| Cover Story |
JULY , 2023 | THE HEALTH
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“ It is best that contraceptive counselling considers the couple ’ s specific family planning needs , health conditions , compliance to treatment , and socioeconomic situation .
Access to family planning services is paramount , she said . One of the ways to reduce unmet needs is to expand contraceptive choice by increasing access to multiple methods .
“ For example , the availability of short-acting reversible methods ( the pill , the injectable and condoms ) would help to meet the needs of women who want to space their children ; availability of long-acting reversible methods ( the IUD and implant ) would help those who wish to delay having their next child for a more extended period and those who may want to limit their childbearing but are not ready to adopt a permanent method .
“ Furthermore , an expansion in the number and composition of available methods is likely to increase contraceptive use by attracting never-users , as well as by facilitating switching among methods .”
Dr Noor Ani shared that specific strategies will be developed to increase the use of modern contraceptives and diversify contraceptive methods , focusing on longacting contraceptives .
Dr Nazimah continued : “ So that opportunities are not missed , family planning services can be integrated into other health services .
“ When a woman is seen by healthcare professionals for other health reasons or at the well-baby clinics , family planning counselling can be offered in a complementary way .
“ Good-quality family planning services attract new clients and help prevent contraceptive discontinuation and reduce unmet needs .”
from page 09 have the right to access information and services , service providers still face challenges in dealing with children under 18 who are involved in risky behaviours and refuse to inform their parents , whereas being minors requires parental consent . Complex and sensitive issues related to sexual and reproductive health include requests for contraceptive information / counselling and services and screening and treatment for STIs .
Dr Radzi noted gaps in policies and legislation regarding providing information and services to minors without parental consent .
“ A clear policy is needed regarding dealing with complex and sensitive issues and considers the challenges faced by service providers in dealing with minors so that they have access to necessary and appropriate information and services , in ensuring their safety , health and wellbeing .”
VACCINE HESITANCY
Meanwhile , the NHMS 2022 : Maternal and Child Health ( MCH ) reported the prevalence of vaccine hesitancy in Malaysia as five per cent , marking the first nationwide study conducted among the population . The prevalence of vaccine hesitancy among parents in 2022 is at 4.9 per cent . This study serves as a baseline for understanding the burden of vaccine hesitancy in Malaysia .
The Obstetrical and Gynaecological Society of Malaysia ( OGSM ) President-elect for 2022 / 2023 Prof Dr Nazimah Idris , said : “ There is a huge increase in incomplete vaccination among children up to the age of 23 months from 4.5 per cent in 2016 to 12 per cent in 2022 . Similarly , the percentage of unvaccinated children has increased 10-fold from 0.1 per cent in 2016 to one per cent in 2022 . It is a very worrying trend indeed .
“ Changing mindset is difficult because the reasons for vaccine hesitancy are usually not based on scientific arguments . Society needs to receive
HIGH LEVEL OF ANTENATAL CARE
Dr Nazimah also noted that there are several encouraging findings in NGMS 2022 .
“ We see an increase in the number of women receiving at least four antenatal visits throughout pregnancy , more women were seen in the first trimester of pregnancy , less anaemia in pregnancy , and antenatal services were well utilised even during the pandemic .
“ This is due mainly to an awareness and understanding that it is very important to have antenatal care to ensure a safe journey through pregnancy and delivery . Other factors are the accessibility of antenatal care services , whether in the public or private sector , affordability , especially the care provided in public healthcare facilities , and the quality and completeness of the service supplied .
“ To a large extent , the nondiscriminatory approach practised by healthcare professionals looking after pregnant mothers has greatly contributed to the high level of antenatal care utilisation among pregnant mothers in Malaysia .” – The Health
Prof Dr Nazimah Idris
the correct information and have sufficient health literacy to make sense of the information and make good health decisions .
NHMS 2019 , she shared , reported that one in three Malaysian adults had low health literacy .
“ We must continue to educate and improve our health literacy and , at the same time , fight misinformation . If that is not enough , we should look into legislation , e . g ., establishing an Act or regulation for all children ( e . g . under five years ) to be immunised .”
Dr Radzi stated that MoH Malaysia knew some parents were refusing or reluctant to vaccinate their children .
“ The MoH ’ s Family Health Development Division has been monitoring the data closely for mothers who refused vaccinations from 2013 . Among the reasons for refusals are concern about the halal status of vaccines , side effects and preference for using traditional or homoeopathy medicines .”
Therefore , the MoH and Immunise4life Programme have developed Modul “ Menangani Ibubapa Yang Ragu atau Menolak Vaksin ” mainly to deal with refused or hesitant parents .
The training was conducted in 2019 and 2020 , with a second cycle of training , was carried out in 2022 involving all categories of staff involved in the National Immunisation Programme at the implementation level . – The Health
Tacking complex and sensitive issues
THE MINISTRY of Health ( MoH ) provides access to comprehensive , quality healthcare services through its nationwide network of healthcare facilities ( hospitals , health clinics and rural clinics ) for all age groups , including adolescent girls and boys .
It provides integrated , comprehensive Adolescent Health Services ( AHS ) as an expanded Family Health Development Division scope in all primary health clinics nationwide .
Adolescent services include promotive , preventive , curative and rehabilitative services covering five major scopes : physical health , nutritional health , mental health , risky behaviour and sexual reproductive health . A referral system was established for multidisciplinary interventions where necessary .
AHS is provided to all age groups without discrimination of gender , ethnicity , marital status , socio-cultural or religious background , guided by national guidelines , laws and regulations . AHS is integrated into all primary healthcare facilities nationwide via static and mobile outreach services .
Best Practice Adolescent Friendly Health Services ( AFHS ) is one of the MoH ’ s initiatives to increase health workers ’ visibility , commitment and focus on adolescent health . Healthcare providers are trained in line with the World Health Organisation ( WHO ) criteria and SOPs developed by the MoH Malaysia .
The importance of adolescent health and friendly health services are emphasised among health personnel towards a whole clinic approach to enhance awareness of adolescent health and ultimately to reduce morbidity and mortality among adolescents in the operational area .
In tackling adolescent health issues that are complex and sensitive , healthcare providers are regularly trained in the management of adolescent health , creating awareness to prevent stigma , and implementing professionalism , confidentiality , and non-judgmental with “ the best interests of the child ” as a primary consideration .
The MoH , in collaboration with various agencies , such as the Ministry of Women , Family and Community Development ( MWFCD ), Ministry of Education ( MOE ) and NGOs , provides continuous advocacy at the clinic , school and community levels .
Community empowerment and mobilisation of civil societies and religious leaders for addressing adolescent health issues at the grassroots were also conducted . Budget allocation is essential to support the expansion and sustainability of programmes / human resources / training for health workers etc .