This article was published in Medical Abortion Matters (May 2013)
In 2008, Inna Hudaya helped found Samsara, an organization in Indonesia dedicated to promoting sexual and reproductive health and rights (SRHR) education and information, including safe abortion. One of Samsara’s main programs is a national safe abortion hotline.
In a recent interview, Hudaya explained the hotline previously focused on helping women find safe abortion providers, but the increasing availability of misoprostol has revolutionized how she and her colleagues assist women.
Why did you decide to start Samsara and what is its mission?
Hudaya: I had an unplanned pregnancy 10 years ago. I was young, lacked information about safe sex, had no access to contraception and no support in deciding anything about my sexual and reproductive health choices. Without understanding my choices and the consequences, I decided to have an abortion when I was six weeks pregnant. I wish I had reliable information and support—then I wouldn’t have had to deal with unnecessary depression afterward. I was emotionally, financially and socially bankrupted by fear and stigma.
That’s why I decided to start Samsara. Originally it started as a blog where I published my abortion story and translated many articles about abortion into Bahasa Indonesia, the national language. I wanted to make sure that women have enough reliable information to make informed decisions. In less than a year, I had received many emails from women in Indonesia who experienced the same situation I did; that’s how Samsara grew. The mission is to provide reliable information and support for women with unplanned pregnancies and for women who have had abortions. We also strive to bring the “A word” into public discussion. For us, sharing is empowering, and the personal is political.
Editor’s note: To see Hudaya tell the story of how she founded Samsara, watch this video.
What is the legal situation regarding abortion in Indonesia? Do you have any problems with the law when Samsara offers counseling about abortion?
Abortion is illegal except to save the life of the woman, and in cases of fetal impairment or rape. But even though abortion is legally restricted, it is actually very common in Indonesia. So far we have had no problems with the law, probably because Indonesia’s government doesn’t consider sexual and reproductive health an important issue—they just don’t care about it.
Where and how does your hotline operate?
It’s national, so we operate all over Indonesia. And we sometimes also receive emails and calls from Southeast Asia—places like Malaysia, the Philippines, Thailand and India. We offer counseling, and the phone hotline is one of the media we use, but we also have a website with an online form women can fill out and submit to us. In addition, women can email us or come visit our office if they live in our city. We respond to emails 24 hours a day, but the hotline is open Monday to Friday.
More than 80 percent of our callers find out about us on the Internet, so when we started the hotline we did not do much promotion—we only used social media for dissemination. I started my blog in 2007 because there’s not enough reliable information in Bahasa Indonesia (our language) on the Internet. But if you Google “abortion” in Bahasa, there are so many search results. In the last few years, my goal has been for Samsara to show up in the first page of Google search results—which it now does. It’s quite interesting because from 2007-2009 we found that most women found us by searching the keyword “abortion,” but since 2009, most people find us with the search terms “safe abortion” or “where to find safe abortion.”
How does Samsara incorporate medical abortion (MA) into its work?
Samsara’s hotline started in 2008. At that time we helped women access surgical abortion by mapping out the clinics that would provide abortions, advising on how to deal with doctors and how not to get cheated, etc. The biggest challenge was that only if you are educated, rich and live in a big city can you access those clinics easily. It breaks my heart that most women have had to go through discrimination and violence to access safe abortion.
We integrated MA into the hotline in 2011. We were in contact with Women on Web, and they came to Indonesia and gave us training on medical abortion, so that’s how we got started. And I would say that MA is revolutionary. It has had a big impact for women in general and for Samsara specifically. Now we receive fewer stories from our clients about how they went through discrimination and violence to access abortion. With MA, women become the doctor for themselves; they can do it at home safely and fully have control over it.
For a country like Indonesia, where most women aren’t well informed about their health and bodies, MA also educates women to be more aware of the changes and signs in their bodies during and after the abortion. For most clients, this experience is a starting point from which they begin to exercise knowledge about their own bodies.
