JAKARTA, Aug 27, Reuter – While Indonesia laps up international praise for promoting contraceptives and braking population growth, its hospitals, doctors and mystic masseurs compete for a share in the illegal abortion market.
Indonesia is alone among the world’s five most populous nations in outlawing abortion in any circumstances, even to save a woman’s life.
Yet most public hospitals and maternity clinics in Jakarta offer what they delicately call "menstrual regulation services".
"MR, we say, but that’s all semantics. It’s abortion, no question about that," said one clinic doctor between operations, wiping his hands on a bloodstained shirt.
Outside, teenage boys vie to take women to doctors who will pay them commission.
"Miss, miss, over here miss. If you want an abortion, I’ll take you to the best place," says one.
Leading gynaecologists estimate the demand for clinical abortions in urban areas at 500,000 a year and rising.
The rate for a private operation runs to a million rupiah (570 dollars).
If that’s too much, a pregnant woman can run the gauntlet of heckling boys and sit in a crowded clinic waiting room for hours for an abortion for at least 30,000 rupiah (17 dollars).
Then there are the traditional healers who, sometimes for a slightly higher price, combine massage and mild poison with uterine interference and magic spells.
"It’s frightful what’s happening here. Only one in about 18 abortion cases makes it to the clinic, and that is often because the job has been so badly botched," said a senior family planning consultant with an aid organisation.
Doctors tell of operating on women whose wombs have been perforated by twigs or metal wire, either self-inflicted or the legacy of encounters with masseurs.
Potions doled out by the masseurs and made from roots and herbs are effective abortifacients, in as much as they kill the foetus. Rarely, however, do they clear the womb.
"The policy is no abortion. But when you are faced with the month-old decomposed remains of a foetus still in the womb, you feel ‘We have to do something to save these girls,’" said Abdullah Syarwani, director of the Indonesian Planned Parenthood Association, a non-government organisation which runs clinics offering "menstrual regulation".
A birth control programme has been phenomenally successful as more and more of the sprawling nation’s 180 million take to contraceptives, helping Indonesia move to its target of zero population growth.
Critics say success in numbers came at the expense of real understanding on the part of users.
"A lot of the women we treat are pregnant because they were given inappropriate contraceptives, or didn’t understand how to use them," Abdullah said.
"Back-up MR services in such cases are an integral part of any successful family planning programme."
Apart from the odd case where a masseur’s patient dies, there have been no prosecutions under the law imposed by Indonesia’s Dutch colonisers in 1919 and unchanged since.
Gynaecologists and lawyers have been pressing for a change since the early 1970’s.
In 1978, they drafted a law allowing abortion if the mother or child risked injury, a position supported by many Islamic scholars in predominantly Moslem Indonesia. It never saw the light of day.
"Really, the difference between the law and general practice is so huge. It has to be changed, but the political scene doesn’t allow that," said Biran Affandi, a gynaecologist who advises the government in its family planning campaign.
The presence of so many tacitly recognised illegal clinics hinges on the Indonesian penchant for consensus, for avoiding outright conflict between different interest groups.
Some orthodox Moslems believe abortion immoral. President Suharto, who received an award for population control from the United Nations in June, is careful to avoid offending the nation’s Moslem majority.
"Suharto always wants to keep everyone happy. So abortion is illegal. That keeps the fundamentalists happy.
"But it happens and no one gets jailed. That keeps the doctors happy," one lawyer said.
Some family planning workers say the fact that abortion is such a political football in the United States has a major bearing on Indonesia’s reluctance to make the law come closer to reality.
The United States now refuses to fund any organisation that even uses the word abortion in its literature.
The U.S. Agency for International Development gave 20 million dollars this month for its population scheme. That would have been jeopardised by government recognition of what goes on in Jakarta’s maternity hospitals.
The success of contraception policies is clearly reflected by the clientele of abortion clinics and masseurs. Older women who came because they could not cope with a fourth or fifth child, previously a mainstay, are now a rarity.
Clinics all insist on counselling before and after abortion. While they do not force contraceptives on anyone, "most of the girls who walk out of here after MR walk out with a packet of pills," a doctor said.
"Demand is like this," said a consultant, shooting his hand skyward.
"But now it’s mostly from young kids, high school students, unmarried girls. Just the one’s we’re not allowed to target in our birth control advertising."