ABORSI YANG AMAN

(TIDAK MELANGGAR ETIK

KEDOKTERAN & DISIPLIN PROFESI)

H. M. Hadi S. FK Unisba

GLOBAL SITUATION (EVERY YEAR)

* 200 M PREGNANCIES 75 M UNWANTED - CONTRACEPTIVE FAILURE - NO CONTRACEPTION - UNMET NEEDS - ADOLESCENTS - INCEST/ RAPE
* WHO, 1997

UNWANTED
-

PREGNANCIES

ONE THIRD CONTINUED - TWO THIRD TERMINATED: 50 M, 20 M UNSAFE: DIED

USAFE ABORTIONS
OUTSIDE HEALTH CARE SYSTEM UNSKILLED PROVIDERS UNSANITARY CONDITIONS 95% DEVELOPING COUNTRIES 0.5 M DEATH

COMPLICATIONS OF UNSAFE ABORTIONS

HEMORRHAGE INFECTION INTRAABDOMINAL INJURIES * BOWEL INTESTINE * CERVICAL LACERATION * UTERINE PERFORATION LONG TERM: DISABILITY
* INFERTILITY * PELVIC PAIN

SPONTANEOUS ABORTIONS
* 15% OF ALL PREGNANCIES - 11.3 M ABORTIONS * NEED IMMEDIATE CARE - MEDICAL EVALUATION - PROMPT REFERRAL & TRANSFER - STABILIZATION & TREATMENT OF EMERGENCY CONTRACEPTION - UTERINE EVACUATION

MATERNAL MORTALITY DUE TO ABORTION

AFRICA ASIA LATIN AMERICA 13% 12% 21%

EUROPE
INDONESIA
WHO, 1998

17%
10 - 30%

MATERNAL MORBIDITY
HEALTH PROBLEMS SUFFERED BY WOMEN WHO SURVIVE PREGNANCY COMPLICATIONS: CHRONIC PELVIC PAIN PID, INFERTILITY ECTOPIC PREGNANCY PREMATURITY, ABORTION CERVICAL INCOMPETENCE OBSTETRICS FISTULA

MATERNAL MORBIDITY
- DETRIMENTAL TO SOCIALECONOMIC - DEVASTATING CONDITION EMOTIONALLY, SOC-EC
731000 ILLNESS/ DISABILITY PER MATERNAL DEATHS

POSTABORTION CARE
ICPD, CAIRO 1994 IPPF, MAURITIUS 1994 FWCW, BEIJING 1995 PAC, MOMBASA 2000
Postabortion Care is vital to womens health

COMPONENTS OF A COMPREHENSIVE PAC SERVICE Prevention of unwanted pregnancy Recognition of a complication Emergency treatment Provision of family planning counselling and services Linkage to other reproductive health services and womens health services Follow-up services

OBJEKTIF
MASALAH ABORTUS DI INDONESIA DAMPAK TERHADAP KESEHATAN IBU ASUHAN PASCAABORTUS MENCEGAH ABORTUS

DEFINISI ABORTUS
BERAKHIRNYA KEHAMILAN SEBELUM JANIN MENCAPAI BERAT 500 GRAM ATAU USIA KEHAMILAN KURANG DARI 20 MINGGU

UU Kes (lama) UU Kes (baru?)

Ps 15 Abortus medisinalis boleh Syarat: kehamilan bahayakan jiwa ibu, tlh dipertimbangkan o/ tim (dr., rohaniwan, jurist, psikolog), PTM dari ibu + suami, dilaks o/ Sp.OG, di sarkes yg punya fas d.p.l. hak hidup janin dlm rahim ibu (-), Hkm: janin dlm rahim blm = manusia Ps 80 Abort kriminalis 15 th penjara + denda < Rp. 500 jt.

Bbrp Pdpt ttg Aborsi

Hkm Ind.: manusia = individu stlh dilahirkan hingga meninggal. Abortus = ? Definisi medis: Abortus = penghentian kehamilan stlh tertanamnya ovum yg tlh dibuahi sblm usia janin 20 mg, Common law: sblm janin viable < 7 bl Keith Moore: s/d embrio berumur 14 hr PKBI: kehamilan yg berakhir spontan sblm usia 40 mg, Ulama syafiiah: sblm usia kehamilan 120 hr, Sblm gerak janin (+) / blm ada ruh Dll.

