Aborsi adalah suatu tindakan untuk menghentikan kehamilan tidak diharapkan. Aborsi tidak aman mempunyai risiko terhadap komplikasi seperti sepsis, perdarahan, traumahobekan alat kandungan atau keracunan yang dapat berakhir dengan kematian. Hal tersebut dapat dicegah melalui peningkatan akses pelayanan kontrasepsi yang aman, pelayanan kegawat daruratan kebidanan esensial termasuk pelayanan aborsi aman, non diskriminatif dan menghormati hak klien.Ketidakpastian hukum di Indonesia tentang aborsi menyebabkan perempuan secara diam-diam, melakukan aborsi dengan caranya sendiri atau meminta bantuan orang lain, tanpa memperdulikan pelayanan tersebut aman dan memenuhi standar medis atau tidak. Demikian pula bahwa ketiadaan perlindungan hukum, justru memberikan peluang bagi pihak-pihak terteniu memanfaatkan keadaan tersebut untuk kepentingan pribadi.Penelitian kualitatif dengan melakukan wawancara mendalam kepada 8 orang informan yaitu perempuan yang meminta layanan aborsi di klinik Raden Saleh pada bulan November - Desember 2004, dengan berbagai variasi karakteristik, dengan teknik penelusuran berantai (snowballing), mencoba memberikan informasi tentang alasan psikososial penggunaan layanan aborsi yang dapat digunakan sebagai lesson learned dalam pengembangan program Keluarga Berencana, upaya advokasi serta memberikan dukungan aborsi aman.Hasil penelitian menunjukkan bahwa semua informan mengatakan tempat layanan aborsi aman hanya dapat diperoleh di klinik Raden Saleh, karena dilakukan oleh tenaga kesehatan yang profesional sesuai dengan standar pelayanan kesehatan, rasa aman dan percaya karena status klinik pemerintah dan sebagai bagian dan RSUPN. Dr. Cipto Mangunkusumo. Disamping biaya yang lebih murah, kedekatan emosional dengan tenaga kesehatan di klinik, adanya pengalaman aborsi yang lalu baik oleh diri sendiri maupun orang lain, dirujuk dan pemberian informasi oleh dokter dan bidan menambah keyakinan dan rasa percaya untuk meminta layanan aborsi aman.Semua informan juga mengemukakan telah melakukan aborsi sendiri sebelum meminta bantuan kepada dokter, bidan dan klinik Raden Saleh. Upaya ini yang sering dilakukan adalah dengan minum jamu dan obat yang diperoleh di took/warung obat, Tindakan ini termasuk aborsi tidak aman yang membahayakan keselamatan jiwa.Adanya dukungan, dari berbagai pihak merupakan faktor yang mempermudah informan mencapai akses pelayanan aborsi aman. Dukungan tersebut meliputi ketersediaan biaya tindakan, diantar dan ditemani, penjelasan dan saran dari petugas kesehatan. Berbagai faktor yang menghambat seperti ketidakcukupan biaya, rasa berdosa yang mendalam, depresi, bidan yang tidak bersedia membuat surat rujukan, adanya calo yang di depan klinik Raden Saleh. Kurangnya pengetahuan tentang kehamilan dan aborsi hambatan lain yang cukup banyak menyebabkan keterlambatan penanganan kehamilan tidak diharapkan. Tidak jarang informan yang kurang memiliki informasi jelas dibawa oleh calo ke tempat pelayanan lainnya. Stigma sosial terhadap klinik Raden Saleh sebagai tempat aborsi menimbulkan rasa malu untuk datang ke klinik.Sebagai kesimpulan bahwa untuk mendukung layanan aborsi aman perlu dilakukan pengembangan program peningkatan akses aborsi aman misalnya pendidikan kesehatan reproduksi, penyebaran informasi program pelayanan kesehatan Raden Saleh, peningkatan program konsultasi dan konseling, pengembangan media informasi, penyusunan prosedur tetap penanganan kehamilan yang tidak diharapkan diantaranya kebijakan pemberian ph kontrasepsi darurat yang non diskriminatif sehingga diharapkan dapat menekan terjadinya aborsi.Daftar Pustaka 40: (1995 - 2003)

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Psychosocial Reason of Using Safe-abortion Care at Raden Saleh Clinic of Dr. Cipto Mangunkusumo of National General Hospital Center- Jakarta, 2004Abortion is a common procedure for terminating pregnancy when it's unwanted. In Indonesia it is predicted that 2 million cases per year or 30 percent from all pregnancies are unwanted (Utomo et. al., 2001). It is well known that unsafe abortion can lead to severe risk of illness, which can also cause to the death. However, the situation above can be prevented by several conditions, such as: increasing the access on safe contraception services, essential emergency obstetric care -including a non-discriminative on safe abortion care-, and respect the client's reproductive rights.

An uncertain on law of abortion in Indonesia leads some women to do clandestine on terminating their pregnancy, whereas its terminating by themselves or asking someone else to do the termination. without any consideration on the guarantee of medical standard procedures. Moreover, without any legal protection on the client makes some people are taking some advantages for the situation.

A qualitative study has been conducting by interviewing to 8 women that seeking the abortion care at Raden Saleh Clinic on November [o December 2004. The study was using the snowballing technique in trying to seek the information on how psychosocial reason on using abortion care can be use as lesson learned on developing family planning program, and the advocacy to and support the program on safe abortion care.

The study shows that all informants stated that only at Raden Saleh Clinic they can access to safe abortion care, because the clinic is offering a skilled health providers, that assure to carried the abortion procedure with the health service standard. They also said that they feel secure to do abortion at the clinic due to that status of the clinic as government owners and as part of the Dr. Cipto Mangunkusumo National General Hospital. Other reasons that strongly influence them to seek the abortion care at the clinic are due to the low cost, strong emotional bond between them and health providers, past experience on self-abortion or unsafe-abortion, and the information given by doctors or midwives.

All informants also affirmed that they do self abortion before they seek for help for treatment to the doctors, midwives, and Raden Saleh Clinic. The usual self-abortion they do was taking traditional herbs or potion that easily bought from drug store or traditional pharmacy This situation can make an unsafe abortion and life threatened.

Some supporting factors lead the informant easily to get access to safe abortion care are the availability of expense for the procedure, have someone accompany with, and the information and suggestion given by health providers. Meanwhile, there are factors that hampered to get to safe abortion, such as having no enough money, feeling in deep sinner, depress, have no letter of referral for abortion, and the existence of some people who waiting outside the clinic and will take the advantage from them on being seeking the abortion care. Lack of knowledge on pregnancy and abortion are another hurdles that make some unwanted pregnancy are too late to handle, Lack of information about safe care abortion is also one situation that makes them -the respondent- an easy prey for bad guy to lead them to the illegal abortion services. Social stigma toward Raden Saleh Clinic is also a burden of being ashamed to use the clinic.

To summarize, being supportive to the safe abortion care, it is needed to develop a program that increasing the access on having save abortion, such as education on reproductive health, information dissemination on Raden Saleh health services, program on consultation and counseling, to develop information media, and to develop standard operation procedure for caring the unwanted pregnancy, including the non-discriminative policy for emergency contraception pills. It is expected these consideration will reduce the evident of abortion.

Reference: 40 (1995 - 2003)