"Welcome to Indonesia’s abortion underground.
Our brief encounter revealed that despite being highly restricted and mostly illegal, it was fairly easy for an Indonesian woman of middle- or upper-class means to obtain what would probably be a safe abortion from a competent medical professional.
Despite this generally benign experience in Indonesia and an equally improbable one in the Philippines — more on that later — most of the abortions in these two countries are considered unsafe. The World Health Organization estimates 14 to 16 percent of the maternal deaths in both countries are the result of botched abortions; in addition, tens of thousands of women are hospitalized annually for complications related to unsafe abortions.
Indonesia, with an estimated 2 million abortions a year — about 37 for every 1,000 women of child-bearing age — is second only to Vietnam in the percentage of pregnancies that end in abortion. Among Muslim nations — and Indonesia is the world’s most populous Muslim nation — it appears to have the highest rate of abortion. The Philippines also has an alarmingly high abortion rate — about 600,000 a year, or 27 per every 1,000 women of child-bearing age — but one that is in line with other Catholic countries in the developing world, according to research from the Guttmacher Institute and local NGOs.
In a region that already suffers from some of the highest abortion rates in the world, predominantly Muslim Indonesia and its neighbor, the profoundly Catholic Philippines, offer a set of instructive case studies on the failure of public policy dictated by religious teachings to dent the abortion rate or provide a viable alternative. In the Philippines, lawmakers have passed legislation that would make modern contraceptives available to millions of poor women across the archipelago nation, an initiative that would almost certainly result in a dramatic decrease in the number of abortions. But the Catholic Church, which battled the law for 14 years, continues to block its implementation because of its opposition to birth control. Meanwhile, in Indonesia, where 86 percent of the population identifies as Muslim, religious authorities have signaled their measured acceptance of abortion, but politicians uncomfortable with the social taboos surrounding abortion have been unwilling to fix the country’s punitive but unenforced anti-abortion laws.
Ruth Benedict, the eminent anthropologist who studied under Franz Boas and mentored Margaret Mead, coined the terms “shame culture” and “guilt culture” to explain certain differences between Asian societies and the West. According to Benedict, Asian societies tend to rely on the threat of public shame as the primary mechanism for maintaining social order and good behavior; in the West, social order is maintained by the notion of “sin” and by constantly reinforcing a sense of individual guilt for transgressions. In Indonesia, shame culture most strongly manifests itself in avoidance or denial of taboo subjects. Indonesians — women and men — seemed to become physically uncomfortable when I brought up the subject of abortion. They avoided eye contact. They changed the subject. Women who have had “a certain medical procedure” rarely admit it — not so much because it is illegal and subject to criminal sanctions, explains demographer Terence Hull, but because of the shame factor.
"In studies in the 1980s, I was impressed by the large numbers of women who were quite committed to terminate their pregnancies and felt no guilt or concern about the consequences, but who went to great lengths to ensure that their activities were not revealed to family members or the public," said Hull, a professor at the Australian National University who has done extensive research in Indonesia.
"You find that people avoid talking about it, or they talk about it in a very disengaged way," he told me. "The culture simply does not want to discuss these moral issues."
No surprise then that official abortion figures collected by government health authorities in Indonesia are preposterously low. Few people outside the fairly limited circles of public health professionals and abortion rights activists are aware of the magnitude of the problem in Indonesia. And the country’s political leaders seem relieved to keep it that way.
Abortion is not a hot-button issue political here as it is in the Philippines. “It’s just not part of our politics,” said Irwan Hidayana, who heads the Center for Gender and Sexuality Studies at the University of Indonesia. “Most people believe that abortion is something shameful, and you will not find too many politicians willing to challenge the public morality on this,” he told me. “Any politician who promoted sex education and safe abortions — he would be a loser for sure.”
In almost every conversation about abortion and maternal health that I had in Indonesia, the phrase “free sex” seemed to pop up. To Indonesians, the words encapsulated everything negative they had gleaned from TV or films about the presumed licentiousness of the West, especially the United States. Even women who agreed that abortion restrictions should be eased told me that they believed sex education was tantamount to teaching children how to have free sex, and that providing access to contraceptives and safe abortions would merely grease the slippery descent to promiscuity for these young people. The conventional wisdom here holds that promiscuous young women are the ones having all the abortions.
Actual studies tell a different story: Most of the women who have abortions in Indonesia — about two-thirds — are married and nearly half already have had at least two children. Their pregnancies are unintended and are generally blamed on an unmet need for modern contraceptives. The studies also show that very few of those seeking abortions are under age 20.
But actual studies are no match for the powerful shaming mechanisms deeply embedded in this society. Schoolgirls who become pregnant are promptly expelled in what seems to be a universal and mostly unquestioned practice (there are rarely consequences for the boy involved). In the national press, sensationalized “scandal” stories about raids on abortion clinics are far more common than serious reporting on a major public health crisis. And for any woman who has had an abortion — should her secret ever become known — she would likely be labelled “promiscuous,” even “murderous.” If she is single, her chances of marriage will be greatly diminished. Even more, she will be stigmatized for bringing shame to her family. This is because it will be assumed that she has gone against the will of her father or husband, thereby dishonoring them.
A lot of this can be explained by the deeply embedded attitudes one would expect to find in any patriarchal and paternalistic society. It’s not all about religion or about shame culture. Still, it sounded strange to hear young, educated and thoroughly cosmopolitan women say that they do not believe their bodies “belong” solely to them. But here was Diana Pakasi, a researcher in the University of Indonesia’s gender studies program, pointedly explaining how various local NGOs, supported by some of the most prominent women’s advocacy organizations in the world, often made the mistake of trying to impose “Western values” without fully considering the power of deeply held Indonesian values, a mistake that led to bruised feelings and ineffective reproductive health programs.
'In our culture, you have to consider what your father says, what your husband and your extended family say. You have to consider what your religion says,” Pakasi told me. “In all aspects of your life — how you dress, your marriage, your relation to your husband — always you have to listen to what the family says.'
Or Tunggal Pawestri, one of the leading feminist voices in Indonesia, put it: ‘Even within women’s groups, you find that [support for abortion rights] is not really solid. There are so many who think, ‘My body is not my own. It belongs to my father, my husband, my family.’”