Ancaman Pidana Abortus

yg kena ancaman: bumil yg lakukan, dr/bidan/dukun yg mbantu, o. lain yg mendukung pelaksanaan Ps-ps KUHP yg berkaitan: 229, 341, 342, 343, 346, 347, 348, 349, Ps 349: tabib/bidan/juru obat yg mbantu lakukan kejahatan spt dlm psl 346, 347, 348, hukuman + & cabut izinnya, Ps 15 UU Kes (lama) 15 th penjara + denda < Rp.500 jt.,

Contoh Abortus Kriminalis

oleh dr. sering terjadi Oleh bidan (TV): di Tungal-Kediri, dg janji Rp.2 jt dg harapan akan terjadi perdarahan abortus, bidan menyuntikkan Oxytocin 2 X kpd bumil muda bumil ancaman pidana u/ bidan, Oleh tenaga non kes pidananya ?

Bbrp Norma Hukum terkait dg Hakhak Reproduksi Perempuan

KUHP UU No.1/1974: Perkawinan UU No.10/1992: Perkembangan Kpddkn & Pembangunan Kel Sejahtera UU No.23/2004: Penghapusan KDRT UU No.39/99: HAM UU No.23/2002: Perlind. Anak dll.

KEJADIAN ABORTUS SPONTAN

10 - 15 % (BILA SUDAH JELAS HAID) 50 - 60 % (TERMASUK TERLAMBAT HAID 1- 2 HARI)

RATIONALE (I)
MMR : 275 PER 100,000 (SDKI, 2004) - THE HIGHEST IN ASEAN 10 - 30 % MATERNAL DEATHS - ABORTION RELATED (WHO,2004) NO DATA ON ABORTION DEATH (DEPKES,2005)

PENERIMAAN KEHAMILAN KARENA KB GAGAL

Penerimaan (%) Cara KB
Sterilisasi Suntik KB Susuk KB IUD Pil KB Cara Sederhana

N
18 67 5 94 128 136

Menerima Menolak
11 22 40 32 13 52 89 77 60 62 78 43

Ragu
0 1 0 6 9 5

Total

448

31

62

RATIONALE (II)
MWRA: 50 M(BKKBN,2008) CONTRACEPTIVE PREVALENCE: 60% (30 M) CONTRACEPTIVE FAILURE: 4-5% 1.2 - 1.5 M PREGNANCIES 60% INDUCED ABORTION 0.72 0.90 M ABORTION

5 Causes For Contraceptive Failure

1. Failure to follow the instructions 2. Contraceptives are used inconsistently. 3. Condom damage include improper use, inadequate use of a water-based lubricant, using condoms past the expiration date, improper storage.. 4. Contraceptive failure may also happen in women taking certain drugs or herbs. 5. Believing that you are not in your fertile period is a huge mistake that can potentially lead to an unplanned pregnancy.

Unmet Need for Contraception Many women who are sexually active would prefer to avoid becoming pregnant but nevertheless are not using any method of contraception. These women are considered to have an "unmet need" for contraception

RATIONALE (III)
UNMET NEEDS : 9 % - 4.5 M MWRA 60% Pregnant 1.8 M PREGNANCIES
30% INDUCED ABORTION

0.54 M ABORTION

Reasons for Unmet Need

Difficulties with access to and quality of family planning supplies and services; Health concerns about contraceptives and side effects; Lack of information; Opposition from husbands, families, and communities; Little perceived risk of pregnancy

RATIONALE (IV)
ADOLESCENT GIRLS (10-19 years):

64 M

(BKKBN, 2008) 10-50% Sexually Active

ADOLESCENT PREGNANCIES ? 60% x 10% x 64 M = 3.84 M

ABORTION (?) 60% x 3.84 M = 2.3 M

Adolescent pregnancy
Many adolescent girls between 15 and 19 get pregnant About 16 million women 1519 years old give birth each year, about 11% of all births worldwide. Ninety-five per cent of these births occur in low- and middle-income countries. The average adolescent birth rate in middle income countries is more than twice as high as that in high-income countries, with the rate in lowincome countries being five times as high. The proportion of births that take place during adolescence is about 2% in China, 18% in Latin America and the Caribbean and more than 50% in sub-Saharan Africa. Half of all adolescent births occur in just seven countries: Bangladesh, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Nigeria and the United States.

