Estimating the Incidence of Induced Abortion in Java, Indonesia,
                    2018

This study sought to understand the experience of buying misoprostol online for pregnancy termination in Indonesia. We conducted a mystery client study August through October, . Interactions were analyzed quantitatively and qualitatively, along with the contents of the packages. One hundred ten sellers were contacted, from whom mystery clients made  purchases and received  drug packages. Almost all sellers sold "packets" containing multiple drugs;  percent of packets contained misoprostol, and  percent contained at least  mcg of misoprostol. Thirty-four packets contained insufficient drugs to complete an abortion. When compared to WHO standards,  percent of sellers imparted incomplete information about potential physical effects; no seller provided information about possible complications. Women buying misoprostol from informal online drugs sellers will be underprepared for understanding potential side effects and complications. Educational activities are needed to increase women's access to information about safe use of misoprostol as a harm reduction strategy. BACKGROUND Abortion is permitted in Indonesia only in medical emergencies where the pregnancy poses a threat to the woman's health and life, in cases of fetal impairment, or rape only up to 40 days gestation (Republic of Indonesia 2009). Nevertheless, every year millions of women in Indonesia seek an abortion, all of which occur outside of the formal healthcare system. A study in 2018 in Java, where close to 60 percent of Indonesia's population of 268 million people

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“…This translates to a rate of 42.5 abortions per 1,000 women of reproductive age (15–49) (Giorgio et al. 2020).…”

Section: Introductionmentioning

confidence: 99%

“…live, estimated that 1.7 million abortions occurred that year. This translates to a rate of 42.5 abortions per 1,000 women of reproductive age (15-49) (Giorgio et al 2020).…”

mentioning

confidence: 99%

Online Abortion Drug Sales in Indonesia: A Quality of Care Assessment

Moore

Philbin

Ariawan³

et al. 2020

Studies in Family Planning

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“…The primary objective of the HFS was to estimate the annual number of PAC patients, and we selected a lower proportion of PONEDs knowing this type of facility treats few if any PAC patients. The HFS sampling strategy is described in more detail elsewhere [10].…”

Section: Data Sourcementioning

confidence: 99%

“…A 2003-2004 study in Banten province attributed over 30% of obstetric admissions in public hospitals to complications resulting from induced or spontaneous abortion, and 16% of induced abortion admissions were classified as near miss [9]. A study in 2018 found that almost 205,000 women in Java were treated for PAC that year [10].…”

Section: Introductionmentioning

confidence: 99%

Health system capacity for post-abortion care in Java, Indonesia: a signal functions analysis

et al. 2020

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Background The quality of obstetric care has been identified as a contributing factor in Indonesia’s persistently high level of maternal mortality, and the country’s restrictive abortion laws merit special attention to the quality of post-abortion care (PAC). Due to unique health policies and guidelines, in Indonesia, uterine evacuation for PAC is typically administered only by Ob/Gyns practicing in hospitals. Methods Using data from a survey of 657 hospitals and emergency obstetric-registered public health centers in Java, Indonesia’s most populous island, we applied a signal functions analysis to measure the health system’s capacity to offer PAC. We then used this framework to simulate the potential impact of the following hypothetical reforms on PAC capacity: allowing first-trimester uterine evacuation for PAC to take place at the primary care level, and allowing provision by clinicians other than Ob/Gyns. Finally, we calculated the proportion of PAC patients treated using four different uterine evacuation procedures. Results Forty-six percent of hospitals in Java have the full set of services needed to provide PAC, and PAC capacity is concentrated at the highest-level referral hospitals: 86% of referral hospitals have the full set of services, staffing, and equipment compared to 53% of maternity hospitals and 34% of local hospitals. No health centers are adequately staffed or authorized to offer basic PAC services under Indonesia’s current guidelines. PAC capacity at all levels of the health system increases substantially in hypothetical scenarios under which authorization to perform first-trimester uterine evacuation for PAC is expanded to midwives and general physicians practicing in health centers. In 2018, 88% percent of PAC patients were treated using dilation and curettage (D&C). Conclusions Offering first-trimester uterine evacuation for PAC in PONEDs and allowing clinicians other than Ob/Gyns to perform this procedure would greatly improve the capacity of Java’s health system to serve PAC patients. Increasing the use of vacuum aspiration and misoprostol for PAC-related uterine evacuation would lower the burden of treatment for patients and facilitate the task-shifting efforts needed to expand access to this life-saving service.

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“…Unsafe abortions are a threat to women's health. A recent study showed that there were 42.5 abortions per 1,000 reproductive-aged women (15-49 years) in Java (Giorgio et al, 2020). The abortion methods used in Java were surgical, medication, jamu (traditional Javanese herbal medicine), and others.…”

Section: Introductionmentioning

confidence: 99%

Side Effects of Injectable and Oral Contraceptive and Unintended Pregnancy Among Reproductive Women in Indonesia

Gayatri¹,

Irawaty²

2021

JBK

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Using contraception is essential for protecting women from the risk of unintended pregnancy. However, contraceptive discontinuation, caused by side effects of contraceptives or health problems, is still high. This study aimed to assess the impact of injectable and pill contraception discontinuation due to side effects or health problems on unintended pregnancy among women aged 15-49 years in Indonesia. This study is based on the 2017 Indonesia Demographic and Health Survey. As many as 1,613 women who discontinued their oral contraceptives and 5,022 women who discontinued their injectables were followed retrospectively. Pregnancy rates were tested for differences between categories using survival analysis. It was found that one year after stopping contraceptives due to side effects, almost 16-17% of oral/injectable contraceptive users were already pregnant. The pregnancy rate was higher among women aged less than 25 years. Unplanned pregnancy occurred more frequently among women who were not working than women who were working. Counseling services need to be strengthened by improving provider knowledge and skills to give comprehensive information including contraceptives’ side effects.

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Estimating the Incidence of Induced Abortion in Java, Indonesia, 2018

Cited by 18 publications

References 0 publications

Online Abortion Drug Sales in Indonesia: A Quality of Care Assessment

Online Abortion Drug Sales in Indonesia: A Quality of Care Assessment

Health system capacity for post-abortion care in Java, Indonesia: a signal functions analysis

Side Effects of Injectable and Oral Contraceptive and Unintended Pregnancy Among Reproductive Women in Indonesia

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