Ignorance that Kills

Mar 03, 2013
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Many Indonesian women face great difficulties in accessing safe terminations of unwanted pregnancies.

Having an abortion at 16 weeks without anesthesia is something you can’t imagine. It should not be experienced by any woman. Yet Dian’s experience is not unique. Many women have these procedures without pain relief. And many of them experience violence or other humiliating treatment.

One of the problems with the illegality of most abortions today is that women who seek the procedure end up having to deal with what is best described as an abortion mafia: a network of brokers and shady clinics, many of which cheat the women financially, or subject them to abuse. One woman, for example, told me that she was asked to have sex with a broker before she was taken to a clinic because the money she carried was not enough for her abortion. Another recalled how when her abortion was performed, she was in the same room with three other women, and had to watch their procedures.

A better way is possible

In September 2012, I had the opportunity to visit a health clinic in Penang, Malaysia. One service it offers is safe abortion. For three days, I observed all the procedures in the clinic, starting from administration, through to counseling, examination and the abortion procedure itself.

It was quite an amazing experience for me. How they dealt with abortions shook my reality. They allowed me to be in the operating room and I observed an abortion performed by a doctor on duty. The doctor explained the procedure step by the step, including how anesthesia was given. The clinic provides three types of anesthesia: the common pain reliever that affects brain function, a local anesthetic injected in the cervix, and verbal anesthesia. Verbal anesthesia was performed by a specialist nurse who was there just to talk with the patient during the procedure. They perform the procedure in under 15 minutes. It was safe, simple and fast.

I visited patients in the recovery room. Both patients with whom I talked said that they did not feel pain during the procedure. Pain management started when the women first entered the clinic. In addition to pain relief, the attitudes of the medical staff and the clinic’s athmosphere really helped the women to feel safe and secure. It was a women-friendly service.

I explained to one of the doctors that many of my clients in Indonesia told me that their doctor did not provide anesthesia because the cost was so expensive. ‘But here, with a very low charge you can provide three types of anesthesia. Don’t you lose money?’, I asked. The doctor answered: ‘It

depends on what your intent is. If money is the goal, then certainly you will lose money. If the intention is to help women, you don't lose anything but gain benefit for the woman herself.’

This answer brought home to me what a new experience it was to see this service in action. But it also made me reflect sadly on the situation in Indonesia, where the dramatisation of abortion, and all the secrecy and stigma that surrounds it, is a result of a conspiracy of ignorance and systemic failure and discrimination.

Respecting women

Abortion is a medical procedure that can save the lives of women. The process should be simple, fast and safe. If the information and medical technology are available and accessible, why should abortion be tragic and traumatic, as it so often is in Indonesia?

The answer is that Indonesia has its priorities wrong. The state should be prioritising provision of information and education about sexual and reproductive health, rather than criminalising women who have abortions. Lack of basic knowledge and skills about sexual and reproductive health is the root of the high number of unplanned pregnancies, sexually transmitted infections, and unsafe abortions, and of a lot of violence too. The state needs to be remedying this problem.

And when a woman decides she needs an abortion, the state should help her have one with safety, security and dignity. In the end, recognising the autonomy of women to make their own decisions about the issues that affect their lives is the central pillar of women's rights. And women’s rights are human rights, which the government of a democratic Indonesia should be dedicated to protecting.

Inna Hudaya is the founder of, and senior counselor at, SAMSARA, an organisation dedicated to providing education and counseling on abortion issues in the context of sexuality, reproductive health and rights and gender equality. She also runs the ‘Ask Inna’ web page which provides information to women considering having an abortion and advocates on reproductive health issues.

- Inside Indonesia