KUALA LUMPUR, April 25 – Health care providers should not impose their personal beliefs on patients, as it could prevent them from accessing treatment, jeopardising their health and well-being, said sexual and reproductive health experts.
More than half of women around the world don’t have decision making power over their own personal health care, according to Dr Geetha Thambyraja, a consultant obstetrician and gynaecologist.
“Not having bodily autonomy can cause safety issues for a woman,” Dr Geetha told a forum on Women’s Health and Rights organised by Malaysian Medics International on April 2.
“Every girl and woman should have the right to make the decision when she wants to have sex with her partner, as well as when, how and what contraception does she want to use.”
Women must also have the right to say whether she wants to be pregnant or not as the decision is integral to her health and well-being, said Dr John Teo, an obstetrician and gynaecologist based in Sabah.
“The ability to say when she wants to be pregnant or not, affects every other thing that she does in terms of her career, finance, family, health and everything else,” Dr Teo said at the same forum.
“It is a human right that has been endorsed by all the international bodies, including the United Nations and many other countries in the world, so there is no doubt about it.”
Unfortunately, he acknowledged that there are huge challenges to exercising the right. “In certain times, it cannot be done because of the complexity of the environment, society and culture.”
Dr Teo believes the Malaysian government is trying its best, but is hampered by socioeconomic and geopolitical constraints.
“And that happens with every government. Health becomes part of a trade-off when there are political needs, social needs, cultural needs and things like that. And so when it comes to the ground, it becomes translated into a lot of barriers.”
Dr Subatra Jayaraj, who moderated the panel and has experience in anaesthesia and intensive care in the Ministry of Health (MOH), concurred with Dr Teo.
“There are so many different facets to women actually being able to achieve that right,” she said.
“These are the systemic barriers we need to fight because we know it’s a right, but sometimes laws, policies, legal regulations that govern us as doctors prevent a woman from coming in and exercising that right.”
Personal Beliefs Must Always Take A Backseat
The panel also acknowledged that at times, women’s ability to exercise their right to health care services is also often hindered by the personal views of health care providers.
“There have also been instances where I myself have witnessed clinicians who deny woman on the basis of: you are not married, I cannot perform a vagina exam on you, I will not give you consultation on contraception, you shouldn’t have STD (sexually transmitted disease) screening done and so on,” said Dr Geetha.
“It is happening. I have seen it and as a clinician, I must remind all the students here, you may have personal beliefs, but your personal beliefs must always take a backseat. You should never impose your religious, cultural or personal beliefs onto the patients.”
The way a patient is treated determines whether she will continue to seek help and get treatment, so hospitals should practice an integrated approach in instituting a culture of non-discrimination as judgmental attitudes are not limited to clinicians.
“I think hospitals from the ground staff, from the person who lets the patient into the hospital to the receptionist, to the nurse who attends to her, to the doctor, to the pharmacist who is prescribing her medicine — everyone should be non-judgemental, everyone should treat her the way she should be treated,” said Dr Geetha.
“Nobody should be looking at her background or ethnicity, then she will feel comfortable.”
Dr Subatra, who runs a women’s primary care clinic on sexual and reproductive health in Petaling Jaya, agreed that policies can be instituted at work to ensure patients are not deterred from seeking the health care they need.
“If your receptionist is going to ask inappropriate questions, they are going to bolt right out of there. In my clinic, we never ask if you’re married or not because it doesn’t affect anything, doesn’t affect my management of your case.
“So, how the staff is trained…are your staff aware of different sexualities, different gender identities, even ways of approaching patients when they step into your clinic, that’s going to give so much confidence to the patients.
“So that when she goes into the office to see you. She can ask the questions that are really needed.”
Dr Teo pointed out that sexual and reproductive health services are not only offered in private clinics and hospitals.
Patients also go to community pharmacies and klinik kesihatan for consultations and treatment.
In many of these places, no space is afforded to ask questions or discuss matters privately and confidentially.
“A lot of women buy contraceptives from community pharmacies, and most pharmacies are an open area. There is no private area.”
How is a woman supposed to ask questions about her vaginal discharge over the counter, for example, he questioned.
“So when there is no confidentiality and privacy, there is no sexual and reproductive health counselling. That’s the basic principle.
“As health care professionals, regardless whether we are doctors, pharmacists, or nurses, we have to ensure that at every stage there must be an avenue for women to ask all these private and confidential questions.”