The Malaysian Medical Association has called for tackling the issue of unintended pregnancies in the Health White Paper.
The consequences of unintended pregnancies are profound, and often negatively impact women, girls, communities, and society in general.
More than 50 per cent of all pregnancies are unintended.
Approximately half of unintended pregnancies end in abortion, and a significant proportion are unsafe, resulting in maternal deaths and permanent health impairment.
The World Health Organization’s (WHO) Sustainable Development Goal 3 aims to ensure healthy lives and promote wellbeing for everyone at all ages. Among its targets are the reduction of maternal mortality and the preventable deaths of newborns and children under 5 years.
By 2030, there should be universal access to sexual and reproductive health care, including family planning, information, and education, and most importantly, the integration of reproductive health into national strategies and programmes.
The known factors associated with the high incidence of unintended pregnancies include lack of access to family planning services, poverty, low education, lack of contraceptive method uptakes, and social, cultural, political, and religious determinants.
When a girl has an unintended pregnancy, it affects her ability to attend school, limits opportunities for higher education, and impairs her ability to continue working.
Her economic potential can be severely impacted and her contributions to the nation`s economy will then be curtailed.
Often occurring within lower socioeconomic groups, unintended pregnancies can lead to a vicious cycle of poverty, with adverse consequences such as domestic violence, drug or alcohol dependence, and even crimes.
Society and the nation as a whole will be impacted negatively if the reproductive needs of women and girls are neglected.
The Current Status Of Reproductive Health Care In Malaysia
According to the Health Facts 2021, the Maternal Mortality Ratio ( MMR) is 24.9 per 100,000 live births . The three most important components that can bring the MMR down further are adequate antenatal care, safe deliveries, and the use of contraceptives.
While Malaysia has done well for the past few decades on both caring for women and girls during pregnancies and deliveries, sadly, we are far behind in the use of contraceptives.
The contraceptive prevalence rate for modern methods among married women in Malaysia is only 34.3 per cent, with the most commonly used method of oral contraceptive pills at only 13.2 per cent.
Highly effective contraceptive methods such as hormonal implants or hormonal intrauterine systems are not widely available to all women, and usage is extremely low.
The contraceptive prevalence rate for unmarried women is not available or documented, and is likely to be very low.
There is also a lack of specially dedicated family planning clinics with trained doctors.
Integrating family planning and reproductive health care into the structure of general practitioner clinics often defeats the purpose of providing reproductive health care.
Adolescents’ and young adults’ sexual and reproductive health care must be comprehensive, and easily accessible. This is important in light of a recent Durex study, which found that a large majority of Malaysian youths had their first sexual experience before 22 years old, and they often have poor knowledge of pregnancy, contraception, and sexually transmitted diseases.
A total of 41,083 teen pregnancies were recorded by the Ministry of Health (MOH) between 2017 and 2022. There are about 10,000 teenagers per year who have sought services at government health facilities. This is equivalent to 830 cases each month, or about 28 per day.
The figures from the private sector and those who do not seek health care services are unavailable.
In Malaysia, an average of nine babies are reported abandoned each month, with half found dead, and some even macerated, according to police statistics.
It is estimated that for every baby found abandoned, another 10 or 20 may never be found.
Solutions
The MOH, the Ministry of Education, and the Ministry of Women, Family and Community Development are duty-bound to work together to come up with an integrated and comprehensive strategy that can empower women and girls in having complete access to sexual and reproductive health care services.
Working in silos is not a realistic option, and existing policies and programmes are also not feasible.
Women’s health care and reproductive health encompass a wide range of services.
When formulating programmes, policies, and services, prioritising and placing women’s and children’s needs and welfare must be the core element on which every plan is based on.
All stakeholders must be involved if we are serious in tackling the problems. Solutions must be generated from the ground up, rather than relying on the usual top-down approach that has proven to be a failure.
The following are some proposed solutions:
Ensure that doctors and health care staff are trained in sexual and reproductive health care, and be sensitive to the needs of women and girls.
Specially dedicated family planning and sexual and reproductive health clinics need to be set up nationwide.
Full access to sexual and reproductive health care for everyone, regardless of marital status, age, religious beliefs, or sexual orientation.
Methods of contraception must be made available free of charge, or at very low cost, to all who need such services, including highly effective hormonal Implants or intrauterine systems.
Comprehensive sexual education must be made available in all schools. This should not be limited to so-called ‘approved’ topics.
Community leaders, parents, and teachers must be engaged in efforts to tackle unintended pregnancies and teenage pregnancies.
Political leaders must be sensitive to the importance of the unintended pregnancy issue, and its impact on society.
Laws must be amended to ensure full access to sexual and reproductive health services. Discriminatory practices must be discarded, and gender equality must be promoted.
A non-judgmental approach must be instilled, with a support system in place for all vulnerable women and teenage mothers.
How Malaysia tackles the neglected crisis of unintended pregnancies will show the nation’s resolve and seriousness in ensuring universal health care for all, and placing women and children as its most important assets.
Dr John Teo is a consultant obstetrician and gynaecologist.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of Ova.
