of misoprostol have improved theuse of misoprostol, have improved the  care of women.  • Access to safe, legal abortion is a  fundamental right of womenfundamental right of women,  irrespective of where they live.  Grimes et al Unsafe abortion: the preventable pandemic The Lancet Sexual and Reproductive Health Series October 2006Grimes et al. Unsafe abortion: the preventable pandemic. The Lancet Sexual and Reproductive Health Series, October 2006.
  • 18. The underlying causes ofThe underlying causes of  morbidity and mortality frommorbidity and mortality from  unsafe abortion today are not  blood loss and infection but,  rather, apathy and disdain  t dtoward women Grimes et al. Unsafe abortion: the preventable pandemic. The Lancet Sexual and Reproductive Health Series, October 2006.
  • 19. Areas for action  1. Provide comprehensive sexual and  reproductive health servicesreproductive health services  Once legal or available, abortion and  menstrual regulation services need to be  provided as part of a quality assured sexual p p q y and reproductive health package. Safe  abortion services are an essential part of theabortion services are an essential part of the  service package needed to reach targets for  universal access to reproductive healthuniversal access to reproductive health.  Realising Rights  (2009) . Factsheet #2 Combating  unsafe abortion is key to improving maternal health.
  • 20. 2. Make the links between unsafe  abortion and maternal health  There is a tendency to separate the issueThere is a tendency to separate the issue  of unsafe abortion from maternal health  li d d b t d t liti lpolicy and debate due to political  sensitivities. The de‐linking of the two issues  ignores the evidence that many women  undergoing unsafe abortion are already g g y mothers whose health is then seriously at  risk.risk. 
  • 21. 3.Make the economic argument for g access to safe abortion services  Th t f t ti li tiThe costs of treating complications  from unsafe abortion are a burden on  already fragile health systems in  developing countries Contraceptivedeveloping countries. Contraceptive  services and safe abortion services are  very cost effective. 
  • 22. 4.      Involve men To overcome familial,  community and political barriers tocommunity and political barriers to  accessing safe abortion services g men need to be engaged as  h i f ’ l dchampions for women’s sexual and  reproductive rights. p g Realising Rights  (2009) . Factsheet #2 Combating  unsafe abortion is key to improving maternal health.

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