Indonesia: Taboos Lead to High Levels of Maternal Mortality

By Sofia Tillo

14 November 2010
“Left without a choice” is both the title and the key finding of a recent Amnesty International report about women’s reproductive health in Indonesia. In the wake of President Obama’s visit to the country, Amnesty has sought to expose how a dangerous combination of legal and social conditions hinders Indonesian women from accessing health services.

Five years away from the due date for achieving the Millennium Development Goal of eradicating maternal mortality, the current situation threatens to prevent Indonesia from meeting international targets. “Unsafe abortions and unmet needs for family planning are responsible for a high proportion of maternal mortality in Indonesia,” said Carole Marzold, Amnesty’s Indonesia Country Specialist, in an interview to MediaGlobal.

The Indonesian Health Law of 2009 prohibits access to sexual and reproductive health services for unmarried women and girls, including access to contraception. When an unmarried woman approaches a health service provider in Indonesia, she can be refused treatment and advice, on legal grounds. In practice, the law translates into a stark form of gender discrimination; unmarried women often face the harsh consequences of an unplanned pregnancy alone. It is also unclear how a woman who becomes pregnant out of wedlock would access any prenatal care.

Far from being a problem facing only unmarried women, the Indonesian healthcare policy often also prevents married women from controlling fertility. According to the country’s 2009 Population and Family Development Law, the husband’s consent is necessary in order for a woman to be prescribed certain forms of contraception. Furthermore, Amnesty’s report suggests that midwives, nurses, and doctors often refuse contraception to married women without children.

Advocates blame these policies for many of Indonesia’s estimated two million abortions per year. “Unwanted pregnancies lead to millions of abortions and the World Health Organization estimates 16 percent of maternal health is a result of unsafe abortions. So this has a big impact,” Marzolf told MediaGlobal.

The climate of misinformation regarding sexual and reproductive health has been further intensified by recent restrictions on information distribution. “The anti-pornography law of 2008 leaves a lot of health workers and educators very reluctant to provide information. Pornography is very loosely defined in the law, and if educational materials are found to be pornographic, educators could face severe prison sentences,” Marzolf said.

Aside from concerns regarding maternal mortality, the situation in Indonesia also starkly contradicts Millennium Development Goal 3, to “promote gender equality and empower women.”

“Under the marriage law that was passed in 1974, a man is entitled to take a second wife while his wife does not have children,” said Marzolf. “This means newly wed girls fall pregnant very early to ensure they don’t provide their husbands with a reason to take a second wife. As a result, a lot of girls younger than 18 years old get pregnant and are at a higher risk of maternal mortality. When you bear a child under the age of 16 you are actually five times more likely to die as a result of pregnancy.”

Several Indonesian civil society organizations and activists have been working to improve women’s access to information and health services in the country. One of such activists is Theresia Isawrini, of Kapal Perempuan (Women Learning Center for Global Justice and Pluralism) in Jakarta. In interview with MediaGlobal. Isawrini stressed that “our mission is to increase the critical thinking of the people about what is happening around them, especially of women”.

In the meantime a lack of official political will further complicates the situation of women in Indonesia. “In 2007 there was an independent report about three Indonesian provinces, where the data shows how early marriage contributes to problems in girls education. For example, young married girls, as young as 15 or 16, stop going to school. This is a big problem but there is still no policy to protect these girls.” Isawrini told MediaGlobal.

At an international level, observers fear for Indonesia’s lack transparency in communicating MDG progress. “For example, in independent research we find illiteracy rates of females to be around 12 percent. If you look at government statistics the number is 5 percent,” said Isawrini. When it comes to the elevated levels of maternal mortality numbers, “the government does not provide the data, the actual numbers of maternal mortality, so estimates go from 225 to 400 per 100 00 births. But in some areas, like Papua, local organizations think the numbers are as high as 1000.” said Isawrini.

Amnesty International’s report concludes that women’s rights in Indonesia are restricted due to current health policies. With a local perspective, Isawrini is prepared to take the matter further: “this is form of state violence against women and the government should take it seriously and give this issue attention.”

ENDS

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