ADOLESCENT PREGNANCY WHICH IMPACTS ON A CRIMINAL ACTION

Ariel Timy1, Dwiana Ocviyanti2

1
Faculty of Medicine Universitas Indonesia, Obstetric and Gynecology Department
Cipto Mangunkusumo National Referral Hospital

ABSTRACT
Adolescent pregnancy is a pregnancy with a female age of less than 19 years. In this
pregnancy very much affects various biopsychosocial aspects. According to United
Nations Development Economic and Social Affairs (UNDESA, 2010), Indonesia is
among the 37 countries with a high percentage of young marriages and is the second
highest in ASEAN after Cambodia.1
Marriage at a young age is risky because of insufficient readiness from aspects of health,
mental and emotional, education, socio-economic and reproduction. In adolescent
pregnancy, especially a pregnancy that is not expected, it could increase the incidence of
the act of abortion or abortus provocatus, which is still included in criminal cases.2
Objective: to carry out a holistic approach from the biological, psychological and social
aspects of patients with abortus provocatus in G1, 18 weeks pregnant, IUFD fetus, and
unwanted pregnancy.
Case Illustration : A 17-year-old woman came to Cipto Mangunkusumo Hospital with
complaints of late menstruation since 4 months ago, the patient did not know that she was
pregnant, then an examination was obtained from a test pack, and the result was positive.
the patient then went to Jakarta to avoid family and neighbors in Makassar, and came to
Cipto Mangunkusumo Hospital. She was then diagnosed with a single IUFD fetus. From
information which is obtained from the family, the patient's mother felt angry and
disappointed with her, from the patient's statement showed that the pregnancy was not
expected. The patient denies any abortion.
Discussion: Adolescent pregnancy can bring biopsychological and social effects to the
patient’s life. Unknown and unplanned pregnancies can result in a criminal act, namely
an illegal abortion.
Keywords: adolescent pregnancy, abortus provocatus