Adolescent pregnancy is dangerous for the mother

Although adolescents aged 10-19 years account for 11% of all births worldwide, they account for 23% of the overall burden of disease (disability- adjusted life years) due to pregnancy and childbirth. Fourteen percent of all unsafe abortions in low- and middle-income countries are among women aged 1519 years. About 2.5 million adolescents have unsafe abortions every year, and adolescents are more seriously affected by complications than are older women. In Latin America, the risk of maternal death is four times higher among adolescents younger than 16 years than among women in their twenties. Many health problems are particularly associated with negative outcomes of pregnancy during adolescence. These include anaemia, malaria, HIV and other sexually transmitted infections, postpartum haemorrhage and mental disorders, such as depression. Up to 65% of women with obstetric fistula develop this as adolescents, with dire consequences for their lives, physically and socially.

Adolescent pregnancy is dangerous for the child

Stillbirths and death in the first week of life are 50% higher among babies born to mothers younger than 20 years than among babies born to mothers 2029 years old. Deaths during the first month of life are 50100% more frequent if the mother is an adolescent versus older, and the younger the mother, the higher the risk. The rates of preterm birth, low birth weight and asphyxia are higher among the children of adolescents, all of which increase the chance of death and of future health problems for the baby. Pregnant adolescents are more likely to smoke and use alcohol than are older women, which can cause many problems for the child and after birth.

Adolescent pregnancy adversely affects communities

Many girls who become pregnant have to leave school. This has long-term implications for them as individuals, their families and communities. Studies have shown that delaying adolescent births could significantly lower population growth rates, potentially generating broad economic and social benefits, in addition to improving the health of adolescents.

ABORTUS DI INDONESIA
SPONTAN : 10 - 15% DARI 6 JUTA KEHAMILAN = 600 - 900.000

BUATAN : 0.7 + 0.5 + 2.3 M = 3.5 M

PELAKU ABORTUS DI PERKOTAAN DAN PEDESAAN

PELAKU ABORSI KOTA KURANG MAMPU MAMPU DESA KURANG MAMPU MAMPU

Dokter Bidan/ Perawat Dukun Sendiri

57 16 19 18

24 28 25 24

26 26 31 17

13 18 47 22

Sumber: International Family Planning Perspectives, Juni 1997

CARA ABORTUS
CARA
KURET ISAP D/C PG/SUNTIK OBAT JAMU PIJAT LAIN-LAIN

TENAGA MEDIK DUKUN/ SENDIRI

91% 30% 4% 8% 33% 79% 17%

PROFIL ABORTUS
PROFIL
MENIKAH BELUM MENIKAH
- AKAN MENIKAH: 45% - BELUM MENIKAH: 55%

%
89% 11%

UMUR: 19 20 29 30 39 40 15% 51% 26% 8%

STATISTICAL PROFILES, 1994

IPC
BRUNEI INDONESIA VIETNAM PHILIPPINES MALAYSIA THAILAND SINGAPORE
Unicef, 1996

LE TFR MMR
76.3 64.5 67.3 68.2 73.0 71.8 77.4 3.1 2.9 3.9 3.9 3.6 2.1 1.7 60 450 120 100 59 50 10

14,240 880 190 960 3,520 2,210 23,360

DAMPAK UNSAFE ABORTION

Wilayah AKI akibat Unsafe Jumlah Jumlah Kasus Unsafe Unsafe Abortion Kematia fatal Abortion AbortIon per 1000 n akibat per 100 per Unsafe Unsafe (per Wanita 100.000 Abortion 1000) 15 49 Abortion Kelahiran Hidup 2340 17620 3740 9240 260 4620 2080 8 17 26 12 2 41 30 600 69000 23000 40000 100 6000 500 4 55 83 47 2 48 10 0.03 0.40 0.60 0.40 0.04 0.10 0.03 Risiko Kematian

Negara Maju Negara Berkembang Afrika Asia Eropa Amerika Latin Unisoviet (terdahulu)
Sumber: WHO 1995

1 per 3700 1 per 250 1 per 150 1 per 250 1 per 2600 1 per 800 1 per 3900

UNSAFE ABORTION
Adalah abortus yang dilakukan oleh orang yang tidak terlatih/ kompeten sehingga menimbulkan banyak komplikasi bahkan kematian.

