Indonesian doctors have been persecuted for providing safe abortions for almost a century
Terry Hull and Ninuk Widyantoro
Indonesian women need reliable access to safe abortions
In November 2000 activists pushing for abortion law reform were shocked by the news that one of their colleagues had been arrested at his clinic on charges of carrying out abortions. It was virtually unheard of for authorities to arrest a specialist obstetrician gynaecologist without evidence of harm to a patient or complaint from an aggrieved husband.
The person in question, Dr Sarsanto Sarwono, is the son of two of the pioneers of the Indonesian family planning movement and was an officer of the Indonesian Association of Obstetricians and Gynaecologists (POGI). As he sat in the police station patiently answering the questions of arresting officers, his interrogators became more and more unsettled by the string of professors, civil servants, activists and former patients who came or called demanding to know what was going on. Clearly the police were caught in a situation they little understood.
Within days the matter was resolved. It appeared that a disgruntled university colleague had urged the police to arrest Sarsanto. It took only a short time for senior police to see that their underlings had been used in a personal vendetta. The event mobilised reproductive health activists and forged them into common cause with police, legal experts and key health officials. It was clear that the vagaries of the legislation concerning abortion served no good purpose. In fact, abortion laws had long been misused in Indonesia. Since the early twentieth century, officials have chosen not to identify and punish all instances of the 'crime' of abortion. Instead, laws have been used highly selectively as a means of persecuting individuals.
Dr Houtman's story
The risk of political persecution faced by doctors prepared to provide safe abortions is nowhere clearer than in the story of the arrest and imprisonment of Dr Suzanne Houtman, a pioneer in the struggle for women's reproductive rights. Suzanne, a woman of Indonesian-Dutch parentage whose father was a rich spice trader in Batavia, was among the first qualified Indonesian female doctors when she gained her medical degree in 1908 in Amsterdam. While at university she became involved in the political activities of the Indonesian expatriate community and married Sam Ratulangi, who later became one of the heroes of the Indonesian struggle for independence. In Holland, the couple wrote extensively on progressive issues. Suzanne wrote on women's rights under the name S. Ratulangi. After their return home they moved around the country promoting political consciousness and irritating the colonial government. Secret dossiers on Sam and Suzanne reveal that they were considered security risks and were constantly under surveillance.
They were living in Sulawesi where Suzanne had established a tuberculosis hospital and Sam was teaching high school when Dutch officials spread rumours of Sam's infidelity, and the marriage broke up, forcing Suzanne to leave her two children and return to her family home on Java. She opened a medical practice in a large house with airy pavilions where patients could be healed in comfort and safety. The practice flourished and before long she married again, this time to Koenraad Schelts van Kloosterhuis, a Dutchman who had been a planter but had taken up a job as a district level official in West Java. After the birth of two more children, that relationship broke down, possibly because Kloosterhuis was transferred to the eastern islands and Suzanne wanted to keep up her medical practice in Java.
Suzanne refused to treat Dutch families or any men at her clinic, concentrating instead on the problems of indigenous women and children. Her daughter Madelon still remembers the bustling atmosphere of the household, with Sundanese, Javanese and Chinese families coming and going. But everything changed in 1933 when Madelon's mother told her children that she would have to go away for a while and they would be cared for by their aunt. She didn't know at the time that her mother had been arrested for carrying out abortions. Suzanne Houtman was tried and sentenced to five years in the women's prison in Semarang.
Really about abortion?
In the Netherlands Indies, debates about abortion raged, while each year thousands of women died either in childbirth or as a result of attempts to terminate a pregnancy. Abortion was criminalised in 1918, 37 years after it became illegal in the Netherlands, but it was never rare. In fact, both terminations performed clandestinely by doctors or by traditional healers were widespread across the archipelago.
To her family, friends and neighbours, Suzanne must have appeared reckless in her insistence on providing safe abortions
So why was Suzanne arrested when so many other doctors carried out abortions with relative impunity? Only careful study of the archives and newspapers of the day could really explain this, but a number of factors were probably in play. Suzanne was a woman, of mixed racial background and a prominent member of society from a wealthy family. In both her marriages and in her young adult life she had demonstrated a rebellious streak, which often brought her into direct confrontation with conservative leaders. Last, but not least, in 1933 she no longer had a protector. She was divorced from both a prominent nationalist and a minor Dutch official and was running her clinic on her own. To her family, friends and neighbours, she must have appeared reckless in her insistence on providing safe abortions to poor local women. To those who persecuted her, she was a threat to the rightful order of the colonial state.
Echoes of the past
Suzanne Houtman's case is not remembered by current generations of doctors. But the dynamic responsible for her arrest continues to play out across the archipelago. The police, the press and politicians condemn abortion in moralistic terms and charge individuals when it suits them, while over a million abortions are carried out in Indonesia each year. Although the criminal code is often invoked against backyard practitioners who lose a patient through bleeding or infection, the numbers of women losing their lives each year far outnumbers the number of reckless practitioners who are charged. Meanwhile, however, doctors with enemies or jealous colleagues live with the constant threat of trumped up charges and personal attacks on their integrity.
Abortion is now one of the safest of all medical procedures. But Indonesian women will continue to die as long as the legal provisions used to harass doctors are there to be invoked. Within weeks of Sarsanto Sarwono's arrest, the activists totally changed their attitude toward abortion laws. Where before they had hoped to persuade the Department of Health to ignore the strong anti-abortion language of the Criminal Code and the vague double-talk of the 1992 Health Law, now they declared that nothing short of wholesale reform would protect patients and doctors from arbitrary interventions by the police and courts.
Over the eight years since advocates put the issue on the legislative agenda, upwards of ten million abortions have been carried out, most under very dangerous conditions. Multi-millions of doses of herbal medicines designed to bring on a late period have been sold to women who wish to terminate their unwanted pregnancies. And an unrecorded and unmeasurable number of women have died as a result of unsafe abortions. It is time for the nation to wake up to the need for legal, medical and social reform.
Terry Hull (firstname.lastname@example.org) is Professor of Demography at the Australian Demographic and Social Research Institute, Australian National University.
Ninuk Widyantoro (Ninuk_who@yahoo.co.id) is a practising psychologist and women's reproductive health advocate in Jakarta.