Does MA now comprise the majority of your counseling?
Yes, it’s mostly medical abortion now. Most women with unplanned pregnancies who contact us are unmarried and have mid- to lower-level incomes, so they don’t have access to contraception and that’s why they’re facing unwanted pregnancy. That’s also why most of them choose medical abortion—it’s cheaper. Privacy is also a factor. In a country where abortion is legally restricted, privacy and security are the most needed.
How do you advise women to access MA in Indonesia?
Women can access misoprostol in pharmacies as a medicine for gastric ulcers. Usually it’s easier to access in small cities and drug stores as opposed to big cities and big pharmacies. Misoprostol is also available over the Internet, but this is risky. Many women report they get cheated; they send money but the medicine never arrives, or the medicine arrives but has no effect.
We tell women the highest price that is acceptable for a seller to charge; we also tell women the name of the brands to ask for. One barrier is that if you go to a pharmacy and say you need misoprostol for a gastric ulcer, the maximum amount they will give you is three or four pills, so women have to find at least three pharmacies and get four pills from each pharmacy—or use the same pharmacy but first the woman visits, then maybe her boyfriend, and then perhaps a friend. So it’s quite tricky.
Another problem is medical abortion protocol. Many drug sellers on the Internet do not provide women with the right protocol. And for doctors, many of them give women only enough misoprostol to start a miscarriage so the women will come back to them and pay more for a uterine evacuation. It’s legal for the doctor to do this because abortion is legal if the woman presents with a miscarriage. So doctors know how to use medical abortion, they just don’t want to give the right protocol.
The availability of misoprostol helps women access safe abortion, but reliable information and counseling take an important role in ensuring that women know how to do it by themselves. In my opinion, the definition of safe abortion needs to be changed: It’s the combination of a woman’s choice, reliable information and medical treatment only if needed.
Can you explain further what you mean when you say the definition of safe abortion needs to be changed?
Before I always thought that safe abortion is like everyone says: performed by a doctor in a clinic, and then it’s safe. But our experience shows that it’s safe for women to do it themselves as long as they have reliable information. Sometimes, even if a woman goes to the doctor, he or she will not give you any information about what is happening in your body. So for me, with medical abortion, you give back this authority to the hands of women. They can become the doctor for themselves as long as they have the information, the right protocol, and knowledge of normal side effects and when to seek medical treatment. Women are very smart, strong and capable of doing this. If they don’t need medical treatment, why should they pay for it?
In the future, what do you hope Samsara will accomplish?
I wish to see more women able to access our hotline. Our biggest challenge is to reach more women in rural areas who do not have access to the Internet.
I also want to see Samsara be a model for MA hotlines. Working on an abortion hotline is not easy, and people who do this work are at risk of burning out. It takes hard work and guts to do it. But it’s very powerful because hotlines can reach the grassroots. Therefore, I want to create a system that can help hotlines work more effectively and efficiently and place fewer burdens on the counselors.
I’m working now on the concept of a hotline model that includes how to manage resources and how hotlines can work more efficiently and effectively within a tight budget, and hopefully this can be helpful for other hotlines. We have shown the world that funding and resources are not limitations when you really believe in something. Most women who work on hotlines have passion for and interest in this issue, but the job is quite difficult. .
Do you have plans to advocate changing Indonesia’s abortion law?
I do believe in advocacy, but pregnant women cannot wait for that. Pregnant women cannot wait for the law to change, so I think hotlines can offer the change they need. Hopefully we will see law change in the future, but I’m not thinking it will change soon. I believe advocacy to change the law must go along with advocacy to change society. What we do now is work to change society’s perspective on abortion. We talk about abortion in public, about abortion stigma and how this can affect women, their families and society. Even if the law changes, if society is not ready for it, then there will be no true change. I think it’s better that other organizations and networks work to change the law, and for Samsara to work to change our society—so when the law changes, society is open and ready for that. That would be great.
Source : Ipas