Estimating the Incidence of Induced Abortion in Java, Indonesia, 2018
In Indonesia, maternal mortality is high and abortion is restricted. Reliable information on induced abortion is needed; however, the difficulty of measuring abortion in settings where it is legally restricted and highly stigmatized calls for innovation in approaches to measuring abortion incidence.
The data were from three original surveys conducted in Java among health facilities, knowledgeable informants and women aged 15–49, fielded in April 2018–January 2019. Two methods were used to estimate the one-year induced abortion incidence rate in Java: the standard Abortion Incidence Complications Method (AICM) and a modified AICM. Each method was evaluated on the basis of data quality, and what is known about sexual and reproductive health indicators related to abortion rates, to determine which performed best in measuring abortion incidence in Java.
Estimates of complications resulting from induced abortion from knowledgeable informants and the women differed substantially. The modified AICM produced an estimate of 42.5 abortions per 1,000 women aged 15–49, while the standard AICM estimate was lower (25.8 per 1,000). A comparison of the distribution of abortion methods used revealed that knowledgeable informants believed abortion was less safe than indicated by women's reports of their own experiences. Therefore, the standard AICM likely underestimates abortion.
The modified AICM performed better than the standard AICM and indicates that abortion is common in Java. Increased access to contraceptives and high-quality postabortion care is needed. Future research should investigate the safety of abortion, especially with respect to self-managed abortion.
Margaret M. Giorgio is senior research scientist; Melissa Stillman is senior research associate; Jesse Philbin is senior research associate; Susheela Singh is distinguished scholar and vice president for global science and policy integration; and at the time of this work, Gilda Sedgh was principal research scientist—all at the Guttmacher Institute, New York. Budi Utomo is senior researcher, Nugroho Soeharno is professor and Besral is professor—all at the Faculty of Public Health, University of Indonesia, Jakarta. Riznawaty Imma Aryanty is national program officer for reproductive health, UNFPA Indonesia, Jakarta.