20 Apr 2016

Hospitalised Abortions in Yogyakarta: Characteristics and Implications

Riznawaty Imma Aryanty, April 2013
The Australian National University

Abstract
Abortion is among the most neglected of the health-research issues in Indonesia. Various debates focus on whether or not abortion should be permissible and they often deny the fact that women continue to have abortions regardless of the legal status of the procedure. Advocacy towards having broader grounds for abortion is supported by only a few studies that attempt to estimate the annual number of abortions that are carried out. The research explored and provided an in-depth analysis of abortion in Yogyakarta province. It utilised data on total numbers of abortion-related complications and the characteristics of the cases from the hospitals.

Data availability on the medical records of abortion-related cases suggests that data are poorly managed. The completeness of the medical records is poor and analysis shows that the adequacy of medical records is influenced by several factors such as the hospital location, type of hospital and diagnosis. Cases from the relatively more remote districts had the least complete data indicating the need for health information system strengthening, particularly in rural hospitals. Whether data incompleteness reflects anything about the quality of services is not clear.

Analysis of various socio-demographic characteristics shows that the age and education profiles of the women presenting with spontaneous and abortion symptoms are significantly different by district and type of diagnosis. While most are treated in hospital in Yogyakarta City, by residency the cases are more evenly spread among the four other districts surrounding the city. In total, the rate of abortion hospitalisation in Yogyakarta province is 3.8 per 1000 women aged 15 to 44 years.

Two different direct methods to estimate the incidence and rate of abortion were applied in Yogyakarta Province: the Abortion Incidence Complication Method (AICM) and the Residual Method. The two methods yield abortion rate of 14.6 per 1000 women aged 15 to 44 years (ranging from 12.2 to 17.1) with the AICM, and 20.0 per 1000 women aged 15 to 44 years with the Residual Method. This level is equal to the medium rate of abortion compared to other countries’ rates and they are much lower than the estimate for Indonesia in 2000 by Budi Utomo of 37 per 1000 women aged 15 to 49 years.

The data confirm the suspicion that the abortion problem is poorly understood in Indonesia in general and more specifically in Yogyakarta Province. Women with unwanted pregnancies, who decide to terminate them, are left with no other choice than to turn to menstrual regulation drugs and herbs whose effectiveness is unknown. They resort to hospital when the attempted abortion causes serious side-effects or fails to achieve a termination. Abortion contributed quite significantly to obstetric and gynaecological admissions.

Finally, this study concludes that despite the importance of having estimates on induced abortions, the more important issue to be addressed is to ensure women’s reproductive rights. The study’s findings have provided evidence on the need to prioritise the health system’s response to address abortion complications.

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