CIRI-CIRI UNSAFE ABORTION

a. Membahayakan b. Kurang Pengetahuan c. Kurang Fasilitas d. Biayanya Selangit e. Terlambat f. Masabodoh g. Tanpa Kontrasepsi Pasca Abortus

 from public health point of view the most important thing of abortion is not whether it is legal or illegal but whether it is safe or unsafe
Diczfalusy, 1998

Lawful termination (1)

A pregnancy could be terminated lawfully. The grounds for lawful termination were that the doctor honestly believed, on reasonable grounds, that the termination was necessary to preserve the womans life or to protect her from serious danger to her mental or physical health, and that the danger of the termination was not out of proportion to the danger being averted.

Lawful termination (2)

The circumstances in which an abortion could be performed lawfully i.e. where the continuance of the pregnancy involves greater risk to the life of the woman or greater risk of injury to her physical or mental health, than if the pregnancy were terminated. This requires a thorough counselling The abortion must be performed in a prescribed hospital.

UU No. 36/2009: Kesehatan

Pasal 75 (1) Setiap orang dilarang melakukan aborsi (2) Larangan pd ayat (1) dpt dikecualikan: a. Keda ruratan medis yg mengancam nyawa ibu dan/atau janin, peny. genetik berat/cacat bawaan shg menyulitkan hidup bayi di luar kandungan; b. Kehamilan akibat perkosaan yg menyebabkan trauma psikologis berat / in eenzeerernstig overspannings toestand (doktrin yg tdk disebut dlm UU Kes lama) (3) Tindakan pd ayat (2) dilakukan stlh konseling dg konselor yg kompeten (4) Kttn lbh lanjut diatur dg PP

Sblm UU No. 36/2009: Kesehatan

Ps 15 UU No. 23/1992 ttg Kes: (1) Dlm keadaan darurat utuk menyelamatkan jiwa ibu hamil dan atau janinnya dpt dilakukan tindakan medis ttt. (2)
Catatan: Cacat hukum, karena pengguguran kandungan diartikan sebagai upaya menyelamatkan jiwa ibu dan atau janin. Pengguguran kandungan tidak pernah akan dapat menyelamatkan janin, malah sebaliknya.

 Abortion is a medical procedure and should be treated accordingly. If the law is to be changed as part of the Model Criminal Code process, that change should be to remove abortion from the criminal code altogether. Remember the adage: Princeps legibus solutus est.

HAMIL TIDAK DIKEHENDAKI 60 - 70 % ABORTUS MENCEGAH ABORTUS

MENCEGAH HAMIL TIDAK DIKEHENDAKI KONTRASEPSI, TERMASUK

KONTRASEPSI DARURAT

Lafal Sumpah Dokter 1993

Saya akan menghormati kehidupan insani sejak mulai dari saat pembuahan. Dalam menunaikan kewajiban terhadap penderita, saya akan berikhtiar dengan sungguh-sungguh supaya saya tidak terpengaruh oleh pertimbangan Keagamaan, Kebangsaan, Kesukuan, Politik, Kepartaian atau Kedudukan Sosial

FERTILISASI: 1/3 DISTAL TUBA

10 - 15% ABORTUS SPONTAN

(JELAS HAMIL)

60 - 70% ABORTUS SPONTAN

(TERMASUK TERLAMBAT 1-2 HARI)

BAYI TABUNG : FERTILISASI DI TABUNG EMBRYO TRANSFER EMBRYO DI TABUNG PECAH = ABORTUS ?

KESIMPULAN
ABORTUS MASALAH KESEHATAN MASYARAKAT MASYARAKAT PERLU DITOLONG PERLU RAMBU-RAMBU LAFAL SUMPAH DOKTER: KEHIDUPAN = PEMBUAHAN

Trima kasih