Case Illustration
A G1P0 woman, is 17-year-old tribe of
Bugis, Muslim and currently unmarried.
The patient is currently a 3rd grade high
school student in the city of Makassar.
The patient lived with her parents, and is
the last child of 3 siblings. Her father's
job is an entrepreneur and he has a
printing business in the Soppeng area of
Makassar, while the patient's mother is a
housewife. The patient came to the
maternity room at Cipto Mangun
Kusumo Hospital with complaints of late
menstruation since 4 months ago, with
the results of a positive test pack test, the
first day of the last menstrual period was
on September 3rd, 2018. Patient claimed
not to be pregnant, and never get tested
with the test pack. The patient claimed to
have had sex with her partner as much as
twice without using a condom. Patient
claimed to take menstrual smoothing
medication 1 month ago and herbal
medicine as many as 2 pills, but she did
not know the name of the herbal
medicine. Patient got information about
the herbal medicine from her friends.
There were complaints of water broke
and blood spots last week which were
accompanied by nauseous. Then, the
patient went to Jakarta (there was a
family of an obstetrician) and was said to
be pregnant, the fetus died and then she
was referred to Cipto Mangunkusumo
hospital.
Patient came with 110/70 mmHg of
blood pressure, pulse : 84 beats per
minute, breathing : 20 breaths per minute.
On physical examination, no
abnormalities were found. On obstetric
examination, inspection: the vulva and
urethra were smooth, negative active
bleeding. Speculum examination:
slippery portio, OUE opening was 2 cm,
visible tissue in portio, fluor negative,
fluxsus positive. On vaginal toucher
examination : soft portio, axial, 2 cm
thick, 2 cm opening, palpable tissue in
portio.
Based on USG result, it was found that
there was an intrauterine single fetus,
negative FHR, CRL were difficult to
assess, negative spalding sign, amniotic
fluid ran out. Patient were diagnosed
with incipient abortion in G1, 18 weeks
pregnant, IUFD fetus, adolescent
pregnancy, and unwanted pregnancy.
Management of this patient was with
induction of 200 mcg of vaginal
misoprostol every 6 hours, injection of
ampicillin sulbactam 4x1,5gr
intravenously, psychiatric and medico-
legal forensics consultation. The result
of discussions with MOD, patient whose
age was less than 18 years, was
suspected trials of abortion, according to
the medico-legal forensic counseling
procedure. Based on the results of the
psychiatry consultation, the patient
consumed herbal medicine 1 week ago
with the intention of wanting to abort it.
The victim admitted to being in sexual
contact with her partner around
September / October (forgetting exactly
when it was), forced without safety,
having sex twice. No history of threats,
physical violence, or providing food /
drink. From the forensic department,
patient with incipient abortion in G1, 18
weeks pregnant, was suspected to be an
abortus provocatus. Medical
management according to the midwifery
department, which is recommendations
to report to the police department. From
the results of the psychiatric consultation,
on history taking, the patient was
relieved and glad that the baby had come
out of her belly. The patient said that she
did not know that she was pregnant. The
patient only found out she was pregnant
after being told by her mother 4 days ago.
The patient said she had sex with her
partner twice. Her partner is 2 years older
and is a senior, he has graduated from
high school but has not worked. The
patient feels sad and disappointed with
her partner and intends to forget him.
The patient said that she felt scared when
she found out that she was pregnant. The
patient and her parents want the baby to
be expelled from her belly immediately.
The patient's parents said that they felt
sad and disappointed that their only
daughter had to experience this. The
patient's parents want her to finish high
school and succeed, not like them who
only graduated from junior high school.
On physical examination, the mental
status is obtained, appearance:
adolescent girl according to age, attitude:
less cooperative, resistant, psychomotor
behavior : calm but seeming to be on
guard or alert, speech: less spontaneous,
enough volume, clear articulation, many
answering "don't know", "Do not
remember or forget", mood: dysphoric
mood, affect: limited, harmonious,
coherent thought process, content
thought: fear of angry mother, enough
ideas, perceptions: good. Management
of psychiatry: supportive psychotherapy
(empathy validation, reassurance).
Discussions
Adolescent pregnancy is often
associated with unwanted pregnancy,
and can also increase the lifting of crime
such as the act of abortion or abortus
provocatus illegally.2,3 Pregnancy in
adolescence is much influenced by
several factors such as weak supervision Psychological aspects
from parents or family, disappointment There are several psychological aspects
with family, bad environmental factors that cause adolescent pregnancy such
and advances in communication as4: 1. The lack of the role of parents in
technology that can easily access the family. Attention and the role of
pornography.2,4 The biopsychosocial parents greatly influence the mental and
concept is a medical approach from psychological development of the
various perspectives such as behavioral, children. Children who do not feel peace
cognitive, psychological health and in their families will tend to seek peace
social health. outside in various ways, there are times
Biological aspects when they do things that many of them
Adolescent pregnancy has a higher tend to do negative things as a form of
number of complications in both the their regret towards the parents. 2. Lack
mother and fetus, in this case the of Sex Education from Parents and
complications that occur are more Families to Adolescents. Information is
towards the psychological and social provided that around 65% of information
aspects of the patient by acting abortus about sex comes from friends, 35% from
provocatus illegally because patient and pornographic films, and only 5%
families feel ashamed of the surrounding information about sex are from parents.
community. 3. Development of science and
Psychologically, adolescents with technology which is not based on strong
premarital pregnancies will feel mental development.
depressed, scared, confused, and The more advanced science and
embarrassed, as a result, they tend to technology makes it easier for teenagers
have an abortion. Worse, women who do to get information about sex.
not want a pregnancy generally have an Adolescents who are pregnant outside of
abortion clandestinely and through marriage face a variety of psychological
unsafe abortion, which is an abortion problems, namely fear, disappointment,
performed by an incompetent person regret, and low self-esteem towards their
such as a “dukun”, so that it can cause pregnancy, resulting in efforts to
cases such as bleeding, infection and eliminate them by way of abortion.
other abnormalities, even death.5 Doing abortion has the smallest loss
compared to continuing the pregnancy,
where the situation will become more
complicated if the young man or the man
who impregnate woman is not
responsible so that the suffering is only
borne alone with the family. The family
faces difficult problems in the
community as if they are unable to
provide moral education to their
daughters, so often the woman takes
steps to take an abortion, which leads to
criminal acts.
There is also a new problem that is after
a woman has committed an act of
abortion, the woman will have feelings
of guilt that can endanger her life, if not
immediately helped, she will experience
major depression, frustration and
emptiness or will experience "Post
abortion syndrome", namely, loss of
self-esteem, multiple nightmares about
babies, unable to enjoy sexual relations,
hysterics, trying drugs, and wanting to
commit suicide.6,7
Social aspects
There are a number of social effects
related to adolescent pregnancy, one of
which is criminal acts such as illegal
abortion because a woman and her
family are embarrassed to accept the
current situation. In other respects
adolescent pregnancy can also have an
impact on education dropping because
they have to care for their children or are
ashamed to be seen by their friends.6 so
that it can cause a criminal effect.
Abortus provocatus criminalis; is
abortion that is intentionally carried out
which violates or contravenes various
legal provisions in force in Indonesia.
Intentional abortion with various other
reasons, such as embarrassment to
neighbors, economically unprepared and
so on.)8
Abortion in Indonesia has a law
stipulated in the Criminal Code,
according to Article KUHP Bab XIX
pasal 346 which forbids abortion, “ A
woman who on purpose perform
abortion or perform an action that makes
the baby die in her womb or ask other to
perform the procedure, threatened with
the longest imprisonment 4 years.”10,11
Strategies to address social problems
associated with adolescent pregnancy
need to involve joint interventions,
including education, skills development,
clinical and social support for adolescent
mothers, so as not to have a negative
impact on crime.8
Conclusions
In adolescent pregnancy, it has complex
biopsychosocial problems, especially if
the patient does not want her pregnancy,
and will have an impact on crime such as of pregnant and parenting
adolescents. Pediatrics.
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In this patient there is also an action of 7. Patch LK. Adolescent pregnancy:
psychosocial issues. Indiana
abortus provocatus which is not safe,
medicine : the journal of the Indiana
even can be fatal which can lead to death State Medical Association.
1990;83(1):30-3.
of the mother.
8. Suryono Ekotama dkk, 2001,
Therefore, supervision in adolescent Abortus Provokatus bagi korban
pemerkosaan perspektif viktimologi,
pregnancy is very important. In addition
kriminologi, dan hukum pidana,
to health and medical aspects, UAJY, Yogyakarta
9. Cook SMC, Cameron ST. Social
supervision also includes social and
issues of teenage pregnancy.
psychological support to make Obstetrics, Gynaecology &
Reproductive Medicine.
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2015;25(9):243-8
optimal conditions. 10. Hamzah, Andi, Dr.SH., 1984, Kitab
Undang-undang Hukum Pidana,
Ghalia Indonesia, Jakarta.
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