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Paediatricians Warn Terengganu Of Maternal, Infant Deaths With Pregnancy Criminalisation

The Malaysian Paediatric Association says criminalising pregnancy and childbirth may increase maternal and infant mortality, with unsafe abortions and baby dumping.

The Malaysian Paediatric Association says criminalising pregnancy and childbirth may increase maternal and infant mortality, with unsafe abortions and baby dumping.
Consultant paediatrician and Malaysian Paediatric Association treasurer Dr Musa Mohd Nordin at the Cox’s Bazar refugee camp in Bangladesh. Picture posted February 16, 2019 from Nur Jalila Mohd Ariffin’s Facebook page.

KUALA LUMPUR, Dec 5 – The Terengganu state government’s move to criminalise pregnancy and childbirth for unmarried Muslim women under Shariah law may increase maternal and infant mortality, paediatricians said.

The Malaysian Paediatric Association (MPA) pointed out that some single young pregnant women have undergone abortions by unqualified medical practitioners, resulting in long-term complications or even death, amid the lack of access to safe legal abortions in Malaysia.

MPA also cited police statistics of an average of 100 baby dumping cases annually, which it said represented just the tip of the iceberg, noting that some babies are dumped in unsafe places, endangering their lives.

“This act of criminalisation of the pregnant unmarried woman fails to grasp the bigger picture of this social ill, which will impact adversely on the fate of these women and their unborn child,” MPA said in a statement last Saturday.

Last Thursday, the Terengganu state legislative assembly approved amendments to the Shariah Criminal Offences (Takzir) (Terengganu) Enactment 2001, including a new provision, Section 29A, that criminalises out-of-wedlock pregnancy and childbirth.

Section 29 prohibits “an act preparatory to sexual intercourse out of wedlock” with a fine not exceeding RM3,000, or imprisonment up to two years, or both, without defining such prohibited acts.

Both maternal and under-five child mortality in Malaysia increased last year, according to Department of Statistics Malaysia (DOSM) figures. 

DOSM reported that Malaysia’ maternal mortality ratio (MMR) rose by 175 per cent from 24.8 per 100,000 live births in 2020 to 68.2 in 2021, amid the Covid-19 pandemic. In absolute figures, this represented 117 and 300 maternal deaths in 2020 and 2021 respectively. 

Consultant obstetrician & gynaecologist Dr John Teo noted that the last time Malaysia recorded MMR over 60 per 100,000 live births was in the 1980s, some four decades ago.

As for the mortality rate of children aged under five years, DOSM reported a slight increase from 7.3 per 100,000 live births in 2020 to 7.4 in 2021.

MPA noted that it is as yet unclear whether rape victims or health care professionals providing antenatal care of these unmarried, gravid women would be exempted from the new provision in the law.

The paediatricians’ group stressed that pregnancies out of wedlock, often teenage pregnancies, are caused by multiple factors, including the lack of comprehensive life and reproductive education.

MPA cited a survey among teens aged 13 to 17 that showed 7.3 per cent had already had sex, 35 per cent of female youths mistakenly believe that they can’t get pregnant the first time they have sex, 66 per cent first learned about sex from watching pornography and from friends, and 45 teenage girls give birth every day. Only 16 per cent first learned about sex from schools (10 per cent) and parents (6 per cent).

“Resorting to punitive measures instead of education will discourage these young mothers out of wedlock to seek help, who will instead attempt to get rid of the problem resulting in babies being abandoned in unsafe places,” MPA said.

“Unwanted pregnancies and child abandonment is a real problem in Malaysia. The couple, boy and girl (the boy is allowed scot free from the law) may have made a ‘mistake’, but the child is absolutely innocent. 

“He or she did not choose to be an unwanted child and should not be penalised by being abandoned and left to die. The higher objectives of the Shariah (Maqasid Shariah) protect their right to life (nafs), preservation of their intellect (aql), and progeny (nasl).”

MPA urged authorities instead to:

  1. Provide a comprehensive life and reproductive education and information program to all adolescents. Research has shown that this decreases high-risk sexual behaviour and increases the age when a person becomes sexually active.
  2. Organise awareness campaigns on the harmful impact of teen pregnancy on health, academic pursuits and social wellbeing.
  3. Provide non-judgmental services, compassion and support for girls and their partners faced with unintended pregnancies, irrespective of age, race, religion or marital status.
  4. Protect the physical and mental health of the girl with an unwanted pregnancy, through the provision of safe and empathetic antenatal services.
  5. Provide information and access to effective and safe contraceptive services.
  6. Prevent dropouts from school. Keeping teens in school till secondary education has proven to reduce high-risk behaviours including teen pregnancy.
  7. Assist families with financial difficulties to enable teens to continue schooling.

Several other medical practitioners have also spoken out on Twitter against the Terengganu state government’s legislation against out-of-wedlock pregnancy and childbirth.

“Punitive actions may lead to increase incidence of unsafe late-term abortions, foeticide, infant and maternal deaths. We need to consider harm reduction strategies and education instead,” Dr Teo tweeted.

Infectious disease expert Dr Christopher Lee said the Terengganu legal amendment would likely lead to an increase of baby dumping.

“Luckily the baby in Mersing was found alive,” he tweeted, referencing a particular case reported Saturday. “Other cases were less fortunate.”

“Education, engagement and support are key to addressing out-of-wedlock pregnancies/ births. Legal punitive actions instead will drive this underground and risk the lives of both mother and baby. Have a rethink,” Dr Lee added.

Another infectious disease expert, Prof Dr Adeeba Kamarulzaman, tweeted: “This is so so wrong on so many levels and must be stopped.”

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