MARCH, 2019 | The Health
column: health watch
19
By Azrul Mohd Khalib
I
n many countries around the world, both devel-
oped and developing, the need to always seek the
highest level of morality has claimed many lives.
Most belong to women.
When viewing Ministry of Health data on
teenage and underage pregnancies shared
recently, I can only think that despite Malaysia having
a healthcare system better than a number of neighbour-
ing developing countries, we continue to do a disservice
to many of these women and girls.
Unintended
According to this data, annually more than 15,000
girls between the ages of 10 and 19 become pregnant
and sought medical assistance or pregnancy related
treatment in public facilities; 4,222 were unmarried.
At the Obstetrics and Gynaecology department of
the Tengku Ampuan Rahimah Hospital in Klang, out
of 12,000 babies delivered annually, around 10 percent
are born to girls below the age of 19. The youngest girl
to give birth at that hospital was 12.
There are intended pregnancies and then there are
unintended pregnancies. Many of the pregnancies
mentioned above were unintended. There are many
possibilities for the latter. Unprotected sex, obviously.
Maybe it was their first time and they didn’t know what
they were doing. Didn’t use contraceptives of any kind
or not being able to even have the option to use one to
begin with. The condom broke. Rape.
What I do know is that for many women, young
girls and even children (as in the case of the above
12-year-old) in our country, the eventual outcome of
an unintended pregnancy is childbirth.
Her health, her body,
her choice
The burden of law, religion, and society
Utopia, idealism and religion would say that every child
is wanted but we know that to be untrue. All we need to
do is look at the occupants of orphanages and welfare
homes, the data on the abandonment of babies at
roadsides, dumpsters, mosques, temples and hospitals.
A teenager has double the chance of dying from
pregnancy or childbirth complications than women in
their twenties.
As such, MOH considers them to be high risk
pregnancies. A woman faced with an unintended preg-
nancy has four possible options: keep the pregnancy
and marry the father (or rapist. Yes, this happens in
Malaysia too); carry the pregnancy to term and put up
the baby for adoption; go through an abortion; or dump
the baby somewhere at birth. The reality is that the law,
religion and society place the burden of responsibility
of pregnancy squarely on the shoulders of women.
Around the world, women
and girls are being denied
abortions and dying as a result.
It brings into sharp relief the
question of who really controls
a woman’s body
Keeping safe
They should decide
This is why it is essential for women to have the ability
to decide whether or not to carry a pregnancy to term.
It has implications for every aspect of her life from
educational and career aspirations to economic status.
Basically her ability to live the life she planned.
A teenage girl forced to carry her unintended
pregnancy to term could be deprived of an education,
future job opportunities and a different life. She might
be desperate enough to go through unsafe abortion or
try DIY methods of inducing an abortion, like using a
hanger or knife. In the process, she could die.
That is why it is necessary to provide safe abortion
services where the termination of a pregnancy is done
by trained health care providers using correct, sanitary
technique and proper equipment. It needs to be pro-
vided not only through private clinics or hospitals but
also at government healthcare facilities.
It is a simple health service which prevents the
complications of unsafe abortions such as infections
and infertility. It also saves lives.
Legal, yet frowned upon
Abortion is legal in Malaysia. Many people, including
many medical professionals, don’t know of this fact
and mistakenly think that it is an illegal and
clandestine practice.
Despite a 1989 amendment made to the Penal Code,
abortion services continue to not be available in most
public hospitals. The reality is that despite the formal
existence of the right to a safe and legal abortion, for
many women in Malaysia access to abortion services
continues to be limited, too tightly regulated or expen-
sive that it is almost entirely out of reach, especially
if you are poor, a minority and marginalised. Many
cannot afford the often exorbitant fees for abortion
services offered by private clinics and hospitals.
The reality is that those with money will be able to
access and afford abortion. Those who are unable to
afford it become statistics and/or criminal cases.
The reality is that
those with money
will be able to access
and afford abortion.
Those who are
unable to afford it
become statistics
and/or criminal
cases.”
We need to also be able to talk freely about contracep-
tion and encourage its use. Malaysia’s contraceptive
prevalence rate has stagnated at around 30 per cent
for over 25 years and is a shocking testimony of how
we have thus far responded (or not) on issues regarding
sexual reproductive health.
Want evidence? Look at the data from MOH and the
statistics of abandonment of babies and teenage preg-
nancies. Studies have shown that when contraception is
widely available and used, the incidence of unintended
pregnancy and abortion both decrease dramatically. We
must do better.
Often, women and girls are unable to exercise their
rights to make decisions regarding their own sexual
reproductive health.
We need proper comprehensive sexual reproductive
education for girls and boys which promote the rights
of women to determine when and if they want to have
children and control over their own sexual health. We
also need to realise the fact that it is a woman’s health,
her body, and her choice.
Azrul Mohd Khalib, with an education in genetics
and public health policy, has worked as a development
communications and programme specialist for more
than 18 years. He is currently the Chief Executive
Officer for Galen Centre for Health and Social Policy.
— The Health