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The recent cases of low-income women selling their babies in order to pay for their medical bills highlights the need for a comprehensive national health care insurance scheme, an academic said on Monday.

Suparti, a resident of Gunung Kidul district near Yogyakarta is one such case. The 41-year-old said she was forced to sell one of her twin girls in order to pay the delivery fees at a state hospital.

Munawaroh, another low-income earner, offered to sell her newborn boy to cover the birth and related medical bills from a Bali hospital. Her bills have now reached Rp 17 million ($1,870).

And on it goes. In the latest case, Dewi Mukarom, a 17-year-old migrant worker from Tegal in Central Java has given her baby up for adoption after she failed to come up with the money to pay a Jakarta midwife.

An affluent couple from the capital has already petitioned the Central Jakarta District Court to allow them to adopt the child.

Hasbullah Thabrany, a public health professor from the University of Indonesia, said that even though he was not against the adoption itself, the reasons behind the adoption should be made illegal.

“A midwife or doctor or hospital should not and cannot advise patients to give away a baby just because the parents cannot afford the delivery fees,” he said.

He also said that Dewi was a clear example of the people who were falling through the massive cracks of a shattered health care system.

“Because she is from outside Jakarta, I am sure that she was not applicable for the regional health insurance scheme [Gakin] for the poor,” Hasbullah added.

“There are loopholes in our system. There is yet to be a regulation that obliges local and national government to cover the health care of their people.”

The public health expert said that a lack of information for the poor on their rights and access to health care and insurance is exacerbating the problem — and in many cases is driving women to give up their newborns.

Usman Sumantri, head of financing and insurance at the Health Ministry, said on Monday that he believed Dewi had not been covered by the national health care scheme for the poor, also known as Jamkesmas.

“If she were a member of Jamkesmas, which is valid nationwide, her fees would be covered,” he said.

“But I believe she wasn’t. She could also have asked for a letter of recommendation from the Jakarta Social Affairs Agency, but it might be difficult since she is not a registered resident.”

Usman said that Dewi was also ineligible for the regional insurance scheme.

“Jakarta is quite unfriendly to migrants,” he added.

In Monday’s first hearing of the proposed adoption of Dewi’s baby, the court heard from an acquaintance of the couple, who testified that Susanto, an enterpreneur, and Risna, an air stewardess, were financially secure and had no children.

The witness, Sri Mulyono, also said he had been to the birth mother’s home and said that “in my opinion, Dewi could not afford to keep the child.”

Dewi, who was also present for the hearing, told the court that she came to Jakarta last year to work but had become pregnant shortly afterward.

“The father did not acknowledge the child and did not want to be responsible for it,” she said, adding that she had no family in the capital and was living with a friend.

According to a 1983 Supreme Court memo on child adoption procedures, prospective parents need to file their adoption request with the district court in their jurisdiction before a judge and a court clerk, and present two witnesses who can attest to their social and financial wellbeing.

In Bali, Munawaroh, who plies a hard trade as a washerwoman, was allowed to leave the clinic where she gave birth to a baby boy recently, although she could not afford to pay her bill.

“We allowed her to leave. We cannot do anything,” said Gede Widarta, an official at the Sari Dharma Clinic in Denpasar.

The baby, who was suffering from a lung infection, had been referred earlier to Sanglah General Hospital in Denpasar for treatment.

The baby was later placed in an incubator.

The hospital’s director for general and operational affairs, Triputro Nugroho, said that the baby’s treatment costs at the hospital had already reached Rp 17 million.

But because Munawaroh did not claim a reduction under the Jamkesmas scheme, “the cost we charged her is the same as for any other patient in general, and not the discounted cost.”